1. History of the development of the pharmaceutical care

2. History of the development of the pharmaceutical care
Clinical pharmacy practice -1960's
Move toward "patient-oriented practice“
and away from chemistry and drug product orientation
Responsibilities to control drug use
- Growth of unit dose systems in institutions
- Drug utilization review: authorized, structured, ongoing review of prescribing, dispensing and use of medication.

3. History of the development of the pharmaceutical care
Transitional stage (Hepler and Strand)
Definitions of practice differ
– pre 1960’s to clinical practices
Commitments and responsibilities vary
– some commitment to the product
– ultimate responsibility to patient not yet clear (the organizations are clear, but implementation in practice does not)
– not just a service provided for a patient
•Pharmacokinetic dosing
•Therapeutic monitoring
•Drug information

4. History of the development of the pharmaceutical care
Cipolle
Emphasis on patient
- Beyond that of serving the physician
- Beyond patient education
Patient advocacy, support and encouragement.
Mandate to protect patient from drug misadventuring

5. History of the development of the pharmaceutical care
Defined as a practice1 in 1997
Pharmaceutical care is a patient-centered practice in which the practitioner assumes responsibility for a patient’s drug-related needs and is held accountable for this commitment.2
1 Cipolle, R.J., Strand, L.M., Morley, P.C. (1998). Pharmaceutical Care Practice. New York: McGraw Hill.
2 Cipolle, R.J., Strand, L.M., Morley, P.C. (2004). Pharmaceutical Care Practice: The Clinicians Guide New York: McGraw Hill.

7. History of the development of the pharmaceutical care
Hepler and Strand defined pharmaceutical care as
the responsible provision of drug therapy for the purpose of achieving specific outcomes that improve a patient's quality of life.

8. Clinical Skills and Pharmacist’s Role
We are not physicians
Distinctive responsibility for optimal drug therapy.
Apply medical evidence and literature to an individual patient in collaboration with other healthcare professionals.

9. Clinical Skills and Pharmacist’s Role
Patient assessment
Patient education and counseling
Interview skills
Communication skills ( e.g. listening , speaking or writing at the patient's level of understanding )
Ability to motivate and inspire
Identification and resolution of compliance barriers
Patient – specific pharmacist care plan
Recognition, prevention and management of drug interactions
Pharmacology and therapeutics (innovative and conventional)
Interpretation of laboratory tests.

10. Clinical Skills and Pharmacist’s Role
Dosage adjustment
Identify patients at risk for exaggerated or sub therapeutic response
Apply pharmacokinetic principles to determine patient – specific dosing.
Order and interpret relevant tests at correct time intervals to assess dosage adjustment (e.g. plasma drug concentration , blood glucose levels, blood pressure measurements
- Selection of therapeutic alternatives:-
- Use drug information resources effectively.
- construct comparative analyses to support therapeutic decisions
Preventive services (e.g immunizations).
- Screenings.

11. The changing role of the pharmacist
Dispensing pharmacy
Product business
Bring the product to consumer
Decisions focus on the business
Success measured as # of Rx
Space to display and sell
Records kept for legal purposes
Visits determined by refill supply
Pharmaceutical care
Service (people) business
Bring the practitioner to patient
Decisions focus on the patient
Success measured as patient outcomes
Space organized to meet patient needs
Documentation to provide quality care
Visits determined by patient risk/benefit