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PHARMACEUTICAL CARE
ARATHY R NATH
DEFINITION
The pharmaceutical care is defined as :
“the responsible provision of drug
therapy for the purpose of achieving
definite therapeutic outcomes that
improve the patients quality of life”.
1.Cure of a disease
2.Elimination or reduction of patients
symptomology
3.Arresting or slowing of a disease
process
4.Preventing a disease or symptoms
OUTCOMES
✓ Pharmaceutical care involves the
process through which a pharmacist
cooperates with a patient and other
professional in designing,
implementation, and monitoring a
therapeutic plan that will produce
specific therapeutic outcomes for the
patient 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
✓ Pharmaceutical care is important element of health
care and should be integrated with other elements of
health care.
✓ Pharmaceutical care is however provided for the direct
benefit of the patient and the pharmacist is
responsible directly to the patient of that care.
✓ Before a pharmacist accepts this responsibility to
provide pharmaceutical care he must pass through the
criteria they are:
➢He must possess knowledge and skill in
pharmaceutics and clinical pharmacology
➢He must be able to mobilize the drug distribution
system by which drug use decisions are
implemented
➢He must be able to develop relationship with the
patients and other health care professionals
needed to provide pharmaceutical care
➢He must be available in the society /community
for patient in time
➢He should have commitment to quality
improvement and assessment procedure
PROCESS OF PHARMACEUTICAL CARE
✓ Collection of patient data
✓ Identification of problems
✓ Establishing outcomes goals through a
good therapeutic plan
✓ Evaluating treatment alternatives ,
by monitoring and modifying therapeutic plan
✓ Individualising drug regimens
✓ Monitoring outcomes.
❑COLLECTION OF PATIENTS DATA
• The pharmacist must collect and generate
subjective and objective information regarding the
patients general health and activity status , past
medical history medication history, social history,
diet, exercise; study, history of present illness and
economic situations sources of information may
include ;but not necessarily limited to the patient
medical charts and reports pharmacist conducted
health physical assessment, the patients family or
caretaker ,insurers and other healthcare providers
like his doctors ,nurse and his regular pharmacists
to whom he goes.
Elements of patient information data
• Demographics : Age, sex, race, height‐weight
• Current problems : sign/ symptoms
• Past medical history
• Past medication history
• Allergies and intolerance
• Pregnancy and lactation status
• Habits (tobacco , alcohol consumption)
• Economic conditions
• Relevant laboratory data
❑ IDENTIFICATION OF PROBLEMS
• The data collected can be used to identify actual or
potential drug‐related problems.
• Since the main focus of pharmaceutical care is
patient and since the pharmacist attends the
patient, it follows that the a pharmacist only can
tackle , all drug related problems.
• These problems may be related to the patients
current drug therapy drug administration drug
compliance, drug toxicity, adverse drug reactions
and failure to achieve desired outcomes by the
treatment. It is estimated by USFDA that 12000
deaths and 15000 cases of hospitalization in the
USA were due to the ADR
DRUG RELATED MORBIDITY
• DRM(drug related morbidity) is a
phenomenon of therapeutic malfunction.
• It is a failure of a therapeutic agents or
agents together to produce intended
therapeutic outcome.
• The concept of DRM includes both treatment
failure and production of a new medical
problem , like ADR or toxic drug effect.
• If DRM is not recognized in time it may lead
to drug related mortality which is ultimate
disaster
Drug related problems examples:-
✓ New or additional drug required
✓ Wrong drug
✓ Too little of the right drug
✓ Too much of the right drug
✓ Adverse drug reaction
✓ Drug not taken appropriately
✓ Medication not indicated
❑ESTABLISHING OUTCOME GOALS
• Drug therapy can produce a range of
positive clinical outcomes it may also result
in negative outcomes resulting in disease
morbidity and even in extreme case
mortality.
• Clearly the potential clinical outcomes are
related to the disease being treated and
the efficacy of the available drug
treatments
DISEASE POSITIVE OUTCOMES
Hypertension Decreased risk of MI, stroke
arrhythmia
Ischemic heart disease Fewer mi angina attacks
reduced risk of sudden death
Peripheral vascular disease Better circulation decreased
need of circulation
Diabetes Fewer hypoglycemic events
less compliance of kidney or
vision
Asthma Fewer acute attacks less
occasions of hospitalization
• Important consideration taken into account
1. Patients expectation of the treatment
2. Patient's suitability for the treatment
3. All his resources to meet the cost of the treatment
• A patient may have a curable disease but his other
concurrent ailment may prevent the most effective
treatment to be given.
• Example:‐ A DM patient may not be given steroids
for severe allergyas it will aggregate his condition.
An Asthma patient also having DM cannot be
treated with steroids for his chronic airflow
obstruction
• Similarly , non availability of certain most
effective drugs that cannot be prescribed
due to hospitals DTC , decisions putting
restrictions on the number of drugs per
prescription or strict antibiotic policy.
• Therefore it is necessary to educate the
patient for the potential outcomes of
drug therapy – positive or negative – so
that he can make an informed decision.
❑ EVALUATING TREATMENT ALTERNATIVES BY
MONITORING AND MODIFYING THERAPEUTIC
PLAN:
▪ While evaluating treatment alternatives or therapeutic options the
following factors have to be considered such as efficacy and safety
availability and cost of treatment and suitability of the treatment to
the patient .
▪ Efficacy and safety must be considered when evaluating the risk
benefit ratio of a particular treatment. The risk – benefit ratio will
depend upon many factors.
▪ Some of the factors are:
Seriousness of disease
Consequences of not treating the disease
The efficacy of the drug.
ADRs associated with the drug therapy
Efficacy of alternative drug or non‐drug therapy
Side effect profile of alternative drugs.
• The pharmacists role especially clinical pharmacists role is
increasingly becoming more evident in evaluating therapeutic
options, modifying and monitoring therapeutic plan.
• Some of the case studies to support this, can be cited as follows. In
one case , pharmacist monitored therapeutic plan of one group was
2.4 days shorter than the control group in which the plan was not
monitored by pharmacist.
• In another case study it was found that pharmacist managed group
(i.e. therapeutic plan being constantly monitored by pharmacist) had
significantly fewer active prescriptions significantly more discharges
from hospitals and significantly fewer deaths.
• The pharmacists managed group also had a less number of
hospitalizations than the control group had. The net monetary savings
between the two groups was 7000 dollars per patient.
❑INDIVIDUALIZING DRUG REGIMEN:
Patient factors Drug factors
1. Diagnosis
2. Treatment goals
3. Physiological and pathological
factors
4. Past medical history, past
medicines received
5. Contraindication
6. Allergies and adverse effects
7. Patient compliance
8. Patients cooperation and
convenience
9. Special consideration
1. Efficacy
2. Adverse effects
3. Prevalence, ability to minimize
4. Ability to monitor for efficacy
and avoid ADR
5. Drug‐drug interactions
6. Pharmacokinetics and
pharmacodynamics
7. Dosage form
8. Route and method of
administration
9. Cost to the patient
10. Government or insurance
company payments, presentation
of bills in their formats.
❑MONITORING OUTCOMES:
• The goals of any therapeutic treatments are
obviously the following:
- To cure the disease
- To eliminate or reduce patients symptoms
-To arrest or slow down disease process
- To prevent the disease or its symptoms to
reappear.
• But often suboptimal result due to the following
broad reasons ,
• some of which are circumstantial, like the following:
-Inappropriate prescribing Inappropriate or
unnecessary drug regimen.
-Inappropriate drug regimen
-Drugs not available ,dispensing error.
-Inappropriate behavior of the patient.
- Inappropriate compliance or non‐compliance of
the drug treatment
-Patient idiosyncrasy
-Inappropriate monitoring
• Inappropriate monitoring is often cited as a major cause
for therapeutic failure. It leads to failure to detect and
resolve inappropriate therapy decisions; and or failure to
monitor for the drugs with narrow therapeutic index.
• Example : if digitalis or theophylline IV delivery is not
followed by TDM, either the desired outcome to stop
arrhythmia (by digitalis), or shortness of breath (by
theophylline)is not achieved or worst a digitalis or
theophylline toxicity may develop, due to overdose.
• Monitoring outcomes involve monitoring four S’s they are :
SIGNS
SYMPTOMS
SIDE EFFECTS
SEQUELAE(CONSEQUENCES)
This applies to all diseases
❑DOCUMENTATION OF INFORMATION
• One of the jobs of a pharmacist as outlined above,
is to regularly update records of the patient with
documentation.
• This is a critical component of pharmaceutical care.
Documenting the provision of pharmaceutical care
is important for many reasons, but the primary
reason is to improve the quality of patient care .
• Documentation provides a record of care provided
and history of the decision made for a specific
patient. IF IT IS NOT DOCUMENTED, IT IS NOT DONE
pharmaceutical care
pharmaceutical care
SUMMARY – PHARMACEUTICAL CARE PLAN
• Establish pharmacist‐ patient relation ship
• Collect data Interpret data
• Identify drug related problems
• Determine priority of drug related problems
• Determine desired outcomes(clinical or
therapeutic)
• Develop therapeutic plan
• Develop monitoring plan
• Implement and follow up pharmaceutical care
plan
THANK YOU

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pharmaceutical care

  • 2. DEFINITION The pharmaceutical care is defined as : “the responsible provision of drug therapy for the purpose of achieving definite therapeutic outcomes that improve the patients quality of life”.
  • 3. 1.Cure of a disease 2.Elimination or reduction of patients symptomology 3.Arresting or slowing of a disease process 4.Preventing a disease or symptoms OUTCOMES
  • 4. ✓ Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professional in designing, implementation, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient this in turn involves three major functions.
  • 5. 1 Identifying potential and actual drug related problems. 2 Resolving actual drug related problems 3 Preventing potential drug related problems ✓ Pharmaceutical care is important element of health care and should be integrated with other elements of health care. ✓ Pharmaceutical care is however provided for the direct benefit of the patient and the pharmacist is responsible directly to the patient of that care. ✓ Before a pharmacist accepts this responsibility to provide pharmaceutical care he must pass through the criteria they are:
  • 6. ➢He must possess knowledge and skill in pharmaceutics and clinical pharmacology ➢He must be able to mobilize the drug distribution system by which drug use decisions are implemented ➢He must be able to develop relationship with the patients and other health care professionals needed to provide pharmaceutical care ➢He must be available in the society /community for patient in time ➢He should have commitment to quality improvement and assessment procedure
  • 7. PROCESS OF PHARMACEUTICAL CARE ✓ Collection of patient data ✓ Identification of problems ✓ Establishing outcomes goals through a good therapeutic plan ✓ Evaluating treatment alternatives , by monitoring and modifying therapeutic plan ✓ Individualising drug regimens ✓ Monitoring outcomes.
  • 8. ❑COLLECTION OF PATIENTS DATA • The pharmacist must collect and generate subjective and objective information regarding the patients general health and activity status , past medical history medication history, social history, diet, exercise; study, history of present illness and economic situations sources of information may include ;but not necessarily limited to the patient medical charts and reports pharmacist conducted health physical assessment, the patients family or caretaker ,insurers and other healthcare providers like his doctors ,nurse and his regular pharmacists to whom he goes.
  • 9. Elements of patient information data • Demographics : Age, sex, race, height‐weight • Current problems : sign/ symptoms • Past medical history • Past medication history • Allergies and intolerance • Pregnancy and lactation status • Habits (tobacco , alcohol consumption) • Economic conditions • Relevant laboratory data
  • 10. ❑ IDENTIFICATION OF PROBLEMS • The data collected can be used to identify actual or potential drug‐related problems. • Since the main focus of pharmaceutical care is patient and since the pharmacist attends the patient, it follows that the a pharmacist only can tackle , all drug related problems. • These problems may be related to the patients current drug therapy drug administration drug compliance, drug toxicity, adverse drug reactions and failure to achieve desired outcomes by the treatment. It is estimated by USFDA that 12000 deaths and 15000 cases of hospitalization in the USA were due to the ADR
  • 11. DRUG RELATED MORBIDITY • DRM(drug related morbidity) is a phenomenon of therapeutic malfunction. • It is a failure of a therapeutic agents or agents together to produce intended therapeutic outcome. • The concept of DRM includes both treatment failure and production of a new medical problem , like ADR or toxic drug effect. • If DRM is not recognized in time it may lead to drug related mortality which is ultimate disaster
  • 12. Drug related problems examples:- ✓ New or additional drug required ✓ Wrong drug ✓ Too little of the right drug ✓ Too much of the right drug ✓ Adverse drug reaction ✓ Drug not taken appropriately ✓ Medication not indicated
  • 13. ❑ESTABLISHING OUTCOME GOALS • Drug therapy can produce a range of positive clinical outcomes it may also result in negative outcomes resulting in disease morbidity and even in extreme case mortality. • Clearly the potential clinical outcomes are related to the disease being treated and the efficacy of the available drug treatments
  • 14. DISEASE POSITIVE OUTCOMES Hypertension Decreased risk of MI, stroke arrhythmia Ischemic heart disease Fewer mi angina attacks reduced risk of sudden death Peripheral vascular disease Better circulation decreased need of circulation Diabetes Fewer hypoglycemic events less compliance of kidney or vision Asthma Fewer acute attacks less occasions of hospitalization
  • 15. • Important consideration taken into account 1. Patients expectation of the treatment 2. Patient's suitability for the treatment 3. All his resources to meet the cost of the treatment • A patient may have a curable disease but his other concurrent ailment may prevent the most effective treatment to be given. • Example:‐ A DM patient may not be given steroids for severe allergyas it will aggregate his condition. An Asthma patient also having DM cannot be treated with steroids for his chronic airflow obstruction
  • 16. • Similarly , non availability of certain most effective drugs that cannot be prescribed due to hospitals DTC , decisions putting restrictions on the number of drugs per prescription or strict antibiotic policy. • Therefore it is necessary to educate the patient for the potential outcomes of drug therapy – positive or negative – so that he can make an informed decision.
  • 17. ❑ EVALUATING TREATMENT ALTERNATIVES BY MONITORING AND MODIFYING THERAPEUTIC PLAN: ▪ While evaluating treatment alternatives or therapeutic options the following factors have to be considered such as efficacy and safety availability and cost of treatment and suitability of the treatment to the patient . ▪ Efficacy and safety must be considered when evaluating the risk benefit ratio of a particular treatment. The risk – benefit ratio will depend upon many factors. ▪ Some of the factors are: Seriousness of disease Consequences of not treating the disease The efficacy of the drug. ADRs associated with the drug therapy Efficacy of alternative drug or non‐drug therapy Side effect profile of alternative drugs.
  • 18. • The pharmacists role especially clinical pharmacists role is increasingly becoming more evident in evaluating therapeutic options, modifying and monitoring therapeutic plan. • Some of the case studies to support this, can be cited as follows. In one case , pharmacist monitored therapeutic plan of one group was 2.4 days shorter than the control group in which the plan was not monitored by pharmacist. • In another case study it was found that pharmacist managed group (i.e. therapeutic plan being constantly monitored by pharmacist) had significantly fewer active prescriptions significantly more discharges from hospitals and significantly fewer deaths. • The pharmacists managed group also had a less number of hospitalizations than the control group had. The net monetary savings between the two groups was 7000 dollars per patient.
  • 19. ❑INDIVIDUALIZING DRUG REGIMEN: Patient factors Drug factors 1. Diagnosis 2. Treatment goals 3. Physiological and pathological factors 4. Past medical history, past medicines received 5. Contraindication 6. Allergies and adverse effects 7. Patient compliance 8. Patients cooperation and convenience 9. Special consideration 1. Efficacy 2. Adverse effects 3. Prevalence, ability to minimize 4. Ability to monitor for efficacy and avoid ADR 5. Drug‐drug interactions 6. Pharmacokinetics and pharmacodynamics 7. Dosage form 8. Route and method of administration 9. Cost to the patient 10. Government or insurance company payments, presentation of bills in their formats.
  • 20. ❑MONITORING OUTCOMES: • The goals of any therapeutic treatments are obviously the following: - To cure the disease - To eliminate or reduce patients symptoms -To arrest or slow down disease process - To prevent the disease or its symptoms to reappear.
  • 21. • But often suboptimal result due to the following broad reasons , • some of which are circumstantial, like the following: -Inappropriate prescribing Inappropriate or unnecessary drug regimen. -Inappropriate drug regimen -Drugs not available ,dispensing error. -Inappropriate behavior of the patient. - Inappropriate compliance or non‐compliance of the drug treatment -Patient idiosyncrasy -Inappropriate monitoring
  • 22. • Inappropriate monitoring is often cited as a major cause for therapeutic failure. It leads to failure to detect and resolve inappropriate therapy decisions; and or failure to monitor for the drugs with narrow therapeutic index. • Example : if digitalis or theophylline IV delivery is not followed by TDM, either the desired outcome to stop arrhythmia (by digitalis), or shortness of breath (by theophylline)is not achieved or worst a digitalis or theophylline toxicity may develop, due to overdose. • Monitoring outcomes involve monitoring four S’s they are : SIGNS SYMPTOMS SIDE EFFECTS SEQUELAE(CONSEQUENCES) This applies to all diseases
  • 23. ❑DOCUMENTATION OF INFORMATION • One of the jobs of a pharmacist as outlined above, is to regularly update records of the patient with documentation. • This is a critical component of pharmaceutical care. Documenting the provision of pharmaceutical care is important for many reasons, but the primary reason is to improve the quality of patient care . • Documentation provides a record of care provided and history of the decision made for a specific patient. IF IT IS NOT DOCUMENTED, IT IS NOT DONE
  • 26. SUMMARY – PHARMACEUTICAL CARE PLAN • Establish pharmacist‐ patient relation ship • Collect data Interpret data • Identify drug related problems • Determine priority of drug related problems • Determine desired outcomes(clinical or therapeutic) • Develop therapeutic plan • Develop monitoring plan • Implement and follow up pharmaceutical care plan