Developing a Pharmaceutical Care Plan

Patient care planning involves systematically assessing a patient’s health problems and needs, setting objectives, performing interventions, and evaluating results. Not all patients require a written PCP. Pharmacists must assess their own patients and identify specific areas on which to focus. For example, the pharmacist may want to identify patients with specific diseases (e.g., asthma, hypertension, diabetes mellitus, or hyper-cholesterolemia).

The development of a PCP can be summarized as a five step process involving the SOAP format (Subjective data, Objective data. Assessment, and Plan of care). Using the example in Figure 1 for an asthma patient, the process can be described as follows.

Step 1. Gathering Information

The pharmacist should gather an accurate medication history, including both prescription and non-prescription medications and the reasons the medications were prescribed or taken. The pharmacist will likely have to obtain some information from the physician, such as laboratory test results and hospitalizations. If so, the pharmacist should get written permission from the patient before soliciting this information. Once this information is compiled, the preparation of a PCP can begin.

Step 2. Identifying Problems

From the patient’s medication profile in Figure I, only one problem is evident: diagnosis of asthma. If applicable, the other problem should also be listed.

In Figure I, subjective and objective findings correlated to the problem are listed. Subjective findings are those that the patient describes (e.g., ’I feel tired all the time, “I feel bloated,” or “I woke up coughing”). References 12, 13, and 14 describe methods to ascertain this information. Objective findings are those that can be observed or measured by the pharmacist (e.g., patient appears tired, blood pressure is 180/105, pitting edema in ankles).

In the patient with asthma, the pharmacist would have the patient use a peak expiratory flow meter and record the results.

Stop 3. Assessing Problems.

The pharmacist analyzes and integrates tile information gathered in steps 1 and 2 and draws conclusions in preparation for developing a patient-specific PCP, For example, in the asthma case (Figure 1), the pharmacist may first investigate the etiology of the factors that exacerbated the asthma. The pharmacist does not have to be involved in skin testing, nor does the pharmacist have to conduct a detailed, extensive history of all of the factors that may have precipitated the asthma. However, the pharmacist should attempt to determine if drugs (e.g., aspirin, non-steroidal anti-inflammatory agents, or beta-blockers) caused or exacerbated the asthma in the patient. Thus, the importance of an accurate and complete drug history becomes evident 12, 14

Next, the pharmacist assesses the severity of the asthma. This could be accomplished (as shown in the plan) by determining the PEFR, examining the patient’s daily symptom and peak flow diary, or determining if the patient had been hospitalized and placed on steroidsor a mechanical ventilator.

Step 4. Developing the Plan

In step 4, the pharmacist establishes goals linked to each of the patient’s problems and specifies a course of action aimed at meeting each goal.

Each goal (i.e., desired improvement) should be stated in terms of measurable outcomes that indicate the extent to which the particular problem has been resolved. Often, the patient has several problems, and the plan must be comprehensive enough to have a positive effect on the overall health of the patient.