ABOUT PHARMACEUTICAL CARE

1. PHARMACEUTICAL CARE
INTRODUCTION
The word "Pharmaceutical Care" was coined by Mikeal et.al in1975
defined pharmaceutical care as 'The care that is given to patient requires
& recieve which assure safe &rational drug use.
DEFINITION:
Underwent various modifications, In 1990, Duglas C hepler and Linda M
Strand gave a new definition to pharmceutical care which is globally
accepted.
-It is defined that"Pharmaceutical Care as the responsible provision of
drug therapy for the purpose of achieving definite outcomes that improves
quality of life.
-Adopted by International Pharmaceutical federation (FIP) in 1998.
Outcomes of Pharmaceutical Care :
• 1. Cure of a disease
• 2. Elimination or reduction of patient's symptomology .
• 3. Arresting or slowing of a disease process.
• 4. Preventing a disease or symptoms.
Basic Elements Of Pharmaceutical Care:
• Patient Oriented
• Both acute and chronic problems adressed
• Stress on prevention of drug related problems
• Document system on patients record need &care
• Offering continous care in systematic way.
• Emphasize in optimizing patient health quality of life.

2. • Emphasizes on patient's health education and health promotion
- Pharmaceutical care involves the process through which a
pharmacist cooperates with a patient and other professionals
indesigning, Bimplementing andmonitoring atherapeutic plan that
will produce a specific therapeutic outcomes for the patients
Functions Of Pharmaceutical Care :
 Identifying potential and actual drug related problems.
 Resolving actual drug-related problems and
 Preventing potential drug-related problems
CRITERIA
The pharmacist should pass these five criterias to provide
pharmaceutical care:
1. Possess knowledge and skill in pharmaceutics and clinical
pharmacology.
2. Able to mobilize the drug distribution system by which drug use
decisions are implemented.
3. Able to develop relationship with patients and other healthcare
professionals needed to provide pharmaceutical care
4. Available in the society/community for patients in time.
5. Should have commitment to quality improvement and assessment
procedure.
STEPS INVOLVED IN PHARMACEUTICAL CARE :
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

3. 5. INDIVIDUALISING DRUG REGIMENS
6. MONITORING OUTCOMES
1. COLLECTION OF PATIENTS DATA :
 Patient Demographics: Age, race, sex
 Pertinent medical information
 Current and past medical history
 Family history
 Medication history
 Dietary history
 Social habits
 Physical findings
 Laboratory Findings
 Patient complaints: Signs and symptoms
2. IDENTIFICATION OF PROBLEMS :
 It is drug related problems
 The goal is to identify actual or potential problem
 ACTUAL: A condition that requires the initiation of a new or
additional drug
 POTENTIAL: The patient may be at risk to develop a new medical
problem.
 These problems may be related to the patient's current drug therapy,
drug administration, drug compliance, drug toxicity, ADR's and a
failure to achieve desired outcomes by the treatment.
 It is used to identify the PRIME pharmacotherapeutic problems.
 Drug related problems examples:-
 Wrong drug
 Too little of the right drug
 Too much of the right drug
 Adverse drug reaction
 Drug not taken appropriately
 Medication not indicated
3. ESTABLISHING OUTCOME GOALS :

4.  Drug therapy can produce positive outcome:
 Cure of the disease
 Elimination or reduction of patient's symptomology.
 Arresting or slowing of a disease process.
 Preventing a disease or symptoms.
It may also produce negative result, i.e. resulting in disease morbidity
and sometimes mortality.
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,Decerased need of circulation
Diabetes Fewer Hypoglycemic agents,lesscompliance of kidney or vision
Asthma Fewer acute attacks,less occasions of hospitalization.
4. EVALUATING TREATMENT ALTERNATIVES BY
MONITORING:
Pharmaceutical care –
 Efficacy, safety, availability and cost of treatment &suitability of the
treatment to the patient should be
considered while evaluating.
 The risk-benefit ratio factors should also be considered: seriousness of the
disease, complications if untreated, efficacy of drug, ADR's.
5.INDIVIDUALISING DRUG REGIMENS :
✓When more than one therapeutic alternative exist, the following factors to be
considered:

5.  Patient factors:- diagnosis, treatment goals, past
medical and medication history, contraindication, allergies, compliance,
etc.
 Drug factors:- efficacy, adverse effects, dosage form, cost, drug-drug
interactions, pharmacokinetic and pharmacodynamics,
5. MONITORING OUTCOMES
The goals of any therapeutic treatment are:
 Cure of the disease
 Elimination or reduction of patient's symptoms
 Arresting or slowing of a disease process
 Preventing a disease or symptoms.
Suboptimal outcomes include:
 Inappropriate pprescribing
 Unnecessary drug regimen
 Dispensing error
 Non-compliance
 Patient idiosyncracy
To ensure good monitoring outcomes:
 Regularly reviews subjective and objective monitoring parameters and
checks whether satisfactory progression is
made or not according to the therapeutic plan
 To determine whether original plan should continue or any
treatment modifications has to be made or not.
 Reviews ongoing progress in achieving desire outcomes and
provides report to the patient and other healthcare providers.
 Provides follow up with the patient
 Should regularly update patient's medical/pharmacy records with
information concerning patient's progress.
6. DOCUMENTATION

6.  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
Types of Pharmaceutical Care :
1. SOAP Analysis
2. CORE Pharmacotherapy plan
3. FARM Analysis
4. PRIME Pharmacotherapy Plan
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 findings
Exp-chief complaints and duration or severity of symptoms.
 *O=objective findings
Exp-laboratory data, weight, height, blood pressure, and pulse. Diagnogsis or
possible explanations for the
 A=assesment
patients medical problems.
 P=Plan
Drug 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.

7.  Patient outcomes (POEMS: patient oriented evidence that matters)
There are generally five category of patient outcome:
1. Mortality
2. Morbidity
A)-related to disease process,
B)-related to medication/ treatment plan
3. Behavior
4. Economic
5. Quality of life
 regimen to achieve desired outcome
1. Therapeutic regimens
Existing therapy
Initial therapy
2. Goal setting and behavior regimens
 Identify the type of goal being set, such
as the following Start a new positive action-exercise program.
 Stop or decrease- stop smoking
- Continue an action that is perfect
continue to exercise 30 min a day, every day.
 State the behavior goal in terms that are
clear, specific and reasonable.
E=Evaluation parameter to assess outcome achievement.
1. Efficacy parameters
2. 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= findings
 The patient-specific information that gives a basis for, or leads to, the
recognition of a pharmacotherapy problem or indication for pharmacist

8. 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 problem
. 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 pharmacist:
1. observing,

 2. Counseling
3. Making recommendations to the patients
4. Informing the prescriber
5. Making recommendations to the prescriber.

6. Withholding medication or advising against use.
PRIME Pharmacotherapy:
 •P-Pharmaceutical based problems
 ' 1-pt not receving a prescribed drug
 2-routine monitoring (lab data)
 R-risks,to patients-ADR
 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

9.  Wrong drug, device, intervention, or regimen prescribed; more efficacious
choice possible)
 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)
PHARMACIST'S ROLE IN PHARMACEUTICAL CARE :
1. PATIENT ASSESSMENT
✓Physical assessment
✓Barriers to adherence
✔Psychological issues
2. PATIENT EDUCATION AND COUNSELLING
✔Interview skills
✓Communication skills
✓Ability to motivate, inspire Identification & resolution of compliance
barriers
 PATIENT-SPECIFIC PHARMACIST CARE PLANS
-Recognition, prevention & management of drug iinteractions.
✔ Pharmacology & therapeutics.
✓ Interpretation of laboratory tests.
✓ Knowledge of community resources.
✔Professional referrals.
 * DRUG TREATMENT PROTOCOLS

 ✓Develop & maintain protocols
✔Follow protocols as a pharmacist clinician

10.  ¥ DOSAGE ADJUSTMENT:
✔Apply pharmacokinetic principles to determine
patient specific dosing.
 >SELECTION OF THERAPEUTIC ALTERNATIVES:
✓Use drug information resources effectively
✓Construct comparative analysis to support therapeutic decisions
PHARMACEUTICAL CARE IN HOSPITALS :
 >Prescription monitoring
>Prescribing advice to medical and nursing staff
 >Medication errors and adverse reaction monitoring
 ~Medication history interview
>Patient education and counselling
>Pharmacokinetics and therapeutic drug monitoring
~Hospital formulary
Skill required for good pharmaceutical care practice:
 Good communication skill

 Sound knowledge on therapeutics
Prescription interpretation skills
• Maintenance of records
Barriers to implement pharmaceutical care :
 A. The Pharmacist Based Barriers :
•Lack of time
 •Lack of knowledge
• Training to provide the service
 •Lack of assertivenes.
 •Poor communication skills
.Non legalization of services .

11.  •Lack of remuneration
.Assumption that patient care is the doctor's responsibility.
 B. Pharmacy specific:
➤ Inadequate space and facilities
 ➤ Inadequate aids for providing
Pharmaceutical care to the patients
