1. In Which Areas Have Clinical Pharmacists Been the Most Successful in Patient Care ? Hospital inpatient unit (wards) –Therapeutic drug monitoring –Anticoagulation services –IV antibiotic usage Establishing collaborative drug protocols –Prescriber authorizes pharmacists to engage in specified activities including adjusting and/or initiation therapy –Examples AnticoagulationNutrition support services Smoking cessationPain management

2. In Which Areas Have Clinical Pharmacists Been the Most Successful in Patient Care ? Community pharmacists –Administering immunizations –Dispensing emergency contraception

3. How Were Health Care Providers/Authorities Convinced to Increase Pharmacist Involvement? Key steps –Decentralization of pharmacy services to patient care areas (out of basement!) –Developing relationships and building trust between pharmacists and prescribers Demonstration of reduced drug and overall costs and better clinical outcomes with pharmacist involvement

4. Main Difficulties? Lack of standardization of pharmacist training Lack of reimbursement for services Buy-in from healthcare administration –Lack of awareness of range of services pharmacists can provide Pharmacist perceptions of their professional role Competition with other non-physician prescribers –e.g. nurse practitioners, physician assistants