Forum for innovators: Pharmaceutical services implementation Successes and outcomes case study from Lithuania Title: 74 th FIP World Congress of Pharmacy and Pharmaceutical Sciences Chairs: Jūratė Švarcaitė Pharmaceutical care programmes manager, Nemuno vaistinė
Geography
Key facts and figures - 3 million inhabitants - 1,400 Pharmacies -Market is dominated by 3 major pharmacy chains. - Camelia pharmacy chain -300 pharmacies (270 operated directly and 30 by franchise partners), -400 pharmacists and 300 pharmacy technicians, -1st by the number of pharmacies and 2nd by turnover. - Pharmacy remuneration -Regressive margin, -Average margin 15%. -Pharmacy services -Dispensing service. 3
ANSWER: Pharmacy services Pharmacies compete by prices and discounts, Rumours about tenders, Prices of medicines are falling, Demotivated workforce, Nurses acquiring more competencies in healthcare services delivery, Implementation of pharmaceutical care in national legislation from 2015,
You have to start somewhere
PILOT PROJECT: PHARMACEUTICAL CARE SERVICE TO ASTHMA PATIENTS Project partner Glaxo Smith Kline (education grant and In check dial devices), 17 pilot sites- pharmacies, 8 in big cities, 9 in towns, 40 pharmacists Trained in asthma care and appropriate inhalation technique. Objectives: Improve patient inhalation technique, Improve asthma control and quality of life, Optimise medicines use, Collect evidence to support wider service roll out and reimbursement.
TIMEFRAME 04.07-08 Training 05.01 Project kick-off 07.31 Midterm evaluati on 09.30 Evaluati on
IN THE PHARMACY Materials and equipment: InCheck Dial medical device, Demo inhalers, Asthma Control Test, Pharmacy protocol and intervention form, Personalised Patient information leaflet, Posters in the pharmacies, Advertising on the website, Information leaflets for local GPs. Service takes approx. 10-15 min (free): Completing ACT, Providing education and counseling, Documentation.
PHARMACY SUPPORT AND MARKETING Practitioner support: Regular visits to the pharmacies, Regular e-mail and phone communication with practitioners, Marketing: 5 presentations to selected local Primary Care Centers, Advertising to patients (website and journal). Advertising in local media.
MID TERM RESULTS (I) Full service received by 172 asthma patients: - Average age of a patient 62 years old (9 children). - 99 female, 73 male patients. Average asthma control score 15,8 (the worst result recorded 4). 68% of the cases asthma control was unsatisfactory (>19). Average number of mistakes when using inhaler 2,11 (the worst score 10 mistakes). 72% of patients did at least one mistake when inhaling.
MID TERM RESULTS (II) 7 patients were prescribed inhaler for the first time. 7 patients were using only symptom reliever (salbutamol). Most frequent inhalation mistakes: doesn t exhale before inhalation (4), incorrect inhalation strength (6), doesn t hold their breath (7), didn t rinse their mouth after inhalation (12). Other problems identified: non-adherence, contraindications (beta-blockers), potential medicine- disease interaction aspirin, NSAIDs, ACE inhibitors.
POTENTIAL Egz.: (Vilnius) a female patient (1972) during her first visit did 2 major inhalation mistakes, during the second visit reduced to 0. ACT score improved from 21 to 24. Egz.: (Širvintos) a male patient (1944) during his first visit did 6 mistakes during the second visit 0 mistakes observed. ACT score improved from 8 to 21.
MID TERM RESULTS (III) Inhaler sales in the whole market and Camelia chain: 2013 1-7 2014 1-7 Difference Camelia 65000 67388 3,7% Market 256171 242750-5,2% Percentage 25,4% 27,8% Inhaler sales in the whole Camelia chain and in the pilot pharmacies: 2013 5-7 2014 5-7 Difference All Camelia pharmacies 38077 40424 6% Pharmacies participating in the pilot 4672 5122 10%
MID TERM RESULTS (IV) Inhaler sales in the pilot pharmacy where GPs were involved KAZLURUDA,VALANCIAUS22 143 186 30% SALBUTAMOL 100MCG/DOZEJE INHALERIS 200DOZIU 1 SERETIDE DISCUS 50MCG/100MCG/DOZEJE 60DOZIU 2 1 SERETIDE DISCUS 50MCG/250MCG/DOZEJE 60DOZIU 24 36 SERETIDE DISCUS 50MCG/500MCG/DOZEJE 60DOZIU 35 28 SERETIDE INHALER 125 25MCG/125MCG/DOZEJE 120DOZIU 4 3 SERETIDE INHALER 250 25MCG/250MCG/DOZEJE 120DOZIU 3 6 VENTOLIN 2MG/5ML SIR. 150ML 4 2 VENTOLIN INH.100MCG/DOZEJE 200DOZIU 70 110 Inhaler sales in the pilot pharmacy where GPs were not involved RASEINIAI,VILNIAUS126 180 192 7% SERETIDE DISCUS 50MCG/100MCG/DOZEJE 60DOZIU 10 1 SERETIDE DISCUS 50MCG/250MCG/DOZEJE 60DOZIU 23 18 SERETIDE DISCUS 50MCG/500MCG/DOZEJE 60DOZIU 57 85 SERETIDE INHALER 125 25MCG/125MCG/DOZEJE 120DOZIU 3 1 SERETIDE INHALER 250 25MCG/250MCG/DOZEJE 120DOZIU 9 9 VENTOLIN 2MG/5ML SIR. 150ML 7 8 VENTOLIN INH.100MCG/DOZEJE 200DOZIU 71 70
CONCLUSIONS AND LESSONS LEARNT 15 min consultation by a pharmacist costs 28 LT (approx. 10 $) not accounting for the loss in potential sales, In a busy pharmacy it is required to change workflow and organisation, Impossible to provide service where there is one pharmacist working in a shift, Resistance by some practitioners to engage in the service delivery, main argument is lack of time and difficult to recruit patients, Best results in the pharmacies where pharmacy staff was motivated and local GPs where informed, Great interest from the partner (4% of patients didn t use their symptom control medication).
WHAT IS NEXT? Training all pharmacy staff in asthma care and inhaler use (beginning 2015), Service roll out in 2/3 of the pharmacies that belong to the chain, Collaboration with pulmonologists and GPs, Collecting more results to prepare thorough economical analyses on the cost-savings of pharmacy service, Negotiations with state insurance fund and health ministry for possible service reimbursement.
THANK YOU? Any QUESTIONS? jurate.svarcaite@camelia.lt