Pharmaceutical Care: Definition, Scope, and Philosophy

Pharmaceutical care is defined as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life. The phrase, introduced by Hepler and Strand in 1990, names a philosophy that places explicit pharmacist accountability for medication outcomes at the centre of practice.

Definition

Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life; outcomes include cure of a disease, elimination or reduction of symptoms, arresting or slowing of a disease process, and preventing disease, with the pharmacist accountable for the medication-related results.

Scope

This topic covers the canonical definition of pharmaceutical care, the philosophical commitments it carries (responsibility, accountability, and a covenantal relationship with the patient), and how its scope is distinguished from neighbouring constructs such as clinical pharmacy and medication therapy management. It is a definitional and conceptual entry rather than clinical guidance.

Core questions

• What exactly did Hepler and Strand mean by 'pharmaceutical care'?
• What philosophical commitments distinguish a care philosophy from a service?
• Where are the boundaries between pharmaceutical care, clinical pharmacy, and medication therapy management?
• What outcome domains define the scope of pharmaceutical care?

Key concepts

• Responsible provision of drug therapy
• Definite outcomes and quality of life
• Accountability and the covenantal relationship
• Philosophy of practice versus service
• Outcome domains: cure, symptom control, disease slowing, prevention
• Relationship to clinical pharmacy and medication therapy management

Key theories

Covenantal, outcomes-accountable practice

Hepler and Strand argued that pharmacy's professional maturity required moving from a product orientation to a relationship in which the pharmacist accepts responsibility for and is accountable to the patient for the outcomes of drug therapy.

Practice as a defined philosophy, patient-care process, and management system

Cipolle, Strand, and Morley frame any mature practice as three linked elements — a philosophy of practice, a consistent patient-care process, and a practice management system — and define pharmaceutical care as the application of these to drug therapy.

Mechanisms

As a philosophy, pharmaceutical care specifies whom the pharmacist serves (the patient), what the pharmacist is responsible for (the patient's drug-related needs), and what the pharmacist is accountable for (the outcomes of therapy). These commitments are then enacted through a consistent patient-care process and supported by a practice-management system, so that the definition is not merely aspirational but tied to repeatable activity and to measurable outcome domains.

Clinical relevance

A shared definition lets services be designed, taught, and evaluated consistently, and lets outcomes be compared across settings. This entry explains what the term means and how its scope is drawn; it is descriptive and does not provide individual treatment recommendations.

Evidence & guidelines

The defining statement is Hepler and Strand (1990), elaborated as a full practice model by Cipolle, Strand, and Morley (2012). The American College of Clinical Pharmacy (2008) offers a parallel definition of clinical pharmacy that helps locate the boundaries of the term. Programmes operationalising the definition, such as the Minnesota medication therapy management experience (Isetts et al., 2008) and facility-level studies of clinical pharmacy services (Bond & Raehl, 2007), illustrate how the scoped concept is measured.

History

Although pharmacists had long contributed clinical judgement, the explicit definition of pharmaceutical care dates to Hepler and Strand's 1990 paper, which framed it as a new social mandate for the profession. The definition was subsequently refined, and overlapping terms — clinical pharmacy in hospitals and medication therapy management in policy — emerged to describe related delivery models, prompting recurring efforts to clarify scope.

Debates

Is pharmaceutical care a philosophy, a service, or a label for many services?

Some authors treat pharmaceutical care as a single unifying philosophy of practice, while others use it interchangeably with specific services such as clinical pharmacy or medication therapy management, which complicates comparison of outcomes and definitions.

Key figures

• Charles D. Hepler
• Linda M. Strand
• Robert J. Cipolle
• Peter C. Morley

Seminal works

• hepler-strand-1990
• cipolle-strand-morley-2012

Frequently asked questions

Who first defined pharmaceutical care?

Charles Hepler and Linda Strand defined it in their 1990 paper as the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient's quality of life.

Is pharmaceutical care the same as clinical pharmacy?

They overlap closely. Pharmaceutical care names a patient-centred philosophy of accountability for medication outcomes, while clinical pharmacy is often used for the discipline and services, particularly in hospital settings, that deliver such care.