Pharmaceutical care

Dr. Binaya SapkotaBPharm, PharmD

DEFINITION: Pharm. care (Pharmacist care)

• A necessary element of total “HC”.

• "The responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.”- Charles D. Hepler and Linda Strand

• Forces pharmacy practitioners to change their focus, broaden their professional responsibility.

• Focuses pharmacists' attitudes, behaviors, commitments, concerns, ethics, functions, knowledge, responsibilities & skills on the provision of drug therapy with the goal of achieving definite outcomes toward the improvement of QoL of pt.

• Co-operative, pt. centered system for achieving specific & +ve pt. outcomes from the responsible provision of medicines.

• 3 key elements of the core process are pt. assessment, determining the care plan and evaluating the outcome.

• Ability to consult with pts is a key process in the delivery of pharm. care and requires regular review & development regardless of experience.

• Clinical pharmacy process: incorporated into a competency framework to develop further skills & knowledge.

Principles of Pharm. Care

• In the Pharm. care process, the pharmacist is engaged in:1. Drug monitoring, for a specific drug or for therapy for a specific disease state2. Disease monitoring, for a specific disease state3. Drug therapy and disease management/collaborative practice by protocol 4. A pharmacist may incorporate ≥1 areas of focused practice into a general practice of pharmacy or may specialize within a narrow field of practice.• Examples of highly specialized practice include pharmacist -directed DM mgmt.

clinics, HTN clinics, anticoagulation clinics, hosp.-based ID services.

Scope of Practice within Pharm. Care

A. Role. Pharm. care has evolved from an emphasis on prevention of DRPs (basically drug mgmt.) to the expanded roles of pharmacists in the triage of pts, Rx of routine acute illnesses, mgmt. of chronic diseases & 10 disease prevention.

B. Function• Provision of pharm. care does not imply that the

pharmacist is no longer responsible for dispensing fxs. • In many instances, implementation of pharm. care

services necessitates a redesign of the professional workflow, with assignment of technical fxs to technical personnel under the direct supervision & responsibility of the pharmacist.

Uniqueness of Pharm. Care

• Provision of pharm. care overlaps somewhat with other aspects of pharmacy practice.

• However, pharm. care is not the same as these other areas, which include

A. Clinical pharmacyB. Pt. counseling

C. Pharm. services• When the activities of a pharmacy are performed

for “faceless” pts or charts, the activity is one of pharmacy service, not pharm. care (i .e., chart or drug profile reviews without input from pt. or caregiver is not pharm. care).

Essential Components of Pharm. Care

A. Pharmacist -patient relationship:• Importance of putting a face & personality with the clinical

picture is a key component of pharm. care. • A pharmacist can have a caring relationship with a pt. but

not with a chart or drug profile. • A pharmacist cannot have empathy for words on a page or

on a computer screen. • Pharm. care is based on a collaborative effort between

pharmacist & pt.

B. Pharmacist 's workup of drug therapy (PWDT)

• Provision of pharm. care is often centered on a process described as the PWDT.

• PWDT contains the thought processes necessary for pharm. care.

• PWDT is too lengthy to be used as the chart note for pharmacist interventions; an abbreviated format k/a FARM (findings, assessment, resolutions/recommendation & monitoring) note or SOAP (subjective, objective, assessment & plan) note is more appropriate for a chart notation.

Importance of Pharm. Care in Pharmacy Practice

A. Potential for medication errors is growing & one professional group must assume a 10 role in addressing this issue, rather than various groups or individuals making fragmented efforts. • Pharmacist is trained specifically to address these

therapeutic issues.

B. Use of POM & OTC medications is growing & now constitutes the 10 therapeutic modality available to HC practitioners & pts.

C. No., complexity & potency of POM & OTC products are increasing.

D. Need for pharm. care secures an enduring role for the pharmacist in the HC system. • Every encounter with pts, regardless of practice setting,

provides pharm. care.

E. Pharm. care activities integrate pharmacists into the HC system.

Barriers to the Provision of Pharm. Care

• Lack of time• Insufficient knowledge & confidence• Conflicting job functions• Poorly designed workflow• Physical layout problems• Lack of institutional or corporate support

Strategies to Overcome the Barriers

• The 2003 White Paper endorsed by 12 prominent national pharmacy organizations states that "implementation of pharm. care requires a fundamental change in the way pharmacies operate. Pharmacists must relinquish routine product-handling fxs to competent technicians & technology.”

• Pharmacists who want to be pharm. care providers will need support, reassurance, mentors, role models & networks of pharmacists who are working toward a common goal of pharm. care.

• Pharmacy must create, implement & evaluate a plan for pharm. care service provision.