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Tapping the Potential of Pharmacists in Primary Care Services A/Prof Timothy F Chen President, Social & Administrative Pharmacy Section, FIP
22nd-24th April 2015
The University of Sydney Page 2
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The University of Sydney Page 3
The University of Sydney Page 4
The University of Sydney
Founded 1850
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The University of Sydney Page 5
The University of Sydney Page 6
How do we tap the
potential of
pharmacists in
primary care?
The University of Sydney Page 7
Tapping the full potential of community pharmacy depends on the interplay between:
Education
Practice
Research
Policy
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The University of Sydney Page 8
Tapping the full potential of community pharmacy depends on the interplay between:
Education
Practice
Research
Policy
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RESEARCH •Clinical sciences •Social sciences •Pharmacological sciences •Basic pharmaceutical sciences •Pharmacoepidemiology •Ethics / Management / Policy •Other
The University of Sydney Page 9
Tapping the full potential of community pharmacy depends on the interplay between:
Education
Practice
Research
Policy
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POLICY & REGULATION •Government department •Professional organisations •Policy development –
•National Medicines Policy •Quality Use of Medicines
•Other
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Tapping the full potential of community pharmacy depends on the interplay between:
Education
Practice
Research
Policy
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EDUCATION •Curriculum needs to map to needs •Course work & research degrees •Face-to-face & online •Other
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Tapping the full potential of community pharmacy depends on the interplay between:
Education
Practice
Research
Policy
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PRACTICE •Traditional: Dispensing & compounding •Professional pharmacy services: medication management, health promotion, disease management, other •Community, hospital, aged care, clinics etc •Other
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What do we know from the international literature?
Documentation of Role
– Numerous key documents: position papers, white papers and other key documents
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Documentation of Role
– Numerous key documents: position papers, white papers and other key documents
The University of Sydney Page 14
Documentation of Role
– Numerous key documents: position papers, white papers and other key documents
The University of Sydney Page 15
The University of Sydney Page 16
The National Medicines Policy
Quality Use of Medicines (QUM) refers to
1. Judicious
2. Appropriate
3. Safe
4. Efficacious
Department of Health and Ageing (1999). The National Medicines Policy 2000. Canberra: Commonwealth of Australia
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Pharmacists may contribute at different levels
Patients / Carers
• Dispense Prescriptions
• Prescribe non-prescription products
• Health promotion & screening
• Triage role
• Research
• Other
Health Care Professionals
• Recommendations on pharmacotherapy
• Referrals
• Drug information
• Shared decision making – case conferences
• Education
• Research
• Other
Health Care system
• Inform policy through practice and evidence
• Professional organisations
• Government & other third party payers
• Non-government organisations
• Research
• Other
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The University of Sydney Page 18
http://www.psa.org.au/download/standards/competency-
standards-complete.pdf
The University of Sydney Page 19
http://www.psa.org.au/download/standards/competency-
standards-complete.pdf
The University of Sydney Page 20
http://www.psa.org.au/download/standards/competency-
standards-complete.pdf
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Vision – Philippine Pharmacists Association
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Why is medication expertise critical?
Rationale: Ageing Population
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http://www.un.org/esa/population/publications/worldageing19502050/
18% 40.8%
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Ageing Population in Philippines
http://ageingasia.org/ageing-population-philippines1/
Information from Ageingasia
– The number of older people is growing
– Older people need care and support
– Older people struggle with poverty
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Australian Institute of Health and Welfare (AIHW) 2006
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Proportion of higher users of medications (as a percentage of those taking at least one medication*)
NPS Newsletter 13, 2000; http://www.nps.org.au/publications/health-professional/nps-news/pre-2006/nps-news-13
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Number of medications
Total under 65 years
65-74 years
75-84 years over 85 years
4 or more 14.5 10.1 33.2 40.7 38.2
6 or more 4.6 2.6 13.1 17.0 16.2
*Excludes complementary medicines (vitamins, herbal preparations, etc).
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What are the major roles in primary care?
1. Medication management & safety – prescription & non-prescription / CAMS
2. Health promotion and self care
3. Screening and disease state management
– Many others – dose administration aids, adherence services, clinical interventions at the time of dispensing, administering vaccinations
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1. Concept of Medication Review: from drug to patient focus
Supply or
Dispensing
role
Provision
of service in
collaboration1
with other
health care professionals
HMR / RMMR
Drug Patient Patient focus -
Quality Use of Medicines
(QUM)
Chen TF, AC de Almeida Neto. Pharmacy World and Science, 2007, 29:574-576. Chen T, Crampton M, Krass I, Benrimoj S. Journal of Social and Administrative Pharmacy, 2001; 18:83-90
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Australian Community Pharmacy – “Forward Pharmacy”
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1. Medication Safety and Quality
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0
• Manufacturer
• TGA
• Specialists
• GPs
• Pharmacists
• Nurses
• Consumer
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1. Impact of Medication Management Review - on anticholinergic & sedative medicines (DBI)
Nursing Homes (RMMR) Community (HMR)
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Nishtala PS et al. Drugs & Aging 2009; 26: 677-86; Castelino RL et al. Drugs & Aging 2010; 27: 135-48.
Pre-DBI = 0.50 (equivalent to 1 AC/S)
Post-DBI = 0.22 (equivalent to ½ AC/S
Pre-DBI = 0.50 (equivalent to 1 AC/S)
Post-DBI = 0.33 (equivalent to ½ AC/S)
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1. Impact of HMR on MAI – a measure of prescribing appropriateness
Castelino et al., Annals of Pharmacother, 2010.
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1. Impact of residential medication management review
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Nishtala et al Am J Geriatr Psych 2008; 16: 621-32
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1. How to effect change: Case Study Meetings
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1. Case Conference Meeting Pharmacist and Medical Practitioner
Chen, Bennett, Smith et al., 2000 http://www.guild.org.au/public/dmmrfiles/report_stgeorge.pdf
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1. Post-discharge HMRs & Case Conference
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2. Health Promotion and Self Care
– Health promotion and self care
programs are a core activity
– Various programs to support
pharmacists in this role eg
– inPHARMation – professional
magazine for both
pharmacists, technnicians &
assistants
– Self Care Fact Cards
(approximately 80 topics)
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2. Health Promotion and Self Care
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2. Health Promotion and Self Care
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3. Screening Programs & Disease State Management
– Screening programs in community pharmacy
– Common for physical illnesses eg diabetes, hypertension
– Less common for mental illnesses eg depression
– Evidence to support disease state management programes, especially in
asthma and diabetes, however professional fee for service remuneration is
patchy
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0
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3. Screening Programs & Disease State Management
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3. Feasibility Study: Depression Screening
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3. Depression Screening
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3
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In Summary, how
do we tap the
potential of
pharmacists in
primary care?
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Consider the interplay between:
Education
Practice
Research
Policy
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Mission – Philippine Pharmacists Association
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What are the challenges and how can we secure additional roles?
Product-centred supply
function
Patient-centred clinical
focus
Business focus Health focus
Independent practitioners who
compete
Integrated into health care
teams to collaborate
Maintain status quo and be
reactive
Responsive to emerging
needs and be proactive
Under utilised health resource Fully utilised health resource
Laggards Innovators
Judged by consumers & HCP
as expendable
Judges by consumers and
HCP as essential
Get the balance right:
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Vision – Philippine Pharmacists Association
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Thank You
Questions & Comments …
A/Prof Tim Chen
Preisident,
Social & Administrative Pharmacy Section
International Pharmacy Federation
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Supplementary slides
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Concluding Comments:
Principles of how do we get there?
– Leadership to set priorities and plan
– Champions from within and outside our profession
– Research and practice evidence to support new roles
– High quality education and training
– Appropriately skilled and distributed workforce (including support staff)
– Dissemination and practice change support
– Willing to collaborate with others
– Be “Eight Star Pharmacists”
– Most importantly – we must be passionate, willing and committed to change
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Many Other Major Roles
– Packing dose administration aids
– Medication adherence assessments (usually based on consistency with which consumers get their medicines dispensed)
– Clinical interventions at the time of dispensing
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http://www.cdc.gov/nchs/data/databriefs/db42.pdf
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Global burden of disease study 2010: 10 Leading Causes of Disease Burden
The Lancet, August 29, 2013 DALY YLD YLL
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Is there a shortage of pharmacists in the Philippines?
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– Community pharmacy 70%
– Hospital pharmacy
– Industry
– Academia 1%
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