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PHARMACEUTICAL CARE 1PHARMACEUTICAL CARE 1(GENERAL PRINCIPLES OF HEALTH CARE)(GENERAL PRINCIPLES OF HEALTH CARE)
AssoAsso. Prof. Ma. Cristina. Prof. Ma. Cristina CatanguiCatangui -- DoriaDoria
UST Faculty of PharmacyUST Faculty of Pharmacy
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Good
Morning
!!!
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UNIT I:UNIT I:
OVERVIEW OF HEALTH CAREOVERVIEW OF HEALTH CARE
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Values and Benefits
The Health Beliefs Model
To fully serve person as a patient
- understand his/hervalues and beliefs in relationship to
the persons concept of health.
Common theme in health profession literature:
- to highlight the difference between the
professionals understanding of the patients
disease and the patients interpretation of feeling
unwell.
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Values and BenefitsThe Health Beliefs Model
In this distinction we see the:
- patients need formore than a scientific
formulation and treatment of problems.
Patients generally want:
- to feel understood and valued
- to be involved in:making sense of their health problems.
decisions about care management
.
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Values and Benefits
The Health Beliefs Model
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Values and Benefits
The Health Beliefs Model
Individual factors include:
perceived susceptibility to illness;perceived seriousness of illness,
perceived barriers to action;
perceived benefits of action, motivation, and self-
efficacy.
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Values and Benefits
The Health Beliefs Model
Modifying factors include:
past personal and family experiences,
information and advice from family and friends,
age, knowledge, fitness level,
external influence of the media.
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Values and Benefits
The Health Beliefs Model
Person:
decides if he or she is ready to take the health actionperceived as necessary by weighing its costs and
benefits. will finally act when a cue of some type occurs---usually
a profound negative event (e.g. stroke after uncontrolledhypertension, hospitalization after uncontrolledhyperglycemia secondary to uncontrolled diabetes).
practical representation of belief and holds up to bothcultural variation and differing definitions of health.
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Patient Relationships
The other decision makers who are in relationship to yourpatient.
A spouse may actually be decision maker in care or mayhave great influence.
A patient may make decisions through the family
members as a unit. Both of these relationships are observed as routine in
some cultures.
patient may have a caregiver, either voluntarily fromrelatives, friends, and neighbors, or formally through the
health system. other people important to the patient may play a role in
influence him or her.
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Medication Use
What does this person believe about the
use of medication as a form of treatment?
Many studies indicate that perceptions ofthe role of medication use are highly
varied---as varied as the characteristics
that affect concepts of health.
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Medication Use
Multiple studies have shown that:
- patients from different ethnic and cultural
backgrounds use alternative medicines or home
remedies, while also participating in a formalhealth care system approach.
Your knowledge of the patients beliefs and his
or her evaluations of treatment options- considered when developing therapeutic plans
and monitoring patient outcomes.
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Health Behavior
Healthrelevant behavior and attitudes
- products ofculture and are viewed in theoverall cultural contextin which they occur.
Fundamental to this new paradigm of practice- understanding behavior, its relationship tohealth, and methods by which it can be altered.
Current concepts of health behavior heavily
influenced by- social learning theory, self- efficacy theory,and a biopsychosocial view of health anddisease.
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Health Behavior
The way that patients behave in relationship totreatment depends on a complex interplay of:
- many psychological, social, and environmental
variables.
To assists them in reaching their goals- understand how behavioral techniques may beused.
Patients with less positive health practices
- more likely to be health illiterate. The stronger a persons perceived capability
to carry out behavior, the more successful heor she is in doing so.
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Health Behavior
Self-care
- a prominent aspect of patient behavior.
- an individual taking responsibility for both
identifying ones problem and determining
the preferred treatment.
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Health Behavior
Over-the-counter product market
- a person can, without ever consulting a
health professional, self-diagnose and
treat. Range of self-care products broad and
varied, including such things as
- herbal remedies, nutraceuticals,vitamins, minerals, and other dietary
supplements.
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Health Behavior
The concept of self-care- extends to patients in hospitals.
A recent study showed that 90% of hospitalpharmacy departments
- allowed own use medications to be brought inby patients.
Prior literature has shown that
- between 35 and 64% of patients bring their own
medications to the hospitals, averaging threemedications per patient.
- Patients often do so to reduce anxiety and lossof self-control while being hospitalized.
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Health Behavior
Individual also self-help by identifying
with self-help groups (e.g., Alcoholics
Anonymous).
- offer emotional support and practical
advice about a common problem they
share.
- almost always member run, voluntary,
and fairly inexpensive.
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Health Behavior
An estimated 15 million Americans are members
of self-help groups, which often lead patients to
seek health information.
- With 70,000+ web sites disseminating healthinformation, more than 50 million people are
seeking health information online.
- Online information is frequently inaccurate, and
people general have poor information-evaluation
skills.
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Health Behavior
However, the fact that 50 million people
use the Internet for this purpose
- potential of the source as part of a largerhealth communication system.
- An investigation and understanding of the
Internets influence on health beliefs and
behaviors is needed.
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Health Behavior
As a pharmacist,
- accessible to the public yet have a highdegree of expertise.
- Patient will seek you out to verify the
accuracy of health information and obtain
your advice.
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Types ofPatients
To optimally care for a patient,
- need to determine what type of patient
the patient is.- Your goal should be to:
recognize and respect the patients
autonomy and support him or her in thedetermination of needs.
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Types ofPatients
In this context, you might view the patient ascoming from three different possible points ofview:
1. The patient as a consumer. The patient viewsyou (the professional) as a competitorwhohas something he or she wants or needs, butviews you as willing to give as little as possiblefor the amount of money. In this case, theconsumer shops around for the commodity(i.e., health care services, pharmaceuticals).
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Types ofPatients
In this context, you might view the patient
as coming from three different possible
points of view:
2. The patient who is dominated by the
professional. The patient views him- or herself
as powerless in decision making and hands
over in a highly dependent way the decisionsto be made to you ( the health professional).
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Types ofPatients
In this context, you might view the patient as
coming from three different possible points of
view:
3. The patient as autonomous and interdependentwith the professional. The patient views him- or
herself as vulnerable and seeks care in an
interdependent fashion. The patient wants to
trust the professionals expertise. However, heor she wants to participate in, rather than hand
over, decisions to the professional.
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Types ofPatients
As a pharmacist,
- encounterall three types of patients.
- Understanding them can help you todetermine how to best meet their needs.
- professional responsibility remains the
same in all three cases. The way you meetyour responsibility will vary.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Does the patient have a concept of the
pharmacist as a care provider?
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THE PATIENT-PHARMACIST
RELATIONSHIP
Expertise and Trust
Some research suggests that from apatient perspective,
- pharmacist expertise is the main factornecessary for establishing qualityrelationship between pharmacist andpatients.
Mutual disclosure
- critical for building trust in pharmacistpatient relationship.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Expertise and Trust
In a study of 200 patient who came to the
pharmacist for prescription,
- 80% expressed the importance of
confidence(professional trust), while
- 58% thought the knowing and liking
(personal trust) the pharmacist was
important in their selection of a pharmacy.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Expertise and Trust
For a nonprescription remedy,
- 72% stated they would accept the pharmacists
advice. For prescription medication,
- 57% were willing to accept advice.
A strong interrelationship exists between- personal and professional trust in both selecting
a pharmacy and accepting advice from a
pharmacist.
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THE PATIENT-PHARMACIST
RELATIONSHIPUnderstanding the Pharmacist as Healer
Some patient view as a healer.
Pharmacists
- occupy a specialized community role,holding the social status as a healer by theuse of medications as treatment.
- recognized as experts who hold the capacity
to cure as well as harm. In general, as with other healers, the
pharmacist is a trusted and respectedmember of the community.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Understanding the Pharmacist as Healer This status is grated by patients who give the pharmacist
this power.
When a patient seeks a pharmacist for advice,
- he or she is placing trust in the intention and skill of thepharmacist.
Many patients understand the pharmacist
- has knowledge that is specialized for this purpose.
For the patient who invests in relationship, a hand holdor touch to the forearm has meaning from you as ahealer, every bit as much as the medications youdispense, monitor, and educate about.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Understanding the Pharmacist as Merchandiser
Some patients may view you as
- a merchandiser, recommending drug product
from the point of view of sales. The 2001 National Pharmacy Consumer Survey
found that
- 30% of patients view pharmacists as their first
choice for information regarding medications,
- only 4% view pharmacists as their first choice
for information regarding disease.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Understanding the Pharmacist asMerchandiser
Individuals may have pre-formed ideas aboutthe role and value of pharmacist without everhaving a direct experience with a pharmacist.
A patients perception of the pharmacist is
- formed by interacting with you.
To change perceptions, change the patientsexperiences by
- helping them realize all the health care valueyou can provide.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Understanding the Pharmacist asMerchandiser
Patients usually come to pharmacists
- to receive services, products, and /or care.
It is usually their choice.
However, as illness progresses or acute eventsrequire intervention,
- the patients choices become limited. When patients come to the hospital to get care,
they dont choose you.
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THE PATIENT-PHARMACIST
RELATIONSHIP
Understanding the Pharmacist asMerchandiser
You are assigned or provided.
Similarly, when patients are referred to homecare services or long-term facilities, pharmacistservices are assigned.
As choice is eliminated, the patient becomes
more dependent on the- pharmacists attributes as a care provider who
advocates for patient needs.
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