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Pharmaceutical care is a pharmacy practice model developed in the 1990s [1] that describes patient-centered medication management services performed by pharmacists.
There are many definitions for "medication management service." The following definition was proposed in the 2012 textbook Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management:
"Medication management services are the professional activities needed to meet the standard of care which ensures each patient's medications (whether they are prescription, nonprescription, alternative, traditional, vitamins, or nutritional supplements) are individually assessed to determine that each medication is appropriate for the medical condition being treated, that the medication is being effective and achieving the goals established, that the medication is safe for the patient in the presence of the co-morbidities and other medications the patient may be taking, and the patient is able and willing to take the medications as intended." [2]
Pharmaceutical care as a pharmacy practice model developed out of the need to re-professionalize pharmacy.
It is thought the first mention of pharmaceutical care came from Dr. Donald Brodie's 1973 lecture shared at The Ninth Annual Rho Chi Lecture in Boston, MA, USA. [3] Dr. Brodie defined pharmaceutical care as "the care a given patient requires and receives which assures safe and rational drug usage." It was then popularized in 1990 after the American Journal of Health-System Pharmacy (AJHP) published an article by Drs. Charles Hepler and Linda Strand entitled ‘Opportunities and responsibilities in pharmaceutical care'. [1]
The concept was endorsed by American Society of Health-System Pharmacists (ASHP) and the American Association of College of Pharmacy (AACP) in 1991. [4] [5] In 1992, the American Pharmacists Association (APhA) followed suit. [6]
In 1993, ASHP issued a statement in response to members seeking a standardized definition of pharmaceutical care. [7] In this statement they defined pharmaceutical care as "the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life." [8]
In 1998, the textbook Pharmaceutical Care Practice: The Patient-Centered Approach to Medication Management was first published. [9] This included a definition of pharmaceutical care informed by the research of Drs. Robert Cipolle, Linda Strand, and Peter Morley that spanned 5 years and involved 20 different community pharmacy practice sites and 54 practicing pharmacists. [9]
The American Medical Association (AMA) approved relevant reimbursement codes in 2004. [2]
In 2013, a European organization, the Pharmaceutical Care Network Europe (PCNE), created a new definition that could satisfy experts from a multitude of countries. After a review of existing definitions, a number of options were presented to the participants and in a one-day meeting consensus on a definition was reached: Pharmaceutical Care is the pharmacologist/pharmacist's contribution to the care of individuals in order to optimize medicines use and improve health outcomes. [10] [ citation needed ]
"The philosophy of pharmaceutical care practice consists of:
A philosophy of practice is expected when working with medicine and nursing and is practiced by all health care professionals." [2]
The patient care process is a cognitive process in which the drug-related needs of patients are approached systematically and comprehensively.
"The patient care process, which must be consistent with the patient care processes of the other health care providers, consists of:
A principle of the patient care process is patient-centeredness.
The patient care process was initially called the "Pharmacists Workup of Drug Therapy" and served as a means to document drug therapy decisions. [11]
"The practice management system includes all of the resources required to bring the service to the patient. Physical space, the appointment system, documentation, reporting, evaluation, payment for the service, and much more are included in the management of a service." [2]
The ultimate goal of pharmaceutical care (optimize medicines use and improving health outcomes) exists in all practice settings and in all cultures where medicines are used. It involves two major functions: identifying potential and manifest problems in the pharmacotherapy (drug therapy problems, or DTPs), and then resolving the problems and preventing the potential problems from becoming real for the patient and his therapy outcomes. This should preferably be done together with other health care professionals and the patient through a review of the medication (and diseases) and subsequent counselling and discussions.[ citation needed ]
A pharmacist is a healthcare professional who specializes in the preparation, dispensing, and management of medications and who provides pharmaceutical advice and guidance. Pharmacists often serve as primary care providers in the community, and may offer other services such as health screenings and immunizations.
Pharmacy is the science and practice of discovering, producing, preparing, dispensing, reviewing and monitoring medications, aiming to ensure the safe, effective, and affordable use of medicines. It is a miscellaneous science as it links health sciences with pharmaceutical sciences and natural sciences. The professional practice is becoming more clinically oriented as most of the drugs are now manufactured by pharmaceutical industries. Based on the setting, pharmacy practice is either classified as community or institutional pharmacy. Providing direct patient care in the community of institutional pharmacies is considered clinical pharmacy.
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary. The committee usually consists of healthcare providers involved in prescribing, dispensing, and administering medications, as well as administrators who evaluate medication use. They must weigh the costs and benefits of each drug and decide which ones provide the most efficacy per dollar. This is one aspect of pharmaceutical policy. P&T committees utilize an evidence-based approach to drive change within health systems/plans by changing existing policies and bringing up-to-date research to support medical decision-making.
Pharmacotherapy, also known as pharmacological therapy or drug therapy, is defined as medical treatment that utilizes one or more pharmaceutical drugs to improve on-going symptoms, treat the underlying condition, or act as a prevention for other diseases (prophylaxis).
American Society of Health-System Pharmacists (ASHP) is a professional organization that represents pharmacists who serve as patient care providers in hospitals, health systems, ambulatory clinics, and other healthcare settings. The organization's nearly 60,000 members include pharmacists, student pharmacists, and pharmacy technicians. ASHP maintains a national database on U.S. drug shortages that is published on their website.
In the field of pharmacy, compounding is preparation of custom medications to fit unique needs of patients that cannot be met with mass-produced products. This may be done, for example, to provide medication in a form easier for a given patient to ingest, or to avoid a non-active ingredient a patient is allergic to, or to provide an exact dose that isn't otherwise available. This kind of patient-specific compounding, according to a prescriber's specifications, is referred to as "traditional" compounding. The nature of patient need for such customization can range from absolute necessity to individual optimality to even preference.
Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.
Pharmacy residency is education a pharmacist can pursue beyond the degree required for licensing as a pharmacist. A pharmacy residency program allows for the implementation of skill set and knowledge acquired in pharmacy school through interaction with the public either in a hospital setting or community practice. The program is done over a span of about 2yrs after graduation from pharmacy school and licensure as a pharmacist. Pharmacy residency helps improve the resume of a pharmacist so as to increase chances of obtaining employment outside community practice. A 2022 review suggested that there is sufficient evidence that residency develops key competencies for junior pharmacists.
A pharmacy is a retail shop which provides pharmaceutical drugs, among other products. At the pharmacy, a pharmacist oversees the fulfillment of medical prescriptions and is available to counsel patients about prescription and over-the-counter drugs or about health problems and wellness issues. A typical pharmacy would be in the commercial area of a community.
Medication therapy management, generally called medicine use review in the United Kingdom, is a service provided typically by pharmacists, medical affairs, and RWE scientists that aims to improve outcomes by helping people to better understand their health conditions and the medications used to manage them. This includes providing education on the disease state and medications used to treat the disease state, ensuring that medicines are taken correctly, reducing waste due to unused medicines, looking for any side effects, and providing education on how to manage any side effects. The process that can be broken down into five steps: medication therapy review, personal medication record, medication-related action plan, intervention and or referral, and documentation and follow-up.
The Classification of Pharmaco-Therapeutic Referrals (CPR) is a taxonomy focused on defining and grouping together situations requiring a referral from pharmacists to physicians regarding the pharmacotherapy used by the patients. It has been published in 2008. It is bilingual: English/Spanish.
Drug therapy problems (DTPs) represent the categorization and definition of clinical problems related to the use of medications or "drugs" in the field of pharmaceutical care. In the course of clinical practice, DTPs are often identified, prevented, and/or resolved by pharmacists in the course of medication therapy management, as experts on the safety and efficacy of medications, but other healthcare professionals may also manage DTPs.
Psychiatric pharmacy, also known as mental health pharmacy, is the area of clinical pharmacy specializing in the treatment of people with psychiatric illnesses through the use of psychotropic medications. It is a branch of neuropsychiatric pharmacy, which includes neurologic pharmacy. Areas where psychiatric pharmacists are found most abundantly are in chemical dependency, developmental disabilities, long-term care facilities, adherence clinics, mental health clinics, and within the prison system. However, psychiatry and neurology are not the only areas where psychiatric pharmacists require comprehensive knowledge. They must also be proficient in clinical problem solving, interprofessionalism, and communication with understanding and empathy for the patient population they serve, as they are a sensitive group.
Pharmacocybernetics is an upcoming field that describes the science of supporting drugs and medications use through the application and evaluation of informatics and internet technologies, so as to improve the pharmaceutical care of patients. It is an interdisciplinary field that integrates the domains of medicine and pharmacy, computer sciences and psychological sciences to design, develop, apply and evaluate technological innovations which improve drugs and medications management, as well as prevent or solve drug-related problems.
Telepharmacy is the delivery of pharmaceutical care via telecommunications to patients in locations where they may not have direct contact with a pharmacist. It is an instance of the wider phenomenon of telemedicine, as implemented in the field of pharmacy. Telepharmacy services include drug therapy monitoring, patient counseling, prior authorization and refill authorization for prescription drugs, and monitoring of formulary compliance with the aid of teleconferencing or videoconferencing. Remote dispensing of medications by automated packaging and labeling systems can also be thought of as an instance of telepharmacy. Telepharmacy services can be delivered at retail pharmacy sites or through hospitals, nursing homes, or other medical care facilities.
A collaborative practice agreement (CPA) is a legal document in the United States that establishes a legal relationship between clinical pharmacists and collaborating physicians that allows for pharmacists to participate in collaborative drug therapy management (CDTM).
The Joint Commission of Pharmacy Practitioners (JCPP) is the largest professional delegation representing the interests of pharmacists within the United States. JCPP represents 13 professional associations in the field of pharmacy, developing consensus policy directives for the profession. It is well known for the 2014 development of "The Pharmacists’ Patient Care Process," which provides broad, consensus guidelines for how clinical pharmacists should practice.
The pharmacy management system, also known as the pharmacy information system, is a system that stores data and enables functionality that organizes and maintains the medication use process within pharmacies.
Comprehensive medication management (CMM) is the process of delivering clinical services aimed at ensuring a patient's medications (including prescribed, over-the-counter, vitamins, supplements and alternative) are individually assessed to determine that they have an appropriate reason for use, are efficacious for treating their respective medical condition or helping meet defined patient or clinical goals, are safe considering comorbidities and other medications being taken, and are able to be taken by the patient as intended without difficulty.
Autonomous pharmacy is an approach to medication management that seeks to create a more automated and data-driven process for medication inventory and dispensing. The main concept behind autonomous pharmacy is to use technology in place of manual medication processes in order to help healthcare providers reduce medication errors, decrease costs and save staff time. Autonomous pharmacy may use a combination of hardware, software and technology-enabled services to allow pharmacists to more effectively manage medication dispersal.
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