An editorial in the International Journal of Clinical Pharmacy by van Mil and Fernandez-Llimos entitled: What is ‘pharmaceutical care’ in 2013? poses several relevant questions about the current definitions of PC. It shed a light on the mesh of working definitions since the original definition proposed by Hepler and Strand and the subsequent alternative terms proposed by other organizations and groups. I invite those individuals with interest in the subject to share their thoughts in this forum.
Some of the 'significant' questions asked in the editorial by van Mil and Fernandez were:
1. Does ‘‘the responsible provision of drug therapy’’ as propsed by Hepler & Strand (H&S) in their original definition mean that pharmaceutical care is necessarily associated with the provision, (or dispensing) of drugs (medicines)?
2. Medication Therapy Management (MTM) comes with an articulation of services that ‘‘are independent of, but can occur in conjunction with, the provision of a medication product’’- Does this separate PC from MTM (i.e. each is a different term with different requirements)?
3. Does the PC ultimate objective which is ‘‘achieving definite outcomes that improve the patient's quality of life (QoL)’’ limit PC to outcomes that improve QoL and not necessarily clinical or economic outcomes?
The authors here argue that: quote "We should keep in mind that improving clinical aspects may sometimes improve (or maintain) humanistic outcomes, like quality of life, but not necessarily. Care may also prolong life, even when it does not affect its quality. Improving economic outcomes might sometimes even imply that the humanistic outcomes are neglected"- unquote.
Let me start the ball rolling by voicing my own opinion that all of theis sound like sementics, but they are not simply sementic terms. To propse a definition you need to craft it with attention to each and every letter. I would have thought that the term: drug therapy in H&S definition should have been 'care', or 'healthcare', and not merely drug therapy. Pharmacists today are expected to refer patients where required, provide non-pharmacological interventions, and health promotion startegies, all of which do not involve drug therapy but do ultmately improve QoL. But that's just me. What say you?
Pharmaceutical Care is a patient-centered, outcomes oriented pharmacy practice that requires the pharmacist to work in concert with the patient and the patient's other healthcare providers to promote health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that drug therapy
The principal elements of pharmaceutical care are that it is medication related; it is care that is directly provided to the patient; it is provided to produce definite outcomes; these out- comes are intended to improve the patient's quality of life; and the provider accepts personal responsibility for the outcomes.
These outcomes are (1) curing a disease, (2) elimination or reduction of a patients' symptomatology, (3) arresting or slowing down a disease process, or (4) preventing a disease or symptomatology.
Clinical pharmacy was originally defined as the area of pharmacy concerned with the science and practice of rational medication use, pharmaceutical care as the responsible provision of drug therapies to achieve definite outcomes