1. Patient- centered care 2. Partnering (with patients, other providers, communities) 3. Quality improvement (measuring care delivery and outcomes; learning and adapting to change; translating evidence into practice) 4. Information and communication technology 5. Public health perspective (population-based care delivery, seamless care, primary health care-led systems, etc.) (2005) (2009) 5 core competencies to provide better care for patients living with chronic health problems The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

2 « Collaborative Pharmacy Practice is defined as the clinical practice where pharmacists collaborate with other health care professionals in order to care for patients, carers and public. » FIP Statement of Policy on Collaborative Pharmacy Practice Draft document actually in a processus of discussion FIP Statement of Policy on Collaborative Pharmacy Practice Draft document actually in a processus of discussion Five levels of CPP have been identified from a number of models across the world AdveAdve Advanced CPP; authority to initiate or modify medicine therapy. Prospective advice and/or referral by another healthcare professional. Reactive advice to other health care professionals. System wide authority to supply medicines. Minimal contact between pharmacists and other healthcare professionals Degree of collaboration Amount of responsability The pharmacist’s perspectives o f the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

The five dimensions of Patient-centered care and their objectives (A. Niquille and O. Bugnon, Niquille’s PhD Thesis 2009, Geneva University) Quality of life Clinical outcomes Efficiency Public Health Quality Care Effectiveness Safety Patient Disease(s) Health Economics and Policy Health Care workforce Therapy(ies) The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Strategy for implementation of collaborative care practice in primary care (O. Bugnon and M. Buchmann, 2010) 4 Implementation in primary care Advancement of collaborative care practice EDUCATION & COACHING (transfer from research into practice) EDUCATION & COACHING (transfer from research into practice) REGULATION for carers and patients (health policy; remuneration; quality standards; monitoring) REGULATION for carers and patients (health policy; remuneration; quality standards; monitoring) RESEARCH & DEVELOPMENT ( frameworks; methods and standards of practice; technologies; management; outcomes research ) RESEARCH & DEVELOPMENT ( frameworks; methods and standards of practice; technologies; management; outcomes research )

Examples of community pharmacists contributing to improvement of Patient-centred medication-use process The pharmacist’s perspectives of the team approach in Patient- centered Health Care Dr Pharm Michel Buchmann

A stable group of 3-10 GPs and 1-2 pharmacists as moderators Volunteers to have meetings together Evaluation of the daily prescribing practice Based on their own and actual prescription data Working together for continuously improving their practice Implementing practice guidelines and standards A continuous monitoring and feedback of the success of the common decisions that have been taken This means that every participant is active! What is a Physicians-Pharmacists Quality Circle ? (PPQC) ? The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Working process within a PPQC ? The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Community pharmacists and GPs together to lower the health costs Medications: «Implemented since 2002, pharmaceutical care services have allowed to decrease the costs in a spectacular way » The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

1st axe of collaborative care  practice guidelines and interdisciplinary education programmes The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Niquille A. Ruggli M., Buchmann M., Jordan D. and Bugnon O. A nine- year sustained cost-containment impact of Swiss pilot physicians-pharmacists quality circles. The Annals of Pharmacotherapy, in press Locca J.-F., Ruggli M., Buchmann M., Huguenin J. and Bugnon O. Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton. Pharm World Sci (2008). PMID: Locca J.-F., Bula C., Zumbach S and Bugnon O. Pharmacological treatment of behavioral and psychological symptoms of dementia (BPSD) in nursing homes: development of practice recommendations in a Swiss canton. JAMDA (2008 Jul);9 (6): To know more about the « Physicians- Pharmacists Quality Circles » … The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Examples of community pharmacists contributing to improvement of Patient-centred medication-use process The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

-Medication Event Monitoring System (MEMS®) : objective and dynamic measure of daily medication intake. -LCD display. 2. Adherence measurement 3. Adherence Report and record -Data collection, visualization and interpretation. -Feedback to the patient. -Quality management system - Interface with patient’s records. 1. Motivational interviewing patient- pharmacist -Individualized cognitive and behavioral intervention. -Seamless monitoring of medication adherence, adverse events and co- treatments in relation to health outcomes. Community pharmacy remunerated service for supporting patient adherence (Switzerland) The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Examples of results of community pharmacists-led supporting patient adherence programs (Switzerland) 1. HIV patients Examples of results of community pharmacists-led supporting patient adherence programs (Switzerland) 1. HIV patients I. Krummenacher’s PhD thesis (2010)/ Pharmacie de la PMU, Lausanne (Switzerland)

Examples of results of community pharmacists-led supporting patient adherence programs (Switzerland) 2. Hypertensive patients Examples of results of community pharmacists-led supporting patient adherence programs (Switzerland) 2. Hypertensive patients H. Figueiredo’s PhD thesis (2010)/ Pharmacie de la PMU, Lausanne (Switzerland)

Schneider M.P., Krummenacher I., Figueiredo H., Marquis J. and Bugnon O. Adherence : a review of education, research, practice and policy in Switzerland. Pharmacy Practice 2009; 7 (2): Recent posters: Krummenacher I., Cavassini M., Bugnon O., Schneider M.P. Retrospective analysis of an HIV-adherence program. The 13th edition of the European Symposium on PAtient COMpliance and Persistence 2009 ESPACOMP, Bangor (Wales), Guignard Hefti E., Achtari Jeanneret L., Lange A.C., Vrijens B., Luthi F., Bugnon O., Schneider M.P. Adherence to oral anticancer treatment : focus on persistence and execution during continuous schema of treatment. 30st European Society of Clinical Pharmacy (ESCP) and GSASA symposium, Geneva, 4-6 Nov To know more about the Swiss « patient adherence programmes » … To know more about the Swiss « patient adherence programmes » … The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

In relation to physicians working alone, the main points are the following: A real collaborative practice is not a dream, The objectives are to optimize the safety and effectiveness of the treatments for the patients. A need to be persistent for best results An important saving capacity on medicines costs based on professional decisions and not on price reductions. An increased resistance of the Health workers against industrial marketing activities. A recognized interdisciplinary education in favor of person- centered care. A more efficient spreading or the pharmacovigilance messages. Swiss physicians-pharmacists collaborative practices Results in short lines... The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

Messages to be taken from this presentation  FIP, in his mission of the pharmaceutical world leader, is determined to open ways for collaborative practice within the health care team. FIP will clearly declare its intention by the adoption of a Statement of policy on Collaborative Pharmacy Practice during his next World Congress in Lisbon.  Swiss pharmacists are very active in the development of collaboration projects with physicians and nurses. They didn’t want to dream about it but really wanted to do it!  Person-centered care is evidence for us to improve the care and quality of lifes of our patients. It is evident to every decision makers that the future is clearly connected to collaborative practice because our societies will never have enough money to pay for ’all’ treatments. The building of this new world has to sprout up from beneath. We all have l the same responsabilities to support the change of our practices and of our attitudes. The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann

For the help received in preparing this presentation I want to thank: FIP, for the opportunity the represent our World Federation during this Conference. Prof Olivier Bugnon Phone: +41 (0) , Head of Community Pharmacy Practice Unit, Pharmaceutical Sciences Section (University of Geneva, University of Lausanne) My research and professional colleagues of the Pharmacie de la PMU, Rue du Bugnon 44, CH-1011 Lausanne (Switzerland) My friends physicians, pharmacists and nurses actually involved in all these new Swiss patient-centered projects The pharmacist’s perspectives of the team approach in Patient-centered Health Care Dr Pharm Michel Buchmann