1. I NTERDISCIPLINARY PATIENT CARE PHCL 472 Nouf M Aloudah Clinical Pharmacy lecture King Saud University

2. Today Quiz!

3. I NTERDISCIPLINARY TEAM / PATIENT CARE

4. I NTERDISCIPLINARY PATIENT CARE Introduction Why some pharmacists have been more successful than others in moving to a new practice model? Key difference is that they didn’t get it alone, they established solid relationships with other health care professionals who care for the same patients they do and developed clear lines of communication with other practitioners

5. I NTERDISCIPLINARY PATIENT CARE Introduction Pharmaceutical care can’t be practiced in vacuum! It is cooperative partnership between the pharmacist, other healthcare professionals, and the patient Workable patient care program established after taking time to uncover issues important to local provides and talked with them about targeted solutions Others picked patient care program that was popular with other pharmacists but failed to discuss their choices with local provides (e prescription?, automation?)

6. I NTERDISCIPLINARY PATIENT CARE Introduction IPC helps you to launch programs that meets the needs of the pharmacist, physician and the patient

7. I NTERDISCIPLINARY PATIENT CARE IPC: A Team Approach Direct and ongoing relationship between the pharmacist and one or more health care providers who work together to improve the health of a particular patient IPC requires to thoroughly understand each other’s unique knowledge and skills and to recognize the limits of one’s own discipline in solving a patient’s health problems

8. I NTERDISCIPLINARY PATIENT CARE IPC: A Team Approach IPC is not “collaborative practice agreement” or “practicing under protocol” Others involved cooperation but IPC is broader in its scope of responsibilities Collaborative practice involved a written, negotiated agreement in which both physician and pharmacist describe their responsibilities IPC involves a true give and take relationship in which you use independent judgment and tailor your care to the overall needs of the patient

9. I NTERDISCIPLINARY PATIENT CARE Collaborative practice protocol

10. I NTERDISCIPLINARY PATIENT CARE IPC: A Team Approach IPC and “comprehensive case management” Physician maintain overall responsibility for the patient but the pharmacist is responsible for patient education, medication adherence, and many aspects of patient monitoring

11. I NTERDISCIPLINARY PATIENT CARE IPC: A Team Approach Collaborative practice agreement and practicing under control both interdisciplinary ?! YES but both approaches restrict pharmacist’s activities to narrowly specified service

12. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC The need is urgent ! 100,000 people die in American hospitals annually from preventable medical errors (a leading cause of mortality in the united state) $17-29 billion is the total cost of preventable medical errors Patient safety with the upcoming innovative expensive new drugs, increase in the number of prescription generated and dispensed Progressively aging population, extended life expectancy and increase in the number and duration of chronic health conditions

13. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC Examples of formally sanctioned IPC arrangements to address specific health problems Nutrition support Diabetes Pain management

14. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC Department of Veteran’s Affairs (VA) in which pharmacist and physician establish care plans together and interdisciplinary patient rounds

15. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC Other health care systems also have ambulatory clinics in which pharmacists are directly involved with patient management, positive results that have been documented from pharmacists’ efforts are an increase in office appointment compliance rates, increase medication adherence rates, increase patient satisfaction, decrease demand for physician to spend time on routine problems, improved continuity of care, decreased rates of adverse drug events, decreased demands for emergency departments or hospital care and improved cost to benefit rations for the institution

16. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC A study: pharmacist scheduled appointments every 6-8 weeks to educate and monitor patients with hypertension, diabetes, asthma, and elevated cholesterol and they communicated with physician on patients’ progress These patients mean total health care costs declined by $293 per person compared with patients who received standard care

18. I NTERDISCIPLINARY PATIENT CARE The Case Of IPC Program developed in an independent pharmacy in rural eastern Iowa, pharmacist received special training, followed written protocols, and sent documentation to physician with whom they collaborated to immunize patients at high risk for influenza Patients had to be 60 years or old Received Rx for chronic cardiovascular, respiratory, or metabolic conditions From October 15 to December 6 1996, pharmacists administered 343 doses of vaccine No adverse events were reported Go and read other studies !

19. I NTERDISCIPLINARY PATIENT CARE June Felice Johnson’s experience with IPC So nice go and read it, it will help to get depth understanding of what we are talking about

20. I NTERDISCIPLINARY PATIENT CARE Basic Ingredients For IPC What knowledge, skills, and attitude must be in place to be broadly applied within a pharmaceutical care practice?

21. I NTERDISCIPLINARY PATIENT CARE Basic Ingredients For IPC First: genuinely care about your patients! You must get to know them and understand their unique background The better you are at this the more accepting patients will be about your involvement and the more likely that your interventions will be individually tailored rather than “one size fits all” ! Do you know my patient?!?!

22. I NTERDISCIPLINARY PATIENT CARE Basic Ingredients For IPC Second: you must have solid grounding and depth of knowledge in content disciplines that pertain to detecting and solving drug therapy problems Services provided from drug interaction soft wares and pocket size therapeutic reference your services will not be needed! Your knowledge and willingness to keep learning will solidify your value to the team and make your input indispensible

23. I NTERDISCIPLINARY PATIENT CARE Basic Ingredients For IPC Third: teamwork requires a high level of interpersonal skills Listen actively, negotiate, act with assertiveness, communicate clearly in writing, and maintain cooperative outlook

24. I NTERDISCIPLINARY PATIENT CARE Basic Ingredients For IPC Finally: you must be committed to making certain changes and to sustaining them long enough for the practice to change as a whole Don’t assume that others will automatically trust pharmacist, you must patiently and persistently spend significant time establishing and maintain relationships with other providers

26. I NTERDISCIPLINARY PATIENT CARE Processes And Outcomes Establishing a patient focused practice takes time But you are interested in knowing the results? Collect information on the processes you used to provide care No of intervention made Percent of recommendations accepted After that monitor true patient outcomes

27. I NTERDISCIPLINARY PATIENT CARE Processes And Outcomes Typical outcomes ECHO Economics Direct, indirect, intangible costs Clinical Medical results ex HG A1c Humanistic Effects of the disease or treatment on the patient’s functional status or quality of life

28. I NTERDISCIPLINARY PATIENT CARE Benefits of IPC Patients Fewer adverse effects, improved quality of daily life, more satisfaction with their care Physician decrease workload, better pt adherence, more clinic appointment kept, better monitoring and feedback on pts’ status between office visits Pharmacists Enhance patient loyalty, develop a reference network with other trusted providers, improve career satisfaction, contributing to cost effective outcome

29. I NTERDISCIPLINARY PATIENT CARE Collaboration is important in today's complex health care environment Develop the appropriate knowledge, skills and attitude Plan carefully Select capable staff Maintain positive relationships Keep your mission to improve the lives of the patient in your life!

30. Thanks