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ASHP Statement on Pharmaceutical Care
The purpose of this statement is to assist pharmacists in understanding pharmaceutical care. Such understanding must precede efforts to implement pharmaceutical care, which ASHP believes merit the highest priority in all practice settings.
Possibly the earliest published use of the term pharmaceutical care was by Brodie in the context of thoughts about drug use control and medication-related services.1,2 It is a term that has been widely used and a concept about which much has been written and discussed in the pharmacy profession, especially since the publication of a paper by Hepler and Strand in 1990.3–5 ASHP has formally endorsed the concept.6 With varying terminology and nuances, the concept has also been acknowledged by other national pharmacy organizations.7,8 Implementation of pharmaceutical care was the focus of a major ASHP conference in March 1993.
Many pharmacists have expressed enthusiasm for the concept of pharmaceutical care, but there has been substantial inconsistency in its description. Some have characterized it as merely a new name for clinical pharmacy; others have described it as anything that pharmacists do that may lead to beneficial results for patients.
ASHP believes that pharmaceutical care is an important new concept that represents growth in the profession beyond clinical pharmacy as often practiced and beyond other activities of pharmacists, including medication preparation and dispensing. All of these professional activities are important, however, and ASHP continues to be a strong proponent of the necessity for pharmacists’ involvement in them. In practice, these activities should be integrated with and culminate in pharmaceutical care provided by individual pharmacists to individual patients.
In 1992, ASHP’s members urged the development of an officially recognized ASHP definition of pharmaceutical care.9 This statement provides a definition and elucidates some of the elements and implications of that definition. The definition that follows is an adaptation of a definition developed by Hepler and Strand.3
Definition
The mission of the pharmacist is to provide pharmaceutical care. Pharmaceutical care is the direct, responsible provision of medication-related care for the purpose of achieving definite outcomes that improve a patient’s quality of life.
Principal Elements
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 outcomes are intended to improve the patient’s quality of life; and the provider accepts personal responsibility for the outcomes.
Medication Related. Pharmaceutical care involves not only medication therapy (the actual provision of medication) but also decisions about medication use for individual patients. As appropriate, this includes decisions not to use medication therapy as well as judgments about medication selection, dosages, routes and methods of administration, medication therapy monitoring, and the provision of medication-related information and counseling to individual patients.
Care. Central to the concept of care is caring, a personal concern for the well-being of another person. Overall patient care consists of integrated domains of care including (among others) medical care, nursing care, and pharmaceutical care. Health professionals in each of these disciplines possess unique expertise and must cooperate in the patient’s overall care. At times, they share in the execution of the various types of care (including pharmaceutical care). To pharmaceutical care, however, the pharmacist contributes unique knowledge and skills to ensure optimal outcomes from the use of medications.
At the heart of any type of patient care, there exists a one-to-one relationship between a caregiver and a patient. In pharmaceutical care, the irreducible “unit” of care is one pharmacist in a direct professional relationship with one patient. In this relationship, the pharmacist provides care directly to the patient and for the benefit of the patient.
The health and well-being of the patient are paramount. The pharmacist makes a direct, personal, caring commitment to the individual patient and acts in the patient’s best interest. The pharmacist cooperates directly with other professionals and the patient in designing, implementing, and monitoring a therapeutic plan intended to produce definite therapeutic outcomes that improve the patient’s quality of life.
Outcomes. It is the goal of pharmaceutical care to improve an individual patient’s quality of life through achievement of definite (predefined), medication-related therapeutic outcomes. The outcomes sought are
- Cure of a patient’s disease.
- Elimination or reduction of a patient’s symptomatology.
- Arresting or slowing of a disease process.
- Prevention of a disease or symptomatology.
This, in turn, involves three major functions: (1) identifying potential and actual medication-related problems, (2) resolving actual medication-related problems, and (3) preventing potential medication-related problems. A medication-related problem is an event or circumstance involving medication therapy that actually or potentially interferes with an optimum outcome for a specific patient. There are at least the following categories of medication-related problems3:
- Untreated indications. The patient has a medical problem that requires medication therapy (an indication for medication use) but is not receiving a medication for that indication.
- Improper drug selection. The patient has a medication indication but is taking the wrong medication.
- Subtherapeutic dosage. The patient has a medical problem that is being treated with too little of the correct medication.
- Failure to receive medication. The patient has a medical problem that is the result of not receiving a medication (e.g., for pharmaceutical, psychological, sociological, or economic reasons).
- Overdosage. The patient has a medical problem that is being treated with too much of the correct medication (toxicity).
- Adverse drug reactions. The patient has a medical problem that is the result of an adverse
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