Hospital Pharmacy In Canada Report

2013/14

Kevin Hall and Jean-Francois Bussieres

Future Trends In Hospital Pharmacy Practice

Surowiecki argues that aggregated data from groups of informed, independent

individuals can result in better predictions and decisions than those of individual

experts.

Informed, independent individuals = Hospital Pharmacy directors and managers

who respond to the HPC survey.

The Wisdom of CrowdsWhy the many are smarter than the few

• Forty (40) statements were developed

• Each statement addressed a pharmacy practice issue that had been identified by members of the HPC Board as a potential future challenge

• Statements covered 5 domains of pharmacy practice

Assessing future trends in hospital pharmacy practice in Canada - Methods

•Hospital pharmacy leadership• Pharmacy practice models•Ambulatory care services• Pharmacy Informatics•The pharmaceutical marketplace

The 5 domains of pharmacy practice

“By 2019, your hospital pharmacy department will have a systematic strategic planning process in place that includes the establishment of explicit goals, a system for tracking the achievement of those goals, and an annual report to senior management”

Statement Examples

Probability that the statement will reflect the reality in your hospital by 2019 (five years in the future)

• Very likely• Somewhat likely• Somewhat unlikely• Very Unlikely

Response options

1. For each of the four response options

2. For the combined responses of :

Very likely and somewhat likely, that were combined to create a “likely” measure

Very unlikely and somewhat unlikely, that were combined to create an “unlikely” measure

Results reported:

Typical response rates for many of the statements:

Very likely: 15% to 25% Somewhat likely: 20% to 50%Unlikely: 15% to 30%Very unlikely: 5% to 15%

Results and comments

Typical response rates for many of the statements, compared to Kotter’s Change Model

Very likely: Early adopters Somewhat likely: Early majorityUnlikely: Late adoptersVery unlikely: Laggards

Results and comments

“By 2019 your hospital pharmacy department will have a formal, documented succession plan for key pharmacy leadership positions”

Very likely 26% Somewhat likely 37% Combined “Likely” 63%

Pharmacy Leadership Domain Example:

“By 2019, your hospital pharmacy department will have a systematic strategic planning process in place that includes the establishment of explicit goals, a system for tracking the achievement of those goals, and an annual report to senior management”

Very likely 63% Somewhat likely 29%

Combined “Likely” 92%

Pharmacy Leadership Domain Example:

“By 2019, at least 75% of your pharmacists will function in a clinical practice-centred model, defined as one in which pharmacists function largely in clinical roles, with less than 20% of their time spent performing distributive activities (e.g product preparation, order-verification, checking the distributive work of other pharmacists and technicians, etc.)”

Very likely 44% Somewhat likely 39% Combined “Likely” 83%

Note: In 2013/14 report, the average percentage of pharmacists practicing in a clinical practice centred model was only 19%. This was actually a drop from the results in 2011/12 2here 20% of pharmacists were re reported to be practicing in a clinical practice centred model. Can that gap be closed? How?

Pharmacy Practice Model Domain Example:

“By 2019, pharmacy students in the experiential training component of their pharmacy program will be active, regularly scheduled participants in the delivery of essential patient care services at your hospital, to the extent that if the students were not there, additional pharmacist staff would have to be hired to perform those essential services”

Very likely 4% Somewhat likely 42% Likely 46%

Note: ASHP and AACP have placed considerable emphasis on this , as part of their pharmacy practice model initiative

Pharmacy Practice Model Domain Example:

By 2019, pharmacists in your hospital will have the authority to write discharge prescription orders in order to reconcile mediations taken before admission, medications discontinued while in hospital and new medications started during hospitalization.”

Very likely 20% Somewhat likely 43% Combined Likely 63%

Is this achievable?

Ambulatory Care Domain Example:

”By 2019, in your hospital, pharmacists will provide

ongoing medication therapy management (MTM) services for selected groups of ambulatory patients who are receiving multiple medications or high risk medication therapy and have been identified by the hospital or health system as frequent users of the emergency department or inpatient beds”

Very likely 23% Somewhat likely 48%

Combined Likely 71%

Ambulatory Care Domain Example:

“By 2019, your hospital will use a validated, automated method for identifying patients most likely to benefit from pharmacy-based patient care services, including medication therapy monitoring Very likely 18% Somewhat likely 49%

Likely 67%

Note: How many hospitals have this now? How many are seriously pursuing it?

Pharmacy Informatics Domain Example:

” “By 2019, sterile products will be compounded in a USP Chapter 797 compliant program operated by your hospital, or will be outsourced to another hospital or commercial compounding centre that is USP Chapter 797 compliant”

Very likely 69% Somewhat likely 20% Likely 89%

Note: How many hospital pharmacies are USP Chapter 797 compliant now?

Pharmacy Operations Domain Example:

“By 2019, your hospital will be part of a group of hospitals that are serviced by a centralized medication preparation, repackaging, and distribution systems. Very likely 32% Somewhat likely 23%

Combined Likely 55%

Note: How will this be achieved? Outsourced to commercial providers?

Pharmacy Operations Domain Example:

“By 2019, your pharmacy department will have a formal review process in place that will collect data on how staff responded to computer generated alerts, assess the appropriateness of alert over-rides and implement changes that will optimize the value and minimize the drawbacks of the computerised decision-support applications that exist in your pharmacy information system”

“Very likely 15% Somewhat likely 52% Combined “Likely” 67%

Note: In 2011/12 only 17% of respondents had any kind of policy dealing with alert over-rides

Pharmacy Informatics Domain Example:

“By 2019, the number of medication shortages that your hospital will have to manage will have decreased by at least 25%, as compared to the baseline in 2013/2014” “Very likely 3% Somewhat likely 27% Likely 30%

Note: 47% of respondents indicated that they thought it was somewhat likely or very likely that medication shortages will have increased by at least 25%

Pharmaceutical Marketplace Domain Example:

““By 2019, at least 25% of new pharmaceuticals entering the market every year will have an accompanying diagnostic test that will enable patient selection or optimal dosing (or both) based on the patient’s genetic characteristics ”

Very likely 1% Somewhat likely 21%

Combined “Likely” 22%

Is personalized medicine a mirage?

Pharmaceutical Marketplace Domain Example:

How will you use this information?

Future Trends