Pharmacists’ Patient Care Process (PPCP)
Case: 57-year-old male taxi driver with type 2 diabetes mellitus (T2DM),
hypertension, obesity, GORD, and depression.
Goal: Achieve diabetes remission, improve mobility, and reduce medication
burden.
PPCP Step Content
Subjective data: Reports stress-related overeating, limited
activity, long working hours (12-hour shifts, 5–6 days/week),
and convenience food intake. Aims to reverse diabetes and stop
medications. Objective data: T2DM (3 years, HbA1c 10%), BP
controlled on candesartan, LDL 129 mg/dL, BMI 43.4 kg/m²
Collect
(148.6 kg, 1.85 m). Medical history: Hypertension, GORD,
depression, family history of CVD and T2DM with complications.
Medications: Metformin 1000 mg BID, candesartan 8 mg daily,
trazodone 50 mg HS. Lifestyle: Ex-smoker, social drinker,
minimal physical activity.
Indication/effectiveness: Metformin appropriate but
inadequate alone (HbA1c 10%). Candesartan effective.
Trazodone appropriate for depression. Safety: No reported
adverse effects; renal function should be monitored.
Adherence: Possible dietary and lifestyle nonadherence due to
Assess occupational barriers. Lifestyle risks: Obesity, poor diet,
stress, physical inactivity. Identified DRPs: (+) unnecessary
drug: none; (–) missing drug: statin indicated; (↑) dose too high:
not applicable; (↓) dose too low: glycemic control inadequate;
(DDI) none significant; (ADE) obesity-related complications and
poor diet.
Plan Therapeutic goals: HbA1c <7%, weight reduction ≥10% in 6–
12 months, LDL <100 mg/dL (preferably <70), maintain BP
<130/80 mmHg, improve mobility and well-being.
Pharmacologic plan: Continue metformin; consider adding
GLP-1 receptor agonist (e.g., semaglutide) or SGLT2 inhibitor
(e.g., empagliflozin); initiate moderate-intensity statin (e.g.,
atorvastatin 20 mg daily); continue candesartan and trazodone.
Nonpharmacologic plan: Referral to dietitian and weight
management program; individualized low-calorie or
Mediterranean-style diet; gradual physical activity as tolerated;
PPCP Step Content
behavioral counseling for stress and eating patterns; encourage
sleep hygiene. Monitoring: HbA1c every 3 months; lipid profile
every 6 months; BP, renal, and hepatic function routinely;
weight monthly.
Collaborate with GP/endocrinologist to add GLP-1 RA or SGLT2i
and start statin therapy. Provide patient education on dietary
modification, physical activity, medication adherence, and self-
Implement
monitoring. Refer to dietitian and behavioral therapist.
Document interventions and communicate care plan with
healthcare team.
Reassess HbA1c, weight, adherence, mood, and side effects at 3
months. Review lipid profile, renal and hepatic function, and
Follow-up
overall goal progress at 6 months. Adjust pharmacotherapy and
and
reinforce lifestyle interventions based on response. Evaluate for
Evaluate
possible diabetes remission if HbA1c <6.5% without
medications.