17 October 2014 1

The practice of pharmacy is continuing to

undergo a paradigm shift from a dispensing-
focused to a patient-care-focused profession.
Pharmacists have more time to provide
clinical services
Pharmacists have the opportunity to become
involved in patient care is disease
management
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Aspects of case and outcomes management, but
the approach focuses on specic diseases,
looking at what creates the costs, what
treatment plan works, educating patients and
providers, and coordinating care at all levels:
hospital, pharmacy, physician, etc.
DM has also been dened as a systematic
management tool applied to specic diseases
with an emphasis on prevention and best
practices to provide high quality care at a
reasonable cost with an ongoing process of
monitoring and continuous improvement.

17 October 2014 3
Device and laboratory companies,
Medical product wholesalers and distributors,
Physician groups, and
Community pharmacies

There are now companies that specialize in
selling DM services to health care providers
who choose not to develop programs with
their own staff.
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The origin of pharmacists involvement in DM
can be traced back to the hospital
environment.
In the late 1960s and early 1970s, clinical
pharmacy practice began to discuss
direct patient contact
clinical involvement of the pharmacist.
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Hence the concept of pharmaceutical care was started.
Pharmaceutical care means the responsible provision of drug
therapy for the purpose of achieving definite therapeutic
outcomes that improve a patients quality of life.
Pharmaceutical care targets those with risk factors for drug-
related problems, a history of non-adherence, and frequent
changes in medication regimens.
In practicing pharmaceutical care, a pharmacist is expected to
assume greater responsibility for patients medication-related
outcomes.
For example,
pharmacists have taken on roles to help assess patients
therapeutic needs,
prevent adverse drug reactions,
individualize drug therapy, manage chronic disease, and
monitor follow-up care.
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Research suggests that the potential impact
of a pharmacists intervention in patient care
is significant.
In a follow-up project, it is estimated that
pharmacist intervention and pharmaceutical
care could reduce the annual expense of
drug-related problems by $45.6 billion
making a great difference.

17 October 2014 7
Patient access:
Consistency between sites:
Organization and structure of pharmacies (e.g.,
chain drug stores), which allow the administration
of a program through pharmacists practicing at
different locations.
Expanding the role of pharmacy technicians:
Greater use of technicians might allow pharmacists
to devote more time to patient care.
It is expected that advanced training of technicians
will reduce the amount of time that pharmacists
typically devote to medication dispensing and allow
more time for pharmacists to provide pharmaceutical
care.

17 October 2014 8
Governmental efforts:
Under this legislation, pharmacists
with appropriate training can be
reimbursed for providing cognitive
services for patients with
diabetes,
asthma,
lipid disorders, and
anticoagulation under patient-
specific treatment protocols
approved by a physician

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Targets specific patient populations suffering from a
disease.
Integrates health care services directed toward the chosen
disease by various components of the health care system,
providing a seamless system of prevention and care.
Support health care services on consistent application of:
the best scientific information available on treatment and
evaluation of care,
constant updating and improvement through use of quality
improvement techniques.
Links care to the outcomes of interest to consumers of
health care,
This takes into account
clinical,
economic, and
humanistic outcomes.
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Most DM efforts have focused on chronic
conditions that are common or have high
associated treatment costs, or both.
Some specific disease states for which the
impact of the pharmacists has been
demonstrated are
asthma,
cardiovascular conditions (hypertension,
hyperlipidemia, and anticoagulation),and
diabetes.
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Educate patients about the role of each medication.
Instruct patients about the proper techniques for
inhaling medications.
Monitor medication use and refill intervals to help
identify patients with poorly controlled asthma.
Encourage patients purchasing nonprescription
asthma inhalers or tablets to seek medical care.
Help patients use peak-flow meters appropriately.
Help patients discharged from the hospital after an
asthma exacerbation to understand their asthma
management plan.
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Pharmacist can provide:
Diabetes education,
medication counseling, and
evaluation and adjustment of the medication
regimen in noninsulin-dependent diabetes mellitus
(NIDDM) patients
This has significance in:
lowering average weekly blood glucose levels,
a decreased incidence of hyperglycemic events, and
significant increase in their understanding of diabetes
medications as well as a positive difference in their
perception and attitude toward communication with
the pharmacist.
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