PHARMACEUTICAL CARE

(GENERAL PRINCIPLES OF HEALTH CARE)

May T. Magtoto
UST Faculty of Pharmacy
Many people
spend their
HEALTH to gain
WEALTH, and
later on, spend all
their WEALTH in
a desperate effort
to regain
HEALTH
GENERAL PRINCIPLES OF
HEALTH CARE



























HEALTH
BACKGROUND

Sickness has been
one of mans greatest
adversaries







HEALTH
BACKGROUND
To identify or
diagnose a specific
disease or injury
Physicians,
pharmacists, and
other health care
professionals
utilize clues

MEDICINE
Latin word medicus
It is a healing art
Aims to help people
become more active
and live longer and
happier lives with less
suffering and disability

MEDICINE
Constant search
New drugs
Effective
treatments
More advanced
technology
Health care
professionals can prevent,
control or cure hundreds
of diseases


Frederick Banting & Charles Best insulin
Gerhardt Domagk Prontosil (sulfa drug) for
hemolytic streptococci
Alexander Fleming penicillin
Selman Waksman streptomycin
(tuberculosis)
Jonas Salk injectable vaccine for polio
Albert Sabin oral vaccine for polio
Paul Ehrlich chemotherapy, arsphenamine
for the treatment of syphilis

Karl Scheele oxygen, tartaric acid,
arsenic, chlorine, glycerin and
organic acids
Edward Jenner eradication of
small pox

Era of antibiobitics
Important observations made by
Pasteur ( rabies &anthrax)
Discovery of penicillin by Fleming
(1929) and development work by
Florey & Chain (1940).
Discoveries of antibiotics
progressed significantly in the
40s.

MEDICINE

Has become a part of
the health care
industry
One of the largest
industries in the
world
One of the leading
employers in most
communities

At the turn of the
20th century (1900)
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 the
20th century
Medical advances
Life expectancy
increased to 76
years

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

HISTORY OF HEALTH CARE

Serious diseases were of primary
interest to early humans but they
were not able to treat them
effectively

HISTORY OF HEALTH
CARE
Diseases were attributed to
the influence of malevolent
demons
Diseases were believed to
project an alien spirit, a stone,
or a worm into the body of the
unsuspecting patient

Demons and Disability
It was once thought that
demons or evil spirits could
cause disabilities such as
mental illness and physical
deformities.
HISTORY OF
HEALTH CARE
Diseases were warded
off by incantations,
dancing, magic charms
and talismans, and
various other measures
Make the body
uninhabitable to the
demon by beating,
torturing and starving
the patient

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

Trepanated skull, Iron age. The
perimeter of the hole in the skull is
rounded off by ingrowth of new bony
tissue, indicating that 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 the U.S
18th century French
illustration of trepanation
The Spinning Treatment was
one of many treatments that
attempted to rid the body of
mental illness through
physical means
The Spread Eagle Cure was
used to treat disorderly
patients. Cold water was
poured from a height over the
persons face until the patient
is "calm"
Mild electric shock was used to
stimulate the muscles and the
mind in this 19th century cure
for mental illness known as
Faradization.
HISTORY OF HEALTH CARE

Surgical procedures practiced in ancient societies
Cleaning and treating wounds by cautery
(burning or searing tissue), poultices, and
sutures
Resetting dislocations and fractures, and using
splints to support or immobilize broken bones

HISTORY OF HEALTH CARE
Additional therapy included laxatives and enemas to
treat constipation and other gastrointestinal diseases

HISTORY OF
HEALTH CARE
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)


Modern age (18
th
century)
William Withering digitalis,
digoxin

Opium poppy (Papaver
somniferum) is the
species of plant from
which opium and poppy seeds
are extracted. Opium is the
source of many opiates,
including morphine (and its
derivative heroin), thebaine, co
deine, papaverine,
and noscapine.
Modern age (18
th
century)
Frederick Serturner morphine
Johannes Buchner salicin from willow
bark and nicotine from tobacco which
led to aspirin and nicotinic acid
production
Rudolf Brandes & Philip Geiger
isolated hyoscyamine and atropine




Joseph Caventou & Pierre Pelletier
emetine from ipecacuanha,
strychnine & brucine from nux
vomica; quinine and caffeine
Pierre Robiquet codeine





HISTORY OF
HEALTH CARE

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
B.C.

Rationalization of treatment was sought during the time of
Hippocrates (460 B.C.). He is known as the Father of
Medicine. His followers abided by the fundamentals of the
scientific method, i.e. observation and classification,
rejection of unsupported theory & superstition, and a
cautious generalization that remained open to critical
discussion & revision.
GREECE
HEALTH CARE
PROFESSIONALS

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

Work in health care services, involved in the diagnosis
and treatment of patients
Research, teaching or administration of medical
facilities

PHARMACIST
Has a unique body of
knowledge and skills to
contribute in our
health care system
Dispenses the
appropriate drug
product and has the
knowledge to assure
safe and rational use of
drugs

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
labeling

4. Advising and
educating
patients on
proper use of
drugs

6. Serving as a
community
resource person
on drug and
health
information

THE
TEN STAR
PHARMACIST

Pharmaceutical Care Giver

Researcher

Manager

Communicator

Leader

Life-long learner

Decision-maker

Entrepreneur

Teacher

Agent of Positive Change
CONCERNS AMONG HEALTH CARE
PROVIDERS
Potential abuse, misuse and
inappropriate use of drugs
Increase in health care cost
Patient suffering

THE NEED OF PATIENT-ORIENTED PROFESSIONAL
Need to apply and provide drug
knowledge to improve drug use in the
health care system
There is call for the colleges of pharmacy
to raise new breed of clinically sound
pharmacist
PRIMARY AIM
To attain success in the goals for therapy, pharmacist must approach
the patientcounseling encounter as a HELPER and an EDUCATOR

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 SHIFT IN PHARMACY MODEL

From focus on the medication to a focus on the patient
Need for a shift in the pharmacists approach
From the health professionalcentered MEDICAL
MODEL to the patientcentered HELPING MODEL

MEDICAL MODEL
Patient is passive
Trust is based on expertise and
the authority of pharmacist
Pharmacist identifies problem
and determine solutions
Patient is dependent on
pharmacist
Parentchild relationship

HELPING MODEL
Patient is actively involved
Trust is based on personal
relationship developed over time
Pharmacists assist patients in
exposing problem and possible
solution
Patient develops self-confidence to
manage problems
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 use from the patients
perspective

AN OATH
I will use knowledge
and skills to the best of my
ability in serving the public
and other health
professionals


WHY HEALTH
IS VERY
IMPORTANT?

HEALTH
comes from the
English word
heal
HEALTH (WHO)
POSITIVE DEFINITION :
The state of complete
mental, physical, and social
well being, and does not
merely the absence of
illness or infirmity
HEALTH (WHO)
NEGATIVE DEFINITION :
Total absence of diseases
or illness in ones body
ENVIRONMENT
SOCIETY
Physical
Mental
Emotional
Spiritual
Sexual
Social
6 BIOLOGICAL
ASPECTS OF HEALTH
BIOLOGICAL
HEALTH
A goal to strive for
It is not obtainable
No one ever achieves a
state of complete
mental, physical,
emotional, sexual,
spiritual,
and social well being

CURE
Latin word
cura
CARE
CARE
Providing for the
welfare of another
Attentive
conscientiousness
of devotion

CARE
Conveys a
compassionate
state of being
and not merely
an attitude
Involves a
profound
respect for the
otherness of
the other

CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP
Establish personal relationship
Mutual respect
Honesty/Authenticity
Seeing the patient as a person


HOW TO GIVE RESPECT TO A
PATIENTS?

1. Display a genuine respect for the patient.
2. Respond to the patient as a person, not a prescription
or case (e.g., The Dengue patient in room 106).
3. Maintain a professional relationship and avoid
exchanging personal and confidential information.

RESPECT FOR THE PATIENT IS
CONVEYED BY

A. Acknowledging without judgment patient-specific
attributes that may be different from the pharmacists
value system or even offensive to the pharmacist but must
be dealt non judgmentally.

1. Smoking
2. excessive drinking
3. use of illicit drugs
4. self-destructive behaviors, and non adherence to prescribed
regimens
5. deficient hygiene
6. gross obesity


RESPECT FOR THE PATIENT IS
CONVEYED BY


Acknowledging patient-specific traits backgrounds such as
1. belief in folk physiology or use of alternative remedies or
unorthodox medical treatments also must be acknowledged
without judgment.
2. socioeconomic backgrounds and ethnic origins without
passing judgment.

CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP
Empathy
Sensitivity
Paying attention to the patients physical
and emotional comfort

SPECIAL SITUATIONS

1. Elderly Patients

A. Do not assume that every elderly person
has impaired hearing. Speak directly to
the patient and do not assume the
patient is incompetent.

B. Use large printed materials
SPECIAL SITUATIONS

2.. Physically Challenge patients

A. Communicating with physically
challenged patients is no different than
communicating with physically able
patients. Engage the patient in unhurried
conversation and give the patient ample
time to respond.

B. Speak directly to the patient and do not
assume that the patient is incompetent.
SPECIAL SITUATIONS



C. Do not stare at the patient or avoid eye
contact and do not physically assist the
patient unless invited to do so.

SPECIAL SITUATIONS



3. Mentally ill patients- avoid passing
judgment by asking why

CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP

Putting the patient first
Exercising patience and
understanding



CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP
Open communication


SPECIAL SITUATIONS

Mute Patients
A. Written communication and point and
spell letter boards can be time consuming
but often are the only means for two-way
communication. Encourage these
techniques and allow sufficient time for
adequate communication.
B. Maintain your end of the conversation
and do not limit your verbal responses just
because the patient is mute.


CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP
Supporting the patient
Promotion of patient independence
Cooperation and Collaborate (patient and practitioner

CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP

Offering reassurance
Confidence
Trust
SPECIAL SITUATIONS

Touching the patient lightly on the arm or
shoulder may reassure the patient.
CHARACTERISTICS OF A CARING
BEHAVIOR: VITAL COMPONENTS OF
A THERAPEUTIC RELATIONSHIP
Offering advocacy
Assuming responsibility for intervention
Accountable
Competence
HEALTH CARE NEEDS OF A PATIENT
Medical Care I care
Mental Health Care Geriatric Care
Dental Care Pharmaceutical Care
Nursing Care Surgical Care
Chiro-practice Care Nutritional Care
Pediatric Care Eye Care
Maternal Care

PRIMARY CARE
Frontline or
first contact care
Personcentered
Not disease or
organ system
centered
Comprehensive in
scope
Not limited to
illness episodes or
by organ systems
or disease process
involved

INTERACTIONS
WITH PATIENTS AND OTHER HEALTH CARE
PROVIDERS

COUNSEL
CONSULT
EDUCATION
4 Rs OF THE PHILOSOPHY OF PRACTICE
Rules
Roles
Relationship
Responsibilities

PHARMACEUTICAL
CARE
A responsible
provision of therapy
for the purpose of
achieving definite
outcomes that improve
the patients
quality of life

Hepler and Strand

PHARMACEUTICAL
CARE
Applying knowledge to
promote well-
being of others
Requires
responsiveness,
sensitivity
and commitment to
others
Generalist practice that
emphasizes
health, prevention and
care
A form of primary health
care

THE FOCUS
1. Patientcenteredness
2. Addressing both acute
and chronic conditions
3. Emphasizing
prevention
4. Implementing
documentation
systems
that continuously
record patient need
and care provided

THE FOCUS
5. Being accessible to
frontline
first contact
6. Ensuring integration of
care
7. Being accountable
8. Placing emphasis on
ambulatory patient
9. Including
education/health
promotional
intervention

5 FACTORS TO BE CONSIDERED IN
PHARMACEUTICAL CARE PRACTICE
A general understanding of how people feel
about being ill, the seriousness of the disease
(patients susceptibility to other factors)
DENIALNot me!
ANGERWhy me?
DEPRESSIONYes, me!
BARGAININGYes me, BUT.
ACCEPTANCEIm ready









VITAL POINTS
Dont assume patients had information from the doctor
Dont assume patients understand all information given
Dont assume patients have resources to comply
Dont assume patients dont care or are stupid
Dont assume patients will comply if they understand
Dont assume others will monitor of followup
Dont assume 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
professionals
PATIENT
Continuity Upon demand Discontinuous CONTINUOUS
Strategy Obey Find fault or
prevention
ANTICIPATE or
IMPROVE
Orientation Drug product Process OUTCOMES
WHAT A
PHARMACIST
CAN DO?
Patients on medications
experience
a lot of drug
misadventures
adverse effects, drug
interactions,
errors in the use of
medication and
noncompliance
MINIMIZE WASTE
and MAXIMIZE
BENEFITS of
medical treatments

OLD PARADIGM
Emphasis on acute patient care
Emphasis on treating illness

Responsible for individual
patients
All providers are essentially
similar
Success achieved by increasing
market share of in-patient
admissions
Goal is to fill beds

Hospitals, physicians, and
health plans are separate

NEW PARADIGM
Emphasis on the continuum of care
Emphasis on maintaining and
promoting wellness
Accountable for the health of define
populations
Differentiation based on ability to
add value
Success achieved by increasing the
number of covered lives and
keeping people well
Goal is to provide care at the most
appropriate level
Integrated health delivery system

TRANSFORMATION OF HEALTH CARE

THE ROLE OF THE
NEW
PHARMACIST
Has evolved from
being product
oriented to a patient
oriented
professional
Extremely healthy for
both patient
and pharmacist
Dispensers of therapy
and drug effect
interpretations as well
as drugs

In the future, pharmacy
services must be
evaluated on patient
outcome rather than the
number of prescriptions
dispensed

It must evolved towards
interpretation and
patient consultation,
related to the use of
medication technologies