Background.

It is no longer news that the health care indices of Nigeria has continued to deteriorate, thereby placing the country at about position 189 out of 191 countries surveyed in recent times. The life expectancy of Nigerians has also been put to about 54 years according to experts , while in some nations like the USA and UK, the average life expectancy is 98 and 97 years respectively. Many experts have attributed these differences between that of Nigeria and those of the nations mentioned to quality health care management by their governments. In those countries, the health care work force is viewed and related to as a real team similar to a football team whereby every player's input really matters for winning or scoring goals.   

A onetime director general of World Health Organization in the person of Richardson, stated that: without drugs, a health service is without substance and credibility. This statement by Richardson is due to the fact that drugs(medications) must either be used in the beginning or at the end of almost all health care interventions in the care of the sick and even the healthy. In the same vein, it is important to reemphasize to our leaders that there is only one health care Professional recognized globally who  excels  on all drug matters than others. That health care Professional is no one other than the pharmacist. The training of Pharmacists at the first degree level is about 6 years or 5 years depending on whether the recipient graduates with doctor of pharmacy or bachelor of pharmacy degree respectively. That rigorous training is all about a unique set of skills that is not a replica of any other health care Professional's  training. Hence the specific job that a Pharmacist is designed to do on graduation from the University cannot be done by any other health care Professional. Just equally as Pharmacists cannot do a replica of the job of other health care providers. Furthermore, Pharmacy training and practice extends its roots to other deeper aspects, one of which is known as Clinical Pharmacy.

  

Clinical Pharmacy is a special area of the Profession dealing with direct (a.k.a bedside) care of Patients. Clinical Pharmacy is recognized globally. Unfortunately, in Nigeria Clinical Pharmacy is yet to be fully recognized and instituted within our health care system. This lack of proper recognition and full implementation of clinical Pharmacy Practice in our health care sector has been at the detriment of the Nigerian health seeking Population, and by implication it has also negatively affected our health indices.

  

Though the Nigerian National Drug Policy of year 2005 makes reference to the promotion of clinical pharmacy in our health care institutions, together with the recent approval of consultancy Pharmacy Cadre by the national council on establishment, one is yet to see any  aggressive implementation of this laudable factor that will hasten our health indices to return to enviable levels.

  

Should one be tempted to feel that some persons could be playing politics with that? Are we happy with the embarrassing level of medical tourism by Nigerians?

  

What really have other countries with good health indices done well that Nigeria has not been able to do? That one thing is the full recognition of Clinical Pharmacy Practice and Consultant Pharmacist Cadre implementation.

  

The following points below will make things clearer to our policy makers and FG so as to give Nigerians the best health care possible for both the sick and even the healthy.

  

Importance Of Clinical Pharmacy & By Extension Consultant  Pharmacist  Cadre.

  

1)   Globally, Several Studies have shown that Clinical Pharmacy interventions could improve the economic and Clinical outcomes, playing a significant role in reducing medication errors by prescribers and consumers, reducing readmission rates, reducing length of hospitalizations, and reducing Medication quantity usage and costs.

  

2)   Clinical Pharmacists are the recognized ultimate medication experts who ensure that hospitalized Patients take the right medication, for their diseases, for their age, and help to prevent complex drug interactions when the patient must take several drugs as is commonly seen in many cases. Clinical Pharmacists also provide appropriate drug information to other health care providers, to prevent irrational use of drugs that can result in medication harm and possible death.

  

Drug treatment is one of the most health care technological advancements. Pharmacists alone are trained and legally saddled to take all responsibilities emanating from drugs usage. As the last defence, the Clinical Pharmacist's expertise prevents medication errors, drug harm, medication confusion, and untimely death due to drug misuse or drug abuse. Pharmacists intervention can help reduce drug abuse in the society and consequently reduction in crime rate. Organ damage, failed health system etc cannot be quantified in monetary terms or values. It is not just fake drugs only that can cause such damage. Genuine drugs too, do create unquantifiable damage when misused by consumers or as oversight errors from other health care providers. It is the global practice to include and remunerate Clinical Pharmacists in the health care team as medication consultants .

  

While other health care providers such as Physicians focus on diagnosis, Clinical Pharmacists focus on what the drug can, might, or is doing to the Patient positively or negatively.

  

3)   it is important to let the authorities know that Bachelor of Pharmacy degree holders alone who are Pharmacists and work in health care settings do not have the same training as Clinical Pharmacists who have acquired additional training. Clinical Pharmacists have the doctor of pharmacy degree or some other post bachelor degree such as Masters, PhD or Fellowship in Clinical Pharmacy. While Pharmacists with Bachelor's degree are good in handling drugs products expertise, Clinical Pharmacists possess both drug product expertise and direct  Patient Care  drug expertise at a more advanced level. Many Clinical Pharmacists are also Specialists in different aspects of Patient Care utilizing drugs. This is because no single person can be an expert on drugs for all diseases and all ages, just like someone cannot be a specialist in gynaecology and paediatrics  at the same time.

  

Some of the subspecialties of Clinical Pharmacy include:

  

          i.   Oncology Pharmacists

         ii.   Paediatric Pharmacists

       iii.   Cardiology Pharmacists

       iv.   Renal Pharmacists

        v.   Critical care Pharmacists

       vi.   Ambulatory care Pharmacists etc,

  

Just to mention but a few. There is no medical field without a Pharmacist Specialist. It is necessary to always bear in mind that Life lost cannot be replaced, hence the duty of a clinical pharmacist is to ensure that the health care team gets it right the first time and always. Only an expert and most importantly a specialist can attain such a standard. In the interest of public health, both the Federal Government and all other stakeholders in healthcare should join hands towards a speedy and full   institutionalization of clinical Pharmacy Practice and Consultant Pharmacist Cadre in all our health care facilities, just as obtainable in countries with quality health indices. This will bring medical tourism, morbidity and  untimely death due to drugs misuse and abuse to the barest minimum.

  

CONCLUSION.

  

Why recognize Clinical Pharmacy  and the Consultant Pharmacist cadre?

 

1)   Clinical pharmacy is the branch of the pharmacy profession in which clinical pharmacists provide direct patient care that ensures  the best use of medicines  and promotes health, wellness, and disease prevention. Clinical Pharmacists practice in all health care settings by

utilizing and applying their advanced and in-depth knowledge of medications and disease states to manage medication therapy within a multi-professional healthcare team.

 

 2)   Clinical pharmacists are responsible and accountable for medication therapy and patients’ therapeutic outcomes. The Consultant  pharmacist  cadre is an advanced level of career position within the Pharmacy profession and they are leaders of the Pharmacy profession in education, research, and in the delivery of expert pharmaceutical practice.

  

3)   This apex Consultant  pharmacist  cadre is necessary for the perpetual growth of the Pharmacy profession globally. Recognizing this cadre in-country is a welcome development as it gives the younger cadres in the Pharmacy profession a height of professional learning and practice to look up to.

  

4)   Clinical Pharmacists contribute significantly towards basic healthcare delivery and optimizing healthcare outcomes. Some examples based on documented scientific research evidence are listed hereunder: Optimal medication therapy. Clinical pharmacist’s consultation service improves the effectiveness of treatment for Infectious Diseases and other diseases.

  

Edited By :

Dr Joseph Madu MCPAN, PharmD, FPCPharm, DCPharm, MAW.

National Chairman,

Clinical Pharmacists Association Of Nigeria.

  

(https://ejhp.bmj.com/content/ejhpharm/27/3/131.full.pdf);

(https://www.frontiersin.org/articles/10.3389/fphar.2020.575022/full);

(https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410298).

•       Medicines reconciliation and reducing medication discrepancies which

improve healthcare outcomes

(https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0193510);

(https://link.springer.com/article/10.1007/s00520-020-05400-5) and

patients’ length of hospitalization and readmission rate.

(https://link.springer.com/article/10.1007/s11096-020-00972-y).

•       Improved patients’ medication adherence: as the experts in drugs and medicines pharmacist‐led interventions have been shown to contribute to improved adherence to medications and better disease control.

(https://onlinelibrary.wiley.com/doi/full/10.1111/ijpp.12462);

(https://onlinelibrary.wiley.com/doi/full/10.1111/jcpt.13126).

(https://onlinelibrary.wiley.com/doi/epdf/10.1111/ijpp.12462).

•       Reduced healthcare costs: Clinical Pharmacists Services was associated with significant cost savings and generated positive economic value in the healthcare process. (https://bmjopen.bmj.com/content/bmjopen/10/1/e034862.full.pdf).

The participation of a clinical pharmacist in a multidisciplinary healthcare team reduces healthcare expenditures through the activities of Clinical Pharmacists towards treatment optimization and cost avoidance. (https://onlinelibrary.wiley.com/doi/epdf/10.1111/jcpt.13195).

•       Medications Therapy Monitoring (MTM): Pharmacists' intervention during the healthcare process significantly improves medication appropriateness and rational medication use, primarily through medication reviews. Clinical Pharmacists effectively perform this role through skills acquired during advanced specialized training and experience.

(https://www.sciencedirect.com/science/article/abs/pii/S1544319119305217).

•       Improved Public Health Services and responses during pandemics such

as COVID-19. (https://www.sciencedirect.com/science/article/pii/S155174112031202X).

•       Managed Self-care and Chronic disease management. The integration of

clinical pharmacists into multidisciplinary teams improve the management of chronic diseases such as type 2 diabetes, hypertension, among others. (https://www.pharmacypractice.org/journal/index.php/pp/article/view/2000/834);

•       (http://www.scielo.br/scielo.php?script=sci_arttext&pid