Transcript Strategies for Improving Medicine Use

Collaboration with Pharmacy
at a
National Level
Elizabeth Plant
President,
Pharmaceutical Society of NZ Inc
Collaboration with Pharmacy
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Current Situation
Medicines New Zealand
National Strategic Alliances
National Pharmacist Services Framework
Funding Challenges
Pharmacy in New Zealand
• New Zealand Pharmacists under utilised
• Not integrated into General Practice
• Generally operate in isolation
• Funding is fee for service and not patient focused
– Current Funding model drives prescription volume
incentives
– Legislation requires Pharmacists to dispense
– No sustainable alternative funding options
currently in operation
Medicines New Zealand
• Medicines Strategy for New Zealand launched in 2007
– Quality, safe and effective medicines
– Access to medicines
– Optimal use
– Identified within the Actioning Medicines New Zealand 2010
Action Plan
• “Support initiatives to realise the potential of the pharmacist
workforce and address the barriers to the delivery of innovative
pharmacy and pharmacist services, including those identified at the
health sector workshop in August 2009”
Actioning Medicines Workshop
2009
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PSNZ facilitated the workshop on behalf of the Associate Minister
Peter Dunne
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Six work streams resulted as outputs of the workshop:
1. Define the medicine management continuum and which healthcare
provider is involved at what level and for what type of patient group.
This will include a review of the National Pharmacist Framework.
2. Carry out financial modelling on alternative funding formulae to identify
sustainable alterative options.
3. Identify legislative barriers - what requires change?
4. Develop shared visions, build alliances and clinical networks across
and within health professions.
5. Support and facilitate IT initiatives ensuring appropriate, compatible
and interoperable.
6. Investigate and report on barriers to access.
National Collaboration
PSNZ and RNZCGP Strategic
Alliance signed in March 2010
• Enable two professions to work more
closely together for benefit of patient
– Focus on education
– CPD
– Quality
– Workforce development
– Meeting the needs across the patient continuum
– Political advocacy
National Collaboration cont’d
Strategic Alliance with GPNZ
May 2011
• Aim - to improve primary health services by
progressing models of integrated care
• Enable cohesive and joint advocacy
• Demonstrate unified leadership
• Facilitate strong relationships at national,
regional and most importantly at local levels
Pharmacy Workforce Forum 2010
• Multidisciplinary Forum
• Is Pharmacy Fit for Purpose for 2014 and Beyond?
• Five work-streams resulted:
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Development of career structure across all aspects of pharmacy
Define educational structure aligned to career paths
Professional capability campaign
Clearly defined model of care across patient groups with agreed
collaboration between health providers
5. Addressing capacity
National Pharmacist Services
Framework
• All Pharmacist services referenced in the Framework
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Existing Dispensing Service
Health Education (HE)
Medicines Clinical information Services (MCIS)
Medicines Use Review and Adherence Support (MUR)
Medicines Therapy Assessment (MTA)
Comprehensive Medicines Management (CMM)
• Launched in 2007 by DHBNZ and promoted by PSNZ
• Currently under review by PSNZ
• New services to be developed and added
Community Pharmacy Anticoagulation
Management (CPAMS)
• Aim: to provide a safe, effective and cost effective
care acceptable to patients and other health
professionals
• New model of care - Comprehensive Medication
Management (CMM)
• Integrated care - an opportunity to make it work
• One point-of-care for the patient
• Better use of clinically trained pharmacists
CPAMS Interim Results
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Internationally robust and exceptional
At four months - 671 patients
TTR 77.6% (cp 45-55% av current model)
85% compliance (99% if add in one to
three days late)
• Survey responses excellent with positive
feedback (100% Pharmacist, 60% Patients
and 40% Doctors replied)
Collaboration Opportunities
• CPAMS has proved that Community
Pharmacy can deliver on an integrated
care model
• Use it for:
– Diabetes Management
– Cholesterol Management
– Mental Health Medication Management
– Residential Care Patient Care Management
To quote Professor Des Gorman,
Chair of Health Workforce NZ• “A Profession should be operating at the
top of it’s scope of practice not the bottom”
• Dispensing is a technical function that
technicians can and should be enabled to
fulfil
• Pharmacists are Medication Management
experts - use them appropriately!
Funding Challenges
• Must be patient not prescription centred
• Patient groups need different funding approaches
– Acute medications
– Long term conditions
– Special populations (rest homes, NGO mental health
residents) will have special dispensing needs eg
blister/robotic packs
– Targeted populations (specific health initiatives priority area for funder)
– Minor ailments
Funding Challenges cont’d
• Chronic Patients
– At risk
– Long term stable/self managing
– Long term not stable/not fully self managing
Funding options likely to be mix of capitation (long term
conditions), specific population based – adjusted bulk
funding (special populations), fee for service (acute
meds)
Patient enrolment for Pharmacist services must be
debated
In Summary
• Willingness for collaboration and integration
• National alignment and alliances
• Funding for Pharmacy services MUST change
NOW
• General Practice needs to engage and embrace
Community Pharmacy at local level and
integrate pharmacists into their primary care
models