QUB Centenary Presentation

Dr Martin Henman

October 25th, 2008

Health Strategy

• Quality and Fairness – A health system for you

• Launched November 2001

Department of Heath & Children• The Department of Health and Children's

statutory role is to support the Minister in the formulation and evaluation of policies for the health services.

• Also the strategic planning of health services. – This is carried out in conjunction with the Health

Service Executive, voluntary service providers, Government Departments and other interests.

• Minister for Health and Children – responsible to Cabinet

• Three Ministers of State with responsibility for specific areas

• Chief Pharmacist

Health Services ExecutiveRole: Day-to-day management of health service

Main Divisions in HSEProf Brendan Drumm - Chief Executive Officer.

HSE reports to a Board appointed by the Tánaiste & Minister for Health & Children, Ms Mary Harney, TD.

• Primary, Community and Continuing Care • National Hospitals Office• Population Health

– Support services• Cost of Health Service - €13 billion• 65,000 employees; 35,000 others

DELIVERY OF HEALTH SERVICES

• HSE should determine type & location of Health Services available in Country Region Locally

• Responsible for checking Quality of services

• Responsible for of materials

• Responsible for negotiating the terms services

e.g. Community Pharmacists, Hospital Consultants

Corporate Pharmaceutical Unit

• ‘promote best practice in relation to the use of drugs and devices’

• ‘evaluation of and propose changes to schemes for medicines’

• ‘standardisation and quality assurance’

• ‘primary contact between Industry and HSE’

HSE Drug Expenditure 2005

• Hospitals €280m

• Community Schemes €1.89.414b

Health Service in Ireland• ‘Mixed’ system

– State & Private provision & funding– Public employees & Private contractors

• Under pressure– Increasing population– Increased economic growth → increased

expectations– Access to information & technology from outside

Ireland

• Current dilemmas– State (Public) vs Private provision– Planned competition vs Open competition

Primary Care (Ambulatory Care)• Majority of service provided by Independent

Practitioners

• Each has Public & Private Patients

• Public patients – health care costs met totally by State– ‘Poor’ & elderly

– Certain chronic illnesses e.g. diabetes mellitus, epilepsy

• Private patients – pay all or some of health care costs– Usually pay for Physician visit

– Some medicines costs may be met by State

Organisation of Primary Care

• Team – GP lead

– Mostly GP employees or independent

– Health Centres

• Network – all independent

• Planning for low population density &

distribution of Primary Care services

Role within Primary Care

• Medicines Supply• Prescription/Medication Review• Patient Counselling

– Medication– ‘all such matters as the pharmacist, in the

exercise of his/her professional judgement, deems significant’

• Cost – effectiveness & wastage

Community Pharmacy• Independent Contractors who provide services • Contract with Health Services ExecutiveServices• Supply of prescription drugs • Non-prescription medicines supply• Medical foods & medical devices• Non medical/non pharmaceutical goodsOwnership• Pharmacy ownership – ‘independents’ & chains,

1,450 pharmacies• 2 main chains – Boots & Unicare• one vertically integrated group - Unicare

Present Position• Pharmacy Review Group – Govt established

committee– No limit on number of Pharmacy contracts– Published report – ambiguous conclusions– Dept Health & Children obtaining ‘legal advice’– Unrestricted development of chains continuing– IPOS – Independent Pharmacy Ownership Scheme– Wholesaler support for ‘Independent Ownership e.g.

Catalyst– Health Centres being privately developed e.g.

Touchstone

• Govt advised to seek ‘simplification’ of medicines payment schemes and a ‘reduction in payments to well-off professionals’

OPD• Tabs/Caps; Liquids• Original Packs e.g. Combined Oral

Contraceptives– Course of treatment – 21 days– Doses individually wrapped– PIL– Pack dispensed - labelling

• Broken Bulk– Pack of 100 -1000 tabs/caps– ‘Count & Pour’– New container - labelling

53

13

13

12

5

1

1

1

1

1

5

15

Source Of Information About Medication Other Than Doctor

13.

(Base: All Visited Doctor/Hospital in Last 12 Months)

Pharmacist

Friends/family

Nurse

Other doctor

Internet

The company that makesthe medicineHealth programmeson radio/TV

Relevant patient associationfor the medical condition

Other

Don't know

%

Medical dictionary/reference book

Magazines

Irish Patient’s Association 2007 survey

Chemist - Incidence Of Explanation Of Last Prescription

12.

(Base: All Visited Doctor/Hospital in Last 12 Months)

YesWhat the options were in termsof different types of medicationavailable to treat your condition

When to take your medication

How long to take your medication

What to avoid (e.g. alcohol drugs) whentaking your medication

Any side effects

Chemist - all

Medical Card Holders

NoDon'tRecall

2728

6566

6160

4750

3434

5755

2422

2827

3632

4845

1617

1012

1113

1717

1920

Those on Long Term Medication

31

66

60

51

36

58

28

34

37

51

11

6

7

12

13

Irish Patient’s Association 2007 survey

REGULATORY BODY

• The Pharmaceutical Society of Ireland– Membership necessary for use of title of

‘pharmacist’ – Register– Register of ‘retail pharmacy businesses’– Annual re-certification– Code of Ethics– Practice Standards– Inspection of Premises– Accreditation of Pharmacy Degree courses

REPRESENTATIVE BODIES• The Irish Pharmaceutical Union

– Trade Association– Negotiates terms & conditions under which pharmacists

will provide medicines & other services with DoHC & HSE

– Represents Community Pharmacists – e.g. raises concerns about security with An Garda Siochana

– Promotes role of Community Pharmacist in health service

– http://www.ipu.ie/– Professional Journal – IPU Review

Pricing Structure

* Manufacturer sets Trade Price in accordance with IPHA/HSE agreement.

* Product is sold to wholesaler at Trade less 15%.

• Wholesaler may pass on all or some of 15% to Community Pharmacies – Wholesaler discount• Wholesaler’s also may give additional discount to certain customers

• Separate arrangements for Hospitals – also being changed

Payment to Pharmacists by Health service

• Based upon Dispensing

• Cost of product + fee(s)

Community Pharmacies & Mark up

• GMS pricing is a formula – GMS cost price plus Pharmacist’s fee

• High Tech Medicinal Products Scheme – Patient Care Fee – Product cost paid by HSE direct to Wholesaler/supplier

• Non-GMS pricing – Cost Price plus 50% mark up

Pharmaceutical Price Regulation in Ireland - New agreement 2007

• HSE & Manufacturer’s (represented by IPHA)

• Price Freeze for duration of agreement• Prices of new medicines based on average price in

nominated EU countries• Price reductions for off patent medicines and

medicines due to go off patent within 6 months of agreement – affects pharmacist mark up on supply of medicines under non-State Schemes

• New (novel) medicines may be subject to Pharmacoeconomic evaluation – i.e. to assess the costs and benefits to Health Service

(HSE) Expert Advisory Groups

• Role – health care reform

– operational policy development, and ensure appropriate policy implementation

• Children, Diabetes, Mental Health, Older People, Cardiovascular services, Disability, Maternity services and Oral Health

Non-HSE bodies responsible for some aspect of Health Services

Ireland http://www.hiqa.ie/

Health Information and Quality Authority

• Setting Standards in Health and Social Services

• Monitoring Healthcare Quality • Social Services Inspectorate • Health Technology Assessment • Health Information • All health and social services system,

except Mental Health Services.

Health Technology Assessment

Systematic processes for evaluating the clinical and cost effectiveness of its health services

• HTA is for purchasers of healthcare, providers and users of services:

• Does this treatment work?

• For whom?

• At what cost?

• How does it compare with alternative treatments?

National Pharmacoeconomic Centre

• Provides advice & carries out analyses for Govt

IMB• Product Authorisation• Clinical Trials• Inspection of manufacturing & compliance

– Human meds– Veterinary Meds– Blood, blood products, tissues & cells

• Certification for Export• Importation & distribution• Classification of medicines• Controlled drugs & precursor chemicals

Pharmaceutical Industry

• Representative Bodies

– Irish Pharmaceutical and Healthcare

Association – R & D companies

– Association of Pharmaceutical Manufacturers

of Ireland – Generic manufacturers

Advertising

• Advertising of medicinal products in Ireland is regulated by the Medicinal Products (Control of Advertising) Regulations, 2007.

• Based on Directive 2001/83/EC as amended by Directive 2004/27/EC relating to medicinal products for human use.

UKTransnational

Patient Safety• Commission on Patient Safety and

Quality Assurance – Established by DoHC– Recommended ‘Patient Advocates’ but not

Patient Safety Authority

• Hospitals– Many have established ‘Audit and Quality

Review’ sections/units/department

Ongoing Research

• Diabetes Awareness through Community Pharmacies – Trevor Hunter– CAWT – collaboration with Prof C Hughes– Medication Review

• Weight Control – Catriona Bradley– Psuedo-patient

• Insitutionalised elderly medication review– Collaboration with RCSI & QUB

• Pharmaceutical Care in Intellectual Disability – Bernadette Flood

Research Interests• Role of Pharmacist

– Community Pharmacist in a Public/Private service– Hospital Pharmacist

• Reimbursement options for Pharmacists• Pharmaceutical Care

– Brief Interventions– Chronic Disease– Integrated Medicines Management & ePatientRecord

• Medicines regulation, Pharmacovigilance & patient safety

• Patient’s experiences of medicines & of pharmacy• Pharmaceutical Education – UG & CPE/D

– Competence & its implementation– Moral development & professionalisation– Research skills

• Pharmaceutical Policy