Anantha Naik Nagappa and Uday Venkat Mateti
Manipal College of Pharmaceutical Sciences, Manipal University, Manipal-576104, India.
What is Pharmaceutical care?
What is the scope of Pharmaceutical care in health care delivery?
What is the historical background of Pharmaceutical care?
Describe the stages of Pharmaceutical care cycle?
What are the different types/ varieties of Pharmaceutical care?
What is Pharmaceutical care?
Pharmaceutical care is a professional service provided to patients delivered by qualified, registered and trained pharmacist in clinical, community and hospital settings. The main aim of Pharmaceutical care is ensure the best standards of practice while using medicines and health care to achieve the optimized predetermined safety and efficacy goals.
What is the scope of Pharmaceutical care in health care delivery?
Pharmaceutical care has come into practice to fill the gap in conventional health care delivery. In conventional health care delivery doctors role is to diagnose and prescribe, nurses role is to provide patient comfort and care by nursing services where the pharmacists use to fill the prescriptions and advice patients regarding the matters of medicines. The necessity of informing , educating and monitoring became essential due to epidemiological change in disease patterns and burden for example emergence of diabetes -type 2 as major causality. The patients need to be educated and monitored for the disease management so that their blood sugars remain under normal range to ensure protection from the complications of diabetes. As drugs are limited in their scope for comprehensive management of condition and the patient related practices like exercise and balanced diet playing equally important role was realized of late after many people suffered casualties due to negligence on the part of patients. The pharmacists who are equipped with adequate clinical and social skills can provide the supporting role for patients by coordinating with doctors and nurses.
The emergence of pharmaceutical care begins in 1960s in USA where in pharmacist felt the need of ensuring quality of services to the patients in the mean time the fellow health care professionals are feeling difficulty in practicing in their own profession due to availability of new knowledge and tools. The demand by the patients as consumer forced the health care delivery team and government to look for a profession to fill the gap and provide the quality services. From then onwards pharmacy practice started to provide the services which in due course became more accountable and mandatory. The renewed pharmacy practice which assumes the ownership and responsibility to deliver the best outcome of therapy became a shared goal and termed as Pharmaceutical care. The developments of pharmacy practice are also emerging in Europe, Canada, UK, Japan and Australia.
The pharmaceutical care cycle can be divided into four stages
* Assessment of need
* Formulation of customized care plan
* Implementation of care plan
* Review of outcomes and re-assessment of condition
Assessment of need: Begins with when patient approaches the pharmacist with a prescription. The pharmacist before filling the prescription shall engage a dialogue with the patient or the attendee of the patient to assess the current knowledge regarding drug, disease and lifestyle of the patient. Based on this the assessment of need for patient counseling and education are made this will help the pharmacists to prepare a customized care plan for the patients. It involves the matters regarding drugs storage, the instructions while using medicines for example how and when to administered, and to identify and alert any risk involving expected adverse drug reactions.
As for the life style and disease factors the pharmacist has responsibility to inform and educate the latest knowledge with due diligence and care not to hurt and inflict any negative influence on patients psyche. The aim of the above step is to influence the attitudes and subsequently the practices by patients with willingness and confidence.
Formulation of customized care plan: Each patient is unique in his genetic makeup and socioeconomic background. The patients need to understand the aspects of drugs they have been prescribed along with the medication ADRs which is common for all patients. As patients are having diverse background in terms of education, social beliefs due to which the patient educational and counseling needs vary for example if the patient belongs to special population like geriatrics and pediatrics than the patients need for pharmaceutical care vary and need to be customized. Which will help the patients to comply with the instructions so that expected outcomes of therapy becomes achievable.
* Implementation of care plan: the Implementation of care plan is mainly demands communication and professional skills of pharmacist to impress upon the patients so that the patients gets fully convinced regarding the value of medications and importance of advice on the lines of Do's and Don'ts clear enough that the patients goes with clarity of mind regarding the care plan. The care plan also involves patient education and advice regarding the appropriate diet and exercise which is going to benefit patients with improved quality of life. The patient should advice to call on the pharmacists and get him checked regarding the positive/ negative outcomes of therapy regarding 10-15 days.
Review of outcomes and re-assessment of condition: The patients are advised consultant the pharmacist and explain the experience of them while practicing the pharmaceutical care (PC) plan. Pharmacist in the review sessions also checks upon the outcomes whether any extent of improvement or deterioration of patient condition. In case there is deterioration the pharmacist assesses and tries to figure out why there is a failure of outcome and classifies the issue as diagnostic, nursing care or drug related. The diagnostic issues and nursing care are referred to doctors and nurse while drug related issues are resolved by pharmacist himself. The care program will be continued till the outcome goals are achieved and the patients has regain the normal health.
The pharmaceutical care is a service which can be delivered in conventional clinic model. Here a clinical pharmacist is a part of health care team who will available for doctors, nurses and patients for consultations for inpatients and outpatients. Other alternative models include Home medication review, ambulatory care pharmacist, pharmacists on call and also through the call centers where a pharmacist answers the enquiries of the patients. Adoption of e-commerce is novel approach for pharmacy practice.
Evidence based medicine depends upon the data of previous Randomized controlled trials (RCTs). While delivering the pharmaceutical care the pharmacist may come across a clinical dilemma or he may be asked why fellow health care professionals to clarify the matter regarding the clinical decisions. So the Evidence based medicines are already available in the form of RCT, Meta analysis, systematic reviews. The pharmaceutical care also aims at achieving the best outcomes for the patients in terms of safety and efficacy. The application of Evidence from the data base from Cochrane library and other data bases is rational for decision making while delivering pharmaceutical care.
The optimization of drug therapy and evaluation of risk and benefits of the prescribed medicines gives an opportunity to identify and alert the prescribers regarding laps in the treatment. Hence there will be check on unnecessary exposure of medicine in patients. Further the pharmaceutical care optimizes the therapy to achieve the best outcomes by application of principle of Pharmacokinetic and Pharmacodynamic. Hence improves upon the positive outcome rates. Further cautions the patients regarding problems and effect on health by unscientific use of medicines. So all these approaches reduces the expenditures arising due to negligence of pharmacy practice.
How the Pharmaceutical care can help in improving the quality of life?
There is strong evidence that drugs alone can prescribe in a conventional way and asked to taken by the patients. The expected outcomes is elise for example in chronic condition diabetes and hypertension the patients who are using medicines under the guidance of doctors alone still end up with serious consequences like stroke, heart attacks and kidney failure. Where as it is well established if the conditions like diabetes and hypertension controlled should never be victim of heart attack and Chronic Kidney Disease. The provision of PC motivates the patients in systematic model of knowledge attitude and practice.
How to implement the Pharmaceutical care in critical illness patients?
The patients in critical condition are in admitted in Intensive Care Unit (ICU) where the drug information is vital for providing the treatment. The doctors and nurses are engaged in monitoring the patient condition and making decisions depending on the progress of the patient condition. While doing so they need the information and evidence of previous RCTs in the matter of drug if well trained clinical pharmacists are the team member of ICU can make a sea of change in practice.
Explain the significance of Pharmaceutical care in drug store management?
The retail pharmacies are catering the dispensing of medications prescribed by physicians. The doctors usually do not elaborate regarding the medicines due to lack of time and work pressure. This is left to the pharmacists to complete the patient counseling in the form of dialogue and discussions. The pharmacist should utilize the pharmacist for patient counseling and try to impress upon the patients. Thus improving the business opportunities to the pharmacies.
How to maintenance the confidentiality of the patient during the Pharmaceutical care
The trust and belongingness are essential for a patient to explain his/her condition in private. The patient will never open up in case he has on professional bondage for the pharmacists. The information about patient condition should be discussed with any other persons under any circumstances without the permission o the pharmacies patient himself as this would violate the professional ethics and may lead to follow of image of the pharmacist in mind of the patient.
What are the advantages of home medication review based Pharmaceutical care
The Home medication review (HMR) offers a unique opportunity to the patients and pharmacists for the patients are happy because the care delivered at their own home and no need to go to clinic where as the pharmacist is an opportunity to assess the patients to assist in their natural habitat. HMR brings a win-win situation for PC where the patient and pharmacist get benefited.
How the Pharmaceutical care is different from Medication therapy management?
PC is an active process involving patient engagement and developing an holistic strategy with an objective of achieving predetermined outcomes. Whereas MTM focuses on optimization of medicine with respect to dose, PK, ADRs, DDIs, Drug-Food Interactions for the prescribed medicines. The major difference is MTM is a part of PC.
How the Pharmaceutical care is different from patient counseling?
PC is a cogitative service where as Patient counseling is giving the patient all the needed information on prescribed medicines. The patient counseling expects the patient to ask the pharmacist for Drug Information. Whereas PC assumes the responsibility by the pharmacists to educate the patient and implements the set of instructions and measures the outcomes of PC plan in a periodical review. Further the pharmacist proactive in the interest of the patient what should be done in case the expected outcomes are not achieved.
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