Pharmacotherapy Principles and Drug Information for Patient-Centered Care

Pharmacotherapy and Patient-Centered Care

Person-Centered Care

Person-centered care is an approach that prioritizes the patient's perspective in all aspects of drug therapy and healthcare delivery.

• Key Components:

  • Knowledge of drug therapy

  • Drug information skills

  • Therapeutic planning skills

  • Patient’s monitoring skills

  • Physical assessment skills

• Respect for patient’s values and preferences is essential for effective care.

Pharmacotherapy

Definition and Purpose

Pharmacotherapy is the use of medications to treat diseases, aiming for safe, appropriate, and economical use of medications.

Guiding Principles of Drug Therapy

• Valid documentation is required to justify the use and discontinuation of medications.

• Lowest effective dose for shortest duration: Medications should be used at the lowest dose and for the shortest time necessary to achieve the desired outcome.

• Monotherapy: Use one drug if it is effective; avoid unnecessary combination therapy.

• New vs. old medications: New drugs should only be used if they offer clear advantages over older medications (e.g., fewer side effects, less drug interaction, improved outcomes).

• Evidence-based selection: Medication choices should be based on clinical evidence.

• Patient preferences: Consider patient input, especially regarding administration route and treatment outcomes.

• Oral vs. injectable: Oral administration is generally preferred unless injection is necessary.

• Cost-effectiveness: When multiple drugs are equally effective, the drug with the lowest cost or most convenient regimen should be chosen.

Drug Therapy Problems

Categories of Drug Therapy Problems

Needs	Problems
INDICATION	1. Unnecessary drug therapy 2. Needs additional drug therapy
EFFECTIVENESS	3. Ineffective drug 4. Dosage too low
SAFETY	5. Adverse drug reaction 6. Dosage too high
ADHERENCE	7. Non-adherence or noncompliance

Examples and Explanations

• Unnecessary Drug Therapy: Duplicate therapy, no current indication, or prescribing cascade (side effects from one drug lead to more prescriptions).

• Need for Additional Therapy: Preventive therapy, untreated conditions, or need for synergistic therapy.

• Ineffective Drug: Inappropriate dosage, wrong drug for condition, or drug not responding.

• Dosage Issues: Dose too low or too high for the patient’s needs.

• Adverse Drug Reactions: Allergic reactions, incorrect administration, or drug interactions.

• Non-adherence: Patient does not take medication as prescribed due to various reasons (e.g., side effects, cost, misunderstanding instructions).

Drug Information and Evidence-Based Practice

Drug Information Resources

Drug information is essential for supporting safe, appropriate therapy. Resources are categorized as:

Source Type	Description	Examples	Purpose
Tertiary	Summarizes information from other sources	Textbooks, full-text databases, review articles	Provides a general overview and directs you to more detailed sources
Secondary	Interprets and analyzes primary sources	Indexing and abstracting services (PubMed, Scopus)	Helps you find and evaluate primary literature
Primary	Presents original research or data	Clinical studies (RCTs, cohort studies, case-control studies, case series)	Provides firsthand accounts of research findings and clinical evaluation

Evaluating Drug Information

• Credibility: Check author credentials and source reliability.

• Accuracy and Currency: Ensure information is up-to-date and correct.

• Depth and Organization: Prefer sources with detailed, well-organized content.

• Red Flags: Avoid sources without author/date, social media posts, or vague proprietary blends.

Using Internet for Drug Information

• Always evaluate the quality of online information before using it for clinical decisions.

• If information is limited or unclear, consult a subject expert or drug information service.

Pharmacist Patient Care Process (PPCP)

Steps in the PPCP

• Collect: Gather relevant patient information.

• Assess: Analyze the information to identify problems and needs.

• Plan: Develop an individualized care plan.

• Implement: Carry out the care plan.

• Follow-up: Monitor and evaluate the effectiveness of the plan.

Pharmacist Services

• Immunizations

• Preventative care

• Collaborative care services

• Medication Therapy Management (MTM)

• Chronic disease management

• Self-care education

• Patient education

• Test to treat

Documentation and Patient Profiles

SOAP Note Format

• Subjective: Patient’s reported symptoms and concerns.

• Objective: Measurable data (e.g., vital signs, lab results).

• Assessment: Clinical judgment about the patient’s problems.

• Plan: Proposed interventions and monitoring parameters.

Patient Profile Information

• First and last name

• Date of birth

• Gender

• Phone number/email

• Allergies

• Other relevant medical information

Patient profiles must be maintained for at least 5 years from the most recent entry.

Legal and Regulatory Aspects

Controlled Substance Act (CSA)

• Regulates the manufacture, distribution, and possession of controlled substances.

• Prescriptions for controlled substances must be filled within 30 days of the date ordered.

• Cannot be filled for more than a 30-day supply.

• No more than 5 refills in a 6-month period.

Brand vs. Generic Drugs

• Brand: Marketed under a proprietary, trademark-protected name.

• Generic: Same active ingredient, dosage, safety, strength, and intended use as the brand, but usually less expensive.

• Generics must contain the identical amounts of the same active pharmaceutical ingredient (API).

HIPAA and Patient Privacy

• The Health Insurance Portability and Accountability Act (HIPAA) protects patient health information (PHI).

• Pharmacies are considered covered entities and must safeguard patient data.

Summary Table: Drug Therapy Problem Categories

Category	Examples
Unnecessary Drug Therapy	Duplicate therapy, no indication, prescribing cascade
Needs Additional Drug Therapy	Preventive therapy, untreated condition, synergistic therapy
Ineffective Drug	Wrong drug, inappropriate dosage, drug not responding
Dosage Too Low/High	Subtherapeutic or toxic dosing
Adverse Drug Reaction	Allergic reaction, drug interaction, incorrect administration
Non-adherence	Patient does not take medication as prescribed

Additional info:

• Some content inferred to provide context for pharmacy practice and patient care process.

• Tables reconstructed for clarity and completeness.