PHARMACEUTICAL CARE AND THE SCOPE OF PHARMACY PRACTICE

I. Introduction

     The Practice of Pharmacy embraces a variety of settings, patient populations, and specialist as well as generalist pharmacists. Central to the practice of pharmacy, however, is the provision of clinical services directly to, and for the benefit of patients.

     Definition. The term Pharmaceutical care describes specific activities and services through which an individual pharmacist “ cooperates with a  patient and other professionals in designing, implementing and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.”

II. Scope of Practice within Pharmaceutical Care

\    Role. Pharmaceutical care has evolved from an emphasis on prevention of drug- related problems (basically drug management) to extend roles of pharmacists in the Triage of patients, treatment of routine acute illnesses, management of chronic diseases, and primary disease prevention.

    
     Function. The provision of pharmaceutical care does not imply that the pharmacist is no longer responsible for dispensing functions. In many instances, however, implementation of pharmaceutical care services necessitates a redesign of the professional work flow, with assignment of technical functions to technical personnel under the direct supervision and responsibility of the pharmacist.

III. Uniqueness of Pharmaceutical care

Provision of pharmaceutical care overlaps somewhat with other aspects of pharmacy practice (Table 1). However, pharmaceutical care is not the same as these other areas, which include:

1st.       Clinical Pharmacy

2nd.         Patient counseling

3rd.         Pharmaceutical services; when the activities of a pharmacy or pharmacy department are performed for “ faceless” patients or charts, the activity is one of pharmacy service, not pharmaceutical care (e.g., chart or drug profile reviews without input from the patient or care giver is not pharmaceutical care).

Table 1 – Uniqueness of Pharmaceutical Care

	Traditional Pharmacy	Clinical Pharmacy	Pharmaceutical Care
Primary Focus	Prescription 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

IV. Essential Components of Pharmaceutical Care

A. Pharmacist – patient relationship

B. Pharmacist’s workup of drug therapy (PWDT)

• Data collection. Collect, synthesize, and interpret relevant information.
• Develop or identify the CORE (Condition, Outcomes, Regimen) Pharmacotherapy Plan.
• Identify the PRIME( Pharmaceutical, Risk, Interactions, Mismatch, Efficacy) pharmacotherapy problems or indications for pharmacist intervention.
• Formulate a FARM (Finding, Assessment, Resolution, Monitoring) process note to describe and document the interventions intended or provided by pharmacist.

V. Clinical Skills and Pharmacists roles in Pharmaceutical

       care

1. Patient assessment
2. Patient education and counseling
3. Patient-specific pharmacist care plans
4. Drug treatment protocols
5. Dosage adjustment
6. Selection of therapeutic alternatives
7. Prescriptive authority

VI. Pharmaceutical Care as the Model for Pharmacy      

        Practice

The concepts, activities,, and services of pharmaceutical care form the  basis for provision of clinical services directly to, and for the benefit of patient in all pharmacy practice settings. These settings include home health, hospital, ambulatory care, primary care, consultation, long term care, and community pharmacy practice. Workflow, staffing patterns, processes, and pharmacy programs might differ, but the core approach to patient care remains pharmaceutical care in all settings.

VII. Documentation of Pharmaceutical Care

Documentation of pharmaceutical care is integral to continuity of care, demonstration of clinician competence, communication among health care providers, evidence of contributions to patient care, and reimbursement of professional services.

VIII. Pharmaceutical Care : An ongoing process

The patient profile is revised and re-assessed each time a new drug is added to or deleted from the medication regimen, a new disease or condition is diagnosed, or the patient undergoes other clinical intervention, such as surgery

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Key Points

                                                                                  

1. Focus on outcomes, not interventions.

2. Daily pharmacy rounds are important  – Pharmacists can make rounds without medical team.

3. Use this approach with all clinical programs, such as pharmacokinetic  dosing, disease management clinics, clinical pathways, etc

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