Clinical Pharmacology is the scientific discipline that involves all aspects of the relationship between drugs and humans. Its breadth includes the discovery and development of new drugs, the application of drugs as therapeutic agents, the use of drugs, the beneficial and harmful effects of drugs in individuals and society, and the deliberate misuse of drugs.
Clinical pharmacology is a multidisciplinary team science that encompasses professionals with a wide variety of scientific skills including medicine, pharmacology, pharmacy, biomedical science and nursing. Other professionals who are important in various aspects of clinical pharmacology include social and behavioral scientists, dentists, economists, epidemiologists, geneticists, toxicologists, mathematicians and computer scientists.
The descriptor ‘clinical pharmacologist’ is normally used in a professional sense to refer to physicians involved in the medical care of patients who are specialists in clinical pharmacology. They have usually undertaken several years of postgraduate training focusing on important aspects of clinical pharmacology including clinical trials, drug evaluations, pharmacoepidemiology, pharmacoeconomics, pharmacovigilance and clinical drug toxicology. Some countries have accreditation programmes for clinical pharmacology as a physician specialty but many do not.
Key clinical pharmacology services in patient care
Critical evaluation of new and old therapies is fundamental for patient care. It should be a core activity in clinical consultations, in the provision of drug information, in services to DTCs, in consultations with clinical colleagues ⁄clinics, in drug selection and in the design of clinical trials. Critical drug evaluation is the cornerstone for RUM and is important in rich as well as in resource-poor settings. The role of critical drug evaluation is particularly important when new and expensive drug therapies and drug combinations are introduced
Drug and Therapeutics Committees (DTC) All institutions, no matter what size, should have some appropriate version of a DTC. It should preferably recruit both hospital based specialists and primary care physicians in order to provide the same type of recommendations irrespective of the level of healthcare .
The membership will vary depending on local circumstances and resources but may include physician clinical pharmacologists, relevant medical staff, clinical and other pharmacists and other staff as appropriate. Where available, physician clinical pharmacologists provide a leadership role bridging medical, pharmacy and other staff . DTCs should issue recommendations for drug use within the facility based on scientific evidence and medical needs at the local level. This will usually take the form of a local formulary or ”Wise List” with the WHO Essential Drug concept being a useful model
Drug utilisation studies and pharmacoepidemilogical services are closely linked to the work of DTCs and to quality assurance of drug therapy in clinics and in hospitals . Ideally, a multi-professional approach is preferred involving experts in clinical specialties, pharmacoepidemiology, pharmacoeconomics and clinical pharmacology.
These services are important for a systematic introduction and monitoring of new drug therapies in the facility and can then be linked to forecasting future drug use in healthcare organizations. Knowledge about the use of drugs is a prerequisite for follow-up studies of the adherence of prescribers to drug recommendations and of the effectiveness of drug information and educational activities
Services in pharmacovigilance may include the responsibility to be a coordinating centre for reports of adverse drug reactions (ADRs) from clinicians and other prescribers at a regional or national level . ADR reports should be evaluated systematically and the conclusions fed back to the reporting clinicians and the DTC. Regional clinical pharmacology centres for pharmacovigilance have been successfully implemented in countries such as France and Sweden .
Pharmacovigilance should be given priority in resource poor settings when implementing population based therapies to control major infectious diseases such as HIV/AIDS, malaria and tuberculosis
Continuing medical education.
The focus should be on major pharmacotherapeutic areas, on the principles of RUM and on new drug therapies and drug combinations. Interactive models for learning such as integration of e-learning tools in academic drug detailing and open access internet should be considered and will help to improve the quality of knowledge in drug therapy in remote healthcare institutions in resource poor countries. Continuing medical education should preferably be interactive as this will foster the best involvement of clinical colleagues.