Intro Pharm Prac Week 3

Pharmacists Patient Care Process

Kelsee Tignor, PharmD, BCPS
Assistant Professor of Pharmacy Practice
PPR 6230 Introduction to Patient Care
October 16, 2025

Objectives

  • Identify the key steps in the pharmacist's patient care process.

  • Recognize definitions of the patient care processes as defined by varying health professions.

  • Develop an assessment and plan for a patient utilizing the pharmacist’s patient care process.

What is a Patient Care Process?

  • A patient care process is defined as a fundamental series of actions that guide the activities of health professionals.

  • All health professions that provide direct patient care should consistently apply a process of care to their practice, including:

    • Pharmacy

    • Medicine

    • Dentistry

    • Nursing

Patient Care Process

  • All professional practice requires three essential elements for person-centered care:

    • Philosophy of practice

    • Process of care

    • Practice management system

  • Differentiation aspects between professions include:

    • Application of the process as defined within the context of the profession’s knowledge/expertise.

    • Addressing unique patient needs; professions vary in the way patient-specific information is assessed.

Steps to a Patient Care Process

  1. Collecting subjective and objective information.

  2. Assessing the collected data to identify problems, determine the adequacy of current treatments, and set priorities.

  3. Create an individualized care plan that is evidence-based and cost-effective.

  4. Implement the care plan.

  5. Monitor the patient over time during follow-up encounters to evaluate the effectiveness of the plan and modify it as needed.

Remaining Person-Centered

  • Requirements:

    • Effective communication.

    • Seeking to understand the patient’s needs.

    • Exploring patient preferences.

    • Respecting patient values.

    • Interprofessional collaboration among various health professions.

  • Remaining consistent in the approach to patient care is essential to prevent gaps in patient care.

Pharmacist’s Patient Care Process (PCPP)

  • The PCPP was defined by the Joint Commission for Pharmacy Practice (JCPP) in 2014.

  • Allows for patient care that is:

    • Specific

    • Measurable

    • Predictable

Patient Case

  • Phyllis Lappin

    • DOB: 05/04/1962

    • Gender: Female

    • Height: 5’ 5”

    • Weight: 170 lbs

    • Chief Complaint: Phyllis presents to the clinic today for a routine follow-up with her primary care provider and mentions, "she feels like she is taking too many pills."

Collect

  • Conduct a review of the medical record to gather relevant information, which includes:

    • Patient demographics.

    • Active problem list.

    • Admission and discharge notes.

    • Office visit notes.

    • Laboratory values.

    • Diagnostic tests.

    • Medication lists.

  • Commonly involves collection of subjective and objective information.

Collect Detailed Information

  • Conduct a comprehensive review of medications associated with health/social history, which includes:

    • Interview of the patient.

    • Physical assessment.

    • Social history and social determinants of health.

    • Allergies and past medication history.

    • Details on indication, dose, route, frequency, formulation, effectiveness, safety, adverse effects, and management of medications.

Patient Case - Chart Information

  • PMH (Past Medical History):

    • Hypertension (HTN)

    • Type 2 Diabetes Mellitus (T2DM)

    • Hyperlipidemia (HLD)

    • Osteoarthritis

    • Chronic Kidney Disease (CKD)

    • Gastroesophageal Reflux Disease (GERD)

  • Social History:

    • Former smoker for 10 years.

    • Social drinker (1-2 glasses of wine/week).

    • Exercise: 30 minutes a day.

    • Diet: Utilizes plate method and carb counting.

    • Allergies: Penicillin (hives/rash), Shellfish (shortness of breath).

Patient Case - Current Medications (Updated as of last visit - 08/01/2024)

  • Lisinopril 20mg once daily.

  • Metformin 1000mg once daily.

  • Atorvastatin 40mg once daily.

  • Amlodipine 5mg once daily.

  • Lantus 10 units SQ daily.

  • Hydrochlorothiazide (HCTZ) 25mg once daily.

  • Omeprazole 20mg once daily.

  • Alendronate 70mg once weekly.

  • Losartan 50 mg once daily.

  • Tylenol 500mg prn.

  • Calcium Carbonate 500mg twice daily.

  • Vitamin D3 1000 IU daily.

  • Cetirizine 10mg once daily.

  • Aspirin 81mg daily.

  • Lab Values:

    • A1c: 8.3%

    • BP: 102/72 mmHg

    • LDL: 75 mg/dL

    • SCr: 1.3 mg/dL

Patient Case - Interview Information

  • Occupation: Business analyst at a paper company.

  • Marital Status: Single/Never married.

  • Living Situation: Lives alone, no children.

  • Medication Pickup: Has no issues picking up medications from the pharmacy.

  • Medication Compliance Issues: Reports occasionally skipping Lantus, which is non-formulary and unaffordable; currently utilizes insulin three times a week to make the medication last longer.

  • Symptoms: Reports frequent dizziness throughout the day, especially when moving from sitting to standing.

Subjective and Objective Collection

  • Subjective: Information from patient interviews, complaints.

  • Objective: Clinical assessments and lab results.

Assess

  • Assessment involves organization into a problem list consisting of the patient’s active medical problems and medication therapy problems.

Steps to Assessment

  1. Assess and prioritize the patient’s active medical conditions accounting for the patient’s goals of therapy.

  2. Assess the indication of each medication:

    • Does the patient have an indication for the medication?

    • Is the medication appropriate for the medical condition?

    • Does the patient have an untreated medication condition?

  3. Assess the effectiveness of each medication:

    • Is the patient meeting clinical goals of therapy?

    • Is the patient meeting their personal goals?

    • Is it the most appropriate treatment?

    • Is the appropriate dose/duration prescribed?

  4. Assess the safety of each medication:

    • Is the patient experiencing adverse effects?

    • Are there safer alternatives?

    • Are there any pertinent drug-disease, drug-drug, or drug-food interactions?

    • Do additional labs need to be obtained?

  5. Assess adherence and the patient’s ability to take each medication:

    • Is this the most affordable option?

    • Is the patient able to obtain the medication?

    • Is the patient missing doses?

    • Is the frequency and formulation appropriate for the patient?

  • Formulate a medication therapy problem list after assessing the information.

Plan

  • Develop a care plan in collaboration with the patient:

    • Identify monitoring parameters to assess indication, effectiveness, safety, and adherence to the medications.

    • Review all medication lists and update as appropriate.

    • Determine the type of follow-up needed, including time frame.

    • Determine appropriate mode for follow-up (e.g., Telehealth, in-person).

Implement

  • Discuss the care plan with the patient:

    • Ensure understanding and alignment with goals of therapy.

    • Provide education as needed.

    • Arrange patient follow-up.

    • Communicate all instructions to the patient.

    • Document the encounter in the electronic health record.

Documentation

  • Clear documentation and billing for other healthcare professionals, payers, and information technology to reference as needed.

  • Documentation usually involves coding:

    • International Classification of Disease (ICD-10): Coding for medical procedures/encounters.

    • Current Procedure Terminology (CPT): Coding system for medical procedures developed and maintained by the American Medical Association primarily for billing services.

    • RxNorm: Standardized nomenclature for clinical drugs created by the National Library of Medicine.

Follow-Up and Monitoring

  • Provide targeted follow-up and monitoring as needed to track response to therapy and refine the care plan to achieve patient and clinical goals of therapy.

  • Repeat comprehensive medication management follow-up visits at least annually.

Summary

  • All health professions who provide direct patient care should consistently apply a process of care to their practice.

  • Person-centered care requires three essential pieces:

    • Philosophy of practice

    • Process of care

    • Practice management system

  • The Pharmacists Patient Care Process was set forth in 2014 and provides specific, measurable, and predictable approaches to patient care.

References

  • Haines ST, Kliethermes M, Sorensen TD. Patient Care Process. In: DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod VL, Posey L. eds. DiPiro’s Pharmacotherapy: A Pathophysiologic Approach, 12th Edition. McGraw Hill; 2023. Accessed August 08, 2024. https://accesspharmacy.mhmedical.com/content.aspx?bookid=3097&sectionid=26738888

  • The pharmacists’ patient care process. JCPP. October 26, 2018. Accessed August 8, 2024. https://jcpp.net/patient-care-process/.

Questions?

  • Contact: ktignor@south.edu