Clinical Trials Involving Pharmacists in Pakistan’s Healthcare System: A Leap from Paper to Practice

Abstract

The inclusion of pharmacists in the healthcare system of a developing country like Pakistan has always been a subject of debate among the healthcare professionals (HCPs), especially physicians, who have long ruled the healthcare system alone and who have had a long-held position of supremacy. The common argument against the inclusion of pharmacists is the dynamics of the healthcare system, and patients being physician oriented, hence, consider the inclusion of pharmacists as no good. Although the trend of defiance is changing, it is worthwhile mentioning here that the concept of the inclusion of pharmacist was implemented in developed countries by an evidence-based approach, i.e., to actually involve pharmacists in the disease state management of a patient and conducting a trial. This opinion calls for the same to be implemented in a developing country like Pakistan to evaluate its significance.

1. Introduction

Pharmacists and their activities have always been a subject of strong discussion among healthcare professionals (HCPs) in developing countries that are implementing quality pharmaceutical care in their healthcare system. Countries, such as Pakistan, where the profession of clinical pharmacy and pharmacy practice in general are rapidly evolving, the inclusion of pharmacists in the past has always been viewed in a wary manner by the health, as well as the academic sector [1,2]. One of the major reasons normally given against this novel concept is the dynamics of the healthcare system and the mind-set of patients being physician oriented [3]. Moreover, physicians also assume pharmacists to be a threat to their job security [4]. However, the situation is rapidly changing, and the majority of HCPs agree that the benefits of the inclusion of qualified clinical pharmacists are numerous [5]. The development process is slow, and progressive changes need a bit of time to be implemented. Currently, the situation of Pakistan in the context of pharmacy practice is between recognition of the potential of clinical pharmacy and its full-fledged service execution. The authorities have taken early steps in its development stage and, at present, are dealing with the aforesaid issues with success, now eyeing the concept of an evidence-based approach, as implemented in developed countries.

2. Discussion

In developed countries where the decision making process is always subjected to basis of evidence, a number of clinical trials have been conducted involving pharmacists in the disease state management of patients, evaluated by means of desirable health indicators or outcomes set by various clinical guidelines [6,7]. The aim of this opinion is to highlight the fact that the same concept of the evidence-based model implemented in developed countries can be applied in developing countries, like Pakistan, to verify the significance of recently-introduced clinical pharmacists and their services, which is currently in discussion among the health authorities of Pakistan.

Referring to the point of perceiving clinical pharmacist as a threat to prescribers and changing the mind-set of prescriber-oriented patients, it is worthwhile to mention that the healthcare system of the country has long struggled to counter health problems with only prescribers recognized as the sole work force. The authorities have recognized this, and the trend is now changing [1,5]. The re-structuring and up-grading of the pharmacy curriculum, as well as the creation of clinical pharmacist jobs in the country are the steps that have already been taken by the health authorities [8,9,10].

Furthermore, unlike the past, the majority of HCPs more openly acknowledge and appreciate the role a clinical pharmacist can play. It is hoped that with the inclusion of clinical pharmacists and the support from the HCPs of the country, the mind-set of patients can be changed over time. This approach has also been observed to work in the right direction in studies conducted recently [11].

It can be hoped that this continuing trend of the empowerment of clinical pharmacist will help them become acquainted with the situation. This can also be further improved by the implementation of the evidence-based approach to highlight their significance in the disease state management of patients. This opinion suggests that progress could be achieved by the involvement of clinical pharmacists in clinical trials of patients.

In the region, a similar model was applied in China, where the significance of clinical pharmacists was evaluated by means of trials and by witnessing their role in the particular disease state management of patients [12]. Similar trials were also conducted in India, where the role of pharmacist’s counselling was evaluated [13]; however, Pakistan is poised on the verge of recognizing the importance of clinical pharmacists in this case. The pharmacy profession in the country is still struggling to have its full potential recognized, and together, the pharmaco-political situation of the healthcare system of Pakistan and its inclination towards physicians is a hurdle in this process of acknowledgment [14]. The authorities dealing with the aforementioned issues need to address and initiate an evidence-based approach in evaluating the significance of clinical pharmacists in the country, as this would complement the efforts made thus far. Moreover, it has been observed that academicians and HCPs in Pakistan are joining hands and calling for an initiation of the evidence-based approach, as well. This is a new trend, as it is being witnessed for the very first time in the country.

Keeping in view the social and healthcare dynamics of the country, the reason for this step is the belief of the HCPs that this evidence-based approach in highlighting the importance of pharmacist is the need of the hour. To prove the clinical significance of clinical pharmacists, this step needs to be taken, as the prerequisite milestones, such as the recognition of the profession by the health authorities, over-hauling of the pharmacy curriculum by educational authorities and the goal of required support from the HCPs, have already been accomplished. The clinical trials thus conducted will yield quality evidence-based information, which will ensure the confidence over the long run with regard to pharmacists and their role in disease state management [15].

3. Conclusions

Clinical trials involving clinical pharmacists will verify their significance in the healthcare system of Pakistan and pave the way toward the recognition of their role in the disease state management of patients. This evidence-based model will also serve as a confirmation of their importance in the health-care system of the country and help to inch closer toward realizing the dream of a healthier society.