La integración del farmacéutico en el equipo de salud

Presentación del tema: "La integración del farmacéutico en el equipo de salud"— Transcripción de la presentación:

1 La integración del farmacéutico en el equipo de salud
Colaboración con otros profesionales de la salud para obtener mejores resultados: La integración del farmacéutico en el equipo de salud Dr Michel Buchmann Presidente de la FIP [Abstract- "People who experience a health problem do not always consult a physician: certain studies suggest that only 1 in 3 consult a physician. The others take no action, or consult another primary healthcare professional such as a community pharmacist. When physicians and pharmacists collaborate on the responsible use of medicines and patient safety, for example through engagement in physician-pharmacist Quality Circles in Switzerland, the patients benefit individually, in terms of increased quality of care, and collectively, in terms of cost savings. Triage of healthcare issues by community pharmacists is being undertaken, where patients are referred to physicians as needed, notably through telemedicine. The future for community pharmacists lies in the use of their competencies and cooperation with other members of the healthcare team." Objective of the presentation to encourage pharmacists to pro-actively establish bridges of cooperation with other healthcare professionals in whichever ways are available to them minutes in length. Goncalo will be making a presentation on adherence and medicines use review in Montevideo] DIFFERENT INTRODUCTIONS

2 Las 126 Organizaciones Miembros de la FIP (enfocadas en la profesión farmacéutica o las ciencias farmacéuticas) For those of you who are new to FIP, the International Pharmaceutical Federation, or FIP, is the global Federation of National Associations of pharmacists and pharmaceutical scientists. We have 126 Member Organizations from over 80 countries. We also have individual Members, those pharmacists and pharmaceutical scientists who may or may not be members of their national association but who would like to have closer contact with FIP. These two groups together, means that FIP represents three million pharmacists around the world. Our goal is to connect them to each other, and to us. Our wish is to build with our members, the tools and knowledge necessary to move pharmacy and the pharmaceutical sciences forward in your own countries and communities.

3 FIP Nuestra misión es “mejorar la salud mundial a través del desarrollo de la profesión y las ciencias farmacéuticas, de modo a permitir una mejor descubierta, desarrollo, acceso y uso seguro de medicamentos de calidad, adecuados, eficaces y asequibles en todo el mundo.” La FIP fue fundada en 1912 en Holanda. La FIP mantiene relaciones oficiales de colaboración con la Organización Mundial de la Salud (OMS) y tiene asiento en el Consejo Económico y Social de las Naciones Unidas. FIP’s global mission and ultimate goal is better patient care, increased patient safety and improved global health through the responsible use of medicines.

4 View videos of the roundtables online at:

5 Cumbre Ministerial, Ámsterdam 2012
As part of FIP’s 100 year celebrations, the issue of responsible medicines use was raised to the attention of Ministers of Health at the Summit, organized with the Ministry of Health of the Netherlands, last year and the role of pharmacists was highlighted. FIP has insisted that the pharmaceutical workforce requires recognition and investment to ensure that: • The correct medicine is provided to the right patient at the right time • The use of antibiotics and generic medicines are optimized, while medication errors are avoided. • Patient adherence to treatment increases, especially for patients with chronic diseases. • Technology is used to improve patient care and improve communication between health professionals

6 Cumbre Ministerial 500 Mil Millones de dólares en juego El Instituto IMS identificó la oportunidad de ahorrar un gasto anual en salud a nivel global de 500 mil millones de dólares a través de un uso responsable de los medicamentos en todo el mundo. During the Summit, Prof Harvey Fineberg, President of the Institute of Medicine of the United States insisted on the benefits of using the untapped potential and skills of pharmacists, in close collaboration with doctors and nurses. The opportunities are immense. The IMS report, which also informed the Ministers Summit, estimated that $ 500 billion is being wasted in global health spending because of lack of responsible medicines use. New perspectives are calling for new activities to be developed for patients, especially through supporting patients in local community pharmacies. $500,000,000,000

7 Declaración del Centenario de la FIP
Pharmacists are confident in the future and are committed to contribute to the responsible use of medicines. During the Centennial Congress, the Centennial Declaration was unanimously adopted and signed by all present FIP Member Organisations, and signifies our joint, professional commitment to increasing responsible use of medicines globally. Our goal is that every citizen and policy-maker understands and sees the benefits of the role that pharmacists play in improving responsible medicines use.

8 Necesidades de los pacientes
Ejemplo de los EE.UU. y el Reino Unido en 2001 Cada mes: En una población de 1000 personas 800 tienen algún problema de salud 327 buscan cuidados de salud 217 consultan a un médico 65 consultan a un terapeuta de medicina alternativa 9 personas son ingresadas en hospital However, if we want better health, then we first need to know what our population’s health needs are. Let me share an example with you from the US and the United Kingdom that raises questions about patients’ health needs and their use of the healthcare system. In 2001, a study was published about what actions people would take when faced with a health problem. The results of the study showed that in every month, for every 1000 people, 800 experienced a health problem, but only 327 of them requested medical assistance. Of these 327, 217 visited a physician while 65 consulted an alternative medicine therapist. Of these 327, 9 were hospitalised. Yet almost two thirds - almost 500 people - chose not to access medical care. In the USA, some patients may not have been able to access medical care due to economic difficulties, since there was no national health service. However, the question still remains - what did the other 500 people who did not request medical assistance do? This issue was not addressed in the article and so I sent this question to the study authors, but never received a response. It would be very interesting to know if similar studies have been conducted in your country, to know more about the health seeking behaviours and needs of your population. In an era when countries are striving to provide equitable and universal health coverage, this is an important question for public health and for healthcare budgets. What are these patients doing to address their health concerns – searching the internet? Asking family and friends? Or perhaps they are accessing local resources, such as pharmacies? My extensive years of practice in community pharmacy has convinced me that many of these individuals visit us in our community pharmacies. Green LA, et al, N Engl J Med 2001, 344, Citado 387 veces

9 Acceso a cuidados de salud y aconsejamiento
Aquellos que promueven el bienestar Otros profesionales de la salud, como por ejemplo, los farmacéuticos Médicos In most cases, the physician is no longer considered the first, nor the only source that patients access for health care and advice. Therefore health professionals have a growing role to play in optimizing the care of their citizens. Interprofessional conflict will not help. It is time to collaborate, to develop the competencies needed to provide an adequate web of primary care services. The central concern of all health professionals must be to support the patient.

10 Atención primaria: el papel de los profesionales de la salud
Funciones de los farmacéuticos Triage farmacéutico (pronóstico) Derivación/ referencia 1 2 3 Tratamiento a corto plazo con OTC Medidas preventivas y educación en salud Funciones de los médicos A physician colleague of mine stated it well, when he said that "We cannot be competitors, since patients who go to the pharmacy, DECIDE NOT to use our services. Rather, you pharmacists have the same initial role as physicians. You are accessible to listen to the patient when he comes to you with a health concern. The difference is in our complimentary skill sets. You pharmacists are able to perform an initial triage, through your training and experience, to decide whether a short term treatment with OTC medicines/self-care is warranted, OR if preventative measures and health education are necessary, OR to refer the patients who require an adequate diagnosis to us physicians when the problem is more serious. You are able to follow the treatment required and ensure the patient is compliant with their medicines over the long-term.” To optimize primary care, we must collaborate. We no longer speak to the future of primary care medicine but of primary care, where the care may be medical, nursing or pharmaceutical. Let me share with you an example for each number and area of collaboration identified in this diagram. Diagnóstico y prescripción Validación de recetas 4 adherencia 5 Seguimiento médico y prevención

11 Triage farmacéutico – un ejemplo
1 Pharmacists’ education should prepare graduates with the competencies needed to undertake an initial triage; screening patients who choose to see them first. This slide presents the decision algorithm for a project being implementing in my home country in Switzerland. The professional organization, pharmaSuisse, has developed a ‘netCare’ service in collaboration with physicians, since there is a shortage of primary care physicians in the country. This service allows for remote consultations with physicians by internet. For example, when the pharmacist receives a request from a patient concerning a potential conjunctivitis of the eye, the pharmacist conducts an initial assessment in a private area. Then the pharmacist will either: 1. propose a short-term treatment (self-care with OTC medicines), OR 2. contact a physician through the internet for advice, OR 3. refer the patient directly to see a physician or send them to the hospital emergency services, if no local physician is available. The pilot test was very successful and so this service has now been rolled out nationwide with over 200 pharmacies providing this new ‘netCare’ service to date. I have been informed of the recent proposal made by Federal Council of Pharmacy of Brazil demanding the recognition of a pharmaceutical prescription for OTC medicines and medicinal plants. In the same proposal, they seek to establish protocols of collaboration with physicians for medicines that do require a prescription. FIP provides its full support for initiative such as this, that help ensure the responsible use of medicines.

12 Primer punto al que acceden los pacientes para asesoramiento en temas de salud
When we are concerned and act ethically to ensure the best quality, safety and health for our communities, we become true health professionals. And I am proud to tell you that I know the reality; I know how demanding practice can be when we are looking for excellence, I know how difficult it is to push for change.

13 Beneficios económicos y sanitarios del triage farmacéutico
Another example is the NHS Scotland Minor Ailment Service, which has been implemented since In Scotland they identified the need to improve access to medicines and it was recognised that pharmaceutical triage and the provision of OTC medicines by competent pharmacists led to both better patient health and economic benefits. Through this service, pharmacists provide advice, treatment or referral to another health care professional according to the patients’ needs, and are remunerated for these services. This programme has reduced unnecessary visits to GPs and nurses while ensuring better health through responsible medicines use. The key is that when a patient simply asks to purchase a product, the pharmacist, in their role as a health professional, is able to assess the patients’ symptoms and provide support to help solve the health problem. When needed, the pharmacist will recommend OTC treatment that is not contra-indicated, that is safe and effective for the patient.

14 Educación en salud y prevención
2 I will not spend much time on this topic, but would simply like to state the importance of the pharmacists public health role in spending the time to educate patients on their medicines, their health and preventative measures. By reinforcing and repeating messages that the patient receives from other healthcare professionals we can stimulate better patient dialogue and understanding.

15 3 Círculos de Calidad: Impacto económico en el gasto farmacéutico 30%
Ahorro en 2010  € por médico 30% For this step where influencing the physician’s prescription is important, let me illustrate the potential collaboration between physicians and pharmacists through the example of Quality Circles. These quality circles in Switzerland, are formed of physicians working with one or two facilitators pharmacists. They work based on analysing and comparing the prescribing costs (as indexes) of local physicians (in blue) with a national control group (in red) and with evidence-based guidelines. The results presented demonstrate that a partnership can achieve a significant economic impact as well as an optimization of the choice of medicines used. In 2010 for the group of 19 physicians working together for the past 11 years, there was an annual savings per physicians of approximately 190,000 Euros. Doctors' prescriptions are known in detail (they have agreed), open to the discussion of each, in all humility, and subjected to comparison with independent research published to determine the quality / price ratio of the different treatment options. Confidentiality is assured within the circle. Based on the therapeutic efficacy and pharmacovigilance data, consensus is established and accepted by physicians participating in the discussion. Monitoring is conducted annually to confirm or refute the previous choices. M. Ruggli; Source de données brutes : OFAC 2011 La Revue Prescrire, 2000,20,1203,146; 2002,22,234,926; 2005,25,266,780; 2008,28,297,542. The Annals of Pharmacotherapy, Abril 2010, vol 44 15

16 Nivel de colaboración entre farmacéuticos y otros profesionales de la salud
Prácticas farmacéuticas de colaboración – autoridad para iniciar o modificar un tratamiento farmacológico Nivel 5 Círculos de calidad Nivel 4 Asesoramiento prospectivo y/o derivación a otro profesional de la salud Nivel de responsabilidad Nivel de colaboración Asesoramiento reactivo tras la intervención de otro profesional de la salud Nivel 3 If we look at the level of collaboration between pharmacists and other healthcare professionals defined by FIP, from minimal contact, to pharmacists who are seen as a core part of the multi-disciplinary team with the authority to initiate and modify medicine therapy. The quality circle example is at the 4th highest level of collaboration: the pharmacist offers advice that the prescriber has the option to accept or reject. Nivel 2 Autoridad en todo el sistema de salud para suministrar medicamentos Nivel 1 Nivel mínimo de comunicación entre farmacéuticos y otros profesionales de la salud 16 Work process Continous quality improvement of prescription 1. Prescription data (benchmarking per physician and therapeutic class) 7. Assessment of the results and improvements 6. Check on the impact of the consensus 2. Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5. Application of the consensus 3. Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market 4. Consensus of each quality circle

17 Círculos de calidad: metodología
1. Datos sobre la prescripción 7. Evaluación de los resultados y mejoramientos 2. Pautas terapéuticas basadas en la evidencia 6. Verificación del impacto del consenso 3. Análisis de los hábitos de prescripción en comparación con datos científicos y económicos, y búsqueda de alternativas en el mercado de medicamentos This is the cycle of the quality circle method. The prescription data is obtained from a national billing organisation, the guidelines on medicines use are reviewed, the prescribing habits of the physicians are analysed, and then these are discussed and consensus is reached with the local physicians on the most responsible prescribing. Physicians then apply the consensus to their practice, the impact is checked and then the results and improvements are analysed. 5. Aplicación del consenso 4. Consenso 17 Work process Continous quality improvement of prescription 1. Prescription data (benchmarking per physician and therapeutic class) 7. Assessment of the results and improvements 6. Check on the impact of the consensus 2. Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5. Application of the consensus 3. Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market 4. Consensus of each quality circle

18 Médicos y farmacéuticos reunidos para optimizar la prescripción de medicamentos
Here is a picture of one of our discussion with physicians where we present the guidelines and evidence base, present the prescription habits and then discuss and come to a consensus on what the physicians will do in their practice. The collaboration and relationships have been built over many years. When I started my community pharmacy practice I had the goal of collaborating and working with local health professionals and I took every opportunity to share my knowledge and interest to collaborate with others.

19 Los círculos de calidad tras 11 años…
Una práctica real de colaboración, y no un sueño! Los objetivos: Optimizar la seguridad y la eficacia de los tratamientos Divulgar los mensajes de farmacovigilancia de un modo eficiente Ahorrar en el gasto farmacéutico gracias a decisiones profesionales y no a recortes en los precios Aumentar la resistencia de los profesionales de la salud a la influencia de las actividades de marketing de la indústria farmacéutica. Reconocer el valor de la educación inter-profesional en favor de una atención sanitaria centrada en el paciente. PERO la persistencia es absolutamente imprescindible! After 11 years we can definitely say that this collaboration between health professionals is not a dream but reality, The objectives of better efficiency, higher safety, reduction of the costs are reached thanks to professional choices and recognised interdisciplinary education. But persistance is absolutely necessary! 19 19 19

20 Validación de recetas 4 When looking at step 4, Validating a prescription, means that there is a quality control of its content and compatibility with other medicines the patient is taking. Since the year 2000, I keep all the significant professional interventions I make in a file. Here you see an example from February 2010 when a dose of a medicine was corrected in the doctor's absence. The doctor sent his agreement with thanks to me the following day.

21 Servicios farmacéuticos comunitarios remunerados por mejorar la adherencia terapéutica
5 1. Entrevista de motivación entre paciente y farmacéutico Medición de la adherencia 4. Informe de la intervención farmacéutica 3. Informe de adherencia terapéutica One example I show here, however, is where the pharmacists are trained in motivational interviewing and use an electronic device that records information on the patients’ medicine taking behaviour. Adherence is essential to successfully combating disease. What is needed to achieve adherence? Communication and trust between patients and the health care team. Pharmacists must show that we are part of the health care team, providing important and innovative services. Prof Olivier Bugnon, PMU , Lausanne

22 Directrices Conjuntas FIP/OMS de Buenas Prácticas en Farmacia (BPF)
This brings me to Good Pharmacy Practice, that is at the very heart of the profession of pharmacy. The joint FIP/ World Health Organization guidelines on Good Pharmacy Practice highlight that pharmacists are an essential part of any comprehensive health system; and that pharmacists play an important role in improving access to health care. Closing the gap between the potential benefit and the actual value realized from medicines. Pharmacists are medicines experts that should be enabled to use their skills and knowledge to ensure responsible medicines use in their communities. We must promote excellence in practice for the benefit of those served.

23 Equipo de salud de una residencia geriátrica
As a community pharmacist myself, delivering quality means providing services, information, medicines, and support that will ensure that my community’s health improves. Not isolated in my community pharmacy but in close collaborative practice with the ten physicians working in the same region and with the health professionals providing care to the 250 residents in 4 nursing homes. When we are concerned and act ethically to ensure the best quality, safety and health for our communities, we become true health professionals.

24 El papel del farmacéutico de comunidad
The goal of the pharmacist is to ensure the SAFE, QUALITY and EFFECTIVE use of medicines. Through appropriate pharmaceutical triage, responsible use of OTC medicines and communication with patients, the community pharmacist has a vital role to play in supporting patient self-care. 24

25 Es imprescindible demostrar el valor añadido de nuestra profesión.
Mensaje final No olvidemos nunca el mensaje que nos envió la Organización Mundial de la Salud en 2011: “los farmacéuticos serán juzgados por cómo pongan en práctica su compromiso en todos sus ámbitos de intervención.” Es imprescindible demostrar el valor añadido de nuestra profesión. My dear colleagues never forgot the WHO message published in 2011: “pharmacists will be judged on how they translate their commitment into practice in all settings” Evidence demonstrating our added value is indispensable in the coming years.

26 Les invito a disfrutar de la experiencia de un congreso de la FIP en…
I hope that you will take the opportunity and commit to improving the responsible use of medicines in your communities. We are ready and looking forward to hearing about your progress at the FIP annual congress to be held in Bangkok 2014, or the Pharmaceutical Sciences World Congress in Melbourne in April 2014, AND….

27 Y una invitación especial…
Congreso Mundial de Farmacia y Ciencias Farmacéuticas de la FIP de 2016 en… I especially invite you, and announce that the FIP congress in 2016 will return to Latin America and be held in: Buenos Aires! I hope to see you there! Thank you very much. ¡Buenos Aires!