1. Introduction

2. Pharmaceutical care Def
A patient’s centered practice in which the practitioner responsibility is oriented for patient-drug related needs.
It describes specific activities and services through which an individual pharmacist cooperates with patient and other professionals in designing and monitoring a therapeutic plan that will produce specific therapeutic outcomes to the patient.

3. Pharmaceutical care This responsibility will be for all drug therapy
- Rx
- OTC
- Traditional or alternative medicine (Complementary and alternative medicine (CAM)
This responsibility to succeed needs
- Pharmacist coordination with patient and other health care providers.

4. Patient-drug related needs
- Medication is appropriate. - Medication is effective. - Medication is safe. - Patient is compliant.

5. Importance of Pharmaceutical care
As medication errors is growing, so professionals' efforts must be united.
The number, complexity, and potency of prescription and non prescription drug products are increasing.
Pharmaceutical care activities integrate pharmacists into the health – care system.

6. The need of pharmaceutical care practitioners comes from ….
Multiple practitioners writing prescriptions for a single patient (sometimes without coordination).
Large number of medications used by patients.
Patients play an important role of selection and use of their medications (to enhance their adherence).
Increase complexity of medication therapy.
Increase self care (i.e use of OTC and CAM).
High level of drug related problems (DRP).

7. Language of practice
Pharmaceutical care practitioner should use the same vocabulary of other health care provide.
Terms used:
- Assessment
- Care plan
- Follow up
Facilitate good communication among them.
Pharmaceutical care practitioner has a unique practice also which is related to DRP, medication experience, drug related needs

8. Therapeutic relationship
The collaborative effort between the pharmaceutical care practitioner and the patient.
Should be personal (private information is exchanged from the patient).
Determine the quality and the quantity of care delivered to the patient.

9. Therapeutic relationship
Characteristics of the therapeutic relationship
Mutual respect
Trust
Open communication
Cooperation
 Mutual decision making

10. Pharmacotherapy workup
Structured, rational thought process for clinical decision (rational decision making process).
Cognitive work occurs in mind of practitioners while caring of patients.
It is among all patient care practitioners.
Use knowledge already known and apply on new patients.
it is too lengthy to use a chart note, an abbreviated format known such as FARM Note or a SOAP Note can be used.

11. Pharmacotherapy workup
Purpose
- Assess the needs of patient.
- Identify DRP (to prevent or resolve them).
- Organize intervention or care plan.
- Establish appropriate parameters to evaluate follow up.

12. Pharmacotherapy workup
Consists of
- Asking questions.
- Generate hypothesis.
- Searching for solution (to accept/ reject the hypothesis!)
- Elicit more information.

13. Pharmacotherapy workup
Most questions asks or hypothesis generated by pharmaceutical care practitioners
- Is the patient’s problem caused by drug therapy.
- Can the patient's problem treated by drug therapy.

14. Pharmacotherapy workup
Most questions asks or hypothesis generated by pharmaceutical care practitioners
- Is the patient’s problem caused by drug therapy.
- Can the patient's problem treated by drug therapy.

15. Patient Care Process
Describes the interaction between patient and practitioner.
- Assessment of patient
- Care plan development.
- Follow up evaluation

16. Patient Care Process versus Pharmacotherapy workup
Patient care process: describes the work done physically.
Pharmacotherapy workup: describes the work done mentally.

17. Patient Care Process - Assessment
Purposes
Understand patient’s condition well (to make rational drug therapy decision).
To determine the patient-drug related needs (appropriate, effective, safe, compliant).
Identify DRP.

18. Patient Care Process - Assessment
Information needed to give good assessment
Patient’s data
- socio-demographics (age, gender, … )
- medication experience
Disease data
- Current and past medical history
- Family history, social history
- Dietary history
- Physical findings (e.g.: weight, height, blood pressure)
- Laboratory or other test results. (e.g. K level, serum creatinine level)

19. Patient Care Process - Assessment
Information needed to give good assessment
Drug data
- current medication
- previous medications
- social drug use
- immunization
- allergy
- drug alerts.

20. Patient Care Process - Assessment
Medication experience
The summation of all the events a patient has in his lifetime that involves drug therapy.

21. Patient Care Process - Assessment
Activities done during assessment
Meet the patient. (establish a therapeutic relationship).
Eliciting information from the patients (patients, disease and drug data).
Making clinical decision about patient’s medications (done by pharmacotherapy workup).

22. Patient Care Process - Assessment
Components of assessment (pharmacotherapy workup)
Data collection
Patient symptoms and signs
Develop and identify CORE pharmacotherapy plan
- C = Condition or potential need.
- O = Outcomes desired for the condition.
- R = Regimen to achieve the desired outcomes.
- E = Evaluation parameter to assess outcome achievement.

23. Patient Care Process - Assessment
Components of assessment (pharmacotherapy workup)
Identify the PRIME pharmacotherapy problems:
- P = Pharmaceutical based problems.
- R = Risks to patient e.g. adverse effects.
- I = Interactions:
- Drug – drug, drug - disease, drug - food interactions.
- M = Mismatch between medications and condition or patient needs.
- E = Efficacy issues:
- Too much of the correct drug
- Too little of the correct drug
- Wrong drug, device, intervention or regime prescribed

24. Patient Care Process - Care plan development
Definition
Organization of all the work agreed upon by the practitioner, other health care providers and by the patient to achieve the goal of therapy (Intervention).
Collaboration with patient (first) and with other health care provider (if needed).

25. Patient Care Process - Care plan development
Steps of care plan
Resolve DRP if occur.
Optimize patient medication experience (needs to change the drug therapy, provides patients instruction, counseling and education)
Prevent DRP from occurring (for patients at risk).
Schedule for follow up (to determine the outcome of therapy).
to achieve the goal of therapy.

26. Patient Care Process - Care plan development
Goal of therapy
Is the positive outcome that should be achieved.
The future desired endpoint.
To be measured, it needs
- Parameter.
- Value.
- Time frame.

27. Patient Care Process - Care plan development
To Reach the desired goal of therapy, the followings should be considered:
The care plan is consistent with patient’s preference and desire.
The care plan should be agreed by the patient and the practitioner.
The goal of therapy should be explicitly stated.
The care plan and the goal of therapy should be clinically sound.
The care plan and the goal of therapy should be observable or measurable in stated time frame.

28. Patient Care Process - Follow up evaluation
- This step is where the clinical experience, new knowledge and learning are gained.
Purpose
To determine the actual outcome of drug therapy.
To compare the results with the intended goal.
To determine the appropriateness, efficacy and safety of the medications.
To evaluate the patient’s compliance.
To establish the current status of the patient.

29. Patient Care Process - Follow up evaluation
Activities Performed in follow up
Observe or measure the positive results that the patient experienced from drug therapy (Effectiveness)
Observe or measure the undesirable effect that the patient experienced from drug therapy (Safety)
Determine the actual dosage of medications the patient has taken that produce the results observed (Compliance)
Make a clinical judgment of the status of patient’s condition being managed by drug therapy (Outcome)
Reassess the patient to determine if he develops a new DRP.

30. Patient Care Process - Follow up evaluation
Activities Performed in follow up
To evaluate the Effectiveness:
Improve or reduction in signs and symptoms of medical condition.
Lab tests return to normal.
To evaluate the Safety:
Evaluation of unintended side effect of patient drug therapy.
If lab test is abnormal.

31. Patient Care Process - Follow up evaluation
Both safety and efficacy need compliance to medications to be positive once measured.
The patient’s outcome
Resolved.
Stable.
Improved.
Partially improved.
Unimproved.
Worsen.
Failed.

32. 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
This must be in the mind and the heart of the practitioner before caring for a patient

33. Philosophy of practice
Therapeutic relationship with patients
An understanding of the patient’s medication experience
Rational thought process
pharmacotherapy workup and drug therapy problems
Patient care process
Documentation system
Reimbursement system

34. Philosophy of practice
What a practitioner does
Meets a social need
Meets patient-specific responsibilities
How a practitioner does it
With a patient-centered approach
Using a caring process