PHA 5103: Principles of Patient Centered Care Midterm

Notes from Dr. Segal:

 Exam is covering modules 0, 1, 2, and 3.
 Chapter 1 Communication Skills in Pharmacy Practice: 3-5 questions on the
advantages/implications that come from using a patient-centered model and
respond to a situation in which you work toward creating an environment in
which there is shared decision-making with a patient. 
 Module 01 and 02: 15 to 20 questions.  Given a table showing both medical
visits and dates when prescriptions are dispensed for a fictitious patient. You
will be asked to examine the data for certain time periods and to identify
whether a drug therapy problem or drug related morbidity is evident. 
Determine whether a DTP is classified as access, effectiveness or safety (can
be more than one).
o Refer to Post-mortem for Mod01 vignettes.  I will be giving you
straight-forward DTPs. 

Module 0 Reading:
 Pharmacists are accepting increased responsibility in patient care to avoid
adverse effects and reach desired outcomes.
 Pharmacists must participate in activities that enhance patient adherence.
 Patient Centered care depends on trusting relationships, involving patients in
the decision making process, helping patients meet goals that are
understood, and communicating effectively.
 Communication process: establishes relationship between you and patients;
provides exchange of information necessary to assess patient, reach
decisions, implement plan, and evaluate effects of treatment.
 Purpose of relationship between patient and pharmacist/professional is to
achieve mutually understood and agreed upon goals for therapy that
improve patient’s quality of life.
 In patient centered care, pharmacists must be able to: understand all aspects
of the patient’s illness; perceive each patient as a person (unique); build a
therapeutic alliance, and develop self-awareness of how they might influence
patient behavior.
 A large number of prescriptions are written and never filled.
 Mutual agreed upon treatment plans effect unintentional or intentional
modifications of the drug.
 A problem lies in that patients often lack information on what to expect from
treatment and apply their own common sense criteria.
 Pharmacists should encourage patients to share their experiences with
therapy.
o Patients may have unanswered questions, may have
misunderstandings, may experience problems with therapy, may
make their own decisions, and may not reveal key info to you unless
you ask.
  Analysis of medication use process: Pharmacist and other providers
recommend drug treatment; patients and professionals carry out parallel
decision making with sporadic communication; communication may be
incomplete / ineffective.
 Yours and patients’ understandings should be congruent.

Module 0:
 Patient Centered Care: Pharmacist must be able to understand illness of
patient, perceive each patient’s experience as unique, foster an unrestricted
relationship with patients, build a therapeutic alliance with patient to meet
mutually understood goals of therapy, and develop self-awareness of
personal effects on patients.

Module 1:
 Katherine Lastima: patient with moderate asthma on albuterol inhaler. She
was admitted to the hospital after attending a county fair and was
overwhelmed by allergens. She was put on respiratory arrest and died. This
is because her asthma was not controlled properly. She was using too much
of her albuterol and not enough of the corticosteroid (preventer med.) She
was treating the symptoms rather than the disease.
 Drug related problems are America’s 2nd drug problem; the first is addiction
 Objectives of beneficent care: not to inflict harm; to prevent harm; to remove
harm; to promote good
 Adverse drug reactions are between the 4th and 6th leading causes of death.
 5% of hospitalizations result from drug therapy.
 50% of adverse drug therapy outcomes are preventable.
 Preventable drug related morbidities cost about $200 per physician office
visit
 Medication use process:
o 1. Recognize patient problem
o 2. Clinical impression (diagnosis)
o 3. Plan / prescribe medication
o 4. Implement plan (dispense/advise)
 administer/ consume
 Drug Therapy Problem (DTP): a normal part of the process that should be
recognized and resolved
o Problems result from problems related to access, effectiveness and
safety.
o Access: patient is not getting necessary therapy for a valid indication.
o Effectiveness: the drug is not having a desired effect.
o Safety: The drug is having an undesired effect.
 Drug Related Morbidity (DRM): an outcome that is not correctable or
requires significant medical attention.
o Severe, injurious, or disabling problem beyond the normal process.
 o It could include therapy given and therapy that should have been
given but wasn’t.
 Preventable DRM: Preceded by a recognizable drug therapy problem.
o DRM was foreseeable under the circumstances
o Cause of the DTP and resulting DRM was identifiable
o Identified cause of the DTP and resulting DRM was controllable within
the context of therapy

Classification of Drug Therapy Problems

Access Effectiveness Safety
Patient is not receiving a Patient is taking the Patient is taking the
drug for the indication wrong drug ineffective for wrong drug that may
the indication. interact to create an
adverse reaction, side
effect or toxicity
Prescription was not Patient has a drug Adverse reaction or side
ordered interaction that makes the effect to the correct drug
drug ineffective Wrong dose; too much
Patient can’t afford it, Patient is taking the Drug-food interactions or
accept it, or obtain it wrong dose drug-drug interaction
Patient administers the Drug-food interactions Patient is taking drug for
device incorrectly Dispensing error no valid reason
Drug ordered is Problem results from
insufficient drug-lab interaction
Low drug-bioavailability Excess drug bio-
availability

Module 2: make sure to look at charts in lecture and practice assessing them
 Documentation is important for efficiency, coordination, cooperation, and
quality management.
o Documented care can be communicated to other providers
 Problem Oriented Medical Record (POMR): documentation organized
according to a problem list
o Drug therapy problems linked to medical problems
 SOATP: ‘T’ includes therapeutic objectives
o Subjective and objective data: relevant information about a person’s
illness, bodily functions, and psycho-social status
o Assessment: written appraisal of that information for diagnostic/
therapeutic purposes.
o Therapeutic objective: observable event relevant to the assessment (is
the disease controlled/cured?)
o Therapeutic Plan: means to achieve therapeutic objective
 Professional Dialogue: form of active listening; asking questions which
progressively focus discussion to a conclusion
 Consistency in dialogue assesses validity of data
 Asthma deaths are preventable: causes are often delay in seeking medical
care; medication misuse (albuterol vs. steroid) , or inappropriate care
(insufficient corticosteroids)
o Heavy use of the bronchodilators should alert clinicians that it is
necessary to reevaluate the patient’s condition
 Effective drug therapy requires: prescribing, supervision, and facilitation
 Co-therapists (pharmacists) should have a cooperative relationship among
all participants and basic/necessary information about the patient
 Pharmaceutical Care System Process:
(follows SOAP)
1. Record and interpret patient information (what you need to know about
patient)
2. Document therapeutic objectives (what you need to achieve)
3. Evaluate therapeutic plan (drug interactions? affordable? appropriate?)
4. Design monitoring plan (how to monitor; when to see results)
5. Dispense products and advise patient
6. Implement monitoring plan (make sure its documented)
7. Identify possible DTPS
8. Respond to problems
 Make sure to review lecture slides for charts to practice spotting DTPS and
evaluating charts

Module 3:
 Must document everything: if it’s not documented, it didn’t happen.
o Serves as communication between other pharmacists and providers.
Also necessary for billing.
 SOAP: subjective, objective, assessment, plan
 Subjective: chief complaint, past medical history, social history (recreational
drugs and alcohol), family history, allergies, immunizations
 Objective: things that can be measured (BP, pulse, temp, lab values, current
meds). These are not patient-reported
 Assessment: the most important part of the pharmacist’s SOAP note.
Identifies therapeutic goal, drug therapy problem, and therapeutic options
o Indication, effectiveness, safety, convenience/adherence
 Plan: changes to be made based on the assessment.
o Outlines who is responsible for what (patient, pharmacist, other
provider)
o Also plans out monitoring and how and when to follow up
 Documentation should be short, sweet, but complete.
o Organize by condition; most important information goes in
assessment section.
o Follow up!
o Remember that our goals may be different from the patient’s goals.
Recognize that.