Pharmacy based metabolic syndrome

management program in Hungary

Antal Samu; Gyöngyvér Soós; Sándor Szabó; Péter Bánkuti; Attila Horváth-Sziklai;

Balázs Hankó

Hungarian National Committee of Pharmaceutical Care

Budapest, Hungary, Dózsa György Street 86/b, ph.care@mgyk.hu; www.gyogygond.hu

• The general health status of Hungary1

• the average life expectancy at birth 2007 (male: 69,2 year; female: 77,3 year)

• 132 800 deaths in 2007

• 50,1% of the total death is from cardiovascular diseases (CVD)

• Hungarian National Cardiovascular Program2

• to reduce the morbidity and mortality ratio in CVD the Hungarian government have started

the National Cardiovascular Program (NCP) since 2006.

• the professional coordinator of the NCP is the Association of Hungarian Medical Societies

• aim of the NCP is the prevention and the early identification of CVD, and to

provide integrated care and rehabilitation for the patients

• the Hungarian Metabolic Syndrome pharmaceutical care program is integrated into the NCP

Patient with cardiovascular risk

PA form,

Risk evaluation,

Documentation of MSP form

Patient asks,

pharmacist offers

the metabolism parameters

control

Patient education

Health promotion

Patient gets MSP leaflet

Patient education

Health Prevention

Patient gets MSP leaflet

No

Yes

Patient with

cardiovascular risk. Patient asks,

pharmacist offers the metabolism

parameters control.

PA form. Risk evaluation.

Documentation of MSP form.

Point of care testing (Blood

glucose, cholesterol, triglyceride;

pressure, weight measurement)

Evaluation of the measurement,

and metabolic syndrome.

Patient guidance.

Documentation of MSP form.

Direction to GP

Patient information, patient gets

MSP leaflet. Referral letter

Contact with the GP,

feedback facilitation.

Patient education.

Lifestyle changes

Patient gets MSP leaflet.

Control appointments

(1year, 3 months, 1 month)

No GP’s diagnosis and

drug therapy

Yes

Patient with diagnosed

cardiovascular disease,

and on drug therapy

PA form.

Cardiovascular risk evaluation.

Point of care testing.

Evaluation of patient drug use.

Evaluation of DRPs.

Documentation of MSDM form.

Direction to GP,

because of metabolic

parameter or/and

DRP

Patient information, referral letter,

DRPPI form. Contact with GP,

feedback facilitation.

Abbreviations:

PA form: Patient Approval form; MSP form: Metabolic Syndrome Prevention form; MP: Metabolism parameters; MSP leaflet: Metabolic Syndrome Patient leaflet; DRP: Drug Related problem;

MSDM form: Metabolic Syndrome Drug Management form; DRPPI Form: Drug Related Problem Pharmacist Intervention form

Pharmacy Based Metabolic Syndrome Program flowchart

Therapeutic modification

from the GP

Patient education. Lifestyle and drug

use recommendations. Adherence

improvement.

Control appointment

at the next drug dispensing.

No

Yes

Hungarian National Committee of

Pharmaceutical Care• Professional coordinator, managing body

• organization of the programme process

• inclusion of participating pharmacies

Supporting partners• Pharmacists’ Associations

• The Association of Hungarian Medical

Societies

• Roche (Hungary), Omron Ltd

• A bit of Attention Foundation

National Public Health and

Medical Officer Service • permission

• control

Pharmacy-Pharmacists• Voluntary participation

• 32hours training, exam

• Fulfill Staff and Technical

Requirements

Participant GPs• collaboration partners

• feedback the outcome of the

examination

Patient• Level one: everybody who comes into the pharmacy

• Level two: Patient with defined risk factors

• Level three: Diagnosed patient

Organizational Structure of the Metabolic Syndrome Program

• The aims of the Metabolic Syndrome pharmaceutical care program are the followings

• to provide information regarding healthy lifestyle and about the possibilities

and ways to prevent or postpone MS

• to increase awareness of the character of early diagnosis of MS

• to recognize people exposed to high risks

• to ensure a wide range of accessibility to self control products and services

Pharmaceutical care developments In Hungary3

• The three successful pilot pharmaceutical care programs led by the pharmacists

associations- Pilot Pharmacy Care Study of Hypertension in Hungary (PIPACH study) - Hungarian

Chamber of Pharmacists

- Pharmaceutical Care Program in headache, sunburn - Hungarian Society for

Pharmaceutical Sciences

- Diabetes Prevention Program - Hungarian Private Pharmacists’ Association

• Hungarian National Committee of Pharmaceutical Care

- 2-2 representatives from the Pharmaceutical Associations governing, professional body

of the pharmaceutical care programs

• Development of the Metabolic Syndrome pharmaceutical care program

Introduction

Aims

• Therapeutic outcome monitoring

• DRP prevention, detection, solution

• to increase treatment adherence of patients

• documentation and evaluation of pharmaceutical care activities

Setting and Methods

Staff and technical requirements

• Staff requirements- Diabetes, hypertension, dyslipidemia training seminar, successful exam

- Communication skills

• Technical requirements

- Level one:

- questionnaires, documentation forms

- Written patient leaflets

- Quiet area in the pharmacy

- Level two:

- Level one technical requirements and

- Place for the secure screening

- documentation forms

- Referral letter to GP

- Level three

- Pharmacy software and documentation forms

Yes

N o

Yes

Results Conclusion

• The pharmacists have a place in Metabolic Syndrome management

• Both the applied risk test and the screening methods enable the pharmacist to identify

individuals exposed to high risks

• Allows pharmacy to tap into a growing health and lifestyle market in the community

• The further steps will be

- the computerization of the program

- the enhancement of the feedback

- the third level of the program

• Participating pharmacies

- December 2008

- 450 pharmacies

- August 2009

- 606 pharmacies (30% of the Hungarian retail pharmacies)

• Continuing professional education

- 4 days – 32 hour long education

- 702 participants

References

1. OECD health division, Hungarian data, available: http://www.eski.hu/new3/adatok/nemzetkozi.php

2. István Kiss. The importance and possibilities of the National Cardiovascular Program. Hypertonia és Nephrologia 2009; 13 (2):69-74

3. Hungarian National Committee of Pharmaceutical Care. Metabolic Syndrome Pharmaceutical Care Program 2008.