Transcript Pharmaceutical care

Pharmaceutical care as
reprofessionalization
In the late 1950s and 1960s, astute pharmacists began to
conceptualize a new role for pharmacists that would
involve the specialized provision of information about
these powerful new agents that were beginning to reach
the market.
As it came to be known, the clinical pharmacy movement
sought to create a role for pharmacists in the provision of
patient-specific drug information or advice to physicians
and other members of the health care team.
Helper has identified three simultaneous trends that served
as the basis for the clinical pharmacy movement:
1. Drug information
2. Drug distribution
3. Teaching and research programs in pharmacology and
biopharmaceutics
These three currents combined for the first time in the
famous 1966 " Ninth Floor Project" at the university of
California-San Francisco, in which the faculty sought to
find a way to train students for a role that did not
previously exist.
The project began in September 1966 with the following
goals:
- To develop a hospital floor-based pharmaceutical service
that would provide maximal patient safety in the
utilization of drugs.
- To charge the pharmacist with the responsibility for all
phases of drug distribution, except the administration of
medication to the patient.
- To provide an unbiased and easily available source of
reliable drug information ( the pharmacist) and to
disseminate information according to the needs of
professional personnel.
- To provide clinical experience for interns and residents
and other qualified pharmacy students in hospital
pharmacy.
- To design and conduct studies in cooperation with the
physician and nurse so that a full evaluation may be
obtained of institutional pharmacy service within the
framework of the team approach to patient care.
The publication of Drug Intelligence and Clinical
Pharmacy ( now Annals of Pharmacotherapy) began in
1967, and two pharmacy therapeutics textbooks came
out of San Francisco in 1972.
By 1974, the Federal government recognized a clinical
role for pharmacists when it began requiring the
pharmacist to conduct monthly Drug-regimen reviews
of residents in skilled-care nursing homes.
 Thus, the clinical pharmacy movement created the
opportunity for pharmacy to continue as a profession
worthy of the respect and trust of its patients
 Clinical pharmacy was involved in the health care of
patients, it required specialized knowledge and skills,
and it was individualized.
Affirmation of the trend: The Millis Report
 In 1975, the American association of colleges of
pharmacy commissioned a study of pharmacy by a 12member group headed by dr. John Millis. Known
commonly as the Millis commission, the group issued
its finding in a 161-page report called pharmacists for
the Future: The Report of the study Commission on
Pharmacy.
Among the changes in pharmacy and pharmacy
education as a direct result of the Millis Commission
were the following :
- Acceleration of development of Clinical sites for
pharmacy school faculty.
- Development of a national examination for licensure of
pharmacists, now called the NAPLEX ® (North
American Pharmacist Licensure Examination®).
- Increased movement toward making pharmacy a
knowledge-based clinical profession.
- Creation of a small number of clinical scientist
programs in schools of pharmacy at the doctor of
philosophy.
- Creation of a Board of Pharmaceutical Specialties
within APhA to recognize specialty practices in
pharmacy and certify individuals in those specialties.
 However, as Helper has noted, the Millis Report failed
to produce a real shifting in pharmacy dramatically
and irreversibly toward its desired goals.
 Unlike some previous similar reports in pharmacy or
medicine, the Millis Report did not outline specific
changes in pharmacy school curricula or give a plan for
the future.
 It provided only external recognition for the advances
made by pharmacy as a clinical profession.
Helper raises the stakes with pharmaceutical care
 The clinical pharmacy movement continued in the
1980s. two new journals were published:
pharmacotherapy was founded in 1981 by Miller, and
Clinical pharmacy, by the American society of hospital
pharmacists from 1982 through 1993.
 A third textbook in the clinical pharmacy field,
pharmacotherapy: A Pathophysiologic Approach, was
first published in 1989.
Hepler began to conclude that the clinical pharmacy and
pharmacotherapy movement was not the sole answer to
pharmacy's problems. Beginning at the 1985 directions for
clinical practice in pharmacy ( called commonly the Hilton
Head conference), Hepler explained the notion that
pharmacists had to do more than just try to control the use
of drugs.
Hepler recommended that they had to take responsibility for
the care provided to patients through the clinical use of
drugs. In 1987, he first applied the term pharmaceutical
care in describing what he and colleague linda strand
called these new self-actualization roles for pharmacists.
Definition of Pharmaceutical Care
Pharmaceutical care is the direct responsible provision
of drug therapy for the purpose of achieving definite
outcomes that improve a patient's quality of life. these
outcomes are:
1. Cure of disease
2. Elimination or reduction of a patient's symptoms
3. Arresting or slowing of a disease process
4. Preventing a disease or symptom.
Pharmaceutical care involves the process through which a
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.
This in turn involves three major functions:
1. Identifying potential and actual drug-related problems
2. Resolving actual drug-related problems
3. Preventing potential drug-related problems.
 Pharmaceutical care is a necessary element of health care, and
should be integrated with other elements. Pharmaceutical care
is, however, provided for the direct benefit of the patient, and
the pharmacist is responsible directly to patient for the quality of
that care.
 The fundamental relationship in pharmaceutical care is a
mutually beneficial exchange in which the patient grants
authority to the provider, and the provider gives competence and
commitment ( accepts responsibility) to the patient.

The fundamental goals, processes, and relationships of
pharmaceutical care exist regardless of practice setting.
Making a decision about the entry-level degree
 pharmacy profession struggled and disccused for 40
years as to what the appropriate entry-level degree for
pharmacy should be. Finally, in the early 1990s, the
profession settled on the doctor of pharmacy.
 An increasing number of student pharmacists had
been voluntarily seeking the pharmD degree during
the 1980s, but many of them did so after obtaining
their baccalaureate degrees and, in many cases,
working for a few years.
 Most pharmacy graduates, however, finished with B.S.
degrees in pharmacy. By 1995, the enrollment in
PharmD programs would total 9,346 individuals ,
compared with 24,069 in B.S. degree programs.
 In 1989, the American Council on Pharmaceutical
education ( now the Accreditation counsel on pharmacy
education), which accredits schools of pharmacy,
announced plans to consider revising its accreditation
standards such that the B.S Pharmacy degree would be
eliminated by 2000.
 Since many state boards require pharmacists to be
graduates of ACPE-approved programs, this ACPE action
essentially eliminated the B.S. Pharmacy as an entry-level
degree for pharmacy practice, replacing it with the
PharmD credential.
 In 1997 ACPE finalized the standards for the Pharm D
programs.
 The Medicare Modernization Act ro MMA Act of 2003
required that MTM services be provided to high-risk
patients with the goals of enhancing patients'
understanding of appropriate drug use, increasing
adherence to medication therapy, and improving the
detection of adverse drug events.
The MTM service model in pharmacy practice includes
the following five core:
- Medication therapy review
- Personal medication record
- Medication-related action plan
- Intervention and/or referral
- Documentation and follow-up
Pharmacy : The future belongs to you
 Pharmacists are now positioned well to be the drug-
therapy experts on the health care team.
 The bold decisions made about the appropriate role
for pharmacists and the entry-level degree have
produced formal recognition of pharmacists' clinical
services, and through MTM, many believe that
pharmacists in coming years will spend most of their
time in this mode of practice rather than in the drug
preparation duties that dominated in the past.
Thank