Chapter 3

Pharmaceutical Care and Medication Therapy Management

Outcomes:
Discuss the pharmacy profession and the new application of
Pharmaceutical Care and Medication Therapy Management
1.Pharmacy (occupation vs profession):
2.Pharmaceutical Care as reprofessionalization : Drug information,
Decentralized drug distribution, Pharmacology and
Biopharmaceutics

15
3. The Millis report: Pharmacists for future (1975 AACP)
• Development of clinical pharmacy, NAPLEX exam,
enhancing the clinical studies in the pharmacy colleges,
board of pharmaceutical specialties within APHA
4.Pharm.D program.
• 1989 accreditation by ACPE, 2000 eliminating B.Sc. in
pharmacy replaced by Pharm.D
5.Pharmaceutical care in community pharmacies

• Till 1990 Pharm. care provided in hospital only, in 2003 US

congress approved the MTM for high- risk people elderly and
disabled
29 August 2018
people 15
 Pharmaceutical care as re-professionalization

In the late 1950s and 1960s, pharmacists 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.

As it came to be known, 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 the health care team.

PHARMACEUTICAL CARE AND MTM 3

 Hepler has identified three simultaneous trends that served as the basis for
the clinical pharmacy movement:
1. Drug information
2. Drug distribution
3. Teaching and research programs in pharmacology and
Biopharmaceutics

These three currents combined for the first time in the famous 1966 "
Ninth Floor Project" at the university of California-San Francisco, in which
the faculty sought to find a way to train students for a role that did not
previously exist.

PHARMACEUTICAL CARE AND MTM 4

The project began in September 1966 with the following goals:
- To develop a hospital floor-based pharmaceutical service that would
provide maximal patient safety in the utilization of drugs.
- To charge the pharmacist with the responsibility for all phases of drug
distribution, except the administration of medication to the patient.
- To provide an unbiased and easily available source of reliable drug
information (the pharmacist) and to disseminate information according to
the needs of professional personnel.

PHARMACEUTICAL CARE AND MTM 5

- To provide clinical experience for interns and residents and other
qualified pharmacy students in hospital pharmacy.

- To design and conduct studies in cooperation with the physician and

nurse so that a full evaluation may be obtained of institutional pharmacy
service within the framework of the team approach to patient care.

PHARMACEUTICAL CARE AND MTM 6

The 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.

By 1974, the Federal government recognized a clinical role for

pharmacists when it began requiring the pharmacist to conduct monthly
Drug-regimen reviews of patients.

PHARMACEUTICAL CARE AND MTM 7

Thus, 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.

PHARMACEUTICAL CARE AND MTM 8

 Affirmation of the trend: The
Millis Report

In 1975, the American association of colleges of pharmacy commissioned a

study of pharmacy by a 12-member group headed by dr. John Millis. Known
commonly as the Millis commission, the group issued its finding in a 161-
page report called pharmacists for the Future: The Report of the study
Commission on Pharmacy.

PHARMACEUTICAL CARE AND MTM 9

Among the changes in pharmacy and pharmacy education as a direct result of
the Millis Commission were the following :
- Acceleration of development of Clinical sites for pharmacy school faculty.
- Development of a national examination for licensure of pharmacists, now
called the NAPLEX ® (North American Pharmacist Licensure Examination®).
- Increased movement toward making pharmacy a knowledge-based clinical
profession.

PHARMACEUTICAL CARE AND MTM 10

-Creation of a small number of clinical scientist programs in schools of
pharmacy at the doctor of philosophy.

- Creation of a Board of Pharmaceutical Specialties within APhA to

recognize specialty practices in pharmacy and certify individuals in those
specialties.

PHARMACEUTICAL CARE AND MTM 11

PHARMACEUTICAL CARE AND MTM 12
 However, as Hepler has noted, the Millis Report failed to produce a real
shifting in pharmacy dramatically and irreversibly toward its desired goals.

Unlike some previous similar reports in pharmacy or medicine, the Millis

Report did not outline specific changes in pharmacy school curricula or give
a plan for the future.

It provided only external recognition for the advances made by pharmacy

as a clinical profession.

PHARMACEUTICAL CARE AND MTM 13

 Hepler raises the stakes
with pharmaceutical care

The clinical pharmacy movement continued in the 1980s. two new journals
were published: pharmacotherapy was founded in 1981 by Miller, and
Clinical pharmacy, by the American society of hospital pharmacists from
1982 through 1993.

A third textbook in the clinical pharmacy field, pharmacotherapy: A

Pathophysiologic Approach, was first published in 1989.

PHARMACEUTICAL CARE AND MTM 14

Hepler began to conclude that the clinical pharmacy and pharmacotherapy
movement was not the sole answer to pharmacy's problems.

Beginning at the 1985 directions for clinical practice in pharmacy (called

commonly the Hilton Head conference), Hepler explained the notion that
pharmacists had to do more than just try to control the use of drugs.

PHARMACEUTICAL CARE AND MTM 15

Hepler recommended that they had to take responsibility for the care
provided to patients through the clinical use of drugs. In 1987, he first
applied the term pharmaceutical care in describing what he and
colleague Linda Strand called these new self-actualization roles for
pharmacists.

PHARMACEUTICAL CARE AND MTM 16

 Definition of Pharmaceutical Care

Pharmaceutical care is the direct responsible provision of drug therapy for

the purpose of achieving definite outcomes that improve a patient's quality
of life. these outcomes are:
1. Cure of disease
2. Elimination or reduction of a patient's symptoms
3. Arresting or slowing of a disease process
4. Preventing a disease or symptom.

PHARMACEUTICAL CARE AND MTM 17

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

This in turn involves three major functions:

1. Identifying potential and actual drug-related problems
2. Resolving actual drug-related problems
3. Preventing potential drug-related problems.

PHARMACEUTICAL CARE AND MTM 18

Pharmaceutical care is a necessary element of health care, and should be
integrated with other elements. Pharmaceutical care is, however, provided
for the direct benefit of the patient, and the pharmacist is responsible
directly to patient for the quality of that care.

The fundamental relationship in pharmaceutical care is a mutually

beneficial exchange in which the patient grants authority to the provider,
and the provider gives competence and commitment (accepts
responsibility) to the patient.

The fundamental goals, processes, and relationships of pharmaceutical

care exist regardless of practice setting.

PHARMACEUTICAL CARE AND MTM 19

 Making a decision about the entry-level degree

Pharmacy profession struggled and discussed for 40 years as to what the

appropriate entry-level degree for pharmacy should be. Finally, in the
early 1990s, the profession settled on the doctor of pharmacy.

PHARMACEUTICAL CARE AND MTM 20

An increasing number of student pharmacists had been voluntarily seeking
the Pharm.D degree during the 1980s, but many of them did so after
obtaining their baccalaureate degrees and, in many cases, working for a few
years.

Most pharmacy graduates, however, finished with B.S. degrees in

pharmacy. By 1995, the enrollment in PharmD programs would total 9,346
individuals , compared with 24,069 in B.S. degree programs.

PHARMACEUTICAL CARE AND MTM 21

In 1989, the American Council on Pharmaceutical education (now the
Accreditation counsel on pharmacy education), which accredits schools of
pharmacy, announced plans to consider revising its accreditation standards
such that the B.S Pharmacy degree would be eliminated by 2000.

Since many state boards require pharmacists to be graduates of ACPE-

approved programs, this ACPE action essentially eliminated the B.S.
Pharmacy as an entry-level degree for pharmacy practice, replacing it with
the Pharm.D credential.

PHARMACEUTICAL CARE AND MTM 22

In 1997 ACPE finalized the standards for the Pharm D programs.

The Medicare Modernization Act ro MMA Act of 2003 required that MTM
services be provided to high-risk patients with the goals of enhancing
patients' understanding of appropriate drug use, increasing adherence to
medication therapy, and improving the detection of adverse drug events.

PHARMACEUTICAL CARE AND MTM 23

The MTM service model in pharmacy practice includes the following five
core:
- Medication therapy review
- Personal medication record
- Medication-related action plan
- Intervention and/or referral
- Documentation and follow-up

PHARMACEUTICAL CARE AND MTM 24

 Pharmacy : The future belongs to you
Pharmacists are now positioned well to be the drug-therapy experts on the
health care team.

The bold decisions made about the appropriate role for pharmacists and
the entry-level degree have produced formal recognition of pharmacists'
clinical services, and through MTM, many believe that pharmacists in
coming years will spend most of their time in this mode of practice rather
than in the drug preparation duties that dominated in the past.

PHARMACEUTICAL CARE AND MTM 25

Thank you

PHARMACEUTICAL CARE AND MTM 26