Patient Care Process

INTRODUCTION

• The patient care process is a fundamental series of actions that

guide the activities of health professionals (HP).
• Joint Commission for Pharmacy Practitioners (JCPP)—endorsed
a framework for providing patient care services called
Pharmacist’s Patient Care Process.
• Medicine, nursing, and dentistry all follow a similar process of
care.
• Although it is similar, each health profession brings a unique set
of knowledge, skills, attitudes, and values to the patient.
• A practice requires 3 essential elements

• HP have an ethical obligation to the health and well-being of the

patients they serve.
• The patient care process

• In addition, a patient-centered approach to decision making is essential.

• Also requires collaboration—working with other health professionals to
develop and implement plan of care.
• Each step of the process must be documented.
• A practice also have a practice management system that
supports the effective delivery of services.
• This includes the infrastructure—the physical, financial, and
human resources—as well as policies and procedures to carry
out the patient care work.
• To achieve its mission, a practice must implement quality
improvement methods that measure, evaluate, and improve the
actions of practitioners (individually) and the practice
(collectively).
 PATIENT CARE PROCESS TO OPTIMIZE
PHARMACOTHERAPY

• There are two aspects that differentiate a profession-specific process

of care.
• First, application of the care process based on the profession’s
knowledge and expertise.
• For pharmacy, the care process is focused on a patient’s medication
related needs and medication therapy.
• Dentists focuses on a patient’s oral health.
• Second, the manner in which patient-specific information is assessed.
• When assessing information of a patient (HPI, PE, LD), physicians
employ differential diagnosis of one disease vs other diseases.
• For pharmacists assessment involves a systematic examination of the
indication, effectiveness, safety, and adherence.
 Collect Information
• Collection of the necessary information about the patient and
analyzing data to understand medical needs, medication-
related problems, and clinical status.
• In some cases, this information is directly collected by
interviewing the patient or reviewing a medical record.
• In other cases, the practitioner may rely on other personnel to
collect the information.
• This may include a BP determined by a clinical assistant or a
list of medications recorded by a nurse.
• This information is critical to the practitioner to complete an
assessment that will appropriately address all of a patient’s
medication-related needs (see Table 1-2).
Collect Patient-Specific Information
 Assess Information and Formulate a Medication Therapy
Problem List
• Assessment is organized into patient’s medical problems list
and medication therapy problems list.
• Once identified, problems are prioritized to make decisions
regarding the patient’s medication.
• Review that each current medication is indicated (or
necessary) for the condition and each condition that requires
drug therapy is being appropriately treated.
• Then determine whether each medication is effective,
achieving the intended outcome.
• Next, consider the safety of each medication, assuring that the
patient is not being exposed to AE or an unintended
interaction.
• Finally, evaluate each medication for adherence-related
concerns.
• Throughout the assessment process, keep the patient’s goals
for therapy at the forefront of their decision making.
• Table 1-3 outlines the assessment process.
Patient-Specific Information to Determine Health-Related Needs
• There are 10 medication therapy problem categories.
• The greatest frequency are “needs additional therapy” and
“dose too low,” followed by “adherence.”
Medication Therapy Problem Categories Framework
 Develop the Care Plan
• The plan should be developed in collaboration with patient or
caregiver to meet the patient’s expectations and priorities.
• Also in collaboration with other HCP to agree and support the
plan.
• The care plan include goals of therapy to adjust medications,
doses, or delivery, as well as monitoring parameters.
• The steps for developing a patient-centered care plan are
outlined in Table 1-5.
Develop the Care Plan
 Implement the Care Plan
• Implement the plan designed to prevent and resolve
medication therapy problems.
• The care plan will likely include activities that the patient and
other healthcare providers will be responsible for (Table 1-6).
• Practitioners will employ strategies such as patient education,
motivational interviewing techniques, tools that support
medication adherence, and patient self-monitoring
technologies.
Implement the Care Plan
 Follow-up with the Patient
• Monitoring and follow-up to evaluate the effectiveness and
safety of the plan are essential.
• As needed the plan should be modified in collaboration with
other HCP and the patient or caregiver.
• It is the responsibility of the practitioner to determine the
outcome of drug therapy.
• Follow-up process can occur through face-to-face encounters,
phone calls, electronic health record messaging, and
telehealth technologies (Table 1-7).
Follow-up with the Patient
• A practitioner practicing in an acute care environment will
transfer responsibility for follow-up to other providers,
including another pharmacist, when the patient transitions to
another setting.
• In the ambulatory care setting, a practitioner should ensure
that a patient has a comprehensive evaluation of their
medications and health status annually, at a minimum.
• In some cases, medication therapy problems may be resolved
which the patient no longer requires ongoing monitoring.
 ENVIRONMENTAL ISSUES

• The third critical element of practice is a practice management

system.
• In today’s healthcare environment, there are several aspects of
managing a practice that practitioners must consider:
 Quality Metrics
• To determine quality, there must be a standard to measure the
level of quality against.
• The patient care process sets a standard by defining the
parameters of the process that can be measured.
• It is critical to objectively measure the impact a patient care
service has on a patient’s health and well-being.
• The standard process gives pharmacists an opportunity to show
value on a large scale.
 Workflow, Documentation, and Information Systems
• Analysis of data regarding the care provided and the resulting
health outcomes are important for organizations and individual
providers.
• Healthcare systems are embracing the technology to analyze
information.
• This technology is only useful if clinical care is documented,
collected, and managed.
• Data is collected as part of the workflow process using IT tools.
• The practitioner often has some patient information available
before the encounter; however, the practitioner will likely collect
new information.
• This work can now electronically be captured in the collect phase
of the workflow.
• The practitioner will then assess the information and identify
new or unresolved medication-related problems.
• The practitioner will then update or add to the care plan for the
patient.
• The practitioner may implement some or all of the plan.
• During the follow-up and monitoring phase, the resolution of
identified problems and the response to treatment are
documented.
 Documentation, Attribution, and Payment
• Payment to healthcare providers for patient care services in the
US has traditionally been based on the documentation and
reporting of standard processes of care.
• Using a standard care process accompanied with a standard
documentation will result in:
✓efficiencies of practice
✓enable appropriate and accurate billing,
✓facilitate the attribution of care to desired patient outcomes
needed in value based payment models.