Value Expectancy Theory

#

1. Value of outcome

2. expectation that action will lead to specific outcome

Health Belief Model

# of Steps

1. Perceived Illness

2. Factors affecting action.

3. Cues spring patient into action 

4. Likelihood of behavior

Theory of Reasoned Action

# of Concepts

1. Behavioral intention - individuals inclination to perform an action

2. Subjective Norm - perception of whether behavior is appropriate or not ( based on other' belief)

Steps of TRA (Theory of Reasoned Action)

1. Likelyhood of behavior - affected by 4 factors.

2. Factor 1+2 contribute to performance of behavior

and Factors 3+4 contribute to subjective norm.

3.  Individual consider importance of attitude toward behavior and subjective norms when determining intention to perform a behavior.

4. Behavioral intention predict behavior.

One who intends to perform behavior is more likely to to perform behavior.

Assumes behavioral is rational and under a person's control

1. Internal Locus of control - Thinking one has ability to control their lives and exert control over illnesses

2. External Locus of control - Thinking others/God has control over themself

Dispensing Framework

Circa 1950 vs 1985

Pharmacist seen as?

Can not do what?

Expected to do what?

1950

*Pharmacist do not discuss therapeutic effects or composition of prescription with patient.

*Pharmacist make knowledge of mediction available to other healthcare professional

*Direct any patient questions to qualified practitioner

Clinical Pharmacy Framework

What happened to school curriculum?

Knowledge

Role of information

APhA CoE 1969

Expansion of school curriculum. Topics were focused to help growing role of pharmacists in drug control in hospitals.

PharmD felt that topics covered helped them most in hospital and pursued hospital careers.

*Increased pharmacist knowledge and application of knowledge

"drug information expert" <---- sounds so lame

Increased role of communication of drug information

Health and safety of patients as priority. Render service to patient to the best of pharmacist ability.

1. Expection that behavior leads to outcome

2. (+)(-) evaluations of outcome

3. Beliefs of what other think is appropriate or not

4. Motivation to comply with others think is appropriate.

Pharmaceutical Care Framework

Began

Definition

Why different than previous frameworks/practice eras

1990+

*Responsible provision of drug therapy to achieve definite outcome to improve patients' quality of life.

Process of care. Not just provision (providing and supplying) of products or services.

Elements of Pharmaceutical Care

# of elements?

1. Meeting Societal Need

2. Patient Centered Approach

3. Therapeutic Relationship

4. Specific Practice Responsibilities

First element of Pharmaceutical Care

* Who was seen as primary agent in providing assurance of appropriate/effective/safe drug therapy?

Extension

How did PC change this?

Meeting Societal Needs

Physicians were seen as the primary agent.

Nurses/pharmacists were seen as extensions in meeting assurance.

*PC views pharmacist as primarily responsible for meeting societal needs for appropriate, safe, and effective drug therapy.

2nd Element of Pharmaceutical Care Framework

Patients

Patient Centered Approach

Patient have rights/knowledge/experiences when entering healthcare process

Patients are active decision workers with specific needs and conerns.

*Pharmacist responsible for considering patients background and needs when delivering care.

3rd Element of Pharmaceutical Care

Therapuetic Relationship

Listen and understand consumer wishes/needs

Assure consumer's health needs are met

4th PC Element

Drug Therapy

Specific Practice Responsibitilies

Ensure drug therapy is appropriate and that indications for drug is treated appropriately with mediactions

Makes sure drug therapy is effective and safe. Identify/resolve/prevent drug therapy problems.

Promote adherance to medications plan instructions to maximize

 (+) outcome

Models of Provider Care

Role of Physician vs Patient

1. Paternalism - High provider control, low patient control

Tradiational relationship where patients are passive

2. Mutuality - high physician and patient control. Both contributes.

3. Consumerism - High patient control, low provider control, patient as skeptic

4. Default - low provider and patient control. Patient might visit provider but fail to comply with regiments. Provider might see patient but not educate/ evaluate patient therapy.

Other Models of Provider's Care

#

1. Biomedical Model - passive patient

2. Client-Centered Model - Provider assess patient and tailors therapy to patient needs and desires

3.Concordance - Mutual agreement on treatment and decisions

CoE

Formal Selection of new members

Institution where knowledge is obtained

Social organizations to perpetuate goals of profession

Ensurance of proper conduct of member

Methods to control source of expertise

Professional socialization

Another name

2 defintions

Professionalization

**Process where students selectively acquire knowledge, values, attitudes, and skills of pharmacists**

Development of professional ethos, embodiment of care,morals, and ethics.  

1. Teach core knowledge

2. serve as model of professional behavior

3. provide social support

4. evaluate skill mastery

5. communicate professions' goals

Perspectives of Professional Socialization

#

Structural-Functional Perspective

-assumes students molded into ideal practitioners

-assume students receive consistent messages from agents

- Failed or incomplete socialization

Situations- Adaptive Perspective

- students actively interacting with agents

- mixed and conflicting messages can occur

Failed or incomplete socialization

Interpersonal communications Model

Players, Steps,

Sender --> Message --> Receiver --> Feedback --> Barriers

Feedback is when the role of the sender and the receiver switches

-Factors affect collaboration process and outcomes

- Quality of Provider Care

- Patient Comprehension/Recall

- Quality of Provider Support

- Patient Motivation and satisfaction of care

-patient adherence and adherance barrier

-patient feedback

- quality of provider monitoring

- quality of problem solving and reinforcement

- Patient satisfaction/adherence

- Enhanced treatment outcomes