Clinical Pharmacy is a new term with a history of less than a century. One of which the ancestor is the UCSF School of Pharmacy, United States, who started the clinical pharmacy after 1960, with the landscape of “The UCSF Ninth Floor Project”.
Despite that Pharmacy Schools in China had started the discipline of Clinical Pharmacy since nearly 35 years, this area of pharmacy stays in the primary role of Biopharmaceutics, GLP, Pharmacy Analysis, where there is still a long distance to the clinical pharmacy practice – providing direct daily clinical services to our patients, to our colleagues, and other healthcare professionals.
Pharmacy dreamers and doers had tried hard to make this discipline more and more necessary, and meaningful. For example, the West China School of Pharmacy had created the first degree of clinical pharmacy, the bachelor degree of clinical pharmacy, in 1980. The most recent and inspiring event in the history of clinical pharmacy in China was the launch of the post-graduate program Clinical Pharmacy Residency, begun in 2006 in West China Hospital. It’s really a milestone, which symboling the dire and the attempts of these pharmacy dreamers and doers to transfer the formal clinical pharmacy into the new healthcare provider role.
However, in most of hospitals in China, not limited to ones in the past but I could say including ones today, the healthcare pharmacists’ role remains a far away from the clinical service provider. Even in the university hospital such as West China Hospital, the pharmacists there are still in confusion about the professional responsibility of pharmacists in healthcare system, or most of they would ask what should I do when I am there? Or what is my obligation. They do not lack passion, they do not lack diligence, so what is the issue? Thus I made some brief summary about the difficulty we face at present.
First, the social rank of healthcare pharmacists in China is relative low compared with other healthcare professionals like physicians, surgeons, etc. This is not due to that pharmacists have fewer knowledge learnt from school, nor we have less college education background. This is due to what services we can provide to our patients, our colleagues, and other healthcare professionals and the society. No need, no value. Think, why a physician should go for a pharmacist who cannot tell him/her how to figure the complex pharmacotherapy problem out?
Second, we have not had this profession yet. Is there any national standard which defines the concepts, the criterias and requirements, the privileges, and the obligations of clinical pharmacists? There are many young trying to become a clinical pharmacist. There are many older pharmacists dedicating their life time after graduation to the profession of hospital pharmacy. Therefore, the second difficulty of the transforming of this profession is that we need a standard, to make sure that future clinical pharmacists are all highly trained and can provide high quality clinical services. For example, there is a pharmacy organization called NABP – National Association of Boards of Pharmacy. And before you become a licensed pharmacist, the candidate must pass the NAPLEX – North American Pharmacy License Exam.
The third question is how to teach these young students, with the intention to make them have the fundamental knowledge required to provide clinical pharmacy services. What services we can provide are dependent on what we have learnt from colleges. A pharmacist who lacks the knowledge of pharmacotherapy is not able to discuss the therapeutic regimen with his/her patients, nor his/her colleagues. Although we have strong background of pharmacology, but the background is limited to the pharmacologic action. Actually, the other two most important aspects of pharmacology are the physiologic effect and the clinical outcome. In my opinion, the curriculums of pharmacy colleges and schools need upgrading, to adapt the new role of pharmacists, to meet the necessaries required by our patients, our healthcare colleagues, and our society.
In addition to the basic knowledge, another question is how to train pharmacy students, in order to enable them the basic abilities and skills required by this profession. The key prerequisites to provide clinical pharmacy services is based on the clinical abilities and skills, or more precisely, the pharmacy practice experiences. Clinical pharmacy is not only a discipline of research or science, but also one involved with daily clinical practice.