Introduction
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Pharmaceutical care
Def
• A patient’s centered practice in which the practitioner
responsibility is oriented for patient-drug related needs.
• It describes specific activities and services through which
an individual pharmacist cooperates with patient and
other professionals in designing and monitoring a
therapeutic plan that will produce specific therapeutic
outcomes to the patient.
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Pharmaceutical care
• This responsibility will be for all drug therapy
- Rx
- OTC
Traditional
or
alternative
medicine
(Complementary and alternative medicine
(CAM)
• This responsibility to succeed needs
- Pharmacist coordination with patient and
other health care providers.
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Patient-drug related needs
- Medication is appropriate.
- Medication is effective.
- Medication is safe.
- Patient is compliant.
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Importance of Pharmaceutical care
• As medication errors is growing,
professionals' efforts must be united.
so
• The number, complexity, and potency of
prescription and non prescription drug
products are increasing.
• Pharmaceutical care activities integrate
pharmacists into the health – care system.
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The need of pharmaceutical care
practitioners comes from ….
• Multiple practitioners writing prescriptions for a single
patient (sometimes without coordination).
• Large number of medications used by patients.
• Patients play an important role of selection and use of their
medications (to enhance their adherence).
• Increase complexity of medication therapy.
• Increase self care (i.e use of OTC and CAM).
• High level of drug related problems (DRP).
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Language of practice
• Pharmaceutical care practitioner should use the same
vocabulary of other health care provide.
• Terms used:
- Assessment
- Care plan
- Follow up
• Facilitate good communication among them.
• Pharmaceutical care practitioner has a unique practice
also which is related to DRP, medication experience,
drug related needs
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Therapeutic relationship
• The collaborative effort between the
pharmaceutical care practitioner and the
patient.
• Should be personal (private information is
exchanged from the patient).
• Determine the quality and the quantity of care
delivered to the patient.
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Therapeutic relationship
Characteristics of the therapeutic relationship
•
•
•
•
•
Mutual respect
Trust
Open communication
Cooperation
Mutual decision making
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Pharmacotherapy workup
• Structured, rational thought process for clinical decision
(rational decision making process).
• Cognitive work occurs in mind of practitioners while
caring of patients.
• It is among all patient care practitioners.
• Use knowledge already known and apply on new
patients.
• it is too lengthy to use a chart note, an abbreviated
format known such as FARM Note or a SOAP Note can
be used.
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Pharmacotherapy workup
• Purpose
- Assess the needs of patient.
- Identify DRP (to prevent or resolve them).
- Organize intervention or care plan.
- Establish appropriate parameters to
evaluate follow up.
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Pharmacotherapy workup
• Consists of
- Asking questions.
- Generate hypothesis.
- Searching for solution (to accept/ reject
the hypothesis!)
- Elicit more information.
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Pharmacotherapy workup
• Most questions asks or hypothesis generated
by pharmaceutical care practitioners
- Is the patient’s problem caused by drug
therapy.
- Can the patient's problem treated by drug
therapy.
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Pharmacotherapy workup
• Most questions asks or hypothesis generated
by pharmaceutical care practitioners
- Is the patient’s problem caused by drug
therapy.
- Can the patient's problem treated by drug
therapy.
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Patient Care Process
• Describes the interaction between patient and
practitioner.
- Assessment of patient
- Care plan development.
- Follow up evaluation
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Patient Care Process
versus
Pharmacotherapy workup
• Patient care process: describes the work done
physically.
• Pharmacotherapy workup: describes the work
done mentally.
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Patient Care Process - Assessment
Purposes
• Understand patient’s condition well (to make
rational drug therapy decision).
• To determine the patient-drug related needs
(appropriate, effective, safe, compliant).
• Identify DRP.
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Patient Care Process - Assessment
Information needed to give good assessment
• Patient’s data
- socio-demographics (age, gender, … )
- medication experience
• Disease data
- Current and past medical history
- Family history, social history
- Dietary history
- Physical findings (e.g.: weight, height, blood pressure)
- Laboratory or other test results. (e.g. K level, serum
creatinine level)
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Patient Care Process - Assessment
Information needed to give good assessment
• Drug data
- current medication
- previous medications
- social drug use
- immunization
- allergy
- drug alerts.
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Patient Care Process - Assessment
Medication experience
The summation of all the events a patient has in
his lifetime that involves drug therapy.
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Patient Care Process - Assessment
Activities done during assessment
• Meet the patient. (establish a therapeutic
relationship).
• Eliciting information from the patients (patients,
disease and drug data).
• Making clinical decision about patient’s
medications (done by pharmacotherapy workup).
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Patient Care Process - Assessment
Components of assessment (pharmacotherapy workup)
1. Data collection
2. Patient symptoms and signs
3. Develop and identify CORE pharmacotherapy plan
- C = Condition or potential need.
- O = Outcomes desired for the condition.
- R = Regimen to achieve the desired outcomes.
- E = Evaluation parameter to assess outcome achievement.
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Patient Care Process - Assessment
Components of assessment (pharmacotherapy workup)
4. Identify the PRIME pharmacotherapy problems:
- P = Pharmaceutical based problems.
- R = Risks to patient e.g. adverse effects.
- I = Interactions:
- Drug – drug, drug - disease, drug - food interactions.
- M = Mismatch between medications and condition or
patient needs.
- E = Efficacy issues:
- Too much of the correct drug
- Too little of the correct drug
- Wrong drug, device, intervention or regime prescribed
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Patient Care Process - Care plan development
Definition
• Organization of all the work agreed upon by
the practitioner, other health care providers
and by the patient to achieve the goal of
therapy (Intervention).
• Collaboration with patient (first) and with
other health care provider (if needed).
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Patient Care Process - Care plan development
Steps of care plan
• Resolve DRP if occur.
• Optimize patient medication experience (needs
to change the drug therapy, provides patients
instruction, counseling and education)
• Prevent DRP from occurring (for patients at risk).
• Schedule for follow up (to determine the
outcome of therapy).
 to achieve the goal of therapy.
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Patient Care Process - Care plan development
Goal of therapy
• Is the positive outcome that should be achieved.
• The future desired endpoint.
• To be measured, it needs
- Parameter.
- Value.
- Time frame.
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Patient Care Process - Care plan development
To Reach the desired goal of therapy, the followings should be
considered:
• The care plan is consistent with patient’s preference and
desire.
• The care plan should be agreed by the patient and the
practitioner.
• The goal of therapy should be explicitly stated.
• The care plan and the goal of therapy should be clinically
sound.
• The care plan and the goal of therapy should be observable
or measurable in stated time frame.
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Patient Care Process - Follow up evaluation
- This step is where the clinical experience, new
knowledge and learning are gained.
Purpose
• To determine the actual outcome of drug therapy.
• To compare the results with the intended goal.
• To determine the appropriateness, efficacy and
safety of the medications.
• To evaluate the patient’s compliance.
• To establish the current status of the patient.
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Patient Care Process - Follow up evaluation
Activities Performed in follow up
• Observe or measure the positive results that the patient
experienced from drug therapy (Effectiveness)
• Observe or measure the undesirable effect that the patient
experienced from drug therapy (Safety)
• Determine the actual dosage of medications the patient has
taken that produce the results observed (Compliance)
• Make a clinical judgment of the status of patient’s condition
being managed by drug therapy (Outcome)
• Reassess the patient to determine if he develops a new DRP.
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Patient Care Process - Follow up evaluation
Activities Performed in follow up
To evaluate the Effectiveness:
• Improve or reduction in signs and symptoms of medical
condition.
• Lab tests return to normal.
To evaluate the Safety:
• Evaluation of unintended side effect of patient drug
therapy.
• If lab test is abnormal.
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Patient Care Process - Follow up evaluation
• Both safety and efficacy need compliance to
medications to be positive once measured.
• The patient’s outcome
- Resolved.
- Stable.
- Improved.
- Partially improved.
- Unimproved.
- Worsen.
- Failed.
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Philosophy of practice
• A set of values that guides behaviors associated
with a professional practice
• Helps the practitioner determine what is
important and how to set priorities.
• Represents what “should” be done
• This must be in the mind and the heart of the
practitioner before caring for a patient
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Philosophy of practice
• Therapeutic relationship with patients
• An understanding of the patient’s medication experience
• Rational thought process
• pharmacotherapy workup and drug therapy problems
• Patient care process
• Documentation system
• Reimbursement system
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Philosophy of practice
What a practitioner does
• Meets a social need
• Meets patient-specific responsibilities
How a practitioner does it
• With a patient-centered approach
• Using a caring process
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