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A consultant pharmacist is a pharmacist who works as a consultant providing expert advice on clinical pharmacy, academic pharmacy or practice, public health pharmacy, industrial pharmacy, community pharmacy or practice, pharmaceutical analysis etc., regarding the safe use and production of medications or on the provision of pharmaceutical services to medical institutions, hospitals, universities, research institutions, medical practices and individual patients. [1]
In Australia, a consultant pharmacist has historically referred to a pharmacist accredited to access funding to be remunerated for providing Residential Medication Management Reviews and Home Medication Reviews.
These pharmacists undergo a credentialing process, that was historically referred to as accreditation, and were then able to access the funding to perform these roles. The major accreditation organisation, known as the Australian Association of Consultant Pharmacy, was disbanded in 2022. The Pharmaceutical Society of Australia, Society of Hospital Pharmacists Australia and the Australian College of Pharmacy (owned by the Queensland branch of the Pharmacy Guild of Australia) are now the three organisations that provide credentialing for pharmacists to be able to undertake domiciliary medication management reviews.
The Australian Pharmacy Council will develop Aged Care Accreditation Standards in 2023 for pharmacists working in residential aged care settings and undertaking medication management reviews. These standards are being developed in response to a series of research papers published by the Consultant Pharmacists' Services Research Network (COHERENT) that has found inconsistencies in the delivery of these services and the preparedness of pharmacists generally to move into these settings. [2] [3] [4]
In the US, a consultant pharmacist focuses on reviewing and managing the medication regimens of patients, particularly those in institutional settings such as nursing homes. Consultant pharmacists ensure their patients’ medications are appropriate, effective, as safe as possible and used correctly; and identify, resolve, and prevent medication-related problems that may interfere with the goals of therapy.
The demand for consultant pharmacists is on the rise. Licensing and accrediting agencies such as Centers for Medicare and Medicaid (CMS), [5] Accreditation Association for Ambulatory Health Care (AAAHC), The Joint Commission (JC) and individual states licensing bodies encourage healthcare facilities to use consultant pharmacists.
Consultants may specialize in one of the following areas: Regulatory, Quality, Technical, or Clinical.
In the UK's NHS, the term consultant pharmacist refers to a pharmacist who has advanced roles in patient care, research and education in a specific medical speciality or expert area of practice.
The Department of Health for England produced guidance in 2005 which described the role of the Consultant Pharmacist which is distinct from other roles in England and internationally. The posts are intended to be innovative new posts that will help improve patient care by retaining clinical excellence within the NHS and strengthening professional leadership. The consultant pharmacist posts have been created to provide a dynamic link between clinical practice and service development to support new models for delivering patient care. The title consultant pharmacist should only apply to approved posts that meet the principles, set out in the guidance, around four main functions:
The guidance recommends that the title consultant pharmacist is not conferred on individuals purely in recognition of innovative or excellent practice, but for those practitioners who meet the required competencies for the post. In the NHS, the posts created within or across NHS organisations, are approved by Strategic Health Authorities (or clusters of SHA’s). The SHA's provide approval panels for ratification of consultants posts to ensure that business plans match the spirit of this guidance and that posts are sustainable, equitable and transferable across the NHS.
The competency requirements for consultant pharmacists are drawn from the Advanced and Consultant Level Competency Framework designed by the Competency Development and Evaluation Group (CoDEG, see www.codeg.org) which is divided into six capability (competency) clusters. Postholders are required to demonstrate:
and
There is work is underway to make explicit links between the Competency Framework and the NHS Knowledge and Skills Framework. The role of consultant pharmacists in the NHS is evolving and although many posts are currently based in hospital practice, the role is developing in primary care.
A pharmacist is a healthcare professional who specializes in the preparation, dispensing, and management of medications and who provides pharmaceutical advice and guidance. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.
A prescription drug is a pharmaceutical drug that is permitted to be dispensed only to those with a medical prescription. In contrast, over-the-counter drugs can be obtained without a prescription. The reason for this difference in substance control is the potential scope of misuse, from drug abuse to practicing medicine without a license and without sufficient education. Different jurisdictions have different definitions of what constitutes a prescription drug.
A Doctor of Pharmacy is a professional doctorate in pharmacy. In some countries, it is a doctoral degree to practice the profession of pharmacy or to become a clinical pharmacist. In many countries, people with their Doctor of Pharmacy are allowed to practice independently and can prescribe drugs directly to patients. A PharmD program has significant experiential and/or clinical education components in introductory and advanced levels for the safe and effective use of drugs. Experiential education prepares graduates to be practice-ready, as they already have spent a significant amount of time training in areas of direct patient care and research.
A pharmacy technician performs pharmacy-related functions. Training, certification, licensing, and actual practice of pharmacy technicians varies not only worldwide but in some countries regionally as well as by employer.
A clinical nurse specialist (CNS) is an advanced practice nurse who can provide advice related to specific conditions or treatment pathways. According to the International Council of Nurses (ICN), an Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. Clinical Nurse Specialists are registered nurses who have had graduate level nursing preparation at the master's or doctoral level as a CNS. They are clinical experts in evidence-based nursing practice within a specialty area, treating and managing the health concerns of patients and populations. The CNS specialty may be focused on individuals, populations, settings, type of care, type of problem, or diagnostic systems subspecialty. CNSs practice autonomously and integrate knowledge of disease and medical treatments into the assessment, diagnosis, and treatment of patients' illnesses. These nurses design, implement, and evaluate both patient–specific and population-based programs of care. CNSs provide leadership in the advanced practice of nursing to achieve quality and cost-effective patient outcomes as well as provide leadership of multidisciplinary groups in designing and implementing innovative alternative solutions that address system problems and/or patient care issues. In many jurisdictions, CNSs, as direct care providers, perform comprehensive health assessments, develop differential diagnoses, and may have prescriptive authority. Prescriptive authority allows them to provide pharmacologic and nonpharmacologic treatments and order diagnostic and laboratory tests in addressing and managing specialty health problems of patients and populations. CNSs serve as patient advocates, consultants, and researchers in various settings.
A hospital pharmacy is a department within a hospital that prepares, compounds, stocks and dispenses inpatient medications. Hospital pharmacies usually stock a larger range of medications, including more specialized and investigational medications, than would be feasible in the community setting. Hospital pharmacies may also dispense over-the-counter and prescription medications to outpatients.
Pharmaceutical policy is a branch of health policy that deals with the development, provision and use of medications within a health care system. It embraces drugs, biologics, vaccines and natural health products.
A veterinary pharmacist is a specially trained pharmacist who dispenses veterinary drugs and supplies or products and advice to owners of companion animals and livestock. In addition, they advise the regulatory bodies and are involved in the formulation of veterinary drugs. Veterinary pharmacy is a field of pharmacy practice, in which veterinary pharmacists may compound medications, fill prescriptions, and manage drug therapies for animals. Veterinary pharmacists are licensed pharmacists who specialize in the distribution of medications for animals.
Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.
Pharmacy residency is education a pharmacist can pursue beyond the degree required for licensing as a pharmacist. A pharmacy residency program allows for the implementation of skill set and knowledge acquired in pharmacy school through interaction with the public either in a hospital setting or community practice. The program is done over a span of about 2yrs after graduation from pharmacy school and licensure as a pharmacist. Pharmacy residency helps improve the resume of a pharmacist so as to increase chances of obtaining employment outside community practice. A 2022 review suggested that there is sufficient evidence that residency develops key competencies for junior pharmacists.
A pharmacy is a retail shop which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.
Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.
The Domiciliary Medication Management Review (DMMR), also named as a Home Medicines Review (HMR), in an Australian scheme for the patients residing in community setting. There are many steps included in a Home Medicine Review Service.
Pharmacy in the United Kingdom has been an integral part of the National Health Service since it was established in 1948. Unlike the rest of the NHS, pharmacies are largely privately provided apart from those in hospitals, and even these are now often privately run.
A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).
Drug recycling, also referred to as medication redispensing or medication re-use, is the idea that health care organizations or patients with unused drugs can transfer them in a safe and appropriate way to another patient in need. The purpose of such a program is reducing medication waste, thereby saving healthcare costs, enlarging medications’ availability and alleviating the environmental burden of medication.
The Joint Commission of Pharmacy Practitioners (JCPP) is the largest professional delegation representing the interests of pharmacists within the United States. JCPP represents 13 professional associations in the field of pharmacy, developing consensus policy directives for the profession. It is well known for the 2014 development of "The Pharmacists’ Patient Care Process," which provides broad, consensus guidelines for how clinical pharmacists should practice.
The Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria supports clinicians to manage medication use specifically for people with dementia without focusing only on the management of the dementia itself.
Claire Anderson is a British pharmacist who is a professor at the University of Nottingham. She investigates pharmacy practice research, and developed the first diploma in community pharmacy.