PHARMACEUTICAL CARE CONCEPT

PHARMACEUTICAL CARE CONCEPT

Definition: It is a patient centered, outcomes oriented pharmacy practice. The pharmacist is working in concert with the patient & patient's other health care providers to promote health, prevent disease & to assess, monitor, initiate and modify medication use, to assure that drug therapy regimens are safety and effective,

• It involves the direct professional relationship between patient and pharmacist.
• Requires patient specific, medication specific information to be collected.
• Patient specific medication or medical information to be evaluated.
• A therapeutic plan to be designed, implemented, monitored to achieve the best outcome of the therapy.

PRINCIPAL ELEMENTS OF PHARMACEUTICAL CARE CONCEPT

The principal elements of pharmaceutical care are:

 1.      Medication Related

2.      Care

3.      Outcomes

4.      Quality of Life

5.      Responsibility

1. Medication Related: Pharmaceutical care involves not only medication therapy (the actual provision of medication) but also decisions about medication use for individual patients. As appropriate, this includes decisions not to use medication therapy as well as judgments about medication selection, dosages, routes and methods of administration, medication therapy monitoring, and the provision of medication-related information and counseling to individual patients. 

2. Care: Patient healthcare is an integrated process by which physicians, nurses, pharmacists and other health professionals provide care to patients according to their expertise. Pharmacists as members of this caring team should commit a direct care to patients by applying all their knowledge and skills to achieve the best therapy outcome. The hart of the pharmaceutical care is one pharmacist in a direct professional relationship with one patient. In this relationship, the pharmacist provides care directly to the patient and for the benefit of the patient. The pharmacist cooperates directly with other professionals and the patient in designing, implementing, and monitoring a therapeutic plan intended to produce definite therapeutic outcomes that improve the patient’s quality of life.

3.      Outcomes: It is the goal of pharmaceutical care is to improve an individual patient’s quality of life through achievement of definite (predefined), medication-related therapeutic outcomes.

The outcomes sought are

·         Cure of a patient’s disease.

·         Elimination or reduction of a patient’s symptomatology.

·         Arresting or slowing of a disease process.

·         Prevention of a disease or symptomatology.

This, in turn, involves three major functions: 

a.       Identifying potential and actual medication-related problems, 

b.      Resolving actual medication-related problems, and 

c.       Preventing potential medication-related problems.

A medication-related problem is an event or circumstance involving medication therapy that actually or potentially interferes with an optimum outcome for a specific patient. There are at least the following categories of medication-related problems.

·         Untreated indications: The patient has a medical problem that requires medication therapy (an indication for medication use) but is not receiving a medication for that indication.

·         Improper drug selection. The patient has a medication indication but is taking the wrong medication.

·         Sub therapeutic dosage: The patient has a medical problem that is being treated with too little of the correct medication.

·         Failure to receive medication: The patient has a medical problem that is the result of not receiving a medication (e.g., for pharmaceutical, psychological, sociological, or economic reasons).

·         Over dosage: The patient has a medical problem that is being treated with too much of the correct medication (toxicity).

·         Adverse drug reactions: The patient has a medical problem that is the result of an adverse drug reaction or adverse effect.

·         Drug interactions: The patient has a medical problem that is the result of a drug–drug, drug–food, or drug– laboratory test interaction.

·         Medication use without indication: The patient is taking a medication for no medically valid indication.

4. Quality of Life: A complete assessment of a patient’s quality of life should include both objective and subjective (e.g., the patient’s own) assessments. Patients should be involved, in an informed way, in establishing quality-of-life goals for their therapies

5. Responsibility: Responsibility involves both moral trustworthiness and accountability. In pharmaceutical care, the direct relationship between an individual pharmacist and an individual patient is that of a professional covenant in which the patient’s safety and wellbeing are entrusted to the pharmacist, who commits to honouring that trust through competent professional actions that are in the patient’s best interest. As an accountable member of the health-care team, the pharmacist must document the care provided.

PHARMACEUTICAL CARE PROCESS :

Pharmaceutical care process include the following steps:

1.      Assessment, such as taking a medication history.

2.      Identifying real and potential drug-related problems (DRPs).

3.      Pharmacy care plan development.

4.      Follow up and evaluation.

1.      Assessment: Such as taking a medication history.

2.      Identifying real and potential drug-related problems (DRPs).

3.      Pharmacy care plan development: Such as making and implementing recommendations and monitoring parameters to resolve and prevent DRPs.

4.    Follow up and evaluation: Such as following up to determine whether clinical outcomes have been achieved.

FUNCTIONS OF PHARMACEUTICAL CARE

According to the ASHP (American Society of Health-System Pharmacists) Standards of practice, the pharmaceutical care functions are:

·         Collecting and organizing patient-specific information.

·         Determining the presence of medication-therapy problems.

·         Summarizing patient’s health care needs.

·         Specifying pharmacotherapeutic goals.

·         Designing a pharmacotherapeutic regimen.

·         Designing a monitoring plan.

·         Developing a pharmacotherapeutic regimen and corresponding monitoring plan in collaboration with the patient and other health professionals.

·         Initiating the pharmacotherapeutic regimen.

·         Monitoring the effects of the pharmacotherapeutic regimen.

·         Redesigning the pharmacotherapeutic regimen and monitoring plan.

·         Answering the physician in choosing right drug and ancillary therapy.

LEVELS OF PHARMACEUTICAL CARE

The different levels of pharmaceutical care include,

·         Primary pharmaceutical care

·         Secondary pharmaceutical care

·         Tertiary pharmaceutical care

A patient needs to know the types of pharmaceutical care services that must be provided by the pharmacist. The pharmacist is responsible for achieving the desired outcomes at all levels of pharmaceutical care.

IMPLEMENTING PHARMACEUTICAL CARE

Pharmaceutical care is applicable in all practice settings in hospitals for inpatients, and outpatients, or community pharmacies. To operationalize the concept it is essential to consider pharmaceutical care in the mission of the pharmacy and develop a practice model that accommodates pharmaceutical care functions.

Professional relationship must be established and maintained:

Professional communication between pharmacists and patients, and between pharmacists and the other healthcare professionals to assure continuous seamless patient care.

Patient-specific medical information must be collected, organized, recorded, and maintained:

Pharmacists must collect and/or generate subjective and objective information regarding the patient's general health and activity status, past medical history, medication history, social history, diet and exercise history, history of present illness, and economic situation (financial and insured status). Sources of information may include, but are not limited to, the patient, medical charts and reports, pharmacist-conducted health/physical assessment, the patient's family or caregiver, insurer, and other healthcare providers including physicians, nurses, mid-level practitioners and other pharmacists. It must be timely, accurate, and complete, and it must be organized and recorded to assure that it is readily retrievable and updated as necessary and appropriate. Patient information must be maintained in a confidential manner

Patient-specific medical information must be evaluated and a drug therapy plan developed mutually with the patient:

Based upon a thorough understanding of the patient and his/her condition or disease and its treatment, the pharmacist must, with the patient and with the patient's other healthcare providers as necessary, develop an outcomes-oriented drug therapy plan. The plan may have various components which address each of the patient's diseases or conditions. In designing the plan, the pharmacist must carefully consider the psycho-social aspects of the disease as well as the potential relationship between the cost and/or complexity of therapy and patient adherence. The essential elements of the plan, including the patient's responsibilities, must be carefully and completely explained to the patient. Information should be provided to the patient at a level the patient will understand. The drug therapy plan must be documented in the patient's pharmacy record and communicated to the patient's other healthcare providers as necessary.

The pharmacist assures that the patient has all supplies, information and knowledge necessary to carry out the drug therapy plan:

The pharmacist providing Pharmaceutical Care must assume ultimate responsibility for assuring that his/her patient has been able to obtain, and is appropriately using, any drugs and related products or equipment called for in the drug therapy plan. The pharmacist must also assure that the patient has a thorough understanding of the disease and the therapy/medications prescribed in the plan.

The pharmacist reviews, monitors, and modifies the therapeutic plan as necessary and appropriate, in concert with the patient and healthcare team:

The pharmacist is responsible for monitoring the patient's progress in achieving the specific outcomes according to strategy developed in the drug therapy plan. The pharmacist coordinates changes in the plan with the patient and the patient's other healthcare providers as necessary and appropriate in order to maintain or enhance the safety and/or effectiveness of drug therapy and to help minimize overall healthcare costs. Patient progress is accurately documented in the pharmacy record and communicated to the patient and to the patient's other healthcare providers as appropriate.

DOCUMENTING PHARMACEUTICAL CARE

Different terms have been used to describe methods of pharmaceutical care documentation:

• PWDT ( Pharmacists Workup of Drug Therapy)
• PMDRP (Pharmacists Management of Drug-Related Problems)
• PCP ( Pharmacist Care Plan)
• SOAP ( Subjective, Objective, Assessment, Plan of care)

In all methods Patient information, medication information (past, present), medication related problems, recommendations, desired outcomes and goals, monitoring parameters and evaluation should be documented. Pharmacists must have a good knowledge about diseases and therapy, and should exert good analytical thinking in gathering all essential information either directly from patients, or through the medical records with maintaining confidentiality.