Europharm Forum Annual Meeting, 4 October 2008
Chair: Inger Lise Eriksen
Session 1: Reimbursement
World class commissioning will deliver better health and well-being for all, better care for all, and better value for all. Literature reviews show that, whereas areas such as smoking cessation, hypertension and diabetes, as further evidence was identified, other key areas need to be explored further to ensure evidence of effectiveness.
Implementation of cognitive services: Recent developments in pharmacy practice in the UK comprise new repeat dispensing arrangements, Patient Group Directions and supplementary pharmacist prescribing as well as electronic prescribing and electronic transmission of prescriptions. The services offered by pharmacies are being divided into three groups, being essential (eg repeat dispensing), advanced (eg MURs) and enhanced.
Implementing MUR has had a negative effect on the inter-professional collaboration, and also a perceived time constraint in the pharmacies is an issue. In Europe, the barriers seem to be similar, consisting of lack of time, attitude/opinion of other healthcare professionals, lack of clinical education, lack of education within communication and lack of money.
Lessons learned: Identify local needs, a need for understanding of how the pharmacy operates and ensure robust monitoring arrangements.
Summary: key drivers for successful implementation are interested of key stakeholders, sufficient resources, clarity and continuity in project leadership.
From Product to Service in Pharmacy Business
– the Case of Value-based Pricing
Claus Møldrup, University of Copenhagen
E-mail:
cm@farma.ku.dk
Business as unusual: The presentation focused on two different partners: the industry and the pharmacies. 4 years ago, it was controversial to offer a refund of money if the results of a treatment were not satisfactory. Is that rational pharmacotherapy? Yes – because of the economical aspect in the patient's perspective. Today, the strategy is rather popular, turning into “value-based pricing”. Now, the industry has an interest in delivering services that can provide a better outcome in the end. This will be the future way of conducting rational pharmacotherapy; consumers paying more for the service following the original product, instead of saving money on the generic product. Maybe the future pharmaceuticals will be for free, but with patients a contract with the company.
Thus, today, companies are producing pharmaceutical packages, containing not only drugs, but also elements such as diet-plans, measuring equipment or other items that can be of value to the patient. Comparing the original product with the product package will show that the package has a better effect than the original - and, furthermore, being different from the generics of the original drug, saving the market share if the package is being prescribed.
This is business as usual, selling products as usual; however, with packages instead of only drugs. Nevertheless, this is UNusual in the sense of providing more than just a drug, and, instead, selling a cognitive service, which will be implemented by the pharmacy. The pharmacists are essential to the industry, and, in the end, pharmacists should be paid for providing the needed information and follow-up.
Country experiences
Denmark: How Danish Pharmacies Are Remunerated for Providing Cognitive Services
Helle Jakobsgaard, The Association of Danish Pharmacies
E-mail:
hj@apotekerforeningen.dk
In Denmark, pharmacists are not used to pay for pharmaceutical services, because it is free to visit the GP or go to the hospital. However it is essential that the pharmacists are paid to deliver those services in order to encourage pharmacies to provide them. On the other hand, it is worth noticing that the patients will show more interest in the offer if it is for free.
Obtaining the right to receive payment for health services is based on a need for the service, convincing the government of the need for funding. First asthma inhaler services were supported by the state, justified by the argument that a poorly treated asthma patient is a financial burden to the society. Smoking Cessation is supported by the Ministry of Health and by municipalities. Medication Reviews and Special Services in Nursing Homes are being negotiated between the pharmacies and the state, dealing also with the GPs. It has turned out to be easier to start a project, gaining some experiences, and then be able to prove its effectiveness.
Advice: You need to prove that you can solve a problem for the politicians, be able to document of the ef-fect of the services and have others recommend that pharmacies solve a problem.
Germany: Reimbursed Services and New Activities
Andrea Hämmerlein, ABDA
E-mail:
a.haemmerlein@abda.aponet.de
Family Pharmacy Contracts: Patients can choose a family pharmacy, the pharmacy having a complete jour-nal of the patient kept only in the pharmacy. Also collaboration with GPs and an insurance company (BAR-MER) is established, ensuring a higher degree of drug safety for the patients.
EDGAr, an assessment of the patients’ skills in measuring their own blood glucose, showed that conversa-tions and thorough instructions from the pharmacist significantly improve the quality of blood glucose measuring. Another survey has been conducted to monitor the inhalation technique of asthma patients, showing that all patients did benefit from the pharmaceutical intervention. Both experiments received high approval from many sides.
The current community pharmacy needs to consider new concepts in order to secure the future; however it has proven difficult to undertake more responsibility.
United Kingdom: Medicines Use Review
Colette McCreedy, National Pharmacy Association, UK
E-mail:
c.mccreedy@npa.co.uk
Contractual framework: Essential services are provided by all pharmacists, advanced services can be of-fered by some specialized pharmacies, whereas the enhanced services are commissioned in order to ad-dress local needs. Other health care professionals can also apply for the funding for the enhanced services.
Medicines Use Review enables the pharmacist to deal with any doubt or misunderstanding of the patient, the patient participating for free. The project is nationally managed, using a nationally agreed template form.
90 % of UK pharmacies have consultation areas, suitable for cognitive services and private talks. This has been highly approved by the patient society. Barriers to the MUR uptake are time, understanding of the service, training, lack of collaboration, premises, publicity and awareness, etc. These barriers have been approached with more engagement with the physicians, reformed MUR-forms as well as new reporting procedures, increased support at a local level and better marketing and publicity for the service.
Lessons learnt: Money is not the only problem with implementing a mainstream pharmacy service. The service should be in collaboration with GPs from the beginning, and IT solutions are essential. The future calls for more focus on quality in the pharmacies.
Session 2: Non-adherence
The User Perspective and Non-adherence
Ebba Holme Hansen, University of Copenhagen
E-mail:
ehh@farma.ku.dk
How do we measure adherence? Non-adherence is especially relevant in the case of poly pharmacy, but also when the treatment is long-term, and when the medication has troublesome adverse effect. There are several problems in researching non-adherence, the measurements often being imprecise, outcomes being intermediate, too small studies and to short follow up.
Several components are essential for successful interventions for chronic care, among these information, counselling, reminders, family care and well-considered follow-ups. Trends in compliance research define terms which have developed over a period of time considering the identity of the non-compliant patient. Thus our understanding of how interventions should be conducted is closely related to our perception of the patient.
Information and cognitive models
The user is not a robot, just doing what he is asked. Also he is not an empty vessel with no background knowledge, but an autonomous being who should not have his autonomy compromised. Professionals should know more about the users, being able to estimate their background, in order to ensure adherence. An understanding of different cultures is necessary.
Can concordance be achieved? The professional integration of the user perspective is essential. General instruments are needed for screening for non-adherence and identification of problem types. Individual coaching is time consuming and needs availability of devices and expertise. It is, and will always be, neces-sary to meet the user at his level in order to be able to take him to a higher level of understanding.
Country experiences
A new professional electronic tool is being used by pharmacists, containing all medicines dispensed to a patient in the last 4 months, and is shared between all French pharmacies through a central service. It is a database which can be used to identify the patient’s use of drugs, thereby making the dispensation of medicines safer.
Sweden: Non-adherence: Swedish Experiences on Tools
Astrid Kågedal, Apoteket AB
E-mail:
astrid.kagedal@apoteket.se
An intense debate in Sweden is focused on patients taking the wrong medicine. For a long time the Swedish Pharmacists has not been able to see what medications a patient is taking, but in 2002 the pharmacists was allowed access to patient records, and today three main tools is in use: Patient Medication Review, Medica-tion Use Review and the National Pharmacy Register. The latter ensures that all dispended medicine must be register and be accessible online.
It is possible for the patient to book an appointment with a pharmacist, also including a follow-up meeting. 300 pharmacies provide this service, with 250 customers signing in per month. Patients view is that the meeting has a positive effect on their knowledge about their medication.
Home