pharmacy in a new age mr sultan ‘sid’ dajani royal pharmaceutical society

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!

The Message is Coming Through

- Change is Inevitable!

Thank You

sid2708@aol.com