IMM 01 and IMM 06: Pharmaceutical Care I and II – Patient-Centred Pharmaceutical Care and Assessment Flashcards
What is pharmaceutical care?
a patient-centred practice in which the practitioner assumes responsibility for a patient’s drug-related needs and is held accountable for this commitment
What are the elements of pharmaceutical care? (4)
- medication related – use and management of medications
- care that is directly provided to the patient – focused on patient needs, values, concerns, questions, well-being
- provided to produce definite health outcomes
- provider accepts personal responsibility for the outcomes
What are the outcomes of pharmaceutical care? (4)
- cure of disease/condition
- arrest or slow a disease process – ie. cancer, diabetes, arthritis
- prevent a disease or symptoms – ie. osteoporosis, myocardial infarction, stroke
- eliminate or reduce symptoms – ie. pain management
What are the 5 aspects of patient-centred care?
- personal concern for well-being of patient
- establishment of a trusting, respectful, professional, caring, ethical relationship
- commitment to always act in best interest of patient – their health-related needs, preferences, goals, and values should be incorporated in all clinical decisions
- cooperation with other healthcare professionals and patient to optimize care
- patient is at centre of all decision-making
What are the 3 components of the pharmaceutical care process cycle?
- assessment
- care plan
- evaluation
Assessment
systematic review of patient’s drug therapy needs
- gather, synthesize and interpret relevant patient information
- determine whether patient’s drug-related needs are being met (NESA)
- identify, justify and prioritize drug therapy problems (DTPs)
Care Plan
involves agreeing on the goals of therapy and selecting interventions to achieve those goals – collaborative process with the patient, aiming to align their needs and preferences with the treatment plan
- identify desired outcomes and goals of therapy
- identify, assess, justify and prioritize feasible therapeutic alternatives
- develop, justify and implement patient-specific recommendations – make clinical decisions based on the available evidence, patient values and preferences, and our professional expertise
- design and implement a therapeutic monitoring plan
Evaluation
involves following up to assess the goals that were set and determining if they’ve been achieved, and looking for any new drug therapy problems that may have arisen
- important as it determines the effectiveness of the care plan and associated interventions in achieving the goals of therapy for each of the patient’s medical conditions
- document actual patient outcomes
- assess whether outcomes are being achieved (→ return to assessment step PRN)
What are the outcomes of Assessment?
- complete and accurate problem identification
- selection of the best recommendations for your patient (care plan)
- identification of appropriate monitoring parameters (care plan)
What is the ‘thought process’?
a structured, logical, and systemic approach that allows the practitioner to assess whether patient’s drug therapy needs are being met for each of the patient’s medical conditions
- provides you with a rationale process for making sound clinical decisions
- used to assess each medical condition a patient has/may have
- responses to questions in the thought process may be provided by interviewing the patient, medical records, literature
Necessary
explain whether medication (prescription/non-prescription, over-the-counter (OTC), natural health products (NHP)) is necessary to treat this medical condition
- describe this patient’s medical condition/diagnosis in terms of pathophysiology, signs/symptoms, causes, risk factors, etc.
- describe patient’s signs/symptoms/lab values and whether they are consistent with the medical condition
- explain whether any of the current medical conditions, medications, or interactions contribute to this patient’s medical condition
- articulate the desired therapeutic outcomes for this condition
- describe the therapeutic regimens (ie. both pharmacological and non-pharmacological) that are recommended (ie. commonly used) to achieve the therapeutic outcomes
- identify drug therapy the patient is already receiving – all medication patient currently taking AND any new prescriptions patient has presented
- discuss any additional drug therapy that may be required – consider preventative therapy, untreated condition, synergistic therapy
Effectiveness
explain whether this patient’s drug therapy is effective for this condition, discuss whether drug therapy is achieving the therapeutic outcomes for this condition, compare desired outcomes with actual patient status
- identify whether drug is indicated for the condition and describe the mechanism of action (MOA) of the medication to treat condition
- discuss whether drug is most effective drug to treat condition (describe more effective alternatives, if available)
- discuss whether drug therapy(ies) are optimal / appropriate for this patient – consider generic drug name, dose, route, frequency, dosage form, duration, max daily dose (PRN meds)
- discuss whether the clinical onset of action is appropriate, and describe clinical expectations of drug in achieving therapeutic outcome(s)
- describe mechanism of any severe interactions (drug-drug, drug-food, drug-NHP, etc.) that can make the drug less effective that may result in modification of therapy – identify whether the patient is taking another product that would alter the effectiveness of this drug
Safety
discuss the safety of this patient’s therapy(ies) for this condition, describe whether this patient is experiencing/at risk of experiencing an undesirable effect (adverse drug reactions or drug toxicity) from this drug
- describe the mechanism of any contraindications the patient has to this medication
- describe the mechanism of any adverse drug reactions (ADR) the patient is experiencing or may experience (including side effects)
- discuss any duplication of therapy and whether it is harmful, or potentially harmful, to the patient
- describe the mechanism of any severe interactions (drug-drug, drug-food, drug-condition, drug-NHP, etc.) that may result in modification of therapy
Adherence
discuss this patient’s ability to adhere to therapy
- availability of product
- lifestyle
- complexity of regimen
- finances
- cultural or personal values/beliefs
- dosage form
- language barrier
- physical or mental challenges
Unmet Needs
would the patient benefit from any other interventions
- prophylactic therapy (ie. vaccinations)
- non-drug measures
- referrals
- other medical condition
