1

PGEU SYMPOSIUM

ECONOMIC CONTRIBUTION OF THE COMMUNITY PHARMACIST TO HEALTH

SYSTEM

 

Palma de Mallorca, 15 June 2004

Carmen Peña López

General Secretary

2

INTRODUCTION

 

We present an initiative which the Professional Pharmaceutical Organisation of Spain took some years ago, which has continued in time and has turned out to be of enormous interest: a study to assess the health advice of pharmacists.

 

3

JUSTIFICATION (1)

• The pharmaceutical profession needs to highlight the work carried out by pharmacists, and which results in major savings for the Government.

 

• In 1996, the Professional Pharmaceutical Organisation commissioned a study to find out the contribution made by pharmacy to the Spanish health system, with the aim of demonstrating to society the added value of the pharmacist.

4

• Published in 1997 in the form of a white book

“The contribution of the pharmacist to health care in Spain”:

JUSTIFICATION (2)

- It had considerable impact on the media.

- It was received with enormous interest by the Administration.

• It was the first time that a specific economic value had been assigned to the everyday work which the pharmacist in a pharmacy carries out with the patient other than the dispensing of medicines.

5

• Seven years later (2003), the Professional Pharmaceutical Organisation decided to quantify professional actions again in order to study their evolution.

• This study has been developed in a context in which cost containment of health, and especially spending on medicines, is a priority for the Administration, in the light of the need to work out measures aimed at the sustainability of the system.

 

• All measures taken by the government to cut down health expenditure have acted directly on spending on medicines (best known and transparent)

JUSTIFICATION (3)

6

• Pharmacists, are not the cause of the increase in spending on medicines and there are numerous factors beyond our control (prescription, ageing of the population or the introduction of effective but more expensive medicines).

• We need to have concrete and assessable data available in order to be able to use it in our negotiations with the Administration.

JUSTIFICATION (4)

7

MAIN OBJECTIVES (1)

• Examination of health actions preferably carried out by pharmacies.

• Consideration of the health content of those actions.

• Assessment of health actions.

 

8

Other points of interest:

 

• Training activities being carried out.

 

• Jobs created by pharmacies.

 

• I.T infrastructure in pharmacies and analysis of their use.

MAIN OBJECTIVES (2)

9

METHODOLOGY (1)

The study was carried out by a independent consulting firm (ALGOR Consultores and José Luis Perona, ex-Secretary of State for Health), and is divided into four phases:

 

Phase 1.- Qualitative

• Conceptual review with a panel of experts

• Preparation of the questionnaire

10

METHODOLOGY (2)

Phase 2.- Survey

• Universe: Total of pharmacies (19,766 at the moment of the study)

• Sample: 1,371 replies (6.9%)

• Margin of error: theoretical random sample error +/- 2.8%

• Questionnaire

• Mailing and replies: 3rd week of October to 15 December 2002 (9 weeks)

11

METHODOLOGY (3)

Phase 3.- Processing of the information

• Debugging

• Coding

• Recording

• Statistical processing 

12

Phase 4.- Analysis and drawing up of conclusions

 

In carrying out the work, the importance has to be emphasised of quantifying and assessing the health actions, and comparing the values attributed to equivalent actions when they are performed by other health professionals.

METHODOLOGY (4)

13

MAIN RESULTS

1996 2003

• Each Spaniard made 12 visits a year to pharmacies

• Each Spaniard made 14 visits a year to pharmacies

In 2003, more than two million people visited pharmacies each day: 21% more than in 1996.

USERS WHO VISIT SPANISH PHARMACIES

14

ADVISORY WORK BY PHARMACIESIn 2003, one out of three people who went to

a pharmacy asking for a non- prescription medicine did not buy anything since the purchase of a medicine was not the most suitable option

1996 2003

1 out of every 4 Spaniards who entered a pharmacy did not buy a medicine and instead received health advice.

1 out of every 3 Spaniards who entered a pharmacy did not buy a medicine and instead received health advice

15

In 2003, pharmacies performed 182 million health actions not directly related with the dispensing of medicines: 20.1% more than in 1996, in which 151 million health actions were carried out.

HEALTH ACTIONS CARRIED OUT IN PHARMACIES. SAVING FOR THE HEALTH SYSTEM (1)

16

It is estimated that Spanish pharmacies, with their attention to public service, absorb 25% of the demand for access to the Health System which, without their presence, would be difficult for the latter to take on without a drop in the quality of the health care, or a notable increase in the material and human resources of the system.

HEALTH ACTIONS CARRIED OUT IN PHARMACIES. SAVING FOR THE HEALTH SYSTEM (2)

17

The saving for the Health System, has been estimated in 2003 of 1,740 million €. An increase of 44% compared to 1996.

HEALTH ACTIONS CARRIED OUT IN PHARMACIES. SAVING FOR THE HEALTH SYSTEM (3)

1996 2003

• 151 million health actions not directly related to the dispensing of medicines.

• 1,150 million € in savings each year for the Public Health System.

• 182 million health actions not directly related to the dispensing of medicines.

• 1,740 million € in savings each year for the Public Health System.

18

DISTRIBUTION OF HEALTH ACTIONS CARRIED OUT IN PHARMACIES

Health actions and demands dealt with by pharmacies in 2003 are distributed as follows:

 

• Pharmaceutical advice: 56%

• Health campaigns: 36%

• Pharmacotherapeutic monitoring: 8%

19

Activities of pharmaceutical advice:

• Advice on the most appropriate medicine (for non prescription medicines) a particular treatment

• Advice on the dosage / methods of administration of the medicines

• Advice on magistral formulations

20

• Advice on medicinal plants and homeopathy

• Nutritional advice for children or adults

• Advice on skin care

• Early detection of illnesses and/or health problems

• Consultations which as a result of which the pharmacist refers the individual to the doctor

• Others

Activities of pharmaceutical advice (cont.):

21

Activities of pharmacotherapeutic monitoring:

• Detection of interactions, incompatibilities and contraindications of medicines

• Detection of side effects of medicines

• Personalisation of treatments

• Coordination activities between the doctor and the pharmacist in chronic patients

• Others

22

Campaigns and other activities of a health nature:

• Health training and information activities

• Monitoring of weight/height in adults and babies

• Monitoring of vaccination schedules

• Treating patients with dressings/bandages

• Conducting and interpretation of diagnostic tests

• Advice on mental and psychological problems

       

23

• Actions on drug addiction and AIDS

• Collection of containers for medicines

• Actions in order to facilitate relations between patients and the Administration

• Others

Campaigns and other activities of a health nature (cont.):

24

TRAINING (1)

• Number of courses increasing by more than 32%.

• Investment of more than 13 million euros per year.

• 58.5% of pharmacies carry out training activities.

Spanish pharmacies have redoubled their training efforts:

25

TRAINING (2)

1996 2003• 2.6 courses per

pharmacy active in training.

• 100 hours per pharmacy per year.

• 3.2 courses per pharmacy active in training.

• 178 hours per pharmacy per year.

• 20% of pharmacies hold Supervised Practices for students of pharmacy who are finalising their degree, with an average of 1.5 students trained in each pharmacy.

26

OTHER DATA OF INTEREST (1)

The results obtained are not fortuitous:

• Pharmacists are becoming more and more aware of their health care function with patients and their role as part of the multidisciplinary health team.

 

• The number of pharmacies in Spain has grown at almost double the rate of the population, and they have increased their human resources by around 20% amounting a figure of 65,000 people, representing 10% of jobs in the Health System.

27

OTHER DATA OF INTEREST (2)

• The computerisation process of pharmacies is now virtually complete, with the total figure going from 62% to 96%, advancing at a rate of 1,275 pharmacies per year and an annual investment of 36 million euros.

 

• It is estimated that 61% of pharmacies access the Internet, to search for information and to e-mail and consulting the Corporate Portal www.portalfarma.com.

28

CONCLUSION (1)

• The real objective of the work is to demonstrate the economic contribution of the pharmacist to the Health System and the added value of the pharmacist’s advice, beyond dispensing.

 

• Pharmacy in Europe is passing a situation in which the health role of the pharmacist is not always appreciated, and it is difficult to get European Authorities to find the right balance between the health value of a medicine and its economic considerations. 

29

• Our common objective is for medicines to be valued as a health good and not as merchandise, and that the pharmacist be regarded as the expert health professional in medicines who is most accessible to the population.

 

• In this regard, we believe that studies like the one we have just presented have an undoubted value and can be extremely useful when it comes to negotiations with the EU Institutions.

CONCLUSION (2)

30

CONCLUSION (3)

• We would hereby like to suggest to our European colleagues that they consider the advisability of undertaking a similar study within the common scope of pharmacists represented in the PGEU, for which we offer the Secretariat General of the Association all our support and collaboration.

31

CONCLUSION (4)

To get to act on the conclusions of the study, we are convinced that it is essential to have the support and the cooperation of our key partners in the healhcare system (the medical profession, the industry, the distributors and the patient).

Thank you