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574

BOARD CERTIFICATION

Following didactic and experiential training, many clinical

pharmacists seek Board of Pharmacy Specialties (BPS)

certification (13). There are more than 21,000 pharmacists

worldwide who are BPS board certified in eight pharmacy

specialties: ambulatory care, critical care, nuclear, nutri-

tion support, oncology, pediatric, pharmacotherapy, and

psychiatric pharmacy. Future specialty certifications may

include infectious disease and cardiology among others.

Board certified pharmacists must pass a rigorous examina-

tion and then maintain accreditation through continuing

education or additional testing every 7 years. Board certi-

fication is a typical requirement to achieve privileges for

independent or collaborative practice. Aspects of privi-

leging are similar to those used for other medical providers.

CURRENT ROLES/BENEFITS OF CLINICAL

PHARMACISTS

Clinical pharmacists in the US have established roles in

many healthcare teams. Most are part of a multiprofes-

sional team for acute care or ambulatory care populations,

but some have a private practice upon referral from a broad

population of physicians. There are numerous examples of

the impact made by clinical pharmacists, and this paper

will highlight some recent publications (14).

Since medication management is the primary focus, most

measurements reflect optimal use of medications and

avoidance of adverse events. The broad use of antihyper-

tensive medications may lead to adverse outcomes if doses

are not properly titrated. The benefit of clinical pharmacist

education, monitoring and intervention was demonstrated

in a prospective, randomized study of 800 heart failure

or hypertension patients treated at the clinics of a large

public hospital (15). The patients with clinical pharmacist

interventions had a 34% lower risk of any adverse drug

event (ADE) or medication error (ME) (risk ratio 0.66, 95%

confidence interval [CI], 0.50-0.88) including a signifi-

cantly lower risk of ADE, preventable ADE, potential ADE,

and medication errors compared with control patients

treated at the same clinics. Patients with complicated

cardiovascular histories had the greatest number of medi-

cations and events. Pharmacist interaction, education, and

regular communication with the rest of the team improved

medication adherence, patient satisfaction, and reduced

healthcare utilization and direct costs of care. A system-

atic review of 12 randomized trials of clinical pharmacist

impact on heart failure patients showed similar benefits

with a reduced rate of all-cause hospitalization (Odds ratio

[OR] 0.71, 95%CI (0.54-0.94) and heart failure hospitaliza-

tion rate OR 0.69, 95%CI (0.51-0.94) (16). Other reviews

have described additional benefits of clinical pharma-

cist monitoring and interventions on a variety of treat-

ment endpoints (blood pressure, lipid profile, weight, and

glycemic control) (17). The American College of Cardiology

has endorsed a strategy of team-based care, including

clinical pharmacists (18).

Clinical pharmacists on medical inpatient acute care teams

have been shown to reduce preventable adverse drug

events by 78% (19). A clinical pharmacist who rounded

with a critical care team more effectively identified and

prevented more adverse drug events than pharmacists

involved in order entry and verification, and avoided the

potential expenditure of over $210,000 in 4.5 months.

(20) A review of 36 studies describing the impact of

clinical pharmacists on hospital inpatients suggests that

the addition of a clinical pharmacist to the acute care

team resulted in improved care, with no evidence of harm.

(21) Interacting with the team on rounds, interviewing

patients, reconciling medications from outpatient to

inpatient, patient discharge education, and follow-up all

resulted in improved outcomes. Highest risk patients such

as the very elderly, and the very young have been shown to

benefit from the presence of and contributions of clinical

pharmacists.(22,23)

INTERNATIONAL

Clinical pharmacists have increased in number throughout

the world, and patients have benefited. A survey in 2005

described critical care clinical pharmacist roles in 24

countries outside North America (24). The majority 74.4%

indicated that they attended medical rounds, almost all

(90%) prospectively reviewed drug therapy and intervened

to prevent drug interactions, ADE, and to optimize dosing

and frequency of administration. Pharmacists in Australia

have described medication therapy interventions for

hospitalized inpatients and demonstrated their ability to

reduce length of stay and over $4 million dollars of annu-

alized hospital cost savings in 8 hospitals (25). Over 25% of

the interventions were major or life-saving.

Pharmacists in the Netherlands have significantly reduced

prescribing errors and related patient harm by their pres-

ence on the ward compared with the baseline central

pharmacy services (26). Pediatric pharmacists in China

demonstrated a significant reduction in adverse drug

reactions, length of stay, and drug costs compared with a

control group of similar patients without a rounding phar-

macist (27). While these illustrate only a few examples,

there are pharmacists providing patient focused inter-

ventions throughout the world, including Chile. Clinical

[REV. MED. CLIN. CONDES - 2016; 27(5) 571-577]