Dear Bloggers, after a first blog relating to the Old and New Concept of Pharmacy through its origin, let us move forward with a concept that most of health care providers always use but sometimes ignore its fullness in terms of Goals, Classification and Challenges. This Concept is Pharmaceutical Care or simply Pharmacare.

Pharmaceutical care (PharmaCare) is a ground-breaking concept in the practice of pharmacy which emerged in the mid-1970s. Possibly the earliest published use of the term pharmaceutical care was by Brodie in the context of thoughts about drug use control and medication-related services. ^{[1, 2]} It is a term that has been widely used and a concept about which much has been written and discussed in the pharmacy profession, especially since the publication of a paper by Hepler and Strand in 1990. ^[3-5]

Pharmaceutical care represents an exciting new vision for pharmacy.

Many pharmacists have expressed enthusiasm for the concept of pharmaceutical care, but there has been substantial inconsistency in its description. Some have characterized it as merely a new name for clinical pharmacy; others have described it as anything that pharmacists do that may lead to beneficial results for patients.

Pharmaceutical Care is the responsible provision of pharmaco-therapy for the purpose of achieving definite outcomes that improve or maintain a patient's quality of life. On behalf of the patient and related into the Pharmacare, four major functions are deeply involved : (1) identifying potential and actual drug-related problems, (2) resolving actual drug related problems, (3) preventing potential drug-related problems, and (4) optimizing patient therapy outcomes. It is recognized that the patient might be best served if medication is not provided. Pharmaceutical care requires a direct relationship between a pharmacist and an individual patient

From various definitions stated above, we can clearly notice that Pharmacare is not only related to Clinical Pharmacy but extends its definition to various disciplines where the Patient's Health is at the Center of the Care given. Pharmacare can be delivered in different clinical settings in different clinical cultures by different teams of pharmacists, technicians, doctors and nurses. Pharmaceutical care can therefore be understood as a quality assurance system based on improved teamwork and improved systems for providing drug treatment. It encompasses a variety of services and functions - some new to pharmacy, others traditional - which are determined and provided by pharmacists serving individual patients. The concept of pharmaceutical care also includes emotional commitment to the welfare of patients as individuals who require and deserve pharmacist's compassion, concern and trust. ^[6]

Pharmaceutical care as a concept brings together the idea that pharmacists must develop their own personal practice as well as improve the systems that enable cooperation with other professions. ^[7] That requires changes in the form of pharmacy practice and creation of a multidisciplinary system focused on achieving better patient outcomes by attention to the quality of the processes in drug therapy provision. ^[8-10]

Hepler and Strand ^[11] defined Pharmaceutical Care as "The responsible provision of drug therapy for the purposes of achieving definite outcomes that improve a patient's quality of life"

The Pharmaceutical Care Issues can be classified in several categories and sometimes, problems may result in more than one pharmaceutical Care Issue. Below is the classification of these Pharmacare issues.

Classification of pharmaceutical Care Issues ^[12]

1. Adverse Drug Reaction (ADR)

2. Drug Interaction

3. Drug or Dose Selection

4. Compliance/Concordance Issues

5. Education

6. Repeat Prescribing

7. Indications

8. Monitoring Issues

9. Duplication of Therapy

10. Potential Drug-Disease Interaction

11. Out of Date Medicine

12. Duration of Therapy

American Society of Health System Pharmacists (ASHP) believes that pharmaceutical care is an important new concept that represents growth in the profession beyond clinical pharmacy as often practiced and beyond other activities of pharmacists, including medication preparation and dispensing.

Pharmaceutical care is therefore a description of what the patient should receive and not what the pharmacist does.

Challenges of pharmacists for provision of pharmaceutical care

Pharmaceutical care has been accepted and adopted across countries

The provision of pharmaceutical care is not limited to pharmacists in inpatient, outpatient, or community settings, or to pharmacists with certain degrees, specialty certifications, residencies, or other credentials. It is not limited to those in academic or teaching settings. Pharmaceutical care is not a matter of formal credentials or place of work. Rather, it is a matter of a direct personal, professional, responsible relationship with a patient to ensure that the patient's use of medication is optimal and leads to improvements in the patient's quality of life.

Barriers related to providing pharmaceutical care reported by community pharmacists around the world included a lack of funds, difficulty in accessing patient's clinical and laboratory data, lack of clinical knowledge and motivation, lack of time and a private counseling area, little financial incentive, and low expectation of the pharmacy profession ^[13-15].

References

[1] Brodie DC. Is pharmaceutical education prepared to lead its profession? The Ninth Annual Rho Chi Lecture. Rep Rho Chi. 1973; 39:6-12.

[2] Brodie DC, Parish PA, Poston JW. Societal needs for drugs and drug-related services. Am J Pharm Educ. 1980; 44:276-8.

[3] Hepler CD, Strand LM. Opportunities and responsibilities in pharmaceutical care. Am J Hosp Pharm. 1990; 47:533-43.

[4] Penna RP. Pharmaceutical care: pharmacy's mission for the 1990s. Am J Hosp Pharm. 1990; 47:543-9.

[5] Pierpaoli PG, Hethcox JM. Pharmaceutical care: new management and leadership imperatives. Top Hosp Pharm Manage. 1992; 12:1-18.

[6] Bolton-Maggs P, Brook L. The use of vitamin K for reversal of over-warfarinization in children. Br J Haematol 2002; 118:924.

[7] Krska J, D Jamieson, Arris F, et Al. A classification system for issues identified in pharmaceutical care practice. Int J Pharm Pract, June 2002; 10(2):91-100.

[8] Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice. New York: McGraw Hill, 2005.

[9] American Society of Heath Systems Pharmacists. ASHP Statement on Pharmaceutical Care. Am J Hosp Pharm 1993; 50: 1720-1723.

[10] UK Clinical Pharmacy Association. Statement on Pharmaceutical Care. The Pharmaceutical Journal 1996; 256: 345-46.

[11] American Society of Health System Pharmacists. ASHP Guidelines on Standardized Method for Pharmaceutical Care. 1996; 53: 1713-6.

[12] Wiedenmayer K, Summers RS, Mackie CA, Gous AGS, Everard M, Tromp D. Developing pharmacy practice - A focus on patient care. World Health organization. International Pharmaceutical Federation 2006.

[13] K.B. Farris, F. Fernanadez-Llimos, and S. Benrimoj. Pharmaceutical care in community pharmacies: practice and research around the world, Ann. Pharmacother. 2005;39: 1539-1541

[14] C. Rossing, E.H. Hansen, and I. Krass. Barriers and facilitators in pharmaceutical care: perceptions and experiences among Danish community pharmacists, J. Soc. Adm. Pharm. 2001;19: 55-64

[15] H.M. Bell, J.C. McElnary, and C.M. Hughes. A quantitative investigation of the attitudes and opinion of community pharmacists to pharmaceutical care, J. Soc. Adm. Pharm. 1998;15: 284-295