A logic model for pharmaceutical care

Abstract

ObjectivesTo develop a logic model for pharmaceutical care that can be used by stakeholders as a tool to support innovation and to monitor the performance of the pharmaceutical care system in the Netherlands and abroad. The ultimate aim of such a system is the responsible provision of drug therapy to improve patients’ quality of life.MethodsThe logic model for pharmaceutical care was created following a process consisting of four steps: (1) a literature review to identify what pharmaceutical care is and what elements it consists of; (2) separate interviews with 10 stakeholder organizations to discuss the results of the literature review; (3) construction of the logic model based on the findings from steps 1 and 2; and (4) separate interviews with three stakeholder organizations to discuss and fine-tune the model. This project was carried out by the National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu) in the Netherlands.ResultsAccording to the proposed logic model, pharmaceutical care is care defined as: (1) patient-centred; (2) effective and safe; (3) efficient and affordable; (4) in physical, financial and timely ways; and (5) with minimal environmental impact.ConclusionThe proposed logic model provides stakeholders with a common framework for the innovation or further development of pharmaceutical care.

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“…Traditionally, the practice of community pharmacists focused on outputs, which were mainly process or practice focused. 56 While outputs remain important performance indicators of pharmacists' intervention, professional services provided by pharmacists should strive to demonstrate their true values, ie the translation from process output into patient outcomes. For instance, direct measurement may be sufficient to demonstrate the effect of pharmacist-led smoking cessation programmes in increasing smoking cessation rates compared with usual care.…”

Do European pharmacists really have to trespass on medicine?

“…The activity of collaboration with healthcare colleagues would imply providing additional patient-related services of clinical pharmacy [7]. In the light of the continuously growing numbers of elderly people, multimorbidities have become common in Europe and polypharmacy is an obvious consequence [4], with many patients taking five or more medicines daily. Therefore, medication review-a structured evaluation of a patient's medicine regimens with the aim of optimizing them and improving health outcomes [25]-has become a frequently cited concept in the literature, sort of 'umbrella term' including drug therapy adherence and reconciliation between medicines [26].…”

“…In the new millennium healthcare pharmacists have started claiming that the focus of their services-delivered as acknowledged drug therapy experts-has been increasingly shifted from the 'product' to the 'patient' regardless of where they work [4]. Switching the slogan from 'getting the right drug to each patient' to 'getting the drug therapy right for each patient' [5], both hospital and community pharmacists are expected to contribute increasingly to reduce clinical errors and ultimately improving the efficient use of health care resources [6].…”

Community and hospital pharmacists in Europe: encroaching on medicine?

“…In the last years pharmacists have strongly advocated that the focus of their services as drug therapy has increasingly switched from the ‘product’ to the ‘patient’ regardless of where they work [ 3 ]. Shifting the slogan from ‘getting the right drug to each patient’ to ‘getting the drug therapy right for each patient’ [ 4 ], both hospital and community pharmacists are expected to increasingly contribute to reduce clinical errors and eventually improve the efficient use of health care resources [ 5 ].…”

“…Consistently with pharmaceutical care, the former activity should involve a narrative approach meant to develop communication and empathy skills with patients, while the latter would imply providing additional patient-related services of clinical pharmacy [ 6 ]. Owing to the continuously increasing numbers of elderly people, multimorbidities have become prevalent in Europe and polypharmacy is an obvious consequence [ 3 ], with many patients taking five or more medicines daily. So, medication review—a structured evaluation of a patient’s medicine regimens with the aim of optimizing them and improving health outcomes [ 15 ]—has become a frequently cited concept in the literature, being a sort of ‘umbrella term’ covering drug therapy adherence and reconciliation between medicines too [ 16 ].…”