european and international innovation in healthcare …€¦ · 199/2016 //evolution of...
TRANSCRIPT
EUROPEAN AND INTERNATIONAL INNOVATION IN HEALTHCARE PHARMACY:
pharmaceutical model
PORTUGAL
ANA PAULA MARTINSPortuguese Pharmaceutical Society
• A little about Portugal
• Evolution of pharmaceutical services in Portugal
• Antiretroviral therapy in community pharmacies
• Structuring development with competencies
• Information technology shaping modern pharmacy
//SUMMARY
• Ageing Population:
o Increase Life Expectancy at Birth ( ♂ 77,2 ♀ 83,0 )
o Low fertility rate (7,9 ‰)
• Major Causes of Death:
o Cardiovascular Disease – 30%
o Cancer – 24 %
• Increasing number of diabetic patients
• Increasing number of illness in elderly women
Population:
~10.500.000
//A LITTLE ABOUT PORTUGAL
//A LITTLE ABOUT PORTUGAL
3.600INHABITANTS / PHARMACY
2.918COMMUNITY PHARMACIES
2,9PHARMACISTS / PHARMACY
• Home care support
• First-aid support
• Medicines administration
• Use of auxiliary means of diagnostic and therapeutics
• Administration of vaccines out of the national immunization plan
• Pharmaceutical care programmes
• Information campaigns
• Collaboration in Health education and promotion plans
MinisterialOrder
1429/2007
Decree-Law307/2007
Pharmacies can provide services targeting patient healthcare and general well-being according to further legislation by Agency of the Ministry of Health
Decree-Law171/2012
//EVOLUTION OF PHARMACEUTICAL SERVICES IN PORTUGAL
From 2007 onwards
• Value community pharmacies as healthcare providers
• Development of the rational use of medicines
• Articulate Community Pharmacy services with other NHS units
• Pilot the partial delegation of administration of oral medicines in the areas of
Oncology and Infectious Diseases
MinisterialOrder
199/2016
//EVOLUTION OF PHARMACEUTICAL SERVICES IN PORTUGAL
Most recent changes
• HIV medicines – exclusive to hospitals
o Price of therapy and overall costs
o Management of adherence to therapy
• Distance to hospital can affect adherence
o Travel expenses
o Frequency of travel associated with the availability of medicines
• Proposal to have community pharmacies dispensing
o Homogenous distribution throughout the national territory
• Protocol with the central government and regional administrations
• Cooperation with hospital units
//ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES
//ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES
Are community pharmacists COMPETENT to dispense ARVs?
• Competence based model
• Education refreshment
• Legal certification by the PPS
• (Hospital Pharmacists have always done it!)
//ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES
• Laboratory Medicine and Human Genetics
• Regulatory Affairs
• Hospital Pharmacy
• Pharmaceutical Industry
• 5 year cycle of Continuous Professional Development
• 15 Professional Development Credit Points
• PPS supervision and management of process
• Online system
//STRUCTURING DEVELOPMENT WITH COMPETENCIES
SPECIALIZATIONS
1) Mandatory curricular evaluation;2) Different evaluation methods for each specialization
Curricular evaluation
Interview Evaluation
Monography Exam
Curricular evaluation
Interview Evaluation
Monography Exam
COMPETENCIES 1 Specialization 2Advanced
COMPETENCIES 1
Submission of competencyframework
Curricular validation Elegibility
Evaluation Interview Monography
Exam Practical / Laboratory
//STRUCTURING DEVELOPMENT WITH COMPETENCIES
• State delegates on the PPS
o Recognition of competence
o Certification of educational programs
o Valid with certificate for Basic Life Support
• Educational program
o 75% theory + 25% Practice
o Minimum content set out by PPS
• Recertification
o Every 5 years
o Proof of practice + refreshment course
//STRUCTURING DEVELOPMENT WITH COMPETENCIES
5
VACCINATION – a competency example
//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY
Slides EXTRA
Medicines with restricted prescriptionFor hospital use only
Pharmacological characteristics
New medicines
Public health issues
For primary care diagnosis but with severe adverse reactions to be expected and patient vigilance during treatment
For pathologies diagnosed in the hospital setting aloneMedicines can be taken in ambulatory care
Special reimbursement clauses for these medicines (100%) and high price.
ARV
213M € in 2015 [21% of Hospital expenditure in
Medicines]
//ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES
Source: Portugal – Infeção por VIH, SIDA e Tuberculose em números 2015
How are ARVs dispensed now?
• Only hospital pharmacists do it
• Special counselling and consultation in the pharmacy
• SI.VIDA – IT System for monitoring ARV medicines dispensing
o 25 units which cover for 93% patients (10 more by the end of 2016)
o 30.956 patients followed + 150 cases of PoEP
o Monitors patients, lab data and therapeutics
//ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES
Electronic Health Record
Integrated vision of patient data
Support the clinical decision
Accessible by several healthcare professionals
Available to the citizen through its national ID card
//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY
E-prescription
Wider choice for the citizen (empowerment)
oMore versatile system where all medicines are in one list and patient is
free to dispense each medicine when and where he chooses
More control by the central administration to avoid fraud
Better understanding of patient medication
//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY
Pharmacist electronic ID
Allow access to ICT systems – Patient Electronic Health Record
Digital signature to validate Pharmacist only actions
oPrescriptions in hospital
oMedical Biology analysis
oBatch release in pharmaceutical industry
//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY
In the horizon
Pharmacy as an outpost for mediation between patient and access to
the healthcare system
o Compensate imbalance in access to ICT for patients without knowledge
or means
o Have a present trustworthy health professional
//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY