Pharmaceutical Care

Practice
Dispensing pharmacy Pharmaceutical
Care
 Product business  Service (people)
business
 Bring the product to
consumer  Bring the
practitioner to
 Decisions focus on the
patient
business
 Decisions focus on
 Inventory generates
the patient
revenue
 Patient care
 Available service supports
generates revenue
products
 Available products
support service
One is not better than the other, but they require different
skills, knowledge, personnel, equipment, time, and resources.
Dispensing pharmacy
 Success measured as # of
Rx
 Space to display and sell
 Records kept for legal
purposes
 Visits determined by refill
supply
 Business passive via
prescriptions
Pharmaceutical
Care
 Success measured as
patient outcomes
 Space organized to
meet patient needs
 Documentation to
provide quality care
 Visits determined by
patient risk/benefit
 Practice grows via
patient recruitment
Direct patient care
Assessment Follow-up
Care Plan Evaluation
Patient SELF CARE

Practitioner Practitioner
Pharmaceutical Care in Health Care
Primary Knowledge Responsibility in
the drug use
Focus Base process
Diagnosis
and
Medical Care Pathophysiology Prescribing
Treatment of the
patient’s disease

Giving care to the Biological,

Nursing whole patient psychological, social, Drug
Care during the cure or or spiritual human administration
treatment responses

Identifying and Identification,

Pharmaceutical meeting a patient’s prevention, and
Pharmacotherapy
Care drug-related resolution of drug
needs therapy problems
Pharmaceutical care
Definition:
Pharmaceutical care is a patient-
centered practice in which the
practitioner assumes responsibility
for a patient's drug-related needs and
is held accountable for this
commitment.
Pharmaceutical care
 PC is a professional practice that has evolved from
many years of research and development.

 PC is designed to complement existing patient care

practices to make drug therapy more effective and
safe.

 This practitioner is not intended to replace the

physician, the dispensing pharmacist, or any other
health care practitioner.
Pharmaceutical care
 It is taking responsibility for ensuring that all
of a patient’s medications are appropriately
indicated, effective, as safe as possible, and
that the patient is able and willing to take
them as intended.

 This is accomplished by assessing all the

patient’s drug-related needs in order to
identify if any drug therapy problems exist.
Pharmaceutical care
 Pharmacists accept responsibility for optimizing all
of a patient's drug therapy, regardless of the source
(prescription, nonprescription, alternative, or
traditional medicines), to achieve better patient
outcomes and to improve the quality of each
patient's life.

 With the patient's cooperation and in coordination

with the patient's other health care providers.
Why do we need PC
 An increase in the complexity of drug
therapy;

 An increase in self-care through

alternative and complementary medicine;

 A high level of drug-related morbidity and

mortality which results in significant
human and financial costs.
Why do we need PC
 Multiple practitioners writing
prescriptions for a single patient, often
without coordination and communication;
 The large number of medications and
overwhelming amount of drug information
presently available to patients;
 Patients playing a more active role in the
selection and use of medications;
Pharmaceutical care as a generalist practice

 The PC practitioner assesses all of a

patient's medications, medical conditions,
and outcome parameters, not just those
chosen by disease state, drug action, or
quantity of medications consumed
 PC is applicable in all patient care practice
settings including ambulatory, long-term
care, hospital, and clinic settings
 Pharmacits's responsibility
 Assure that the goals of therapy are achieved by
 developing a care plan for each medical condition

 by conducting follow-up evaluations at appropriate times.

 preventing drug therapy problems whenever possible

Pharmaceutical care
 The key components of this description
include
 the PRACTITIONER
 this individual must posses EXPERT
KNOWLEDGE in the area of
PHARMACOTHERAPY
 Must apply this knowledge to the benefit of
a patient by meeting that patient’s drug-
related needs, which BENEFITS the
PATIENT.
Pharmaceutical care
 The key components of this description
include
 the PRACTITIONER
 this individual must posses EXPERT
KNOWLEDGE in the area of
PHARMACOTHERAPY
 Must apply this knowledge to the benefit of
a patient by meeting that patient’s drug-
related needs, which BENEFITS the
PATIENT.
Practitioner requirements to
practice
•Philosophy of practice
•Therapeutic relationship with patients
•An understanding of the patient’s medication
experience
•Rational thought process
-pharmacotherapy workup and drug therapy
problems
•Patient care process
•Documentation system
•Reimbursement system
Characteristics
of the therapeutic relationship

 Mutual respect
 Trust
 Open communication
 Cooperation
 Mutual decision making
 Structure of the Pharmacotherapy
Workup
Drug Therapy Problem Drug Therapy Problem
Unnecessary drug therapy Dosage too low
Needs additional drug therapy
Effectiveness
Dosage too high

Indication Drug product Dosage regimen Outcomes

Safety
Drug Therapy Problem Drug Therapy Problem
Ineffective drug Noncompliance
Adverse drug reaction

•In order for a practitioner to evaluate the effectiveness

and safety of a patient’s drug therapy he must understand
all the steps of the steps above.
•Drug therapy problems can occur anywhere in the patient’s
drug use process
 The Patient's Drug-Related Needs

 We have 2 scenarios
Scenario 1
1-All of the criteria are met;
 The patient's drug-related needs are also being met

 No drug therapy problems exist.

 the pharmacist’s responsibility is to ensure that the goals

of therapy for each medical condition continue to be

achieved.
Scenario 2
. 2- Criteria are not met
 a drug therapy problem exists.

 pharmacits's responsibility to resolve drug therapy

problems with and for the patient

The patient care process
Establish a therapeutic relationship

ASSESSMENT CARE PLAN EVALUATION

What does What am I How will we
my patient going to do know if it is
want and for my working?
need? patient?

Continuous Follow-up
EXAMPLE
Key Points
 A database of 20,761 patients who received

pharmaceutical care during 59,361 patient

encounters has been established over the past 10

years.

 A sample of 5136 was selected and evaluated.

 patients <65 years (n = 3064), had an average of 3

medical conditions with an average of 5 drug

therapies.
Frequency of patients by age.
Frequency of patients by number of
medical conditions
Key Points
 Patients >65 years (n = 2072), had an average of 5

medical conditions being treated with 7

medications.

 34% of the younger patients had a drug therapy

problem, while 54% of the older patients had ≥ 1

drug therapy problems identified by the clinician at

the first pharmaceutical care visit.

Key Points
 The most common drug therapy problem, in both groups,
was the need for additional drug therapy, followed by
dosages too low and then patient compliance problems.
Key Points
 The decisions made by pharmaceutical care
practitioners have been found to be clinically credible
based on the evaluations and comments of peer-
reviewed panels.
Key Points
 Pharmaceutical care practitioners resolve
almost 80% of drug therapy problems
directly with the patient.
 Practitioners were able to produce
positive patient outcomes in 90% of
patients, regardless of the patient's age,
medical conditions, or type of drug
therapy problem.
Key Points
 Pharmaceutical care practice saves patients and the
health care system a significant amount of money and
produces a positive savings to cost ratio
MOST FREQUENT INDICATIONS FOR DRUG
THERAPY
(N = 26,238 Patient Encounters)
1. HYPERTENSION 6. ALLERGIC RHINITIS
2. HYPERLIPIDEMIA 7. ESOPHAGITIS
3. DIABETES 8. DEPRESSION
4. OSTEOPORSIS 9. MENOPAUSAL
5. VITAMIN/DIETARY SYMPTOMS
SUPPLEMENT 10. ARTHRITIS PAIN

These 10 conditions represent

50% of all indications for drug therapy
 DRUG THERAPY PROBLEMS (DTP)
(N =26,238 Patient Encounters)

Percent
Unnecessary Drug Therapy 6%
Indication 34%
Needs Additional Drug Therapy 28 %
Ineffective Drug 8%
Effectiveness 28%
Dosage Too Low 20 %
Adverse Drug Reaction 14 %
Safety 19%
Dosage Too High 5%
Compliance Noncompliance 19 % 19%
Total 100%
Table 7-6
Drug therapy problems by category.
Table 2-13 Type of Drug Therapy Problem—Needs Additional
Drug Therapy

Cause of the problem Patients < 65 Patients 65

yrs olda yrs oldb

Medical condition requires the initiation of 235 (40.1%) 225 (34.9%)

drug therapy

Preventive drug therapy is required to 228 (38.9%) 274 (42.6%)

reduce the risk of developing a new
condition

Medical condition requires additional drug 123 (21.0%) 145 (22.5%)

therapy to attain synergistic or additive
effects
Table 2-19 Most Common Drug Therapy Problems and
Associated Medical Conditions

Patients < 65 yrs old Patients 65 yrs old

Diabetes Needs additional Arthritis Needs additional drug
drug therapy therapy

Depression Needs additional Arthritis Dosage too low

drug therapy

Asthma Needs additional Hypertension Needs additional drug

drug therapy therapy

Asthma Dosage too low Anxiety Needs additional drug

therapy

Menopausal Needs additional Hyperlipidemia Needs additional drug

symptoms drug therapy therapy

Hypertension Needs additional Hypertension Dosage too low

drug therapy

Allergic rhinitis Needs additional Arthritis Adverse drug reaction

drug therapy

Diabetes Dosage too low Arthritis Noncompliance

Hyperlipidemia Needs additional Ischemic heart Needs additional drug

drug therapy disease therapy

Allergic rhinitis Dosage too low Diabetes Dosage too low

PRIMARY METHOD OF RESOLUTION
OF DRUG THERAPY PROBLEMS

Protocol Carrier

Physician
(19%) Patient
(79%)
 Table 2-24 Interventions Made to Resolve Drug Therapy Problems

Patients < 65 years Patients 65 year

% of interventions % of intervention
Required patient intervention only
Initiate new drug therapy 358 451
Change drug product 58 81
Change dosage regimen 293 352
Discontinue drug therapy 129 138
Initiate laboratory test 126 204
monitoring
Education beyond OBRA 330 430
Provided medication reminder 43 54
device
Removed patient barrier 126 131
Other 209 59
Total 1672 (77.6%) 1905 (81.7%)
Required protocol/carrier intervention
Initiate new drug therapy 4 0
Change drug product 6 1
Change dosage regimen 4 0
Discontinue drug therapy 1 4
Other 8 1
Total 23 (1.1%) 6 (0.2%)
 IMPACT OF PHARMACEUTICAL CARE
PRACTICE
Resolution of drug therapy problems with Physicians
initiate new drug therapy 31 %
change drug dosage regimens 23 %
change drug product 15 %
discontinue drug therapy 15 %
laboratory monitoring initiated 10%
other 6%
Change in Clinical Status at Follow-up Evaluation
4492 Patients and 10,485 Medical Conditions

Condition Declined
(16 %)
Condition Improved
or
Remained the Same
(84 %)
 Clinical Outcomes
84% of the medical conditions requiring drug
therapy, which were not already stable at
the time of the first pharmaceutical care
encounter, improved (69%) or remained the
same(15%) through the provision of
pharmaceutical care.