There are three steps that are involved in the Pharmacotherapy process which are;
· Patient assessment
· Development of the pharmacotherapy care plan.
· Evaluation of the impact or results of the care plan.
Patient Assessment
· In this step, the focus is on drug therapy problems in which case it is important to assess if the patient’s problem(s) is/are be caused by drug therapy and can be managed by a change in drug therapy
· The following is the list of drug therapy problems that should be identified;
o Inappropriate drug selection
o Need for additional drug therapy
o Unnecessary drug therapy
o Incorrect drug regimen
o Therapeutic duplication
o Drug allergy/adverse drug event
o Drug Interactions
o Medication adherence issues
· Once a drug therapy problem is identified and categorized, it is then necessary to identify the cause of the problem, thereby leading to potential solutions.
· The process of drug therapy problem identification is to assessing the patient’s drug therapy needs and ensuaring appropriateness, effectiveness and safety of medications, and
the patient’s adherence
Pharmacotherapy Care Plan
· The pharmacotherapy care plan is important in order to achieve improved pharmacotherapy outcomes.
· It is the action plan developed from assessment of patient described above
· Each item in the patient’s problem list must be addressed in the care plan, and the care plan should be prioritized in the same way as the problem list.
· The pharmacotherapy care plan has several key components for each problem:
- Current drug regimen
- Drug therapy problems
- Therapy goals, desired endpoints
§ The goals of therapy must be achievable and realistic for the patient.
§ Drug therapy may aim to
• cure a disease;
• reduce or eliminate signs and/or symptoms
• slow or halt the progression of a disease
• prevent a disease
• normalize laboratory values and/or
· assist in the diagnostic process
· Therapeutic recommendations
· Rationale
· Therapeutic alternatives
· Monitoring
- Monitoring helps in determining whether treatment goals and endpoints (achieving positive goals and avoiding negative endpoints) are being reached.
- An effective monitoring plan must be realistic for the patient setting and include
§ specific monitoring parameters (clinical and laboratory/diagnostic test)
§ frequency of monitoring, and
§ When the patient needs to be seen again for follow-up.
· Patient education
Evaluation
· The patient care process involves continuous follow-up.
· As the pharmacotherapy care plan is implemented, the patient’s response to therapy
is monitored, and changes in therapy may be necessary.
· Changes in previous problems or the development of new signs and symptoms will require the assessment process and changes in the pharmacotherapy care plan
· During the Pharmacotherapy process, it is important to consider/review the following factors for optimal therapeutic outcome;
- Patient Dermographics—name, age, etc.
- Chief Complaint—why the patient is seeking help, in the patient’s own words
- History of Present Illness (HPI)—the patient’s story about why they are seeking help
- Past Medical History (PMH)—including all significant illnesses, surgical procedures, injuries
- Family History—age and health of immediate family (parents, siblings, children); for deceased relatives, the age and cause of death are included; any hereditary diseases should be noted
- Social History—may include where the patient is from or lives, ethnicity/race, marital status, number of children, educational background, occupation, diet
- Tobacco/Alcohol/Substance Use
- Allergy/Intolerances/Adverse Drug Events (ADEs)—a common area where information from the patient is missing or incomplete
- Medication History—should include current (or medications prior to admission if hospitalized) and previous medications; the list should include what the patient actually is taking, not just what is prescribed, and must include OTC drugs and dietary supplements (including herbal and complementary/alternative products).
- Signs and symptoms
- Laboratory and Other Diagnostic Tests
- Diagnosis.
- Treatment (Drug) plan
- Follow-up plan
References
Wells BG, DiPiro J, Schwinghammer T (2013), Pharmacotherapy Handbook (6th Ed). New York, NY: McGraw-Hill.
DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey ML, (2008): Pharmacotherapy: A Pathophysiologic Approach (7th ed): New York, NY: McGraw-Hill.
Katz M D., Matthias KR., Chisholm-Burns M A., Pharmacotherapy(2011) Principles & Practice Study Guide: A Case-Based Care Plan Approach: New York, NY: McGraw-Hill.
Schwinghammer TL, Koehler JM (2009) Pharmacotherapy Casebook: A Patient-Focused Approach (7th ed): New York, NY: McGraw-Hill.
