Upon completion of the Patient Care Series of PharmD courses and given a case of a patient with one or more of the disorders/pharmacotherapy needs, the student will be able to:
1. Integrate knowledge and use clinical reasoning skills in accomplishing the following steps when managing a patient with the disease state:
1.1 Collect: Gather subjective and objective information about the patient in order to understand the relevant medical and medication history and clinical status of the patient.
1.1.1 Subjective and objective information is collected through patient interview, medical record review, pharmacy profile review, and communication with other members of the health care team.
1.1.2 A holistic view is initiated during collection in order to consider physiological, psychological, and sociological variables of the patient and this view is maintained throughout the patient care process.
1.2 Assess: Assess the information collected and analyze the clinical effects of the patient’s therapy in the context of the patient’s overall health goals in order to identify and prioritize problems and achieve optimal care.
1.2.1 Understand, explain, and assess a patient’s health status.
1.2.2 Interpret physical and patient assessment findings
1.2.3 Assess each medication for appropriateness, effectiveness, safety, and patient adherence.
1.2.4 Assess health and functional status, risk factors, health data, cultural factors, health literacy, and access to medications or other aspects of care.
1.2.5 Assess immunization status and the need for preventive care and other health care services.
1.2.6 Integrate knowledge, clinical experience, and patient data to formulate and test hypotheses about the etiology of medication-related problems. (Generate hypotheses)
1.2.7 Establish potential and actual medication-related problems.
1.3 Plan: Develop an individualized patient-centered care plan in collaboration with other health care professionals and the patient/caregiver.
1.3.1 Therapeutic Goals: Develop specific and general therapeutic goals for the patient. These goals achieve clinical outcomes in the context of the patient’s overall health care goals and access to care.
1.3.2 Therapeutic Plan: Integrate knowledge, evidence-based literature/information, clinical experience, patient data, patient goals and desires, and the prescriber’s judgment when developing the best pharmacotherapeutic plan for the patient.
1.3.2.1 Therapeutic Alternatives: Evaluate pharmacotherapeutic alternatives for the patient before establishing the therapeutic plan.
1.3.2.2 Develop the Therapeutic Plan: This plan addresses medication-related problems and optimizes medication therapy. Considerations for the plan include:
1.3.2.2.1 Goals and desires of the patient
1.3.2.2.2 Application of established practice guidelines, evidence-based medicine, and population-based treatment plans in developing the plan.
1.3.2.2.3 Accurate and patient-specific dosing (including dosage adjustment for renal/hepatic dysfunction, starting dose, maximum doses, timing of doses and pharmacokinetic design for narrow therapeutic index drugs,).
1.3.2.2.4 Parameters for monitoring response and frequency of monitoring
1.3.2.2.5 Parameters for monitoring adverse effect and frequency of monitoring
1.3.2.2.6 Plan for patient counseling/education
1.3.2.2.7 Supports care continuity, including follow-up and transitions of care as appropriate.
1.3.2.3 Patient/Caregiver engagement: The patient/caregiver are involved through education, empowerment, and self-management.
1.4 Implement: Implement the care plan in collaboration with other health care professionals and the patient/caregiver. When implementing the care plan, the following are accomplished:
1.4.1 Medication and health-related problems are addressed.
1.4.2 Preventative care including vaccine administration are provided.
1.4.3 Medication therapy is initiated, modified, discontinued, or administered as authorized.
1.4.4 Education and self-management training is provided to the patient/caregiver.
1.4.5 Refers and provides transitions of care as needed.
1.4.6 Schedules follow-up care as needed to achieve goals of therapy.
1.5 Follow-up (Monitor and Evaluate): Monitor and evaluate the effectiveness of the care plan and modify the plan in collaboration with other health care professionals and the patient/care giver. The following are continually monitored and evaluated:
1.5.1 Medication appropriateness, effectiveness, and safety and patient adherence through available data, biometric test results and patient feedback.
1.5.2 Clinical endpoints that contribute to the patient’s overall health.
1.5.3 Outcomes of care, including progress toward or achievement of goals.
1.6 Patient-Centered Care: Foster a patient-centered care approach by accomplishing the following:
1.6.1 Communicate: Succinctly communicate with other health care team members and the patient/caregiver throughout the patient care process.
1.6.2 Collaborate: Discuss with team members the specific therapeutic approaches for individual patients based on scientifically and logically validated assessment of the patient’s health care needs and an ethical consideration of the patient’s health care goals and desires.
1.6.3 Document: Prepare a written communication that is well-organized, logical, complete, appropriate, and evidence-based.
2. Apply and integrate foundational knowledge (i.e., pharmaceutical, social/behavioral/administrative, and clinical sciences) throughout the patient care process. This will require the ability to:
2.1 Describe the pathophysiology of disease state(s) and identify appropriate drug targets (cellular/molecular), biochemical processes, and organ changes for therapeutic intervention. Specifically, for a given disease state:
2.1.1 Describe the basic pathophysiology of the disease including an explanation of the abnormal processes and the resulting disease signs and symptoms.
2.1.2 Outline risk factors and/or diagnostic indicators (e.g., lab values, diagnostic test results).
2.1.3 Determine classes of drugs that will treat the disease state and ameliorate the underlying pathophysiology and signs/symptoms.
2.2 Apply knowledge about structure-activity relationships and cellular/molecular mechanisms of action to identify drug classes that are appropriate for treatment of the disease state. Specifically, for each drug class:
2.2.1 Identify the relevant therapeutic targets and explain the mechanism(s) of action.
2.3 Describe major pathways for metabolism and the pharmacological/therapeutic consequences of metabolism.
2.4 Compare and contrast the therapeutic and adverse effects of drug classes that are appropriate for treating the disease state.
2.4.1 Identify the most common/serious drug interactions and adverse effects.
2.5 Compare and contrast the therapeutic and adverse effects of drugs within a given class and then recommend the best drug for the patient.
2.6 Identify important precautions and contraindications.
2.7 Recommend any unique storage, handling, or use requirements to ensure patient safety and clinical efficacy.
2.8 Discuss significant pharmacokinetic and pharmacodynamic considerations.
2.9 Integrate the following transcending concepts when assessing a patient and developing a care plan:
2.9.1 Apply concepts about health information and informatics in the inpatient setting (Informatics)
2.9.2 Evaluate cohort trials and apply to a patient’s needs (Evidence-based practice)
2.9.3 Use clinical reasoning and clinical judgment (Problem-solving)
2.9.4 Address health and wellness in the context of the management of diabetes
2.9.5 Consider the role of drug delivery systems in the context of contraceptives
2.9.6 Apply dosage individualization practices in pregnant women.
2.9.7 Address cultural competency for lesbian, gay, bisexual, and transgender issues.
2.9.8 Address issues related to law and ethics in the context of birth control for teenagers.
2.9.9 Apply oncology pharmacogenomics (Personalized Medicine)
2.9.10 Assess the role of self-care for health issues in women and men
2.9.11 Use SBAR when communicating with another health professional (Interprofessional collaboration)
2.9.12 Consider medication safety for women’s and men’s health issues
2.9.13 Apply population-based care for women’s and men’s health issues
2.9.14 Apply pharmacoeconomics erectile dysfunction agents