Pharmaceutical Care
Pharmaceutical care concerns the pharmacist's shared responsibility for a patient's drug therapy outcomes. It tests the care model, the classification of drug therapy problems, the tools used to assess and document therapy, and the practical services a Greek community pharmacy provides.
The care model
- The Cipolle–Strand–Hepler framework defines pharmaceutical care as a patient-centred practice in which the practitioner accepts responsibility for meeting defined outcomes: curing disease, reducing symptoms, slowing progression and preventing disease.
- The pharmacist identifies, resolves and prevents drug therapy problems (DTPs) through assessment, a documented care plan and follow-up evaluation.
- Assessment covers four domains: indication (is there a valid reason for each drug?), effectiveness, safety and adherence.
The seven categories of drug therapy problems
- Unnecessary drug therapy - no valid indication, duplicate therapy, treatable by non-drug means.
- Needs additional therapy - untreated indication, preventive therapy missing.
- Ineffective drug - wrong drug for the condition, resistance, subtherapeutic formulation.
- Dose too low - underdosing, interaction reducing effect, duration too short.
- Adverse drug reaction - an unintended effect that requires a change.
- Dose too high - toxicity, too rapid titration, impaired clearance.
- Non-adherence - the patient does not take the drug as intended.
Tools and Greek practice context
- Medication reconciliation on admission, transfer and discharge; the brown-bag review; the medication list kept in the pharmacy record.
- Adherence tools: Morisky scale, pill counts, refill records, and structured motivational interviewing.
- In older patients, STOPP/START criteria, Beers criteria and anticholinergic burden scores guide deprescribing.
- Documentation uses SOAP notes (Subjective, Objective, Assessment, Plan).
- In Greece the community pharmacy is a first point of access for blood pressure and glucose screening, smoking cessation support, and vaccination against influenza and COVID-19 under the national programme.
Worked example
A 78-year-old woman on nine medicines presents with dizziness and two falls. Her list includes a benzodiazepine at bedtime, a diuretic started two weeks earlier, and an antihistamine. Reasoning: the recent diuretic is a plausible cause of postural hypotension (dose too high, or adverse drug reaction); the benzodiazepine contributes to sedation and falls (adverse drug reaction); the antihistamine adds anticholinergic burden. The plan is a documented referral to the prescriber proposing a diuretic review, a benzodiazepine taper and antihistamine substitution, with a follow-up fall-risk and blood pressure check.
Traps that cost marks
Labelling every failure as non-adherence instead of distinguishing ineffective drug from dose too low; assuming an adverse effect must be listed in the SmPC to count; writing a care plan without a follow-up date.