Medication review services in primary care- experience from Slovenia Mitja Kos Head, Chair of Social Pharmacy University of Ljubljana, Faculty of Pharmacy E-mail: mitja.kos@ffa.uni-lj.si Chairman, Pharmaceutical Care Network Europe (PCNE)

Pharmaceutical Care Network Europe Pharmaceutical care researchers in Europe Established in 1994 Aim: stimulating research and implementation projects organising working conference and a symposium 2nd-3rd February 2018 Seamless care www.pcne.org

Pharmaceutical Care Pharmaceutical Care is the pharmacist’s contribution to the care of individuals in order to optimize medicines use and improve health outcomes. PCNE 2013 And several other defintions in the past. http://www.pcne.org//upload/files/3_PCNE_Definition_Position_Paper_final.pdf

Success?

Success in Slovenia ?

Past activities PhC programs: hypertenson, asthma, ask about your medicines, diabetes… Undergraduate and postgraduate education A number of conferences & symposia Theses, specialisations & other research Submissions to the health council in order to get remuneration

Positive attitude Knowledge & skills Long, unfocused programs not acceptable Weak arguments not always count Developments at the international level

Medication review new/old?

Medication review Medication review is a structured evaluation of patient‘s medicines with the aim of optimizing medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions. PCNE consensus 2016 MR services: those that are based on such activity.

Retrospective review => Ph. Care

Retrospective review => Ph. Care MR Retrospective review of information

Retrospective review => Ph. Care Intervention MR Retrospetive review of information

Retrospective review => Ph. Care Intervention MR Outcomes? ECHO Retrospetive review of information

Retrospective review => Ph. Care Monitoring & Follow-up Intervention Intervention Intervention MR MR MR Outcomes ECHO Retrospetive review of information

Two sided process

Two sided process Concept Standards Procedures In cooperation with:

Pilot project in 2012, „economic crisis“ Main driver: rationalisation, at the back the complexity of polypharmacy

What kind a MR in primary care?

Types of medication review PCNE

Questions Access to health care documentation Confidentiality Is a pharmacist a health care provider?

Questions YES Access to health care documentation Confidentiality Is a pharmacist a health care provider? YES

Questions NOT YET Access to health care documentation Confidentiality Pharmacist is a health care provider. Is this obvious to everybody? NOT YET

Developments in Slovenia Medication use review „Pregled uporabe zdravil“ Type 2a Avanced medication review „Farmakoterapijski pregled“ Type 3

Developments in Slovenia Medication use review „Pregled uporabe zdravil“ Type 2a Focus on patient M.Pharm. Avanced medication review „Farmakoterapijski pregled“ Type 3 Recommendations to physicians M.Pharm. & specialist in clinical or community pharmacy

Pilot project Alenka Premuš Marušič, specialist klinične farmacije Valerija Vukan, specializantka klinične farmacije Matej Štuhec, specializant klinične farmacije Tina Morgan, specializantka klinične farmacije Maja Petre, specialist klinične farmacije

ZZZS pilot project Avanced medication review „Farmakoterapijski pregled“ Type 3 Health care centers, primary level financing Referral by the physician Recommendations to physicians Pharmacotherapeutic groups at the local level M.Pharm. & specialist in clinical or community pharmacy

Health Care Team Collaboration It will not work for the patient if the collaboration is not in place.

Remuneration ?

Health care system financing Ambulatory setting… fee for service Hospital setting… Diagnosis Related Groups

Remuneration 2016 Medication use review Avanced medication review „Pregled uporabe zdravil“ Type 2a Focus on patient M.Pharm. Free or out of pocket Avanced medication review „Farmakoterapijski pregled“ Type 3 Health care centers, primary level financing Referral by the physician Recommendations to physicians Pharmacotherapeutic groups at the local level M.Pharm. & specialist in clinical or community pharmacy Remunerated by Health Insurance Institute of Slovenia, since 2016

Assuring quality Slovene Chamber of Pharmacy Certification of competencies Courses: theory + practice with menthors A special body „Skrbnik kompetenc“ Assuring quality: development & monitoring of MR services Continuing Professional Development http://www.lek-zbor.si/

Research support Faculty of pharmacy Randomised controlled trial of medication use review Observational study of advanced level medication review Exploratory studies of adherence, other DRPs, health care outcomes, innapropriate prescribing: Pharmacoepidemiology (health claims data) Observational study (prospective/retrospective studies) Cooperation at the international level: PRACTISE study: PhaRmAcist-led CogniTIve Services in Europe

Upgrade of specialisation One, upgraded specialisation in clinical pharmacy Before: two specialisations in community pharmacy and clinical pharmacy Much more clear what are the competencies First time a special service dedicated to the specialist Introduction of activities currenly run to assure certification into the specialisation program

Change of the law Pharmacy Practice Act 2016 Before: Provison of medicines After: also special focus on services: PhC, seamless care… Can a pharmacist be involoved in MR service without being at least partly employed in a pharmacy (community or hospital)? Who is the boss? What is the support to the pharmacist, continuing professional development, etc.? What is the relation with other colleagues? Where is the base?

Innovative, Integrated and Individualised Care Future Innovative, Integrated and Individualised Care