PHARMACEUTICAL CARE CONCEPT Mt ‘Aungkana Chueychat: PharmD Pharmacy Schoo, Weal University qausssarinanteny Ovtaimentitennumes arly Femanirslenies meaviinamendinssy Onmufunaunnmrgnitunnetimeufinamantinera, PHARMACY nun ©The prescription- focused epprosch —-> performed at the time of dispensing the drug product fo the patient. ayer??? Change in medication end how they are used. ©3 Important factor * Increase complexity of medication * Incresse use of medication + Increase cost of medication another factor * continued lack of @ rational, systemetic, end comprehenaive decien-making process fr dug selection, dosing, and monitoring.Increased levels of drug-related morbidity and mortality Highlight report from Gurwitz et al >> “Wt he fdng of the present study ere generalized tothe Populi ofall Medicare enrolese. Thon mare than 800,000 ‘adverse evente-nore than a quarter of which re Preventebl-occur each year among 38 millon Medicare enrollees: furthermore, eatinetes besed on our etudy suggest ‘hat there ere in excess of 180.000 Be threstening or fatal ‘adverse drug events por year, of which more then SOX may be preventable” em. UEDUR, ee Oncse me meraganent PHARMACEUTICAL CARE Pharmaceutical care was develop to ‘Ominimize the use of medications ‘Ominimize the drug-related morbidity and mortality associations with medication use. PHARMACEUTICAL CARE ‘zuvimal >>The patient-centered epproach ©The order of thinking, making decisions and acting elways Is 1 = Patient + 2°! Medical condition +9" - Medicetions “Pattent wants Is the most Important”The Philosophy of practice ‘Expectation to be Patient-centered The patient come first ‘The patient needs determine all that you do and the patient ls st the center of all declelon making, ‘ctions token and results Interpreted. “drug don't have dose-people have doses” PHARMACEUTICAL CARE completely seperate from the dispensing process. 8 specielly trained prectitioner —> usuelly @ pharmacist working in @ clinic setting. the practitioner who provides medication management service Is not there to replace the physician, the dispensing phermacist, or any other health cere practitioner PHARMACEUTICAL CARE AS A GENERALIST PRACTICE Assess all of a patient's medications, medical conditions end outcome perameter, not Just ‘those chosen by disease state, drug action, or quantity of medications consumed, OThe generalist Kenties, resolves and prevent drug therapy problems up to a level of complexity defined by the standard of care for practice. a PHARMACEUTICAL CARE ©The service Is being delivered face-to-face and offered telephonically. ©The practice process end stendards associated with the practice will remain the same setting, only the delivery technique chenges.PHARMACEUTICAL CARE PRACTITIONER They are meant to complement existing patent cere practices to make drug therapy more effective and safe(individval assessment) All medications are the most appropriated, the most effective available, the safest possible ‘and convenient enough for specific patient 4p take as Intended. This standard requires extensive knowledge in the eress of + Pharmacobgy ++ Pharmecotherapeutics ‘+ Pharmacokinetics * Blopharmaceutics Toxicology * Pathophysiology ‘* Physical chemistry * Patient behavior STANDARD OF PHARMACEUTICAL CARE 1. Identfy patients who have not achieved Clinical goals of therepy. 2. Understand the patient’s personal medications ‘experience/ history and preference/ believe 3. [denny actual use patterns of all medications. UNDERSTANDING THE PATIENT'S CONCEPT OF ILLNESS ‘We must first understand how the patient thinks about his health and his illness. Useful set of 4 dimensions * What are the petients Adeas about thelr lthess? ‘+ What are the patient's footing? ‘+ What are the expectations of the clnicten? * What are the effects of the Hlness on functions?‘THE PATIENT'S MEDICATION EXPERIENCE OThe sum of all the events @ patient has In his Metime thet Involve drug therapy oThis lived experience shapes his attitudes, beliefs, and preferences about drug therapy. Your primary responsiblity as @ pharmaceutical care prectifioner Is to Improve each patient's medication experience- to make It better then It was before you provided care. 8 UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE ‘©Whet Is the patient's general attitude toward taking medications? * Beliefs and otttdes work fo establish specific preference that each petient hes ebout teking medications. cnegetve end pontve atttede UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE ©To what extent does the patient understand her medications? ‘The patient may present wih # though and comprehensive understanding of ell her drug therapies or may understand very litle about the medtcattons ‘+The pharmaceutical care practitioner must elicit {enough information from the patient to determine how well she understands medications. ” UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE ‘©What does the patient want/expect from her drug therapy? Example: ‘The patient describes thet she wents fo “not have {o take 80 meny pls every dey” ‘+The practitioner should make every effort fo imhimize the number or frequency ad doses she 1s require to teke every day.UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE ‘What concerns does the patient have ebout her drug therapy? ‘It le Important to know all of @ patient's conceme. because they have @ dramatic Impact on the Patient's medication taking behavior. UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE Are the cultural, religious, or ethic Issue that Influence the patient's willingness to take medication? * They can impact a patients attiude and bebofe bout the eiicacy of the medicetion, its ‘pproprieteness, and the proper way to edminister cs UNDERSTANDING THE PATIENT'S MEDICATION EXPERIENCE IN PRACTICE ‘What Is the patient’s medication teking behavior? + Allof the components (8 patent's expectations, vahves, concerns, understanding, belies, atthudes, preferences, culture end religion) can inivence hat is described ae the patients medication taking behavior. STANDARD OF PHARMACEUTICAL CARE, 4, Asgess each medication The Information required Patient data * demographic information, medication experience Disease data ‘+ current medicel condition, medical history, nutrition ‘telus, review of system Drug deta “+ current medicetion, pest medication use, soci drug ee, Immunizations allergies and alerts ol>>>assessmente<< 03. major activities Gethering Information from the patient, end the patient's health record. Eliciting the patient's medication experience. ‘Making clinical decision about the pattent’s medication. >>passessmente<< 04 logical questions: * Does the patient heve @ clinical indication for each of his or her drug theraples, and Is esch of the patent's Indicetion beng trested with drug therspy? + Are these drug therapies aflacive for the patient's medical condition? ‘+ Are the drug thereples as safe os posable? ‘the pationt able and willng to take the medication Intended? ‘Add >>> Cost of medication 5 5. Identify all drug therapy problems esCategoriee of drug therapy probleme ralaersenmeinrtam | _talubyrenmetn tian TUmeceesry ug ery felt 2. Needs don erg ery S holectre 9 wehteniueeton “Dongs fo ow B Adverse dg ronson rrmientnaaice 6 Dosage foo Mh erature : . STANDARD OF PHARMACEUTICAL CARE, 6. develop @ care plan addressing recommended steps. 7, Patient agrees with end understends care plan.>>9Care Plan Developmentec< ©The purpose of the care plen Is to orgenize alll ‘the work agreed upon by the practitioner end ‘he patient fo achieve the goals of therepy. Care plan contain interventions designed to ‘resolve drug therapy problems. ‘+ achieve the stared gools of therepy ‘Prevent new drug therapy problems from developing (most importent) ‘ STANDARD OF PHARMACEUTICAL CARE. 8, Document all steps and current clinical status versus gools of therapy. 9. Follow-up evaluations. “If you do not follow-up, you do not care” >>2Follow-up Evalvationce< ©The purpose Is to ‘+ dotermine the actual outcomes of drug therapy for the patient and compare these reaul with the Intended goels of therapy. + determine the effectiveness end safety of pharmacotherapy. ‘+ evaluate patient adherence, + eotebiuh the current statue of the patient's medical conditions being managed wih drug therapy. a1 >>9Follow-up Evaluationc<< ‘The specific activities, Observe or messure the postive results the patent has expertenced from drug therapies (effectiveness) Observe or meeaure any undesirable effects the patent hea experienced thet were caused by a drug therapy (oafety) Determine the actvel dosage of medication the patent Is taking thet i producing the results observed (scherence) »>>>Follow-up Evalvationce< The speciic ectivties. Make # chnicel judgment of the status of the Pettent’s medicel condition or Iless being meneged with drug therapy (outcomes) OReassess the patient to determine If he or she developed ony new drug therapy problems. ‘THE PRACTITIONER AND A PATIENT FORM RELATIONSHIP ©The therapeutic relationship defined ‘8 partnership or allance between the practitioner ‘nd the patient formed for the purpose of ‘optimizing the patient's medicetion experience ‘THE PRACTITIONER AND A PATIENT FORM RELATIONSHIP (©The Important of the therapeutic relationship ‘= The quality of the cere provided will depend on the quality of the therepeutic reletionship developed because the reletionship will impect the Information shared, the decisions made, and what you can foam from the patient. ‘THE PRACTITIONER AND A PATIENT FORM RELATIONSHIP ©The patient es @ primary source of information * The patient either knows everything the prectitoner needs fo learn ebout the case or has primary access fo the necessary information. ©The patient as decision maker + The potient is the ultimate decision maker in his, oF her heath care.‘THE PRACTITIONER AND A PATIENT FORM RELATIONSHIP ©The patient's rights Petient expect you fo.. + care about whet they want * put their needs first, before your own ‘possess the technicel knowledge and the clinical ‘experience end confidence It takes to epply thet knowledge fo their individual cose Patient expect you to.. ‘+ compassion and understanding of them as Incvidvale + receive the sppropriate medication for thelr ‘medical problems and they expect the medication to work. ‘*be realistic and honest about what they can ‘expect from thelr medications Patient expect you tou. ‘be their advocate for all thelr drug-related needs. ‘*be accountable for the decisions you make and the advice you give ‘+ know when to refer them to someone with diferent experience ‘THE PRACTITIONER AND A PATIENT FORM RELATIONSHIP (The patient's responsibiltios You can expect your patients to + provide you with eccurate end complete Informetion ‘* participate in establishing the goals of therapy * contribute fo the cere plan #8 agreed upon * maintain a dlery of medication use, signs and ‘symptoms, and results if needed to evaluate effectiveness, sefety end compliance.You can expect your patients to ‘notify you of change and/or problema with thelr drug therepy #0 you can act on before they become harmful ‘+ ask question whenever they arise qnusnlfivasijectiiem PHARM CARE IAA Standard I: Quality of Care ‘+ vse evidence from the Itersture fo evalte performance in practice ‘+ seck peer review on 9 continual end frequent basis + utlizes deta generated from practice to critically ‘evaluate performance OStanderd I Ethics + maintain patent confidently + act 0 « patient advocste * deliver care in 8 nonjudgmental and nondlecriminetory manner that lo eenelive 40 patient dverstty + deliver core in @ manner that preserves/protects patient autonomy, digaty end righto + seek avalsble resources 10 help formulete ethical doctelone. ® Standard II: Collegiality * offers professionel assistance to other practitioners whenever asked. * support positive relationship with patients, physicten, nurses end other heelth care providersStandard 1V: Collaboration ‘+ The patient Is seen as the ultmete decision rmeker, and the practitioner collaborate sccordingly. ‘+ The practioner collaborate with the patient's heslth cere providers wherever It Is In the best Interest of the patient. Standard V: Education * uses the skill of reflecting on practice to entity frees where knowledge needs to be ‘supplemented. * continelly updetes knowledge with Journal subscriptions, current texts, precttioner Interactions, and contiwing education programs Standard VI: Research ‘use research results @s the bests for practice + systematically reviews the literature to identify knowledge, skill techniques and products thet ere helpful in practice and implement them in a timely ‘+ approaches practice with @ perspective to conduct applied research In practice when appropriate Standard VIE Resource Allocation +16 sensitive to the finenctel needs and resource limitations of the patient the heslth care providers ‘and the Insttutons ‘Decision are made by the practitioner to conserve| resources end maximize the value of those resource consumed In practiceTHE PRACTICE MANAGEMENT SYSTEM Olnckdes all the resources required to provide ‘a service to patients In en effective and efficient manner Othe key to a successful practice Is to add new patient continually 80 the practice cen become financially vieble, end survive over the long term. ‘The Practice Management System involve the following major categories of Information about the practice: ‘+8 clear mission for the practice + recognition ofall the resources requires to deliver the service + development the methods for evahution of the practice ‘+ Identifcation of ways to reward the practioner ‘and fnancialy support the longevity of the practice » ‘STRUCTURES FOR DELIVERING MEDICATION MANAGEMENT SERVICES Ambulatory care setting CAPD and hemodialysis patient setting Warfarin clinic setting COPD and esthma clinic setting Acute care setting Critical care setting Oncology setting | Community phermecy setting a rclevsivaa PHARMACEUTICAL CARE PRACTICE Odecrease medical cost Coimprove cinicel outcomes have significant Impact on the appropriateness, effectiveness, safety and compliance with medicationsrelevsfaaa PHARMACEUTICAL CARE PRACTICE ‘Results from @ high-risk medication population ‘The percentage of medical conditions st gos! changed from 54x ot besetine to 80X with the service end on averege sevings of $1584 per patient and $2,729,424 in total cost saving were realized os @ result of Identifying and resolving drug therapy problems,