Clinical and Hospital Pharmacy

After completing my Summer Internship in Clinical and Hospital Pharmacy at Shri Ram Singh Hospital and Heart Institute I would like to express the importance of Clinical Pharmacy in the hospitals.

Clinical Pharmacy and its relation with Rational Therapeutics

Rational use of drugs may be defined as "Patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and the lowest cost to them and their community" (WHO 1985).

Irrational prescribing and dispensing is a worldwide problem. There are reports that suggest that close to 75% of antibiotics are prescribed inappropriately even in teaching medical hospitals. One of the main reasons for antibiotic resistance is attributed to the irrational use of antibiotics. Thus, a policy on rational use of drugs should be an extremely important part of any National drug policy and it should aim at improving the overall health of the country's population by improving the judicious use of medicines by health workers and the ultimate consumers.

Rational drug use attained more significant now a days, in term of medical, social economical, and legal aspects. In addition to the above definition, which is from the angle of medical therapeutic view rational use of drugs can also be viewed from the consumer's perspective. What is rational in a medical sense may not be rational for the consumer and vice-versa. For the consumer, the rationality of use of a drug is based on reinterpretation of its value for daily life influenced by cultural perceptions and economic conditions.

Factors that have led sudden realization for the Rational drug use are:
1. Drug explosion
2. Efforts to prevent the development of resistance
3. Growing awareness
4. Increased cost to treatment
5. Consumer protection act

Recommendations of WHO for Rational use of drugs

WHO recommends 12 key interventions in order to promote the rational use of drugs. These key points are as follows:

1. Establishment of a multidisciplinary national body to coordinate policies on medicine use
2.  use of clinical guidelines
3. Development and use of national essential medicines list
4. Establishment of drug and therapeutics committee in districts and hospitals
5. inclusion of problem-based  pharmacotherapy training in undergraduate curriculums continuing in service medical education as a licensure requirement
6. Supervision, audit and feedback
7. Use of independent information on medicines
8. Public education about medicines
9. Avoidance of preserve financial incentives
10. Use of appropriate and enforced regulation
11. Sufficient government expenditure to ensure availability of medicines and staff.

Conclusion
Rational use of drugs is an important tool in the safe and effective treatment of patients. Indiscriminate uses of drug not only waste scarce resources that could otherwise be spent on the other essential services, but also leads to drug induced diseases. Rational use of medication saves lives, make sense and save cents. It limits undesired toxicity and adverse events and maximizes on the benefits that can be derived from optimal use of medications. To conclude, the demand of rational drug use are:
1. Availability of essential and lifesaving drugs and unbiased drug information with generic name.
2. Adequate quality control and drug control
3. Withdrawal of hazardous and irrational drugs
4. Drug legislation reform.