PRE-CONFERENCE WORKSHOP MATERIALS
Mike Rouse and Arijana Meštrović
Introduction SMART Pharmacy Presentation
Continuing Professional Development in the Pharmacy Profession
Pillars and Foundations of Educational Quality
Pharmacist Competencies Assessment and Development
Creating SMART Goals in a Pharmacist’s Portfolio
Commitment to Quality Means Commitment to Change (Change Management)
In Finland there are several medication review models varying from siple reviews to comprehensive clinical reviews. This presentation describes the different procedures, as well as related continuing education trainings. Also, experiences of implementing medication review services in the healt care system and their uptake in Finland are discussed.
Bjarke Abrahamsen (Curriculum Vitae as PDF): Cost-utility analysis of a medication review service in the Region of Southern Denmark – protocol and evaluation of implementation (download lecture material as PDF)
Polypharmacy is increasing in a growing elderly population. One way to assess the quality of the patient’s medication is to conduct medication reviews which can result in better adherence, patient safety and a more rational pharmacotherapy. However, attempts to evaluate the economic impact of medication reviews have so far lacked conclusive results. To investigate the economic impact of medication reviews of elderly polypharmacy patients at the community pharmacy, we initiated an extended cost-utility study in 2016. Over a six-month period, pharmacies in the Region of Southern Denmark conducted 1,000 medication reviews. Using patients’ unique identification number, patients were followed for 12 months, and data related to any contact with the healthcare system would be used for the cost-utility analysis. To facilitate the implementation of the medication review service, pharmacies received a comprehensive package of support. This presentation will present the protocol of our study together with our support the pharmacies received throughout the study period to facilitate the implementation of medication review service in the participating pharmacies.
Pharmacists have been performing medication reviews as part of their professional duties, aiming to optimize the clinical effectiveness of medicines taken by patients. The review is best achieved through an interview with the patient. The pharmacist looks for accessing information, usually medication-related, through a conversation with the patient. This requires both therapeutic, as well as, communication abilities. Although widely recognized as a key element in healthcare, communication skills are usually less covered in pharmacy education and training. This presentation aims to address and debate how communication skills are essential to take full advantage of direct patient interaction when performing medication reviews. Knowing that caring for others is a mainly a behavioral competence, it is aimed to contribute to participants’ awareness of how critical human relationships are in achieving enhanced patient care.
For more than 20 years we have trained pharmacists to deliver pharmaceutical care to individual patients through the process of medication review. Within the hospital setting, this process starts with medicines reconciliation which is recognised globally to improve patient safety. The process identifies, documents and communicates an accurate list of medicines (prescribed, over the counter or complimentary). Several national organisations have issued guidance and directives to support implementation of this practice when people move from one care setting to another. The process requires trained healthcare professionals with the necessary knowledge, skills and experience. Successful models employ systems for managing this process through a multidisciplinary team approach. Within available resources, it is challenging to establish and implement a system which ensures all patients benefit from potential harm reduction. Within the multidisciplinary team, there is a need to identify and remove barriers to a safe and efficient system. Staff engagement, ownership for roles and responsibilities, training and inter-professional collaborative working, together with clinical and management leadership are key to success. When people are moved between wards or to other healthcare settings, communication among healthcare providers with regards continuation or changes to medicines is necessary and unless information is successfully transferred there is a risk that the potential reduction in medication errors is not realised. Clinical pharmacists assign a priority code through application of risk criteria on initial review. The priority code is used to communicate the frequency of future medication review required during the hospital stay and can be modified if circumstances change. Electronic records facilitate sharing of pharmaceutical care issues to maintain continuity of care and inform communication on discharge. Medication review by hospital pharmacists is required throughout a hospital stay. Patients are likely to benefit most where systems are in place to support collaborative practice, communication and prioritisation.
Medication review is a structured evaluation of a patient’s medicines with the aim of optimising medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions. In 2016 the efforts of many enthusiastic pharmacists in Slovenia have resulted in achieving reimbursement for an advanced medication review (Type 3) that was introduced at the ambulatory level. The service started as a pilot project by Health Insurenace Institute of Slovenia in 2012 with the aim to increase the quality of prescribing in the most eastern region of Slovenia. The service supports physicians in optimizing the individual patients’ therapy and it is performed by certified pharmacists, who are specialists in clinical pharmacy. The certification system was introduced by the Slovene Chamber of Pharmacy, which in 2014 officially defined two types of medication review services. Apart from the advanced medication review (called Pharmacotherapy review) with a focus on prescribing quality also a medicines use review (Type 2a) with the focus on adherence issues. For this purpose, standard operational procedures and educational programs to assure pharmacists’ competencies were set for both services. Both services also gained a place in the renewed Pharmacy Act (December 2016) and were exposed in the debates as positive solutions assuring optimal and rational use of medicines for Slovenian citizens.
The Pharmaceutical Group of the European Union (PGEU) is the association representing the 400.000 community pharmacists from 31 European countries. In this presentation, an outline of the role community pharmacists play in primary care is provided, along with an overview of the demand for Access to healthcare services in primary care. With a growing demand for services and shrinking healthcare budgets, community pharmacists across Europe are developing and implementing innovative services and activities in order to address such demands and provide more patient-facing clinical services in addition to the safe, rational and effective dispensing of medicines. As such, this presentation also includes a description of the varikus services and activities which are provided by community pharmacists, with a specific focus on comprehensive medication reviews for chronic patients and related services for patients starting a new medication. Finally, the barriers, facilitators, vision and next steps for the pharmacy profession are presented.
Multi-dose dispensing (MDD) is a common alternative to ordinary prescription dispensing for people, mostly elderly, with regular medication use combined with difficulties in administering their drugs. The aim of the study was to investigated the impact of multi-dose dispensing on safe and rational medication use of older patients and occurrence of drug-related problems (DRPs). The study sample consisted of a total of 208 patients aged 49-108 years (mean age = 82.6 years), who were involved in the MDD service provided by Pharma Service Oy in Finland in 2015-2016. The EU(7)-PIM (potentially inappropriate medications) list and the SFINX (Swedish, Finnish, Interaction X-referencing) databases were used for identifying potentially harmful PIMs and DDIs (drug-drug interactions).
Statistically significant differences of the PIM and DDI proportions were identified with a Chi-square test throughout the demographic and physical/mental health groups. The survey shows that for 81% of the study participants at least one medicine from the EU (7)-PIM list was prescribed, and 64% of PIMs were potentially harmful . According to the SFINX database, five (5) patients (2.4%) had category D clinically significant DDIs that could manifest as considerable DRPs, particularly with older patients. In addition, with 61% of the patients, the number of medicines had increased within six months after the initial MDD order, and in most cases two medicines were added. In conclusion, the MDD service is suggested to include a regular medication review adjusted to the specific patient groups (i.e. older patients) to avoid inappropriate medication and potential DRP-s.
Marja Airaksinen (Curriculum Vitae as PDF)
Daniela Fialová (Curriculum Vitae as PDF)
Sari Maarit Dimitrow (Curriculum Vitae as PDF)
Ulrika Gillespie (Curriculum Vitae as PDF)