Volume 1, Issue 1, 01/21/2009
What is pharmacotherapy and why should all healthcare providers understand it?
It is well recognized that the scientific discoveries and technological advancements over the past century have already made a significant impact on improving overall public health. However, with such unprecedented advancements in disease prevention and treatment also comes a greater difficulty for most healthcare providers in keeping up with this growing level of knowledge. One area of growth in particular, is the development and approval of pharmaceutical medications. The list of available medications for the prevention and treatment of disease or illness also continues to grow every year. For most practicing healthcare providers, keeping up with these new medications and also knowing how to appropriately implement them into patient care can be time consuming and difficult. This is especially true as the population continues to live longer with a growing number of chronic disease states, each of which requires several medications that must be effectively managed in conjunction with one another. This is where the concept of "pharmacotherapy" is so important.
Simply stated, pharmacotherapy is the appropriate use of drug therapy for the purpose of preventing and treating a disease or illness. While that is easily said, it is actually more difficult to implement in a safe and effective manner to a wide variety of patients and settings. Why? Every patient is unique. In addition, the growing list of new and existing medications makes it more complicated to use the right medication for a particular patient's problem. A healthcare professional is not only expected to factor in the pharmacological principles of a particular drug, but also factor in the individual patient's age, gender, ethnicity, socioeconomic status, personal and spiritual beliefs, possible genetic variations, comorbidities, and other medications the patient is taking. On most occasions, a clinician will have to factor in all or the majority of these patient-specific factors in the final decision of which medication or treatment to implement. While the growing number of available medications is difficult to keep up with, these medications do provide clinicians with the ability to implement patient-specific treatment interventions that facilitate the greatest level of efficacy and safety. However, it is not enough to simply pick the right drug for a patient or situation. More importantly, true understanding and appropriate implementation of that drug therapy primarily occurs when the healthcare provider knows why a particular drug is preferred over other available options. This is the essence and foundation for appropriate application of pharmacotherapy in patient care and is the main goal for this specific newsletter subscription.
In addition, the recent Institute of Medicine (IOM) report, "To Err is Human: Building a Safer Health System," highlighted the impact inappropriate medication use can not only have on the healthcare system, but also on patients' lives.1 They reported that 770,000 hospitalized patients in America alone would likely experience an adverse drug event (ADE) annually. In addition, prescribing errors per order occurred at rates of 0.6 to 53 per 1,000 orders. Errors of omission (i.e., not giving patients necessary and appropriate medications) were also significant. For example, the IOM also found that only 66 to 78% patients who qualified for beta blocker administration when admitted to the hospital for acute myocardial infarction (AMI) received them within the first 24 hours.1-3 In addition, some quality of care studies showed that as little as 53% of patients discharged from the hospital for AMI were appropriately prescribed aspirin.1,4 These are just a few examples that not only reveal the problems associated with inappropriate medication use, but also where the omission of needed drugs could contribute to negative outcomes. So what is the solution to the safe and effective application of drug therapy to patient care?
We at Pharmacology Weekly believe that one mechanism for improving the use of drug therapy comes when healthcare providers not only understand the science and pharmacology of drug therapy, but they also understand why or how a particular medication exhibits a beneficial or negative effect. This goes beyond basic fact or guideline-driven memorization towards a true scientific and evidenced-based understanding of how drugs affect patients. This was highlighted by the Institute of Medicine when they said, "At the beginning of the medication-use process, prescribers often lack sufficient knowledge about how the drugs they are prescribing will work in specific patient populations. If the balance of medication risks and benefits is not known....it is impossible to say whether medication use is safe. Improving medication use and reducing errors, therefore, requires improving the quality of information generated by the pharmaceutical industry and other researchers regarding drug products and their use in clinical practice."
This is the primary basis for the format of all four of our unique newsletter subscriptions. The foundation for the appropriate, effective, and safe use of medications begins when a healthcare provider understands the pharmacology and its clinical relevancy.
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