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