INTRODUCTION: In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important which led to extension of pharmacy practice beyond merely drug-oriented pharmacy-based services. AIM: To outline the development, implementation and outcomes of the methodology that established standards for CP practice in the Czech Republic and which contributed to establishing CP as an independent postgraduate specialization with its own workplaces and full-time employment positions. SETTING: Inpatient and outpatient healthcare settings in the Czech Republic. DEVELOPMENT: Legislative changes in 2011 incorporated CP care into the healthcare system and the national CP methodology was published in 2014. Proactive screening of the medication lists and patient healthcare documentation was introduced. Results of CMRs are discussed with attending physicians and the plans for drug therapy adjustment are added to patient documentation. Clinical pharmacists have become standard partners for physicians on medical wards and outpatient facilities. A comprehensive clinical postgraduate training program (fully interlinked with accredited CP wards) has been established to maintain high standards of CP care. IMPLEMENTATION: Based on the CP care methodology approved by professional medical and pharmaceutical societies and accepted by the Ministry of Health and health insurance companies, three inpatient procedures and one outpatient procedure became eligible for reimbursement thus facilitating the further development of CP practice and independent CP departments. Currently, the Czech Republic has 58 CP facilities and nearly 200 specialized clinical pharmacists. EVALUATION: The provision of CP care according to current national guidelines was shown to provide an effective and cost-effective approach by the results of two extensive studies; the calculated economic cost-benefit ratio was determined at 1:3-4.2. The number of clinical pharmacy specialists and facilities is steadily increasing. CONCLUSION: The development of methodological approach accompanied by changes concerning reimbursement in the Czech Republic have led to the establishment of a stable and well-defined environment for clinical pharmacists to become full-time experts in both inpatient and outpatient settings. Clinical pharmacists are now recognized as skilled experts who are respected for their valuable contribution to inter-professional cooperation within medical teams.

Department of Clinical Pharmacy Faculty Hospital Bulovka Prague Charles University Prague Czech Republic

Department of Clinical Pharmacy Psychiatric Hospital Bohnice Prague Czech Republic

Department of Internal Medicine and Geriatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Social and Clinical Pharmacy Faculty of Pharmacy in Hradec Králové Charles University Hradec Králové Czech Republic

Institute of Pharmacology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

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Mair A, Wilson M, Dreischulte T. Addressing the challenge of polypharmacy. Annu Rev Pharmacol Toxicol. 2020;60:661–81. https://doi.org/10.1146/annurev-pharmtox-010919-023508 . PubMed DOI

Costa FAD, Blondal AB, Chapichadze Z et al. Guidelines on MEDICATION REVIEW. European Directorate for the Quality of Medicines & HealthCare (EDQM); 2024.

Dreischulte T, van den Bemt B, Steurbaut S, et al. European society of clinical pharmacy definition of the term clinical pharmacy and its relationship to pharmaceutical care: a position paper. Int J Clin Pharm. 2022;44:837–42. https://doi.org/10.1007/s11096-022-01422-7 . PubMed DOI PMC

Urbańczyk K, Guntschnig S, Antoniadis V, et al. Recommendations for wider adoption of clinical pharmacy in Central and Eastern Europe in order to optimise pharmacotherapy and improve patient outcomes. Front Pharmacol. 2023;14:1244151. https://doi.org/10.3389/fphar.2023.1244151 . PubMed DOI PMC

Hartinger JM, Šíma M, Hrušková Z, et al. A novel dosing approach for rituximab in glomerular diseases based on a population pharmacokinetic analysis. Biomed Pharmacother. 2024;175:116655. https://doi.org/10.1016/j.biopha.2024.116655 . PubMed DOI

Hartinger JM, Michaličková D, Dvořáčková E, et al. Intraperitoneally administered vancomycin in patients with peritoneal dialysis-associated peritonitis: population pharmacokinetics and dosing implications. Pharmaceutics. 2023. https://doi.org/10.3390/pharmaceutics15051394 . PubMed DOI PMC

Murínová I, Švidrnoch M, Gucký T, et al. Population pharmacokinetic analysis proves superiority of continuous infusion in PK/PD target attainment with Oxacillin in Staphylococcal infections. Antibiotics. 2022. https://doi.org/10.3390/antibiotics11121736 . PubMed DOI PMC

Pilkova A, Sima M, Hartinger JM, et al. Novel approach to adherence assessment based on parent drug and metabolite pharmacokinetics: pilot study with spironolactone. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022. https://doi.org/10.5507/bp.2022.048 . PubMed DOI

Tašková I, KucerovaMichalcova J, Saloun J. New tool to improve the adherence of psychiatric patients during hospitalization via combining a comprehensive medication review and education interview by a clinical pharmacist. Acta Poloniae Pharmaceutica Drug Res. 2022;79:301–8. https://doi.org/10.32383/appdr/149919 . DOI

EuroAgeism H2020 project. 7th scientific program (ESR 7) on “Inappropriate prescribing and availability of medication safety and medication management services in older patients in Europe and other countries" (online). https://portal.faf.cuni.cz/Projects/EUROAGEISM-Horizon-2020-project/ . Accessed 01 July 2025.

Lukačišinová A, Reissigová J, Ortner-Hadžiabdić M, et al. Prevalence, country-specific prescribing patterns and determinants of benzodiazepine use in community-residing older adults in 7 European countries. BMC Geriatr. 2024;24:240. https://doi.org/10.1186/s12877-024-04742-7 . PubMed DOI PMC

Brkic J, Fialova D, Okuyan B, et al. Prevalence of potentially inappropriate prescribing in older adults in Central and Eastern Europe: a systematic review and synthesis without meta-analysis. Sci Rep. 2022;12:16774. https://doi.org/10.1038/s41598-022-19860-8 . PubMed DOI PMC

Bhagavathula AS, Vidyasagar K, Chhabra M, et al. Prevalence of polypharmacy, hyperpolypharmacy and potentially inappropriate medication use in older adults in India: a systematic review and meta-analysis. Front Pharmacol. 2021;12:685518. https://doi.org/10.3389/fphar.2021.685518 . PubMed DOI PMC

Bhagavathula AS, Seid MA, Adane A, et al. Prevalence and determinants of multimorbidity, polypharmacy, and potentially inappropriate medication use in the older outpatients: findings from EuroAgeism H2020 ESR7 project in Ethiopia. Pharmaceuticals (Basel). 2021. https://doi.org/10.3390/ph14090844 . PubMed DOI

Individualized CARE for Older Persons with Complex Chronic Conditions at home and in nursing homes. EU project I-CARE4OLD. (online). https://www.icare4old.eu/ . Accessed 01 Aug 2025.

Hoogendijk EO, Onder G, Smalbil L, et al. Optimising the care for older persons with complex chronic conditions in home care and nursing homes: design and protocol of I-CARE4OLD, an observational study using real-world data. BMJ Open. 2023;13:e072399. https://doi.org/10.1136/bmjopen-2023-072399 . PubMed DOI PMC

Netpharm project—new technologies in pharmaceutical sciences. (WP4: geriatric clinical pharmacy and new technologies for individualization of drug schemes in older patient) Scientific Portal of the Faculty of Pharmacy, Charles University (online). https://portal.faf.cuni.cz/Projects/NETPHARM-project/ . Accessed 01 Aug 2025.

Vlček J, Fialová D, Malý J et al. Concept of clinical pharmacy field-history of the field, definitions, pregraduate and postgraduate education, activities of clinical pharmacists. Czech and Slovac Pharmacy 2016; 1–16.

Rychlickova J, Saloun J, Gregorova J. Evaluation of clinical pharmacists’ interventions in the Czech Republic. Pharmacotherapy. 2016;36:766–73. https://doi.org/10.1002/phar.1777 . PubMed DOI

Viktil KK, Blix HS. The impact of clinical pharmacists on drug-related problems and clinical outcomes. Basic Clin Pharmacol Toxicol. 2008;102:275–80. https://doi.org/10.1111/j.1742-7843.2007.00206.x . PubMed DOI

Gregorova J, Rychlickova J, Saloun J. Standardization of clinical pharmacist’s activities: methodology. Saudi Pharm J. 2017;25:927–33. https://doi.org/10.1016/j.jsps.2017.02.005 . PubMed DOI PMC

Gregorová J, Bačová J, Langmaierová K et al. Concept of clinical-pharmaceutical care in the Czech Republic. Prague: Amca; 2014. ISBN 978-80-905449-7-0.

Gregorová J, Bačová J, Langmaierová K et al. Concept of the field of Clinical Pharmacy in the Czech Republic. Praha: Amca; 2016. ISBN 978-80-906086-7-2.

The European Statements of Hospital Pharmacy. Eur J Hosp Pharm. 2014;21:256. https://doi.org/10.1136/ejhpharm-2014-000526 . DOI

Gregorová J, Langmaierová K. Clinical-Pharmaceutical care in the Czech Republic. Maxdorf; 2019. ISBN 978-80-7345-622-1.

Scott A, Tinelli M, Bond C. Costs of a community pharmacist-led medicines management service for patients with coronary heart disease in England: healthcare system and patient perspectives. Pharmacoeconomics. 2007;25:397–411. https://doi.org/10.2165/00019053-200725050-00004 . PubMed DOI

Martindale AM, Elvey R, Howard SJ, et al. Understanding the implementation of “sick day guidance” to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation. BMJ Open. 2017;7:e017241. https://doi.org/10.1136/bmjopen-2017-017241 . PubMed DOI PMC

Touchette DR, Doloresco F, Suda KJ, et al. Economic evaluations of clinical pharmacy services: 2006–2010. Pharmacotherapy. 2014;34:771–93. https://doi.org/10.1002/phar.1414 . PubMed DOI

Hazen A, Sloeserwij V, Pouls B, et al. Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care. Int J Clin Pharm. 2021;43:1155–62. https://doi.org/10.1007/s11096-021-01304-4 . PubMed DOI PMC

Tašková I, Michalcová J, Šaloun J. An analysis of clinical pharmacist interventions at a Czech psychiatric hospital: a two-year prospective study. Gen Hosp Psychiatry. 2022;79:189–90. https://doi.org/10.1016/j.genhosppsych.2022.10.006 . PubMed DOI

Benes J, Paterova P, Bauer L, et al. Antibiotic Treatment of Infective Endocarditis. Guidelines of the Czech Society of Infectious Diseases of Czech Medical Society of J. E. Purkyně, Czech Society for Medical Microbiology of Czech Medical Society of J. E. Purkyně and Czech Professional Society of Clinical Pharmacy of Czech Medical Society of J. E. Purkyně. Cor Vasa. 2024;66:632–43. DOI

Scientific Portal of the Faculty of Pharmacy, Charles University. Research Unit "Ageing, Polypharmacy and Changes in the Therapeutic Value of Drugs in the Aged“ (online) https://portal.faf.cuni.cz/Groups/Ageing-Polypharmacy-Research-Unit/?lang=en-GB

Weidmann AE, Cadogan C, Fialová D, et al. Behavioural theories, models and frameworks to underpin clinical pharmacy and pharmacy practice research: guidance from the European Society of Clinical Pharmacy. Int J Clin Pharm. 2025. https://doi.org/10.1007/s11096-025-01966-4 . PubMed DOI PMC

Wirth F, Cadogan CA, Fialová D, et al. Writing a manuscript for publication in a peer-reviewed scientific journal: guidance from the European Society of Clinical Pharmacy. Int J Clin Pharm. 2024;46:548–54. https://doi.org/10.1007/s11096-023-01695-6 . PubMed DOI PMC

Okuyan B, Henman MC, Paudyal V, et al. Research priorities of the European Society of Clinical Pharmacy (ESCP): a questionnaire-based study. Int J Clin Pharm. 2025. https://doi.org/10.1007/s11096-025-01954-8 . PubMed DOI PMC

Weidmann AE, Cadogan CA, Fialová D, et al. How to write a successful grant application: guidance provided by the European Society of Clinical Pharmacy. Int J Clin Pharm. 2023;45:781–6. https://doi.org/10.1007/s11096-023-01543-7 . PubMed DOI PMC

Paudyal V, Okuyan B, Henman MC, et al. Scope, content and quality of clinical pharmacy practice guidelines: a systematic review. Int J Clin Pharm. 2024;46:56–69. https://doi.org/10.1007/s11096-023-01658-x . PubMed DOI

Stuhec M, Hahn M, Taskova I, et al. Clinical pharmacy services in mental health in Europe: a commentary paper of the European Society of Clinical Pharmacy Special Interest Group on Mental Health. Int J Clin Pharm. 2023;45:1286–92. https://doi.org/10.1007/s11096-023-01643-4 . PubMed DOI PMC

van Mil JWF, de Boer WO, Tromp THFJ. European barriers to the implementation of pharmaceutical care. Int J Pharm Pract. 2001;9:163–8. https://doi.org/10.1111/j.2042-7174.2001.tb01044.x . DOI

Stuhec M. Clinical pharmacist consultant in primary care settings in Slovenia focused on elderly patients on polypharmacy: successful national program from development to reimbursement. Int J Clin Pharm. 2021;43:1722–7. https://doi.org/10.1007/s11096-021-01306-2 . PubMed DOI

Hazen A, Pouls B, Nazar H, et al. European Society of Clinical Pharmacy: ‘the prescribing pharmacist: a prescription for better patient care.’ Int J Clin Pharm. 2024. https://doi.org/10.1007/s11096-024-01827-6 . PubMed DOI PMC

Sandhu RK, Fradette M, Lin M, et al. Stroke risk reduction in atrial fibrillation through pharmacist prescribing: a randomized clinical trial. JAMA Netw Open. 2024;7:e2421993. https://doi.org/10.1001/jamanetworkopen.2024.21993 . PubMed DOI PMC

Jorgenson D, Halpape K. Evaluation of a pharmacist-led interprofessional chronic pain clinic in Canada. Can Pharm J (Ott). 2023;156:265–71. https://doi.org/10.1177/17151635231188334 . PubMed DOI

Fialová D, Laffon B, Marinković V, et al. Medication use in older patients and age-blind approach: narrative literature review (insufficient evidence on the efficacy and safety of drugs in older age, frequent use of PIMs and polypharmacy, and underuse of highly beneficial nonpharmacological strategies). Eur J Clin Pharmacol. 2019;75:451–66. https://doi.org/10.1007/s00228-018-2603-5 . PubMed DOI

Fialová D, Kummer I, Držaić M, et al. Ageism in medication use in older patients. In: Ayalon L, Tesch-Römer C, editors., et al., Contemporary perspectives on ageism. Cham: Springer; 2018. p. 213–40. https://doi.org/10.1007/978-3-319-73820-8_14 . DOI