Pharmaceutical Care Process:

Assessment – Care Plan – Follow Up

Didik Setiawan, PhD., Apt

- Faculty of Pharmacy,
- Center for Health Economic Studies,
Universitas Muhammadiyah Purwokerto, Purwokerto, Indonesia
Professional Behaviour
Cases

• Mr B, A 45 y.o., said he want to buy

amoxicillin for his 2 days sore throat,
he feels a little bit fever too.
• What Will You Do, If you meet
• His past blood pressure was 170/80, this patient
and he was takeing amlodipine 10mg
to get the fastest results based on
the internet information. And
recently, he was not take the
medicine at all.
 Assessment

All of your subsequent activities, clinical decisions, care planning, interventions,

and evaluation are dependent upon your ability to fully assess your patient's
drug-related needs and identify drug therapy problems
Purpose of Assessment

to determine if a patient's drug-related needs are being met

To accomplish this, the practitioner gathers, analyzes,

researches, and interprets information about

the patient the patient's the patient's drug

characteristic medical conditions, therapies
Assessment Activity

Meet the patient

Elicit relevant information from

the patient

Pharmacotherapy Workup
Assessment Responsibility

Establish the therapeutic relationship

Determine who your patient is as an individual by learning

about
• the reason for the encounter, the patient's demographics, medication
experience, and other clinical information

Determine whether drug-related needs are being met

• (indication, effectiveness, safety, compliance)

Identify drug therapy problems

Meeting the Patient

Introduce Dress and demeanor

Your Self,
influenced Quality and relevance of your comment
by:
Ability to elicit information

your attitude of confidence

your ability to provide information, feedback, and

explanations
Introduce Your Self
Meeting the Patient
The Physical environment

The assessment interview

can be personal and A semi-private or private Unlike a physical
involve the exchange of space must be provided examination,
sensitive information

An environment in which
the patient feels
comfortable and assured
that others cannot hear
the conversation is often
sufficient
The Physical Environment

Semi private Private area

area
Meeting the Patient
Taking Notes

• is important that your patient feels

comfortable with this  explanation

• You can only make good decisions and

provide good advice with good data

• Patient Medical Records (PMR) as one of

requirement in Competent Certificate in
Indonesia
 Age

Occupatio Weight,
n height

Eliciting Demographic
Information Information
from the
Living
Patient arrangeme Gender
nts

Pregnancy
status
Eliciting Information from the Patient

Clinical
information Patient's medication experience
Reason for the Patient's attitude toward taking medication and description
encounter of wants, concerns, understanding, beliefs, and behaviors

Medication history
Relevant Allergies and adverse drug reactions
medical history Social drug use
Special needs

Current medication record

Review of
Medical conditions—all related drug therapies (indication—product-dosage-
systems outcome)
How to Find Out?
Pharmacotherapy Workup
Pharmacotherapy Workup

a framework in which to think about your patient-specific

information, your knowledge of patients, diseases, and drug
therapy, and the decisions you have to make.

The Pharmacotherapy Workup is designed so that your

decision-making is always completed in the rational order of
• indication,
• effectiveness,
• safety,
• compliance.

To Find Out The DRP’s

1. Evaluating the Appropriateness of the
Indication for the Patient's Drug Therapy

Unnecessary
Drug Therapy
& additional
drug therapy
Two main determinant of drug therapy
outcome
2. Determining the Effectiveness of the Drug Regimen

Wrong
Drug or
Dosage
too low
3. Establishing the Safety of the Drug Regimen

Drug
Induce
ADR &
Dosage
too high
3. Establishing the Safety of the Drug Regimen
*****Reminder*****

Drug product And Dosage Regiment

Adverse Drug Reaction Toxicities

undesirable or unintended
idiopathic effects the result of
responses to the known
experienced by the dosages that
pharmacology of the drug
patient are too high
product

GI Bleeding of AINS Allergy

4. Understanding Patient Compliance

In the practice of pharmaceutical care, a noncompliant refers to someone who is

not able or Not willing to

take an appropriate, effective, and safe medication as intended.

Patient has a rational reason for the decisions he/she has made about whether or
not to take the medication.

Your responsibility is to discover that reason so you can help to optimize the
patient's medication experience.
Then you Can Find The DRP’s
Example: Patient medical Records
Example: Patient medical Records
Example: Patient medical Records
Any Question, Suggestion etc??

just ask and we will discuss it..

 Care Plan
The purpose of the care plan is to determine, with the patient, how
to manage his or her medical conditions or illnesses successfully
with pharmacotherapy and includes all the work that is necessary to
accomplish this
Care Plan Activities

1. Establish Goal Therapy

2. Determine appropriate interventions to:

• Resolve drug therapy problems
• Achieve goals of therapy
• prevent new problems

3. Schedule follow-up evaluation

Care Planning Activities and Responsibilities

Activities Responsibilities
Establish Goal Negotiate and agree upon endpoints and timeframe
Therapy for pharmacotherapy's.
Inform patients of their responsibilities to accomplish
goals.
Determine Consider therapeutic alternatives and select patient-
appropriate specific pharmacotherapy, patient education, and
interventions other nondrug interventions
Schedule follow-up Establish a schedule for follow-up evaluation that is
evaluation clinically appropriate and convenient for the patient.
Establish Goal Therapy

•Diarrhea
Cure a disease •Streptococcal pneumonia

Reduce or eliminate signs and/or •Allergic rhinitis

symptoms •Common cold

•Diabetes
Slow or halt the progression of a disease •Congestive heart failure

•Osteoporosis
Prevent a disease •Pneumococcal pneumonia

•Hypokalemia
Normalize laboratory values •Anemia

•Anxiety associated with MRI procedures

Assist in the diagnostic process •Intraocular pressure tests for glaucoma
Goals of therapy have a specific structure and always include:

clinical parameters (signs and symptoms) and/or laboratory values which

are observable, measurable, and realistic;

A desired value or observable change in the parameter;

a specific timeframe in which the goal is to be met.

a patient who suffers from allergic rhinitis and presents with nasal
congestion, runny nose, and eye itching, but no cough or loss of taste

The patient-specific goals of therapy might include the relief of nasal

congestion, runny nose, and eye itching in a timeframe of 48 hours
Task

Define The Goal Therapy of this Medical Condition

Hyper
tension in Hyper
Diabetes Insomnia
diabetic lipidemia
patient
Statement of Intervention

What Pharmacists Should do?

The Interventions

Interventions to Resolve Drug Therapy Problems

Interventions to Achieve Goals of Therapy

Interventions to Prevent Problems

Therapeutic Alternatives

Cost Considerations
Interventions to Resolve Drug Therapy Problems

interfere the goals of therapy and create the drug-related needs

Has to Be Resolved

include the full spectrum of modifications in drug dosage regimens

initiating new drug changing the drug altering the dose discontinuing drug
therapy, product, and/or the interval, therapy

Consider the balance of

potential benefit potential harm

Interventions to Resolve Drug Therapy
Problems

It is important to include the patient at each step in

your decision making process

How do you feel about making these adjustments

in your medications?

Is this a change that you think you can manage in

your daily use of this medication?

What do you think would be the best way to

improve your therapy?
Interventions to Achieve Goals of Therapy

grounded in patient selected according limited by patient

preferences to patient needs tolerance
 how to use the drug
other regimen(s)
remedies, the patient
products, should
and devices receive,

Intervention changes in
s to Achieve nonprescriptio
n drug
drug therapy
that are
Goals of products, and required,

Therapy instructions
Activity on how to
patient-
specific
properly use
education or
prescription
information,
drug,

referrals to
specialists,
Interventions to Prevent Problems

• If your 19-year-old female patient is

pregnant, you may decide to make certain
that she is getting enough folic acid and
other vitamins during her pregnancy. • Which is an
• Additionally, you may also need to suggest intervention to
that she reduce consumption of caffeinated prevent
problems??
and alcoholic beverages during her
pregnancy and not take prescription or
nonprescription drug products without
checking with you first.
Other Example In Preventing a problems

Calcium supplements in postmenopausal females

Subcutaneous heparin to prevent pulmonary emboli and deep vein

thrombosis;

Aspirin to prevent recurrent myocardial infarction

The use of lipid-lowering agents to prevent cardiovascular disease

Maternal folic acid supplements to prevent neural tube defects

and congenital orofacial clefts
Other Example In Preventing a problems

Misoprostol use to prevent gastrointestinal erosions and ulcers

associated with nonsteroidal anti-inflammatory drugs
Need for allergy or bee sting kits for a patient with a history of
severe allergic reactions
Smoking cessation approaches to prevent pulmonary disease,
cardiovascular disease or cancer,
antibiotics used to prevent infections during surgical or dental
procedures
Need to prevent the flu using influenza immunizations in an
elderly patient with chronic diseases.
Therapeutic Alternatives

• At least three alternative for each drug related needs

Cost Considerations
Establishing a Schedule for Follow-Up
Evaluations

When should the follow- Your next follow-up evaluation

should take place in 4-6 weeks.
up evaluation be When would you like to schedule
scheduled? our next visit?

How will you determine if How would you prefer to be

positive outcomes have contacted—by telephone, fax, or
occurred? e-mail?

How will you determine if

negative outcomes have Is there a best time to reach you?
occurred?
Discussion
Continued
 Follow Up
The purpose of the follow-up evaluation is to determine the patient's outcomes
in relation to the desired goals of therapy
Clinical Parameters
Improvement in Patient Signs and Symptoms

Back pain • Severity and frequency of pain, range of motion,

ability to ambulate

Migraine • Headache pain, retro-orbital pain, nausea,

vomiting, visual disturbances

Cough • Severity and frequency of cough, interruption of

daily activities or sleep

Rash • Change in color and/or size, associated

inflammation, itching
Laboratory Parameters
Improvement in Laboratory Test Results

Hyperlipidemia • Cholesterol, LDL, triglycerides, HDL

• CBC, Hb, Hct, RBC count, serum ferritin, iron-

Anemia binding capacity, serum iron, serum B12

Cardiac dysrhythmias • Electrocardiogram

Diabetes mellitus • Blood or plasma glucose, HbA1C

Pharmaceutical care Circle
Determining the Clinical Outcome Status

Partial
Resolved Stable Improved
Improvement

Unimproved Worsened Failure Expired

Discussion
Didik Setiawan, PhD., Apt

Email: d.didiksetiawan@gmail.com
WA: +31 631 254575
Phone: 081 226 700 119
www.ches.ump.ac.id