222 PHCL

Pharmaceutical Care Concept

222 PHCL

Objectives• To understand:

• The concept of pharmaceutical care.

• MTM

• Chapter 3 required reading.

• “Pharmaceutical care gives us hope that our profession can restore its past greatness, not by our becoming chemists again but rather our making a commitment to outcomes that are valuable beyond price to our patient, , in a health care environment that is being stood on its head by rapid change.”

Charles D. Hepler

• In the 1950s and 1960s pharmacist began to conceptualize a new role for pharmacists that would involve the specialized provision of information about these powerful new agents that were beginning to reach the market.

• Hepler had identifed three simulaneous trends that served as the bases for the clinical pharmacy movement.

1) Drug information

2) Drug distribution, especially decentralized programs in hopitals.

3) Teaching and research programs in pharmacology and biopharmacutics.

• The project began inseptember 1966 with the following goals:

• To develop hospital floor based pharmacutical services that would provide maximal patient safety in utilization of drugs.

• To charge the pharmacist with the responsibiltiy for all phases of drud distribution except for administration.

• Available source of reliable drug informaion .

• Clinical experience for interns and residents and other qualified pharmacy students in hospital pharmacy.

• Design and conduct studied in cooperation with the physician and nurse.

Pharmaceutical care definition• Pharmaceutical Care is the responsible provision of drug therapy for

the purpose of achieving definite outcomes that improve a patient's quality of life.

• Hepler preached that they had to take responsibility for the care provided to patients through the clinical use of drugs.

• IN 1987 he first applied the term pharmaceutical care in describing what he and colleague Linda strand called the new self actualizing role for pharmacist.

Pharmaceutical care definition

Provision of drug

therapy

Achieve definite

outcomes

Improve a patient's quality of

life.

Pharmaceutical care definition• These outcomes are:

1. Cure of disease.

2. Elimination or reduction of patient's symptomatology.

3. Arresting or slowing of a disease process.

4. Preventing a disease or symptomatology.


Provision of drug

therapy

Achieve definite

outcomes

Improve a patient's quality of

life.

Pharmaceutical care definition• Pharmaceutical care involves the process through which a pharmacist

cooperate with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.


Physician Pharmacist Patient

Designing

Implementing

Monitoring

Therapeutic plan

Pharmaceutical care definition• This in turn involves three major functions:

1. Identifying potential and actual drug-related problems.

2. Resolving actual drug-related problems

3. Preventing potential drug-related problems.

Medication-related problem• 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.

Am J Hosp Pharm. 1993; 50:1720–3.

Medication-related problem• There are at least the following categories of medication-related

problems:• Untreated indications: The patient has a medical problem that requires

medication therapy but is not receiving a medication for that indication.

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

Am J Hosp Pharm. 1993; 50:1720–3.

Medication-related problem• Subtherapeutic dosage: The patient has a medical problem that is being

treated with too little of the correct Medication.

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

Am J Hosp Pharm. 1993; 50:1720–3.

Medication-related problem• 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.

Am J Hosp Pharm. 1993; 50:1720–3.

Medication-related problem

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

Am J Hosp Pharm. 1993; 50:1720–3.

Pharmaceutical care definition• Pharmaceutical care is provided for the direct benefit of the patient,

and the pharmacist is responsible directly to the patient for the quality of that care.


• The fundamental goals, processes, and relationships of Pharmaceutical care exist regardless of practice setting.

Pharmaceutical care in community pharmacy• Until the mid-1990s, pharmaceutical care was provided primarily in

hospitals with clinical pharmacy services and long-term care facilities where consultant pharmacists reviewed medication therapy on a monthly basis.

Pharmaceutical care in community pharmacy• In community pharmacy, practice remained as Hepler had described it:

Count, pour, lick, and stick.

• In 1997Asheville Project was implemented.

Pharmaceutical care in community pharmacy• In 1997Asheville Project was implemented as an effort by the City of

Asheville, North Carolina.

• To provide education and personal oversight for patients with chronic health problems such as diabetes, asthma, hypertension and high cholesterol.

Pharmaceutical care in community pharmacy• Patients with these conditions were provided with intensive education

through the Mission-St. Joseph’s Diabetes and Health Education Center.

• Patients were then teamed with community pharmacists who made sure they were using their medications correctly.

Pharmaceutical care in community pharmacy

• Patients with diabetes soon began experiencing improved A1C levels, lower total health care costs, fewer sick days and increased satisfaction with their pharmacist’s services.

Pharmaceutical care in community pharmacy• Project ImPACT (Improve Persistence and Compliance with

Therapy).

• Objective: To demonstrate that pharmacists, working collaboratively with patients and physicians and having immediate access to patient data, promote patient persistence and compliance with prescribed dyslipidemic therapy that enables patients to achieve their National Cholesterol Education Program (NCEP) goals.

J Am Pharm Assoc. 200;40:157-65.

Pharmaceutical care in community pharmacy• Results: In a population of 397 patients over an average period of 24.6

months, observed rates for persistence and compliance with medication therapy were 93.6% and 90.1%, respectively, and 62.5% of patients had reached and were maintained at their NCEP lipid goal at the end of the project.


Pharmaceutical care in community pharmacy• Conclusion: Working collaboratively with patients, physicians, and

other health care providers, pharmacists who have ready access to objective clinical data, and who have the necessary knowledge, skills, and resources, can provide an advanced level of care that results in successful management of dyslipidemia.


April 29, 2005

Medication Therapy Management• Medication Therapy Management is a distinct service or group of

services that optimize therapeutic outcomes for individual patients.

Core Components of CommunityPharmacy MTM

Medication therapy review

A personal medication record

A medication action plan

Interventionand referral

Documentation and follow-up


• Medication Therapy Review:• The pharmacist completes a medication therapy review (MTR) consultation

with the patient or caregiver.


• Personal Medication Record: The patient receives a personal medication record (PMR) after a comprehensive MTR.


• Medication Action Plan: The patient receives a medication action plan (MAP) at the end of an MTM visit.


• Intervention and/or Referral: The pharmacist provides consultative services and intervenes to address medication-related problems; when necessary.

• The pharmacist refers the patient to other health care providers.


• Documentation and Follow-up: • MTM services are documented in a consistent manner.

• Follow-up MTM visit is scheduled with the patient or caregiver.

Medication Therapy Management• The model services are designed to:

• Optimize medication use for improved patient outcomes.

• Enhance communication among patients and providers.

• Improve collaboration among providers.

Medication Therapy Management• MTM services will:

• Enhance patients‘ understanding of appropriate drug use.

• Increase compliance with medication therapy..

• Improve detection of adverse drug events.

Medication Therapy Management

• These services will be provided in a private or semiprivate area.

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222 PHCL