Introduction

1

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.

2

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. 3

Patient-drug related needs

- Medication is appropriate.

- Medication is effective.

- Medication is safe.

- Patient is compliant.

4

Importance of Pharmaceutical care

• As medication errors is growing, so professionals' efforts must be united.

• The number, complexity, and potency of prescription and non prescription drug products are increasing.

• Pharmaceutical care activities integrate pharmacists into the health – care system.

5

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). 6

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

7

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.

8

Therapeutic relationship

Characteristics of the therapeutic relationship

• Mutual respect• Trust• Open communication• Cooperation• Mutual decision making

9

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. 10

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.

11

Pharmacotherapy workup

• Consists of

- Asking questions.- Generate hypothesis. - Searching for solution (to accept/ reject

the hypothesis!)- Elicit more information.

12

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.

13

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.

14

Patient Care Process

• Describes the interaction between patient and practitioner.

- Assessment of patient- Care plan development. - Follow up evaluation

15

Patient Care Process versus

Pharmacotherapy workup

• Patient care process: describes the work done physically.

• Pharmacotherapy workup: describes the work done mentally.

16

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.17

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) 18

Patient Care Process - Assessment

Information needed to give good assessment

• Drug data- current medication- previous medications- social drug use- immunization- allergy- drug alerts.

19

Patient Care Process - Assessment

Medication experience

The summation of all the events a patient has in his lifetime that involves drug therapy.

20

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).

21

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.

22

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 23

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).

24

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. 25

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.

26

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.

27

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.

28

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. 29

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.30

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.

31

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

32

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 system33

Philosophy of practiceWhat 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

34