Apr 26, 2017 - Source: PGEU Annual Report 2015 ... Source: PGEU Annual Reports 2010-2016. 0. 5. 10. 15. 20. 25 ... º 1429/2007, de 2 de Novembro. Art 2.º.
Implementation of advanced pharmaceutical services in Europe Filipa Alves da Costa Centro de Investigação Interdisciplinar Egas Moniz (CiiEM)
Katholieke Universiteit Leuven 26th April 2017
From medication centred service towards patient centred services
Classification of services • Core Services: essential services provided by all licensed pharmacies during core pharmacy opening hours. • Basic Services: may require separate consultation facilities and special training of pharmacy staff; may need to be available outside core pharmacy opening hours • Advanced Services: require separate consultation facilities in the pharmacy and accredited pharmacists to provide it. Source: PGEU Annual Report 2010
What has been described?
Source: PGEU Annual Report 2010
Source: PGEU Annual Report 2013
Source: PGEU Annual Report 2014
Source: PGEU Annual Report 2015
Source: PGEU Annual Report 2016
Evolution of the number of European countries providing patient-centred services 25
BP measurement
20
Cholesterol measurement Glucose measurement 15
Weight measurement Smoking cessation Diabetes Management
10
Asthma Management Hypertension Management Medicines Use Review
5
Vaccination 0
2010
2013
2014
Source: PGEU Annual Reports 2010-2016
2015
2016
10
Comparing two data sources 16
15 14
14
14 13 12
12
11 11 10
10
9 8
8
PGEU
6 6 6
4
2
0
Biological parameters
Smoking cessation
Medicines Disease Homecare Use Review management services
Source: PGEU Annual Reports 2013; Martins, van Mil and Costa, 2015
Vaccination
Martins
Provision and remuneration Prescribing Medication administration First aid Training medication usage Public health services Disposal of medicines Needle exchange Sampling biological products for analysis Monitoring pts progress Interchange of therapeutic alternatives Point of care testing Vaccination Assessment og health care needs Services to hospitals Medication reconcilliation Generic susbtitution Night and emergency hours Clinical review of Rx Compounding Administrative review of Rx
Third-party payment Mandatory
0
5
10
15
20
25
Source: FIP, 2015
Source: FIP, 2015
PRACTISE - PhaRmAcist-led CogniTIve Services in Europe
What are the services provided?
The degree of implementation?
Existing remuneration?
Tamara L. Isenegger , Maria I. Branco Soares , Filipa Alves da Costa , Kurt E. Hersberger
PRACTISE - PhaRmAcist-led CogniTIve Services in Europe Preliminary Results: The example of Portugal
20 services
16 services
Policy maker
Reseacher
Practitioner
3 without consensus: INR, NMS, Adherence Tamara L. Isenegger , Maria I. Branco Soares , Filipa Alves da Costa , Kurt E. Hersberger
PRACTISE - PhaRmAcist-led CogniTIve Services in Europe Level of implementation of services INR mon
5
Travel medicine
7
Smoking cessation
7,5
Home delivery
7,5
Adherence support
10
Pharm Care
10
Inhalation techn assess
20
Health promotion
30
Needle exchange
36,7
Admin inject
53,3
Immunisation
77,7
Point of care testing
78,3 0
10
20
30
40
50
60
70
80
90
Evolution of community pharmacy services
80
• Monitoring of biomarkers • Provision of information • Waste management programme
90
• Needle exchange Programme • Opioid replacement programme • Pharmaceutical care Programmes
2005
2007
• Broader framework for pharmaceutical services (e.g. awareness campaigns, screening, medicines management, patient education…)
• Other pharmaceutical services (legal framework)
Portaria n.º 1429/2007, de 2 de Novembro Art 2.º Pharmaceutical Services Pharmacies may provide the following pharmaceutical services focusing on health promotin and patients’ well being: a)
Domiciliary support;
b)
Administration of first aid;
c)
Administration of medicines;
d)
Use of auxiiliairy diagnostic and therpeutic means ;
e)
Administration of vaccines not included in the National Vaccination Plan;
f)
Pharmaceutical care programmes;
g)
Information campaigns;
h)
Collaboration in health education programmes.
Domiciliary support
Administration of first aid
Vaccination Administration Technique
PRACTICE 25% THEORY 75%
Legal Aspects & Good Pharmacy Practice
Basic Concepts of Imunology
Administration of vaccines and injectable medicines
Safety
Vaccines/ Injectable Medicines
Approaching the patient
Raise Public awareness
• 4634 pharmacists acredited by the PPS (55.8%)3
• 2,125 pharmacies provide the service (76.4%)1 • Determinant factors to choose pharmacy: waiting time and trust2 • Satisfaction: 98% would repeat the experience and recommend it 1. Horta, 2015; 2. Costa, 2015; 3. Ordem dos Farmacêuticos, Dez 2016
Administration of vaccines not covered by the National Health Plan 08/09 09/10
10/11
11/12
12/13
13/14
14/15
# participating pharmacies
1.588 57,5%
1.622 58,7%
1.703 61,7%
1.785 64,8%
1.945 70,3%
1.818 65,7%
2.125 76,4%
% vaccines administered by pharmacists
91,0%
92,2%
92,0%
93,5%
98,9%
98,5%
98,7%
% flu vaccines administered in pharmacies
36,4%
49,7%
44,2%
49,0%
38,0%* 40,9%* 49,3%*
% Vaccinates individuals in pharmacies aged ≥ 65
50,4%
49,7%
45,0%
43,3%
20,5%
Source: CEFAR, Centro de Estudos e Avaliação em Saúde da ANF
N/A
Free administration in public health care centers, without prescription, to risk groups, incl. ≥ 65 years
N/A * New method for estimating coverage
• Pneumococcus≈ 60%1 • Flu=49,9% elderly (2013/2014)2
Port 1429 Production failure SARS
H5N1 H1N1
1. Rodrigues, 2009; 2. Nunes, 2014; 3. Pinto, 2013
The value of vaccination With intervention
Without intervention
Difference
Population covered
152,522
152,522
0
# Pharmaceutical interventions
152,522
0
152,522
Time spent on interventions (h)
1,189,672
0
1,189,672
% indiv vaccinated in pharmacies vs HCC
42.4%
25.8%
16.6 pp
Quality of life
76.0%
76.0%
0.0 pp
Years with quality of life
115,917
115,917
0
ECONOMIC VALUE
7459.8 M €
9163.0 M€
-1703.2 M€
Hospitalizations (PNHS)
0.0 M€
853.3 M€
-853.3 M€
Medical appointments (PNHS)
0.0 M€
417.3 M€
-417.3 M€
Remunerated pharmac int
-630.5 M€
0.0 M€
-630.5 M€
Out-of-pocket
197.9 M€
0.0 M€
197.9 M€
SOCIAL VALUE
Want to know more about vaccination in other countries?
Evidence of health gains for public health. PHARMACIST-LED PROGRAMMES: NEEDLE EXCHANGE • Started in 1993 (collaboration with National Commmittee Fighting Against Aids - CNLCS).
• Between 1993 and 2008 a total of 43,045,293 needles have been collected, 30,317,392 of which in community pharmacies. • The number pf pharmacies involved ranged between 1,212 (2000) and 1,685 (1994).
• More than 7,000 new infections have been avoided per 10,000 injectable drug users in the first 7 years of the programme (Exigo, 2002) • The estimated benefit for each exchanged needle was 3,01€ and a reduction in
inequalities of 63% (CEMBE, 2016)
“The role of the Pharmacies was determinant for responding to the infection by HIV/AIDS problem among inhjectable drug users. It was a model worth replicating!”
Prof. Henrique de Barros, National Coordinator for HIV/AIDS
New services? Despacho n.º 199/2016, de 7 de janeiro 2.e) Valuing community pharmacies as agents for care provision, investing in the development of measures to support rational drug use and using their services, in articulation with the PNHS, to rehearse the partial delegation of administration of medicines for oral oncology and communicable diseases;
Education and Training: A Pre-requisit for service provision
Solving and simulating clinical cases and ethical dilemmas
PRACTICE 25%
THEORY 75%
Pathophysiology of HIV and Diagnose
Anti-retroviral therapy
Real life monitoring of patients
Law and ethics
Medication adherence
Communication and counselling
Recognition and remuneration
0,63 €
8,28 €
Portaria 195 C/2015
Portaria 262/2016
Portaria 301-A/2016
Conclusion 1 2
3 4
• Train and educate
• Deliver • Measure • Influence • Receive
