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Creating consistent patient care delivery

SPM: Pharmacists' Patient Care Process

Burns




Derr

Recognizing the need for a consistent process in the delivery of patient care across the profession, the Joint Commission of Pharmacy Practitioners (JCPP) recently released the Pharmacists’ Patient Care Process. The process is applicable to any practice setting where pharmacists provide patient care and for any patient care service that pharmacists provide. This article describes how the Pharmacists’ Patient Care Process came to be, what the process is, and how students pharmacists can become involved with this process.

The foundation

JCPP’s vision statement for the profession and strategic plan for reaching this vision were revised in July 2013 as part of a strategic planning retreat that included thought leaders from inside and outside the profession. The newly adopted vision, “Patients achieve optimal health and medication outcomes with pharmacists as essential and accountable providers within patient-centered, team-based health care,” reflects a patient-centered focus and pharmacist accountability for patient outcomes as a member of the health care team.

The updated JCPP strategic plan identifies the need for the implementation of a consistent and widely-adopted pharmacist patient care process, quality measures to measure the value of pharmacists’ services, robust health information technology to support patient care, and payment for pharmacists’ services as key drivers to achieving JCPP’s vision for the profession.

The need for pharmacists to use a consistent approach to patient care has always been important. However, with the increasing movement to outcomes-based payment models, this need is becoming more urgent. Payment models are starting to emerge where health care professionals are paid for achieving desired outcomes for their patients (e.g. patients’ blood pressure at goal) instead of by the number of patient visits they complete. To measure the outcomes of pharmacists’ services in meaningful way, a consistent process of care must be used to deliver the services. That way an apples to apples comparison can be made for the collective value that pharmacists provide within the health care system.

The  Pharmacists’ Patient Care Process was developed by a group of national pharmacy organizations working under the direction of JCPP. The foundation for the process is embedded within the pharmaceutical care model developed by Hepler and Strand in the 1990s and was developed by examining a number of key source documents on pharmaceutical care and medication therapy management. These key documents were cataloged and compared to create a patient care process consistent with best practice models in pharmacy. The development process included organizational comment periods and testing with clinicians to create the document approved by JCPP on May 29.

What is the  Pharmacists’ Patient Care Process?

The  Pharmacists’ Patient Care Process uses a patient-centered approach that depends first and foremost on the pharmacist having an established relationship with the patient. This relationship supports engagement and effective communication with the patient, family, and caregivers throughout the process. The process also involves the pharmacist working with prescribers and other practitioners to optimize patient health and medication outcomes (see sidebar on page 9).

The follow-up step signals that patient care process is repeated with each and every patient encounter. The level of intensity for each step will vary with the service provided, but the process should not vary. For example, the amount of time to complete the process for an immunization is different than providing a comprehensive medication review for a complex patient.

Student involvement

The Accreditation Council for Pharmacy Education (ACPE) has incorporated the Pharmacists’ Patient Care Process in the Draft Standards 2016 revision for the Doctor of Pharmacy curriculum, and national pharmacy associations are currently working to facilitate implementation of the process across the profession. With the ACPE Standards revision, schools and colleges of pharmacy will be working to incorporate the process into the curriculum.

Student pharmacists can  play an important role in the adoption of this process, starting today! Start by familiarizing yourself here. Talk to your professors and your preceptors on your IPPEs, APPEs, and at your internships. Ask the preceptor if this is the process currently used in their practice or if they would like to see this used in the future. While on rotation and throughout your internship, practice using this process in all of your patient encounters. Reflect upon how well you used the process and how effectively the process facilitated patient care. By practicing as a student, you will be able to better use the process as a practitioner.

The most important steps you can take are to understand this process by asking questions and to provide patient care using the process during your experiential training. By gaining expertise as a student, you will prepare yourself to deliver quality patient care and also advance the profession as a whole in  this evolving health system.


Pharmacists’ Patient Care Process

Using principles of evidence-based practice, pharmacists:

A. Collect

The pharmacist assures the collection of necessary subjective and objective information about the patient in order to understand the relevant medical/medication history and clinical status of the patient. Information may be gathered and verified from multiple sources, including existing patient records, the patient, and other health care professionals. This process includes collecting:

  • A current medication list and medication use history for prescription and nonprescription medications, herbal products, and other dietary supplements.
  • Relevant health data that may include medical history, health and wellness information, biometric test results, and physical assessment findings.
  • Patient lifestyle habits, preferences and beliefs, health and functional goals, and socioeconomic factors that affect access to medications and other aspects of care.
B. Assess

The pharmacist assesses the information collected and analyzes the clinical effects of the patient’s therapy in the context of the patient’s overall health goals in order to identify and prioritize problems and achieve optimal care. This process includes assessing:

  • Each medication for appropriateness, effectiveness, safety, and patient adherence.
  • Health and functional status, risk factors, health data, cultural factors, health literacy, and access to  medications or other aspects of care.
  • Immunization status and the need for preventive care and other health care services, where appropriate.
C. Plan

The pharmacist develops an individualized patient-centered care plan in collaboration with other health care professionals and the patient or caregiver that is evidence-based and cost effective. This process includes establishing a care plan that:

  • Addresses medication-related problems and optimizes medication therapy.
  • Sets goals of therapy for achieving clinical outcomes in the context of the patient’s overall health care goals and access to care.
  • Engages the patient through education, empowerment, and self-management.
  • Supports care continuity, including follow-up and transitions of care as appropriate.
D. Implement

The pharmacist implements the care plan in collaboration with other health care professionals and the patient or caregiver. During the process of implementing the care plan, the pharmacist:

  • Addresses medication- and health-related problems and engages in preventive care strategies, including vaccine administration.
  • Initiates, modifies, discontinues, or administers medication therapy as authorized.
  • Provides education and self-management training to the patient or caregiver.
  • Contributes to coordination of care, including the referral or transition of the patient to another health care professional.
  • Schedules follow-up care as needed to achieve goals of therapy.
E. Follow-up: Monitor and Evaluate

The pharmacist monitors and evaluates the effectiveness of the care plan and modifies the plan in collaboration with other health care professionals and the patient or caregiver as needed. This process includes the continuous monitoring and evaluation of:

  • Medication appropriateness, effectiveness, and safety and patient adherence through available health data, biometric test results, and patient feedback.
  • Clinical endpoints that contribute to the patient’s overall health.
  • Outcomes of care including progress toward or the achievement of goals of therapy. 

The Joint Commission of Pharmacy Practitioners (JCPP) includes the following organizations: Academy of Managed Care Pharmacy, Accreditation Council for Pharmacy Education, American Association of Colleges of Pharmacy, American College of Apothecaries, American College of Clinical Pharmacy, American Pharmacists Association, American Society of Consultant Pharmacists, American Society of Health-System Pharmacists, National Association of Boards of Pharmacy, National Alliance of State Pharmacy Associations, and National Community Pharmacists Association. 

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