forum for innovators: pharmaceutical services ... · title: chairs: 74th fip world congress of...

Title:

Chairs:

74th FIP World Congress of Pharmacy

and Pharmaceutical Sciences

Forum for innovators: Pharmaceutical services

implementation – Successes and outcomes

case study from Lithuania

Jūratė ŠvarcaitėPharmaceutical 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

Training04.07-

08 Project kick-off

05.01

Mid-term

evaluation

07.31Evaluati

on09.30

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:

Inhaler sales in the whole Camelia chain and in the pilot pharmacies:

2013 1-7 2014 1-7 Difference

Camelia 65000 67388 3,7%

Market 256171 242750 -5,2%

Percentage 25,4% 27,8%

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

Inhaler sales in the pilot pharmacy where GPs were not 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

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