Transcript Document

IPHA Annual Meeting
26th November 2008
The Evolving Role of the Community
Pharmacist
Seamus Feely
Secretary General
Irish Pharmacy Union
W.H.O. Report 2008
People are increasingly impatient with
the inability of health systems to “meet
stated demands and changing needs”
and “their failure to provide services in
ways that correspond to their
expectations”.
“PHC can do that.”
European Context – Tallinn
Charter
Target and integrate disease-specific programmes –
Achieve Better Outcomes.
 Health Systems Generally
- Holistic approach including Health Promotion and
Disease Prevention.
 Commitment to values of solidarity, equity and
participation with particular focus on the vulnerable.
Irish Context
“Primary Care is an approach to care that includes a range of
services designed to keep people well, from promotion of health and
screening for disease to assessment, diagnosis, treatment and
rehabilitation as well as personal social services.”
Primary Care – A New Direction
DoHC 2001
 Deliver services that are equitable, inclusive and fair.
 Deal with health problems at the lowest level of complexity at the
first point of contact.
 Achieve better health outcomes for patients and cost
effectiveness.
Tackling Chronic Disease
- DoHC April 2008
 Promote and improve health of population.
 Reduce risk factors of chronic illness.
 Promote integrated care.
 Improve outcomes and quality of life.
“Much of this care can and should take place within the
primary care setting.”
Evolving and Improving
Progress – healthier, wealthier and longer life expectancy.
Two Examples:
Globally:
“If children were dying at 1978 rates, there would have been 16.2 million
deaths globally in 2006 – the global figure was 9.5 million – difference of 6.7M
equates to 18,329 children’s lives being saved every day.”
Key:
Essential Medication
Improved access to water sanitation and ante-natal care
Ireland:
Cardiovascular Strategy (1999) – Impact – 23.4% decline in age standardised
mortality from coronary heart disease.
Determinants of Demand for
Community Pharmacy Services
Population Size
Population Age
Population Health
Health Policy
Income per Capita
Cost of Medicines
Drugs
Health Policy
Service Access
Drug AccessAccess
Medicines
Drug Need Need
Medicines
National Drug
Medicines Demand
Demand
Cost
Globally
 Health Economy growing faster than GDP.
 Total Health spending as % of GDP increased from 8%
to 8.9% - 35% growth between 2000 and 2006.
(adjusted for inflation).
Ireland
 Corresponding statistics for Ireland is 7.5% of GPD,
still below OECD average of 8.9%.
 2000 to 2006-growth of 8.8% per annum (Ireland
started from lower baseline).
PCRS Spend on Public Medicine
Schemes, 2001-2006
€ mn
2001
2002
2003
2004
2005
2006
All PCRS
Spend
€1,024 €1,271 €1,432 €1,653 €1,881 €2,075
Medicine/ €674
Pharmacy
Payments
€816
€942
€1,089 €1,195 €1,362
Medicine/ 66%
Pharmacy
as % of
Total
64%
66%
66%
64%
66%
Analysis of Increased Expenditure
(GMS, DPS and LTI)
Increase In:
€M
 Number of Eligible Individuals
 Items/Scripts per Eligible Individual
 Item Cost
75
284
316
Changes in the cost of individual medicine items accounted for approximately half of
the cost increases associated with the GMS (€250 m) and the DPS (€48 m)
between 2001 and 2006*.
–
* This is most likely driven by new medicines prescribed rather than significant cost changes to
existing items.
Medicine Demand in Ireland 2006
Average € per annum spend (age related)
Source: PricewaterhouseCoopers 2006
1,547
1,293
953
770
424
129
< 25 Years
25-44 Years
45-64 Years
60-74 Years
75 +
A ll Eligible

Strong correlation between age and average medicine spend per capita

For GMS Eligible individuals, the Prescription medicine spend per capita in
2006 increases from €129 for under 25s to €1,547 for over 75s

In the overall population, the average Irish person spent €561 on medicines in
2006
Population trends in Ireland (000’s)
2025-2050
(Source; Eurostat, CSO)
% Change
Age Group
2004
2025
2050
2004-2025
0-14
843,000
896,000
876,000
3.9
15-64
2,750,000
3,214,000
3,166,000
15.2
65+
451,000
812,000
1,435,000
218.3
4,044,000
4,922,000
5,478,000
35.5
456,815
470,057
449,831
-1.5
Ireland Total
EU25 Total
Cost – Value for Money
 Early intervention – long-term savings
 Better Quality of Life and Outcomes
 Need to minimise wastage
 Community based Health Care – e.g. cardiovascular,
mental illness - Budget Transfers
 “Demand Led” concept
 Value – wider and more complex than cost of
medicines
Pharmacy Sector in Ireland - Profile
1539 Pharmacies of which:
 1340 owned by pharmacists
 199 owned by non pharmacists
 837 are single owned pharmacies
 702 in chains of two or more pharmacies
What do Community Pharmacists Do?
 Advise patients on the safe and effective use of medicines.
 Community pharmacies are under contract by the State to
dispense medicines under various schemes. The State
Schemes (GMS, DPS, LTI, etc) now account for over 70% of all
medicines dispensed by pharmacists. Of these, 74% are
dispensed under the GMS scheme and are dispensed on a
flat-fee, zero margin basis.
 Deliver Methadone Protocol and High Tech Scheme
 Pharmacists screen prescriptions for potential drug therapy
problems which may be due to therapeutic duplication, drugdrug interactions, incorrect drug dosage or duration of drug
treatment, etc.
Total Savings Achieved Through
Pharmacy by Non Reimbursed Activity
Payor
Promoting
Compliance
Reducing
Prescribing
Error
Minor Ailment
Advice
Minimising
Adverse Side
Effects
Total
Government
€112,316,965
€38,683,695
€35,314,140
€6,167,707
€192,482,507
Healthcare
Insurer
€66,777,606
€22,895,179
€0
€3,179,886
€92,852,671
Private Patients
€11,325,482
€6,082,104
€78,758,073
€701,642
€96,867,302
Total
€190,420,053
€67,660,978
€114,072,213
€10,049,235
€382,202,479
Estimate of Savings Made by Each
Pharmacy by Non-reimbursed Activity
2006
PwC estimate
€249,806
€247,956
Average Public Scheme Fees and Margin per
Pharmacy
Average Clause 9 Savings per Pharmacy
Challenges Facing Health Systems




Achieving better VFM
- Not just cost but also health
outcomes at the earliest
point of contact with the health system.
Managing Chronic Diseases
- e.g. Obesity – 24% of population – could reach 50% in 20
years.
- Driving incidence of diabetes, heart, condition, cancer, etc.
Delivering services that suit patients rather than policy makers
or service providers.
Pharmacists can do more.
New Services
 Medicine Use Reviews
 Minor Ailments Service – Including
Chronic Disease Management
 Switching- POM to P
 Health Promotion / Screening
 Vaccination
 Generic Substitution
 Manage Prescribed Medicines – Medicine Use Reviews
ensure medicines are safe for the patient and taken correctly
and minimise wastage.
 Manage Chronic Conditions
Better quality of life to patients improve outcomes and cost
savings in secondary care.
 Manage Common Ailments – Extend Equity to GMS
Patients
giving patients reassurance and advice, with or without the use
of non-prescribed (OTC) medicines
 Promote and Support Healthy Lifestyles
helping people protect their own health - cholesterol testing,
blood pressure testing, etc.
 Generic Substitution.
 POM to P – Accessibility and Affordability.
Why Pharmacy
 Community Based Health Professional
 Pharmacy is accessible/convenient for
patients
 New Fitness to Practice will underpin
Government and public confidence in ability
of profession to deliver additional services
 Already commands high level of public
confidence
Public Opinion
 Public Opinion Research results
–
–
–
–
–
97% of respondents rated pharmacy highly for convenience
87% highly positive about continuity of staff
96% rated pharmacy highly for quality of service
86% happy with length of opening hours
86% highly rated range of non Rx products stocked
 Reason for most recent visit to a pharmacy
– 54% to have prescription filled
– 33% to purchase Over the Counter medicine
– 9% for advice on medical/health issues
Source: Behaviour & Attitudes 2008
Conclusions
 Demand for community based services will increase
to meet growing patient needs;
 50% of medicines are consumed by 12% of the
population (the elderly and chronically ill) medicines
(Over 70’s on average of 5)
 Minimise wastage and improve compliance –
estimate of 30-50% of those with a chronic condition
do not take medicines correctly
Conclusion
 Pharmacists are well placed to deliver new
services.
 Will require culture shift among profession but
core pharmacy services critical to health
outcomes.
 Need for Government to take a strategic
approach to pharmacy services (result: Better
Value + improved health outcomes.
 Policy Makers – Need to focus on medium to
long-term gain than short-term cost.
Requires collaboration with policy
makers and other
professionals/Stakeholders
“If you want to go fast, go alone. If
you want to go far, go together.”
- African Proverb