EDITORIAL :

The pharmaceutical care role in laboratory medicine filed to improve clinical outcomes .

Author : Mauro Luisetto . pharm. D, applied pharmacologist , European specialist in lab medicine , hospital pharmacit manager 29122 Italy maurolu65@gmail.com

Abstract. The purpose of this study is to examine and discuss the advantages and roles played by the clinical pharmacists as stabile members of a medical team with physicians when they use the data provided by medicine laboratory, as tools to choose and monitor the therapy .

This presence improve clinical outcomes of the patient, leading to a better cost containment and patients safety.

Keywords: Pharmaceutical Care, Clinical Pharmacy , Medical Laboratory, Hospital Settings, Medication Cost, Clinical Outcomes.

Introduction

In Today healthcare we can see that many pharmacological therapy ( old and new drugs ) in which medical laboratory data drive the therapy in relevant way. ( biochemistry, microbiology , toxicology, molecular biology , genetic and many other discipline ) .

Medical laboratory is crucial in diagnostic activity but also in therapy management .

In example in immunosoppresive therapy in transplant, in oncology therapy, in metabolic disease, infectious disease , artimia, CHF, anticoagulant therapy but in many other conditions.

The role played by micriobiology lab data in infectious disease in order to prevent diffusion of MDR resistence Using antibiograms is a crucial instrument.

New drugs are increasing as well as new medical and diagnostic procedures .Today we have more complex cures and multitherapy is very commonly.

The genetic profile, the mutation added to the classic clinical and pathological data make possible to have the right stadiation with more information about sensibility or resistance to a pharmacologicval therapy.

But as we can see in some field the pharmacological therapy can be improved a lot and using the genetic patient data we can use the right drug to the right patient with more rational approach .

In this situation There is the real need of clinical pharmacist service in order to improve clinical outcomes and the role payed by lab med data is relevant ( To help the pharmacist to do this work in efficient way).

Reduction of medication therapy errors is needed and demanded by patients ,health authorities and government.

We have see that In the last 100 year the clinical pharmacy development in hospital that contributed to improve clinical outcomes. ( luisetto et al 2016 ).

Clinical pharmacy and pharmaceutical care as well as ward pharmacy can be considered as helpful tools in today’s world of cognitive services.

This participation in multidisciplinary medical equip certainly improves some clinical and economic outcomes.

An opportunity for medical authorities , institutions and patients to efficiently contain costs (drugs ).

Multiprofessional healthcare team is a real golden endpoint in today health care systems.

A clinical pharmacist today contributes in onco- haematology logy, toxicology, emergency medicine and ICU nuclear medicine, infectious diseases, nephrology, surgery nutrition service and others.

In order to build an efficient team and assess right pharmacological therapy ( also related to new innovative biological agents) the pharmacists must go up to date their own medicine lab curriculum knowledge.

They will be in condition to use the data provided by medicine laboratory, biochemistry, molecular biology, genetics, toxicology lab and immune-hystochemistry departments.

The presence of clinical pharmacists in medical equips with this expertize represents the right keyword

To make a crucial difference in the management of new innovative pharmacological therapeutics, especially when there is a great necessity of healthcare cost containment.

A consultant pharmacist for patient in the complex world of drugs therapies can be a focal point in the different medical specialty and in the complex health care world and also in medical laboratory field.

Adding the specific clinical pharmacist expertise in medicinal chemistry and pharmacology to his/her clinical work, you’ll have an improving the patients’ clinical outcomes as far as, health and quality of healing and reducing healthcare costs .

The hospital and the institution also will receive great benefit from this combination system.

Observing and analyzing some relevant biomedical literature in function of clinical pharmacist presence in the medical equip we find:

In 1994 Shaw M. wrote: “pharmacists, not only specialists, must be knowledgeable of the role diagnostic imaging plays in pharmaceutical care; diagnostic imaging is utilized to follow the course of therapy; i.e. determining therapeutic outcomes.

Howard P, An introduction to the clinical laboratory for pharmacists. Hosp Pharm. 1984 Jun;19(6):425-6, 430-

“Laboratory results are an essential tool for pharmacists involved in monitoring drug therapy and adjusting dosing regimens. Laboratory medicine, however, is a complex and rapidly changing field with new analytical techniques and instruments continually being Pharmacists should utilize the medical technologist as a consultant on the interpretation and limitations of laboratory tests. Likewise, there are many areas, such as therapeutic drug monitoring, in which the pharmacist can serve as a consultant to the laboratory.

Pharmacists involved in patient care will benefit from a greater understanding of the clinical laboratory, and may also find new opportunities for clinical pharmacy practice and interaction with other health care professionals” 1

1. Bond C.A, et al. in 2007clinical pharmacy service, pharmacy staffing, and hospital mortality rates. “In seven hospitals, clinical pharmacy service reduces mortality rates.”In a significant way. 1

2. Chisholm et al. 2010 in “Pharmacist’s effect as team members on patient care: systematic review and meta-analyses”: “pharmacists provided direct patient care has favorable effects across various patient outcomes, health care settings, and disease states. (significant p<0,005). 2

3. 2015 Pharmacist cognitive service and pharmaceutical care: today and tomorrow outlook UKJPB M Luisetto et al UK J Pharm & Biosci, 2015: 3(6); 71

”The goal of this article is to improve the pharmaceutical care application in countries with an advanced healthcare system in order to provide more rational drug therapy to patients. When this is not possible, it would be a good idea using pharmaceutical care, in particular populations such as: severe disease, critically ill, patients with multiple illnesses, transplants, immunosuppression, oncology or other serious conditions, at least when the treatments cost a lot.” And “In these studies, we observe a general positive influence of pharmacist’s presence in the medical team also in different clinical outcomes.” 3

What we have observed in these studies( 4-9) was a general positive impact of the presence of clinical pharmacist in medical teams which resulted in significant enhancement in some clinical and economic outcomes.

we think the observed achievements were due aslo to medical laboratory knowledge and expertise of the clinical pharmacist, as part of the team in a hospital setting.

We have noticed that such medical laboratory expertise of the clinical pharmacist has resulted in a significant impact on therapy and its monitoring and on the related therapy costs.

For patients’ safety and health and cost reduction it is incumbent upon the private and public hospitals to demand an active role by clinical pharmacists especially in fields of medical laboratory.

Isn’t time for the health authorities, including hospitals, universities to utilize the expertise of clinical pharmacists to reduce the patients’ life threatening risks, enhancing clinical outcomes with cost savings ?

We think that a new discipline named clinical pharmaceutical care can be an useful instrument in today healthcare .

Conflicts of Interest: None

Bibliography:

1) S Shaw, Diagnostic Imaging and Pharmaceutical Care, American J. of Pharmaceutical Education, 1994, 58, 2

2) Howard P, An Introduction to the Clinical Laboratory for Pharmacists, Hosp Pharm. 1984 Jun; 19(6): 425-6, 430-1.

3). Bond C.A, et al. In 2007 Clinical Pharmacy Service, Pharmacy Staffing and Hospital Mortality Rates: “in Seven Hospital, Clinical Pharmacy Service Reduces Mortality Rates.” In a Significant Way.

4. Chisholm et al. 2010 in “Pharmacist’s Effect as Team Members on Patient Care: Systematic Review and Meta-Analyses”: “Pharmacists Provided Direct Patient Care has Favorable Effects across Various Patient Outcomes, Health Care Settings, and Disease States.(Significant p<0,005)

5)Luisetto M, Nili-Ahmadabadi B, Cabianca L, Ibne M (2016) Steps andImpacts of Pharmaceutical Care and Clinical Pharmacy Development onClinical Outcomes. A Historical Analysis Compared with Results,

Clinicians Teamwork bulletin 1:4-8.

6). M Luisetto et al Pharmacist Cognitive Service and Pharmaceutical Care Today and Tomorrow Outlook, UKSPB 2015 Vol 3 (6) 67-72

7 . Stanley M. Shaw, Diagnostic Imaging and Pharmaceutical Care, American J. of Pharmaceutical Education.1994; 58: 2.

8 ). Howard P., An Introduction to the Clinical Laboratory for Pharmacists, Hosp Pharm. 1984 Jun; 19(6):425-6, 430-1.

9) Luisetto M, Sahu RK (2016) Clinical Pharmaceutical Care: A New Management Health Care Discipline in 2016. UKJPB.