In todays rich and diverse communities there is a call for professional medication management; pharmacist are trained to provide this service, and do so with compassion and at a level of individualized patient care unmatched by any other health care profession (Tindall, 2003). In the early 1980s, the notion of care was discovered and quickly exploded in the literature of developmental psychology, then in ethics, bioethics, and the larger disciplines of philosophy and theology; it began when a few women, experts in psychology and education, began examining womens experiences of gaining moral knowledge and making normative judgments (Haddad, 1996).
Pharmaceutical care is a patientcentered practice in which the practitioner assumes responsibility for the patients drug-related needs and is held accountable for this commitment (Cipolle, 2004). And may also be defined as the functions performed by a pharmacist ensuring the optimal use of medications to achieve specific outcomes that improve a patients quality of life; further, the pharmacist accept responsibility for outcomes that ensue from his or her actions, which occur in collaboration with patient and health other health care colleagues (Durgin, 2004:120). Pharmaceutical practitioners accept responsibility for optimizing all of a patients drug therapy, regardless of the source (prescription, nonprescription, alternative or traditional medicines), better patient outcomes and to improve the quality of each patients life (Cipolle, 2004).
Pharmaceutical care has been studied as a method for reducing the amount of preventable drug-related morbidity in patients with diabetes and patients with other chronic diseases (Wilson, 1997:43). The practitioner uses a rational decision-making process called Pharmacotherapy Workup to make an assessment of the patients drug related needs, identify drug therapy problems, develop a care plan, and conduct follow-up evaluations to ensure that all drug therapies are effective and safe. All patients have drug related needs, and it is the pharmaceutical care practitioners responsibility to determine whether or not a patients drug related needs are met (Cipolle, 2004).
The philosophy of pharmaceutical care is centered on four primary elements such as: societal need of pharmacist to address drug related problems; patient centered approach to meet this need; practice based on caring about for patients; and responsibility for finding and responding to the patients drug therapy problems ( Jones, 2003:3).
The practice was defined after a rational decision-making process was developed for drug therapy selection, dosing, and follow-up evaluation. According to Cipolle, pharmaceutical care is designed to compliment existing patient care practices to make drug-therapy more effective and safe; this practitioner is not intended to replace the physician, the dispensing pharmacist, or any other health care practitioners, rather, the pharmaceutical care practitioner is a new patient care provider within the health care system.
What Motivates a Pharmacist to Embrace Pharmaceutical Care?
According to Tindall, in one research article it was demonstrated that pharmacist who are able to work collaboratively with patients have immediate, objective, point-of-care data, and possesses the necessary knowledge, skills, and resources can provide an advance level of care resulting in successful management of dislipidemia; in the survey, pharmacist working in 26 pharmacies in 12 states intervened for three years providing dislipidemia treatment interventions to 397 patients, and each of the 26 pharmacies was selected because of its pharmacist demonstrated a readiness to provide basic pharmaceutical care (Tindall, 2003:8). According to Tindall the result of the study revealed pharmacist could make a two to four fold improvement in patient adherence to medication regimen as well as increase treatment goal objectives.
Obviously, pharmaceutical care interventions cannot occur for every prescription brought into community pharmacy for each medication order filled in a hospital or other institution; it is not feasible, nor is necessary.
Consultant Pharmacist Services
Consultant pharmacist provide a wide range of services which help improve outcomes and improve the quality of life for long term care facility residents and these includes pharmaceutical care plan, participation on committees, disease management, nutrition monitoring, pain management, pharmacokinetic dosing, noncompliance, laboratory test monitoring, monitoring outcomes, drug therapy protocols, participation in survey process, and psychotropic drug monitoring (Lambert, 2002).
Redefining Pharmaceutical Industry
It is stated that the reengineering of pharmacy practice will require the following, which includes: establishing the role of the pharmacist as a primary care provider; integrating the the information systems of health care providers and payers; enhancing the use of support personnel, automation, and other technologies in distributing pharmaceuticals; establishing innovative payment alternatives for achieving patient medication outcomes; providing access to pharmaceutical acre by permitting all patients to select health care providers based on quality, services, and outcomes; and initiating legislative change to empower pharmacist to provide pharmaceutical care (Pathak, 1996).
Expanded Responsibilities in Perspective
According to Abod, the history of pharmacy practice reflects the limitations put in place by pharmacy laws, with their clear distinction between the practices of medicine and the practice of pharmacy; for example, before the 1950s, pharmacist were often taught not to tell their patients about prescribed medications; In 1951, the Durham-Humphrey Amendment to the Food, Drug, and Cosmetic listed for the first time the information that federal law required a pharmacist to place on the label of dispensed medication, and the name of the drug was not on the list.
Although patient counseling and other patient-oriented facets of practice have played a significant role in pharmacy since the middle of the 20th century, the promise that patient oriented practice brings with it has not yet fully materialized (Abod, 2005:324). According to Abod, many pharmacist still practice within the technical model; they believed that it is their responsibility to tell the patient several important facts about a drug but not elaborate further by providing clinical information.
The clinical pharmacist does more than provide warnings; clinical practitioners interview patients and explain the importance of drug therapy and they also collaborate with physicians on decisions about therapeutic alternatives (Abod, 2005:324).
Drug Therapy Problem
A drug therapy problem is any undesirable event experienced by the patient that involves drug therapy and that actually (or potentially) interferes with a desired patient outcome (Jones, 2003). Based on Jones, for the pharmacist to resolve identified drug therapy problems and to prevent future problems, he or she must understand the causes of these problems. To fulfill these responsibilities as well as the goals of therapy (i.e. appropriate, effective, safe, convenient, and economical drug therapy), the pharmacist must use consistent, systematic, and comprehensive process (Jones, 2003).
Personal Barriers to Communication
The world of pharmacy has no strange barriers to optimal professional practice. According to Meldrum, the author and pharmacy and the pharmacy audience generated a list of over 20 factors that impede success; lack of time and pressure to fill script seems to loom largest in peoples mind, and there is no denying the reality that even after mandatory counseling became effective nationwide, there are, there are still not enough pharmacist to fill the consultative role.
Of course, there are barriers arising from the patient as well; even patients have an excellent command of language (which is not always the case), they are often in an angry state because pharmacy is in essence the last stop on a wasted day that began with medical receptionist, moved on to a nurse practitioner, and, after more waiting, to the physician, then to the lab tech, back to a practitioner (Meldrum, 1994:2). According to Meldrum, the hard facts of the matter are that pharmacist cannot always immediately do something to completely remove the barriers constructed by the patient or those inherent in the environment; however, the pharmacist can always minimize the barriers and keep from making the situation worse.
To summarize, the role of pharmacist in managed competition is all that the pharmacist of America have continued historically and so much more. This is a generational opportunity for the profession, but society wont realize the benefits of this change unless a fairly substantive reengineering of pharmacy practice systems, including information support and compensation systems, occur quickly (Pathak, 1996:54).
Pharmaceutical care is the hallmark of the profession; it explains what a practitioner or pharmacy can do to promote the health of patients (Pisano, 2002:72). It requires personal involvement by all members of the profession, some additional training, and much in a way of public relations. According to Pisano, it has all of the elements for strategic planning, gives direction, has vision, and is attainable.
List of References
Abod, R. R. (2005). Pharmacy Practice and the Law. New York: Jones & Bartlett Publishers.
Azzopardi, L. M. (2000). Validation Instruments for Community Pharmacy: Pharmaceutical Care for the Third Millenium. New York: Haworth Press.
Cipolle, R. J., Strand, L. M. (2004). Pharmaceutical Care Practice. New York: McGraw-Hill Professional.
DiPiro, J. T. (2003). Encyclopedia of Clinical Pharmacy. London: Informa Health Care.
Durgin, J. M., & Hanan, Z. I. (2004). Thomson Delmar Learnings Pharmacy Practice for Technicians. New York: Thomson Delmar Learning.
Haddad, A. M., & Buerki, R. A. (1996). Ethical Dimensions of Pharmaceutical Care. New York: Haworth Press.
Jones, R. M., & Rospond, R. M. (2003). Patient Assessment in Pharmacy Practice. London: Lippincott & Williams.
Knowlton, C. H., Penna, R. P. (1996). Pharmaceutical Care. New York: Chapman & Hall.
Lambert, A. A. (2002). Advanced Pharmacy Practice for Technicians. New York: Thomson Delmar Learning.
Meldrum, H. (1994). Interpersonal Communication in Pharmaceutical Care. New York: Haworth Press.
Pathak, D. S., Escovitz, A. (1996). Managed Competition and Pharmaceutical Care: A Challenge for the Profession. New York: Haworth Press.
Pisano, D. J. (2002). Essentials of Pharmacy Law. New York: CRC Press.
Shargel, L., & Souney, P. F. (2006). Comprehensive Pharmacy Review. New York: Lippicott Williams & Wilkins.
Smith, M. C. (1996). Social and Behavioral Aspects of Pharmaceutical Care. New York: Haworth Press.
Tindall, W. N., & MIllonig, C. M. (2003). Pharmaceutical Care: Insights from Community Pharmacists. New York: CRC Press.
Wilson, A. L. (1997). Managing the Patient With Type II Diabetes. New York: Jones & Bartlett Publishers.