• V week

 
• Theme
• Pharmaceutical care as a generalist practice,
Pharmaceutical care as primary health care, Medication
Management service in the medical home,
pharmaceutical care as a new Paradigm, The practice of
pharmaceutical care
• page: 57-73
 
• The practice of pharmaceutical care has been
developed as a generalist practice.
• This is significant because clinical pharmacy
practice developed as a specialty practice.
• Generalist practitioner
Definition: A generalist practitioner is one who
provides continuing, comprehensive, and
coordinated care to a population
undifferentiated be gender, disease, drug
treatment category.
 Other characteristics within this comprehensive definition of generalist
practitioner include:

• Coordinating care with other health care professionals

• Being patient-centered
• Establishing a relationship over time
• Providing longitudinal care
• Using the specific decision-making process
• Managing simultaneously both acute and chronic health
problems
• Early management risk-factors
• Promoting health
• Dealing with health problems in their physical, psychological,
sociocultural and external dimensions
 Pharmaceutical care as primary health care

• As pharmaceutical care was developed as

generalist practice, it is ready for integration
into primary health care.
• Primary health care always been an important
part of medical care in countries other than
US.
 Primary care Defined
• The distinguished physician and bioethicist Eric Cassell
identifies primary care medicine “as the capstone of
twenties century medicine” and “ the foundation for
twenty-first century doctoring” .
• Historically, primary health care has taken on several
different meanings. One of the earliest definitions
(1920) focused on organizing medical services into
primary health centers in teaching hospitals.
• This organizational framework “definition-by-location”
was used to organize medical services until1978 when
an international conference (Alma-Ata) move the
emphasis from medical to health services.
 Two distinct views
After 1979 , discourse on primary care appeared in the form of two
distinct views.
• The first was developed by the WHO which focused on
operationalizing an “approach” to primary care.
This particular approach encompassed a broad range of interests:
• health education
• environmental sanitation
• prevention
• drugs
• nutrition
• traditional medicine
The WHO approach was most commonly accepted in less developed
or modernizing countries.
 Two distinct views
• The second view of primary heaths care was more focused on
a constellation of health activities and /or emphasized
temporality or a basic” level of services” usually at the point
of first contact.
These services might include responsive care for :
• episodic illness
• continuing care for chronic illness
• health screening and monitoring
• preventive services
• appropriate health education
• integration with care in acute and long-term institutions
This view of primary care was most commonly accepted in
developed countries such as US
 Common core elements to primary care
These may be summarized thus:
• Services that are comprehensive, continuous,
coordinated, accessible, and acceptable
• Strategies for serving the vulnerable
• First contact care
• “ de facto” care for most people’s problems, most
of the time
• Care provided by multiple practitioners
• Emphasis on health not medicine
• Proliferation of generalist practitioners
Primary health care is addressed to both
the sick and the well.
 Pharmaceutical care as the new Paradigm

In 1988 Hepler in a more philosophical vein,

describe pharmaceutical care as a covenantal
relationship between a patient and a
pharmacists in which the pharmacists performs
drug use control functions (with appropriate
knowledge and skills) governed by the
awareness of and commitment to the patient’s
interest.
 Community Pharmacy
• A community pharmacy has appropriate procurement,
storage, dispensing and documentation of medicines.
• It is an important branch of the pharmacy profession
and involves a registered pharmacist with the
education, skills and competence to deliver the
professional service to the community.
 Community Pharmacy

• A community pharmacy is a pharmacy that deals

directly with people in the local area.
• It has responsibilities including compounding,
counseling, checking and dispensing of prescription
drugs to the patients with care, accuracy, and
legality.
 The basic focus of primary health care and
pharmaceutical care are the same.

These include:
• Patient-centeredness
• Addresses both acute and chronic conditions
• Emphasizes prevention
• Documentation systems continuously record patient need and care
provided
• Accessible, frontline, first contact
• Continuous and systematic care
• Integration of care
• Accountability
• Emphasis on ambulatory patients
• Includes education/health promotional intervention
 
• Hepler and Strand in 1990 published a paper
that provide the conceptualization of
pharmaceutical care that stimulated
widespread debate within the profession.
• Pharmaceutical Care is that component of
pharmacy practice which entails the direct
interaction of the pharmacist with the patient
for the purpose of caring for the patient’s
drug-related needs.
• “Pharmaceutical care is a necessary element of
health care, and should be integrated with other
elements.
• Pharmaceutical care is, however, provide the
direct benefit of the patient, and the pharmacist is
responsible directly to the patient for the quality
of that care.
• The fundamental relationship in pharmaceutical
care is mutually beneficial exchange in which the
patient grants the authority to the provider and
the provider gives competence and commitment
to the patient.”
 Standard of Care 1: Collection of Patient-Specific
Information
• The practitioner collects relevant patient-specific information to use in decision-making
concerning all drug therapies.
• Measurement Criteria
• 1. Pertinent data are collected using appropriate interview techniques.
• 2. Data collection involves the patient, family and care-givers, and health care providers when
appropriate.
• 3. The medication experience is elicited by the practitioner and incorporated as the context
for decision-making.
• 4. The data are used to develop a pharmacologically relevant description of the patient and
the patient's drug-related needs.
• 5. The relevance and significance of the data collected are determined by the patient's
present conditions, illnesses, wants, and needs.
• 6. The medication history is complete and accurate.
• 7. The current medication record is complete and accurate.
• 8. The data collection process is systematic and ongoing.
• 9. Only data that are required and used by the practitioner are elicited from the patient.
• 10. Relevant data are documented in a retrievable form.
• 11. All data elicitation and documentation is conducted in a manner that ensures patient
confidentiality.
Standard of Care 2: Assessment of Drug-Related Needs
The practitioner analyzes the assessment data to determine if the patient's drug-
related needs are being met, that all the patient's medications are appropriately
indicated, the most effective available, the safest possible, and the patient is able and
willing to take the medication as intended.

Measurement Criteria
• 1. The patient-specific data collected in the assessment are used to decide if all of the patient's
medications are appropriately indicated.
• 2. The data collected are used to decide if the patient needs additional medications that are not
presently being taken.
• 3. The data collected are used to decide if all of the patient's medications are the most effective
products available for the conditions.
• 4. The data collected are used to decide if all of the patient's medications are dosed
appropriately to achieve the goals of therapy.
• 5. The data collected are used to decide if any of the patient's medications are causing adverse
effects.
• 6. The data collected are used to decide if any of the patient's medications are dosed
excessively and causing toxicities.
• 7. The patient's behavior is assessed to determine if all his or her medications are being taken
appropriately in order to achieve the goals of therapy.
 
 Standard of Care 3: Identification of Drug Therapy
Problems

The practitioner analyzes the assessment data to

determine if any drug therapy problems are present.

Measurement Criteria
• 1. Drug therapy problems are identified from the assessment findings.
• 2. Drug therapy problems are validated with the patient, his/her family, care-
givers, and/or health care providers, when necessary.
• 3. Drug therapy problems are expressed so that the medical condition and the
drug therapy involved are explicitly stated and the relationship or cause of the
problem is described.
• 4. Drug therapy problems are prioritized, and those that will be resolved first
are selected.
• 5. Drug therapy problems are documented in a manner that facilitates the
determination of goals of therapy within the care plan.