Chapter 4 - Implementing The Pharmacists' Patient Care Process

University of Tasmania Library
Access Provided by:
Pharmacotherapy Casebook: A PatientFocused Approach, 11e
Chapter 4: Implementing the Pharmacists’ Patient Care Process
Erika L. Kleppinger
Instructors can request access to the Casebook Instructor's Guide on AccessPharmacy. Email User Services (userservices@mheducation.com) for more
information.
INTRODUCTION
Historically, the profession has referred to pharmacist patient care services by a variety of titles, such as pharmaceutical care, medication therapy
management (MTM), comprehensive medication management (CMM), and individualized medication assessment and planning. While a pharmacist’s
activities generally focus on (1) identifying, resolving, and preventing drug therapy problems, (2) improving medication use, and (3) optimizing a patient’s
pharmacotherapeutic outcomes,1 terminology tends to be inconsistent among practice settings, making it difficult to communicate the role of a
pharmacist clearly with other healthcare providers. Without a clear, consistent patient care process, we cannot demonstrate to patients, caregivers, or
other healthcare professionals our contributions to improved medicationrelated outcomes. The Pharmacists’ Patient Care Process (PPCP), as published
by the Joint Commission of Pharmacy Practitioners (JCPP), provides a standardized process applicable to a wide variety of patient care services and
highlights a pharmacist’s medication expertise.2 While a consistent process of care applied to every patient is a foundational principle of most healthcare
professions, the PPCP differs from processes in other professions because of a pharmacist’s unique approach to assessing a patient’s medication regimen
to ensure that medications are appropriately indicated, effective, safe, and able to be taken by the patient as intended. The JCPP states that the goals of
the PPCP are to (1) promote consistency across the profession, (2) provide a framework for delivering patient care in any practice setting, (3) be a
contemporary and comprehensive approach to patientcentered care delivered in collaboration with other members of the healthcare team, and (4) be
applicable to a variety of patient care services delivered by pharmacists, including medication management.3 Pharmacists in different practice settings
have varying levels of intensity in implementing the PPCP. In some situations, pharmacists may not be responsible for all steps in the process or share
responsibility with other pharmacists, yet all pharmacists will follow these basic steps to some degree. This chapter summarizes the steps in the PPCP and
application of those steps to various patient care situations.
DRUG THERAPY PROBLEMS
The primary role of pharmacists when participating in the patient care process is to identify, resolve, and prevent drug therapy problems.4 A drug therapy
problem is defined as “any undesirable event experienced by a patient which involves, or is suspected to involve, drug therapy and that interferes with
achieving the desired goals of therapy and requires professional judgment to resolve.”4 Pharmacists must assess patient factors, drug therapy, and
information on the patient’s medical conditions to thoroughly assess the appropriateness of medication regimens and identify potential drug therapy
problems. This process involves a logical sequence of steps. It begins with evaluating each medication regimen for appropriateness of indication, then
optimizing the drug and dosage regimen to ensure maximum effectiveness, and finally, individualizing drug therapy to make it as safe as possible for the
patient. After completing these three steps, the practitioner considers other issues such as cost, adherence, and convenience.
As described in Chapter 1, drug therapy problems can be separated into seven distinct categories related to medication appropriateness, effectiveness,
safety, or adherence:
Appropriate indication for the medication:
1. The medication is unnecessary because the patient does not have a clinical indication at this time.
2. Additional drug therapy is required to treat or prevent a medical condition.
Effectiveness of the medication:

Downloaded 2024213 8:47 P Your IP is 131.217.6.7
3. The
Chapter 4: medication being
Implementing theused is not effective
Pharmacists’ at producing
Patient the desired
Care Process, Erika patient response.
L. Kleppinger Page 1 / 15
©2024 McGraw Hill. All Rights Reserved. Terms of Use • Privacy Policy • Notice • Accessibility
4. The dosage is too low to produce the desired patient response.
Safety of the medication:

1. The medication is unnecessary because the patient does not have a clinical indication at this time. University of Tasmania Library
Access Provided by:
2. Additional drug therapy is required to treat or prevent a medical condition.
Effectiveness of the medication:
3. The medication being used is not effective at producing the desired patient response.
4. The dosage is too low to produce the desired patient response.
Safety of the medication:
5. The medication is causing an adverse reaction.
6. The dose is too high, resulting in actual or potential undesirable effects.
Adherence to the medication:
7. The patient is not able or willing to take the drug therapy as intended.
See Table 41 for a more comprehensive list of factors to consider in identifying drug therapy problems.4
TABLE 41
Drug Therapy Problems to Be Resolved or Prevented
Assessment Drug Therapy Problem
Indication Unnecessary drug therapy

No medical indication
Duplicate therapy
Nondrug therapy indicated
Treating avoidable adverse drug reaction
Addictive/recreational use
Needs additional drug therapy
Untreated condition
Preventive/prophylactic
Synergistic/potentiating
Effectiveness Ineffective drug

More effective drug available
Condition refractory to drug
Dosage form inappropriate
Not effective for condition
Dosage too low
Wrong dose
Frequency too long
Duration too short
Drug interaction
Incorrect administration
Safety Adverse drug reaction

Undesirable effect
Unsafe drug for patient
Drug interaction
Dose administered or changed too rapidly
Allergic reaction
Chapter 4: Implementing the Pharmacists’ Patient Care Process, Erika L. Kleppinger
Contraindications present
Page 2 / 15
Dosage too high

Safety Adverse drug reaction University of Tasmania Library
Undesirable effect Access Provided by:
Unsafe drug for patient

Drug interaction
Dose administered or changed too rapidly
Allergic reaction
Contraindications present
Dosage too high
Wrong dose
Frequency too short
Duration too long
Drug interaction
Incorrect administration
Adherence Nonadherence
Directions not understood
Patient prefers not to take
Patient forgets to take
Drug product too expensive
Cannot swallow or administer
Drug product not available
Adapted with permission from Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: A Clinician’s Guide. 2nd ed. New York, NY: McGrawHill, 2004:168.
To resolve or prevent a drug therapy problem, the underlying cause of the problem must be clearly understood. Table 42 provides a list of potential
causes of drug therapy problems based on each category described previously.4
TABLE 42
Causes of Drug Therapy Problems
Drug Therapy Problem Possible Causes of Drug Therapy Problems
Unnecessary drug therapy No valid medication indication for the drug at this time
Multiple drug products are used when only singledrug therapy is required
The condition is better treated with nondrug therapy
Drug therapy is used to treat an avoidable adverse drug reaction associated with another medication
The medical problem is caused by drug abuse, alcohol use, or smoking
Need for additional drug therapy A medical condition exists that requires initiation of new drug therapy
Preventive therapy is needed to reduce the risk of developing a new condition
A medical condition requires combination therapy to achieve synergism or additive effects
Ineffective drug The drug is not the most effective one for the medical problem
The drug product is not effective for the medical condition
The condition is refractory to the drug product being used
The dosage form is inappropriate
Dosage too low The dose is too low to produce the desired outcome
The dosage interval is too infrequent
A drug interaction reduces the amount of active drug available
The duration of therapy is too short
Adverse drug reaction The drug product causes an undesirable reaction that is not dose related
A safer drug is needed because of patient risk factors
Chapter 4: Implementing the Pharmacists’ Patient
A drugCare Process,
interaction Erika
causes L. Kleppinger
an undesirable reaction that is not dose related Page 3 / 15
©2024 McGraw Hill. All Rights Reserved. Terms
The regimen was administered or changed•too
of Use • Privacy Policy • Notice Accessibility
rapidly
The product causes an allergic reaction
The drug is contraindicated because of patient risk factors
Adapted with permission from Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: A Clinician’s Guide. 2nd ed. New York, NY: McGrawHill,
University of2004:168.
Tasmania Library
Access Provided by:
To resolve or prevent a drug therapy problem, the underlying cause of the problem must be clearly understood. Table 42 provides a list of potential
causes of drug therapy problems based on each category described previously.4
TABLE 42
Causes of Drug Therapy Problems
Drug Therapy Problem Possible Causes of Drug Therapy Problems
Unnecessary drug therapy No valid medication indication for the drug at this time
Multiple drug products are used when only singledrug therapy is required
The condition is better treated with nondrug therapy
Drug therapy is used to treat an avoidable adverse drug reaction associated with another medication
The medical problem is caused by drug abuse, alcohol use, or smoking
Need for additional drug therapy A medical condition exists that requires initiation of new drug therapy
Preventive therapy is needed to reduce the risk of developing a new condition
A medical condition requires combination therapy to achieve synergism or additive effects
Ineffective drug The drug is not the most effective one for the medical problem
The drug product is not effective for the medical condition
The condition is refractory to the drug product being used
The dosage form is inappropriate
Dosage too low The dose is too low to produce the desired outcome
The dosage interval is too infrequent
A drug interaction reduces the amount of active drug available
The duration of therapy is too short
Adverse drug reaction The drug product causes an undesirable reaction that is not dose related
A safer drug is needed because of patient risk factors
A drug interaction causes an undesirable reaction that is not dose related
The regimen was administered or changed too rapidly
The product causes an allergic reaction
The drug is contraindicated because of patient risk factors
Dosage too high The dose is too high for the patient
The dosing frequency is too short; the duration of therapy is too long
A drug interaction causes a toxic reaction to the drug product
The dose was administered too rapidly
Nonadherence The patient does not understand the instructions

The patient prefers not to take the medication
The patient forgets to take the medication
Drug product is too expensive
The patient cannot swallow or selfadminister the medication properly
The drug product is not available for the patient
Adapted with permission from Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: A Clinician’s Guide. 2nd ed. New York, NY: McGrawHill, 2004:178–179.
STEPS IN THE PHARMACISTS’ PATIENT CARE PROCESS (PPCP)
The core of the PPCP is patientcentered care and establishing a relationship with the patient.2 Including the patient, his/her family, and caregivers in the
process allows for open communication and engagement in managing their own health problems. Communication, collaboration, and documentation are
also key components incorporated into many if not all of the steps in the process. Collaboration among patients, pharmacists, physicians, andPage
other4 / 15
Chapter 4: Implementing the Pharmacists’ Patient Care Process, Erika L. Kleppinger
healthcare providers is essential in providing optimal patient care. These topics are covered
©2024 McGraw Hill. All Rights Reserved. Terms of Use • Privacy Policy • Notice • Accessibilityin more detail in Chapters 3 and 5.
The steps of the PPCP include Collect, Assess, Plan, Implement, and Followup: Monitor and Evaluate, and are illustrated as a circle to indicate the cyclical
STEPS IN THE PHARMACISTS’ PATIENT CARE PROCESS (PPCP) Access Provided by:
The core of the PPCP is patientcentered care and establishing a relationship with the patient.2 Including the patient, his/her family, and caregivers in the
process allows for open communication and engagement in managing their own health problems. Communication, collaboration, and documentation are
also key components incorporated into many if not all of the steps in the process. Collaboration among patients, pharmacists, physicians, and other
healthcare providers is essential in providing optimal patient care. These topics are covered in more detail in Chapters 3 and 5.
The steps of the PPCP include Collect, Assess, Plan, Implement, and Followup: Monitor and Evaluate, and are illustrated as a circle to indicate the cyclical
nature of the process, with Followup leading back to Collect at a future patient encounter (Fig. 41).2 Each of the steps is summarized below followed by a
short patient case vignette example.
FIGURE 41.
The pharmacists’ patient care process. (Adapted with permission from the Joint Commission of Pharmacy Practitioners Pharmacists’ Patient Care Process,
May 29, 2014. https://jcpp.net/patientcareprocess/. Accessed March 29, 2019.)
COLLECT
Collection of subjective and objective information provides the basis for identifying drug therapy problems. This information can be obtained directly
from the patient or caregiver, through review of existing health records, or communicating with other healthcare professionals. In all practice settings, a
primary function of pharmacists is to conduct a medication history as the initial step in identifying drug therapy problems. This is especially important
during patient transitions of care. A complete medication history includes all of the prescription and nonprescription medications the patient is currently
taking; dietary supplements, herbal products, and complementary medicine approaches; and recent previous medications the patient has taken. Other
relevant health data such as a medical history, health and wellness information, biometric test results, and physical assessment findings may also be
collected.
Downloaded Beyond conducting
2024213 8:47medication
P Your IP and health histories, other important factors to gather include lifestyle habits, a patient’s preferences and/or
is 131.217.6.7
beliefs,
Chapterhealth and functional
4: Implementing thegoals, and socioeconomic
Pharmacists’ factors.
Patient Care This additional
Process, information can help to provide a holistic approach to patient Page
Erika L. Kleppinger care. A
5 / 15
©2024 McGraw Hill. All Rights Reserved. Terms of Use • Privacy
sample of specific types of information to collect is provided as follows.Policy
2,4 • Notice • Accessibility
Patient Information
from the patient or caregiver, through review of existing health records, or communicating with other healthcare professionals. In all practice settings, a
University
primary function of pharmacists is to conduct a medication history as the initial step in identifying drug therapy problems. This of Tasmania
is especially Library
important
Access Provided by:
during patient transitions of care. A complete medication history includes all of the prescription and nonprescription medications the patient is currently
taking; dietary supplements, herbal products, and complementary medicine approaches; and recent previous medications the patient has taken. Other
relevant health data such as a medical history, health and wellness information, biometric test results, and physical assessment findings may also be
collected. Beyond conducting medication and health histories, other important factors to gather include lifestyle habits, a patient’s preferences and/or
beliefs, health and functional goals, and socioeconomic factors. This additional information can help to provide a holistic approach to patient care. A
sample of specific types of information to collect is provided as follows.2,4
Patient Information
Name, address, and phone number (for future contact and followup evaluation)
Primary care physician
Demographic and background information: age (date of birth), gender, sexual orientation, gender identity, race, height, weight (important for weight
based dosing)
Social history (SH): living arrangements, occupation, tobacco, alcohol, substance use (include name of substance, amount, and frequency when
possible)
Family history (FH): relevant health histories of parents and siblings
Insurance information: name of health plan and policy number (important for accurate billing of services)
Disease Information
Past medical history (PMH)
Current medical problems
History of present illness (HPI)
Pertinent information from the review of systems (ROS), physical examination, laboratory results, and xray/imaging results
Medical diagnoses
Immunization history
Drug Information
Allergies and side effects (include the name of the medication and the reaction that occurred)
Current prescription medications; for each medication include start date, indication for use, drug name, strength, dosage regimen, and how the
patient is actually taking it. The actual regimen may differ from the prescribed regimen because patients do not always take medications as directed.
Also ask about effectiveness, adverse effects, and patient questions or concerns about current medications for a complete medication history.
Current nonprescription medications, vitamins, dietary supplements, and alternative/complementary therapies
Recent past prescription and nonprescription medications (include the stop date)
The amount and type of information collected by pharmacists will vary based on the patient care service or practice setting. For example, in a community
pharmacy there will be excellent data on a patient’s refill history, but laboratory tests are not as readily available. The pharmacist will rely mostly on
communicating with the patient to obtain information but may also conduct pointofcare testing, blood pressure measurement, or other screening tests
when available. In hospital and clinic settings, pharmacists have access to laboratory and test results, physician physical exam information, and other
objective data; however, they still rely on interviewing the patient to obtain subjective data to fully describe the problem.
Example Case Vignette
Martin Roberts is a 32yearold Caucasian man who presents to the pharmacy today for a refill of his alprazolam. He states that he only has a few tablets left
and doesn’t want to run out. He was recently diagnosed with generalized anxiety disorder and started on sertraline and lorazepam. A review of the patient
profile in the computer system reveals the following:
Sertraline
Chapter (Zoloft) 50 mg,
4: Implementing thetakes one tabletPatient
Pharmacists’ daily, quantity #30 (started
Care Process, Erika2L.
weeks ago by Dr Johnson)
Kleppinger Page 6 / 15
Lorazepam (Ativan) 0.5 mg, takes one tablet daily as needed for anxiety, quantity #30 (started 2 weeks ago by Dr Johnson)
objective data; however, they still rely on interviewing the patient to obtain subjective data to fully describe the problem.

Example Case Vignette
Access Provided by:
Martin Roberts is a 32yearold Caucasian man who presents to the pharmacy today for a refill of his alprazolam. He states that he only has a few tablets left
and doesn’t want to run out. He was recently diagnosed with generalized anxiety disorder and started on sertraline and lorazepam. A review of the patient
profile in the computer system reveals the following:
Sertraline (Zoloft) 50 mg, takes one tablet daily, quantity #30 (started 2 weeks ago by Dr Johnson)
Lorazepam (Ativan) 0.5 mg, takes one tablet daily as needed for anxiety, quantity #30 (started 2 weeks ago by Dr Johnson)
Acetaminophen (Tylenol) 500 mg, takes one to two tablets as needed for headaches (OTC medication)
What additional information is needed to identify potential drug therapy problems in Mr Roberts?
First, it is important to ask Mr Roberts about his medications, specifically what he takes his medications for, how he takes his medications, and any
problems he may be experiencing with them. A brief medication history can also be obtained. These questions reveal the following information: He takes
lorazepam twice a day most days because his doctor told him he could take it more often if he needed it for anxiety. He has only three tablets remaining. He
takes sertraline as prescribed and is not experiencing any adverse effects; however, he doesn’t think it is working very well. He does not use any other
prescription or nonprescription medications and uses the acetaminophen about four to five times per month.
After learning about his medications, it is important to determine what he knows about his generalized anxiety disorder, especially since it is a recent
diagnosis. He is seeing a therapist to help him with nonpharmacologic strategies for dealing with anxiety. He wasn’t told a lot about the medications when
he started them 2 weeks ago, so he wonders why he still needs to take the lorazepam.
ASSESS
A great deal of time is spent analyzing the drug therapy in the context of the patient’s overall health goals. Assessment of a patient’s health and
medications helps to identify and prioritize drug therapy problems. To identify potential drug therapy problems, pharmacists can ask five questions when
assessing a patient’s drug therapy:
1. Is there an appropriate indication for each medication?
2. Is the drug therapy effective?
3. Is the drug therapy safe for this patient?
4. Can the patient comply with the drug therapy and other aspects of their care plan?
5. Is there an untreated indication that needs drug therapy?
Asking these questions will allow the pharmacist to determine if the patient’s drug therapy is appropriate, effective, safe, and convenient for the patient.
When asked in this order, pharmacists can systematically assess for potential drugrelated problems. For example, if a medication is not appropriate for
the patient, one does not need to ask about its effectiveness, safety, or patient adherence because these questions would not be applicable. Additionally,
pharmacists can identify drug therapy problems that may interfere with goals of therapy or other potential problems that could be prevented.
After a drug therapy problem is identified, it is also important to determine the severity of the medical condition or problem. This will help in prioritizing
the problem list, which is the final portion of the Assess step. The most urgent or severe problem should be listed first, with the remaining problems listed
in order of severity. In addition to assessing drug therapy problems, pharmacists may also assess a patient’s health literacy, the patient’s willingness and
ability to make changes, barriers to followup (eg, transportation difficulties, insurance limitations), vaccination status, and other preventive care needs.
The Collect and Assess steps are often conducted simultaneously because pharmacists evaluate the information as it is being collected. The assessment
process is similar across practice settings, but the type and quantity of information available may vary.
Example Case Vignette (continued)
Prioritized problem list for Martin Roberts:
1. Generalized anxiety disorder: early refill of lorazepam (effectiveness problem–prescribed dose is too low). Mr Roberts is 2 weeks early in refilling his
lorazepam. He is regularly taking more medication than prescribed, which has led to running out of his 30day supply of medication in 2 weeks. In
taking 0.5 mg twice per day, he is still below the maximum daily dose of 10 mg. A new prescription will be needed for the increased dose.
2. Generalized anxiety disorder: lack of understanding of sertraline effects (adherence problem). Mr Roberts does not seem informed that the sertraline
Downloaded 2024213
may take some time to8:47 P Your
be fully IP is 131.217.6.7
effective.
Chapter 4: Implementing the Pharmacists’ Patient Care Process, Erika L. Kleppinger Page 7 / 15
3. Headaches: potential for acetaminophen overuse (safety problem–dose too high): Mr Roberts is currently taking less than the maximum daily dose of
acetaminophen (4000 mg/day). However, he should be educated on the maximum daily dose and reminded of other acetaminophencontaining
products to avoid duplication of therapy and potential adverse events.
Prioritized problem list for Martin Roberts:
1. Generalized anxiety disorder: early refill of lorazepam (effectiveness problem–prescribed dose is too low). Mr Roberts is 2 weeks early in refilling his
Access Provided by:
lorazepam. He is regularly taking more medication than prescribed, which has led to running out of his 30day supply of medication in 2 weeks. In
taking 0.5 mg twice per day, he is still below the maximum daily dose of 10 mg. A new prescription will be needed for the increased dose.
2. Generalized anxiety disorder: lack of understanding of sertraline effects (adherence problem). Mr Roberts does not seem informed that the sertraline
may take some time to be fully effective.
3. Headaches: potential for acetaminophen overuse (safety problem–dose too high): Mr Roberts is currently taking less than the maximum daily dose of
acetaminophen (4000 mg/day). However, he should be educated on the maximum daily dose and reminded of other acetaminophencontaining
products to avoid duplication of therapy and potential adverse events.
PLAN
Once a problem list has been identified and prioritized, pharmacists must then develop an individualized, patientcentered care plan specific for the
patient’s needs. Collaboration with other healthcare providers may be necessary if the plan goes beyond the pharmacist’s scope of practice. When
formulating a care plan, it is important to include the medical condition for which the patient has drugrelated needs, the specific drug therapy problems
identified, clear goals of therapy, proposed interventions (nonpharmacologic and pharmacologic), and a followup plan. A plan should be created for all
problems identified in the assessment step.
Goals of therapy for each medical condition should indicate one of the primary therapeutic outcomes as described in Chapter 1: cure of disease,
reduction or elimination of symptoms, arresting or slowing of the progression of disease, or preventing a disease or symptom. To create clear goals, the
SMART acronym can be used. Each goal should be Specific, Measurable (or observable), Achievable, Related to the drug therapy problem, and include a
Timeline for achievement. A patientcentered approach includes the patient in setting goals of therapy that are most important to them and seeking
patient input in the prioritization of nonacute problems. Involving the patient in the care plan allows the pharmacist to address the patient’s unique
concerns, needs, and preferences, and empowers patients to take more responsibility in implementing their portion of the plan.
Specific drug therapy recommendations should include the drug name, dosage form, dose, route of administration, schedule, and duration of therapy.
Nonpharmacologic approaches to treatment and preventive strategies (such as screenings or vaccinations) should also be included as appropriate. A plan
for monitoring and care continuity is also essential in this step, including specific monitoring parameters for the patient’s medical conditions and
recommended medications, a specific timeframe for followup appointments, and information on referrals if needed.
As with Assessment, the process of creating a care plan is similar across practice settings and varies based on the information available for collection and
assessment. Hospital and insurance formularies must be considered when developing patient care plans. In the community setting, pharmacists can
recommend nonprescription products and selfcare strategies but must contact a prescriber if prescription drug therapy needs to be changed, unless a
collaborative practice agreement is in place. Pharmacists in all settings can address many drug therapy problems regarding patient adherence issues.
Plan for Martin Roberts:
1. Generalized anxiety disorder: early refill of lorazepam. Goal of therapy is to alleviate acute anxiety symptoms. Contact Dr Johnson for a new
prescription for lorazepam 0.5 mg; take one tablet twice daily.
2. Generalized anxiety disorder: lack of understanding of sertraline effects. Goal of therapy is to reduce anxiety symptoms. Educate Mr Roberts on
sertraline, specifically its onset of action and the time needed to experience maximal effectiveness.
3. Headaches: potential for acetaminophen overuse. Goal is to prevent acetaminophen overdose. Educate Mr Roberts on the maximum dose of
acetaminophen. Provide examples of other products that contain acetaminophen, such as overthecounter cold medications and sleep aids.
IMPLEMENT
A pharmacist’s ability to implement care plans depends on the scope of activities allowed by state laws and regulations or through a collaborative practice
agreement. Collaborative practice agreements can be broad or limited to a specific condition, such as anticoagulation. In clinical settings, pharmacists may
also be a part of a healthcare team conducting collaborative patient visits or rounding. When a plan requires expertise outside a pharmacist’s scope of
practice, it is important to provide a referral to the appropriate healthcare provider (eg, physician, podiatrist, dietician) and explain to the patient the
importance of followup. A main component of implementation is providing education and selfmanagement training for the patient and/or caregiver.
When counseling patients, a pharmacist can discuss reasons for drug therapy, medication actions, administration, adverse effects, what to expect from
treatment (eg, when the medication will begin working, if it provides a cure or just relieves symptoms, if it relieves symptoms completely or just improves
them), and appropriate followup (eg, proper duration of therapy, when to see a physician if the problem continues).
Chapter
If 4: Implementing
authorized, the may
implementation Pharmacists’ Patient modifying,
include initiating, Care Process, Erika L. Kleppinger
discontinuing,
Page 8 / 15
or administering medication therapy. Under a collaborative practice
agreement, pharmacists may be able to implement these changes directly with the patient. Preventive care strategies are also important, such as
vaccinations, diabetic foot exams, diet and exercise counseling, and various screenings (eg, blood pressure, cholesterol, depression, blood glucose, HIV,
also be a part of a healthcare team conducting collaborative patient visits or rounding. When a plan requires expertise outside a pharmacist’s scope of
practice, it is important to provide a referral to the appropriate healthcare provider (eg, physician, podiatrist, dietician) and University of Tasmania
explain to the patient theLibrary
Access Provided by:
importance of followup. A main component of implementation is providing education and selfmanagement training for the patient and/or caregiver.
When counseling patients, a pharmacist can discuss reasons for drug therapy, medication actions, administration, adverse effects, what to expect from
treatment (eg, when the medication will begin working, if it provides a cure or just relieves symptoms, if it relieves symptoms completely or just improves
them), and appropriate followup (eg, proper duration of therapy, when to see a physician if the problem continues).
If authorized, implementation may include initiating, modifying, discontinuing, or administering medication therapy. Under a collaborative practice
agreement, pharmacists may be able to implement these changes directly with the patient. Preventive care strategies are also important, such as
vaccinations, diabetic foot exams, diet and exercise counseling, and various screenings (eg, blood pressure, cholesterol, depression, blood glucose, HIV,
osteoporosis). Many of these strategies could be implemented and patients referred to appropriate providers if abnormal results are found.
Communication and documentation of the plan are also important to ensure that care is coordinated with other healthcare providers.
You call and speak with Dr Johnson about Mr Martin’s management of his anxiety. The physician confirms that Mr Martin was instructed to take the
lorazepam more often if he needed it in the next few weeks. He provides you with a verbal prescription for lorazepam 0.5 mg, with instructions to take one
tablet up to three times per day as needed for anxiety, Quantity #45, two refills. He states that this should be an adequate supply until Mr Martin’s next
appointment in 4 weeks. You then speak with Mr Martin and summarize your conversation with Dr Johnson. You also counsel Mr Martin on his sertraline
and inform him that it may take up to 4–6 weeks to see the full effects of the medication, and that he should notice some effects soon and not need as
much lorazepam. You counsel him on the importance of taking his medications as prescribed and contacting his physician if he needs more lorazepam
than prescribed. You also discuss his acetaminophen use and educate him that the maximum daily dose is 4000 mg. While he is well under this dose
currently, he should be aware of other medications that contain acetaminophen, including overthecounter cold medications and sleep aids. He agrees to
talk with you if he is unsure if a medication contains acetaminophen. You document your conversation with the patient in his profile in the computer
system.
FOLLOWUP: MONITOR AND EVALUATE
The final step in the PPCP clearly delineates a continual process because at some future time subjective and objective data will again need to be collected
and assessed. During followup, the pharmacist evaluates the positive and negative impact of the care plan on the patient, identifies new drug therapy
problems, and takes action to address new problems or adjust therapy. It is also important to determine an appropriate followup time frame to ensure
that efficacy and safety parameters can be evaluated appropriately. In some settings, patients may have scheduled visits at predetermined intervals while
others may be conducted primarily as a walkin. In these situations, patient noshows for visits can make followup problematic. With followup, various
outcomes can also be tracked and reported such as:
Clinical outcomes: blood pressure, A1C, medication problem resolution, adverse drug events, adherence
Humanistic outcomes: patient medication knowledge, patient functioning, selfmanagement capability, satisfaction, patient concerns about the
treatment
Economic outcomes: hospitalizations, emergency department visits, medication costs
When evaluating the care plan, a pharmacist should compare the goals of therapy with the patient’s current status. Cipolle et al developed terminology to
describe the patient’s status, the medical condition, and the comparative evaluation of that status with the previously determined therapeutic goals.4
These terms also describe the actions taken as a result of the followup evaluation:
Status Definition
Resolved Therapeutic goals achieved for the acute condition; discontinue therapy
Stable Therapeutic goals achieved; continue the same therapy for chronic disease management
Improved Progress is being made in achieving goals; continue the same therapy because more time is required to assess the full benefit of therapy
Partial Progress is being made, but minor adjustments in therapy are required to fully achieve the therapeutic goals before the next assessment
improvement
Unimproved Little or no progress has been made, but continue the same therapy to allow additional time for benefit to be observed
Chapter 4: Implementing
Worsened the inPharmacists’
A decline Patient
health is observed Care
despite Process,duration
an adequate Erika L.using the optimal drug; modify drug therapy (eg, increase the dose of the Page 9 / 15
Kleppinger
©2024 McGraw Hill. All Rights
current Reserved.
medication, Termsagent
add a second of Use • Privacy
with Policy
additive or • Notice
synergistic • Accessibility
effects)
Failure Therapeutic goals have not been achieved despite an adequate dose and duration of therapy; discontinue current medication(s) and start
Economic outcomes: hospitalizations, emergency department visits, medication costs
When evaluating the care plan, a pharmacist should compare the goals of therapy with the patient’s current status. Cipolle et al developed terminology to
Access Provided by:
describe the patient’s status, the medical condition, and the comparative evaluation of that status with the previously determined therapeutic goals.4
These terms also describe the actions taken as a result of the followup evaluation:
Status Definition
Resolved Therapeutic goals achieved for the acute condition; discontinue therapy
Stable Therapeutic goals achieved; continue the same therapy for chronic disease management
Improved Progress is being made in achieving goals; continue the same therapy because more time is required to assess the full benefit of therapy
Partial Progress is being made, but minor adjustments in therapy are required to fully achieve the therapeutic goals before the next assessment
improvement
Unimproved Little or no progress has been made, but continue the same therapy to allow additional time for benefit to be observed
Worsened A decline in health is observed despite an adequate duration using the optimal drug; modify drug therapy (eg, increase the dose of the
current medication, add a second agent with additive or synergistic effects)
Failure Therapeutic goals have not been achieved despite an adequate dose and duration of therapy; discontinue current medication(s) and start
new therapy
Expired The patient died while receiving drug therapy; document possible contributing factors, especially if they may be drug related
Mr Martin returns to the pharmacy in 2 weeks to pick up his sertraline prescription. You ask him how he is doing, and he reports that he is feeling better
and his anxiety has improved. He expresses appreciation for the help you provided during his last visit to the pharmacy. He admits using less lorazepam in
the past week and feels like the sertraline is starting to have some positive effects. He has an appointment with Dr Johnson in 2 weeks for followup. You
evaluate your care plan as follows:
1. Generalized anxiety disorder: early refill of lorazepam. Goal of therapy is to alleviate acute anxiety symptoms, and symptoms are improving.
2. Generalized anxiety disorder: lack of understanding of sertraline effects. Goal of therapy is to reduce anxiety symptoms. Symptoms are improving, and
the patient understands the current therapy.
3. Headaches: potential for acetaminophen overuse. The goal is to prevent acetaminophen overdose. The patient understands the need to avoid other
acetaminophencontaining drug products; thus, this potential drug therapy problem was prevented at this time, but ongoing monitoring is advised.
EXAMPLES OF PATIENT CARE PROCESS IMPLEMENTATION

The PPCP can be applied in a variety of patient care situations such as CMM, IVtooral dosing in the hospital setting, medication reconciliation during a
care transition, disease state management, and provision of immunization services, to name a few. To assist pharmacists with implementing the PPCP,
organizations have published resource guides for specific conditions such as immunization services5 and managing high blood pressure.6 In more general
terms, many pharmacists use the PPCP in providing MTM, assisting patient’s with selfcare needs, and chronic disease state monitoring.
MEDICATION THERAPY MANAGEMENT
The American Pharmacists Association (APhA) and the National Association of Chain Drug Stores (NACDS) published core elements of MTM to assist
pharmacists in providing these services consistently for patients, regardless of the setting.7 Medication therapy management (MTM) focuses on the
identification and resolution of drug therapy problems, similar to the main purpose of the PPCP. Therefore, the steps of the PPCP can be easily seen in
MTM’s five core elements7:
1. Medication therapy review (MTR): Involves discussing the full list of the patient’s medications (Collect), identifying and prioritizing potential drug
therapy problems (Assess), and creating a plan to resolve the identified drug therapy problems (Plan). This could be conducted in person or via the
telephone.
2. Personalized medication record (PMR): A complete record of the patient’s medications including dosages and directions for use is provided for
The American Pharmacists Association (APhA) and the National Association of Chain Drug Stores (NACDS) published core elements of MTM to assist
pharmacists in providing these services consistently for patients, regardless of the setting.7 Medication therapy management (MTM) focuses on the
Access Provided by:
identification and resolution of drug therapy problems, similar to the main purpose of the PPCP. Therefore, the steps of the PPCP can be easily seen in
MTM’s five core elements7:
1. Medication therapy review (MTR): Involves discussing the full list of the patient’s medications (Collect), identifying and prioritizing potential drug
therapy problems (Assess), and creating a plan to resolve the identified drug therapy problems (Plan). This could be conducted in person or via the
telephone.
2. Personalized medication record (PMR): A complete record of the patient’s medications including dosages and directions for use is provided for
the patient (Implement). All prescription and nonprescription medications should appear on this list in addition to dietary supplements and herbal
products. This record may also include demographic information, a complete list of allergies, the name of pharmacy, emergency contact information,
and the date it was last updated.
3. Medicationrelated action plan (MAP): A document provided to the patient that includes any action items derived from the full medication therapy
review (Plan, Implement). This plan is used by the patient to track their progress for selfmanagement (Followup).
4. Intervention and/or referral: Completing any needed action steps (eg, calling a physician, making written instructions to the patient, counseling on
proper inhaler use). The pharmacist either addresses the drug therapy problems directly or refers the patient to a physician or other healthcare
provider. (Implement)
5. Documentation and followup: All interventions should be documented; however, the format may vary depending on the specific area of practice.
Documentation may include a full SOAP note or something as simple as documenting a brief note in the pharmacy patient profile (Implement). Follow
up appointments are scheduled based on the patient’s needs (Followup).
SELFCARE MANAGEMENT
Pharmacists in many settings assist patients with various selfcare needs. In this capacity, pharmacists perform functions similar to a primary care
provider, specifically gathering and evaluating information about the patient’s problems, differentiating between selftreatable conditions and conditions
requiring medical intervention, and advising and counseling the patient about the proposed course of action. To assist pharmacists with these types of
encounters, the QuEST/SCHOLAR tool was developed.8 In addition to patients presenting with a selfcare complaint, the SCHOLARMAC questions could
also be helpful to organize a patient interview for any patient presenting with a particular symptom complaint. The steps of the PPCP are clearly evident in
QuEST, as described below8:
Q uickly and accurately assess the patient using SCHOLARMAC questions (Collect, Assess)
Symptoms: the main and associated symptoms
Characteristics: a description of the situation and evolution of the symptoms
History: previous experience with the problem; what has been tried so far
Onset: when the problem began
Location: where the problem is located
Aggravating factors: aspects that make the problem worse
Remitting factors: aspects that make the problem better
Medications: prescription and nonprescription medications, dietary supplements, herbal products, complementary therapies
Allergies: to medications and other substances
Conditions: all current medical conditions
E stablish that the patient is an appropriate selfcare candidate (Assess)
S uggest appropriate selfcare strategies (Plan, Implement)
T alk with the patient about the suggested selfcare strategies (Implement, Followup)
CHRONIC
DownloadedDISEASE
2024213STATE MONITORING
8:47 P Your IP is 131.217.6.7
In ambulatory
©2024 McGraw settings,
Hill. Allpharmacists often participate
Rights Reserved. Terms ofinUse
chronic disease
• Privacy state• monitoring
Policy in collaboration with other healthcare professionals. For
Notice • Accessibility
example, a community pharmacist may have a collaborative practice agreement with a physician to manage their patients on chronic anticoagulation
therapy. After starting anticoagulation, the physician may refer patients to the pharmacist for followup appointments. At these appointments the
E stablish that the patient is an appropriate selfcare candidate (Assess)
S uggest appropriate selfcare strategies (Plan, Implement) Access Provided by:
T alk with the patient about the suggested selfcare strategies (Implement, Followup)
CHRONIC DISEASE STATE MONITORING
In ambulatory settings, pharmacists often participate in chronic disease state monitoring in collaboration with other healthcare professionals. For
example, a community pharmacist may have a collaborative practice agreement with a physician to manage their patients on chronic anticoagulation
therapy. After starting anticoagulation, the physician may refer patients to the pharmacist for followup appointments. At these appointments the
pharmacist interviews the patient, conducts pointofcare INR testing, makes adjustments in anticoagulant therapy, and communicates those changes to
the patient’s physician. Pharmacists also participate in chronic disease state monitoring in clinic settings, where they would have full access to the
patient’s medical record. While a patient may be referred to pharmacy services for a particular indication, such as diabetes management, it is important for
the pharmacist to explore all potential drugrelated problems that may arise, even if they go beyond the original intent of the consult. An illustration of
how the PPCP may be implemented during a chronic disease state monitoring situation is provided below:
Example case vignette
As part of a diabetes care clinic, pharmacists manage patients under a collaborative practice agreement and work collaboratively with other healthcare
providers. Harper Johnson is a 62yearold woman with diabetes, hypertension, and dyslipidemia. She presents to the pharmacy clinic today for followup
of her diabetes management.
Collect: Because this patient has been seen previously in clinic, her medical record contains a wealth of information for the pharmacist to identify and
assess Ms Johnson’s medical and drug therapy problems. The encounter begins by interviewing the patient with a focus on what has changed since the
last visit. It is important to assess the patient holistically and not focus exclusively on her diabetes management. Collect relevant patient information,
disease information, and medication information as described previously. This information is organized similar to a medical record:
Chief complaint (CC): “I don’t think this new medication for my diabetes is working any better than the last one.”
Asking the CC up front allows the pharmacist to elicit factors that are most important to the patient and may give some idea of potential drug therapy
problems.
HPI: Last month the physician started Ms Johnson on exenatide because her blood glucose readings were not controlled on metformin monotherapy.
Exenatide is an injectable drug, so Ms Johnson thought that it worked like insulin and she no longer needed to take the metformin. She checks her
fasting blood glucose every morning. Her daily log indicates fasting blood glucose readings of 145–155 mg/dL, which is about the same as when she
was taking metformin monotherapy.
The HPI provides more information about the CC and is a summary of the patient interview. It provides a story describing the situation from the
patient’s perspective. When patients present with specific symptom complaints, SCHOLAR questions can be asked as part of the HPI.
PMH: type 2 diabetes (diagnosed 2 years ago), HTN (diagnosed 5 years ago), dyslipidemia (diagnosed 2 years ago).
FH: mother has type 2 diabetes and dyslipidemia; father has hypertension and history of an MI at age 68.
SH: (−) tobacco; (+) alcohol – one glass of wine or beer 2–3 times per week.
A complete list of the patient’s medical conditions (including when they were diagnosed), relevant family history, and relevant social history are
helpful in identifying and assessing drug therapy problems.
Medications: Ms Johnson takes all medications as prescribed except she stopped taking metformin 1 month ago when the exenatide was started. She
does not use any nonprescription medications, dietary supplements, or herbal products. At this time, she is not experiencing any adverse effects with
her medication.
Metformin 1000 mg, take one tablet twice daily with meals (started 2 years ago and titrated up to the current dose, patient has not been taking for
the past month)
Exenatide 5 mcg, inject subcutaneously twice daily 60 minutes before meals (started 1 month ago)
Lisinopril 10 mg, take one tablet daily (started 5 years ago)
Chlorthalidone 25 mg, take one tablet daily (started 3 years ago)

Atorvastatin
Chapter 4: 40 mg
Implementing daily,
the take one tablet
Pharmacists’ daily
Patient (started
Care 2 years
Process, ago)L. Kleppinger
Erika Page 12 / 15
Documenting all of the medications the patient is currently taking, how the patient is taking them, adverse effects experienced, and adherence
information is important to assist in identifying actual or potential drug therapy problems.
Exenatide 5 mcg, inject subcutaneously twice daily 60 minutes before meals (started 1 month ago) University of Tasmania Library
Access Provided by:
Lisinopril 10 mg, take one tablet daily (started 5 years ago)
Chlorthalidone 25 mg, take one tablet daily (started 3 years ago)
Atorvastatin 40 mg daily, take one tablet daily (started 2 years ago)
Documenting all of the medications the patient is currently taking, how the patient is taking them, adverse effects experienced, and adherence
information is important to assist in identifying actual or potential drug therapy problems.
Allergies: none
ROS: No complaints of hypoglycemic symptoms, shortness of breath, or chest pain. No recent reports of polyuria, polyphagia, or polydipsia. Reports
good sensation in lower extremities.
Pertinent positive and pertinent negative information related to the patient’s medical conditions and drug therapy problems should be collected and
documented.
Vital signs: BP 142/74 mm Hg, HR 68 bpm, weight 85 kg
A targeted physical examination could also be conducted and included if pertinent to the situation. Review of the physician’s previous physical exam
information could also be included.
Laboratory results:
Fasting blood glucose 152 mg/dL (today)
A1C 7.9% (1 month ago)
Lipid panel: TC 164 mg/dL, LDL 98 mg/dL, HDL 42 mg/dL, TG 120 mg/dL (1 month ago)
Electrolytes and liver function tests WNL (1 month ago)
Document all laboratory results relevant to the patient’s medical conditions and drug therapy. This information is helpful in assessing the patient’s
drug therapy problems.
Preventive care: eye exam 6 months ago, foot exam last month in clinic, urine albumin screening 6 months ago (negative results).
Immunizations: All childhood vaccines, flu vaccine annually, Tdap 5 years ago, hepatitis B vaccine 2 years ago.
Relevant preventive care tests and a complete list of vaccinations allow the pharmacist to fully assess the patient to identify additional drug therapy
problems that would otherwise have been missed.
Assess: Evaluate each of the patient’s medical conditions and medications to identify and prioritize all drug therapy problems. An assessment of Ms
Johnson’s problems is provided below. Diabetes is the problem with highest priority not only because it is the reason for the patient’s clinic visit, but also
because it was the patient’s primary concern. Any medical condition that is currently under control (such as dyslipidemia) is prioritized at the end of the
list.
1. Type 2 diabetes: A1C above goal of <7.0% and fasting glucose above goal 80–130 mg/dL.9 No improvement since previous appointment. No reported
episodes of hypoglycemia. Exenatide 5 mcg twice daily is an appropriate dose for this patient, and she is tolerating it well. However, she stopped taking
metformin when she began using exenatide. Patient is up to date with preventive care measures for diabetes.
2. Hypertension: BP elevated above goal of <130/80 on lisinopril and chlorthalidone therapy.10 Patient reports adherence with medications and good
tolerability. Lisinopril is not at the maximum dose and could be increased.
3. Vaccination status: The recombinant zoster vaccine (RZV) is recommended for all patients 50 years of age and older.11 The vaccine is given as a two
dose series 2–6 months apart. The patient is up to date on all other vaccinations.
4. Dyslipidemia: Stable. Lipid panel is controlled on atorvastatin monotherapy (highintensity statin therapy).12
Plan and implement: When documenting the plan, the problem list should appear in the same order as the assessment. All problems identified in the
assessment should be provided with a plan. In addition to specific medication changes, goals of therapy and needed referrals can be included.
Implementation often occurs
Chapter 4: Implementing thesimultaneously with theCare
Pharmacists’ Patient plan.Process,
Counseling provided
Erika for the patient should be documented in the medical record.Page
L. Kleppinger Medication
13 / 15
©2024 McGraw
therapy Hill. All ifRights
can be adjusted Reserved.
a collaborative Terms
practice of Use • Privacy
agreement Policy
is in place and it• is
Notice
within• the
Accessibility
pharmacist’s scope of practice. Any referrals should be clearly
specified and communicated with the patient.
3. Vaccination status: The recombinant zoster vaccine (RZV) is recommended for all patients 50 years of age and older. The vaccine is given as a two
dose series 2–6 months apart. The patient is up to date on all other vaccinations. University of Tasmania Library
Access Provided by:
4. Dyslipidemia: Stable. Lipid panel is controlled on atorvastatin monotherapy (highintensity statin therapy).12
Plan and implement: When documenting the plan, the problem list should appear in the same order as the assessment. All problems identified in the
assessment should be provided with a plan. In addition to specific medication changes, goals of therapy and needed referrals can be included.
Implementation often occurs simultaneously with the plan. Counseling provided for the patient should be documented in the medical record. Medication
therapy can be adjusted if a collaborative practice agreement is in place and it is within the pharmacist’s scope of practice. Any referrals should be clearly
specified and communicated with the patient.
1. Type 2 diabetes: Goal of therapy—HbA1c <7.0% without episodes of hypoglycemia9 and improved medication adherence. Restart metformin 500 mg
twice daily and titrate up to 1000 mg twice daily after 2 weeks if tolerated (new prescription called in to pharmacy for patient). Continue exenatide 5 mcg
twice daily. Counsel patient on mechanism of action and adverse effects of medications for diabetes. Emphasized importance of checking with the
clinic before stopping any medication.
2. Hypertension: Goal of therapy—BP <130/80.10 Increase lisinopril to 20 mg daily for improved BP control (new prescription called in to pharmacy for
patient). Continue chlorthalidone 25 mg daily.
3. Vaccination status: Goal of therapy – up to date on all recommended vaccinations. Have nursing give one dose of RZV intramuscularly today. A second
dose is needed in 2–6 months.
4. Dyslipidemia: Continue atorvastatin 40 mg daily. Patient does not need refills at this time.
Followup: Plans for followup are often included when documenting plans for the identified drug therapy problems but could also be specified
separately. It is important to be clear and specific not only with the monitoring parameters, but with a timeline for followup.
1. Type 2 diabetes: Continue checking daily fasting glucose and recommended checking 2hour postprandial glucose every other day. Schedule followup
appointment with the pharmacist in 1 month. Call patient in 2 weeks to check on metformin tolerability and remind patient to increase the dose. Check
A1C in 3 months.
2. Hypertension: Recheck BP at next clinic visit in 1 month. Encourage patient to check BP at home using an automatic monitor. Check kidney function
(serum creatinine) in 1 month.
3. Vaccination status: Monitor for any soreness in the arm postinjection. Schedule an appointment for a second dose of RZV in 2 months.
4. Dyslipidemia – Recheck lipid panel in 1 year. Monitor for adverse effects of statin therapy, particularly myalgia.
CONCLUSION
Implementing the PPCP throughout the profession of pharmacy provides a common terminology for pharmacist patient care services and allows the focus
of the profession to shift to quality improvement, provider collaboration, improved patient outcomes, and cost savings. This process should be
incorporated into the thought process for all pharmacists providing direct patient care, regardless of the practice setting.
REFERENCES
1. Harris IM, Phillips B, Boyce E, et al. Clinical pharmacy should adopt a consistent process of direct patient care. Pharmacotherapy. 2014;34(8):e133–
e148. [PubMed: 25112525]
2. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process. May 29, 2014. Available at: https://jcpp.net/wp
content/uploads/2016/03/PatientCareProcesswithsupportingorganizations.pdf . Accessed March 29, 2019.
3. Joint Commission of Pharmacy Practitioners. Pharmacists’ Patient Care Process Presentation. Available at: https://jcpp.net/wp
content/uploads/2015/09/Patient_Care_Process_Template_PresentationFinal.pdf . Accessed March 29, 2019.
4. Cipolle RJ, Strand LM, Morley PC, eds. Pharmaceutical Care Practice: The PatientCentered Approach to Medication Management Services. 3rd ed. New
York, NY: McGrawHill, 2012.
5. American Pharmacists Association. Applying the Pharmacists’ Patient Care Process to Immunization Services: A Resource Guide for Pharmacists.
Washington, DC: American Pharmacists Association, 2017.
Chapter
6. Centers4:for
Implementing theand
Disease Control Pharmacists’
Prevention.Patient Care
Using the Process, Erika
Pharmacists’ L. care
Patient Kleppinger Page 14 / 15
Process to Manage High Blood Pressure: A Resource Guide for
Pharmacists. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2016. Available at: https://wwwcdc
gov.ezproxy.utas.edu.au/dhdsp/pubs/docs/pharmacistresourceguide.pdf . Accessed March 29, 2019.
4. Cipolle RJ, Strand LM, Morley PC, eds. Pharmaceutical Care Practice: The PatientCentered Approach to Medication Management Services. 3rd ed. New
Access Provided by:
York, NY: McGrawHill, 2012.
5. American Pharmacists Association. Applying the Pharmacists’ Patient Care Process to Immunization Services: A Resource Guide for Pharmacists.
Washington, DC: American Pharmacists Association, 2017.
6. Centers for Disease Control and Prevention. Using the Pharmacists’ Patient care Process to Manage High Blood Pressure: A Resource Guide for
Pharmacists. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2016. Available at: https://wwwcdc
gov.ezproxy.utas.edu.au/dhdsp/pubs/docs/pharmacistresourceguide.pdf . Accessed March 29, 2019.
7. American Pharmacists Association, National Association of Chain Drug Stores Foundation. Medication Therapy Management in Pharmacy Practice: Core
Elements of an MTM Service Model (version 2.0). J Am Pharm Assoc. 2008;48(3):341–353.
8. Divine H, McIntosh T. Pharmacists’ patient care process in selfcare. In: Krinsky DL, Ferreri SP, Hemstreet BA, Hume AL, Newton GD, Rollins CJ, Teitze
KJ, eds. Handbook of Nonprescription Drugs: An Interactive Approach to SelfCare. 19th ed. Washington, DC: American Pharmacists Association, 2018:24.
9. American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019;42(Suppl 1):S61–S70. [PubMed:
30559232]
10. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection,
evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on
Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. [PubMed: 29146535]
11. Centers for Disease Control and Prevention. Recommended Adult Immunization Schedule, United State, 2019. Available at: https://wwwcdc
gov.ezproxy.utas.edu.au/vaccines/schedules/downloads/adult/adultcombinedschedule.pdf . Accessed March 31, 2019.
12. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of
blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice
Guidelines. J Am Coll Cardiol. 2018. doi: https://doiorg.ezproxy.utas.edu.au/10.1016/j.jacc.2018.11.002.


Chapter 4 - Implementing The Pharmacists' Patient Care Process

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Chapter 4 - Implementing The Pharmacists' Patient Care Process

Uploaded by

Copyright:

Available Formats

University of Tasmania Library

Access Provided by:

Pharmacotherapy Casebook: A Patient­Focused Approach, 11e

Chapter 4: Implementing the Pharmacists’ Patient Care Process

DRUG THERAPY PROBLEMS

Appropriate indication for the medication:

2. Additional drug therapy is required to treat or prevent a medical condition.

Effectiveness of the medication:

Safety of the medication:

Effectiveness of the medication:

4. The dosage is too low to produce the desired patient response.

Safety of the medication:

5. The medication is causing an adverse reaction.

6. The dose is too high, resulting in actual or potential undesirable effects.

Adherence to the medication:

Assessment Drug Therapy Problem

Indication Unnecessary drug therapy

Needs additional drug therapy

Effectiveness Ineffective drug

Dosage too low

Safety Adverse drug reaction

Dosage too high

Unsafe drug for patient

Dosage too high

Drug Therapy Problem Possible Causes of Drug Therapy Problems

Drug Therapy Problem Possible Causes of Drug Therapy Problems

Nonadherence The patient does not understand the instructions

STEPS IN THE PHARMACISTS’ PATIENT CARE PROCESS (PPCP)

Primary care physician

Family history (FH): relevant health histories of parents and siblings

Past medical history (PMH)

Current medical problems

History of present illness (HPI)

Current nonprescription medications, vitamins, dietary supplements, and alternative/complementary therapies

Example Case Vignette

University of Tasmania Library

1. Is there an appropriate indication for each medication?

2. Is the drug therapy effective?

3. Is the drug therapy safe for this patient?

5. Is there an untreated indication that needs drug therapy?

Example Case Vignette (continued)

Prioritized problem list for Martin Roberts:

Example Case Vignette (continued)

Plan for Martin Roberts:

Example Case Vignette (continued)

FOLLOW­UP: MONITOR AND EVALUATE

Economic outcomes: hospitalizations, emergency department visits, medication costs

Example Case Vignette (continued)

EXAMPLES OF PATIENT CARE PROCESS IMPLEMENTATION

MEDICATION THERAPY MANAGEMENT

Symptoms: the main and associated symptoms

Characteristics: a description of the situation and evolution of the symptoms

Onset: when the problem began

Location: where the problem is located

Aggravating factors: aspects that make the problem worse

Remitting factors: aspects that make the problem better

Allergies: to medications and other substances

Conditions: all current medical conditions

E stablish that the patient is an appropriate self­care candidate (Assess)

S uggest appropriate self­care strategies (Plan, Implement)

CHRONIC DISEASE STATE MONITORING

Example case vignette

Lisinopril 10 mg, take one tablet daily (started 5 years ago)

Pharmacotherapy Casebook: A PatientFocused Approach, 11e

FOLLOWUP: MONITOR AND EVALUATE

E stablish that the patient is an appropriate selfcare candidate (Assess)

S uggest appropriate selfcare strategies (Plan, Implement)

Downloaded 2024213 8:47 P Your IP is 131.217.6.7