Clinical Pharmacological Reconciliation, Review, and Feedback in Ensuring Patient Safety: A Commentary

Abstract

To The Editor, A clinical pharmacologist in India is a medically qualified professional who has received formal training in clinical pharmacology. The curricular training helps in building critical knowledge and honing relevant expertise in areas revolving around medicines and their clinical use. A clinical pharmacologist is traditionally engaged in drug development research, in medicine access and usage research, in developing policies and procedures for appropriate and safer use of medicines, and in professional and patient education for rational use of medicines.1 Beyond the conventional role of a clinical pharmacologist, we propose an additional, presumably more direct role in optimization of patient care. In the past decade or so, this role is being explored and cultivated by some trained professionals. The experience so far has been quite encouraging. Here, we describe a scheme of 10 key strategies or activities regarding how clinical pharmacologists can apply their skills and can proactively ensure patient safety. Research reports that approximately 5.2 million medical errors occur annually in India.2 Recent studies estimate that medical errors in the United States are responsible for up to 251,000 fatalities annually, making them the third-leading cause of mortality.3 To minimize adverse outcomes related to medicine use and to maximize benefits, a ready-to-use intervention bundle of clinical pharmacological reconciliation, review, and feedback (CPRRF) is proposed. Evaluating if the duly prescribed medicine is unnecessary or redundant, or no or a wrong medicine is prescribed for a given indication. Deprescribing of medicines that are unnecessary, redundant, contraindicated, or not well tolerated. Identifying omissions and commissions during transition of care. Tailoring the dose adjusting to the individual need and perspectives. Preventing, minimizing, and managing adverse drug reactions. Improving treatment adherence. Considering affordability and availability of medicines vis-à-vis adherence. Individualization of treatment accommodating patient factors. Rationalizing polypharmacy, especially in the elderly. Enhancing quality of life. Clinical pharmacologists can play the above role in two ways: (1) responding to drug-related problem cases and extending referral services to other specialist practitioners; and (2) allowing patients with suspected drug-related problems to directly reach out to them seeking relevant care. Further, some clinical pharmacologists may have an interest in a specific clinical area, namely, hypertension, asthma, or diabetes. They can extend professional support in collaboration with clinical experts in the corresponding areas. Further, some of them with particular interest in toxicology deal with drug overdose poisoning and their emergency management. Deaddiction measures for habitual use of illicit drugs may be the interest area of others. In outpatient clinics, clinical pharmacologists preemptively may monitor and supervise patients at higher risk of drug-related problems. Application of CPRRF principles by clinical pharmacologists can deliver optimum patient care and promote both safety and effectiveness of ongoing therapy. In elderly population polypharmacy, anticholinergic burden and cardiac autonomic neuropathy are important areas, and we in our clinics paid special attention to these areas and achieved better patient outcomes.4, 5 We acknowledge that in reference to treatment success, patient-reported outcomes matter more than physicians’ global judgment about treatment benefit. Evaluating a prescription beyond its snapshot image and looking forward to capture the bigger picture of prescribing continuum are crucial. Judicious deprescribing is often beneficial and ensures prevention of prescribing cascades.6, 7 It is generally held that clinical pharmacologists should play a significant role in promoting prudent use of medicines. The World Health Organization has emphasized the need to integrating clinical pharmacology with the health service system.8 It seems we still have a long way to go to make this a reality.9 Application of CPRRF principles in different subspecialty domains is a need of the hour, and clinical pharmacologists can play a significant role. The authors have no conflicts of interest to declare.

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