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Its not the strongest species that survives, nor the most intelligent, but the ones most responsive to change (Charles Darwin)
Clinical Pharmacy
Gaps
Trends
Future Needs
UCSF Story
Promote rational drug prescribing Teach patients to use drugs appropriately Identify and prevent medication problems
Silverman, M and Lee, PR: Pills, Profits, and Politics UC Press 1975
Clinical Pharmacy
Gaps
Trends
Future Needs
UCSFs Story
1969- the term Clinical Pharmacy comes to be used to denote patient-oriented pharmacy practice
Decentralized Pharmacies:
made it possible for the physician, if he so wishes, to discuss drug usage with the pharmacists at the time the decision is being made
and
provided students with adequate experience in applying scientific and professional knowledge gained in the classroom to the practical aspects of drug usage in therapeutic situations
Day, RL, et al. DICP 1991;25:308-314
Clinical Pharmacy
Gaps
Trends
Future Needs
UCSFs Story
For unplanned admissions, pharmacists take medication history, may write prescription Some pharmacists have trained to
prescribe
Dispensing in hospital
Doctor Clinical Pharmacist electronic prescription Patient
Pharmacy technician
frequency depends on type of ward and correct any errors by discussion with prescribers Pharmacists provide advice to prescribers as required Some pharmacists select drugs and doses for patients and write prescriptions to prescribe Some nurses have trained Pharmacists monitor quality of prescribing
Pharmacists advise other prescribers Primary care pharmacists discuss patients with hospital pharmacists if required
Community pharmacy
Pharmacists must provide advice with all prescriptions and purchased medicines Pharmacists all keep patient medication records Many pharmacists provide medication reviews need to complete training Some also trained as prescribers, provide specialist clinics Some provide screening for diabetes, hypertension, osteoporosis
Pharmaceutical Care ?
Hepler and Strand (1990) from: Am. J Hosp Pharmacy 47,533-543 Is the direct responsible provision of medication related care for the purpose of achieving definit outcomes that improve patients quality of life
Outcomes: kesembuhan (cure of disease) pengurangan gejala penyakit (elimination or reduction of patients symptoms) perlambatan proses terjadinya penyakit (arresting or slowing of a disease process) pencegahan penyakit atau gejala penyakit (preventing a disease or symptoms)
2. EDUCATION
TALKS TO DOCTORS AND NURSES
Selama peresepan
Konseling
Pharmacist
Patient
Kendala
Kurangnya pengetahuan teknis Kurangnya kemampuan berkomunikasi Tekanan kelompok kerja/ketidaknyamanan kerja Kurangnya motivasi dan keinginan untuk berubah Kurang percaya diri Kurang pelatihan dalam arus kerja yg sesuai Peningkatan persepsi tentang tanggung jawab Kurangnya staf di Instalasi Farmasi
Bagaimana di Indonesia ??
Kegiatan manajerial merupakan kegiatan utama merupakan sumber pemasukan uang terbesar di RS Kegiatan klinik masih relatif sangat sedikit dilakukan banyak kendala (apa ?) Farmasis belum banyak dilibatkan dalam tim kesehatan tidak dianggap sebagai tenaga kesehatan, tapi lebih sebagai penunjang medis
Faktor sejarah : farmasi termasuk ilmu MIPA padahal farmasi adalah profesi pelayanan kesehatan Farmasis kurang kompeten mengapa ? (dulu) Pendidikan farmasi tidak fokus farmasis ada di manamana, tapi tidak terasa adanya Farmasis belum bisa menunjukkan kemampuannya di bidang klinis, tidak percaya diri, dan kurang bisa menjalin kerjasama dgn tenaga kesehatan lain Kebijakan direktur RS tidak mendukung : Jumlah farmasis terbatas, disibukkan dengan kegiatan manajerial Belum ada reward yang sepadan dengan pekerjaan But dont worry kebijakan yang diusulkan Bina Farmasi Klinik dan Komunitas Depkes : 1 farmasis untuk 30 bed