Polypharmacy as a Clinical Pharmacist Specialist Practice

The objective of this manuscript is to review an ambulatory care pharmacist service that evolved into a pharmacotherapy, polypharmacy service with multiple submodels. The practice is located in a multispecialty, tertiary care, destination medical clinic in Florida. Ambulatory care pharmacist services have evolved to demand expertise in multiple, specialized areas to address the more complex medical issues of the polypharmacy patient. Many of these patients are older than 65 years of age, with broad medical care needs. A number of changes have led to the need for these expanded services: the growth and diversification of pharmacists' ambulatory care services, the multitude of sophisticated medications, the continued direct-to-consumer commercialization, the growth of dietary supplements, and the implementation of pharmacogenomic testing, In addition, new advances in clinical and laboratory technologies make polypharmacy a viable pharmacist clinical specialty. With the broad knowledge base needed for these patients, a polypharmacy pharmacist may function as a pharmacology troubleshooter expert.