Pharmaceutical care practice

Desselle SP. 1997. Pharmacists perceptions of pharmaceutical care practice standards. J Am Pharm /1b cNS37 29. 

Desselle SP, Rappaport HM. 1995. Feasibility and relevance of identified pharmaceutical care practice standards for community pharmacists. Paper presented at the American Association of Pharmaceutical Scientists Annual Meeting, Miami, FL, November 7. 

Cipolle RJ, Strand LM. 1998. Pharmaceutical Care Practice. New York McGraw-Hill. 

Bislew HD, Sorensen TD. 2003. Use of focus groups as a tool to enhance a pharmaceutical care practice. / Am Pharm Assoc43 424. 

The management systems essential to a successful pharmaceutical care practice... 

To help describe the development of pharmaceutical care practices, it is important to analyze the interrelated conditions, or environment, in which pharmaceutical care exists. The context of pharmaceutical care is systems failure related to the use of medications. In medicine there is a system in place to guide the physician s differential diagnosis, or in dentistry to guide the dentist s oral exam. When it comes to the use of medications, often it is only the most assertive and aggressive patients who can negotiate the health... 

Before analyzing the interrelated systems of pharmaceutical care, a brief overview of this new professional practice will be helpful. The landmark pharmaceutical care article published in 1990 creafed the theoretical constructs for the responsible provision of drug therapy. This article set the foundation for the development of a new professional practice. Through efforts aimed at moving from theory into application, the definition of fhis new professional practice emerged. A pharmaceutical care practice then is defined as a practice in which the practitioner takes responsibility for all of a patient s drug-related needs and is held accountable for this commitment. ... 

Evaluation is defined as the practitioner s determination of the patient s outcome and clinical status at planned intervals. Evaluation represents accountability in the definition of a pharmaceutical care practice. This accoxmtability is witnessed at the patient level by the practitioner assuming responsibility for finding out exactly what happens to the patient in the medication use process and documenting these results or outcomes. 

The framework for presenting the evidence in support of a pharmaceutical care practice managemenf system is clinical, humanistic, and economic outcomes data, which are described next. 

After the organizational framework supporting a pharmaceutical care practice is in place, attention is focused on the job of building the practice. There are five steps to building a pharmaceutical care practice ... 

Mission statement. Without a statement of mission, there is no clear definition of the purpose to guide practitioners through their daily duties and responsibilities. The following is an example of describing the service as part of the mission for a pharmaceutical care practice ... 

Table 15.2 presents an example of a management plan for a pharmaceutical care practice located in an ambulatory care clinic. 

Resource requirements. Resources required to deliver the service include physical, financial, and human resources. The business of managing a pharmaceutical care practice is much different than the business of dispensing medications. All resources required for operating a pharmaceutical care practice focus on delivering a service to the patient as opposed to a commercial product-focused business. 

A successful pharmaceutical care practice must have a clear separation of resources between a product-focused business and fhe patienf service business. A lack of clear resource separation befween the two businesses manifests in patient confusion, as well as practitioner frusfration when having to abandon patient care goals in the face of growing prescription-dispensing demands. Experiences from many attempted practices indicate fhat when the two businesses are indistinguishable to consumers, reimbursement for the provision of pharmaceutical care rarely occurs. A clear separation of services leads to an enhanced professional image and improves fhe opportunity to obtain reimbursement for services. 

Table 15.2 Sample Pharmaceutical Care Practice Management Plan ... 

Promotion and marketing of a pharmaceutical care practice requires persistence and patience. Whenever there is change, consumers express a certain... 

Similarly, pharmaceutical care documentation is intended to improve care delivered to patients and convey information to fellow practitioners. Three important purposes for documentation of the care delivered to patients in a pharmaceutical care practice are to (1) ensure continuity of patient care over the course of the therapeutic relationship, (2) evaluate actual patient... 

Management reports can also be used to continuously improve the quality of a pharmaceutical care practice. Quality improvement concepts are used in many service-oriented industries. Management reports are essential to improve pharmaceutical care services by integrating data from groups or populations of patients served to help make practice management decisions. 

Scott, D.M. Miller, L.G. Letcher, L.A. Assessment of desirable pharmaceutical care practice skills by urban and rural Nebraska pharmacists. Am. J. Pharm. Educ. 1998, 62, 243-252. 

The principles and processes of pharmaceutical care practice are needed and applicable to patients in all pharmacy settings, including (but not limited to) inpatient, outpatient, community pharmacy, and academic sites. Practice is not restricted to select pharmacists based on years of experience, degree, specialty practice certificate, board certification, residency experience, or academic appointment. It is not a function of professional credentials or place of work but rather the desire and competence to take responsibility for the outcomes of each patient s drug therapy. 

The Pharmacist s Workup of Drug Therapy (PWDT) is a tool available to practitioners that serves as a guide through the steps of the patient care process. It offers a standardized format for efficient documentation of patient-specific information needed for a financially viable pharmaceutical care practice. 

Fig. 1 The patient care process within a pharmaceutical care practice. Adapted from Cipolle, R.J. Strand, L.M. Morley, P.C. Pharmaceutical Care Practice, McGraw-Hill New York, 1998, p. 129.

Several different types of billing mechanisms have been used to gain compensation from third parties for services that are not tied directly to dispensing a drug product. Examples include fee-for-service, capitation payment, and the Health Care Financing Administration (HCFA) 1500 claim form. Each method has inherent advantages and disadvantages and may not be a suitable method for compensation for a comprehensive pharmaceutical care practice. 

Payment for the majority of the patient care services provided by physician and nonphysician practitioners is based on the resource-based relative value scale (RBRVS). The RBRVS ranks services according to the relative costs of the resources needed to provide them. The resulting relative value scale is then multiplied by a dollar figure to convert the service into a payment schedule. This payment model was successfully applied to pharmaceutical care practice in the Minnesota Pharmaceutical Care Project. Five levels of patient need were created based on the following 1) the number of the patient s medical conditions 2) the number of medications the patient is taking and 3) the number of drug therapy problems identified. At 10 different community pharmacy practices in 1994, the average payment for a patient encounter was 12.14. 

To date, actual and perceived barriers have impeded widespread acceptance and implementation of pharmaceutical care practice. Some factors affecting individual pharmacists include inadequate education and training in the required skills, absence of suitable role models and mentors, lack of time due to dispensing pressures, unwillingness to change to an entirely new philosophy of practice, fears of legal liability, fear of failure, and the... 

The Foundation is constituted by patrons that can be individuals or institutions. Most individuals are pharmacists, but there are also some physicians. Among the institutions that are patrons of the Foundation are medical organizations such as the Academy of Medical Sciences of Catalonia and Balearic Islands (ACMCB) Spanish primary healthcare net (REAP) Group CESCA, a scientific organization of primary care and the Gerontology International Eoundation (FGI). The support of these medical societies is essential for the credibility and progress of pharmaceutical care practice. 

The Pharmaceutical Care Spain Foundation is also cooperating in an organization called Pharmaceutical Care Network Europe (PCNE) that is promoting pharmaceutical care practice and research. One of the difficulties we have in Europe is the diversity of pharmacy organization system and practice, as well as languages and healthcare structure. Such differences, between European countries, are well discussed by Foppe van Mil. ... 

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