Critical appraisal of the Role of the Clinical Pharmacist in rheumatoid arthritis (Thesis Proposal Sample)

CRITICAL APPRAISAL OF THE ROLE OF THE CLINICAL PHARMACIST IN RHEUMATOID ARTHRITIS
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Critical appraisal of the Role of the Clinical Pharmacist in rheumatoid arthritis
Introduction
There are many diseases that affect the immune system. Rheumatoid arthritis has been known to affect many people across the globe, for example, it affects over two million adults in the US alone. The disease is mostly common to the people of 30-55 years and has a high preference of affecting women than men (American College of Rheumatology 2013). The symptoms include progressive bone erosion, synovial inflammation, destruction and misalignment of joint and weakness of tissues around the joints. The disease presentation can vary from mild to severe, and can cause limitation in functioning. Treatment is mostly aimed at reducing or slowing joint destruction progress, and controlling inflammation and pain. The treatment requires multidisciplinary medical team, in its successful treatment (Briesacher, Andrade, Fouayzi, & Chan 2008). One of the important members of the integrated team of the medical team in the treatment of rheumatoid arthritis is the clinical pharmacist. The roles of clinical pharmacist vary, but the main one is provision of pharmaceutical care to the rheumatoid arthritis patients. The provision of pharmaceutical care and assistance may vary from dispensing medicines, resolving and identifying medication problems, getting the medication history for the patient, counseling and educating health providers and patients about medication, contributing to continued care for patients and monitoring patients and the response to medication (Reach 2011). There is a variety of therapies and medications that are used in the treatment of rheumatoid arthritis. The the medication and therapy to be applied are dependent on the patient’s health conditions and medical history. There are some medications which can have side effects to a patient. The huge medication requirement in the treatment of the rheumatoid arthritis, the presence of the clinical pharmacist becomes very important.Clinical pharmacist work in different settings and are experts in medication. The different settings in which a pharmacist works vary the roles slightly (Mease 2010). They can work in a hospital pharmacy, in a chain drug store, independently, private medical office, or in an outpatient hospital clinic. These settings can be split into two major categories which include community setting and ambulatory care setting. In the community, the clinical pharmacist has a role of filling medication prescriptions, counseling patient, and responding to questions to patients and health care professionals. They can clarify medication and at times suggestions on how to treat a patient (Agarwal 2011). The pharmacist in ambulatory care has a main responsibility of educational counseling, provision of medication information and answering to questions from patients and at times from other health care providers. Medication adherence to medicationPatients with rheumatoid arthritis usually have a low medical adherence which varies from 30-80%.Drug therapy could improve greatly by improving the patient adherence to medication (Mease 2010). The non-adherence is caused by two main reasons which include the forgetfulness and intentional reasons. The unintentional non-adherence may result from physical problems, regime complexity and forgetfulness while the intentional non-adherence results from the decision of the patient not to take medication. The decision of the patient to take medication may be influenced by the weighing of the perceived benefits versus the preserved risks (American College of Rheumatology 2013). Non-adherence to the medication can have greater consequences to the treatment effectiveness and can cause increase cost. In the treatment of rheumatoid arthritis, non-adherence to drugs has negative results to the patients (Singh, Furst, Bharat et al 2012). Diseases-modifying anti-rheumatic drugs are used to reduce radiological progression, disease activity and help in functional outcome in the long term of rheumatoid arthritis patients. The risk factors are higher than the perceived non-adherence benefits by the patient. Non-adherence can result to increased disability and disease flares to the rheumatoid arthritis patients, hence increasing costs and complexity of treatment (Reach 2011). Clinical pharmacists will come in to help the patients adhere to the medication to reduce the risks associated with non-adherence. They will inform and monitor the patients in the treatment period. There are many different therapies of treating the rheumatoid arthritis and a patient can receive a mono-therapy or a combination of several therapies. The therapies can include occupational therapy or/and physical therapy (American Society of Health-System Pharmacists 2008). The treatment or the therapy applied should be tailored to the patient’s individual needs which touch to the occurrence of side effects, effectiveness of different therapies, and severity of the disease. The patients with liver diseases, allergies, and other such factors that might intensify effects of different medications and therapies should be given a different treatment. The clinical pharmacist will communicate different components of drugs and the effects they can have with people with different conditions. The rheumatoid arthritis damages to the joints usually occur between the first 2 years of disease diagnosis, and it become complicated to determine those individuals who will develop complications.The initial therapy and treatment is targeted in reducing or eliminate the inflammation. This treatment may have side effects which must be weighed in comparison to the benefits of this treatment (Gabriel & Michaud 2009). The treatment that reduces joint damages is recommended for all patients at the initial treatment. Success of a long-term treatment of rheumatoid arthritis requires long-term medical and therapy care with a regular schedule visits to a medical professional. A clinical pharmacist must keep following the patient to ensure adherence to the long-term medical care. They will establish the medicines with minimum side effects to a patient and collaboration from other medical professionals; administer the medications to ensure maximum benefits. The medical visits will involve tests, to establish the effectiveness of treatment, and know the side effects. Patients of rheumatoid arthritis will require regular education, counseling and training on the conditions of the disease. Proper counseling and education from all the medical team, including the clinical pharmacist, will help the patients understand the nature of rheumatoid arthritis and important of adherence to different medical and therapeutically procedures (Briesacher, Andrade, Fouayzi, & Chan 2008). The patient has to work with the healthcare providers in coming up with a convenient long-term medical care, and compare the alternative treatments with the standard treatment. Besides the pharmacological measures, the clinical pharmacist should understand the other non-pharmacological measures such as cognitive behavior therapy and biofeedback, which can be combined to ensure maximum benefits to a patient. These measures will help reduce disability and pain and help improve self esteem, which will have a long term effect on patient’s adherence to medication. Programs such as biofeedback, social support, self-management skills and psychotherapy, should be offered alongside the medication, since they help to reduce disability, depression and pain, and help in overall recovery of the rheumatoid arthritis patient.The rheumatoid arthritis patient usually loses appetite, which can be caused by medication or by the effects of the disease, and dietary and nutritional therapy, should be incorporated with pharmacology treatment. Diet changes are at times necessary for the treatment of rheumatoid arthritis, Due to the different drugs content and requirements. A nutritionist will have to work with a clinical pharmacist in recommending the appropriate diets that will have minimum effects to the patient’s health and to the risks of medication. Reducing the amount of calories is necessary to rheumatoid arthritis patients, due to the high risk of coronary artery disease development. Nutritional and herbal supplements can be dangerous and should be avoided in the treatment. Rheumatoid arthritis patients are affected by alcohol and smoking. There is a need for the clinical pharmacist to establish the smoking and drinking history of the patient, to help in recommending the appropriate medication and helping them quit these destructive habits. Smoking affects the treatment of rheumatoid arthritis, and it will be necessary to quit, reducing the risks and helping improve treatment. Moderate drinking alcohol can have minimal effects to the rheumatoid arthritis patients, but an excessive drinking can cause increased risk of the lung damage from certain drugs such as methotrexate. The patients need to have a discussion of their smoking and drinking habits with clinical pharmacists, to allow for the most suitable medication. Medication is a foundation of a successful treatment of rheumatoid arthritis (American College of Rheumatology Subcommittee on Rheumatoid Arthritis Guidelines 2002). The medication will seek to reduce further damages to joints, achieve remission and loss of function. The intensity and the type of medicine to be administered by a clinical pharmacist are dependent on potential negative effects of the medicine and patient’s factors. The medication dosage can be increased until there is suppression of inflation, or risks of medication pass unacceptable levels. The clinical pharmacists have to control and balance between the contro...