third PHARMACEUTICAL CARE PRACTICE THE PATIENT-CENTERED APPROACH TO MEDICATION MANAGEMENT SERVICES Robert J. Cipolle, PharmD Professor Emeritus Linda M. Strand, PharmD, PhD, DSc (Hon) Professor Peter C. Morley, PhD Professor University of Minnesota Minneapolis, Minnesota Gravi/ New York Chicago San Francisco Madrid Milan San Juan Seoul Sydney Toronto
Contents Contributors About the Authors xv xix..... xxiii xxv CHAPTER ONE MEDICATION 1 Medication Management Services A 2 Approaches to Medication 6 The.... 7 The Approach... Taking Responsibiliry for Medication 10 The Need for Medication 12 Changes in Medications and How...... 1 2 of to Drug-related Solutions at Solutions at the Institutional, or Professional Levels......... 20 Solutions at the 22 Patients Most 23 the Data Reveal -... - 23 The Business 25 Initiating This Service in Practice....... The of Medication 26 The Clinical Value to the Patient 27 The Economic Value to the Health..... 27 Structures for Delivering Medication 28 The Ambulatory Setting... 29 Medication Management Services in and the Gare Medication Management Services in Medication Management Services in Medication Management Services in Assisted Living, Mental Health and 33 Summary -.........
viii Contents CHAPTER CARE AS THE PROFESSIONAL PRACTICE FOR PATIENT-CENTERED MEDICATION MANAGEMENT SERVICES 37 The Need for a Professional Practice 39 of All Professional Pracrices 40 Components of a Professional Practice 43 Pharmaceutical Care as a Professional Practice 45 The Philosophy of Practice 45 Statement of Social Need 46 Description of the Practitioner Expectations to be Need to Function in a Caring Paradigm 47 The Patient Care Process 48 The Foundation of the Patient Care Process: The Pharmacotherapy Workup 48 The Steps of the Patient Care Process 49 The Practice Management System 57 The Language and Vocabulary of Practice 58 Pharmaceutical Care as a Generalist Practice 61 Generalist Practitioner 62 Pharmaceutical Care as Health Care 63 Care Defined 64 Medication Management Services in the Medical Home 67 Origins of Pharmaceutical Care Practice 67 Pharmaceutical Care as the New Paradigm 68 I he Practice of Pharmaceutical Care Emerges 70 71 CHAPTER THREE TOWARD A PHILOSOPHY OF PHARMACEUTICAL CARE PRACTICE 73 A Philosophy of Practice Defined 75 The Philosophy of Pharmaceutical Care Practice 77 Meeting a Social Need 77 Fulfilling Specific Responsibilities 78 Ehe Patient-centered Approach 79 Caring as a Practice Paradigm 80 Caring as Covenant 83 The Values Involved in 85 Values to Ethics 86 Ethics in Practice 87
Professional Responsibiliry Expressed as the Standards Contents ix for Professional Behavior 94 Standard 1: Quality of Care 96 Standard Ethics 96 Standard III: Collegiality 97 Standard IV: 97 Standard V: Education 98 Standard VI: Research 98 Standard VII: Resource Allocation 99 CHAPTER FOUR PATIENT-CENTEREDNESS IN PHARMACEUTICAL CARE 103 Patient-Centeredness 104 Understanding the Patient's Concept of Illness 106 The Patient's Medication Experience 109 Understanding the Patient's Medication Experience in Practice Utilizing the Patient's Medication Experience to Optimize Therapeuric The Practitioner and the Patient form a The Therapcutic Relationship Defined 1 The of Therapcutic Relationship 1 19 The Patient as the Primary of Information 1 20 The Patient as Decision Maker 121 The Patient as Teacher The Patient's Rights 122 the Patient Can Expect 1 22 The Patient's Responsibilities 125 Adherence as a Test of Patient-Centeredness 126 Defining Adherence Medication Management as a Solution to Nonadherence Adherence Assessed Last, Not First 129 Patient-centered Adherence Patient Participation in Achieving Adherence Patient-centered Adherence Summary CHAPTER DRUG THERAPY PROBLEMS Drug Therapy Problems: Terminology 143 Components of a Drug Therapy Problem 144
x Contents and Common Causes of Drug Therapy Problems 149 Patient Data Drug Therapy Problem 1: Unnecessary Drug Therapy 156 Drug Therapy Problem 2: Needs Drug Therapy 158 Drug Therapy Problem 3: Ineffective Drug 161 Drug Therapy Problem 4: Dosage Too Low 163 Drug Therapy Problem 5: Adverse Drug Reaction 166 Drug Therapy Problem 6: Dosage Too High 168 Drug Therapy Problem 7: Adherence (Noncompliance) 169 Drug Interactions 175 Drug Therapy Problems 175 Drug Therapy Problems 178 Patients With No Drug Therapy Problems 179 Documenting Drug Therapy Problems 180 Summary 181 CHAPTER THE ASSESSMENT 183 Purpose, Activities, and Responsibilities 184 Standard of Care 1: Collection of Information 187 Meeting the Patient 188 Introducing Yourself. 189 The Physical Environment 189 Taking Notes 190 Eliciting Information the Patient 191 Started 192 Reason for the 193 Patient Demographics 195 Understanding the Patient's Medication Experience 198 Patient Data Other Clinical Information 211 The Pharmacotherapy 214 Standard of Care 2: Assessment of Drug-related Needs 217 Managing Medications: Assessing the Appropriateness of the Indication for the Patient's Drug Therapy 218 Managing Medications: Determining the Effectiveness of the Drug Regimen 221 Managing Medications: Establishing the of the Drug Regimen 223 Understanding Patient Adherence (Compliance) 224 Patient Data 225 Drug Therapy Problem 230 Standards of Care 3: Identification of Drug Therapy Problems 231 Documenting the Assessment 232 Summary 235
Contents xi CHAPTER SEVEN THE CARE PLAN 237 Purpose, and Responsibilities 238 Standard of 4: Development of Goals of Therapy 239 Establishing Goals of Therapy Interventions 249 Patient Data 249 Health Care Savings and Standard of Care 5: Statement of Interventions 254 Interventions to Resolve Drug Therapy Problems 255 Interventions to Achieve Goals of Therapy 256 Interventions to Prevent Problems 257 Therapeutic Alternatives 258 Cost Considerations 259 Schedule and Plan for 259 Standard of Care 6: Establishing a Schedule for Evaluations 260 of Follow-up Evaluations 261 Documenting the Care Plan 262 Summary 263 CHAPTER FOLLOW-UP EVALUATION 265 Introduction 266 Purpose, Activities, and Responsibilities 267 Standard of Care 7: Follow-up Evaluation 267 Evaluating Effectiveness of Drug 270 Clinical Parameters: in Patient Signs and Symptoms 270 Laboratory Parameters: Improvement in Laboratory Test Results Evaluating the Safety of Drug Therapies 273 Clinical Parameters: Patient Signs and Symptoms as Evidence of Drug Safery Problems 275 Laboratory Parameters: in Laboratory Test Results as Evidence of Drug Safery Problems 275 Patient Data: 277 the Clinical Outcome Status 280 Outcome Status Terminology 280 Patient Data: Outcomes 289 Patient Outcome Versus Practitioner Output 290 Assessment for New Drug Therapy Problems 291 Schedule for Continuous Follow-up Evaluations 292 Documenting the Follow-up Evaluation 292 Summary 293
xii Contents CHAPTER DOCUMENTATION PRACTICE 295 Introduction 296 The Electronic Therapeutic Record 297 Justification for the Electronic Therapeutic Record 300 The Content of the Patient's Electronic Therapeutic Record 301 Integrating the Patient's Electronic Therapeutic Record Other Patient Care Providers 302 The Patient's Personalized Care Plan 303 The Content of the Patient's Personalized Care Plan 304 Needs 305 Summary of All of Your Medications 305 Information for Each of the Medications and Instructions 307 New 308 Physician Reports 308 Practice Management Reports The Content Required to Generare Management Reports 312 Software Programs for the Documentation of Medication Management Services 313 Evaluating Software for Use in Practice 314 Meaningful Use for Health Information Technology 316 Guidelines for Documenting Pharmaceutical Care 321 Summary 323 CHAPTER TEN ACQUIRING AND APPLYING THE KNOWLEDGE AND CLINICAL SKILLS REQUIRED TO MANAGE DRUG THERAPY 325 Acquiring the Knowledge Needed to Practice 327 with You Need to Know 328 Understanding the Important 330 Knowledge You Need About the Patient 330 Knowledge You Need About the Patient's Medical Conditions 331 Common Conditions are Common 332 Knowledge You Need About the Patient's Drug Therapies 336 Organizing Information 342 National Guidelines 342 The Use in Pharmaceutical Care Practice 343 Clinical Trials 344 Use of the Pharmacotherapy as a Conceptual Framework to Organize Knowledge in Practice 346 Common Drugs are Common 347 Acquiring the Clinical Skills You Need to Practice 354 Obtaining Clinical Information Your Patient 356 Observational Skills 356 Assessment Interview Skills 358
Contents xiii Physical Assessment Skills Information 362 Skills 365 Communication 365 Practitioner-focused Communication 368 Learning to be in Practice 370 Presenting Patient Cases: The Pharmacotherapy Patient Gase Presentation Format 371 Need for a Specific Format 373 Your First Case Presentation 376 Assessment of the Patient's Drug-related Needs 378 Brief Description of the Patient 378 Reason for the Patient Encounter 378 Medication Experience Reported by the Patient 379 Comprehensive Medication History 380 Current Medication Record: Product-Dosage Regimen-Outcome Past Medical History and Associated Drug Therapies 383 Review of Systems 384 Summary of the Assessment 384 Drug Therapy Problem Identification 385 and Effect 385 Plan 386 Follow-up Evaluation 387 Summary of the Case 388 Common in the Case Presentation 388 Case Summaries 389 Example of a Pharmacotherapy Presentation.389 Summary CHAPTER ELEVEN MANAGING MEDICATION MANAGEMENT SERVICES 395 Understanding the Practice Management System 396 Introduction 396 Establishing a Successful Practice.398 Prepare Yourself 400 a Compctcnt Practitioner 400 and Describe Your Service and the Mission of Your Practice Focus on Your Patient 40.3 Select a Supportive Environment 405 Understand the Resources You Will to Successful 406 the Organization So 1t Can Help 406 Understanding the Demands of a Financially Practice 409 the Costs of Doing Business 409
xiv Contents Building a Revenue Base 412 Realize the Rewards 414 Payment Mechanisms 414 The Capitation Method 417 Resource-based Relative Value Scale System 417 Professional 425 the Business Plan 426 Started 430 Summary 432 CHAPTER THE GLOBAL PERSPECTIVE 435 Introduction 435 Australia 445 New Zealand 461 China 478 Korea 487 496 Arabic-speaking Middle East 508 Germany 525 The Netherlands 542 Spain 556 Iceland and Scandinavia 566 United Kingdom 581 Brazil 596 610 United States 627 Summary: Future Prospects 645 APPENDIX 1 STANDARDS OF PRACTICE FOR PHARMACEUTICAL CARE 647 APPENDIX 2 GLOSSARY 655 APPENDIX 3 PHARMACOTHERAPY WORKUP NOTES 671 683