PHARMACY SERVICES IN IRELAND

Darragh J O’LoughlinSecretary General, Irish Pharmacy Union

Pharmacy in Ireland

• Small country – population 4.7m

• Deregulated 2002 – no restrictions on ownership or establishment of pharmacies.

• Majority of pharmacies pharmacist owned & operated

• Largest chains: Lloyds 94 pharmacies and Boots 83 pharmacies

Irish Pharmacy Union

Pharmacy Services in Ireland

• Most pharmacy income comes from dispensing prescriptions

• State-funded or patient pays, depending on income

• Four services remunerated by Health Service:

• Vaccination

• Speciality Medicines

• Opiate Substitution

• Needle Exchange

Vaccination

• Origin

• Requirements

• Payment

• Review

Vaccination – Origin of Service

• WHO vaccination targets not met

• 2009 – H1N1 “Swine” Flu –• National vaccination campaign• Not enough GPs• 1400 pharmacists trained in vaccination technique but not used

• Pharmacy regulator (PSI) strategy for extended pharmacy services included vaccination

• Support from National Immunisation Office

• 2011 – Minister legislated to allow pharmacists supply and administer flu vaccine

• 2015 – Pneumococcal and Shingles vaccines added to list

Vaccination – Requirements

• Mandatory Accredited Training – face to face or online • Vaccination policies• Injection technique• Management of Anaphylaxis including administration of adrenaline• Cardio Pulmonary Resuscitation and use of Defibrillator

• Administration – must be in pharmacy• Private consultation room• Patient consent• Allergy status• Observation after administration

• Record-keeping• Date, Patient ID number, Batch, Expiry Date • Notification to Health Service and patient’s GP

Vaccination – Target Population

• Flu vaccine recommended in case of:

• Aged 65+ years

• Long-term Medical Condition, e.g. diabetes

• Impaired Immune System

• Down Syndrome

• Morbidly Obese: Body Mass Index (BMI) 40+

• Pregnant Women

• Residents of Nursing Homes

• Healthcare Workers and Carers

• People in close contact with poultry, water fowl, pigs

Vaccination – Reimbursement

Vaccination – Reimbursement

• Flu vaccine supplied by Health Service for eligible and at-risk patients

• Health Service pays pharmacist professional fee of €15 per patient

• Non State-funded patients must pay fee to pharmacist

Vaccination – IPU Awareness Raising

Vaccination – Review of Service

• Patient feedback on vaccination service provided in pharmacies – March 2016

Vaccination – Review of Service

• Patient feedback on vaccination service provided in pharmacies – March 2016

Vaccination – Review of Service

• Patient feedback on vaccination service provided in pharmacies – March 2016

Specialty Medicines

• Origin of Service

• Process

• Payment

Speciality Medicines – Origin of Service

• Pre 1996 – Speciality medicines supplied from Hospitals or Health Clinics

• Inconvenient for patients; expensive for Health Service

• Incomplete health records in pharmacy and GP

• 1996 – High Tech Medicines Scheme launched

• New service to dispense speciality medicines through community pharmacy

Speciality Medicines – How service works

• Medicine initiated in hospital

• Patient nominates community pharmacy for supply

• Hospital notifies pharmacy and Health Service

• Pharmacy orders medicine through usual supply channels (wholesaler or manufacturer)

• Medicine delivered to community pharmacy and invoiced directly to Health Service

• Pharmacist dispenses medicine to patient and notifies Health Service

• Health Service pays supplier

Speciality Medicines – Advantages

• Convenience and accessibility for patient

• Private consultation rooms allows for confidential patient counselling

• Single comprehensive medication record in pharmacy

• Pharmacy avoids inventory cost and financial risk

• Reduction in workload and inventory in Health Clinics

• Uses existing network of pharmacies – no capital cost for Health Service

Speciality Medicines – Reimbursement

Pharmacy receives:

• Monthly Patient Care fee for all support and advice – €62 .03

• No margin on medicine cost

• Monthly fee of €31.26 in months when no dispensing takes place (max 3 months)

Wholesaler / supplier receives:

• Margin on cost of medicine – 10%

Opiate Substitution

• Origin of the Service

• How the service operates

• Payment

Opiate Substitution – Origin of Service

• 1980’s – Large increase in Heroin addiction

• Methadone dispensed from Health Service Drug Clinics

• Local opposition to clinics opening in neighbourhoods

• Pharmacy Methadone Scheme launched 1998

• Special training for GPs and pharmacists in addiction treatment

• 40% of pharmacies now provide this service

• Allows patients to live relatively normal lives

Opiate Substitution – How the Service Operates

• Patient attends drug clinic for diagnosis and initiation of treatment

• Patient registers with one pharmacy•

• Central Treatment List of all methadone patients & pharmacies

• Methadone ID card sent to pharmacy for each patient

• Patients collect methadone daily/weekly from pharmacy

• Supervised consumption initially

• Stable patients get take-out doses

Opiate Substitution – Payment

• Monthly Patient Care Fee €52 – €60 per patient

• Dispensing fee per supervised dose €3.60

• Security Grant – financial support for necessary security upgrades up to €6,000

Needle Exchange

• Origins of service

• How service operates

• Payment

• Review

Needle Exchange – Origins of Service

• 2011 – Elton John Aids Foundation offered to fund NEX service

• Objective: reduce spread of blood-borne viruses among drug users

• Funded jointly by Health Service and Elton John Aids Foundation

• Pharmacies in identified areas of need targeted and asked to participate

• 107 pharmacies in total

Needle Exchange – How Service Operates

• Pharmacists who wish to provide NEX service receive training on• Policy issues• Ethical issues• Practical issues• Contents of NEX kit

• Special sticker on door identifies pharmacy as a NEX facility

• Client places used needles into sharps waste bin

• Pharmacist supplies NEX kit and records transaction

• Also gives safe injection and health advice

Needle Exchange – NEX Kit

What’s in the pack?

• single filter syringe with attached needle

• stainless steel spoon

• one sterile alcohol swab

• sachet of citric acid

• 5ml water for injection

• information leaflet

Needle Exchange – Payment

• Project is jointly funded by Elton John Aids Foundation and Health Service

• Pharmacist receives €5 per kit given out

• Health Service funds waste collection

• Hepatitis vaccination provided to all staff

Needle Exchange – Evaluation

Liverpool University was commissioned to review the NEX service in 2015

• High client satisfaction with• Service provision• Pharmacy location• Opening hours• Staff knowledge• Availability of needs• Provision of information

• Clients reported receiving advice on• Wound care• Safe injecting tips• Sexual health