Tapping the Potential of Pharmacists in Primary Care Services

Transcription

1 Tapping the Potential of Pharmacists in Primary Care Services A/Prof Timothy F Chen President, Social & Administrative Pharmacy Section, FIP 22 nd -24 th April 2015 The University of Sydney Page 1

2 The University of Sydney Page 2 2

3 The University of Sydney Page 3

4 The University of Sydney Founded 1850 The University of Sydney Page 4 4

5 The University of Sydney Page 5

6 How do we tap the potential of pharmacists in primary care? The University of Sydney Page 6

7 Tapping the full potential of community pharmacy depends on the interplay between: Education Policy Practice Research The University of Sydney Page 7 7

8 Tapping the full potential of community pharmacy depends on the interplay between: Education Policy RESEARCH Clinical sciences Social sciences Pharmacological sciences Basic pharmaceutical Research sciences Pharmacoepidemiology Ethics / Management / Policy Other Practice The University of Sydney Page 8 8

9 Tapping the full potential of community pharmacy depends on the interplay between: Education POLICY & REGULATION Government department Professional organisations Policy development Policy National Medicines Policy Quality Use of Medicines Other Practice Research The University of Sydney Page 9 9

10 Tapping the full potential of community pharmacy depends on the interplay between: EDUCATION Curriculum needs to map to needs Course work & research degrees Face-to-face Education & online Other Policy Practice Research The University of Sydney Page 10 1

11 Tapping the full potential of community pharmacy depends on the interplay between: Education Policy PRACTICE Traditional: Dispensing & compounding Professional pharmacy services: medication management, health promotion, disease management, Practice other Community, hospital, aged care, clinics etc Other Research The University of Sydney Page 11 1

12 What do we know from the international literature? Documentation of Role Numerous key documents: position papers, white papers and other key documents The University of Sydney Page 12

13 Documentation of Role Numerous key documents: position papers, white papers and other key documents The University of Sydney Page 13

14 Documentation of Role Numerous key documents: position papers, white papers and other key documents The University of Sydney Page 14

15 The University of Sydney Page 15

16 The National Medicines Policy Quality Use of Medicines (QUM) refers to 1. Judicious 2. Appropriate 3. Safe 4. Efficacious Department of Health and Ageing (1999). The National Medicines Policy Canberra: Commonwealth of Australia The University of Sydney Page 16

17 Pharmacists may contribute at different levels Patients / Carers Dispense Prescriptions Prescribe nonprescription products Health promotion & screening Triage role Research Other Health Care Professionals Recommendations on pharmacotherapy Referrals Drug information Shared decision making case conferences Education Research Other Health Care system Inform policy through practice and evidence Professional organisations Government & other third party payers Non-government organisations Research Other The University of Sydney Page 17 1

18 The University of Sydney Page 18

19 The University of Sydney Page 19

20 The University of Sydney Page 20

21 The University of Sydney Page 21

22 Vision Philippine Pharmacists Association The University of Sydney Page 22

23 Why is medication expertise critical? Rationale: Ageing Population 18% 40.8% The University of Sydney Page 23 2

24 Ageing Population in Philippines Information from Ageingasia The number of older people is growing Older people need care and support Older people struggle with poverty The University of Sydney Page 24

25 The University of Sydney Page 25 Australian Institute of Health and Welfare (AIHW) 2006

26 Proportion of higher users of medications (as a percentage of those taking at least one medication*) NPS Newsletter 13, 2000; Number of medications Total under 65 years years years over 85 years 4 or more or more *Excludes complementary medicines (vitamins, herbal preparations, etc). The University of Sydney Page 26 2

27 What are the major roles in primary care? 1. Medication management & safety prescription & non-prescription / CAMS 2. Health promotion and self care 3. Screening and disease state management Many others dose administration aids, adherence services, clinical interventions at the time of dispensing, administering vaccinations The University of Sydney Page 27

28 1. Concept of Medication Review: from drug to patient focus Drug Supply or Dispensing role Patient Provision of service in collaboration 1 with other health care professionals HMR / RMMR Patient focus - Quality Use of Medicines (QUM) Chen TF, AC de Almeida Neto. Pharmacy World and Science, 2007, 29: Chen T, Crampton M, Krass I, Benrimoj S. Journal of Social and Administrative Pharmacy, 2001; 18:83-90 The University of Sydney Page 28

29 Australian Community Pharmacy Forward Pharmacy The University of Sydney Page 29 2

30 1. Medication Safety and Quality Consumer Pharmacists Nurses Specialists GPs Manufacturer TGA The University of Sydney Page 30 3

31 1. Impact of Medication Management Review - on anticholinergic & sedative medicines (DBI) Nursing Homes (RMMR) Community (HMR) Pre-DBI = 0.50 (equivalent to 1 AC/S) Pre-DBI = 0.50 (equivalent to 1 AC/S) Post-DBI = 0.33 (equivalent to ½ AC/S) Post-DBI = 0.22 (equivalent to ½ AC/S The University of Sydney Page 31 Nishtala PS et al. Drugs & Aging 2009; 26: ; Castelino RL et al. Drugs & Aging 2010; 27:

32 1. Impact of HMR on MAI a measure of prescribing appropriateness Castelino et al., Annals of Pharmacother, The University of Sydney Page 32 3

33 1. Impact of residential medication management review The University of Sydney Page 33 Nishtala et al Am J Geriatr Psych 2008; 16:

34 1. How to effect change: Case Study Meetings The University of Sydney Page 34

35 1. Case Conference Meeting Pharmacist and Medical Practitioner Chen, Bennett, Smith et al., The University of Sydney Page 35

36 1. Post-discharge HMRs & Case Conference The University of Sydney Page 36

37 2. Health Promotion and Self Care Health promotion and self care programs are a core activity Various programs to support pharmacists in this role eg inpharmation professional magazine for both pharmacists, technnicians & assistants Self Care Fact Cards (approximately 80 topics) The University of Sydney Page 37

38 2. Health Promotion and Self Care The University of Sydney Page 38

39 2. Health Promotion and Self Care The University of Sydney Page 39

40 3. Screening Programs & Disease State Management Screening programs in community pharmacy Common for physical illnesses eg diabetes, hypertension Less common for mental illnesses eg depression Evidence to support disease state management programes, especially in asthma and diabetes, however professional fee for service remuneration is patchy The University of Sydney Page 40 4

41 3. Screening Programs & Disease State Management The University of Sydney Page 41

42 3. Feasibility Study: Depression Screening The University of Sydney Page 42

43 3. Depression Screening The University of Sydney Page 43 4

44 In Summary, how do we tap the potential of pharmacists in primary care? The University of Sydney Page 44

45 Consider the interplay between: Education Policy Practice Research The University of Sydney Page 45 4

46 Mission Philippine Pharmacists Association The University of Sydney Page 46

47 What are the challenges and how can we secure additional roles? Get the balance right: Product-centred supply function Business focus Independent practitioners who compete Maintain status quo and be reactive Under utilised health resource Laggards Judged by consumers & HCP as expendable Patient-centred clinical focus Health focus Integrated into health care teams to collaborate Responsive to emerging needs and be proactive Fully utilised health resource Innovators Judges by consumers and HCP as essential The University of Sydney Page 47 4

48 Vision Philippine Pharmacists Association The University of Sydney Page 48

49 Thank You Questions & Comments A/Prof Tim Chen Preisident, Social & Administrative Pharmacy Section International Pharmacy Federation The University of Sydney Page 49

50 The University of Sydney Page 50

51 Supplementary slides The University of Sydney Page 51

52 Concluding Comments: Principles of how do we get there? Leadership to set priorities and plan Champions from within and outside our profession Research and practice evidence to support new roles High quality education and training Appropriately skilled and distributed workforce (including support staff) Dissemination and practice change support Willing to collaborate with others Be Eight Star Pharmacists Most importantly we must be passionate, willing and committed to change The University of Sydney Page 52 5

53 Many Other Major Roles Packing dose administration aids Medication adherence assessments (usually based on consistency with which consumers get their medicines dispensed) Clinical interventions at the time of dispensing The University of Sydney Page 53 5

54 The University of Sydney Page 54 5

55 Global burden of disease study 2010: 10 Leading Causes of Disease Burden The Lancet, August 29, 2013 DALY YLD YLL The University of Sydney Page 55 5

56 Is there a shortage of pharmacists in the Philippines? The University of Sydney Page 56

57 Community pharmacy 70% Hospital pharmacy Industry Academia 1% The University of Sydney Page 57

58 The University of Sydney Page 58

59 The University of Sydney Page 59