Pharmaceutical care patient assessment

This is particularly true at this time in the evolution of our profession. As we globally embrace the precepts of pharmaceutical care, as we find an appropriate balance between knowing our products, our patients and their disease states, it is increasingly critical to constantly review new findings as well as legacy principles. One way of doing that is self-assessment. 

The patient care process clearly describes how a pharmaceutical care practitioner fulfills responsibilities outlined in the philosophy of care. The fhree sfeps in the patient care process are assessment, care plan, and evaluation. These three steps are continuous, or may be viewed as being cyclical in nature. The initial assessment helps the practitioner formulate a care plan in concert with the patient, and follow-up evaluation includes documenfation of acfual patienf oufcomes, leading back to assessment of new drug-relafed needs. 

The pharmaceutical care practitioner always starts by assessing the patient s drug-related needs. Assessment is a systematic review of a patient s drug-related needs. Drug-related needs pertain to the intended use of all of a patient s medications, the effectiveness of each medication, the safety of... 

The process of pharmacists dispensing prescriptions is designed to ensure that patients receive the proper drug in the correct dosage and with correct directions for use. This pharmaceutical care requires the pharmacist to perform an assessment of the patient s medications, to monitor their use and effects, and to communicate with the prescriber and patient to correct or prevent drug-related problems. This drug therapy review service is codified in the term medication therapy management. 

Nonadherence to medication regimens remains a major problem in health care. The National Council on Patient Information and Education (NCPIE) has termed noncompliance America s other drug problem.Pharmacists are in an ideal position to assess and treat adherence-related problems that can adversely affect patients health outcomes. Strategies to monitor and improve adherence are key components of pharmaceutical care plans, especially for patients with chronic diseases, such as hypertension, diabetes, and atherosclerotic heart disease. Nonadherence is a behavioral disorder that can be assessed and managed through a carefully devised pharmaceutical care plan. 

Once the initial adherence plan is implemented, follow-up is important to gauge how well the plan is working and whether changes are needed. Most studies have reported that almost all adherence strategies, regardless of their initial acceptability, will decline in responsiveness over time. Therefore, the pharmaceutical care plan must include periodic reinforcement strategies for long-term success. The plan should also be reevaluated from time to time to assess its effectiveness and determine how well it meets patient expectations. 

Pharmacists are expected to deliver pharmaceutical care, that is, to accept responsibility for patients well-being by ensuring optimum outcomes of drug therapy. Therefore, their performance must be evaluated based on this expectation. The template should be a useful tool for assessing the extent to which clinical pharmacists performance meets predefined practice standards. Its adaptability will allow it to meet site-and pharmacist-specific requirements for performance appraisal. The evaluator and clinical pharmacist should work together to establish a priori percentage standards. 

The focus of laboratory courses is to develop students skills in various areas of pharmacy practice. In labs, students practice dosage form preparation and administration, product selection, medication dispensing, patient counseling, physical assessment, and other components of delivering pharmaceutical care. Laboratory experiences may be components of didactic courses or may exist as stand-alone courses. 

The patient care process (Fig. 1) describes how an individual practitioner fulfills the responsibilities delineated in the philosophy of practice. This process includes three distinct elements that must be completed for each patient 1) patient assessment 2) creation of a pharmaceutical care plan and 3) follow-up evaluation. The success of the process depends on the quality of the therapeutic relationship established with the patient. 

Currie and colleagues devised a tool to assess the quality of pharmacists documentation. These researchers created a list of data elements after a comprehensive literature search and input from practitioners and expert panels. The elements are divided into two groups those essential to each individual patient encounter and those essential to a patient record (Table 4-2). The acquisition of each of these elements is critical to the provision of pharmaceutical care. 

Patient assessment is the basis from which a pharmaceutical care plan evolves. Problem identification and therapeutic monitoring cannot occnr nntU a thorongh assessment is complete. The initial assessment is also the basis for evalnating response to therapy throughout the course of treatment. Psychiatric assessment requires sensitivity and good listening skills on the part of the clinician because it is based primarily on a subjective interview and not objective tests. With careful data collection, clinicians can make substantial contributions to care that improve patient outcomes. 

A comprehensive pharmaceutical care plan for the patient with DM will integrate considerations of goals to optimize blood glucose control and protocols to screen for, prevent, or manage microvascular and macrovascular complications. In terms of standards of care for persons with DM, one can review the document published by the American Diabetes Association that outlines initial and ongoing assessments for patients with DM. For quality-of-care measures, one can refer to the National Diabetes Quality Improvement Alliance web site at... 

Pharmaceutical Care is a patient-centered, outcomes-oriented pharmacy practice that requires the pharmacist to work in concert with the patient and the patient s other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy regimens are safe and effective. The goal of Pharmaceutical Care is to optimize the patient s health-related quality of life, and achieve positive clinical outcomes, within realistic economic expenditures. To achieve this goal, the following must be accomplished ... 

The implementation of pharmaceutical care is supported by data collection and documentation systems that accommodate patient care communications (e.g., patient contact notes, medical/medication history), interprofessional communications (e.g., physician communication, pharmacist to pharmacist communication), quality assurance (e.g., patient outcomes assessment, patient care protocols), and research (e.g., data for pharmacoepidemiology, etc.). Documentation systems are vital for reimbursement considerations. 

The implementation of pharmaceutical care is supported by tools that facilitate patient care, including equipment to assess medication therapy adherence and effectiveness, clinical resource materials, and patient education materials. Tools may include computer software support, drug utilization evaluation (DUE) programs, disease management protocols, etc. 

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