As articulated in the 2002 strategic plan, ACCP's 20- to 30-year vision for the profession is that "pharmacists will be recognized and valued as the preeminent health care professionals responsible for the use of medicines in the prevention and treatment of disease." To achieve this vision, the profession must ensure that there will be an adequate supply of appropriately educated and skilled clinical pharmacists. Toward that end, the ACCP Board of Regents established the following objectives:

• publish a definition of clinical pharmacy and the core competencies of a clinical pharmacist;
• provide or endorse mechanisms for individual pharmacists to assess their clinical competencies against the defined core competencies, thereby facilitating their professional development; and
• ensure that ACCP provides educational programs to help develop and maintain the core competencies of a clinical pharmacist.

  The first implementation step in this plan was the articulation of a definition of clinical pharmacy. As an extension of the clinical pharmacy definition, the core competencies of a clinical pharmacist are scheduled to be reviewed by the Board of Regents and released within the next 6 months.

  In August 2003, a workgroup composed of ACCP members and Regents drafted a proposed definition of clinical pharmacy. Subsequently, the Board of Regents engaged in a series of focused discussions leading to further refinements and the development of a separate definition for the clinical pharmacist. A pair of preliminary draft definitions of clinical pharmacy and the clinical pharmacist was proposed by the Board of Regents in January 2004 and published in the February 2004 ACCP Report together with a request for member feedback. Broad-based input was received from ACCP members and the profession-at-large during 2004, and the Board then incorporated this feedback into its final draft. The final document approved by the Board of Regents includes both a short, abridged definition and a more comprehensive, unabridged version (see below).

Clinical Pharmacy (abridged)

  That area of pharmacy concerned with the science and practice of rational medication use.

Clinical Pharmacy (unabridged)

  Clinical Pharmacy is a health science discipline in which pharmacists provide patient care that optimizes medication therapy and promotes health, wellness, and disease prevention. The practice of clinical pharmacy embraces the philosophy of pharmaceutical care; it blends a caring orientation with specialized therapeutic knowledge, experience, and judgment for the purpose of ensuring optimal patient outcomes. As a discipline, clinical pharmacy also has an obligation to contribute to the generation of new knowledge that advances health and quality of life.

  Clinical pharmacists care for patients in all health care settings. They possess in-depth knowledge of medications that is integrated with a foundational understanding of the biomedical, pharmaceutical, sociobehavioral, and clinical sciences. To achieve desired therapeutic goals, the clinical pharmacist applies evidence-based therapeutic guidelines, evolving sciences, emerging technologies, and relevant legal, ethical, social, cultural, economic and professional principles. Accordingly, clinical pharmacists assume responsibility and accountability for managing medication therapy in direct patient care settings, whether practicing independently or in consultation/collaboration with other health care professionals.       Clinical pharmacist researchers generate, disseminate, and apply new knowledge that contributes to improved health and quality of life.

  Within the system of health care, clinical pharmacists are experts in the therapeutic use of medications. They routinely provide medication therapy evaluations and recommendations to patients and health care professionals. Clinical pharmacists are a primary source of scientifically valid information and advice regarding the safe, appropriate, and cost-effective use of medications

The clinical pharmacist definition has been eliminated; in its place, details regarding clinical pharmacist activities and roles have been incorporated into the unabridged definition of clinical pharmacy.

A Three-part Definition

  The unabridged definition is organized into three sections: the discipline of clinical pharmacy; the clinical pharmacist; and the roles of the clinical pharmacist in the health care system. Key words or phrases were carefully chosen for inclusion in each section—their intended interpretation follows.

  The Discipline of Clinical Pharmacy. The concept of optimizing therapy and promoting health, wellness, and disease prevention was felt to be essential in highlighting the focus on both pharmacologic and non-pharmacologic strategies for promoting patient health. By noting that clinical pharmacy embraces the philosophy of pharmaceutical care, the definition calls attention to the fact that the primary object of practice and research is ultimately the patient. Finally, emphasizing that the discipline relies on caring values with specialized knowledge, experience, and judgment underscores the critical importance of the synergy achieved by combining a caring ethos, in-depth therapeutic knowledge, clinical experience, and expert judgment. As a discipline, clinical pharmacy must be engaged also in research to contribute to the generation of new knowledge that advances human health and quality of life.

  The Clinical Pharmacist. Stating explicitly that the clinical pharmacist cares for patients in all health care settings emphasizes two points: 1) that clinical pharmacists provide care to their patients (i.e., they don't just "provide clinical services"), and 2) that this practice can occur in any practice setting. The clinical pharmacist's application of evidence and evolving sciences points out that clinical pharmacy is a scientifically rooted discipline; the application of legal, ethical, social, cultural, and economic principles serves to remind us that clinical pharmacy practice also takes into account societal factors that extend beyond science. By stating that clinical pharmacists assume responsibility and accountability for achieving therapeutic goals, the definition makes it clear that they are called upon to be more than consultants. Further, the mention of managing therapy in direct patient care settings is particularly important because it reinforces existing definitions of the term "clinical."1 That is, clinical pharmacists are involved in direct interaction with, and observation of, the patient. In addition, it is noted that clinical pharmacists practice both independently and in consultation/collaboration with other health care professionals, making it clear that they are members of an autonomous profession within their scope of practice, yet they also function as members of a cooperative health care team. At the conclusion of this paragraph, attention is drawn to the scientific impact of clinical pharmacist researchers by stating that they generate, disseminate, and apply new knowledge that contributes to improved health and quality of life.

  Roles Within the Health Care System. By noting that the clinical pharmacist is an expert in the therapeutic use of medications, this section indicates that the clinical pharmacist is recognized as providing a unique set of knowledge and skills to the health care system and is therefore qualified to assume the role of "drug therapy expert." In addition, this expertise is used proactively to ensure and advance rational drug therapy, thereby averting many of the medication misadventures that ensue following inappropriate therapeutic decisions made at the point of prescribing. Stating that the clinical pharmacist is a primary source of scientifically valid information and advice on the best use of medications emphasizes that the clinical pharmacist serves as an objective, evidence-based source of therapeutic information and recommendations. This expertise extends beyond traditional medications to include nontraditional therapies as well. Finally, indicating that clinical pharmacists routinely provide therapeutic evaluations and recommendations underscores the fact that their daily practice involves regular consultation with patients and health care professionals regarding medication therapy evaluations and recommendations.

Next Steps

  With the release of its official definition of clinical pharmacy, ACCP is now seeking inclusion of the definition (in its abridged or unabridged format) in appropriate compendia and dictionaries. The 2004-2006 Task Force on Clinical Pharmacist Competencies will submit its final draft of the core competencies of a clinical pharmacist later this year. In addition, the Task Force will be charged with composing a complementary white paper that articulates the professional pathways necessary to develop and maintain the core competencies of both a clinical pharmacy generalist and clinical pharmacy specialist. The clinical pharmacy definition, core competencies, mechanisms for clinical competency self-assessment, and "pathways" to achieve generalist and specialist competence will be published as a series of ACCP publications. The series will be initiated with publication of the definition and core competencies in early 2006.