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Part II

Practitioner Requirements to
Practice
Lalitha Raman-Wilms, PharmD, FCSHP
Associate Professor
Leslie Dan Faculty of Pharmcacy,
University of Toronto

Learning Objectives
At the end of this session, the student will be able to:
Describe the Philosophy of Pharmaceutical Care
Practice
Discuss the importance of a Professional Relationship
with the Patient
List the three steps of the Patient Care Process
List the components of the Patients Medication
Experience
Describe the purpose of the Pharmacotherapy Workup,
List the seven types of Drug Therapy Problems

Pharmaceutical Care1
Patient-centered practice
Patients drug-related needs
Pharmacist assumes
responsibility for this
1Cipolle,

R.J., Strand, L.M., Morley, P.C. (2004, 2012). Pharmaceutical Care


Practice: The Clinicians Guide New York: McGraw Hill.

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documenation System
Reimbursement System

PHILOSOPHY OF PRACTICE
A set of values that guides behaviors
associated with a professional
practice
Helps the practitioner determine
what is important and how to set
priorities
Represents what should be done

Pharmacists responsibility:
societal need

Medication costs in Canada


Cost of adverse drug events
Change in demographics in Canada
Patients self-selecting over-the-counter
medications
Commonly seen drug therapy problems

Pharmacist Responsibilities:
To the Patient
To ensure that all of a patients drug therapy
is INDICATED, EFFECTIVE, the SAFEST
possible, and that the patient is
COMPLIANT (able to take it) with it
The pharmacist identify, resolves, and
prevents drug therapy problems.

Pharmaceutical Care Practice


Philosophy
What does a pharmacist do?
meets a societal need
meets patient-specific responsibility:
identification, resolution & prevention of drug
therapy problems

How does a pharmacist do this?


With a patient-centered approach: patients
drug-related needs is the focus of the
pharmacists practise
Using a consistent process in providing
care: Patient Care Process

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documenation System
Reimbursement System

Patient-Pharmacist Relationship
Based on: mutual Respect, Trust, Open
Communication, Cooperation, Mutual
Decision Making
Essential clinical skills: inquiry, listening, and
observational skills
Effective use pharmacotherapeutic knowledge
Practitioner must collect information and
make clinical decisions, in partnership with
the patient
Work collaboratively with patients other
health care providers to optimize care

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documentation System
Reimbursement System

Patients Medication Experience


A. The Patients Description of the
Medication Experience
B. The Medication History
C. The Current Medication Record

The Patients Description of


the Medication Experience
Patient expectations and wants
Patient concerns
Patients understanding of drug
therapy
Preferences, attitudes, and beliefs influenced by personal experience,
influence of family members & friends
Cultural & religious influences
Medication taking behavior

The Medication History


Immunizations
History of social drug use - e.g.
caffeine, alcohol, tobacco
Drug allergies
Adverse drug reactions
Alerts and special needs e.g.
difficulty swallowing, difficulty hearing
or seeing
History of relevant medication use
(previous response to drug therapy)

The Current Medication Record


INDICATION the reason the patient is taking
the medication
DRUG PRODUCT includes the drug name,
the dosage strength
DOSAGE REGIMEN the dose, the frequency
of administration, the route
START DATE when patient started to take the
medication
RESPONSE includes both positive effects
and negative effects of drug therapy

The Current Medication Record


Effectiveness

Indication

Drug product

Dosage regimen

Outcomes
Safety

Figure 7-1

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documentation System
Reimbursement System

Systematic Thought Process


The systematic thought process is
called the Pharmacotherapy
Workup
This process guides the
pharmacists in assessing the
patients drug related needs and
identifying drug therapy problems

Drug Therapy Problem


Unnecessary drug therapy
Needs additional drug therapy

Indication

Drug product

Drug Therapy Problem


Dosage too low
Dosage too high

Dosage regimen

Effectiveness

Outcomes

Drug Therapy Problem

Drug Therapy Problem

Ineffective drug
Adverse drug reaction

Noncompliance

Cipolle, R.J., Strand, L.M., Morley, P.C. (2004, 2012). Pharmaceutical Care
Practice: The Clinicians Guide New York: McGraw Hill.

Safety

Figure 7-1

DRUG THERAPY PROBLEMS


Pharmacists responsibility: The
identification, resolution, and
prevention of drug therapy
problems

TYPES OF DRUG THERAPY PROBLEMS


1. Unnecessary Drug Therapy patient has no clinical
indication for drug
2. Additional drug therapy required for clinical indication
3. Drug not effective in producing response Ineffective
Drug
4. Too low a dosage Dosage Too Low
5. Causing an Adverse Drug Reaction (not dose-related)
unsafe
6. Dosage Too High resulting in side effects unsafe
7. Patient not able or willing to take drug therapy as
intended

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documentation System
Reimbursement System

The Patient Care Process


A method that allows the pharmacist to
make rational clinical decisions
This is supported by a problem-solving
process which is the Pharmacotherapy
Workup
There are three components to this process
All three must be completed and
documented

Patient Care

1
Process

Assessment
Of patients drug-related needs
Identify problems related to drug therapy

Establish a therapeutic
relationship

Care Plan
Address identified drug therapy problems and
work to achieving goals for each condition

Follow-up evaluation
Ensure goals are met; no new problems
related to drug therapy
1Pharmaceutical

Care Practice, 2004 & 2012, Cipolle et al

Continuous follow-up

ASSESSMENT
A systematic review of the patients drugrelated needs
Assessment enables the pharmacist to
determine if all of the patients drug
therapy is indicated, effective, safe and the
patient is compliant (able to take it)
During this process, the pharmacist
identifies drug therapy problems

CARE PLAN
The pharmacists plan of action to resolve any
drug therapy problems and to meet goals for
each medical condition or indication
The plan should include:
1. Specific Goals agreed upon by the patient
and the pharmacist with respect to drug
therapy (in conjunction with other health care
team members)
2. Specific Interventions to accomplish these
goals
3. A Follow-up Schedule to monitor outcomes

FOLLOW-UP EVALUATION
Schedule follow-up in order to:
1. Evaluate patients health status in
meeting agreed upon goals
2. Document outcome of drug therapy
3. Identify any new drug therapy problems

Practitioner Requirements
Philosophy of Practice
Professional / Therapeutic Relationship with
Patient
An understanding of the Patients Medication
Experience
Systematic Thought Process: Pharmacotherapy Workup and Patients Drug
Therapy Problems
Patient Care Process
Documentation System
Reimbursement System

Patient Care

1
Process

Assessment
Of patients drug-related needs
Identify problems related to drug therapy

Establish a therapeutic
relationship

Care Plan
Address identified drug therapy problems and
work to achieving goals for each condition

Follow-up evaluation
Ensure goals are met; no new problems
related to drug therapy
1Pharmaceutical

Care Practice, 2004 & 2012, Cipolle et al

Continuous follow-up

An exercise
Please take some time to speak with a
family member or another individual who is
taking at least one medication
regularly.
Ask the individual the 3 questions listed on
the next slide for each of their medications
and jot down these responses; these will be
addressed in the next session.

An exercise
1. What is your understanding of why
you are taking this medication?
2. What are your expectations of this
medication? (i.e. what do you hope it
will do for you?)
3. What are your concerns about this
medication? (i.e. what do you not
want from the medication?)