Cognitive Pharmacy Services

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1.What are cognitive pharmacy services (CPS)?

Cognition is a process of finding and processing information with an aim of applying knowledge to decide upon the best possible decision. The pharmacy services include the involvement of pharmacist to patients on one to one basis. Here, the pharmacist collects the information from the patient, from the resources of health science like Micromedex concerning the issues of the patient. Further he integrates the information to resolve the patient issues. The pharmacist himself initiates to patient regarding the cognitive pharmacy services by explaining and demonstrations.

2.Why all services of pharmacy cannot be self-managed by the health consumer/ patient?

The pharmacy being highly technical becomes more challenging and difficult to understand by patients. For example, we have invented the cell-phones and it is sufficient for a consumer how to use it. It is not necessary that the end-user be technically competent to know each and every thing about the details of cell-phone. Hence, whenever a problem arises the consumer approaches the technical expert to resolve the issue. Similarly, the pharmacy products and services are becoming technical and there is a need of an expert pharmacist to resolve the issues. For example, biotherapeutics.

3.What is the role of communication in delivery of pharmacy services?

The pharmacy products and services are having a scientific basis which should be communicated to an extent of patients awareness becomes adequate enough to become and behave as a responsible consumer and patient. The products like NDDS are developed on certain conditions of usage unless these conditions are not met while using may not produce the expected outcome. Hence, the patient needs to be updated and motivated regarding the correct process of usage. Conventionally, the pharmaceuticals manufactured had little technical in-built aspects. So, effective communication is a required skill for delivery of pharmacy services and products.

4.How the CPS is different from other pharmacy services?

The pharmacy services include dispensing, compounding and counseling apart from diagnostic services and vaccinations in community pharmacy. In clinical and hospital pharmacy, the pharmacy services include ADR monitoring, Pharmacovigilance, Ward rounds, Ward pharmacy, Drug information center and extemporaneous compounding. The cognitive pharmacy services require initiative from the pharmacist to learn what is that required by the patient in order to improve his or her condition. He should volunteer and deliver service although the patient never asked for it.

5.What is the role of pharmacist in delivering the CPS?

The pharmacist being an expert is described as "Seven-star pharmacist" by FIP document which declares the pharmacist as Caregiver, Decision-maker, Communicator, Manager, Life-long-learner, Teacher, Leader and researcher. The pharmaceutical care and pharmacy practice is becoming essential to achieve economic, clinical and quality of life outcomes in therapeutics. The doctors and nurses along with pharmacist as a team can deliver evidence based therapeutics. The pharmacist should be able to deliver CPS effectively by utilizing the skills of seven-star pharmacist with commitment and dedication.

6.How the challenge of patient compliance/ adherence to therapy can be met with CPS?

In CPS, the pharmacist is in close contact with the patient and involved in delivery of therapy. Pharmacist is documenting the complete incidents and episodes of patients' conditions. Hence it is possible to observe the signals regarding patient non-compliance/ adherence. After observing he can interact with the patient and find out the reasons or causes for non-compliance/ adherence. He can resolve the issues of non-compliance/ adherence by patient education and counseling.

7.What is the main factor which distinguishes the CPS from pharmacy services?

CPS is a personalized care where the pharmacist is in direct one to one contact with the patient and has opportunity to influence and motivate patient regarding self management of the disease. However, in other pharmacy services the pharmacist although interacts in an institutionalized manner restricting to patient education and instructions in a passive manner.

8.How to deliver CPS in community pharmacy setting?

The CPS can be delivered to a patient in privacy where the pharmacist can interact one to one with the patient. The patient is encouraged to ask questions, doubts and learn the important things pertaining to the disease, drugs and lifestyle modifications. There is a dedicated patient counseling cubicle or room where the pharmacist and the patient meet each other face to face.

9.Give the list of CPS available.

Category

CPS

Health promotion and health-education

Smoking cessation

Birth control devices

Hygiene education

Dietary information services

Skin health education

Medicine therapy management

Medication Order review

Drug information service

Addressing the issues of patient non-compliance/ adherence

Identifying the probable ADRs in prescription

Educating the patient in posology and pharmacokinetics

Disease management and preventive healthcare

Diabetes management

Osteoporosis management

Obesity management

CHD prevention and management

Immunizations

Management of Hypertension

10.How to evaluate the effectiveness of CPS?

The CPS is a physical and psychological domain which can be evaluated by Quality of Life studies and Pharmacoeconomic evaluations. The established measures and protocols in a group of patients is usually applied to document the effectiveness in terms of clinical, pharmacoeconomic and outcome research.

11. What are the benefits of CPS?

The CPS brings about the issues of patient suffering to the pharmacist who is challenged to deliver and resolve. In that process, the patient feels comfortable as the pharmacist acts as an empathetic listener. There is an opportunity for the healthcare team to motivate the patient towards the optimism from pessimism in the patient's psyche.

12.What are the drawbacks of CPS?

There is a need for dedicated trained pharmacy professional which is indispensible for delivery of CPS. The CPS may become unorganized in case there is a lack of documentation and review of content of CPS. The patient has to agree to spend extra money which increases the cost of treatment.

13.Explain the process of CPS in a pharmaceutical care model of FIP-WHO.

The pharmaceutical care model of FIP-WHO authorizes the pharmacist to be the provider in existing healthcare delivery system. The pharmacist on receiving prescriptions begins to chart a care plan in consultation with the patient wherein the face to face interaction begins. After implementation of the care plan, pharmacist calls on patient to review the outcomes of treatment. Here also pharmacist gathers information by direct interaction with the patient. Further if there are lacunae identified in diagnosis and nursing care, the pharmacist directly communicates with doctors and nurses. In case there is any issue with medication, Pharmacist himself resolves the issue hence the pharmaceutical care model of FIP-WHO has inbuilt CPS as a component.

14.What is the ethical-social responsibility for CPS?

The services being delivered individually and independently; the vulnerability of the patient to be exploited becomes possible. Hence, there should be thorough training on ethical practice is essential for the pharmacist involved in delivery of CPS. Socially, there can be misleading advice to patients in the matter of health promotion products. Hence, there is a need to establish standards for CPS delivery which can be regulated.

15.What are the Pharmacoeconomic evidences for CPS?

There is ample of evidence available in literature the value of contribution towards savings in healthcare provision along with improved quality of life. Some of the classic studies in this aspect include Watkins et al 2012 demonstrate to physicians, advanced practice nurses, physician assistants, nurses and patients that pharmacists are integral providers within the multidisciplinary team. The pharmacists are willing and capable to carry the profession into a new era where the contribution to patient care is recognized as having value.

16.What are the outcomes research evidences for CPS?

The pharmacist in their communication and accessibility to the patients are always preferred for personal consultation. The pharmacist taking an active role is found to be highly effective and the patients have expressed their choice as pharmacist for resolving the doubts about medication and lifestyle. When the services are provided to the patients, there is documented evidence that the Quality of Life has increased significantly. For example, Gould et al 2013 has established the role of hospital pharmacists which includes from preparation and distribution of medications to active involvement in health care teams, through identification and resolution of patients' medication-related issues in an effort to improve patient outcomes. However, patients' preferences about pharmacy services are not well known.

17.What are the clinical evidences for effectiveness of CPS?

The clinical improvement is first to appear and considered as a minimum criteria for healthcare effectiveness. There are various possibilities which influence the clinical outcome due to variation in the healthcare delivery. For example, misunderstanding the prescription by a nurse who is not an expert in pharmacy. In case pharmacists in charge of providing the services to patients in the matter of drugs and prescription there could be less chances of error. A study by Jennifer et al 2008 has established in Australia that the CPS provided in the context helps in subsidizing the cost of prescription medicines along with improved clinical outcomes.

18.What is the role of CPS in preventing drug related hazards in patients?

The pharmacist by his training in pharmacokinetics, pharmacodynamics, adverse drug reactions, pharmacotherapy is capable of visualizing a drug related hazard while dispensing the medicines. He has the background of medicine from basic research to final drug dispensing to the patient. The prescribers and nurses would have overlooked the forthcoming issue of ADR. The pharmacist being trained as drug information specialist is capable to check any possible serious drug related hazard before administering the drug by referring the advanced drug information databases like Micromedex and check the prescriptions for any possible drug related hazards and prevents by alerting the healthcare professionals to take corrective measures.

19.How the CPS can discourage the irrational use of drugs and self-medication?

The CPS is having a component of documentation of the healthcare delivery which is available for retrospective evaluation of the healthcare delivery process. In this way, the type and nature of error can be identified in a healthcare setting. The reports by CPS can be used to identify the cases of irrational use of drugs. Regarding self-medication, the patients ignorance is the key cause for practice which can be dangerous and irrational. The counseling of the patient regarding the demerits and the risks involved in self-medication by patients themselves can curb the urge of the patients to resort to self-medication.

Reference:

1. Jack L. Watkins, Andrea Landgraf, Chad M. Barnett, Laura Michaud. Evaluation of Pharmacist Provided Medication Therapy Management Services in an Oncology Ambulatory Setting at a Comprehensive Cancer Center: Medication Therapy Management in the Oncology Ambulatory Setting J Am Pharm Assoc (2003)2012 Mar-Apr; 52(2): 10.1331/JAPhA.2012.11171. doi: 10.1331/JAPhA.2012.11171

2. Odette Gould, Paula Buckley, Douglas Doucette. What Patients Want: Preferences Regarding Hospital Pharmacy Services. Can J Hosp Pharm. 2013 May-Jun; 66(3): 177-183. PMCID: PMC3694939

3. Jennifer L. Marriott, Roger L. Nation, Louis Roller, Marian Costelloe, Kirstie Galbraith, Peter Stewart, William N Charman. Pharmacy Education in the Context of Australian Practice. Am J Pharm Educ. 2008 December 15; 72(6): 131. PMCID: PMC2661177

About the Author

Anantha Naik Nagappa's picture

I am professor, intrested in developing the community pharmacy services in India, We have an association called ASSOCIATION OF COMMUNITY PHARMACISITS OF iNDIA. CHECK AT www.acpi.in for further detials

Comments

Albert Ana-Maria's picture

How can we improve the pharmacist-patient relationship? We have to start from the pharmacist or patient this?

Anantha Naik Nagappa's picture

The pharmacist should take initiative as he is professionally bound to ensure the best practices regarding patient safety and the efficacy of the treatment. The pharmacist although not involved in diagnosing & prescribing, he has to supplement by acting as a bridge between the doctors, nurses and the patients. The pharmacist should not feel any hesitation in exploring and using his knowledge for the benefit of the patient. The pharmacist should be pro-active and help the patient to resolve tension and doubts regarding drug, disease and lifestyle.

Prof Anantha Naik Nagappa

My Page : http://www.pharmainfo.net/ananthanaik

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