Lecture 3 - Introduction to Pharmaceutical Care

Question 1

How has the pharmacy practice evolved?

Answer 1

Pharmacy has evolved from being a product focused profession towards a patient-centred profession. It’s not just about the drug, but also about managing patients

Question 2

The new pharmaceutical act has expanded the role of pharmacists. Explain

Answer 2

Pharmacists can now order lab tests in a community setting, they can give vaccinations and injections, they can order prescriptions, etc.

Question 3

What are the benefits of pharmacist-managed medication services?

Answer 3

Increased patient safety (less side effects), improved disease state management/improved efficacy, more effective health care spending (shorter hospital stays, less patients being admitted), improved adherence, improved quality of life

Question 4

What can patient-centred care mean for the patients?/How does patient-centred care impact patients?

Answer 4

• Health/medication counseling and education
• Medication review
• Clinical services (therapeutic drug monitoring, clinical monitoring for effectiveness and/or side effects/toxicity)
• Screening for diseases
• Developing and implementing pharmacotherapeutic care plans
• Recommending or prescribing medications
• Referral to other health care professionals

Question 5

Why has the need for patient-centre pharmaceutical care emerged?

Answer 5

• Multiple prescribers of medications
• Large numebr of differing medications in patient’s regimen
• Emergence in patient autonomy: the right of patients to guide decisions about their own medical care
• Increased complexity of pharmacotherapy
• Increased self-care (OTC, natural medicines, etc.)
• Significant level of drug-induced morbidity and mortality

Question 6

What is the definition of pharmaceutical care?

Answer 6

Patient-centred practice in which the practitioner assumes responsibility for a patient’s drug-related needs and is held accountable for this commitment

Question 7

What is the goal of pharmaceutical care?

Answer 7

Optimization of all the patient’s drug therapy to achieve the best possible patient outcome and improve that patient’s quality of life

Question 8

What is the method used in pharmaceutical care? Explain

Answer 8

The Pharmacotherapy Workup. It’s a thought process for pharmacotherapeutic clinical decision-making. It’s important for (1) efficiently solving common problems as well as (2) provides a framework for novel scenarios

Question 9

The assessment is a crucial component of the pharmaceutical care process. Explain

Answer 9

• Meeting the patient and obtaining consent
• Eliciting relevant information (past medical history, history of presenting illness, current medications, allergies, pregnancy/nursing considerations, culture and/or patient-specific issues)
• The Pharmacotherapy Workup

Question 10

What are questions asked during the Pharmacotherapy Workup

Answer 10

Is the problem being caused by a drug? Can the problem be treated using drug therapy?

Question 11

What is the goal of the assessment?

Answer 11

To evaluate if that patient’s drug-related needs are being met

Question 12

What happens if the drug-related needs of a patient are not being met?

Answer 12

That patient can be identified as having a drug-related problem (DRP)

Question 13

Name the seven DRPs

Answer 13

1. Drug therapy is needed
2. Drug therapy is not indicated for a specific drug the patient is currently taking
3. Drug therapy is ineffective/more effective drug available
4. Dose is too low
5. Dose is too high
6. Drug is causing an adverse effect (side-effect; drug-interaction; pregnancy or nursing considerations)
7. Patient is not adhering to the prescribed regimen

Question 14

What follows the assessment?

Answer 14

You may gain more information (symptoms worsening, describing specific signs, timeline, daily life, etc.)
Determine is drug therapy is needed
Determine a pharmacotherapeutic plan
-Evaluate appropriateness
-Evaluate effectiveness
-Evaluate safety
-Evaluate adherence

Question 15

How does a pharmacist evaluate appropriateness?

Answer 15

Evaluating appropriateness: in other words, looking at current guideline recommendations, which agents are recommended as potential options in a patient with presenting illness

Question 16

How does a pharmacist evaluate effectiveness?

Answer 16

Do a significantly larger number of patients predictably respond to therapy with one agent over the other? Is there a greater intensity of response with one agent over the other? Is there a longer duration of response with one agent over the other? Is there a greater body of research and study with one agent over the other?

Question 17

How does a pharmacist evaluate safety?

Answer 17

Evaluate safety: in other words, does one agent have significant advantage in terms of less side-effects, drug interactions with concurrent medications, safety in pregnancy, etc.

Question 18

How does a pharmacist evaluate adherence?

Answer 18

Dose frequency: once or twice daily vs over 3 times daily
Dose form: is one agent available as an oral tablet vs an injection; messy ointment vs. fully absorbed cream; bitter-tasting suspension vs. palatable chewtab etc.
Cost
Coverage by provincial/federal and/or third-party payors

Question 19

What is the importance of developing a monitoring plan?

Answer 19

Developing a monitoring plan and ensuring patient follow-up is just as important as the drug selection process. What can the patient expect for improvement (either as clinical symptoms or laboratory monitoring) and when? (ex. 50% reduction of pain, 1-2 weeks after starting therapy; resolution of fever within 24-48 hours of starting antibiotics

Question 20

How does a pharmacist monitor safety of a regimen?

Answer 20

Warn patients about common side-effects
Provide advice for prevention and relief of side-effects
Provide advice for preventing drug-drug & drug-food interactions (ex. grapefruit juice)
Provide guidance on which side effects are common and self-manageable vs. those that need immediate follow-up with the pharmacist or MD (watch and wait vs. see pharmacist or MD in a timely manner vs. seek urgent attention at emergency department)