primary care pharmacist
TRANSCRIPT
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A Pharmacist in Primary Care?16th of May 2013. School of Pharmacy. University of Eastern Finland
Carlos Barreda VelázquezPrimary Care Pharmacist NorWest of Madrid
E.mail: [email protected] Twiter: @CarlosBarredav
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NORTHWEST HEALTH DISTRICT
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NORTHWEST HEALTH DISTRICT
Population: 975.400 inhabitants
40 HEALTH CENTERS
21 LOCAL SURGERIES
3 HOSPITALS
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HOSPITALS PRIMARY CARE
NATIONAL HEALTH SYSTEM
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PROFESSIONALS
668 Doctors 502 Nurses
334 No health Professionals
87 Other Professionals
77 Emergency Service
14 Head Office
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What is a Primary Care Pharmacist?
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
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EFFICACYSAFETY
ADHERENCE COST
RATIONAL USE OF DRUGS
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EVIDENCE BASED MEDICINE
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But, but …what is a Primary Care Pharmacist?
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
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INFORMATION
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INFORMATION
And Sometimes who Provides that information?
Primary Care Pharmacist give scientific, objective and corroborated information
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Where do we look?
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Drugs Evaluations
WRITTEN INFORMATION
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Bulletins and Guides
WRITTEN INFORMATION
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CLINICAL QUESTIONS
What is the evidence for lowering cholesterol and using statins in stroke patients?
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
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Education and training for local prescribers and other healthcare professionals
EDUCATION
PLACE OF WORK
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EDUCATION
Continued Education Programs
Education Programs to Residents and Interns (Family doctors and Hospital Pharmacists)
Patients Education Programs
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FUNDACIÓN JIMÉNEZ DÍAZ
HOSPITAL PUERTA DE HIERRO
HOSPITAL DE EL ESCORIAL
CARE COORDINATION
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Local Protocols
CARE COORDINATION
Rationale Use of Drugs Commission
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Local Protocols
CARE COORDINATION
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
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HEALTH CENTER TARGETS
Ensuring that local prescribing is evidence-based and follows best practice
Prescribing indicators
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PRESCRIBING INDICATORS
SAFETY
EFFICACY
EFFECTIVENESS
EFFICIENCY
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DA % ARA II
Importe envase Estatina
Osteoporosis mujeres de 40 a 65 años
AINE en
anciano%NuevoACO
% PacSYSADOA
% Omepraz
DHD UPP (**) IBP
DA 42,45% 7,24 4,32% 9,64% 4,74% 10,13% 87,67% 15,21
DA 41,37% 7,74 2,95% 10,63% 6,37% 9,55% 87,72% 15,99
DA 42,79% 7,65 3,05% 8,61% 4,17% 9,43% 87,25% 14,15
DA 45,03% 9,11 4,24% 9,13% 3,94% 8,22% 83,27% 14,27
DA 39,27% 7,95 3,66% 9,68% 2,04% 6,77% 86,39% 18,37
DA 30,79% 6,23 3,25% 10,48% 2,10% 5,37% 86,96% 16,67
DA 39,38% 8,59 3,80% 11,08% 2,46% 8,62% 87,04% 17,74
A. Primaria 40,39% 7,78 3,64% 10,08% 3,89% 8,42% 86,80% 15,92
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IndicatorPromote ACE inhibitors vs ARBs
Cost-effective indicator
DDD ARBs
DDD ACEI + DDDARBS
AS AN EXAMPLE…
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In The 90s Primary Care Pharmacist was considered…
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Educational outreach visits: Trained Professiol visit Prescriber in Healthcare
FACE TO FACE
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Pharmacists have changed
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
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Storehouse(Pharmacy
Service)
H.C.
H.CH.C
Supplying medicines to Health Centers
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Which Medicines?
Crash Cart
Vaccines
Cares
Emergency Drugs
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Which Medicines?
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INSPECTION
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Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
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SafeUse of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
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RISKS…?
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Polypharmacy in elderly people
IMPROVE THE QUALITY OF LIFE IN OVER 75 PATIENTS TAKING 5 OR MORE DRUGS
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1) Treatment Review
+
Polypharmacy in elderly people
2) Patient Education
+
3) Adherence
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INFORMATIC APPLICATIONS
INTERACTIONSMAXIMUM DOSES
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Treatment should be stopped if the patient develops ischaemic heart disease, peripheral arterial disease or cerebrovascular disease or if hypertension becomes uncontrolled..
STRONTIUM RANELATE
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MEDICATIONS ERRORS
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MEDICATIONS ERRORS
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DOSIS DEL PACIENTE
F. Organizativos y estratégicos
F. Ligados a la tarea
F. Recursos Condiciones de trabajo
F. Profesionales
Carga de trabajo?
Fatiga, cansancio ligada al turno/horario?
F. comunicación
F. Formación y conocimientos
F. Equipo y sociales F. paciente
Falta de manejo de dosis y presentacioens
Escasez de tiempo por Paciente?
OrganizaciónDe la consulta???
Falta de Comunicación del Protocolo.
Poca implicación del paciente porTratarse de un proceso agudo pocorelevante
Distracción
Falta de formació nen antimicrobianos
Falta de medidas de Adecuadas para la Implantación y Monitorización de los Protocolos
Falta de Incorporación de los Procedimientos a la Práctica Clínica
Falta de manejo de dosis y presentacioens
MEDICATIONS ERRORS
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1 MEDICATION ERROR
?????????????
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MEDICATIONS ERRORS
Patient Safety Good Clinical Practices
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MEDICATIONS ERRORS
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Woman 65 years Candida infection of the skinKetoconazol gel 2% is prescribed
MISTAKE REPORTED
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Patient used the medication as a shower gel
What it happened?
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Is a formal process in which healthcare providers work together in avoid Medicatio Errors origined across transitions of care
MEDICATION RECONCILATION
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MEDICATION RECONCILATION
1. Develop a list of current medications; 2. Develop a list of medications to be prescribed; 3. Compare the medications on the two lists 4. Make clinical decisions based on the comparison 5. Communicate the new list to appropriate caregivers and to the patient.
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NEW CHALLENGES
PRESCRIPTION CARD
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TREATMENT REVIEWS
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http://populationpyramid.net/WORLD/2010/
FINLANDSPAIN
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THANK YOU VERY MUCH!!!!