Introduction

Pharmaceutical care (PC) is one of the many ways pharmacists serve the world. Others are via drug discovery, synthesis, formulation, compounding, and dispensing of pills. PC is an all-encompassing concept that involves meeting patients’ medication needs to ensure safe and rational use of the medication.¹

In the past, pharmacy practice was focused on ensuring medications were dispensed as prescribed. A role that held them behind the counter with little to no interactions with the patients beyond obtaining their medications. With this role came problems such as polypharmacy (the use of multiple medications), the rise of chronic diseases, and even drug therapy-related problems, actual and potential.

This gap revealed the need for pharmacists to assume a more dynamic role in healthcare. Pharmaceutical Care is the corroboration of clinical judgement and enhanced therapeutic outcome. This role harnesses the pharmacist’s expertise in medication use from dose and dosage forms to drug therapy monitoring and medication counselling to improve patients’ quality of life.¹

Pharmaceutical care is “the direct, responsible provision of medication-related care” with the end goal of either curing/managing the health condition, reducing symptoms, or slowing down the progress of a disease/health condition.² The focus is on helping the patient.

This article aims to shine a light on pharmaceutical care, how it has evolved, and its growing importance in today’s healthcare systems.

The evolution of pharmacy practice

Walking into a pharmacy to fill a prescription is probably what the majority of the public knows about the role of a pharmacist. They were seen as custodians of medications; they compound medicines, to ensure their purity and dispense them.

With the pharmacy training came the in-depth knowledge of pharmacology. Yet, involvement with patient care was limited to compounding and information about basic medication usage. Because of this limit, pharmacists' expertise in compounding was not a part of therapy decision-making.

By the mid-20th century, the manufacturing of pharmaceutical products had become advanced with the use of machines, reducing the pharmacist’s involvement in compounding and production. This shift came with the emergence of clinical pharmacy, where the pharmacist’s focus is more on the patients (recipients of the products produced by the pharmaceutical industry).

In the 1990s, the introduction of pharmaceutical care was noticed. A movement that will go on to reframe the pharmacist’s role entirely, placing responsibility for the patient’s medication-related outcomes on the pharmacist’s shoulders. With this significant step, Pharmacists were no longer seen only as dispensers but as key contributors to therapeutic decision-making.³

What is pharmaceutical care?

According to Hepler and Strand, pharmaceutical care is “the responsible provision of drug therapy to achieve definite outcomes that improve a patient’s quality of life”.¹

In pharmaceutical care, there is a process: to assess the needed medication, develop a care plan and state the therapeutic goals, educate the patient, ensure follow-up and monitor closely.⁴ 

Assess the medications

The pharmaceutical care plan begins with assessing a patient’s medications, and this must be done thoroughly, as it forms the foundation on which other phases of the process are built. 

To begin, Pharmacists must gather information specific to the patient, like; 

• Patient demographics – Name, Age, Sex, Occupation/Origin, marital status, Address, Religion, Tribe (NASOMART)
• Past medical history
• Past and present medications and allergies 
• Social and Family History
• Laboratory investigations and physical examination results

Starting here gives the pharmacist enough information to gather subjective and objective data, the Physician’s assessment and diagnosis, with medications prescribed.  

Assessing medications allows the pharmacist to determine the appropriateness of the medications. For this, the questions asked are;

• Is the medication valid for use in the disease condition? 
• Is it the most effective choice available?
• Is the medication used at the correct dose, frequency, and duration?
• Is it contraindicated in the patient, given the allergies, comorbidities, and laboratory investigations?
• Is it being purchased and taken correctly by the patient?

The primary purpose of the assessment is to determine the extent to which the patient's drug-related needs are being met.⁵

Develop a care plan and state the therapeutic goals

After assessing the medication-related needs of the patient, a plan is written based on the individual’s needs, upon communication with the physician and the patient’s consent. The goal of developing a care plan is to;

• Identify a patient's drug-related problems
• Resolve the patient's actual drug-related problems
• Prevent the patient's potential drug-related problems

To develop this plan, the pharmacist has to know the basic information about the patient.

The Pharmacist assess the drug therapy problems. Drug therapy problems as categorised by Cipolle’s method;^6,7

• Unnecessary drug therapy 
• Ineffective drug therapy 
• Need for an additional drug
• Dosage too low
• Dosage too high
• Adverse drug reaction
• Non-compliance

These problems can occur as ‘any unwanted incident during the period of taking medications that can actually or potentially affect the desired goal of treatment’.⁶

Educate the patient

In all of these, the patient is not left ignorant. Instead, the patient is educated in every step of the process. A pharmaceutical care plan must include steps to inform the patient on why they are taking their medications, how to take them properly, and what to expect in terms of benefits and potential side effects.

The pharmacist takes time to:

• Explain the identified drug therapy problems
• Provide rationale for any therapy changes to improve compliance 
• Clarify and reiterate dosing instructions and timing
• Discuss expectations and therapeutic goals

Ensure follow-up and monitor closely

The Pharmacist should ensure to work closely with other healthcare providers to improve therapeutic outcomes.

The role of the pharmacist in pharmaceutical care

The emergence of clinical pharmacy has shifted the pharmacist’s focus from product to patients, making them offer.

• Clinical decision-making
• Patient counselling and health education
• Collaboration with other healthcare professionals
• Advocacy and health promotion

Others are:⁸

• Establish and maintain professional relationships with patients 
• Maintain adequate collection and recording of health data 
• Review health data and provide an adequate PC proposal 
• Ensure patient alignment and facilitate the execution of the PC plan 
• Ensure circular management of the PC plan

Benefits of pharmaceutical care

Incorporating pharmaceutical care helps to improve therapeutic outcomes. When pharmacists are involved in pharmaceutical care, they review medications and monitor how well they work. With this, patients experience improvements. Studies show that pharmacist-led interventions can significantly lower blood pressure and improve blood sugar control. These changes help prevent complications and keep people out of the hospital, which additionally reduces unnecessary expenditure.⁹

This also means that through regular reviews and ongoing monitoring, pharmacists can catch issues which reduce medication errors and drug reactions.¹⁰ Discussing medication with patients also helps to improve patient adherence. It is easy to forget a dose, take the wrong medicine, or give up because of side effects. But with pharmaceutical care, pharmacists educate patients, help simplify medication routines, which in turn improves adherence.¹¹

Barriers and challenges

Regardless of the benefits of pharmaceutical care, there are barriers and challenges, which are;

• Time to implement care
• The number of pharmacists needed to carry out care
• The need for interprofessional collaboration
• Pharmacist training and acceptance of the dynamic roles

Summary

Pharmaceutical care represents a shift in pharmacy practice, from a product to patients. Away from filling prescriptions, pharmacists have a more dynamic role, involvement in therapy decision-making, collaboration with other healthcare providers, assessing medication needs, identifying and resolving drug therapy problems, providing follow-ups and ensuring that an optimal outcome is achieved to improve patients’ quality of life.

At the heart of pharmaceutical care is a structured process involving an individualised care plan. This plan allows pharmacists to recognise and resolve drug-related problems, tailor therapy to each person’s health status, and guide patients through treatments during the treatment while improving patient satisfaction with care and reducing economic burden. This has further enhanced the call for pharmacists to drive towards embracing clinical roles to support healthcare systems.