India has launched Doctor of Pharmacy (PharmD) study program in the year 2008, and it has sprouted huge discussions about both, the program and the role of clinical pharmacists (CPs) in the country. Before launching of the study program (i.e. PharmD), the role of a pharmacist in the nation was mostly considered to be “dispensing/manufacturing/marketing of the drugs” and clinical pharmacy education was mostly given under the study program of Master of Pharmacy (M. Pharm) (Pharmacy Practice/Clinical Pharmacy). Furthermore, there had been “almost no” professional clinical pharmacy services (CPS) provided in the country. As a consequence, the concepts of CP and PharmD are quite new in India.

Medication history interview

Accurate medication history of the patient is important to assess − the medical concordance, rationale for the drugs prescribed previously, patient understanding toward medicines, evidence for drug abuse, patient acceptance for the treatment, documenting allergies and adverse drug reactions (ADRs), etc.

Clinical review

In clinical review, pharmacists have to check the drug therapy to ensure that the patient is getting the most appropriate dose, dosage, dosage form, duration of therapy for their medical/disease state. Also, he has to correlate the signs and symptoms of the patient, laboratory results, medical diagnoses and therapeutic goals with the medication history for better patient care.

Patient counseling

Patient counseling can be considered as the most important CPS from the patient's point of view. The pharmacists may provide the information about current clinical condition/proceedings of the patient and educate him about the safe and appropriate use of medicines, thereby enhancing his therapeutic outcomes. Generally, there are many questions in patient's mind about disease, drugs, lifestyle modifications, diet, treatment, duration of therapy and medical devices, e.g., metered dose inhalers for asthma patients or insulin pen for diabetics. Here, the pharmacists can educate the patients about all such areas as a part of CPS.

A CP may provide information on ongoing care to the patient to ensure continuity of supply of drugs, continuity of medication concordance aids, communication of special problems, appropriate monitoring of the dosages and for minimal disruption.

The patient may be counseled/educated for the following points about the drugs by the pharmacists.

• Generic name, brand name of the drug
• Dosage
• Indications/benefits of the medicine and expected action
• Proper storage
• How to take the medication?
• When and how long to take medication?
• Information about ceased/new medication
• Special precautions about the drug
• Common ADRs
• Action to be taken when a dose is missed
• Drugs and/or foods to be avoided

Ward round participation

As a member of healthcare team, the pharmacists can attend ward rounds. The goals are improved understanding of patient's history, progress, clinical details, to provide the information on clinical aspects of patient's therapy and to improve discharge planning. The pharmacists can also help in decision-making to select the quality low-cost medicine; optimize the quality of patient care and clinical outcomes; ensure medicine selection as per formulary and local guidelines.

Community pharmacy

Community pharmacy services generally involve dispensing of drugs, promotion of healthy lifestyles, support for self-care, provision of practice leaflets to the patients, medicines use review, smoking/alcohol cessation programs etc. CPs can participate in various community service programs such as smoking cessation, alcohol consumption cessation, health promotion, health nutrition, etc.

Role of clinical pharmacists in research

For the current contribution, Indian physicians, nurses and other healthcare providers are playing more or less roles. As the concept of clinical pharmacy is still in the initial stages of development, contribution of CPs toward the research is negligible at this point of time. On the other hand, because of the busy schedules and high patient load, physicians can’t contribute to the full of their capacity for research. As a result of this scenario, less data from the hospitals are getting published; the country lags behind other developed countries in producing quality data and research; and tremendous data from the hospitals remain unpublished in journals, e.g., rare case reports/case studies, retrospective studies etc.

Meanwhile, qualities of CPs toward the research include-presence of thesis work as a part of the syllabus, enough exposure to hospital and knowledge of subjects such as pharmacotherapeutics, clinical pharmacy, hospital pharmacy, clinical toxicology, biostatistics, research methodology, clinical pharmacokinetics, pharmacoeconomics, etc.With the assistance of CPs physicians, nurses and other healthcare providers, India may come up with tremendous data published (which is now unpublished) and apart from this, presence of CPs will open new research opportunities in the country for pharmacoeconomics, clinical research, patient-reported outcomes, quality of life, pharmacovigilance, clinical pharmacokinetics etc.