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Paradigm shift-.pptx
- 1. Paradigm shift: fromproduct to patient
- 2. How do peoplesee us?
- 3. “Take care ofmedicines”
- 4. “They just countfew tablets”
- 5. “They just weighand measure things”
- 6. “A bunch ofshop-keepers”
- 7. “Not really healthcare practitioners – they’re businessmen”
- 8. “Tell me howand when to use the Medicine”
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- 10. “Do you needa degree to be a pharmacist?” * Acknowledgment to FOTOSEARCH.COM for images
- 11. “What we aspharmacist believe our profession to be determines what it is” Wendell T.Hill,Jr.
- 12. Pharmacist • The professionof pharmacy exists to safeguard the health of the public. • The pharmacist is one who is licensed to prepare and dispense medications, counsel patients, and monitor outcomes pursuant to a prescription from a licensed health professional. • The role of the modern pharmacist evolved • from compounder and dispenser. • to providing medication information and preventing medication-related problems. • to promote RDU
- 13. The Medicines ManagementCycle Decision to prescribe Patient Order entry Review order Supply medicine Supply information Distribute Administer Monitor response Transfer information From Bates et al 1995 Doctors Pharmacists Nurses
- 14. Clinical Pharmacy: AShift in Practice Philosophy and Education From To Drug Product Drug Therapy Pharmacy Bedside Dispenser Caregiver Solo Team Knowledge Information As ordered As best prescribed
- 15. Evolution of thePharmacist’s Role During the twentieth century, the pharmacy profession has evolved through four stages. • Traditional Era • Scientific Era • Clinical Era • Pharmaceutical care Era
- 16. Evolution of thePharmacist’s Role- Traditional Era • Early twentieth century • Formulation and dispensing of drugs from natural sources •Pharmacognosy • The study of the medicinal properties of natural products of animal, plant, and mineral origins •Galenical pharmacy • Techniques for preparing medications
- 17. Scientific Era • Beganafter World War II (1945) • Emergence of the pharmaceutical industry • Drugs made in factories, not apothecary shop • Pharmacy education emphasized sciences •Pharmacology • The scientific study of drugs and their mechanism of action including side effects •Pharmaceutics • Release characteristics of drug dose forms
- 18. Clinical Era • 1975:Millis Report, Pharmacists for the Future • New educational emphasis on clinical (patient-oriented) pharmacy •Pharmacokinetics • the activity of a drug within the body over a period of time; includes absorption, distribution, metabolism, and elimination •Pathophysiology • the study of disease and illnesses affecting the normal function of the body
- 19. Pharmaceutical-Care Era • Pharmaceuticalcare • a philosophy that expanded the pharmacist’s role to include appropriate medication use to achieve positive outcomes with prescribed drug therapy. (1990: Hepler and Strand) • Monitoring response to therapy. • Educating patients and dispensing prescriptions.
- 20. Pharmaceutical Care inHealth Care Primary Focus Knowledge Base Responsibilit y in Drug Use proces Medical Care Diagnosis and Treatment of Patient’s Disease Pathophysiology Prescribing Nursing Care Giving care to the whole patient during treatment Biological, Psycho- social, spiritual and human responses Drug Administration Pharmaceu tical Care Identifying and meeting patients’ drug related needs Pharmacotherapy Identification, prevention and resolution of drug therapy problem
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- 22. Pharmacy Practice • PharmacyPractice is the discipline of pharmacy which involves developing the professional roles of pharmacists. • Areas of pharmacy practice include; •Disease-state management; •Clinical interventions (refusal to dispense a drug, recommendation to change and/or add a drug to a patient's pharmacotherapy, dosage adjustments, etc.)
- 23. • Professional development;Pharmaceutical care; Extemporaneous pharmaceutical compounding. • Communication skills; Health psychology; Patient care; Drug abuse prevention; Prevention of drug interactions; Prevention (or minimization) of adverse events; Incompatibility; Drug discovery and evaluation • Community Pharmacy
- 24. Pharmacy Practice Requirements Patient care Knowledge of drug therapy Knowledge of thedisease Knowledge of laboratory and diagnostic skills Communication skills Patient monitoring skills Physical assessment skills Drug Information Skills Therapeutic planning skills Knowledge of nondrug therapy
- 25. Pharmacy Practice • Allthe services performed by pharmacists practising in hospitals, community pharmacies, nursing homes, home-based care services, clinics and any other setting where medicines are prescribed and used. • The term “clinical” does not necessarily imply an activity implemented in a hospital setting.
- 26. Goals of PharmacyPractice • To promote the correct and appropriate use of medicinal products and devices. • These activities aim at: •maximising the clinical effect of medicines •minimising the risk of treatment-induced adverse events •minimising the expenditures for pharmacological treatments.
- 27. Level of Actionof Clinical Pharmacists • Clinical pharmacy activities may influence the correct use of medicines at three different levels: • Before, • During and • After the prescription is written.
- 28. 1. Before theprescription • Clinical trials • Formularies • Drug information • Drug-related policies
- 29. 2. During theprescription • Counseling activity • Clinical pharmacists can influence the attitudes and priorities of prescribers in their choice of correct treatments. • The clinical pharmacist monitors, detects and prevents Medication related problems • The clinical pharmacist pays special attention to the dosage of drugs which need therapeutic monitoring. • Community pharmacists can also make prescription decisions directly, when over the counter drugs are counselled.
- 30. Medication-related Problems • Untreatedindications. • Improper drug selection. • Sub-therapeutic dosage. • Medication Failure to receive. • Medication Overdose. • Adverse drug reactions. • Drug interactions. • Medication use without indication.
- 31. 3. After theprescription • Counseling. • Preparation of personalised formulation. • Drug use evaluation. • Outcome research. • Pharmacoeconomic studies.
- 32. Activities of ClinicalPharmacists • Consulting: Analysing therapies, advising health care practitioners on the correctness of drug therapy and providing pharmaceutical care to patients both at hospital and at community level. • Selection of drugs: Defining "drug formularies" or "limited lists of drugs" in collaboration with hospital doctors, general practitioners and decision makers. • Drug information: Seeking information and critically evaluating scientific literature; organising information services for both the health care practitioners and the patients.
- 33. Activities of ClinicalPharmacists... • Medication Review: Review medication chart, Review medication history • Attending Rounds • Drug use studies and research: Drug use studies/ pharmacoepidemiology/ outcome research/ pharmacovigilance and vigilance in medicinal devices. • Pharmacokinetics/ therapeutic drug monitoring: Studying the kinetics of drugs and optimising the dosage. • Clinical Trials: Planning, evaluating and participating in clinical trials.
- 34. Activities of ClinicalPharmacists… • Pharmacoeconomics: Using the results of clinical trials and outcome studies to determine cost- effectiveness evaluations. • Clinical Toxicology: Poison information and analytical services and Toxicological risk assessment • Teaching & Training: Pre- and post-graduate teaching and activities to provide training and education programmes for pharmacists and other health care practitioners
- 35. Aims of Pharmaceutical Care Effective drug therapy Safedrug therapy Economic drug therapy Improve quality of life
- 37. Aims of PharmaceuticalCare • Identify actual and potential drug related problems, • Resolve actual drug related problems, • Prevent potential drug related problems.
- 38. Pharmaceutical care planning •Process of work –Collect relevant patient information. –Assess information. –Identify problems. –State desired outcomes. –Prioritise problems. –Develop an action plan for each problem. –Was desired outcome achieved?
- 39. Pharmaceutical Care Activities... •PatientConsultation: discuss expectations and concerns. •Pharmacist’s assessment: identify current or potential drug therapy problems. •Creation of a care plan: establish goals of therapy, action to be taken and outcomes to be monitored. •Communication of that plan: eg; Doctor, nurse other pharmacist, patient, carer.
- 40. Pharmaceutical Care Activities... •Patienteducation and/or referral: provide individualised, current information about drug therapy and how to use; Demonstrate special techniques; refer to doctor or other HCP. •Patient monitoring and follow-up: goals being met.
- 41. Formulary Prescribing protocols Prospective review Clinicalpharmacy Admission medication history Allergy check Drug distribution system Opportunity For Error Administration instructions Clinical Pharmacy Role in Reducing Risks
- 42. Formulary Prescribing protocols Prospective review Clinicalpharmacy Admission medication history Allergy check Drug distribution system Adapted by P.Thornton from J. Reason, 9/01 Opportunity For Error Administration instructions If we are not there…!
- 43. Outcomes of PharmaceuticalCare • The patient receives effective drug therapy - based on the evidence of current medical literature (Evidence based Medicine). • The patient receives safe therapy - based on a knowledge of their individual clinical circumstances.
- 44. Outcomes of PharmaceuticalCare... •The patient receives the most economic therapy - not compromising efficacy or toxicity. •The patient receives drug therapy desired to improve their quality of life.
- 45. Patient Assessment Questions •Does the patient need this drug? • Is this drug the most effective and safe? • Is this dosage the most effective and safe? • If side effects are unavoidable does the patient need additional drug therapy for these side effects? • Will drug administration impair safety or efficacy? • Are there any drug interactions? • Will the patient comply with prescribed regimen?
- 46. Key Responsibilities 1. Actin the interest of patients and seek to provide the best possible health care for the community. • Treat all with courtesy, respect and confidentiality. • Respect patients’ rights to participate in decisions about their care. • Provide information which can be understood. 2. Must ensure that their knowledge, skills and performance are of high quality, up to date, evidence based and relevant. 3. Behave with integrity • adhere to accepted standards of personal and professional conduct
- 47. Summary • Drugs arebeneficial but can also cause harm. • Society needs a gatekeeper who manages the use of drugs. • Pharmacists must adopt a patient focused approach to identifying and resolving drug related issues. • The consultation process and effective communication lies at the heart of achieving this.
- 48. • We havecome a long way, but we are still far from our ideal destination • Pharmacist has a big role in communicating treatment options effectively, honestly, trustingly to the doctor & patient • Currently, it is happening only at the level of the industry to doctor • Negligible post prescription follow up • Neglible pharmacovigilance • This cannot happen without properly trained pharmacists nurtured in the right environment
- 49. • Ethical issuesshould be paramount • India self- sufficient in drug manufacture; but no one cares about effective utilization • Collaboration with developed countries would make a big difference • IT HAS ALREADY MADE A DIFFERENCE! • Bottom line: Legislation alone can change perceptions in India • Medicines are nothing in themselves, if not properly used, but very hands of god, if employed with reason and prudence. (Herophilus, Greek Physician-Approx 300 B.C)
- 50. So remember: Ifyou don’t want to be replaced by a robot, don’t act like one. Find or create the kind of practice site where you will be happy. This strategy is also known as success.
- 53. Industry Opportunities.. Industries • Medical writing& Communication • Clinical Research • Pharmacovigilance • Drug Information and knowledge processing • Patient advisor (Appointed by companies) • Many more….
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- 56. All the bestfor the journey ahead