PATIENT FOLLOW-UP

Dr. Binaya SapkotaBPharm, PharmD

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• Once the initial adherence plan is implemented, F/U is imp. to judge how well the plan is working & whether changes are made.

• Pt. F/U is one of the vital elements of pt. care process that must be completed for individual pt.

• Continuity of care is essential to many pts (particularly those with chronic conditions).

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• Pharmacist should track medications taken by such pts & regularly update pt’s medication history as long as the pt. is under his care.

• Whenever the pharmacist has any reason to believe that another “HC” provider would give better Rx to the pt., the pt. should be given a referral slip stating his condition & medication.

• Pharmacist’s name & pharmacy contact no. should be stated on the referral slip to facilitate any further inquiries by the other “HC” provider.

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• F/U may be accomplished during subsequent visits of pt. or through telephone callbacks for which the pt’s consent may be obtained.

• Pharmacist must personally make F/U calls or meetings & enquire about:

i. Pt’s general condition & response to therapyii. General problems, adverse events encountered by the pt.iii. Dose & frequency at which medicines have been taken by the pt.iv. Missed doses

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• Possible causes of non-compliance by the pt. should be evaluated & the pts counseled accordingly.

• Pharmacist should keep the prescribers updated about all adverse events reported by or elicited from pt. & the stated or probable reasons for pt. not complying with the prescription/therapy.

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Diagrammatic interpretation of Pt. care process

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Purposes/needs of F/U evaluations

• To determine actual outcomes achieved by pharm. care plan.

• To assess the extent to which the plan has achieved desired outcomes.

• To determine if there are new or changing medication therapy problems that must be addressed.

• To determine if anything has occurred that increases pt.’s risk for developing new medication therapy problems.

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• Pt.’s progress is documented accurately in pharmacy record & communicated effectively to pt. & other HPs.

• Status of each medical condition described a/c following categories:– Resolved: Therapeutic goals achieved & therapy

completed.– Stable: Goals achieved but continue the same therapy

(CST).– Improved: Progress being made towards achievement of

goals. So, “CST”.– Partial Improvement: Progress being made but minor

adjustments in therapy required.

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Status of each medical condition

– Unimproved: No measurable progress yet but “CST”.

– Worsened: Decline in health condition. So, revise therapy accordingly.

– Failure: Goals not achievable with the present therapy. So, initiate new therapy.

– Expired: Pt. died while receiving medication therapy.

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Status of each medical condition

• If changes in the plan reqd. to maintain or improve its efficacy, safety or economy, clinician coordinates these changes & communicates them to the pt. & other “HC” providers.

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Plan for Regular F/U

• Pharmacist plans to interact with pt. at regular, brief intervals to reinforce adherence plan.

• Brief appointments scheduled when pt. visit the pharmacy for prescription refills.

• Plan adapted to pt.’s lifestyle & re-evaluated from time to time to adjust for life changes such as ageing or change in work or school schedules.

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F/U counseling sessions

• Identification of following factors should be considered while conducting F/U counseling by pharmacist:

i. Pt. problems with medication (S/S, complex drug regimen, medication therapy interfering with lifestyle)

ii. Deterioration in health status requiring pharmacotherapy review

iii. Medication errorsiv. Medication mgmt.

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