1. Introduction 2

2. Pharmaceutical care is a professional patient care practice, which, when provided as an organized service, is experienced, documented, evaluated, and paid for as medication management services. A professional practice is necessary to function as the ethical reference point, the clinical framework, and the basis for legal definitions and defenses in the health care professions.

3. All professional patient care practices, whether it be medicine, nursing, or dentistry, consist of three major components; a philosophy of practice, a patient care process, and a practice management system. Pharmaceutical care has all three components defined. Pharmaceutical care uses the common vocabulary of medicine, nursing, and other patient care practices. This is necessary to integrate pharmaceutical care with these services.

4. The philosophy of pharmaceutical care practice consists of (a) a description of the social need for the practice, (b) a clear statement of individual practitioner responsibilities to meet this social need, (c) the expectation to be patient-centered, and (d) the requirement to function within the caring paradigm. A philosophy of practice is expected when working with medicine and nursing and is practiced by all health care professionals.

5. The patient care process, which must be consistent with the patient care processes of the other health care providers, consists of (a) an assessment of the patient's drug- related needs, (b) a care plan to meet the specific needs of the patient, and (c) a follow-up evaluation to determine the impact of the decisions made and actions taken.

6. The practice management system includes all of the resources required to bring the service to the patient. Physical space, the appointment system, documentation, reporting, evaluation, payment for the service, and much more are included in the management of a service. Pharmaceutical care practice evolved from clinical pharmacy as a direct patient care practice with specific standards of practice consistent with other health care providers.

7. Ever since the functions of the physician and the pharmacist separated into different professions in the 1800s, pharmacists have not been responsible for providing direct patient care. In fact, pharmacy is the only profession included in the health science professions (medicine, nursing, dentistry, and veterinarian medicine), which does not have (take) direct patient care responsibilities. Pharmacy has developed “differently” in this respect. Although clinical pharmacy services are delivered in the “environment” of the patient and the pharmacist functions very “close” to the physician, it is the physician or the nurse who still assumes ultimate responsibility for the decisions or recommendations made by the pharmacist, in most situations.

8. Practicing pharmaceutical care means to apply knowledge to promote the well-being of others. The Pharmacotherapy Workup is a rational decision- making process used in pharmaceutical care practice to identify, resolve, and prevent drug therapy problems, establish goals of therapy, select interventions and evaluate outcomes

9. Medication management services require a professional practice as its ethical, clinical, and legal basis. Pharmaceutical care is this professional practice. A professional practice includes a philosophy, patient care process, and practice management system. In addition, a professional practice has standards, a specific vocabulary, and must “fit” with the other patient care professional practices.

10. A philosophy of practice is the set of values that guides a practitioner's behavior to be ethically appropriate, clinically accurate, and legal. It defines the rules, roles, relationships, and responsibilities of the practitioner. A philosophy of practice is specific to a practice, not the practitioner. A practitioner's philosophy of life is different and separate from the practice philosophy.

11. The philosophy of pharmaceutical care establishes the purpose for the practice that is to meet the social need to control drug-related morbidity and mortality by managing medications well. The professional responsibilities defined by the philosophy of pharmaceutical care are to identify drug therapy problems, resolve them, and most importantly, prevent them from occurring in patients

12. The philosophy of pharmaceutical care states that these responsibilities will be carried out in a patient centered manner using the caring paradigm that has been defined by the professions of medicine and nursing. This paradigm requires that the practitioner comprehensively assess a patient's drug-related needs, that he develops a care plan that can address these needs, and that he follows up to determine that the desired outcomes are achieved and no harm has been done. There are standards of professional behavior that determine if a practitioner is applying the philosophy of practice in practice. These standards should be met each time a patient is cared for by the practitioner

13. Basic Professional Behaviors Expected in Practice  Beneficence Do the very best you can for every patient  Nonmaleficence In all cases, do no harm  Veracity Tell the patient the truth  Justice Be fair

14.  Fidelity Be loyal  Autonomy/paternalism Allow the patient to be the ultimate decision maker  Confidentiality Always protect your patient's privacy

15. Patient-centered behavior includes a number of constructs, but the most important one is that the patient comes first. What the patient wants and needs is what drives the patient encounter. Little can be accomplished until the practitioner understands the patient's concept of his illness and his medication experience, in the patient's words, so listen closely.

16. The therapeutic relationship is a partnership or alliance between the practitioner and the patient for the very specific purpose of optimizing the patient's medication experience. The quality of the care provided will depend on the quality of the therapeutic relationship developed because the relationship will impact the information shared, the decisions made, and what you can learn from the patient. The patient has both rights and responsibilities; practitioners must attend to both.

17. Adherence to a medication regimen is a test of the practitioner's ability to practice in a patient-centered manner. Medication management services, when provided in a patient- centered manner, can achieve adherence rates of over 80%, consistently, because of the active participation of the patient. Patient-centered adherence can be achieved when the practitioner takes into account the patient's individual needs, his rights, his responsibilities, and the practitioner's obligation to make decisions in a consistent, systematic, and comprehensive manner for each individual patient.

18. The order of thinking, making decisions and acting always is patient first, medical condition (diagnosis) second, and medications third. This is why a physician starts a patient interview with, “What can I do for you today?” Only after the physician understands what is most important to the patient—why the patient came to see the physician—does he begin to understand the medical problem at hand. This is true in pharmaceutical care practice also. This is a service so what the patient wants is most important

19. What the Patient Can Expect  Patients Expect You to Care About What They Want  Patients Will Expect You to Put Their Needs First, before Your Own  Patients Expect Compassion and Understanding of Them as Individuals  The Patient Expects You to Possess the Technical Knowledge and the Clinical Experience and Confidence It Takes to Apply that Knowledge to Their Individual Case  Patients Expect to Receive the Appropriate Medication for Their Medical Problems, and They Expect the Medication to Work

20.  Patients Will Expect You to Be Realistic and Honest About What They Can Expect from Their Medications  Patients Will Expect You to Be Their Advocate for All Their Drug-Related Needs  Patients Will Expect You to Be Accountable for the Decisions You Make and the Advice You Give  Patients Will Expect You to Know When to Refer Them to Someone with Different Expertise

21. Simply stated, you can expect your patients to 1. provide you with accurate and complete information 2. participate in establishing the goals of therapy 3. contribute to the care plan as agreed upon (act on the education and instructions they received, collect important outcome parameters, keep appointments) 4. maintain a diary of medication use, signs, and symptoms, and test results if needed to evaluate effectiveness, safety, and compliance 5. notify you of changes and/or problems with their drug therapy so you can act on them before they become harmful 6. ask questions whenever they arise.

22. One of the most important results of a positive therapeutic relationship between a patient and a practitioner is the shared decision making applied to goals of therapy The therapeutic relationship is a partnership or alliance between the practitioner and the patient formed for the purpose of optimizing the patient's medication experience

23. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease and Infirmity The patient's medication experience is the sum of all the events a patient has in his lifetime that involve drug therapy The patient's medication experience is the patient's personal approach to the use of medicines—why he believes or feels a certain way about drug therapy

24. Thank you