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Despite the wishful thinking of those who have long prophesied an imminent surge in demand for clinical pharmacists, the tipping point for healthy supply-demand balance in pharmacy has almost certainly been surpassed. Imprudent overbuilding of pharmacy programs has combined with trends toward increasing automation and consolidation in pharmacy practice to create an existential threat in pharmacy education. Surviving the looming industry shakeout will require schools and colleges of pharmacy to do what our colleagues in practice and the private sector have always done: compete.

Public perception of a profession is extremely important, but even more vital is the actual worth the profession provides to those who partake of its services. As pharmacy recreates itself as a consultative profession, many changes are occurring in the college of pharmacy students' education. The onset of the Introductory Pharmacy Practice Experience (IPPE), the continued rotations in the Advanced Pharmacy Practice Experience (APPE), and the proposal to have mandatory residencies occurring by 2020 show the steps that pharmacy will take to move forward. But pharmacy continues to miss the first rung of the ladder as the profession climbs to its future success by not addressing the mandatory education of the primary workforce in day-to-day activities: that of standardized education and training of pharmacy technicians. While IPPE, APPE, and residencies will strengthen the pharmacy "dwelling," its foundation does not have solid ground. A deadline needs to be established for mandatory education, training, and certification for all technicians entering the profession today and, only after achieving these goals, should the pharmacy technicians be licensed to practice. With even more forethought, pharmacy might require that potential college of pharmacy students, as well as those not fortunate enough to be admitted to a college of pharmacy, become pharmacy technicians first. Only then can the pharmacy profession conquer the top rung of the ladder in a strong, upright fashion.

The intensive care unit (ICU) continues to be a major focus of decentralized pharmacy activities in health systems that care for critically ill patients. This is not surprising, given the need for rapid decision-making involving unstable patients, the large number of powerful medications typically used per patient, the high cost of many drugs used in the ICU and, most importantly, the evidence demonstrating the benefits of having a pharmacist as part of an interdisciplinary team. The purpose of this paper is to highlight important issues to consider when introducing or developing critical care pharmacy services beginning with the establishment of basic services and continuing through practitioner development, guideline/protocol development and implementation, patient safety, residency training, and research.

Objective: To describe the provision of patient care in community pharmacies in Finland., Findings: The network of 799 community pharmacies across Finland dispensed 42.1 million prescriptions in 2005. Medication counseling has been mandated by law since 1983 and only pharmacists are permitted to provide therapeutic advice in pharmacies. Measurable improvements in the rates of pharmacists' medication counseling have been observed since 2000. Long-term national pharmacy practice initiatives commenced with the World Health Organization EuroPharm Forum's Questions to Ask About Your Medicines campaign from 1993 to 1996. This was followed by the larger Customized Information for the Benefit of Community Pharmacy Patients project. Since the late 1990s, Finnish pharmacies have actively participated in ongoing national public health programs, initially in the areas of asthma and diabetes, and more recently in the treatment and prevention of heart disease. Automated dose dispensing and electronic prescribing are in the process of wider uptake and implementation. A nationwide multidisciplinary project to improve the use of drugs in older people has recently been announced and research in this area is underway., Discussion: Research has focused on improving the quality of patient care as a strategic priority in community pharmacies. The development of community pharmacy services in Finland has been characterized by strong collaboration among the professional associations, university departments of social pharmacy, continuing education centers, and practicing pharmacists., Conclusions: Implementation of new patient care services has required long-term, systematic, and well coordinated actions at the local and national levels. Future services will seek to promote the quality use of medications and to ensure that rising costs do not limit uniform access to drugs by all Finnish residents.

Objective: To describe how clinical pharmacy is helping to improve medication use at a South Indian teaching hospital by addressing medication use problems, which are commonly encountered in India., Summary: Clinical pharmacy is practiced in many countries and makes a significant contribution to improved drug therapy and patient care. India is a country with significant problems with medication use, but until recently Indian pharmacists have not been educated for a patient-care role. Postgraduate pharmacy practice programs have been established at 2 pharmacy colleges in South India as a result of a joint Indo-Australian program of cooperation. At a teaching hospital associated with the colleges, clinical pharmacy services such as drug information, medication counseling, drug therapy review, adverse drug reaction reporting, and the preparation of antibiotic guidelines are assisting clinicians to improve drug therapy and patient care. Seven hundred twenty-seven requests for drug information were received from July 1997 to February 2001, and 543 suspected adverse drug reactions were evaluated from November 1997 to February 2001. The most common drug classes causing adverse drug reactions were antibiotics, nonsteroidal antiinflammatory drugs, and antitubercular agents. Physician opinion and service utilization have also been surveyed: 82% of respondents had sought drug information from the Clinical Pharmacy Department and 71% of respondents had sought advice on individual patient management. The success of this program is raising awareness of clinical pharmacy among pharmacy educators elsewhere in India and has led to the introduction of clinical pharmacy services at other Indian hospitals.