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Pharmacy in a New Age
Mr Sultan ‘SID’ Dajani Royal Pharmaceutical Society
UK Pharmacists
• Where we were
• Where we are now
• Where we could be
• How we approached identifying extended roles for pharmacy
Pharmacy in the UK
•45,000 Registered pharmacists•10,500 community pharmacies/Walk-in Healthcare Centres across the UK •800 Hospitals•6 million people visit pharmacies daily•Dispense around 700 million prescriptions a year•Have a pharmacy family•In Community, hospital, industry, academia, army, GP surgeries, the government, agriculture, medicines information, prison.
Statistics• 4-21% of patients achieve optimum benefit from their
medication1
• Between a third and a half of prescribed medicines for long-term conditions are not used as intended or recommended2
• Errors found in 7.5% of Rxs written3
• 40-50% of patients discharged have at least one discrepancy4
• Preventable waste costs £750 million in England alone5
• £100m medicines unused and returned to pharmacies annually6
Potential for Progress
• UK ’s £9bn annual prescription medicine cost• 786m Items 07-08• 5% - Preventable ADR Hospitalisations• 10% of prescriptions are never dispensed.• 50% don’t take medicines correctly as prescribed• 58% - Not told about Side-Effects• The largest group of drug users is the over 65’s
who account for 50% of all prescriptions issued• Polypharmacy & Increasing Risks of ADRs
PDRM – drug related morbidity
• Unnecessary therapy• Inappropriate Rxing• Inadequate follow-ups• Failure to recognise symptoms• Over-Rxing• Medication errors• Over/under dosing• ADR• Contraindications• Non-compliance !
What might have changed?
• Societal change– Ageing population living longer– Informed, knowledgeable patients
• Politics• Patient expectations• Professional aspirations• Cost management
What will change?• Information technology
– Robotics, artificial intelligence, home health management systems
– New diagnostic tests performed anywhere• Science
– Stem cell technologies, genomics, nanotechnology, etc.
• Medicines– New cures for new diseases
where does pharmacy fit in?
• See the walking wounded and the wounded well• Availability of healthcare Products• No appointments or referrals necessary• Manage repeat medication• See patients up to 5 times more than other HCPs• Trained experts in medicines and symptoms
• The management of prescribed medicines• The management of long-term conditions• The management of minor ailments• The promotion & support of healthy
lifestyles• Advice and support for other health
professionals
Community
Remove harm and add good
Barriers to Change
• Lack of Evidence Base practice• GP bias• Confidence of the patients and Public• Belief by pharmacists• Funding• Professional settings• Medicinal information and support • Tools e.g. Software, paperwork, record keeping• Could pharmacists really make a difference?
Vision
Partnerships Remuneration
PharmacyFit for the Future
Partnerships
• Other Pharmacy Organisations
• Other Medical Professional Bodies
• Consumer & Patient Groups
• Government/Politicians
•The Pharmaceutical Industry
•Academic/Research Institutions
•Our Members
Vision
What is Pharmacy?
What is our role/vision?
How Have External Drivers Affected Us?
How do we build a strategy?
Consultation Results
• More clinical role• Regular practice guidance and support• Better funding mechanisms• Reduce stress and workload pressures• Want devolved powers to address local not just national needs• Become more multidisciplinary• Must focus on down stream treatment and upscale upstream
prevention• Have an Evidence Base of Our Value• Measureable patient orientated outcomes• Many resisted/feared change!
Roles of the Professional Leadership Body
• Professional Support• Professional Development & Education• Leadership & Advocacy• Professional Networking• Science and Research
New Contract 2005
• Essential
• Advanced
• Enhanced
• 600m GBP to 1.76bn GBP
Current Pharmacy Contract
- £2.3 Billion p.a.• Dispensing• Signposting• Support For Self Care• Disposal Of Unwanted Medicines• Clinical Governance• Computerised patient records of dispensed meds• Annual Patient Surveys• Two annual Audits• Promotion and support of healthy lifestyles – Five
Public Health campaigns a year
Medicines Use Review (MUR)
• Patient interviewed & profile compiled
• Pharmaceutical care plan generated
• Pharmacist implemented agreed plan & MonitoredMean of 2.8 Changes per patient
GP acceptance rates were between 87-95% Similar rates were seen for patient acceptance
The Message is Coming Through
- Change is Inevitable!
MUR outcomes
• 1,265,278 carried out in 08-09• Approx 30,000 forms monitored and assessed:• 19% non GP changes• 67% queried with GP• 90% GP amendments (68% deemed serious)• 42% resulted in medicines stopped• 15% new therapy initiated• 10% referred to specialistic care
Huge savings to hospitals, reduced medicines wasted
Enhanced Services in Pharmacies
• Minor Ailments Services• Smoking Cessation Services• Supervised Administration• Needle Exchange• Anticoagulant Monitoring• Blood Pressure Monitoring• Diabetes Monitoring• Care Home Support• Full Clinical Medication Reviews (Level 3)• Vascular Risk Assessments
• Prescribing• Screening• Flu Vaccination• Travel Vaccines
• Providing Devices• Palliative Care Services
Other Examples of Clinical Roles
The facts…
• Assess patients’ pharmaceutical care needs
• Plan a strategy for the individual
• Monitoring
• Achieving therapeutic goals
Remove harm and add good
Medication Reviews
• 26,000 in 07-08• Pharmacists with premises fitted out for
private discussion will interview selected patients about their medication so as to identify any problems that might have arisen.
• The pharmacist will make a structured assessment of the patient’s prescribed medicines with a view to discussing the matter with the patient’s general practitioner.
The Pharmaceutical Care Cycle
GP
Recognise Patient Problem
Assess Patient Problem
Therapeutic Plan(Rx)
Record / InterpretPatient Information
Consider Therapeutic Objectives
Assess Therapeutic Plan
Design Monitoring Regime
Dispense and Advise
Implement Monitoring Plan
Assess patient problem (if any)
Respond to problem (if any)
RESOLVED
Pharmaceutical Care for the Elderly
• 117 medication reviews
• Average age 79
• Resulted in 49 recommendations
23 hospital admissions prevented
Saving £49,28512
296 recommendations accepted
Self Care & OTC
• Health Campaigns e.g. Obesity, smoking cessation• Training Support for Pharmacists & Staff• Professional Tools• Screening equipment• Information Sharing• Audits• Media/Publicity products & services – ‘Ask Your
Pharmacist First’• Prescription Only Medicines to Over The Counter
medicines
Diabetes Facts & Stats
• Increasing every year - 239 Million in the year 2020
• 4th leading cause of death• 9% NHS budget• Over a million undiagnosed cases • Chronic Disease• Many Complications• Health Promotion just as Important as Medicinal
Care• Early intervention - L/T complication
COPD
•Costs to the NHS £900 Million
•3.4 Million sufferers
•2000 Deaths a year
•80% of the fatalities are estimated to be avoidable
•Asthma results in 85,000 hospital admissions
•25% of Asthmatics suffer daily symptoms
Future• Patient registration• Minor Ailment Services• Pharmacist with a Special Interest (PhwSI)• Generic Substitution• Repeat Dispensing• Medication Reviews/Medicines
Management/Pharmaceutical Care• More use of IT & technology- EPS, patient care records• Clinical Screening• Healthy Living Centres• GP appointments booked through pharmacists• 1st Prescription Service• Prescribers at undergrad level• First Prescription Service
Consultation Questions• What functions do you expect to do more of or
less of in future & why?• What are the 3 changes that need to happen in
order to deliver the aspirations of the profession?• What 3 things should the national pharmacy
bodies do now to create the future for pharmacy?• What 3 things should you do now to create the
future for pharmacy?
Pharmacy Beware!
