PHARMACEUTICAL CARE

(GENERAL PRINCIPLES OF HEALTH CARE)

May T. Magtoto
UST Faculty of Pharmacy

Many people
spend their
HEALTH to gain
WEALTH, and
later on, spend all
their WEALTH in
a desperate effort
to regain
HEALTH

GENERAL PRINCIPLES OF
HEALTH CARE

HEALTH
BACKGROUND
Sickness has been
one of mans greatest
adversaries

HEALTH
BACKGROUND
To identify or
diagnose a specific
disease or injury
Physicians,
pharmacists, and
other health care
professionals
utilize clues

MEDICINE
Latin word medicus
It is a healing art
Aims to help people
become more active
and live longer and
happier lives with less
suffering and disability

MEDICINE
Constant search
New drugs
Effective
treatments
More advanced
technology
Health care
professionals can prevent,
control or cure hundreds
of diseases

MEDICINE
Has become a part of
the health care
industry
One of the largest
industries in the
world
One of the leading
employers in most
communities

At the turn of the

20th century (1900)
Men and women
were frail by age 40
Life expectancy was
47.3 years
Effective treatment
for diseases were
so scarce

By the end of the

20th century
Medical advances
Life expectancy
increased to 76
years

Today
People in their
80s and 90s are
independent and
physically active
Medical
expansion has
been expensive

HISTORY OF HEALTH
CARE
Diseases were attributed to
the influence of malevolent
demons
Diseases were believed to
project an alien spirit, a stone,
or a worm into the body of the
unsuspecting patient

Trepanning
Alien spirits are
expelled by potions
that caused violent
vomiting, or could
be driven out through
a hole cut in the
skull
Remedy for insanity,
epilepsy and
headache

Trepanated skull, Iron age. The

perimeter of the hole in the skull is
rounded off by ingrowth of new bony
tissue, indicating that the patient
survived the operation.

Dr. John Clarke trepanning a skull,

ca. 1664, in one of the earliest
American portraits. Clarke was
allegedly the first physician to
perform the operation in the U.S

18th century French

illustration of trepanation

The Spinning Treatment was

one of many treatments that
attempted to rid the body of
mental illness through
physical means

The Spread Eagle Cure was

used to treat disorderly
patients. Cold water was
poured from a height over the
persons face until the patient
is "calm"

Mild electric shock was used to

stimulate the muscles and the
mind in this 19th century cure
for mental illness known as
Faradization.

HISTORY OF HEALTH CARE

Surgical procedures practiced in ancient societies
Cleaning and treating wounds by cautery
(burning or searing tissue), poultices, and
sutures
Resetting dislocations and fractures, and using
splints to support or immobilize broken bones

HISTORY OF HEALTH CARE

Additional therapy included laxatives and enemas to
treat constipation and other gastrointestinal diseases

HISTORY OF
HEALTH CARE
Discovery of the narcotic and
stimulating properties of
certain plant extracts

Many are still of use today

Digoxin, a heart stimulant
extracted from foxglove
(Digitalis purpurea)

Opium poppy (Papaver

somniferum) is the
species of plant from
which opium and poppy seeds
are extracted. Opium is the
source of many opiates,
including morphine (and its
derivative heroin), thebaine, co
deine, papaverine,
and noscapine.

HEALTH CARE PROFESSIONALS

Work in health care services, involved in the diagnosis
and treatment of patients
Research, teaching or administration of medical
facilities

PHARMACIST
Has a unique body of
knowledge and skills to
contribute in our
health care system
Dispenses the
appropriate drug
product and has the
knowledge to assure
safe and rational use of
drugs

EARLY FUNCTIONS OF PHARMACISTS

1. Assisting in the
selection of
appropriate
drug therapy

2. Preparing,
compounding and
manufacturing
drugs for
individualized
patients

3. Dispensing and
packaging the
prescribed
drug products
including proper
labeling

4. Advising and
educating
patients on
proper use of
drugs

5. Monitoring the
outcome and
responses
of patients to the
effect of drugs,
both
beneficial and
adverse

6. Serving as a
community
resource person
on drug and
health
information

 Pharmaceutical Care Giver

Researcher

Manager
Communicator
Leader
Life-long learner
Decision-maker
Entrepreneur
Teacher

Agent of Positive Change

THE
TEN STAR
PHARMACIST

AN OATH
I will use knowledge
and skills to the best of my
ability in serving the public
and other health
professionals

CONCERNS AMONG HEALTH CARE

PROVIDERS
Potential abuse, misuse and
inappropriate use of drugs
Increase in health care cost
Patient suffering

THE PATIENT-ORIENTED PROFESSIONAl

Able to apply and provide drug knowledge

to improve drug use in the health care
system

PRIMARY AIM
To attain success in the goals for therapy,
pharmacist must approach the patient
counseling encounter as a HELPER and
an EDUCATOR

PQL
Patient Quality of Life
Welfare of humanity and the relief of human suffering is the
primary concern
Must learn to view medications use from the patients
perspective

THE TRADITIONAL PHARMACIST

Involved in the preparation and dispensing of medications
At the direction of the physician
Strongly allied with the medical profession
View that the health professional should be in control of the
patient

WHAT A
PHARMACIST
CAN DO?
Patients on medications
experience
a lot of drug
misadventures
adverse effects, drug
interactions,
errors in the use of
medication and
noncompliance

MINIMIZE WASTE
and MAXIMIZE
BENEFITS of
medical treatments

SHIFT IN THE MODEL OF PHARMACY

From focus on the medication to a focus on the patient
Need for a shift in the pharmacists approach
From the health professionalcentered MEDICAL
MODEL to the patientcentered HELPING MODEL

MEDICAL MODEL

HELPING MODEL

Patient is passive

Patient is actively involved

Trust is based on expertise and

the authority of pharmacist
Pharmacist identifies problem
and determine solutions
Patient is dependent on
pharmacist
Parentchild relationship

Trust is based on personal

relationship developed over time
Pharmacists assist patients in
exposing problem and possible
solution
Patient develops self-confidence to
manage problems
Equal relationship

THE ROLE OF THE

NEW
PHARMACIST
Has evolved from
being product
oriented to a patient
oriented
professional
Extremely healthy for
both patient
and pharmacist
Dispensers of therapy
and drug effect
interpretations as well
as drugs

PHARMACEUTICAL
CARE
A responsible
provision of therapy
for the purpose of
achieving definite
outcomes that improve
the patients
quality of life
Hepler and Strand

PHARMACEUTICAL
CARE
Applying knowledge to
promote wellbeing of others
Requires
responsiveness,
sensitivity
and commitment to
others
Generalist practice that
emphasizes
health, prevention and
care
A form of primary health
care

THE FOCUS
1.
2.
3.
4.

Patientcenteredness
Addressing both acute
and chronic conditions
Emphasizing
prevention
Implementing
documentation
systems
that continuously
record patient need
and care provided

THE FOCUS
5.

6.
7.
8.
9.

Being accessible to
frontline
first contact
Ensuring integration of
care
Being accountable
Placing emphasis on
ambulatory patient
Including
education/health
promotional
intervention

TRADITIONAL
PHARMACY

CLINICAL
PHARMACY

PHARMACEUTICAL
CARE

Primary Focus

Rx order or
OTC request

Physicians or
other health
professionals

PATIENT

Continuity

Upon demand

Discontinuous CONTINUOUS

Strategy

Obey

Find fault or
prevention

ANTICIPATE or
IMPROVE

Orientation

Drug product

Process

OUTCOMES

TRANSFORMATION OF HEALTH CARE

NEW PARADIGM
OLD PARADIGM
Emphasis on acute patient care Emphasis on the continuum of care
Emphasis on maintaining and
Emphasis on treating illness
promoting wellness
Accountable for the health of define
Responsible for individual
populations
patients
Differentiation based on ability to
All providers are essentially
add value
similar
Success achieved by increasing Success achieved by increasing the
number of covered lives and
market share of in-patient
keeping people well
admissions
Goal is to provide care at the most
Goal is to fill beds
appropriate level
Integrated health delivery system
Hospitals, physicians, and
health plans are separate

In the future, pharmacy

services must be
evaluated on patient
outcome rather than the
number of prescriptions
dispensed

It must evolved towards

interpretation and
patient consultation,
related to the use of
medication technologies