Pharmacists' Patient Care Process (PPCP)

What are the five components of the PPCP?

Collect, Asses, Plan, Implement, Follow Up: Monitor and Evaluate

Collect

necessary subjective and objective information about the patient to understand the relevant medical and medication history, overall health status, and other pertinent factors

What aspects are included in the collect component?

- Health concerns

- Beliefs and preferences

- Social determinants of health

- Medication list

- Physical assessment findings

- Medical history

- Lifestyle habits

- Demographics

What are the two types of information collected?

subjective and objective information

What is the chief complaint (CC)?

- Statement of why the patient has presented

- Recorded in patient's own words

- Ask: "What can I do for you today?" or "What brings you here today?"

What does SCHOLAR-MAC stand for?

- Symptoms, Characteristics, History, Onset, Location, Aggravating factors, Remitting factors

- Medications, Allergies, Conditions

What is entailed in past medical history (PMH)?

Past diagnosis, hospitalizations, surgeries, accidents or injuries

What is history of present illness (HPI)?

symptoms, characteristics, history, onset, location, aggravating factors, remitting factors

Medication History and Allergies

- Current medication list (as patient states it): prescription, nonprescription, herbal products and other dietary supplements

- Allergies (as the patient states it) --> along with the reaction

What is included in a current medication list?

- Name of drug

- Dosage: strength of the medication

- Dosing schedule: how often the medication is taken

- Route of administration

- Duration

- Indication

- Outcome: clinical goal of taking the medication

- Previous medications used

What is included in medication experience?

- General attitude toward taking medication

- Patient wants/expectations from drug therapy

- Concerns about drug therapy

- Understanding of medications

- Cultural, religious, or ethical issues influencing willingness to take medications

- Medication-taking behavior

What are examples of objective information?

Vitals, labs/diagnostic tests, physical exam findings, current meds (per chart), refill records, immunization records, history documented in medical records, drug information

How to organize and interpret information?

- Filter information: include only data pertinent to current problems/visits

- Organize information: subjective vs. objective

- Analyze data: validity, accuracy, and consistency; normal vs. abnormal

- Synthesize data: connect and relate data; interpret relationships

Assess

collected information to identify and prioritize patient needs to inform the establishment of a care plan

What aspects are included in the assess component?

Medication evaluation, diagnosing consistent with scope, health literacy, risk factors, prevention care and wellness needs

What should b assessed to determine the appropriateness of a patient's medications?

Drug related need and drug therapy problem

Drug related need includes

- indication and appropriateness

- effectiveness

- safety, interactions and tolerability

- adherence, convenience, cost and access

Drug therapy problem includes:

- Unnecessary drug therapy (indication)

- Needs additional drug therapy (indication)

- Ineffective drug (effectiveness)

- Dose too low (effectiveness)

- Dose too high (safety)

- Adverse drug reaction (safety)

- Non-adherence

Inquiry

- determine what patient wants/needs from you

- open-ended questions

Listening

- allow full responses

- identify what is important to patient

Observational Skills

- physical assessment

- non-verbal communication

Pharmacotherapy Knowledge

- pharmD curriculum

- licensure

- continuing education

- board certification

- others

Organization

- structure to assessment

- logical

- systematic

- comprehensive

- flexible to flow of patient

Influence of patient characteristics

- Context for ALL clinical activities

- Describe patient at time of assessment

- Relevant to making drug therapy decisions

- How patient makes decisions about medications

- Treat as a unique individual

Analyzing information includes what?

- What to do with information that's been collected

- First step in assessment

- Basic approaches: identify abnormal labs, analyze medications, know guideline-based goals for disease states

Indication

active medical condition, illness, disease, signs, and/or symptoms being treated or prevented by use of medications

- effectiveness, goals of therapy, evaluate outcomes, plan of care, subsequent evaluations

Product

drug patient is taking

Dosage

regimen patient is ACTUALLY taking

Outcome

Response to medication; progress toward desired goals of therapy to date

Prioritizing problems

1: most urgent - only 1 problem (what's going to kill the patient first)

2: Address immediately - a few problems (not critical but urgently important)

3: Address later - all the rest (what can be put off for the future)

Plan

develops a person-centered, evidence-based, cost-conscious care plan in partnership with the patient and/or caregiver, and in coordination with other care team members

What aspects are included in the plan component?

- medication therapy problems and related needs

- setting prioritized goals of therapy to achieve desired outcomes

- incorporating lifestyle modifications, preventive care needs and SDOH

- supporting follow-up and transitions of care

- confirming understanding and agreement with goals and plan

What are the steps to create the plan?

1. Develop goals of therapy

2. Identify interventions

3. Establish follow-up schedule

4. Document the plan

Components of goals of therapy?

- Each indication is addressed

- Evaluate both efficacy and safety

- Include the patient and other practitioners

- Realistic to patient's present and potential capabilities

- Include a time frame for achievement

Identifying Interventions

New drug therapy, increase dose, decrease dose, discontinuing drug therapy, providing pt. specific drug info/explanation, referral to another provider

What patient-specific factors should be considered when individualizing the plan?

- Goal(s) of therapy for problem

- Patient specific factors

- Magnitude of implementation

What are ways to document the plan?

SOAP note, Progress note, SBAR note

Implement

prioritized care plan in partnership with the patient and/or caregiver and in coordination with other care team members

What aspects are included in the implement component?

- Addressing medication and health related problems

- Initiating, modifying, discontinuing, and administering medications as appropriate

- Providing education

- Helping coordinate care - referrals, transition of care

- Communicating with other care team members

Follow-Up: Monitor and Evaluate

monitor and evaluate the implementation of the care plan and the patient's overall health in collaboration with the patient, caregiver, and other care team members, as needed

What aspects are included in the follow-up component?

- Medication appropriateness, effectiveness, and safety based on test results, health data, patient feedback

- Review clinical endpoints

- Review outcomes of care and progression toward or achievement of goals of therapy

What are high-risk medications for follow-up?

digoxin, warfarin/anticoagulants, antiplatelets, hypoglycemics, insulin

What are parts of putting it all together into assessment and plan?

- Identify the goal(s)

- Statement of progress toward goal(s) --> be specific

- Drug therapy problem(s) that is present --> statement of DTP

- specific statement of plan - even if continuing the same treatment

- What type of follow-up is needed --> time frame, labs, who should complete the follow-up

Activities during follow-up?

- Evaluate efficacy: clinical/lab evidence, compare to goals of therapy

- Evaluate safety: clinical/lab evidence, adverse effects/toxicity

- Evaluate adherence: refill hx, patient interview

- Identify new DTPs: assess patient

- Revise plan: continue to progress toward goals of therapy, new problems

- Schedule next FU: continuous care