PHARMACEUTICALCARE 2015 Armenia Slogan Only with pharmaceutical care, pharmacy job is professional job introduction Have you ever find sick patient without diagnosed? Have you ever find patient treated with the drug without indication? Have you ever meet patient treated with the drug with a n under/upper doses? Have you ever find patient suffer from the symptoms related to drug side effect? Have you ever met patient using the drug not in a proper time/schedule? Have you ever heart patient complain that his or her disease could not be controled/relieved? Have you ever found prescription not in a proper combination? Have you ever met patient that not be able to buy drugs? If your answer is “yes” It means that those situations need pharmacist interventions Course contents Introduction and PC coverrages Hystory : from compounding to caring Communication techniques Drug used and health care system DRP and pharmaceutical Care Pharmaceutical care and EB Phacotherapy Hospital Formulary and Therapeutical Guide Implementation of and Competence for PC PC in ICU PC PC PC PC PC PC PC in in in in in in in CVD RD GITD geriatry pediatry hazard cases Infective diseases GOAL better patient care service E X P E education USA R I E N C I A L E d u c e t I o n U S A Backgrown number of medicines on the market has increased dramatically quality and rational use of medicines rising costs of health care limited financial resources more than half of all prescriptions are incorrect morethan half of the people involved fail to take medicines correctly. the increase in the global spread of antimicrobial resistance Patient Protection Pharmacy Practice dimencions Pharmaceutical care Evidence based Meeting patient needs Chronic patient care – HIV/AIDS Self-medication Pharmacovigilance (ADRs on specific patient) OBJECTIVES overall goal of the course are: to teach the philosophy of practice patient care process, to introduce the steps necessary to establish a pharmaceutical care practice Targets To be able to: Identify Prevent Solve the DRP THE EFFECTIVE, SAFETY AND EFFICIENT DRUG THERAPY Definition “Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life”. Good Pharmacy Education Practice Pharmacist as (8 stars pharmacist): a caregiver Communicator decision-maker Teacher life-long learner leader and Manager Interpreneur FOCUSED ON allows these responsibilities to be met according to the standards of practice, the standards for professional behavior, the philosophy of practice, the patient care process, documentation standards required to provide pharmaceutical care to patients. to provide the student with a rational, systematic, and comprehensive approach to the patient, the patient’s medical conditions, and the patient’s drug therapy understanding of pharmacy practice and introduces the structure that is needed to learn the skills and knowledge required to integrate and apply patient, disease, and drug information to improve the effectiveness and safety of drug therapy new challenges rising costs of healthcare limited financial resources a shortage of human resources in the health care sector inefficient health systems the changing social, technological, economic and political environment key components Ensuring the Quality and the Safety of Medicinal Products to Protect the Patient Policy on Control of Resistance to Antimicrobials rational medicine use and effective medicines supply management ensures the efficacy, safety and quality of medicines. Patient care: How? through managing drug therapy and concurrent non-prescription or alternative therapies. “Health is a state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.” PRINCIPLES OF PHARMACEUTICAL CARE: Functions: • participating in the process of drug use decisions; • selecting the drug product dosage form; • determining the dose and dosage schedule; • preparing the drug product for patient use; • providing the drug product to the patient; • providing drug information to the patient; • monitoring the patient to detect adverse drug reactions and drug interactions; and • monitoring the patient to enhance the probability that therapy proceeds in accord with patient care objectives outcomes oriented pharmacy practice providers to promote health, to prevent disease, to assess, monitor, initiate, and modify medication use assure that drug therapy regimens are safe and effective. The goal of Pharmaceutical Care to optimize the patient's healthrelated quality of life, and achieve positive clinical outcomes, within realistic economic expenditures PENYAKIT, OBAT DAN DRP DRP Dosis terlalu rendah Dosis terlalu tinggi EFEKTIF DRP REGIMEN DOSIS Perlu obat lain Obat tak diperlukan OBAT EFISIEN AMAN DRP DRP Tak efektif Reaksi tak diinginkan Interaksi obat Tak patuh INDIKASI PENYAKIT LUARAN eight categories of drug-related problems • • • • • • • taking/receiving a drug for no medically valid indication needs pharmacotherapy but is not receiving it taking/receiving the wrong drug taking/receiving too little of the right drug taking/receiving too much of the right drug taking/receiving drug inappropriately experiencing an adverse drug reaction experiencing a drug interaction REQUIREMENTS professional relationship must be established and maintained. Patient-specific medical information must be collected, organized, recorded, and maintained Patient-specific medical information must be evaluated and a drug therapy plan developed mutually with the patient. Practice Principles Data Collection initial interview with the patien initiating the patient's pharmacy record What will you do with pediatrics, geriatrics, critical care, language barrier ? pharmacist should work directly with the patient's parent, guardian, and/or principal caregiver. The interview is organized, professional, and meets the patient's need for confidentiality and privacy. uses health/physical assessment techniques (blood-pressure monitoring, etc.) appropriately and as necessary to acquire necessary patient-specific uses appropriate secondary sources to supplement the information creates a pharmacy record for the patient and accurately records the Information Evaluation are collected information subjective and objective ? Useful for: (1) opportunities to improve and/or assure the safety, effectiveness, and/or economy of current or planned drug therapy; (2) opportunities to minimize current or potential future drug or health-related problems; and (3) the timing of any necessary future pharmacist consultation. records the conclusions discusses the conclusions with the patient, as necessary and appropriate Formulating a Plan: objectives: 1) improve and/or assure the safety, effectiveness, and/or cost-effectiveness of current or planned drug therapy; and/or, (2) minimize current or potential future healthrelated problems. formulates plans to effect the desired outcome Includes: patient-specific drug therapy protocol modify prescribed drug therapy, develop and/or implement drug therapy monitoring mechanisms, recommend nutritional or dietary modifications add non-prescription medications or non-drug treatments refer the patient to an appropriate source of care, or institute an existing drug therapy protocol. NOTES considers the patient's needs reviews the plan and desirable outcomes with the patient and with the patient's other healthcare provider documents the plan and desirable outcomes in the patient's medical Implementing the Plan pharmacist and the patient take the steps necessary to implement the plan works with the patient to maximize patient understanding and involvement in the therapy plan assures that appropriate mechanisms are in place (ensure proper medications, equipment, and supplies are received by the patient in a timely fashion) documents in the medical and/or pharmacy record the steps taken. communicates the elements of the plan to the patient and/or the patient's other healthcare provider Monitoring and Modifying the Plan/Assuring Positive Outcomes: regularly reviews subjective and objective monitoring parameters in order to determine if satisfactory progress determine if the original plan should continue to be followed or if modifications are needed reviews ongoing progress in achieving desired outcomes A mechanism is established for follow-up with patients updates the patient's medical and/or pharmacy record Element needs to provide quality pharmaceutical care (1) knowledge, skill, and function of personnel, (2) systems for data collection, documentation, and transfer of information, (3) efficient work flow processes, (4) references, resources and equipment, (5) communication skills, and (6) commitment to quality improvement and assessment procedures. Pharmacist s practice functions 4 DIMENSION IN PC PRACTICE (i) Drug Information Source; (ii) Information Gathering; (iii) Patient Counseling; and (iv)Drug Monitoring. Q&A