EUROPEAN AND INTERNATIONAL INNOVATION IN HEALTHCARE PHARMACY: pharmaceutical model PORTUGAL ANA PAULA MARTINS Portuguese Pharmaceutical Society

A little about Portugal Evolution of pharmaceutical services in Portugal Antiretroviral therapy in community pharmacies Structuring development with competencies Information technology shaping modern pharmacy //SUMMARY

Ageing Population: o Increase Life Expectancy at Birth ( ♂ 77,2 ♀ 83,0 ) o Low fertility rate (7,9 ‰) Major Causes of Death: o Cardiovascular Disease – 30% o Cancer – 24 % Increasing number of diabetic patients Increasing number of illness in elderly women Population : ~ //A LITTLE ABOUT PORTUGAL

3.600 INHABITANTS / PHARMACY COMMUNITY PHARMACIES 2,9 PHARMACISTS / PHARMACY

80s Monitoring biological parameters Information activities Managing medicine waste Early 90s Syringe Exchange program Late 90s Differentiated services Narcotic substitution programmes (e.g. metadone) Pharmaceutical care programmes (e.g Asthma, Diabetes, Hypertension) Since 2005 Wider pharmaceutical service framework (awareness campaigns, screenings, biological parameters, therepeutical management, patient counselling, …) 2007 Other pharmaceutical services //EVOLUTION OF PHARMACEUTICAL SERVICES IN PORTUGAL

Home care support First-aid support Medicines administration Use of auxiliary means of diagnostic and therapeutics Administration of vaccines out of the national immunization plan Pharmaceutical care programmes Information campaigns Collaboration in Health education and promotion plans Ministerial Order 1429/2007 Decree-Law 307/2007 Pharmacies can provide services targeting patient healthcare and general well-being according to further legislation by Agency of the Ministry of Health Decree-Law 171/2012 //EVOLUTION OF PHARMACEUTICAL SERVICES IN PORTUGAL From 2007 onwards

Value community pharmacies as healthcare providers Development of the rational use of medicines Articulate Community Pharmacy services with other NHS units Pilot the partial delegation of administration of oral medicines in the areas of Oncology and Infectious Diseases Ministerial Order 199/2016 //EVOLUTION OF PHARMACEUTICAL SERVICES IN PORTUGAL Most recent changes

HIV medicines – exclusive to hospitals o Price of therapy and overall costs o Management of adherence to therapy Distance to hospital can affect adherence o Travel expenses o Frequency of travel associated with the availability of medicines Proposal to have community pharmacies dispensing o Homogenous distribution throughout the national territory Protocol with the central government and regional administrations Cooperation with hospital units //ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES

Are community pharmacists COMPETENT to dispense ARVs? Competence based model Education refreshment Legal certification by the PPS (Hospital Pharmacists have always done it!) //ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES

Laboratory Medicine and Human Genetics Regulatory Affairs Hospital Pharmacy Pharmaceutical Industry 5 year cycle of Continuous Professional Development 15 Professional Development Credit Points PPS supervision and management of process Online system //STRUCTURING DEVELOPMENT WITH COMPETENCIES SPECIALIZATIONS

1)Mandatory curricular evaluation; 2)Different evaluation methods for each specialization  Curricular evaluation  Interview  Evaluation  Monography  Exam  Curricular evaluation  Interview  Evaluation  Monography  Exam COMPETENCIES 1 Specialization 2 Advanced COMPETENCIES 1  Submission of competency framework  Curricular validation  Elegibility  Evaluation  Interview  Monography  Exam  Practical / Laboratory //STRUCTURING DEVELOPMENT WITH COMPETENCIES

State delegates on the PPS o Recognition of competence o Certification of educational programs o Valid with certificate for Basic Life Support Educational program o 75% theory + 25% Practice o Minimum content set out by PPS Recertification o Every 5 years o Proof of practice + refreshment course //STRUCTURING DEVELOPMENT WITH COMPETENCIES 5 VACCINATION – a competency example

//INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY

Slides EXTRA

Medicines with restricted prescription For hospital use only Pharmacological characteristics New medicines Public health issues For primary care diagnosis but with severe adverse reactions to be expected and patient vigilance during treatment For pathologies diagnosed in the hospital setting alone Medicines can be taken in ambulatory care Special reimbursement clauses for these medicines (100%) and high price. ARV 213M € in 2015 [21% of Hospital expenditure in Medicines] //ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES

Source: Portugal – Infeção por VIH, SIDA e Tuberculose em números 2015 How are ARVs dispensed now? Only hospital pharmacists do it Special counselling and consultation in the pharmacy SI.VIDA – IT System for monitoring ARV medicines dispensing o 25 units which cover for 93% patients (10 more by the end of 2016) o patients followed cases of PoEP o Monitors patients, lab data and therapeutics //ANTIRETROVIRAL THERAPY IN COMMUNITY PHARMACIES

Electronic Health Record Integrated vision of patient data Support the clinical decision Accessible by several healthcare professionals Available to the citizen through its national ID card //INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY

E-prescription Wider choice for the citizen (empowerment) o More versatile system where all medicines are in one list and patient is free to dispense each medicine when and where he chooses More control by the central administration to avoid fraud Better understanding of patient medication //INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY

Pharmacist electronic ID Allow access to ICT systems – Patient Electronic Health Record Digital signature to validate Pharmacist only actions o Prescriptions in hospital o Medical Biology analysis o Batch release in pharmaceutical industry //INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY

In the horizon Pharmacy as an outpost for mediation between patient and access to the healthcare system o Compensate imbalance in access to ICT for patients without knowledge or means o Have a present trustworthy health professional //INFORMATION TECHNOLOGY SHAPING MODERN PHARMACY