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