Transcript Diapositive 1

5 core competencies to provide better care for
patients living with chronic health problems
1. Patient- centered care
2. Partnering (with patients, other providers,
communities)
3. Quality improvement
(measuring care delivery and outcomes; learning and
adapting to change; translating evidence into practice)
4. Information and communication technology
(2005)
5. Public health perspective (population-based care
delivery, seamless care, primary health care-led systems,
etc.)
(2009)
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
FIP Statement of Policy on Collaborative Pharmacy Practice
Draft document actually in a processus of discussion
« Collaborative Pharmacy Practice is defined as the
clinical practice where pharmacists collaborate with
other health care professionals in order to care for
patients, carers and public. »
Advanced CPP; authority to initiate or modify medicine therapy.
A
Prospective
advice and/or referral by another healthcare professional.
d
v
Reactive
advice to other health care professionals.
e
System wide authority to supply medicines.
Minimal contact between pharmacists and other healthcare professionals
Amount of responsability
Degree of collaboration
Five levels of CPP have been identified from a number of models across the world
2
The pharmacist’s
perspectives o f the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
The five dimensions of Patient-centered care
and their objectives
(A. Niquille and O. Bugnon, Niquille’s PhD Thesis 2009, Geneva University)
Patient
Quality
of life
Therapy(ies)
Effectiveness
Safety
Disease(s)
Clinical
outcomes
The pharmacist’s perspectives of
the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Quality
Care
Health Care
workforce
Efficiency
Public Health
Health Economics
and Policy
practice; technologies; management;
outcomes research)
(frameworks; methods and standards of
RESEARCH & DEVELOPMENT
Advancement of
collaborative care practice
Strategy for implementation of collaborative care
practice in primary care (O. Bugnon and M. Buchmann, 2010)
EDUCATION & COACHING
(transfer from research into practice)
Implementation in primary care
4
Examples of community pharmacists contributing to
improvement of Patient-centred medication-use process
Physicians-Pharmacists Quality Circles
(PPQC)
Patient
Therapy(ies)
Health Care
workforce
Disease(s)
Health Economics
and Policy
The pharmacist’s perspectives of the team approach in Patientcentered Health Care
Dr Pharm Michel Buchmann
What is a Physicians-Pharmacists Quality Circle ?
(PPQC) ?
•
A stable group of 3-10 GPs and 1-2 pharmacists as
moderators
•
Volunteers to have meetings together
•
Evaluation of the daily prescribing practice
•
Based on their own and actual prescription data
•
Working together for continuously improving their
practice
•
Implementing practice guidelines and standards
•
A continuous monitoring and feedback of the
success of the common decisions that have been
taken
•
This means that every participant is active!
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Working process within a PPQC ?
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Drug cost evolution (index) in the first Swiss physicianspharmacists quality circles (Fribourg) compared with the
control group between 1999 and 2007 (drugs listed in the national
formulary)
Evolution du coût médicament annuel par patient (Index)
Community
pharmacists and
GPs together to
lower the health
costs
180.0
/ 24-25 GPs and 6 community pharmacists
In 2007  around 230’000 CHF savings per GP
173.9
Groupe Témoin
170.0
+3.2%
Fribourg - Pionniers
166.9
161.8
160.0
169.9
+1.8%
+2.3%
+12.8%
150.0
+3.2%
+6.4%
143.4
139.0
-1.2%
140.0
+7.3%
130.0
130.6
121.7
130.0
126.7
120.0
+21.7%
110.0
140.6
+2.6%
-1.5%
- 3.2%
138.9
132.6 +6.0%
136.8
132.4
+2.0%
+10.0%
n = 23
médecins
115.2
+15.2%
100.0
1999
2000
2001
2002
2003
2004
2005
2006
 Cercles de qualité
2007
pharmaSuisse
Medications: «Implemented
since 2002, pharmaceutical care
services have allowed to
decrease the costs in a
spectacular way »
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Soulager la douleur en EMS : un projet
interdisciplinaire et un droit pour les résidents
Formation interdisciplinaire
1st axe of collaborative care
Jeudi 11 octobre 2007 (13h00-17h30)
à l’Institut Agricole de Grangeneuve, Posieux
 practice guidelines and interdisciplinary education programmes
Sous le patronage de la Direction de la santé et des affaires sociales du
canton de Fribourg, de l’Association Fribourgeoise des Institutions pour
Personnes Agées (AFIPA), de la Société des pharmaciens du canton de
Fribourg et de la Société de Médecine du canton de Fribourg.
Les demandes d’accréditation par la SSPh, la SSMG et la SSMI
sont en cours
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
To know more about the « PhysiciansPharmacists Quality Circles » …
•
Niquille A. Ruggli M., Buchmann M., Jordan D. and Bugnon O. A nineyear sustained cost-containment impact of Swiss pilot
physicians-pharmacists quality circles. The Annals of
Pharmacotherapy, in press
•
Locca J.-F., Ruggli M., Buchmann M., Huguenin J. and Bugnon O.
Development of pharmaceutical care services in nursing
homes: practice and research in a Swiss canton. Pharm World
Sci (2008). PMID: 19067223
•
Locca J.-F., Bula C., Zumbach S and Bugnon O. Pharmacological
treatment of behavioral and psychological symptoms of
dementia (BPSD) in nursing homes: development of practice
recommendations in a Swiss canton. JAMDA (2008 Jul);9
(6):439-48.
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Examples of community pharmacists contributing to
improvement of Patient-centred medication-use process
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Patient adherence enhancement
programmes
Patient
Therapy(ies)
Health Care
workforce
Disease(s)
Health Economics
and Policy
Community pharmacy remunerated service for
supporting patient adherence (Switzerland)
1. Motivational
interviewing patientpharmacist
- Individualized
cognitive and
behavioral
intervention.
- Seamless monitoring
of medication
adherence, adverse
events and cotreatments in relation
to health outcomes.
2. Adherence
measurement
- Medication Event
Monitoring System
(MEMS®) :
objective and
dynamic measure
of daily medication
intake.
3. Adherence Report and record
- Data collection, visualization and
interpretation.
- Feedback to the patient.
- Quality management system
- Interface with patient’s records.
- LCD display.
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Examples of results of community pharmacists-led
supporting patient adherence programs (Switzerland)
1. HIV patients
I. Krummenacher’s PhD thesis (2010)/ Pharmacie de la PMU, Lausanne (Switzerland)
Examples of results of community pharmacists-led
supporting patient adherence programs (Switzerland)
2. Hypertensive patients
H. Figueiredo’s PhD thesis (2010)/ Pharmacie de la PMU, Lausanne (Switzerland)
To know more about the
Swiss « patient adherence programmes » …
•
Schneider M.P., Krummenacher I., Figueiredo H., Marquis J. and Bugnon O.
Adherence : a review of education, research, practice and policy in
Switzerland. Pharmacy Practice 2009; 7 (2): 63-73
Recent posters:
•
Krummenacher I., Cavassini M., Bugnon O., Schneider M.P. Retrospective
analysis of an HIV-adherence program. The 13th edition of the European
Symposium on PAtient COMpliance and Persistence 2009 ESPACOMP, Bangor
(Wales), 10.9.2009.
•
Guignard Hefti E., Achtari Jeanneret L., Lange A.C., Vrijens B., Luthi F.,
Bugnon O., Schneider M.P. Adherence to oral anticancer treatment :
focus on persistence and execution during continuous schema of
treatment. 30st European Society of Clinical Pharmacy (ESCP) and GSASA
symposium, Geneva, 4-6 Nov. 2009.
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Swiss physicians-pharmacists collaborative practices
Results in short lines...
In relation to physicians working alone, the main points are the
following:
• A real collaborative practice is not a dream, The objectives are to
optimize the safety and effectiveness of the treatments for the
patients.
• A need to be persistent for best results
• An important saving capacity on medicines costs based on
professional decisions and not on price reductions.
• An increased resistance of the Health workers against industrial
marketing activities.
• A recognized interdisciplinary education in favor of personcentered care.
• A more efficient spreading or the pharmacovigilance messages.
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
Messages to be taken from this presentation

FIP, in his mission of the pharmaceutical world leader, is determined to
open ways for collaborative practice within the health care team. FIP will
clearly declare its intention by the adoption of a Statement of policy on
Collaborative Pharmacy Practice during his next World Congress in Lisbon.

Swiss pharmacists are very active in the development of collaboration
projects with physicians and nurses. They didn’t want to dream about it but
really wanted to do it!

Person-centered care is evidence for us to improve the care and quality of
lifes of our patients. It is evident to every decision makers that the future is
clearly connected to collaborative practice because our societies will never
have enough money to pay for ’all’ treatments . The building of this new
world has to sprout up from beneath. We all have l the same
responsabilities to support the change of our practices and of our attitudes.
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann
For the help received in preparing this presentation I
want to thank:
FIP, for the opportunity the represent our World Federation during this
Conference.
Prof Olivier Bugnon Phone: +41 (0)21 314 48 42,
[email protected]
Head of Community Pharmacy Practice Unit, Pharmaceutical Sciences
Section (University of Geneva, University of Lausanne)
My research and professional colleagues of the Pharmacie de la PMU,
Rue du Bugnon 44, CH-1011 Lausanne (Switzerland)
My friends physicians, pharmacists and nurses actually involved in all
these new Swiss patient-centered projects
The pharmacist’s perspectives of the team approach in Patient-centered Health Care
Dr Pharm Michel Buchmann