3. Advancement in Pharmacy Practice
⢠Emphasizes
Product:
1.Identification
2.Preparation
3.Dispensing
4.Availability
5.Selection
Pharmaceutical
Centred
Practice
⢠Clinical Pharmacy
(ACCP definition
2005)
⢠Pharmaceutical care
⢠Medication therapy
management
⢠Patient-Centered
Pharmaceutical care
Patient
care
Practice
⢠Emphasizes
signs, symptoms,
pharmacotherapy
and outcomes of
a particular
disease
⢠Clinical Pharmacy
(ACCP definition
1990âs)
Disease and
Condition-
Centered
Practice
Before
1970âs
1970âs
to 1990
After
1990
5. Emphasizes:
1. Signs
2. Symptoms
3. Pharmacotherapy
4. Outcomes of a
particular disease
5. Clinical Pharmacy
Disease and
Condition-Centered
Practice
6. Emphasizes on:
1. Clinical Pharmacy
(advanced)
2. Pharmaceutical care
3. Medication therapy
management
4. Patient-Centered
Pharmaceutical care
Patient care
Practice
7. The Need & Reasons for Pharmacy
Practice changes
Poly Pharmacy or Multi-
Meds use without
consulting with HCP
Increase in Patient Self
Care with
complementary and
alternative medicine.
Increase in DRP,
Dispensing Errors,
Morbidity and Mortality
Increase in
health care cost
8. From
Focusing on Products &
service
Serving Customers
Knowledge based education
Little communication
Fragmented services
Independent professional
To
Focusing on patients &
therapeutic outcomes
Caring for Patients
Building problem solving
skills
More Communication &
Counseling
Continuity of care
Being member of healthcare
team
Shifting Focus of Pharmacy Practice
Answering Questions
Listening to patient and
explaining meds usage
Dispensing Meds
Providing pharmaceutical
care
9. Activity: Counseling, Medication
Review, Detecting, Resolving and
Monitoring potential DRPs
Provider:
Pharmacist, Physician,
other HCP
Recipient:
Their Patient
Subject: Medicines,
Pharmacotherapy, Medical
Device, Drug Related
Needs, Health Care,
Disease Prevention
Outcome: Optimal
Pharmacotherapy, Optimal
economic , clinical and
humanistic outcome, Optimal
Quality of life
Pharmaceutical
care is the care of
For the
In the field of
In order to assure
By
Pharmaceutical Care
Comprehensive Definition
13. Pharmacists' Patient Care Process
Pharmacists use a patient-centered approach
in collaboration with other health care
providers team to:
1. Optimize patient health
2. Optimize medication outcomes.
Using principles of evidence-based practice,
pharmacists perform the following
elements processes:
16. The evolving
of New
Pharmacy
Services
⢠Examples of professional services include,
but are not limited to:
1. Adapting a Prescription
2. Therapeutic Substitution
3. Prescribing in an Emergency
4. Refusal to Fill
5. Administration of a Medication by
Injection and Immunization
6. Comprehensive Medication
Management
7. Interpreting and Ordering Laboratory
Tests
8. Minor Ailments Assessment and
Management
9. Medication Reconciliation
10. Chronic Disease Management
11. Pharmacy Point Of Care Testing (POCT)
12. Methadone Maintenance Treatment
and for Pain
13. Professional Specialties
17. 1. Adapting a
Prescription
⢠For existing prescriptions:
⢠Pharmacist may:
1. Alter the dosage,
2. Alter formulation,
3. Alter duration or regimen
⢠All 3 above can be done without
prescriber consent but with
patient consent, and follow up
with an update to the prescriber
18. 2. Therapeutic Substitution
⢠For existing prescriptions:
⢠Pharmacist can:
1. Substitute a drug within
a defined therapeutic
class,
2. Substituting another
drug that is expected to
have an equivalent
therapeutic effect with
the goal of meeting the
patientâs therapeutic
goal.
19. 3. Prescribing in an
Emergency
In the absence of an
existing prescription, but
when there is an immediate
need for drug therapy (in
an emergency), a
community pharmacist can
prescribe an Rx drug:
20. 4. Refusal to Fill
⢠Pharmacists may choose NOT to dispense a prescription when in
their professional judgment it is deemed not to be in the patientâs
best interest
⢠Reasons may include but are not limited to:
1. Significant drug interaction (drug-to-drug)
2. Prior adverse reaction
3. Therapeutic duplication
4. Sub-therapeutic dose
5. Dangerously high dose
6. Treatment failure
7. Potential overuse/abuse
8. Suspected poly-pharmacy/multi-doctoring
9. Falsified/altered prescription
10. Moral reason
11. Early Refills
21. 5. Administration of a
Medication by Injection
and Immunization
⢠A Qualified & Authorized
pharmacist may administer a
medication by injection
⢠for either an existing prescription,
or as needed in an emergency
22.
23. 6. Comprehensive Medication
Management (CMM) and
Medication Reconciliation
â˘Medication Reconciliation
involves creating a list of
medications the patient is
taking
â˘CMM: A comprehensive
review of a patientâs
medications to assess for
⢠Appropriateness âŚ
â˘Efficacy âŚ
â˘Safety âŚ
â˘Convenience
â˘Identification of drug-
related problems (DRP)
ďCreate and implement
care plan with patient
ďCollaboration and
communication with
other healthcare
professionals
ďEvaluation,
documentation and
continuous follow-up
24. 7. Interpreting and
Ordering
Laboratory Tests
â˘As part of the process of
Comprehensive
Medication Management,
pharmacists collect and
apply relevant information to
help respond to the patientâs
health needs; this includes
laboratory data
â˘Laboratory data should be
accessible to pharmacists
via the patientâs electronic
health record; in the
absence of such EHR
access, pharmacist may
request recently done lab
test or order a new one.
25. 8. Minor Ailments Assessment and
Management
â˘Pharmacists can assess
symptoms and prescribe for the
treatment of certain minor and
self-diagnosed ailments.
⢠The minor ailments that can be
treated (e.g., head lice, coughs,
colds, allergies, rashes, cold
sores, hay fever)
⢠The pharmacist may recommend
treatment or refers to the another
health care provider, if unable to
confirm the patientâs diagnosis
and/or the patientâs symptoms are
severe
26. 9. Chronic Disease
Management
â˘Pharmacists apply
the principles of
comprehensive
medication
management CMM to
optimize drug therapy
and improve
outcomes
â˘An inter-professional,
collaborative
approach to
managing patients
with chronic long-
term illness (e.g.,
diabetes,
hypertension, heart
disease, lung
disease)
27. 10. Methadone and
SUBOXONEÂŽ (buprenorphine
and naloxone)
⢠For opiates addicts who seeks to quit
⢠Get specialty training
⢠Ensure that the prescription is appropriate,
current, authentic, and complete.
⢠Follow proper dispensing procedures including
proper packaging, labelling, and checking.
⢠Ensure that the prescriber is authorized.
⢠Ensure patient safety by administering or
witnessing the drug administration.
28. 11. Specialty & sterile
compounding
⢠Get specialty training and
certification
⢠Determine whether the product
shall be compounded in a sterile
environment.
⢠Ensure the quality and accuracy of
the ingredients
⢠Recognize the potential for
incompatibilities
⢠Prepare the product in a logical,
safe and pharmaceutically elegant
manner
⢠Document the required
information and maintain
accurate records.
29. 12. Home
and
Retirement
Home Visits
and Audits.
⢠Proactive care services from primary care (in
reach) into care homes.
⢠Review the Medication Administration Record
(MAR) chart
⢠CMM
⢠Administer flu vaccines
⢠Chronic disease management
30. 13. Smoking
cessation services
1. There is a leadership role for
Pharmacists in smoking cessation and
prevention, and in protection of the
public from the harmful effects of
tobacco smoke.
2. A comprehensive approach to smoking
cessation is important (e.g. assessment,
counselling, pharmacotherapy, ongoing
support, relapse prevention).
3. Pharmacists require specific education,
tools and training to facilitate their
roles in tobacco control.
41. 4IR Pharmacist Future Role is in danger
⢠Future developments in internet-based technologies could
remove pharmacists from the process of care delivery.
⢠4IR could disrupt physical, on-the-ground networks between
doctors, patients and pharmacists and create cyber, in-the-
cloud connections that promote âdirect-to-consumer
pharmacyâ. For instance, big data and AI could identify patient
needs, track medicines usage, and search for pharmaceutical
problems.
⢠All of this could happen automatically based upon algorithms
and specified treatment routines, without the input from
pharmacists in real time. Moreover, these services could be
provided outside of traditional pharmacy locations (such as
community MANUSCRIPT ACCEPTED and hospital pharmacies),
existing only in cyberspace with no or only limited face-to-face
contact.
43. 4IR could disrupt physical, on-the-
ground networks between doctors,
patients and pharmacists and create
cyber, in-the-cloud connections that
promote âdirect-to-consumer
pharmacyâ. For instance, big data and
AI could identify patient needs, track
medicines usage, and search for
pharmaceutical problems.
44. All of this could happen automatically
based upon algorithms and specified
treatment routines, without the input
from pharmacists in real time. Moreover,
these services could be provided outside
of traditional pharmacy locations (such as
community MANUSCRIPT ACCEPTED and
hospital pharmacies), existing only in
cyberspace with no or only limited face-
to-face contact.
45.
46. WHO Digital Health Article Summary
â˘âThe use of digital technologies offers new
opportunities to improve peopleâs health,
But the evidence also highlights challenges in
the impact of some interventions.â
â˘âIf digital technologies are to be sustained
and integrated into health systems, they
must be able to demonstrate long-term
improvements over the traditional ways of
delivering health services.â
