Pharmacy and pharmacy practice research in the Netherlands Dr. J.W.F. van Mil Community pharmacist Pharmacy Practice Consultant.

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  • Slide 1
  • Pharmacy and pharmacy practice research in the Netherlands Dr. J.W.F. van Mil Community pharmacist Pharmacy Practice Consultant
  • Slide 2
  • Topics The Netherlands Pharmacy Education Community pharmacy & care provision Practice Research and.. Europe
  • Slide 3
  • Pharmacy in the Netherlands
  • Slide 4
  • 28-10-2008Belfast 20084 Netherlands and Dutch pharmacy Kingdom, parliamentary democracy, approx.18 million inhabitants. Symbolic role of king/queen Approx. 1900 community pharmacies serving average of 8100 patients/pharmacy 1 community pharmacy with 1.5 pharmacist and approx 8.5 FTE assistant pharmacists and 3 FTE other staff 35 Emergency pharmacies (24hrs) in bigger cities Approx. 90 hospital pharmacies Financial situation of pharmacies reasonably sound. Annual turnover approx 2,502,000 Data: SFK Fact & Figures 2008
  • Slide 5
  • Pharmacist education
  • Slide 6
  • 28-10-2008Belfast 20086 Dutch pharmacy education 7 major universities with European style curriculae (4 years: bachelor-master) 2 Universities (Groningen, Utrecht) focus on pharmacy practice and educating pharmacists 6 years curriculum -> Pharm D for all pharmacists After 1 years initial choice: community/hospital/research After 4 years final choice 1 University (Leiden) focus pharmaceutical product research 1 University (Nijmegen) focus patient care 2 additional years in practice for licence in community pharmacy, 3 years for hospital pharmacy To keep license: obligation to follow postgraduate education (18h/year, and increasing)
  • Slide 7
  • 28-10-2008Belfast 20087 Community pharmacy One national association for all pharmacists (KNMP) with a scientific branch, stimulating practice research and care implementation. KNMP has no legislative power; this is exerted by Dutch Inspectorate for Health Care 30% of pharmacies are quality certified; ongoing process and increasing Care packages and projects provided by KNMP Independent community pharmacies have their own organisation (NAPCO)
  • Slide 8
  • 28-10-2008Belfast 20088 Chains 35% of pharmacies in a chain or affiliated on franchise basis Major chains are owned by 3 major wholesalers Chains have own care-packages but no obligations (yet) for their pharmacies to participate
  • Slide 9
  • 28-10-2008Belfast 20089 Payment system Pharmacies are contracted by insurance companies 4 large insurance companies, 10 smaller ones Insurance now assigns preferred generic brand(s) Insurance pays dispensing fee + costs of medicines, subsidised by the state Dispensing fee: New tariff structure approved by the state since July 2008 5.30 Normal prescription 2,90 Week-dosing dispensing (Baxter) 1.50 First time dispensing fee (supplement) 10.60 Dispensing during off hours (supplement) 10.60 In-house preparations (supplement) 79.40 Complex preparations (sterile, etc. supplement)
  • Slide 10
  • 28-10-2008Belfast 200810 Dutch pharmacy and Care Hospital and community pharmacists are care-providers by law. Standard automated medication surveillance in all pharmacies since 1980ies (MUR) Cooperation with GPs in so called FTO-groups (meet every 2 months), also called Pharmacotherapeutic Consultations Structured instructions for first time and second time dispensing Standards based care packages for AsthmaCancer DiabetesTravel advice IncontinencePolypharmacy / review OTCFirst-second time dispensing
  • Slide 11
  • 28-10-2008Belfast 200811 Pharmacy Care standards Prepared by WINAp, part of Dutch pharmacists association. Based on Dutch medical treatment standards Standards to be translated locally into protocols Cancer (incl. pain management) Incontinence Constitutional Eczema Diabetes - Multiple Sclerosis Headache Osteoporosis Asthma/COPD Cardiovascular risk management -
  • Slide 12
  • 28-10-2008Belfast 200812 Care initiatives (1, disease oriented) Local initiatives, uncoordinated but driven by chains or pharmacists association Advantages: PR for pharmacy, improving image amongst GPs and patients Disadvantages: Small scale and uncoordinated, so no evidence of effect, no proof of savings For the time being no (financial) support from payers and not recognised by payers
  • Slide 13
  • 28-10-2008Belfast 200813 Care initiatives (2-epidemiological) Mostly based on GP-treatment (NHG)standards Monitoring use of preventers with high use of relievers in asthma Monitoring use of laxatives with opoids Monitoring use of calcium and biphosphonates with chronic use of oral corticosteroids Monitoring use of gastric protection with NSAIDS etc.. in the elderly >6o Monitoring duration of use of anti-depressants -> All done through epidemiological searches

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