PHARMACEUTICAL CARE 1

GENERAL PRINCIPLES OF HEALTH CARE

Asso. Asso. Prof. Ma. Cristina C. Doria Faculty of Pharmacy University of Santo Tomas

Many people spend their HEALTH to gain WEALTH, and WEALTH, later on, spend all their WEALTH in a desperate effort to regain HEALTH

GENERAL PRINCIPLES OF HEALTH CARE

HEALTH BACKGROUND Sickness has been one of mans greatest adversaries In the past 100 years Medicine has developed weapons to fight disease effectively

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HEALTH BACKGROUND Developed were: Drugs Vaccines Surgical procedures Instruments Sanitation and nutrition

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HEALTH BACKGROUND To identify or diagnose a specific disease or injury Physicians, pharmacists, and other pharmacists, health care professionals utilize clues Requires scientific knowledge and technical skills Apply these abilities in innovative ways

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MEDICINE Latin word medicus-physician medicusScience and art of diagnosing, treating and preventing disease and injury It is a healing art Aims to help people become more active and live longer and happier lives with less suffering and disability

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MEDICINE Constant search New drugs Effective treatments More advanced technology Health care professionals can prevent, control or cure hundreds of diseases

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MEDICINE Has become a part of the health care industry One of the largest industries in the world One of the leading employers in most communities

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At the turn of the 20th century (1900) Men and women were frail by age 40 Life expectancy was 47.3 years Effective treatment for diseases were so scarce

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By the end of the 20th century Medical advances Life expectancy increased to 76 years

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Today People in their 80s and 90s are independent and physically active Medical expansion has been expensive

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HISTORY OF HEALTH CARE Prehistoric medical practice Study of ancient pictographs that show medical procedures and surgical tools uncovered from anthropological sites of ancient societies

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HISTORY OF HEALTH CARE Serious diseases - primary interest to early humans but they were not able to treat them effectively

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HISTORY OF HEALTH CARE Diseases were: attributed to the influence of malevolent (wicked) demons believed to project an alien spirit, a stone, or a worm into the body of the unsuspecting patient

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HISTORY OF HEALTH CARE Diseases were  warded off by incantations, dancing, magic charms and talismans, and various other measures Make the body uninhabitable to the demon by beating, torturing and starving the patient

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HISTORY OF HEALTH CARE Trepanning Alien spirits are expelled by potions that caused violent vomiting, or could be driven out through a hole cut in the skull Remedy for insanity, epilepsy and headache

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HISTORY OF HEALTH CARE Surgical procedures practiced in ancient societies Cleaning and treating wounds by cautery (burning or searing tissue), poultices, and sutures Resetting dislocations and fractures, and using splints to support or immobilize broken bones

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HISTORY OF HEALTH CARE Additional therapy included: laxatives and enemas to treat constipation and other gastrointestinal diseases

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HISTORY OF HEALTH CARE Discovery of the narcotic and stimulating properties of certain plant extracts Many are still of use today - Digitalis, a heart stimulant extracted from foxglove

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HISTORY OF HEALTH CARE  Systems of medicine existed before the coming of the more advanced Greek medicine about the 6th century B.C. based on: - magic folk remedies elementary surgery

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HEALTH CARE PROFESSIONALS 11.6 million people work in health care in other countries 778,000 physicians, 2.1 M nurses and 160,000 dentists Work in health care services, involved in the diagnosis and treatment of patients Research, teaching or administration of medical facilities

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PHARMACIST Has a unique body of knowledge and skills to contribute in our health care system Dispenses the appropriate drug product and has the knowledge to assure safe and rational use of drugs

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EARLY FUNCTIONS OF A PHARMACIST

1.

Assisting in the selection of appropriate drug therapy

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EARLY FUNCTIONS OF A PHARMACIST

2.

Preparing, compounding and manufacturing drugs for individualized patients

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EARLY FUNCTIONS OF A PHARMACIST

3.

Dispensing and packaging the prescribed drug products including proper labeling

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EARLY FUNCTIONS OF A PHARMACIST

4.

Advising and educating patients on proper use of drugs

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EARLY FUNCTIONS OF A PHARMACIST

5.

Monitoring the outcome and responses of patients to the effect of drugs, both beneficial and adverse

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EARLY FUNCTIONS OF A PHARMACIST

6.

Serving as a community resource person on drug and health information

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THE TEN STAR PHARMACIST Pharmaceutical Care Giver Researcher Manager Communicator Leader LifeLife-long learner DecisionDecision-maker Entrepreneur Teacher Agent of Positive Change

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CONCERNS AMONG HEALTH CARE PROVIDERS Potential abuse, misuse and inappropriate use of drugs Increase in health care cost Patient suffering

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DISEASE versus HEALTH

Disease vs Health
Disease comes only when the bodys vital defenses have been indulgences. broken down through improper diet and harmful indulgences. Lack of health means lack of vital resistance against germs and bacteria. Lack of health means lack of immunity from disease. To cure any disease therefore it is only necessary to build health, after which the body can be left on its own to health, correct itself and overcome disease. This is possible as long as the disease has not yet advanced to such a state where more drastic measures like surgery, become necessary.

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THE PATIENT-ORIENTED PROFESSIONAL PATIENTAble to apply and provide drug knowledge to improve drug use in the health care system Pharmacy colleges responded by providing clinical training for the undergraduates Clinically and patientoriented, better patient prepared to dispense drug knowledge and drug products

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PRIMARY AIM To attain success in the goals for therapy, pharmacist must approach the patient patient counseling an encounter as a HELPER and an EDUCATOR

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THE TRADITIONAL PHARMACIST Involved in the preparation and dispensing of medications At the direction of the physician Strongly allied with the medical profession View that the health professional should be in control of the patient

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Pharmaceutical care must be the organizing force for the profession of pharmacy

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THE MODEL Shift in the model of pharmacy From focus on the medication to a focus on the patient Need for a shift in the pharmacists approach From the health professionalcentered professional MEDICAL MODEL to the patientcentered patient HELPING MODEL

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MEDICAL MODEL  Patient is passive  Trust is based on expertise and the authority of pharmacist  Pharmacist identifies problem and determine solutions  Patient is dependent on pharmacist  Parentchild Parent relationship HELPING MODEL  Patient is actively involved  Trust is based on personal relationship developed over time  Pharmacist assist patients in exposing problem and possible solution  Patient develops selfselfconfidence to manage problems  Equal relationship

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Patient Quality of Life (PQL) (PQL) Primary concern - Welfare of humanity and the relief of human suffering View medications use from the patients perspective

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AN OATH

I will use knowledge and skills to the best of my ability in serving the public and other health professionals

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DELINEATION Health is a state of complete physical, mental, and social well-being and not just wellthe absence of disease or infirmity
World Health Organization (WHO)

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HEALTH A goal to strive for It is not obtainable No one ever achieves a state of complete mental, physical and social well being

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CURE Latin word cura cura CARE CARE Providing for the welfare of another Attentive conscientiousness of devotion Conveys a compassionate state of being and not merely an attitude Involves a profound respect for the otherness otherness of the other

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THERAPEUTIC RELATIONSHIP Built on dialogue and commitment Alliance between a practitioner and a patient Formed to meet a patients health care needs

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CHARACTERISTICS OF A CARING BEHAVIOR: VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP  Mutual respect  Honesty/Authenticity  Open communication  Cooperation  Collaboration between patient and practitioner  Empathy  Sensitivity  Promotion of patient independence  Seeing the patient as a person  Exercising patience and understanding  Trust

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CHARACTERISTICS OF A CARING BEHAVIOR: VITAL COMPONENTS OF A THERAPEUTIC RELATIONSHIP  Competence  Putting the patient first  Offering reassurance  Confidence  Paying attention to the patients physical and emotional comfort  Supporting the patient  Offering advocacy  Assuming responsibility for intervention  Being willing to be held accountable for all decisions made and recommendations given

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HEALTH CARE NEEDS Medical Care Mental Health Care Dental Care Nursing Care ChiroChiro-practice Care Pediatric Care Eye Care OF A PATIENT I care Geriatric Care Pharmaceutical Care Surgical Care Nutritional Care Maternal Care

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PRIMARY CARE Frontline or first contact care Frontline first contact Person Personcentered Not disease or organ system centered Comprehensive in scope Not limited to illness episodes or by organ systems or disease process involved

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INTERACTIONS With patients and other health care providers COUNSEL CONSULT EDUCATION

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4 Rs OF THE PHILOSOPHY OF PRACTICE Rules Roles Relationship Responsibilities

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PHARMACEUTICAL CARE A responsible provision of therapy for the purpose of achieving definite outcomes that improve the patients quality of life
Hepler and Strand

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PHARMACEUTICAL CARE PHARMACIST CARE CARE A practice in which the practitioner takes responsibility for a patients drug drug related needs, and is held accountable for this commitment

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PHARMACEUTICAL CARE Applying knowledge to promote wellwellbeing of others Requires responsiveness, sensitivity and commitment to others Generalist practice that emphasizes health, prevention and care A form of primary health care

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OUTCOMES 1. Cure of disease 2. Elimination or reduction of symptoms 3. Arrest or slowing of a disease process 4. Prevention of disease or symptoms

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THE PHILOSOPHY OF PHARMACEUTICAL CARE Recognition of a social need Patient Patientcentered approach Caring as a modus operandi Specific responsibilities to identify, resolve, and prevent drug therapy problems

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THE FOCUS 1. Patientcenteredness Patient 2. Addressing both acute and chronic conditions 3. Emphasizing prevention 4. Implementing documentation systems that continuously record patient need and care provided

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THE FOCUS 5. Being accessible to frontline front first contact 6. Ensuring integration of care 7. Being accountable 8. Placing emphasis on ambulatory patient 9. Including education/health promotional intervention

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PHARMACEUTICAL CARE PRACTICE Patient is always at the center PATIENT CARE PROCESS PRACTICE MANAGEMENT SYSTEM PROCESS PHILOSOPHY OF PRACTICE

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5 FACTORS TO BE CONSIDERED IN PHARMACEUTICAL CARE PRACTICE
A general understanding of how people feel about being ill, the seriousness of the disease (patients susceptibility to other factors)

DENIAL DENIALNot me! ANGER ANGERWhy me? DEPRESSION DEPRESSIONYes, me! BARGAINING BARGAININGYes me, BUT. ACCEPTANCEIm ready ACCEPTANCE

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VITAL POINTS
Dont assume patients had information from the doctor Dont assume patients understand all information given Dont assume patients have resources to comply Dont assume patients dont care or are stupid Dont assume patients will comply if they understand Dont assume others will monitor of followup follow Dont assume patients will voluntarily seek help or information if there are problems

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TRADITIONAL PHARMACY Primary Focus Rx order or OTC request Upon demand Obey CLINICAL PHARMACY Physicians or other health professionals PHARMACEUTICAL CARE PATIENT

Continuity Strategy

Discontinuous CONTINOUS Find fault or prevention Process ANTICIPATE or IMPROVE OUTCOMES

Orientation

Drug product

R Ph
I. Product oriented
COMPOUNDING & DISPENSING OF DRUGS  Manufacturing of drug II. Patient oriented  Dispensing * Clinical Pharmacy - Patient Care - Drug Utilization Evaluation (DUE) - Drug Utilization Review (DUR) - Drug Utilization Monitoring (DUM) *Pharmaceutical Care *Managed Care HMO


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HEALTH CARE Concerned with the prevention as well as the treatment of disease

It is more difficult to convince a person what he must do to stay well than it is to convince an individual what he must do to get well once he is sick.

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When a person is ill, he will generally seek help When he is well, he will not As a rule, seek help to remain well, yet he must take positive steps to maintain good health

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He cannot take these steps unless he is aware of them Even then, he may not take action unless he is educated as to why he must do so and encourage to take action

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Because of his accessibility, professional knowledge and training, the pharmacist is in a premier position to play an important role in maintaining the health of his community by serving as a health educator

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WHAT A PHARMACIST CAN DO? Patients on medications experience a lot of drug misadventures misadventures adverse effects, drug interactions, errors in the use of medication and non noncompliance MINIMIZE WASTE and MAXIMIZE BENEFITS of medical treatments

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REASONS FOR PHARMACISTS INVOLVEMENT Improve Patients Quality of Life (PQL) (PQL) years High cost of health care today

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BENEFITS 1. Reduce drugrelated morbidity and drug its subsequent cost to individual and society 2. Improve PQL

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BENEFITS 3. Reassures that a medication is safe and effective 4. Patient get additional explanation about their illness and medication that they did not receive from their physicians because they were too rushed, too upset or too embarrassed to ask

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BENEFITS 5. Assist patients on selfcare (the self pharmacist is always the first person that a patient will turn to in order to discuss a variety of problems) 6. Assist patients in non-medication nonrelated problem

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TRANSFORMATION OF HEALTH CARE
OLD PARADIGM Emphasis on acute patient care Emphasis on treating illness Responsible for individual patients All providers are essentially similar Success achieved by increasing market share of in-patient inadmissions Goal is to fill beds Hospitals, physicians, and health plans are separate NEW PARADIGM Emphasis on the continuum of care Emphasis on maintaining and promoting wellness Accountable for the health of define populations Differentiation based on ability to add value Success achieved by increasing the number of covered lives and keeping people well Goal is to provide care at the most appropriate level Integrated health delivery system

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THE ROLE OF THE NEW PHARMACIST Has evolved from being product product patient oriented to a patientoriented professional Extremely healthy for both patient and pharmacist Dispensers of therapy and drug effect interpretations as well as drugs

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In the future, pharmacy services must be evaluated on patient outcome rather than the number of prescriptions dispensed It must evolved towards interpretation and patient consultation, related to consultation, the use of medication technologies

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