EuroPharm Forum: Report: EuroPharm Forum Training Seminar 2008

Implementation Strategies - from Global Health Priority to Everyday Practice

The Training Seminar was organised on the premises of WHO Europe in Copenhagen on April 22-23 2008.

EuroPharm Forum President Inger Lise Eriksen had the pleasure of welcoming 46 participants from 19 countries focusing her introduction on the mission of the Forum and the close link to the WHO.

The programme of the Training Seminar was structured in four parts:

Impact of Global Decisions on Local Health Practice
Implementation Processes
Building and Using the Evidence
EuroPharm Forum High-priority Working Groups

Impact of Global Decisions on Local Health Practice

Manager of Pharmaceutical Policy in NIS countries, WHO, Nina Sautenkova, presented “WHO – matching services to new needs.” Ms Sautenkova started her presentation off by praising the close relationship between the EuroPharm Forum and the WHO. She, then, displayed the Eleventh General Programme of Work to display how the WHO works with its Member States, partners and the secretariat. Formerly, the WHO worked with isolated programme management, but the work now takes shape as integrated country work. This means that we will not, in future, see pharmaceuticals and pharmaceutical services treated as a programme; instead, it will be included in all programmes in a matrix structure. The presentation gave a good general insight into the new way of working of the WHO.

Ms Sautenkova’s presentation was followed by two examples on specific WHO programmes: Mental Health and Obesity. Regional Manager for Mental Health WHO Europe, Matt Muijen, explained about the many different problems within the mental health area. He also pointed out that the daily intake of medications for mental health-related illnesses was very high in the western countries compared to the NIS countries, but this certainly did not reflect that the problem was greater in the western countries, but merely that it was not given high priority in the NIS countries. He invited the EuroPharm Forum Working Group on Mental Health to collaborate with him and the WHO to unite knowledge and forces for the benefit of a greater outcome.

Regional Adviser on Nutrition and Food Security, Francesco Branca, then spoke about the vast problems with obesity and described the 6 action areas for possible ways to minimise the problems. He concluded that the policy framework was in place, and that prioritisation had been done, but in order to reach results, the critical mass of actions was missing. He, therefore, invited the EuroPharm Forum to contribute, and the audience provided some examples of how pharmacies work with obesity.

The session demonstrated that there is certainly a basis for collaboration within the issues Obesity and Mental Health.

Manager of the EuroPharm Forum Secretariat, Kirsten Holme Christensen, then presented the tools and materials available for professional work, and Member of the Executive Committee, Th(Dick)FJ Tromp, took the audience through the CD-rom Toolbox and encouraged members to send materials for the first update of the CD-rom.

Implementation Processes

The Training Seminar then moved on to the second issue on the agenda: Implementation Processes.

Dick Tromp and Ala Ciobanu, President of the Association of Pharmacists of the Republic of Moldova, displayed the process of implementing Good Pharmaceutical Practice in Moldova. Among the important points from the process was the prioritisation of activities. Ten activities were prioritised, and the presentation exhibited the progress with these priorities. The lessons learned from this process are very valuable and can be copied by other countries and can give inspiration to implementation of other programmes. The participants also learned that the process has not stopped; on the contrary, there are several plans for further progress and, at the moment, the Moldavian pharmacists are working with implementing asthma services, an obesity project and a smoking-cessation project.

Suzete Costa, Department Manager Pharmacy-Based Disease Management Programs, National Association of Pharmacies in Portugal, shared another interesting country experience with the participants. Ms Costa displayed the changes that Portuguese pharmacies have undergone since 2005 where legislation authorised non-pharmacists to own pharmacies and allowed medicines to be sold outside of pharmacy. In exchange, the pharmacies experienced an expansion of the pharmacy services provided by pharmacy, as a result of which, several services provided by pharmacy have been defined, developed and implemented. Despite the fact that the Portuguese pharmacy world experienced a revolution, Ms Costa reported that the spirit was quite good and, instead of complaining, the Portuguese pharmacies were seeing this as an opportunity to expand activities and to employ non-pharmaceutical staff in order to meet the new challenges.

The first day of the Training Seminar was concluded with a workshop session on implementation. The participants had signed up for either a workshop on Implementing Services or Implementing Reimbursement. Both workshops benefited from very active attendance, and the participants exchanged experiences and knowledge from their everyday lives when trying to implement either a service or reimbursement.

Building and Using the Evidence

On the second day, the item on the agenda was Building and Using the Evidence. Director R&D at Pharmakon, Hanne Herborg, started the morning by describing how, in Denmark, evidence on pharmacy activities has been collected. She went through the framework for trials of complex interventions and illustrated this with examples on dyspepsia and hay fever. Ms Herborg identified the differences between doing Random Clinical Trials and working with implementation research, where the former should be very strict and stick to protocol, while the latter should take into consideration the practical aspect.

Professor of Social Pharmacy, Nottingham, Claire Anderson, then reported from the work with a “Literature review update 2004-7” which has been conducted in England in order to document the importance of pharmacy activities. She explained how the data were rated and showed examples of evidence from smoking cessation, coronary heart disease and diabetes. Her presentation gave the obvious conclusion that pharmacy practice would need more evidence and documentation to be able to negotiate with decision-makers.

Last, but by no means least, on the platform was PGEU General Secretary John Chave. Mr Chave followed up on Claire Anderson’s presentation saying that more evidence is indeed needed to prove the value of pharmacy activities. In his very blunt presentation, Mr Chave said that it is the challenge of the profession to change the perception of pharmacies from that of a money-making machine into health provider. One of the many ways to meet this challenge is to use evidence. At the same time, he pointed out that it is the daily work in the pharmacies that might be the greatest influence. He added that a very important key to acquire influence was to present the message to the decisions-makers in a clear and simple manner.

EuroPharm Forum High-priority Working Groups

Following these very enlightening presentations, the audience separated into the high-priority Working Groups of the EuroPharm Forum Professional Programme to assume discussions on how to advance the work in the Groups.