In an era of rapid healthcare evolution, clinical pharmacy is at a crossroads in Europe, facing both unprecedented opportunities and pressing challenges, and Dr Monika Lutters, ESCP president, is at the forefront of these developments. Here, speaking to Gerry Hughes, she shares her insights on current clinical pharmacy challenges around expansion and integration of hospital pharmacists, and the exciting trajectory this branch of pharmacy is set to undertake in the years ahead.
There has been a remarkable shift in the presence of clinical pharmacy across Europe over the past 20 years, according to Dr Monika Lutters PhD, chief pharmacist at Cantonal Hospital Aarau in Switzerland and president of the European Society of Clinical Pharmacy (ESCP).
‘When I started, there was almost no clinical pharmacy in Switzerland, except for a small centre in the French-speaking region,’ she recalls. ‘Now, almost every hospital pharmacy has at least some clinical pharmacy presence or even a dedicated unit.’
Over previous decades, there have been several inflection points in its progress. For example, the seminal paper by Hepler and Strand in 1990 focused the future of clinical pharmacy away from the traditional sale and supply model towards individualised, person-centred pharmaceutical care.
More recently, the profession of clinical pharmacy has reflected inwardly, again, to redefine its place within the overall healthcare system. In 2022, the International Journal of Clinical Pharmacy published a position paper on the definition of clinical pharmacy and its relationship to pharmaceutical care.
The revised definition highlights that clinical pharmacy is both a professional practice and an area of research. Its primary goal is to optimise the use of medications to achieve person-centred and public health outcomes, incorporating cognitive, managerial and interpersonal tasks throughout all stages of medication use. It is exclusively practiced by pharmacists; can be applied in any environment; and encompasses, but is not restricted to, pharmaceutical care.
Clinical pharmacy workforce challenges
Despite this progress, Dr Lutters acknowledges challenges in some regions, primarily driven by financial constraints and a lack of workforce. ‘We face significant pressure in healthcare budgets, and that makes securing positions for clinical pharmacists increasingly difficult.’
These workforce challenges, particularly after Covid-19, are reflected in the literature, with some hospital pharmacy departments facing insufficient staffing to meet patient needs.
Tackling these shortages demands a skilled and adaptable workforce that can handle the growing complexity of medication-related challenges, such as advanced therapies, medication optimisation and multidisciplinary care.
Results of a recent study on the hospital pharmacy profession in Europe, found that the skill mix within hospital pharmacy departments is closely tied to the successful implementation of clinically focused activities.
Therefore, it is crucial to explore ways to help hospitals develop the necessary capacity and expertise to deliver clinically oriented services effectively. ‘It’s also challenging to convince hospital directors to invest in clinical pharmacy when financial pressures compound the issue,’ Dr Lutters notes.
New frontiers for clinical pharmacists
One of the most promising developments in clinical pharmacy is the role of prescribing pharmacists. While prescribing pharmacist legislation, implementation models and practice varies across Europe, research has demonstrated that pharmacist prescribing practice in hospitals can be as effective as traditional medical prescribing, while adding an additional layer of medication safety.
‘Pharmacists have developed significant clinical skills and should be given the opportunity to apply them,’ Dr Lutters insists. While some countries, such as the UK, have successfully integrated pharmacist prescribers into their healthcare systems, others face regulatory and cultural barriers. ‘We still have to negotiate with doctors and stakeholders to gain their trust and demonstrate our value,’ she explains.
This is particularly evident in Ireland where the pharmacy profession is currently undergoing something of a transformation. Pharmacists are already afforded expanded roles like extending the validity of prescription dates. Further expansion is planned for the coming years to include pharmacist prescribing.
A multidisciplinary focus
As clinical pharmacy continues to evolve, there is increasing emphasis on how roles and responsibilities enhance patient care through a multidisciplinary approach, particularly in hospital settings.
In a post-Covid-19 world, marked by rising health inequalities, chronic diseases and shifting demographics, empowering pharmacists to work effectively within their scope of practice will strengthen collaborative care models.
For Dr Lutters, the importance of multidisciplinary collaboration cannot be overstated. ‘It’s crucial. When pharmacists work alongside doctors, nurses, and other healthcare professionals, patient outcomes ultimately improve,’ she explains.
While hospital pharmacists are already embedded within multidisciplinary teams in many countries, there is still progress to be made, particularly in decentralised settings. ‘In the hospital, we have access to patient records and strong interprofessional collaboration,’ Dr Lutters says. ‘Outside of hospitals, however, it’s much more difficult.’
The integration of pharmacists into specialist care teams is a model she believes should be more widely adopted. ‘Instead of being confined to pharmacies, pharmacists should be working directly with specialists towards enhancing patient care,’ she notes.
Dr Lutters is particularly concerned about the growing complexity of patient populations, especially among older adults. ‘Years ago, for example, many of our surgical patients were younger with minimal pharmaceutical needs,’ she explains. ‘Now, we see older, multimorbid patients on extensive medication regimens.’
This shift has underscored the critical role of pharmacists in deprescribing and optimising medication therapy.
Deprescribing, Dr Lutters notes, is an area where pharmacists and doctors share common goals: ‘We need to focus not just on what medicines to prescribe, but also on what to deprescribe. Reducing polypharmacy is essential for patient safety.’
Addressing overprescribing demands a comprehensive approach that involves collaboration, support and behavioural changes from clinicians, patients and their caregivers.
Prescription overload despite empty shelves
Paradoxically, while an excess of medicines causes a problem in one area of practice, another significant challenge facing hospital pharmacists is the increasing prevalence of drug shortages.
‘In the last years, we had significant and impactful drug shortages in Switzerland alone. Even basic medications like ibuprofen were affected,’ Dr Lutters recalls. Drug shortages now place a chronic burden on hospital pharmacy departments, with changes to policies, procedures and guidelines often required to mitigate the unpredictable drug supply chain.
The European Association of Hospital Pharmacists (EAHP) 2023 Shortage Survey Report revealed that 59% of pharmacists found drug supply chain issues contributed to delays in patient care, 43% confirmed that drug supply chain issues led to suboptimal treatment, and 35% noted care cancellations as a result.
Dr Lutters emphasises that while pharmacists have become adept at finding alternatives, the situation is becoming more critical. ‘We’ve always managed to find substitutes, but we’re reaching a point where even essential drugs may be unavailable. This is a huge problem.’
Worryingly, the advent of better information and communications technologies solutions in recent years is not helping matters. Some 73% of pharmacists responding to the EAHP survey reported that IT systems are not automatically updated on ongoing medication shortages or information on potential alternatives – something that needs urgent improvement.
Embracing digitalisation and artificial intelligence
Despite some barriers, there is no doubt that technology is rapidly changing healthcare, and clinical pharmacy is no exception. Dr Lutters sees great potential in electronic healthcare and clinical decision support systems (CDSS) to enhance pharmaceutical care.
‘With staff shortages, we can’t be everywhere at once, so CDSS allows us to reach more patients effectively,’ she says. In the published literature, CDSS can assist hospital pharmacists towards ensuring medication safety by identifying prescribing errors, prompting pharmaceutical interventions and improving the quality of prescribing. However, to maximise the effectiveness of these systems, they need to be designed and implemented collaboratively, with hospital pharmacist input as key stakeholders.
On the more recent advent of artificial intelligence (AI), Dr Lutters remains sceptical about the current hype. ‘What we’re using now – CDSS and algorithms – isn’t really AI,’ she explains. ‘True AI applications in pharmacy are still in their infancy.’
A systematic review on AI-powered apps and tools for clinical pharmacy services noted the promise of AI in hospital pharmacy practice. For example, clinical pharmacists used AI-supported interventions for medication order reviews and streamlining outpatient dispensing workflows, reducing waiting times for hospital outpatients’ medications.
The Royal Pharmaceutical Society has recently published a policy statement on the use of AI in the pharmacy profession. It advises that, as AI tools become increasingly integrated into everyday devices and clinical practices, awareness and informed decision-making should be central for pharmacists to effectively navigate the potential benefits and risks associated with AI.
This is an understandably cautious endorsement of a not-yet-fully-realised impact of AI on healthcare in general. Dr Lutters is also cautious but says that as technology evolves, pharmacists must be prepared to integrate new tools into their practice. ‘We have to embrace new technologies, just as we’ve done with electronic prescribing and digital health records.’
Shaping the future of clinical pharmacy through ESCP
As ESCP president, Dr Lutters has several priorities for 2025. One key initiative is strengthening connections between national pharmacy organisations across Europe. ‘We want to create stronger links between ESCP and national societies to facilitate collaboration and knowledge exchange,’ she explains.
Another focus is reviving special interest groups within ESCP. Cardiology is set to launch soon, adding to existing groups such as deprescribing, which was set up in 2021. ‘These groups create vital platforms for sharing expertise and advancing specialised areas of clinical pharmacy,’ she says.
On a broader level, she envisions a future where clinical pharmacy continues to grow in influence and scope. ‘I hope to see more clinical pharmacists integrated into healthcare teams, more postgraduate education opportunities, and greater specialisation within the field,’ she says.
As such, Dr Lutters urges hospital pharmacists to embrace innovation and seize opportunities, especially when it comes to networking and collaboration. ‘Pharmacists should not be confined to traditional roles. We need to step outside our comfort zones and explore new ways to contribute to patient care,’ she says. ‘Attending conferences and engaging with peers across Europe is incredibly valuable. Sometimes, small innovations in one country can inspire similar projects elsewhere.’
Ultimately, she believes that clinical pharmacy is on an exciting trajectory and, with the right mindset, hospital pharmacists can play a pivotal role in shaping its future. ‘We need to be proactive, adaptable and always ready to advocate for our profession and our patients,’ Dr Lutters concludes.
As the clinical pharmacy profession continues to evolve, the future holds both challenges and immense opportunities. This call for collaboration, adaptability, and continuous learning is essential in shaping a future where clinical pharmacists can thrive and contribute even more significantly to patient outcomes.
The journey ahead may be demanding, but it promises a future where clinical pharmacy is integral to the healthcare system’s success.
