Pharmaceutical Care
Presentation20 slidesB.Pharm, Pharm.D
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About this presentation
Pharmaceutical care is a patient-centered approach in pharmacy practice that focuses on the responsible provision of drug therapy to achieve specific therapeutic outcomes and improve the patient’s quality of life.
- pharmaceutical care
- patient-centered care
- drug therapy
- therapeutic outcomes
- quality of life
Text of these slides
- Slide 1. PHARMACEUTICAL CARE
- Slide 2. What is Pharmaceutical Care? "The responsible provision of drug therapy for the purpose of achieving definite therapeutic outcomes that improve the patient's quality of life." Hepler & Strand, 1990 OUTCOMES OF DRUG USE: 1. Cure of a disease 2. Elimination or reduction of symptoms 3. Arresting or slowing a disease process 4. Prevention of disease 5. Desired alterations in physiological processes (minimum risk)
- Slide 3. Core Elements of Pharmaceutical Care S No Element Description 1 Patient Oriented Focus on individual needs 2 Acute & Chronic Both addressed 3 Prevention Of drug-related problems 4 Documented System Records, needs, care 5 Continuous Care Systematic & ongoing 6 Collaboration With other healthcare providers 7 Integrated Care Across all providers 8 Accountability High responsibility 9 Optimize QoL Health-related quality of life 10 Health Education Emphasized
- Slide 4. Who Needs Pharmaceutical Care? IDEALLY: - All patients receiving medicines DUE TO CONSTRAINTS (TIME/STAFF) – PRIORITIZE: 1. Chronic diseases: Diabetes, Hypertension, Asthma 2. Patients with polypharmacy (multiple medicines) 3. Complex drug regimens 4. History of non-compliance or adverse reactions
- Slide 5. Essential Pharmacist Skills GOOD COMMUNICATION Active listening, empathy SOUND THERAPEUTICS KNOWLEDGE MOA, dosing, interactions PRESCRIPTION INTERPRETATION Identify DRPs before dispensing RECORD MAINTENANCE Documentation using software
- Slide 6. Prerequisites for the Pharmacist Prerequisite Brief Explanation Knowledge in pharmaceutics & clinical pharmacology Understand drug formulation, ADME, therapeutic use Mobilize drug distribution system Manage storage, dispensing, delivery Develop relationships Collaborate with patients, doctors, nurses Availability for patients Accessible during critical moments Commitment to quality improvement Continuously evaluate outcomes and update practices
- Slide 7. Institutional Setups Required DATA SYSTEMS - Patient contact notes - Medical history - QA & research WORKFLOW - Integrate care into daily activities - Dispensing + clinical tasks RESOURCES - DUR, disease protocols - Patient education materials - Computer software
- Slide 8. Six Practice Functions/Principles of Pharmaceutical Care 1. Data Collection 2. Identification of Problem(s) 3. Formulating a Therapeutic Plan 4. Implementing the Plan 5. Monitoring & Modifying the Plan 6. Monitoring Outcomes 7. Documentation
- Slide 9. The 4-Step Pharmaceutical Care Process Step 1: Assess & Identify DRPs Step 2: Develop Care Plan Step 3: Implement Care Plan Step 4: Evaluate & Review Plan Collect data, identify actual/potentia l DRPs Agreement between pharmacist & patient, set goals Interventions, education, documentation Follow-up, modify plan, communicate
- Slide 10. Data Collection Patient Information Category Data Elements Demographics Age, Sex, Race, Religion, Height, Weight Current Problems Signs, symptoms of disease Past Medical History Doctors visited, past medicines, past Rxs Current Medication Current doctor, current Rx Allergies Medicines & environment Pregnancy/Lactation Status if applicable Addiction Tobacco, alcohol, drugs Economic/Social Social status, insurance
- Slide 11. Identification of Problems Drug-Related Problems (Actual vs Potential) ACTUAL PROBLEMS - New condition needing additional drug - Wrong drug administered - Subtherapeutic dose - Incorrect administration - ADR, drug-drug interaction - Non-compliance POTENTIAL PROBLEMS - Unnecessary medication - Too much/little current therapy - Risk of ADR - Non-compliance - Inappropriate monitoring
- Slide 12. DRP Categories & Causes DRP Potential Cause New/additional drug needed New condition develops Wrong drug Ineffective or allergy Too little of right drug Subtherapeutic dose, wrong route ADR Allergy, risk factors not anticipated Too much of right drug High dose, double dosing, too long therapy Medication not indicated No valid indication, continued after improvement Non-compliance Lack of understanding, unclear instructions
- Slide 13. Formulating Therapeutic Plan 1. Identify, evaluate, choose appropriate action 2. Improve safety, effectiveness, cost-effectiveness 3. Minimize current/future health problems 4. Collaborate with patient & healthcare team 5. Develop monitoring mechanisms (drug + non-drug) 6. Tailor regimen to patient's needs 7. Document plan with desired outcomes
- Slide 14. Implementation Steps & Common Barriers STEPS 1. Contact providers to clarify/modify 2. Educate patient 3. Coordinate medications/supplies 4. Document all steps 5. Share information across settings BARRIERS 1. Patient's economic condition 2. Insurance limits 3. Formulary restrictions 4. Risk of ADR or interactions 5. Cost of hospital stay (LOS)
- Slide 15. Tailoring Therapy – Factors to Consider PATIENT FACTORS Diagnosis, goals Physio-pathological status Medical history, past meds Contraindications, compliance Socioeconomic & special considerations DRUG FACTORS Efficacy, ADRs Ability to minimize risks Drug-drug interactions Dosage form, availability Route, administration method
- Slide 16. Monitoring Outcomes – The Four S's SIGNS Objective findings SYMPTOMS Subjective patient reports SIDE EFFECTS Treatment-related morbidity SEQUELAE Consequences / recurrence Causes of suboptimal outcomes: inappropriate prescription, dispensing error, non- compliance, poor monitoring Special attention: narrow therapeutic index drugs (digitalis, theophylline, carbamazepine)
- Slide 17. Documentation – SOAP Format SUBJECTIVE (S) Non-quantitative data: how patient feels, symptoms OBJECTIVE (O) Verifiable facts: lab tests, BP, medications, diet ASSESSMENT (A) Interpretation of subjective + objective findings PLAN (P) Actions, interventions, recommendations, follow-up "If it is NOT documented, it is NOT done." Why Document? Reimbursement, litigation risk, proof of judgment, cost-benefit evaluation, recognition
- Slide 18. Role of Community Pharmacist in Pharmaceutical Care 1. Dispensing + Drug information + Patient counseling 2. Drug therapy monitoring 3. Health screening services 4. Identify DRPs and resolve with prescriber & patient 5. Maintain patient medication records 6. Educate on lifestyle, diet, safe medicine use 7. Advocate for rational use of medicines 8. "All activities can be done in a spacious community pharmacy manned by a trained practicing community pharmacist."
- Slide 19. Barriers to Implement Pharmaceutical Care Pharmacist-Based Barriers Pharmacy-Based Barriers Lack of time Inadequate space & facilities Increased workload Lack of aids (software, materials) Lack of knowledge/training Poor communication skills No legalization of services No remuneration Assumption that patient care is doctor's responsibility
- Slide 20. Mission of Pharmaceutical Care To help people make the best use of medicines through high quality pharmaceutical care – restoring, maintaining and promoting health and well-being. Pharmaceutical care is patient-oriented, collaborative, accountable, and outcome-driven – with the pharmacist at the center.
