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The Pharmacists’ Patient Care Process (PPCP) provides a consistent process for delivery of care across the pharmacy profession. This process is applicable to any pharmacist practice setting and incorporates a patient-centered and interprofessional collaborative approach to optimizing patient care. Pharmacists use evidence-based principles to collect, assess, plan, implement, and provide follow-up care. These patient care activities are then communicated to the appropriate personnel (e.g., patient, primary care provider) and documented in the patient’s health record to ensure continuity of care.1,2

As patients navigate through the healthcare system, there is a need and an opportunity to improve healthcare transitions. The Centers for Medicare & Medicaid Services (CMS) defines care transitions as the movement of a patient from one provider, or setting of care, to another.3 With each care transition, patients may experience changes to their health status and medications, creating the potential for adverse events. Pharmacists are well poised to improve healthcare outcomes and reduce costs associated with ineffective patient hand-offs during transitions of care. Application of the PPCP to the provision of care transition services can maximize the pharmacist’s role as a valuable member of the healthcare team.

When providing transitional care services, consider the following unique patient-specific considerations in applying the PPCP.


The pharmacist ensures the collection of necessary information to provide safe and effective transition of care (TOC). To guide clinical decision-making and medication therapy optimization, the pharmacist requires relevant health data and lifestyle information which supports TOC activities such as medication reconciliation, patient counseling, medication access or dispensing services, and post-discharge follow-up and monitoring. In addition to medical history, this may include collecting information on adherence barriers, educational deficits, level of independence, and caregiver support. Sources of information may include patient and caregiver interviews, electronic health records, and pharmacy or health facility records. Multiple sources should be utilized, as each source may have limitations.


The pharmacist will assess medications for appropriate indication, effectiveness, safety, and adherence. Clinical decision-making should consider past and current medical history, patient health status, changes to symptoms and labs, and any social, economic, or educational barriers to adherence. Medication therapy problems which may require intervention include unnecessary medication therapy, errors of omission, ineffective or duplicative therapy, incorrect dosages, need for additional monitoring, adverse events and drug interactions, and cost or adherence barriers.

Equally important, pharmacists should also assess the patient’s medical condition(s) beyond what is needed for medication management. In addition to evaluating acute and chronic conditions for disease progression and improvement, pharmacists should assess for preventative care in order to help patients stay healthy.


The pharmacist will develop a plan, in collaboration with the patient and their healthcare team, for actions to be taken to identify and resolve medication problems, medication access issues, and low ...

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