Patient-centered approach

When health care providers decide to supervise withdrawal from psychiatric drugs, they must pay careful attention to the feelings or emotions of their patients or clients. Not only do patients deserve this respect and concern, their emotional reactions are the best gauge of how well the tapering process is going. Drug withdrawal requires a patient-centered approach. 

To address the social need of drug-related morbidity and mortality based on a patient-centered approach that is built on the establishment of a therapeutic relationship, there must be clearly defined practitioner responsibilities. In pharmaceutical care, the practitioner is responsible for all drug-related needs of a patient. As discussed in detail in the next section, this means that a practitioner seeks to ensure that all therapies are appropriately indicated and that all medical conditions of a patient are appropriately treated, and that all therapies in use are effective, safe, and convenient for the patient. 

Figure 12-1 The trend in the evolution of diagnostic testing from observation of the patient, through simple testing, to sophisticated testing in the laboratory and back to a more patient-centered approach.

The practice of pharmaceutical care has a clearly articulated philosophy that defines values and explains what all practitioners must do. According to this philosophy, the practitioner performs the following 1) takes responsibility for meeting society s need to reduce drug-related morbidity and mortality 2) employs a patient-centered approach that addresses all the patient s drug-related needs 3) establishes a caring therapeutic relationship with individual patients and 4) assumes a clearly defined set of responsibilities that directs patient care activities. These responsibilities are to ensure that patients receive the most appropriate, effective, safe, convenient, and economical therapy to identify, resolve, and prevent drug therapy problems and to ensure that optimal patient outcomes are achieved. 

We strongly believe that adoption of such di patient-centered approach to dialysis vascular access could have a very positive impact on patient safety in dialysis vascular access. 

Fig. 2. Patient-centered approach with ciose coiiaboration between members of the access center team. 

Level IB in Table 13-5 refers primarily to the concepts of within-person and among-person biological variation. Levels of optimum, desirable, and minimum performance for both imprecision and bias have been defined based on these concepts. When a test is to be used for monitoring, use of this type of quality specification for imprecision appears appropriate in guidelines. Failure to use this approach is difficult to justify, because data on within-person and among-person biological variation are available for virtually ail commonly used tests. The quality specifications relate directly to the ability to use assays for monitoring and the ability to use common reference intervals within a population. These maybe considered patient-centered objectives in a broad sense if not in a narrow one. 

Academic health centers have started to respond to the challenge of CAM, both by introducing content into medical curricula and by considering research into some of these approaches. Perhaps they recognize that by ignoring CAM, they will fail future physicians and their patients. 

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