1. Pharmaceutical Care Concept

2. Objectives To differentiate between occupation and profession.
The hallmarks characteristic of profession.
Factors that threatened pharmacy as a profession.
Factors that provided the pharmacy profession with valuable opportunity.

3. Occupations vs. Professions
Profession and occupation are almost the same, with only minor differences between them.

4. Occupations vs. Professions
بناء

5. Occupations vs. Professions
The difference between occupation and profession can be stated with a simple example:
Designing a building would be called a profession, whereas, constructing a building is an occupation.
بناء

6. Occupations vs. Professions
Occupation does not need any extensive training and specialized knowledge.
Drivers, clerks.
Needs extensive training and specialized knowledge and has to undergo higher education.
Doctors, engineers.
Clerks=كتبة

7. Profession
A profession is An occupation whose core element is work based upon the mastery of a complex body of knowledge and skills.
Teaching and Learning in Medicine, 16(1), 74–76
Vocation مهنة او موهبة
براعةmastery

8. Profession
A profession is a vocation founded upon specialized educational training, the purpose of which is to supply counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain.
Vocation مهنة او موهبة

9. Pharmacy as a profession
Charles D. Hepler, a pharmacist and pharmacy professor at the University of Florida, wrote extensively about pharmacy and its professional status in the 1980s and 1990s.
يعتمد

10. Pharmacy as a profession
Three basic Characteristics have become the hallmarks
of profession:
The services offered are closely linked to major human values, such as health, property, or religion.
The services are inherently personal or individualized in nature, meaning that they cannot be readily standardized or mass-produced.
Hepler concluded that: these threee requirements surely prove that pharmacy of the 19th century was a profession.why?...page 20
المساعد يعتمد على الملاحظات الأساسية لارسن في توصيف مهنة. أصبحت ثلاث خصائص أساسية بصمات المهنة : ترتبط ارتباطا وثيقا الخدمات المقدمة إلى القيم الإنسانية الكبرى ، مثل الصحة، أو الملكية ، أو الدين. الخدمات تتطلب قدرا من المعرفة والمهارات ، والفهم تتجاوز تلك التي يمتلكها الناس العاديين من اليوم وراء قدرة المواطن العادي على تقييم (على سبيل المثال، فإن دقة التشخيص أو نقاء وصفة طبية). الخدمات الشخصية هي بطبيعتها أو فردية في طبيعتها، وهذا يعني أنها لا يمكن أن تكون موحدة بسهولة أو إنتاجها بكميات كبيرة.
Human values are the need of hour in this world

11. Pharmacy as a profession
Three basic Characteristics have become the hallmarks of profession:
The services require a degree of Knowledge, skills, and understanding beyond those possessed by ordinary people of the day.
Hepler concluded that: these threee requirements surely prove that pharmacy of the 19th century was a profession.why?...page 20
( for example, the accuracy of diagnosis or the purity of prescription)..
المساعد يعتمد على الملاحظات الأساسية لارسن في توصيف مهنة. أصبحت ثلاث خصائص أساسية بصمات المهنة : ترتبط ارتباطا وثيقا الخدمات المقدمة إلى القيم الإنسانية الكبرى ، مثل الصحة، أو الملكية ، أو الدين. الخدمات تتطلب قدرا من المعرفة والمهارات ، والفهم تتجاوز تلك التي يمتلكها الناس العاديين من اليوم وراء قدرة المواطن العادي على تقييم (على سبيل المثال، فإن دقة التشخيص أو نقاء وصفة طبية). الخدمات الشخصية هي بطبيعتها أو فردية في طبيعتها، وهذا يعني أنها لا يمكن أن تكون موحدة بسهولة أو إنتاجها بكميات كبيرة.

12. Pharmacy as a profession(20th century)
Amendment of the Food, Drug and cosmetic ACT required pharmaceutical manufacturers to spend millions of dollars in premarket testing of drugs, and advances in technology allowed mass production of ready-to-dispense tablets, capsules, suppositories, liquids, and injectables.
تعديل او تحسين
The United States Federal Food, Drug, and Cosmetic Act (abbreviated as FFDCA, FDCA, or FD&C), is a set of laws passed by Congress in 1938 giving authority to the U.S. Food and Drug Administration (FDA) to oversee the safety of food, drugs, and cosmetics.

13. Pharmacy as a profession(20th century)
Prescriptions became so standardized that some pharmaceutical companies gave physicians preprinted prescriptions complete with drug name, quantity to dispense, and directions.
As Hepler noted, the only individualization was the patient's name and the prescription number.

14. Pharmaceutical care as reprofessionalization
The same development that threatened pharmacy- the industrialization of the pharmaceutical industry in the 1st half of the 20th century-also provided the profession with valuable opportunity.
threatenedهدد

15. Pharmaceutical care as reprofessionalization
The pathophysiology of many disease states were not well understood.
The efficacious drugs were few.
Antibiotics were not yet available.
far betweenمتباعدة
(from just a few decades ago)

16. Pharmaceutical care as reprofessionalization
Exploration in knowledge of chemicals provided some powerful agents.
In the 1950, scientists began to make major strides in understanding biological systems.
Explorationاستكشاف
Metabolicالأيض
stridesخطوات

17. Pharmaceutical care as reprofessionalization
Medical scientists understood specifically what underlying metabolic or genetic defect caused certain diseases, and with this knowledge powerful new drugs were identified.
Thousands of compounds were tested for antibacterial, antifungal, and antiviral activity.
Explorationاستكشاف
Metabolicالأيض
stridesخطوات

18. Pharmaceutical care as reprofessionalization
In the late 1950s and 1960s, astute pharmacists such as Donalds C Brodie of the university of California-San Francisco, Donald E. Francke of the university of Michigan, and Paul F. Parker of the University of Kentucky began to conceptualize a new role for pharmacists that would involve the specialized provision of information about these powerful new agents that were beginning to reach the market.
Additionally
in the ensuring decades.
Astuteاصفة ذكي داهية فطن ماهر
conceptualize تصور
provisionتوفير

19. Pharmaceutical care as reprofessionalization
The clinical pharmacy movement sought to create a role for pharmacists in the provision of patient-specific drug information or advice to physicians and other members of health care team.
As it came to be known
سعت لخلق
Clinical pharmacy is the branch of Pharmacy where pharmacists and pharmaconomists provide patient care that optimizes the use of medication and promotes health, wellness, and disease prevention

20. Pharmaceutical care as reprofessionalization
Hepler has identified three simultaneous trends that served as the basis for the clinical pharmacy movement:
Drug information.
Drug distribution especially decentralized program in hospitals.
Teaching and research programs in pharmacology and biopharmaceutics.
Drug information def.
decentralized program in hospitals
وقد حددت ثلاثة اتجاهات في وقت واحد المساعد

21. Pharmaceutical care as reprofessionalization
These three currents combined for the first time in the famous 1966 “Ninth floor project” at the University of California-San Francisco, in which faculty sought to find a way to train students a role that did not previously exist.
التيارات
currents

22. Pharmaceutical care as reprofessionalization
Gradually, the worth of such services took hold, and schools of pharmacy began to create a demand for clinical pharmacy.
worthقيمة

23. Pharmaceutical care as reprofessionalization
Publication of Drug Intelligence and Clinical Pharmacy (now Annals of Pharmacotherapy) began in 1967, and two pharmacy therapeutics textbooks came out of San Francisco in 1972.
المقيمين في دور رعاية المسنين الرعاية الماهرة

24. Pharmaceutical care as reprofessionalization
By 1974 , the federal government recognized a clinical role for pharmacists when it began requiring the pharmacists to conduct monthly drug-regimen reviews of residents in skilled-care nursing homes.
المقيمين في دور رعاية المسنين الرعاية الماهرة

25. Pharmaceutical care as reprofessionalization
The clinical pharmacy movement created the opportunity for pharmacy to continue as a profession worthy of the respect and trust of its patients: clinical pharmacy was involved in the health care of patients, it required specialized knowledge and skills, and it was individualized.

27. Pharmaceutical care as reprofessionalization
The clinical pharmacy movement continued in 1980.
Pharmacotherapy was published in 1981.
A third textbook in the clinical pharmacy field, Pharmacotherapy: A Pathophysiologic Approach, was first published in 1989.

28. Pharmaceutical care as reprofessionalization
Hepler began to conclude that the clinical pharmacy and pharmacotherapy movement was not the sole answer to pharmacy's problems.
In 1987, he first applied with his colleague Linda Strand the term pharmaceutical care in describing new roles for pharmacists.
تجسيد الذات

29. Pharmaceutical care definition
Pharmaceutical Care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.
العناية الصيدلانية المسؤولة في توفير العلاج بالعقاقير لغرض تحقيق نتائج محددة من شأنها تحسين نوعية المريض الحياة

30. Pharmaceutical care definition
Pharmaceutical Care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.
العناية الصيدلانية المسؤولة في توفير العلاج بالعقاقير لغرض تحقيق نتائج محددة من شأنها تحسين نوعية المريض الحياة 30

31. Pharmaceutical care definition
Provision of drug therapy
Achieve definite outcomes
Improve a patient's quality of life.
العناية الصيدلانية المسؤولة في توفير العلاج بالعقاقير لغرض تحقيق نتائج محددة من شأنها تحسين نوعية المريض الحياة
Quality of Life (QoL) is a phrase used to refer to an individual’s total wellbeing. This includes all emotional, social, and physical aspects of the individual’s life. However, when the phrase is used in reference to medicine and healthcare as Health Related Quality of Life, it refers to how the individual’s wellbeing may be impacted over time by a disease, a disability, or a disorder.[1]
The recently developed index, EUROQoL [18], assesses perceived health state in five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression)

32. Pharmaceutical care definition
These outcomes are:
Cure of disease.
Elimination or reduction of patient's symptomatology.
Arresting or slowing of a disease process.
Preventing a disease or symptomatology.

33. Pharmaceutical care definition
Pharmaceutical care involves the process through which a pharmacist cooperate with a patient and other professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient.

34. Pharmaceutical care definition
Physician
Pharmacist
Patient
Designing
Implementing
Monitoring

35. Pharmaceutical care definition
This in turn involves three major functions:
Identifying potential and actual drug-related problems.
Resolving actual drug-related problems
Preventing potential drug-related problems.

36. Medication-related problem
A medication-related problem is an event or circumstance involving medication therapy that actually or potentially interferes with an optimum outcome for a specific patient.
حدث أو ظرف
Am J Hosp Pharm. 1993; 50:1720–3.

37. Medication-related problem
There are at least the following categories of medication-related problems:
Untreated indications: The patient has a medical problem that requires medication therapy but is not receiving a medication for that indication.
Improper drug selection: The patient has a medication indication but is taking the wrong medication.
Am J Hosp Pharm. 1993; 50:1720–3.

38. Medication-related problem
Subtherapeutic dosage: The patient has a medical problem that is being treated with too little of the correct Medication.
Failure to receive medication: The patient has a medical problem that is the result of not receiving a medication.
(e.g., for pharmaceutical, psychological, sociological, or economic reasons).
Am J Hosp Pharm. 1993; 50:1720–3.

39. Medication-related problem
Overdosage:The patient has a medical problem that is being treated with too much of the correct medication (toxicity).
Adverse drug reactions: The patient has a medical problem that is the result of an adverse drug reaction or adverse effect.
Drug interactions: The patient has a medical problem that is the result of a drug–drug, drug–food, or drug– laboratory test interaction.
Am J Hosp Pharm. 1993; 50:1720–3.

40. Medication-related problem
Medication use without indication: The patient is taking a medication for no medically valid indication.
Am J Hosp Pharm. 1993; 50:1720–3.

41. Pharmaceutical care definition
Pharmaceutical care is provided for the direct benefit of the patient, and the pharmacist is responsible directly to the patient for the quality of that care.

42. Pharmaceutical care definition
The fundamental goals, processes, and relationships of Pharmaceutical care exist regardless of practice setting.
Pharmacy mission

43. Entry-level Degree
A Doctor of Pharmacy is a first professional degree.
In the United States, the PharmD. (Doctor of Pharmacy) degree is a professional degree that prepares the graduate for pharmacy practice.

44. Entry-level Degree
Previously, in the United States, the bachelor's degree in pharmacy was the first-professional degree for pharmacy practice.
Some schools and colleges of pharmacy offered a post-baccalaureate graduate PharmD degree.

45. Entry-level Degree
In 1990, the American Association of Colleges of Pharmacy (AACP) mandated that a doctor of pharmacy degree would be the new first-professional degree.
The current PharmD degree curriculum is very different than that of the prior BS in pharmacy and now includes extensive didactic clinical preparation.

46. Pharmaceutical care in community pharmacy
Until the mid-1990s, pharmaceutical care was provided primarily in hospitals with clinical pharmacy services and long-term care facilities where consultant pharmacists reviewed medication therapy on a monthly basis.
Long-term care (LTC) is a variety of services which help meet both the medical and non-medical need of people with a chronic illness or disability who cannot care for themselves for long periods of time.

47. Pharmaceutical care in community pharmacy
In community pharmacy, practice remained as Hepler had described it: Count, pour, lick, and stick.
In 1997Asheville Project was implemented.

49. Pharmaceutical care in community pharmacy
In 1997Asheville Project was implemented as an effort by the City of Asheville, North Carolina.
To provide education and personal oversight for employees with chronic health problems such as diabetes, asthma, hypertension and high cholesterol. 

50. Pharmaceutical care in community pharmacy
Employees with these conditions were provided with intensive education through the Mission-St. Joseph’s Diabetes and Health Education Center. 
Patients were then teamed with community pharmacists who made sure they were using their medications correctly.

51. Pharmaceutical care in community pharmacy
The project led pharmacists to develop thriving patient care services in their community pharmacies. 
Employees with diabetes soon began experiencing improved A1C levels, lower total health care costs, fewer sick days and increased satisfaction with their pharmacist’s services.
قاد المشروع صيادلة لتطوير خدمات رعاية المرضى مزدهرة في الصيدليات مجتمعهم.
المتقاعدين وعائلاتهم

52. Pharmaceutical care in community pharmacy

53. Pharmaceutical care in community pharmacy
Project ImPACT (Improve Persistence and Compliance with Therapy).
Objective: To demonstrate that pharmacists, working collaboratively with patients and physicians and having immediate access to patient data, promote patient persistence and compliance with prescribed dyslipidemic therapy that enables patients to achieve their National Cholesterol Education Program (NCEP) goals. 
Design: Observational study.
J Am Pharm Assoc. 200;40:

54. Pharmaceutical care in community pharmacy
Participants: 26 community pharmacies.
Main Outcome Measures: Rates of patient persistence and compliance with medication therapy and achievement of target therapeutic goals.
Results: In a population of 397 patients over an average period of 24.6 months, observed rates for persistence and compliance with medication therapy were 93.6% and 90.1%, respectively, and 62.5% of patients had reached and were maintained at their NCEP lipid goal at the end of the project. 
J Am Pharm Assoc. 200;40:

55. Pharmaceutical care in community pharmacy
Conclusion: Working collaboratively with patients, physicians, and other health care providers, pharmacists who have ready access to objective clinical data, and who have the necessary knowledge, skills, and resources, can provide an advanced level of care that results in successful management of dyslipidemia.
J Am Pharm Assoc. 200;40:

56. April 29, 2005

57. Medication Therapy Management
Medication Therapy Management is a distinct service or group of services that optimize therapeutic outcomes for individual patients.
Medication Therapy Management Services are independent of, but can occur in conjunction with, the provision of a medication product.

58. Medication Therapy Management
The model services are designed to:
Improve care.
Enhance communication among patients and providers.
Improve collaboration among providers.
Optimize medication use for improved patient outcomes.
MTM services are distinct from dispensing.

59. Medication Therapy Management
MTM services will:
Enhance patients‘ understanding of appropriate drug use.
Increase compliance with medication therapy, result in collaboration between pharmacists and prescribers.
Improve detection of adverse drug events.

60. Medication Therapy Management
This model is intended for pharmacists to use with all patients in need of MTM services.
These services will be provided in a private or semiprivate area.
By a pharmacist whose time is devoted to the patient during this service.

61. Medication Therapy Management
MTM services typically are provided by appointment but may be provided on a walk in-basis.
The pharmacist can initiate MTM service when complex medication therapy problems are identified through the dispensing process.

62. Core Components of Community Pharmacy MTM
Medication therapy review
A personal medication record
A medication action plan
Interventionand referral
Documentation and follow-up
Core elementsالعناصر الأساسية
The framework includes these core elements of MTM services, but community pharmacists may offer many other innovative MTM service

63. Core Components of Community Pharmacy MTM
Medication Therapy Review:
The pharmacist completes a medication therapy review (MTR) consultation with the patient or caregiver.
obtain more accurate medication-related information from patient

64. Core Components of Community Pharmacy MTM
Personal Medication Record: The patient receives a personal medication record (PMR) after a comprehensive MTR.
Core elementsالعناصر الأساسية
The framework includes these core elements of MTM services, but community pharmacists may offer many other innovative MTM service

65. Patients are instructed to take the PMR with them if they are being admitted to a hospital or other institution or if they must visit an emergency room.

66. Core Components of Community Pharmacy MTM
Medication Action Plan: The patient receives a medication action plan (MAP) at the end of an MTM visit.

67. Core Components of Community Pharmacy MTM
The MAP includes:
Patient identifier
Patient date of birth
Physician identifier
Pharmacist identifier
Date of MAP
Medication-related issues identified
Proposed actions
Individual responsible for action
Result of action, when known, including result date.

69. Core Components of Community Pharmacy MTM
Intervention and/or Referral: The pharmacist provides consultative services and intervenes to address medication-related problems; when necessary.
The pharmacist refers the patient to other health care providers.

70. Core Components of Community Pharmacy MTM
Circumstances that may require referral to additional health care providers include the following:
New problems discovered during MTR may necessitate referral to a physician for evaluation and diagnosis.

71. Core Components of Community Pharmacy MTM
Patients may require disease management education from pharmacists or other health care providers to help them manage chronic diseases such as diabetes.
Patients who require monitoring for high-risk medications, such as warfarin, may need referrals to Pharmacists with advanced experience, training.

72. Core Components of Community Pharmacy MTM
Documentation and Follow-up:
MTM services are documented in a consistent manner.
Follow-up MTM visit is scheduled with the patient or caregiver.

73. Core Components of Community Pharmacy MTM
Documentation of MTM services should include the following categories of information:
Patient demographics
Known allergies, diseases, or conditions
A record of all medications, including prescription, nonprescription, herbal, and other dietary supplement products
Assessment of medication therapy problems and plans for resolution
Therapeutic monitoring performed.

74. Core Components of Community Pharmacy MTM
Interventions or referrals made
Education received
Schedule and plan for follow-up appointment
Amount of time spent with patient
Feedback to providers or patients

75. General Patient Eligibility Considerations
Patient is referred for MTM services by a health care provider.
Patient is receiving medications from more than one prescriber.
Patient is on four or more chronic medications.
Patient has at least one chronic disease (e.g., congestive heart failure, diabetes, hypertension.).

76. General Patient Eligibility Considerations
Patient has laboratory values outside the normal range that could be improved with medication therapy.
Patient has demonstrated nonadherence to the medication regimen for more than three months.

77. General Patient Eligibility Considerations
Total monthly cost of medication exceeds $200.
Patient has been discharged from a hospital within 14 days and prescribed a new medication regimen.

78. Pharmaceutical care in community pharmacy

79. Conclusion
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.