Defining Clinical Pharmacy and Pharmaceutical Care

Our front cover states that Pharmacy World & Science is a journal dedicated to clinical pharmacy and pharmaceutical care. But what do these terms actually mean? Is there a difference between them? Does it matter? The two concepts of clinical pharmacy and pharmaceutical care clearly are closely related. Of the two, clinical pharmacy has been around the longest and the term is widely used. There are many definitions, though, and the term is understood differently around the world. The United Kingdom Clinical Pharmacy Association (UKCPA) describes clinical pharmacy as encompassing the knowledge, skills and attitudes required by pharmacists to contribute to patient care. The European Society of Clinical Pharmacy (ESCP) defines it as a health specialty that describes the activities and services of the clinical pharmacist in developing and promoting the rational and appropriate use of medicinal products and devices. In the Clinical Pharmacy Survival Guide, clinical pharmacy is described as a name for a series of patient-related services, including prescription monitoring, therapeutic drug monitoring and patient counselling. Elsewhere, clinical pharmacy is defined as the science addressing the pharmacodynamics and pharmacokinetics of drugs in relation to their effects on the human body. Whatever definition is adopted, it is clear that clinical pharmacy is not synonymous with hospital pharmacy. There are two reasons for this. First, hospital pharmacy encompasses a much wider range of activities, such as manufacturing, quality control, supply, procurement, and systems management. Second, clinical pharmacy can also be practiced by community pharmacists. Moving now to pharmaceutical care, Hepler and Strand originally defined this as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life. Interestingly, the pharmacist is not part of this definition, and in theory any health care professional could provide pharmaceutical care. Hepler at that time was a hospital clinical pharmacist, based at the university. But Strand later defined pharmaceutical care as a style of pharmacy practice with the patient at the centre, and she focuses on community pharmacy. It has been suggested that pharmaceutical care describes the original purpose of clinical pharmacy, when it was understood as an approach to professional practice. It has also been separately described as a philosophy on which clinical pharmacy should be based, relating to the morality of the relationship between pharmacist and patient, and as encompassing both clinical pharmacy and social pharmacy. To confuse matters yet further, what others would call pharmaceutical care is being called ‘medicines management’ in some parts of the UK. It is apparent that clinical pharmacy and pharmaceutical care are closely related, but have different meanings in different countries. This poses a challenge for an international journal such as PWS. Even defining a concept such as ‘care’ is difficult, as its interpretation is strongly influenced by national and local circumstances in health care practice. In addition, different linguistic and cultural influences affect the interpretation of any definition. Some say that it is not necessary to define such concepts. However, the different interpretations confuse researchers and practitioners alike, particularly when they try to look across professional and national borders. It will therefore be necessary to define such terms as clinical pharmacy and pharmaceutical care just as long as there is potential confusion about them. For the purposes of this journal we therefore define clinical pharmacy as that part of the practice of pharmacy that contributes directly to patient care and develops and promotes the rational and appropriate use of medicinal products and devices. We define pharmaceutical care as the person-focused care relating to medication, which is provided by a pharmacist and the pharmacy team with the aim of improving the outcomes of therapy. What is most important is that both definitions focus on the individual (usually a patient), whether they are in primary or secondary care. Therefore, from an editorial perspective, we are looking for patientorientated contributions to this journal.