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Pharmaceutical Care Akram Ahmad 2nd Pharm.D(P.B.) Department of Pharmacy Practice. Annamalai University
Pharmaceutical care 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” These outcomes are : Cure of the disease Elimination or reduction of patient`s symptomology Arresting or slowing of a disease process
Basic Elements of Pharmaceutical Care Patient oriented Both acute and chronic problems addressed Stress on prevention of drug related problems Documented system on patients record need and care. Offering continuous care in systematic way. Taking help of other health care providers in integrating the care provided. Highly accuntable and responsible Emphasis on optimizing patients health quality of life.
Basic Elements of PharmaceuticalCare(conti..) Emphasis on patient`s health education and health promotion. Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other professionals in designing,implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patients. Three major functions
Conti… 1-Identifying potential and actual drug- related problems. 2-Pesolving actual drug-related problems and 3-Preventing potential drug-related problems. The pharmacist ,who is the central figure of pharmaceutical care,then he has the following functions to perform
Function of Pharmacist ToPerform 1-Collection of patient data. 2-Identification of problems. 3-Establishing outcome goals through a good therapeutic plan 4-Evaluating treatment alternatives,by monitoring and modifying therapeutic plan. 5-Individualising drug regimens. 6-Monitoring outcomes.
Types of Pharmaceutical Care SOAP Analysis CORE Pharmacotherapy plan FARM Analysis. PRIME Pharmacotherapy plan P-Pharmaceutical based problems’ 1-pt not receving a prescribed drug 2-routine monitoring ( lab data) R-risks ,to patients- ADR
Format of a SOAP note: The SOAP format is the one used most often by medical practitioners; however, when used within the pharmaceutical care context, the content of the sections must be revised to match the pharmacist’s legal scope of practice. S=subjective findingsExp-chief complaints and duration or severity of symptoms.
O=objective findingsExp-laboratory data, weight, height, blood pressure, and pulse.A=assesmentDiagnogsis or possible explanations for the patients medical problems.P=PlanDrug regimen or surgical procedure
CORE C=Condition or patient need, it may include nonmedical conditions or need and is thus not a reiteration of the current medical problem. O=outcome, desired for the condition or needs.1. Patient outcomes (POEMS: patient- oriented evidence that matters)
There are generally five category of patient outcome:1. Mortality2. MorbidityA)-related to disease process,B)-related to medication/ treatment plan3. Behavior4. Economic5. Quality of life
Therapeutic end point (surrogate markers; DOES: disease oriented evidence) A) a therapeutic end point represents the pharmacological or therapeutic effects that is expected, ultimately, to achieve the desired outcome. B)more than one end point is usually needed to achieve an outcome-for example, both near normal glycemic control and normalization of blood pressure are necessary to significant reduce the risk of
R=regimen to achieve desired outcome1. Therapeutic regimensExisting therapyInitial therapy2. Goal setting and behavior regimensa. Identify the type of goal being set, such as the followingStart a new positive action-exercise programIncrease the frequency or intensity of a positive action- drink 2 more cup of
CORE-Analysis Stop or decrease- stop smoking Continue an action that is perfect- continue to exercise 30 min a day, every day.b)State the behavior goal in terms that are clear, specific and reasonable.E=Evaluation parameter to assess outcome achievement.1. Efficacy parameters2. Toxicity parameters- ADRs, allergic reactions, or toxicity is not occuring.
FARM NOTE Formulate a FARM note or SOAP note to describe and document the interventions intented or provided by the pharmacist. Some healthcare facility may specific one format over the other; F= findingsThe patient-specific information that gives a basis for, or leads to, the recognition of a pharmacotherapy problem or indication for pharmacist intervention, finding include subjective and objective information about the patient.
A=assessment a.) any additional information that is needed to best access the problem to make recommendations B) the severity, priority or urgency of the problem C) the short-term and long term goals of the problam Short term goals: eliminate symptoms, lower BP to 140/90 mm Hg within 6 weeks, manage acute asthma flareup without requiring hospitalization.
R= resolution (including prevention)The intervention plan includes actual or proposed action by pharmacist1. observing, reassessing2. Counseling3. Making recommendations to the patients4. Informing the prescriber5. Making recommendations to the prescriber6. Withholding medication or advising against use
M=monitoring and follow up.1. The parameter to be followed (pain, depressed mood, serum potassium level)2. The intent of the monitoring (efficacy, toxicity, adverse event)3. How the parameter will be monitored (patient interview, serum drug level, physical examination)4. Frequency of monitoring (weekly, monthly)5. Duration of monitoring (weekly, monthly)6. Duration of monitoring (until resolved, while on antibiotic, until resolved them monthly for 1 year)
Anticipated or desired finding (no pain, euglycemia, healing of lesion) Decision point to alter therapy when or if outcome is not achieved (pain still present after 3 days, mild hypoglycemia more than two times a week)
PRIME PharmacotherapyPlan I-Interactions -Drug-drug interaction, food drug interaction M-Mismatch between medication and condition or pt needs. E-Efficacy, efficacy issues Too much of the correct drug Too much little of the correct drug Wrong drug, device, intervention, or regimen prescribed ; more efficacious choice possible)