Chapter 2. Pharmaceutical Care as the Professional Practice for Patient-Centered Medication Management Services

1. Pharmaceutical care is a professional patient care practice, which, when provided as an organized service, is experienced, documented, evaluated, and paid for as medication management services.

2. Whenever expert knowledge is required to solve a specific set of problems, a “professional” is brought in to intervene in another individual's life by making decisions and taking actions. A professional practice is necessary to function as the ethical reference point, the clinical framework, and the basis for legal definitions and defenses in the health care professions.

3. All professional patient care practices, whether it be medicine, nursing, or dentistry, consist of three major components; a philosophy of practice, a patient care process, and a practice management system. Pharmaceutical care has all three components defined.

4. Pharmaceutical care uses the common vocabulary of medicine, nursing, and other patient care practices. This is necessary to integrate pharmaceutical care with these services.

5. The philosophy of pharmaceutical care practice consists of (a) a description of the social need for the practice, (b) a clear statement of individual practitioner responsibilities to meet this social need, (c) the expectation to be patient-centered, and (d) the requirement to function within the caring paradigm. A philosophy of practice is expected when working with medicine and nursing and is practiced by all health care professionals.

6. The patient care process, which must be consistent with the patient care processes of the other health care providers, consists of (a) an assessment of the patient's drug-related needs, (b) a care plan to meet the specific needs of the patient, and (c) a follow-up evaluation to determine the impact of the decisions made and actions taken.

7. The practice management system includes all of the resources required to bring the service to the patient. Physical space, the appointment system, documentation, reporting, evaluation, payment for the service, and much more are included in the management of a service.

8. Pharmaceutical care practice evolved from clinical pharmacy as a direct patient care practice with specific standards of practice consistent with other health care providers.

9. Pharmaceutical care is a generalist practice. A generalist practice is necessary to structure specialist practices because they are defined relative to the generalist practice (they use the same patient care process).

10. As pharmaceutical care is a generalist practice, it is consistent with the concepts of primary health care generally and the medical home specifically.

It is most common for a professional practice to develop first and for the services that result from that practice to be defined after the practice has been implemented and recognized as legitimate in the health care system. This is not the case with medication management services. Although the professional practice of pharmaceutical care was introduced and endorsed by the profession of pharmacy as early as 1990, by the time medication management services were introduced in 2006, the practice had been extensively talked about but only minimally developed in practice by practitioners. Perhaps this helps to explain the current confusion and lack of consensus around medication management services ...