Clinical pharmacy, pharmaceutical care, and the quality of drug therapy.

BACKGROUND Because of concerns about patient safety and the quality of health care in America, in particular about drug therapy, pharmacists have unprecedented opportunities to increase their value and significance. When defining clinical pharmacy and pharmaceutical care, pharmacists long ago recognized the need to improve the safety and effectiveness of drug therapy. OBJECTIVE To describe how clinical pharmacy and pharmaceutical care, closely related concepts, can contribute to a strategy for improving the quality of drug therapy. DESIGN Commentary and review of selected publications. CONCLUSION Pharmacists can improve the quality of drug therapy by improving the organizational structures through which drug therapy is provided, specifically by creating medications use systems and by regularly evaluating their performance. As envisaged by the Institute of Medicine, these systems must be patient centered, cooperative, and interprofessional. To maximize pharmacists' participation in such systems, pharmaceutical education should include courses in medications use systems as necessary counterparts to courses in pharmacotherapeutics. Clinical functions must be organized around patient need and directed at outcomes. Clinical practice should constitute the mainstream practice of pharmacy rather than an "optional" specialty. Pharmaceutical care describes the original purpose of clinical pharmacy, when it was understood as a professional practice rather than a health science. It describes a way that clinical pharmacy, especially specialists and subspecialists, could coordinate their work more effectively. The concept of clinical pharmacy adds essential clarity about the process component of pharmacists' participation in, and strengthens the academic basis of, pharmaceutical care. The clinical, humanitarian, and economic case for preventing drug-related morbidity is strong, and pharmacy has much to offer. It is, again, time to work together as a profession to plan our common future.