1UNIT Imonthly-Intro.ppt 2009

PHARMACEUTICAL CARE 1GENERAL PRINCIPLES OF HEALTH CARE

Asso. Asso. Prof. Ma. Cristina C. Doria Faculty of Pharmacy University of Santo Tomas

Many people spend their HEALTH to gain WEALTH, and WEALTH, later on, spend all their WEALTH in a desperate effort to regain HEALTH

GENERAL PRINCIPLES OF HEALTH CAREHEALTH BACKGROUND Sickness has been one of mans greatest adversaries In the past 100 years Medicine has developed weapons to fight disease effectively

GENERAL PRINCIPLES OF HEALTH CAREHEALTH BACKGROUND Developed were: Drugs Vaccines Surgical procedures Instruments Sanitation and nutrition

GENERAL PRINCIPLES OF HEALTH CAREHEALTH BACKGROUND To identify or diagnose a specific disease or injury Physicians, pharmacists, and other pharmacists, health care professionals utilize clues Requires scientific knowledge and technical skills Apply these abilities in innovative ways

GENERAL PRINCIPLES OF HEALTH CAREMEDICINE Latin word medicus-physician medicusScience and art of diagnosing, treating and preventing disease and injury It is a healing art Aims to help people become more active and live longer and happier lives with less suffering and disability

GENERAL PRINCIPLES OF HEALTH CAREMEDICINE Constant search New drugs Effective treatments More advanced technology Health care professionals can prevent, control or cure hundreds of diseases

GENERAL PRINCIPLES OF HEALTH CAREMEDICINE Has become a part of the health care industry One of the largest industries in the world One of the leading employers in most communities

GENERAL PRINCIPLES OF HEALTH CARE

At the turn of the 20th century (1900) Men and women were frail by age 40 Life expectancy was 47.3 years Effective treatment for diseases were so scarce


By the end of the 20th century Medical advances Life expectancy increased to 76 years


Today People in their 80s and 90s are independent and physically active Medical expansion has been expensive

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Prehistoric medical practice Study of ancient pictographs that show medical procedures and surgical tools uncovered from anthropological sites of ancient societies


HISTORY OF HEALTH CARE Serious diseases - primary interest to early humans but they were not able to treat them effectively

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Diseases were: attributed to the influence of malevolent (wicked) demons believed to project an alien spirit, a stone, or a worm into the body of the unsuspecting patient

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Diseases were warded off by incantations, dancing, magic charms and talismans, and various other measures Make the body uninhabitable to the demon by beating, torturing and starving the patient

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Trepanning Alien spirits are expelled by potions that caused violent vomiting, or could be driven out through a hole cut in the skull Remedy for insanity, epilepsy and headache

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Surgical procedures practiced in ancient societies Cleaning and treating wounds by cautery (burning or searing tissue), poultices, and sutures Resetting dislocations and fractures, and using splints to support or immobilize broken bones


HISTORY OF HEALTH CARE Additional therapy included: laxatives and enemas to treat constipation and other gastrointestinal diseases

GENERAL PRINCIPLES OF HEALTH CAREHISTORY OF HEALTH CARE Discovery of the narcotic and stimulating properties of certain plant extracts Many are still of use today - Digitalis, a heart stimulant extracted from foxglove


HISTORY OF HEALTH CARE Systems of medicine existed before the coming of the more advanced Greek medicine about the 6th century B.C. based on: - magic folk remedies elementary surgery

GENERAL PRINCIPLES OF HEALTH CAREHEALTH CARE PROFESSIONALS 11.6 million people work in health care in other countries 778,000 physicians, 2.1 M nurses and 160,000 dentists Work in health care services, involved in the diagnosis and treatment of patients Research, teaching or administration of medical facilities

GENERAL PRINCIPLES OF HEALTH CAREPHARMACIST Has a unique body of knowledge and skills to contribute in our health care system Dispenses the appropriate drug product and has the knowledge to assure safe and rational use of drugs


EARLY FUNCTIONS OF A PHARMACIST1.

Assisting in the selection of appropriate drug therapy



Preparing, compounding and manufacturing drugs for individualized patients



Dispensing and packaging the prescribed drug products including proper labeling



Advising and educating patients on proper use of drugs



Monitoring the outcome and responses of patients to the effect of drugs, both beneficial and adverse



Serving as a community resource person on drug and health information

GENERAL PRINCIPLES OF HEALTH CARETHE TEN STAR PHARMACIST Pharmaceutical Care Giver Researcher Manager Communicator Leader LifeLife-long learner DecisionDecision-maker Entrepreneur Teacher Agent of Positive Change


CONCERNS AMONG HEALTH CARE PROVIDERS Potential abuse, misuse and inappropriate use of drugs Increase in health care cost Patient suffering


DISEASE versus HEALTH

Disease vs HealthDisease comes only when the bodys vital defenses have been indulgences. broken down through improper diet and harmful indulgences. Lack of health means lack of vital resistance against germs and bacteria. Lack of health means lack of immunity from disease. To cure any disease therefore it is only necessary to build health, after which the body can be left on its own to health, correct itself and overcome disease. This is possible as long as the disease has not yet advanced to such a state where more drastic measures like surgery, become necessary.

GENERAL PRINCIPLES OF HEALTH CARETHE PATIENT-ORIENTED PROFESSIONAL PATIENTAble to apply and provide drug knowledge to improve drug use in the health care system Pharmacy colleges responded by providing clinical training for the undergraduates Clinically and patientoriented, better patient prepared to dispense drug knowledge and drug products

GENERAL PRINCIPLES OF HEALTH CAREPRIMARY AIM To attain success in the goals for therapy, pharmacist must approach the patient patient counseling an encounter as a HELPER and an EDUCATOR

GENERAL PRINCIPLES OF HEALTH CARETHE TRADITIONAL PHARMACIST Involved in the preparation and dispensing of medications At the direction of the physician Strongly allied with the medical profession View that the health professional should be in control of the patient


Pharmaceutical care must be the organizing force for the profession of pharmacy

GENERAL PRINCIPLES OF HEALTH CARETHE MODEL Shift in the model of pharmacy From focus on the medication to a focus on the patient Need for a shift in the pharmacists approach From the health professionalcentered professional MEDICAL MODEL to the patientcentered patient HELPING MODEL

GENERAL PRINCIPLES OF HEALTH CAREMEDICAL MODEL Patient is passive Trust is based on expertise and the authority of pharmacist Pharmacist identifies problem and determine solutions Patient is dependent on pharmacist Parentchild Parent relationship HELPING MODEL Patient is actively involved Trust is based on personal relationship developed over time Pharmacist assist patients in exposing problem and possible solution Patient develops selfselfconfidence to manage problems Equal relationship

GENERAL PRINCIPLES OF HEALTH CAREPatient Quality of Life (PQL) (PQL) Primary concern - Welfare of humanity and the relief of human suffering View medications use from the patients perspective

GENERAL PRINCIPLES OF HEALTH CAREAN OATH

I will use knowledge and skills to the best of my ability in serving the public and other health professionals

GENERAL PRINCIPLES OF HEALTH CAREDELINEATION Health is a state of complete physical, mental, and social well-being and not just wellthe absence of disease or infirmityWorld Health Organization (WHO)

GENERAL PRINCIPLES OF HEALTH CAREHEALTH A goal to strive for It is not obtainable No one ever achieves a state of complete mental, physical and social well being

GENERAL PRINCIPLES OF HEALTH CARECURE Latin word cura cura CARE CARE Providing for the welfare of another Attentive conscientiousness of devotion Conveys a compassionate state of being and not merely an attitude Involves a profound respect for the otherness otherness of the other

GENERAL PRINCIPLES OF HEALTH CARETHERAPEUTIC RELATIONSHIP Built on dialogue and commitment Alliance between a practitioner and a patient Formed to meet a patients health care needs

GENERAL PRINCIPLES OF HEALTH CARECHARACTERISTICS OF A CARING BEHAVIOR: VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP Mutual respect Honesty/Authenticity Open communication Cooperation Collaboration between patient and practitioner Empathy Sensitivity Promotion of patient independence Seeing the patient as a person Exercising patience and understanding Trust

GENERAL PRINCIPLES OF HEALTH CARECHARACTERISTICS OF A CARING BEHAVIOR: VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP Competence Putting the patient first Offering reassurance Confidence Paying attention to the patients physical and emotional comfort Supporting the patient Offering advocacy Assuming responsibility for intervention Being willing to be held accountable for all decisions made and recommendations given

GENERAL PRINCIPLES OF HEALTH CAREHEALTH CARE NEEDS Medical Care Mental Health Care Dental Care Nursing Care ChiroChiro-practice Care Pediatric Care Eye Care OF A PATIENT I care Geriatric Care Pharmaceutical Care Surgical Care Nutritional Care Maternal Care

GENERAL PRINCIPLES OF HEALTH CAREPRIMARY CARE Frontline or first contact care Frontline first contact Person Personcentered Not disease or organ system centered Comprehensive in scope Not limited to illness episodes or by organ systems or disease process involved

GENERAL PRINCIPLES OF HEALTH CAREINTERACTIONS With patients and other health care providers COUNSEL CONSULT EDUCATION


4 Rs OF THE PHILOSOPHY OF PRACTICE Rules Roles Relationship Responsibilities

GENERAL PRINCIPLES OF HEALTH CAREPHARMACEUTICAL CARE A responsible provision of therapy for the purpose of achieving definite outcomes that improve the patients quality of lifeHepler and Strand

GENERAL PRINCIPLES OF HEALTH CAREPHARMACEUTICAL CARE PHARMACIST CARE CARE A practice in which the practitioner takes responsibility for a patients drug drug related needs, and is held accountable for this commitment

GENERAL PRINCIPLES OF HEALTH CAREPHARMACEUTICAL CARE Applying knowledge to promote wellwellbeing of others Requires responsiveness, sensitivity and commitment to others Generalist practice that emphasizes health, prevention and care A form of primary health care


OUTCOMES 1. Cure of disease 2. Elimination or reduction of symptoms 3. Arrest or slowing of a disease process 4. Prevention of disease or symptoms

GENERAL PRINCIPLES OF HEALTH CARETHE PHILOSOPHY OF PHARMACEUTICAL CARE Recognition of a social need Patient Patientcentered approach Caring as a modus operandi Specific responsibilities to identify, resolve, and prevent drug therapy problems

GENERAL PRINCIPLES OF HEALTH CARETHE FOCUS 1. Patientcenteredness Patient 2. Addressing both acute and chronic conditions 3. Emphasizing prevention 4. Implementing documentation systems that continuously record patient need and care provided

GENERAL PRINCIPLES OF HEALTH CARETHE FOCUS 5. Being accessible to frontline front first contact 6. Ensuring integration of care 7. Being accountable 8. Placing emphasis on ambulatory patient 9. Including education/health promotional intervention

GENERAL PRINCIPLES OF HEALTH CAREPHARMACEUTICAL CARE PRACTICE Patient is always at the center PATIENT CARE PROCESS PRACTICE MANAGEMENT SYSTEM PROCESS PHILOSOPHY OF PRACTICE

GENERAL PRINCIPLES OF HEALTH CARE5 FACTORS TO BE CONSIDERED IN PHARMACEUTICAL CARE PRACTICEA general understanding of how people feel about being ill, the seriousness of the disease (patients susceptibility to other factors)

DENIAL DENIALNot me! ANGER ANGERWhy me? DEPRESSION DEPRESSIONYes, me! BARGAINING BARGAININGYes me, BUT. ACCEPTANCEIm ready ACCEPTANCE

GENERAL PRINCIPLES OF HEALTH CAREVITAL POINTSDont assume patients had information from the doctor Dont assume patients understand all information given Dont assume patients have resources to comply Dont assume patients dont care or are stupid Dont assume patients will comply if they understand Dont assume others will monitor of followup follow Dont assume patients will voluntarily seek help or information if there are problems

GENERAL PRINCIPLES OF HEALTH CARETRADITIONAL PHARMACY Primary Focus Rx order or OTC request Upon demand Obey CLINICAL PHARMACY Physicians or other health professionals PHARMACEUTICAL CARE PATIENT

Continuity Strategy

Discontinuous CONTINOUS Find fault or prevention Process ANTICIPATE or IMPROVE OUTCOMES

Orientation

Drug product

R PhI. Product orientedCOMPOUNDING & DISPENSING OF DRUGS Manufacturing of drug II. Patient oriented Dispensing * Clinical Pharmacy - Patient Care - Drug Utilization Evaluation (DUE) - Drug Utilization Review (DUR) - Drug Utilization Monitoring (DUM) *Pharmaceutical Care *Managed Care HMO

GENERAL PRINCIPLES OF HEALTH CAREHEALTH CARE Concerned with the prevention as well as the treatment of disease

It is more difficult to convince a person what he must do to stay well than it is to convince an individual what he must do to get well once he is sick.


When a person is ill, he will generally seek help When he is well, he will not As a rule, seek help to remain well, yet he must take positive steps to maintain good health


He cannot take these steps unless he is aware of them Even then, he may not take action unless he is educated as to why he must do so and encourage to take action


Because of his accessibility, professional knowledge and training, the pharmacist is in a premier position to play an important role in maintaining the health of his community by serving as a health educator

GENERAL PRINCIPLES OF HEALTH CAREWHAT A PHARMACIST CAN DO? Patients on medications experience a lot of drug misadventures misadventures adverse effects, drug interactions, errors in the use of medication and non noncompliance MINIMIZE WASTE and MAXIMIZE BENEFITS of medical treatments


REASONS FOR PHARMACISTS INVOLVEMENT Improve Patients Quality of Life (PQL) (PQL) years High cost of health care today


BENEFITS 1. Reduce drugrelated morbidity and drug its subsequent cost to individual and society 2. Improve PQL

GENERAL PRINCIPLES OF HEALTH CAREBENEFITS 3. Reassures that a medication is safe and effective 4. Patient get additional explanation about their illness and medication that they did not receive from their physicians because they were too rushed, too upset or too embarrassed to ask

GENERAL PRINCIPLES OF HEALTH CAREBENEFITS 5. Assist patients on selfcare (the self pharmacist is always the first person that a patient will turn to in order to discuss a variety of problems) 6. Assist patients in non-medication nonrelated problem

GENERAL PRINCIPLES OF HEALTH CARETRANSFORMATION OF HEALTH CAREOLD PARADIGM Emphasis on acute patient care Emphasis on treating illness Responsible for individual patients All providers are essentially similar Success achieved by increasing market share of in-patient inadmissions Goal is to fill beds Hospitals, physicians, and health plans are separate NEW PARADIGM Emphasis on the continuum of care Emphasis on maintaining and promoting wellness Accountable for the health of define populations Differentiation based on ability to add value Success achieved by increasing the number of covered lives and keeping people well Goal is to provide care at the most appropriate level Integrated health delivery system

GENERAL PRINCIPLES OF HEALTH CARETHE ROLE OF THE NEW PHARMACIST Has evolved from being product product patient oriented to a patientoriented professional Extremely healthy for both patient and pharmacist Dispensers of therapy and drug effect interpretations as well as drugs

GENERAL PRINCIPLES OF HEALTH CAREIn the future, pharmacy services must be evaluated on patient outcome rather than the number of prescriptions dispensed It must evolved towards interpretation and patient consultation, related to consultation, the use of medication technologies

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1UNIT Imonthly-Intro.ppt 2009

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