The Evolution of Clinical Pharmacy in Iran, Past to Present

Clinical pharmacy is delineated as that area of
pharmacy involved with the science and practice
of rational medication use. Clinical pharmacy
is a health science discipline in which
pharmacists provide patient care that optimizes
medication therapy and boosts health, wellness,
and disease prevention.
The practice of clinical pharmacy covers the
philosophy of pharmaceutical care; it combines
a caring orientation with specialized therapeutic
knowledge, experience, and judgment for the
purpose of ensuring optimal patient outcomes.
As a discipline, clinical pharmacy also has a
constraint to contribute to the generation of new
knowledge that advances health and quality of
life. Clinical pharmacists care for patients in all
health care settings. They have in-depth knowledge
of medications that is blended with a
foundational understanding of the biomedical,
pharmaceutical and clinical sciences.
To achieve desired therapeutic goals, the clinical
pharmacist uses evidence-based therapeutic
guidelines and professional criterions. Clinical
pharmacists take on responsibility for managing
medication therapy in direct patient care settings,
whether practicing in consultation or collaboration
with other health care professionals.
Clinical pharmacist researchers apply new
knowledge that supports improved health and
quality of life. Within the system of health
care, clinical pharmacists are proficient in the
therapeutic use of medications. They routinely
provide medication therapy assessments and
recommendations to patients and health care
professionals. Clinical pharmacists are a primary
source of information and advice regarding
the safe, appropriate, and cost-effective use
of medications.
The clinical pharmacist is a proficient in the
therapeutic use of medications; they are perceived
as providing a distinctive set of knowledge
and skills to the health care system and are
therefore competent to assume the role of drug
therapy expert. This expertness is used proactively
to make sure and improve rational drug
therapy, thereby preventing many of the
medication therapy errors that come after
inappropriate therapeutic decisions made at the
point of prescribing. The clinical pharmacist
provides an objective, evidence-based source of
therapeutic information and recommendations.
Finally, notifying that clinical pharmacists routinely
provide therapeutic evaluations and
recommendations underlines the fact that their
daily practice involves regular consultation with
patients and health care professionals on the
subject of medication therapy evaluations and
recommendations.
Clinical pharmacy activity began in Iran in
1991 through teaching modern therapeutic
Classes in undergraduate Pharmacy education.
The first group of residents to be trained as
Clinical Pharmacist entered a post graduate program
in 1994. The residency program in clinical
pharmacy was founded in Tehran University
of Medical Sciences, College of Pharmacy. The
first department of Clinical Pharmacy was
established in 1996 at the Tehran University of
Medical Sciences, College of pharmacy. The
program started with five residents. Tehran
University of Medical Sciences has had over
nine groups of residents. Currently there are
over 30 Clinical Pharmacy residents being
trained at this University. The department of
Clinical Pharmacy has 10 faculty members
ranking from Full professors to Assistant
professors. As the second school of pharmacy

in the country Shahid Beheshti University of
Medical Sciences started the post graduate
training of Clinical pharmacists. They admitted
their first group of residents in Clinical Pharmacy
in 2007. Currently they have over 10
Clinical Pharmacy residents being trained.
Clinical Pharmacy Program in Iran is a four
year program. During this program residents
spend 18 months in didactic courses to expand
their theoretical background. Then they are required
to spend 18 months in clinical rotations.
They have 14 months of required rotations and
the rest are optional. The last year of their program
is spent to complete their research project
which can be started from their first year in the
program.
Presently there are over thirty Clinical Pharmacist
graduates; they all have graduated from Tehran
University of Medical Sciences. They are
all member of faculties in College of Pharmacies
all over the country. They are practicing in
different fields of medicines, such as Intensive
Care Units, Infectious diseases, Nephrology,
Endocrinology, Gastroenterology, Hematology,
Oncology, Transplantation, PsychoPharmacotherapy,
Cardiology, Drug and Poison Information.
The Iranian Society of Clinical Pharmacy was
established in 2008. This organization mission
is to promote clinical services of pharmacists in
hospitals and also provide pharmaceutical care
services in hospitals. Also the aim of this society
is to establish the professional and legal responsibilities
of the Clinical Pharmacist in
health care systems.

Clinical Pharmacist Job Description

What does a Clinical Pharmacist do? Does a Clinical Pharmacist job imply direct contact with patients? What services is he / she supposed to offer? To clarify on these matters it is best to define a clear Clinical Pharmacist Job Description.

Overall description of the job.

A Clinical Pharmacist is in charge of providing various services to the Division Director, such as taking part in continuing education programs for Medical staff, health care services, and Pharmacy students, advising physicians on drug usage and dose control in hospitals and clinics, and assisting the Division Director in his everyday duties.

Specific duties and activities

The specialized services demanded by a Clinical Pharmacist Job include advising physicians on the inherent dangers of drugs and their eventual side effects as well as helping them in the prescription of correct doses. This advice promotes improvement in drug usage / dosage and in the supervision of therapeutic procedures for best results.
Clinical Pharmacist responsibilities also include coordinating the pharmacy technician ´s duties – who work in the preparation, labeling and delivery of various medications or supplies according to prescriptions - and making sure that all dispensed drugs are recorded and delivered in accordance with local, state and federal laws or regulations.
Some of the Clinical Pharmacist Job duties are related to Education, as mentor pharmacists. They may train Pharmacy Residents, whose university activities include practical and theoretical knowledge, along with didactic direct experience. They may also deliver conferences at conventions and seminars.

Necessary Qualifications

To work at this level, it is necessary a BS Pharmacy Degree or a Doctor Pharmacy Degree and at least a two-year experience. Certifications in different areas of Pharmacy and an accredited residence program are a plus.
However, certain personal abilities are all vital, such as communication abilities (both oral and written), deep knowledge on drugs, medical procedures and therapies, diagnosis and disease states, and some pharmaco-kinetics. Skills in working with technical automated equipment and information systems are an added value to any Pharmacy Career.

Pharmacists as Researchers

Research is another broad field for Pharmacists who can perform as researchers or co-researchers for programs intended to study the impacts of providing quality care, pharmacoeconomic impact, etc.

Clinical Pharmacy

Clinical pharmacy is the branch of Pharmacy where pharmacists and pharmaconomists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention.^[1] Clinical pharmacists and clinical pharmaconomists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists/pharmaconomists often collaborate with physicians and other healthcare professionals.
Clinical pharmacists and clinical pharmaconomists have extensive education in the biomedical, pharmaceutical, sociobehavioral and clinical sciences. Most clinical pharmacists have a Doctor of Pharmacy (Pharm.D.) degree and many have completed one or more years of post-graduate training (e.g. a general and/or specialty pharmacy residency). Many clinical pharmacists also choose to become Board Certified through the Board of Pharmaceutical Specialties (BPS) which was organized in 1976 as an independent certification agency of APhA (American Pharmacists Association). A pharmacist may become a Board Certified Pharmacotherapy Specialist (BCPS), a Board Certified Oncology Pharmacist (BCOP), Board Certified Nuclear Pharmacist (BCNP), Board Certified Nutrition Support Pharmacist (BCNSP), or a Board Certified Psychiatric Pharmacist (BCPP) through the Board of Pharmaceutical Specialities (BPS). There are also subspecialties within the Pharmacotherapy specialty: Cardiology and Infectious Disease. It is denoted as an "Added Qualification" or AQ. In order to obtain one of these specialties you must first be a Board Certified Pharmacotherapy Specialist and then submit a portfolio to the Board of Pharmaceutical Specialties for review to determine if they will grant you the added qualifications.^[2]
Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and other health care professionals. Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications. Clinical pharmacists are also making themselves more readily available to the public. In the past, access to a clinical pharmacist was limited to hospitals, clinics, or educational institutions. However, clinical pharmacists are making themselves available through a medication information hotline, and reviewing medication lists, all in an effort to prevent medication errors in the foreseeable future.
In some states, clinical pharmacists are given prescriptive authority under protocol with a medical provider (i.e., MD or DO), and their scope of practice is constantly evolving. In the United Kingdom clinical pharmacists are given independent prescriptive authority.
Basic components of clinical pharmacy practice^{[dubious – discuss]}:

1. Prescribing drugs^{[dubious – discuss]}
2. Administering drugs^{[dubious – discuss]}
3. Documenting professional services
4. Reviewing drug use
5. Communication
6. Counseling
7. Consulting
8. Preventing Medication Errors

Scope of clinical pharmacy:

Drug Information

Drug Utilization

Drug Evaluation and Selection

Medication Therapy Management

Formal Education and Training Program

Disease State Management

Application of Electronic Data Processing (EDP)