Drug Therapy Cycle

​Patient’ Complaint
↓ ↑
​Diagnosis ​ ​Undesired
Desired
↓ ↑ ↑
Modes of therapy​​ ​Clinical
Response
↓ ↑
Drug Therapy​​ Drug Usage
↓ ↑
Prescription → ​Dispensing

Rational Drug Therapy

​Patient (Conditions)
↕ ↕
 ​Disease ​ ↔ ​Drug

​Pharmaceutical care process 

Pharmaceutical process 
 
PHARMACEUTICAL CARE PRACTICE
DOMAIN
(Dresselle, S.P., 2005, Pharmaceutical Care as a Management Movement, in
Pharmacy Management​, Dresselle, S.P. and Zgarrick, D.P. Eds., pp 3-18,
McGraw-Hill, New York)

I. Risk Management
a. Devise system of data collection
b. Perform prospective drug utilization
review
c. Document therapeutic interventions and
activities
d. Obtain over-the-counter medication
history
e. Calculate dosages for drugs with a narrow
therapeutic index
f. Report adverse drug events to regulatory
agent
g. Triage patients’ needs for proper referral
h. Remain abreast of newly uncovered
adverse effects and ​drug-drug interactions
II. Patient Advocacy
a. Serve as patient advocate with respect to
social, economic, and psychological
barriers to drug therapy
b. Attempting to change patients’
medication orders when barriers to
compliance exist
c. Counsel patients on new and refill
medications as necessary
d. Promote patient wellness
e. Maintain caring, friendly relationship
with patients
f. Telephone patients to obtain medication
orders called in and not picked up

III. Disease Management

a. Provide information to patients on how to
manage their disease state/condition
b. Monitor patients’ progress resulting from
pharmacotherapy
c. Carry inventory of products necessary for
patients to execute a therapeutic plan (e.g.,
inhaler, nebulizers, glucose monitors, etc.)
d. Supply patients with information on support
and educational groups (e.g., Diabetes
association, Multiple Sclerosis Society)

IV. Pharmaceutical Care services

marketing
a. Meet prominent prescribers in the local area of
practice
b. Be an active member of professional associations
that support the concept of pharmaceutical care
c. Make available an area for private consultation
services for patients as necessary
d. Identify software that facilitate pharmacist’
patient care-related activities

V. Business Management
a. Utilize technicians and other staff to free up the
pharmacist’s time
 b. Ensure adequate workflow for efficiency in
operations

Differences between Dispensing Products and

Providing Pharmaceutical Care

Dispensing Pharmacy Pharmaceutical Care

(New Paradigm)
(Old Paradigm)

Product business Service (people) business

Objective is to bring Objective is to bring the

product to the customer pharmacist to the patient
Decisions focus on the Decisions focus on the
business patient
Inventory generates
revenue
Available service Patient care generates
supports the product revenue
Available product
Success measured as supports the service
number of prescriptions
Success is measured as
patient outcomes

Space is organized to
display and sell
products Space is organized to meet
patient’s needs
Records are kept
primarily to meet legal Documentation supports
requirements patient care
concerning the drug
product

Schedule for follow-up

Schedule for refill determined by risk and
benefit of drug therapies
determined by
and needs of the patient
 customer supply of
drug product Business is actively sought
through the recruitment of
Business is passively patients
sought through the
generation of
prescriptions

Reference

Cipolle, R.J., Strand, L.M., Morley, P.C., 1998, ​Pharmaceutical Care

Practice,​ McGraw-Hill, New York

TO BE SUCCEDED IN PHARMACEUTICAL CARE

PRACTICE

Pharmaceutical care requires:

 1. an expert knowledge of therapeutics,
2. a good understanding of disease processes,
3. knowledge of drug products,
4. strong communication skills,
5. drug monitoring, drug information, and
therapeutic planning skills,
6. The ability to assess and interpret physical
assessment findings.

▪ DRUG THERAPY PROBLEMS, NOT

MEDICAL PROBLEMS

Medical problems are disease states; that is,

problems related to altered physiology that result
in clinical evidence of damage.
 Drug therapy problems are patient problems that
are either caused by a drug or may be treated with
a drug.

▪ FIVE STEPS IN THE PHARMACEUTICAL

CARE PROCESS​​:

1. A professional relationship with the patient

must be established.
2. Patient-specific medical information must be
collected, organized, recorded, and maintained.
3. Patient-specific medical information must be
evaluated and a drug therapy plan developed
mutually with the patient.
4. The pharmacist must ensure that the patient has
all supplies, information, and knowledge
necessary to carry out the drug therapy plan.
5. The pharmacist must review, monitor, and
modify the therapeutic plan as necessary and
 appropriate, in concert with the patient and
health care team.

Care planning for patient involves establishing

therapeutic goals and determining appropriate
interventions to:

1. Resolve all existing drug-therapy problems,

2. Achieve the goals of therapy intended for each
active medical problem,
3. Prevent future drug-therapy problems that
have a potential to develop.

The steps involved in solving drug-related problems​​:

 1. Identification of real or potential drug-related
problems.
2. Determination of the desired therapeutic
outcome.
3. Determination of therapeutic alternatives.
4. Design of an optimal individualized drug
therapy plan.
5. Identification of parameters to evaluate the
outcome.
6. Provision of patient counseling.
7. Communication and implementation of the
drug therapy plan.

The elements of a care plan​​:

a. Medical condition​​: list the disease state for which
the patient has drug-related needs.

b.Drug-therapy problems​​: state the drug-therapy

problems by including the patient’s problem or
condition, the drug therapy involved, and the
 association between the drug(s) and the patient’s
condition(s).

c. Goals of therapy​​: state the goals of therapy. Goals

should be realistic, measurable and/or observable,
specific, and associated with a definite time frame.

d.Interventions​​: in collaboration with the patient,

the practitioner develops and prioritizes a list of
activities to address the patient’s drug-related
needs.

e. Follow-up plan​​: Determine when the patient

should return for follow-up and what will occur at
that subsequent visit.

Follow-up Evaluation

The purpose of a follow-up evaluation is ​to evaluate

the positive and negative impact of the care plan on
the patient​​, to ​uncover new drug-therapy problems​​,
and to ​take appropriate action to address new
problems​​ or adjust previous therapies as needed.

The evaluation involves comparing goals of therapy

with the patient’s current status.

Cipolle et al.​​ developed terminology to describe the

patient’s status, the medical conditions, and the
comparative evaluation of that status with the
previously determined therapeutic goals

Status Definition

Resolved Goals achieved, therapy

completed
Stable Goals achieved, continue
same therapy
Improved Progress being made,
continue same therapy
Partial Progress being made, minor
improvement adjustment required
Unimproved No progress yet, but
continue same therapy
Worsened Decline in health, adjust new
therapy
Failure Goals not achieved, initiate
new therapy
Expired Patient died while receiving
drug therapy