Pharmaceutical Care

Component of Pharmacy practice that entails direct contact with the patient
responsible provision of therapy
Health Background
Sickness has been one of the mans greatest adversaries
To identify/diagnose a specific disease/injury
Physicians, pharmacists and other health care professionals utilize clues
(4) OBJECTIVES/OUTCOMES OF PHARMACEUTICAL CARE
Cure
Elimination or reduction of symptomatology
Slow down the progress of the disease
Prevention of disease
MEDICINE (L. medicus = healing art)
Aims to help people become more active and live longer and happier lives with less
suffering or disability
(3) Constant search
- New drug
- Effective treatment
- More advanced technology
Health care professionals can prevent, control, or cure hundreds of diseases
Has been a part of the health care industry
One of the largest industries in the world
One of the leading employees in most communities
(5) FUNCTIONS OF MEDICINE:
1. Therapeutic
2. Placebo (psychological)
3. Coping
4. Social
5. Cosmetic
PHARMACEUTICAL CARE
Responsible provision of therapy for the purpose of achieving a definite outcome:
HEALTH-RELATED QUALITY OF LIFE
AT THE TURN OF 20
TH
CENTURY
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 20
TH
CENTURY
Medical Advances
Life experiences increased to 76 years

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

HISTORY OF HEALTH CARE

PREHISTORIC MEDICAL PRACTICE

Study of ancient pictographs that show medical procedures and surgical
tools uncovered from anthropological sites of ancient societies
Serious diseases were of primary interest to early humans but they were
not able to treat them effectively.
Diseases were attributed to the influence of malevolent demons.
Diseases were believed to project an alien, spirit, stone, or worm into
the body unsuspecting patient

o DEMONS AND DISABILITY
- It was once thought that demons or evil spirits could cause disabilities
such as mental illness and physical deformities

Diseases were warled off by incantations, dancing, magic charms and
talismans and various other measures
Make the body uninhabitable to the demon by healing, torturing and
starving the patient

(4)

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

SPINNING
TREATMENT

- was one of the many treatments that attempted to
rid the body of mental illness through physical
means
SPREAD EAGLE
CURE
- used to disorderly patients
- Cold water was poured a height over the persons
face until the patients is calm
MILD ELECTRIC
SHOCK
- was used to stimulate the muscles and the mind
in this 19
th
century cure for mental illness known
as FARADIZATION

Trepanted Skull, Iron Age. The perimeter of the hole in the skull is rounded
off by ingrowth of new bony tissue indication 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 US.


Surgical procedures practiced in ancient societies (3:6)

Cleaning and treating wounds CAUTERY (burning, or searing
tissue)
POULTICES
SUTURES
Resetting dislocations and
fractures
SPLINT (to support or immobilize
broken bones)

Additional therapy LAXATIVES AND ENEMAS
(to treat constipated and other
gastrointestinal diseases)









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)
o The species of plant from which opium and poppy seeds are
extracted
o Opium is the source of many opiates; including morphine (and
its derivative heroin), thebaine, codeine, papaverine, and
noscapine

Systems of medicine, based on magic, folk remedies and elementary
surgery existed before the coming of the more advanced Greek medicine
about the 6
th
century BC.











HEALTH CARE PROFESSIONALS
11.6 million people work in health care in other countries
778, 000 - physicians
2.1 M - nurses
160,000 - dentists

FUNCTIONS OF A PHARMACIST
1. Identify potential or actual drug related problem
2. Resolve actual drug-related problems
3. Prevent drug-related problems
(4) BENEFITS
DECREASE INCREASE
Medication Errors Patient compliance and medication regimen
Long-term cause of medical care -
STRONG PHARMACIST-PATIENT RELATIONSHIP

HEALTH CARE PROFESSIONALS
Work in health care services, involved in the diagnosis and treatment of patients
Research, teaching or administration of medical...
PHARMACIST
Has a unique body of knowledge and skills to contribute in our health care system
Dispense the appropriate drug product and has the knowledge to assure safe and
rational use of drugs
(6) 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 labelling
4. Advising and Educating patient on proper use of drug
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 a drug and health information
THE TEN STAR PHARMACISTS
Pharmaceutical Care Giver
Researcher
Manager
Communicator
Leader
Life-long learner
Decision-maker
Entrepreneur
Teacher
Agent of Positive Change
(3) CONCERNS AMONG HEALTH CARE PROFESSIONALS / PROVIDERS
Potential abuse, misuse and inappropriate use of drugs
Increase in health care cost
Patient suffering
PATIENT-ORIENTED PROFESSIONAL
Able to apply and provide drug knowledge to improve drug use in the health care
system
(2) PRIMARY AIM
To attain success in the goals for therapy, pharmacist must approach the patient-
counselling encounter as a HELPER and an EDUCATOR
(4) 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
THE MODEL
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 professional-centered MEDICAL MODEL and to patient-
centered HELPING MODEL
(5) MEDICAL MODEL (5) HELPING MODEL
Patient is PASSIVE Patient is ACTIVELY INVOLVED
Trust is based on EXPERTISE AND THE
AUTHORY of pharmacist
Trust is based on PERSONAL
RELATIONSHIP developed over time
Pharmacist IDENTIFIES problems and
DETERMINE solutions
Pharmacist ASSIST PATIENTS in
EXPOSING problem and possible solutions
Patient is DEPENDENT on pharmacist Patient develops SELF-CONFIDENCE to
manage certain problems
PARENT-CHILD relationship EQUAL relationship

PATIENTS QUALITY OF LIFE (PQL)
Welfare of humanity and the relief of human suffering is the primary concern
Must learn to view medications from the patients perspective
CURE (L. cura) = CARE
o Providing for the welfare of another
o Attentive conscientiousness of devotion
o Conveys a compassionate state of being and not merely an
attitude
o Involved a profound respect for the otherness of the other
wdcr
CHARACTERISTIC OF A CARING BEHAVIOR:
VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP
Mutual Respect
Honesty/Authenticity
Open communication
Cooperation
Collaboration between patient
and practitioner
Empathy
Sensitivity
Exercising patience and
understanding
Trust
Competence
Putting the patient first
Offering reassurance
Confidence
Paying attention to the patients
physical and emotional comfort
Supporting the patient
Offering advocacy
Assuming responsibility for
intervention


(13) HEALTH CARE NEEDS OF A PATIENT
1. Medical
2. Mental Health
3. Dental
4. Nursing
5. Chiro-practico
6. Pediatric
7. Maternal
8. I care (Personal care)
9. Geriatric
10. Pharmaceutical
11. Surgical
12. Nutritional
13. Eye
CDEGI3M2N2PS
PRIMARY CARE
front-line or first contact care
Person-centered
Not disease or organ system centered
Comprehensive in scope
Not limited to illness episodes or by organ systems or disease process
involved
(2) INTERACTIONS
With the patients and other health care providers
COUNSEL
CONSULT
EDUCATION
Provide new knowledge
4 RS OF THE PHILOSOPHY PRACTICE
1. RULES
2. ROLES
3. RELATIONSHIP
4. RESPONSILITIES

PHARMACEUTICAL CARE
Applying knowledge to promote well-being of other
Requires responsiveness, sensitivity and commitment
(9) FOCUS OF PHARMACEUTICAL CARE
1. Patient-centeredness
2. Addressing both acute and chronic conditions
3. Emphasizing prevention
4. Implementing documentation systems that continuously record patient need and
care provided
5. Being accessible to front line first contact
6. Ensuring integration of care
7. Being accountable
8. Placing emphasis in ambulatory patient
9. Including education or health intervention

5 FACTORS TO BE CONSIDERED ON PHARMACEUTICAL CARE PRACTICE
A general understanding of how people feel about ill, the seriousness of the disease
(patients susceptibility to other factors)
DENIAL Not me!
ANGER Why me?
DEPRESSION Yes me.
BARGAINING Yes me, but...
ACCEPTANCE Im ready.


(7) VITAL POINTS
Dont assume patient had information from the doctor.
Dont assume that you have understood all information given
Dont assume resources to comply
Dont assume that patients dont care and are stupid
Dont assume that patients will comply if they understand
Dont assume others will monitor of follow up
Dont assume that patients will voluntarily seek help or
information if there are problems


TRADITIONAL
PHARMACY
CLINICAL
PHARMACY
PHARMACEUTICAL
CARE
PRIMARY FOCUS Rx order or OTC
request
Physicians or other
health professional
PATIENT

CONTINUITY Upon demand Discontinuous CONTINUOUS
STRATEGY Obey Find fault or
prevention
ANTICIPATE OR
IMPROVE
ORIENTATION Drug product Process OUTCOMES

WHAT PHARMACISTS CAN DO?
Patients on medications experience a lot of drug misadventures adverse effects, drug
interactions, errors in the use of medication or non compliance.
MINIMIZE WASTE AND MAXIMATE BENEFITS OF MEDICAL TREATMENT
TRANSFORMATION OF HEALTH CARE
OLD PARADIGM NEW PARADIGM
Emphasis on acute patient care Emphasis on the continuum of care
Emphasis on treating illness Emphasis on maintaining and promoting
wellness
Responsible for individual patients Accountable for the health of define
population
All providers are essentially similar Differentiation based on ability to add
value
Success achieved by increasing market
share of in-patient admissions
Success achieved by increasing the
number of covered lives and keeping
people well
Goal is to fill beds Goal is to provide care of the most
appropriate level
Hospitals, physicals and health plans are
separate
Integrated health delivery system

THE ROLE OF THE NEW PHARMACIST
Has evolved from being product-oriented to a patient-oriented professional
Extremely healthy for both patient and pharmacist
Dispenser of therapy and drug effect interpretations as well as drugs
In the future, pharmacy services must be evaluated on patient outcome rather
than number of prescriptions prescribed.