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Establishing a clinical pharmacy specialization in Portugal
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Chapter 1 introduces the key concepts of clinical pharmacy, including its historical context and the current challenges of clinical pharmacy practice and education.
Due to the lack of systematised and structured evidence on the current state of clinical pharmacy education and practice, the authors conducted two studies to fill in information gaps, presented in Chapter 2. Both studies were conducted in Europe resorting to surveys. One survey targeted clinical pharmacy academics (Chapter 2.1.) while the other targeted national associations representing pharmacy students in different European countries (Chapter 2.2.). More than half of European countries (52.5%) recognised clinical pharmacy as an area of specialization, mainly applied in the hospital setting. Despite this, almost all European countries (94.9%) included clinical pharmacy in their undergraduate curricula. At the time of survey application, clinical pharmacy was not a compulsory area in the Pharmaceutical Sciences curricula, according to European legislation; however, given the recent European legal changes, it will become in the next two years. The fact that countries include clinical pharmacy in their undergraduate curricula was found not to have direct correlation with the perception of students feeling adequately prepared to perform clinical tasks at the end of their academic journey (Chapter 2.2.). Only students in the United Kingdom (UK) felt fully prepared to perform clinical tasks and considered the undergraduate education to be fit for professional clinical practice. Because the UK is an international example of success in clinical pharmacy education and practice, a case study was carried out in collaboration with a London Hospital to explore the impact of life-long learning on practice (Chapter 3). A course on cardiovascular diseases (CVDs) targeting pharmacists working in primary care was delivered, following which significant improvement was seen in knowledge and confidence to perform clinical tasks related to the management of CVDs. However, this translation of knowledge and confidence into improved professional practice was somewhat uncertain since the study was conducted in an uncontrolled environment where other co-occurring initiatives may have had an influence.
Chapter 4 presents the results of interviews with 13 international key opinion leaders (KOLs) with academic and/or practice backgrounds. The interviews revealed that there are two international models of education leading to a specialization in clinical pharmacy (Chapter 4.1.). The prevailing model typically emphasises clinical pharmacy as the profession’s foundation. This is manifested in undergraduate training, characterised by a substantial clinical component, enabling pharmacy school graduates to directly engage in clinical activities. The alternative model suggests that pharmacy school graduates need further postgraduate education and training to autonomously conduct clinical activities. Portugal follows the first model, despite previous studies showing that national undergraduate training has a low clinical component. Also in the same chapter, KOLs identified success factors and barriers related to education that enable the development of a career in clinical pharmacy. Chapter 4.2, which focuses on KOLs vision for clinical pharmacy practice, outlines the results of the success factors for changing practice, whether they are related to the pharmacist (e.g., motivation) or to the political and health-care sector environment (e.g., remuneration for clinical pharmacy services). KOLs also identified future directions, including the expansion of clinical pharmacy services, increasing the number of pharmacists dedicated to this field, and developing these services at the community level.
Chapter 5 reports the results of a nominal group technique involving the main Portuguese stakeholders in the pharmaceutical sector. Portuguese stakeholders were consensual that a potential specialization in clinical pharmacy should ensure a strong clinical component at the undergraduate level, which currently needs to be strengthened, and therefore considered the need to make postgraduate education and training available, ensuring a balanced theoretical and practical component. To successfully implements such specialization, the stakeholders stressed that it will be necessary to: i. establish the legal framework, which will include details about the career progression pathway and the proposed remuneration for these professionals; ii. involve pharmacy stakeholders; and iii. establish the characteristics of the future graduates.
Chapter 6 features an in-depth discussion of the results presented throughout the thesis, describing the positive aspects but also the limitations of the studies conducted. The authors present 15 recommendations for improving clinical pharmacy education and practice in Portugal. The chapter also includes a proposal for a specialization model for Portugal, fulfilling the proposed research objective.
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Farmácia Clínica Farmacêutico educação especialização prestação de cuidados de saúde Portugal Clinical Pharmacy pharmacists specialization delivery of health care education