1. Quality prescribing in general practice
Jana Mrak, Alenka Premuš Marušič, Mojca Prislan, Brian Godman, Jurij Fürst
EUMASS, Ljubljana,

2. DISCLOSURE
Stock shareholder: AstraZeneca, Abbot Laboratories, Abbivie Inc., Novo Nordisk, GlaxoSmithKline, Merck & Co Inc.

3. ZZZS efforts in the field of quality prescribing during last years
Development task - Quality prescribing in general practice (8 quality indicators issued), May 2011
Systematic presentation of quality indicators in the regions/ Health Community Centers, 2012
New development task - Quality prescribing in general practice (clinical pharmacists as members of general practitioner’s team), November 2012 too December 2015
Systemic implementation of clinical pharmacists at a primary care level through a General agreement, starting in 2016

4. Aim and objectives of the development task - Quality prescribing in general practice 2012 - 15
to implement continuous improvement of prescribing (safety and efficacy of treatment with medicines)
Objectives:
A systematic review of less appropriate medications for elderly patients (through lectures)
A systematic review of medications in patients with polypharmacotherapy (5 or more different medications)
Reduced growth in polypharmacotherapy

5. Clinical pharmacist Refers a patient
Reviews patient’s
pharmacotherapy
Issues a written report for
the GP
General practitioner:
Refers a patient
Adjusts or modifies patient’s pharmacotherapy in agreement with the patient
Regular meetings of physicians and clinical pharmacists to share
expertise and experiences.

6. Model introduction timeline
From November 2012 till March 2014 (first part):
Region Murska Sobota
From April till December 2014 (second part):
Health Community Center Ljubljana.
From January till December 2015 (third part):
Region Murska Sobota,
Health Community Center Ljubljana
Health Community Center Idrija.

7. Scientific program approved by the Medical Chamber of Slovenia
First part:
PRISCUS list
Second part:
Region Murska Sobota: medications during pregnancy, newer diabetes medicines , some herbal preparations
Health Community Center Ljubljana: PRISCUS list
Third part:
Region Murska Sobota: beta blockers, ivabradine, ranolazine, trimetazidine; medicines for dementia, asthma & COPD medications, lipid-lowering drugs
Health Community Centers Ljubljana and Idrija: newer anticoagulants, newer diabetes medicines, some herbal preparations

8. Results of model implementation
192 group meetings (clinical pharmacist and physicians)
1097 weekly afternoon sessions (clinical pharmacist)
3640 pharmacotherapy reviews which uncovered (LexiComp database):
944 X-drug interactions (these agents are generally considered contraindicated - avoid combination)
5721 D-drug interactions (assessment should be conducted in order to determine whether the benefits of such combination outweights the risks - consider therapy modifications)

9. No. of persons with polypharmacotherapy*
*Polypharmacotherapy is defined as 5 or more active ingredients (ATC level 4) prescribed at the same time.

10. Physicians endorsed the development task and supported cooperation with clinical pharmacist. (Questionnaire at the end of each part of development task.)

11. Age of the respondents
2014* (1.4. – ); 2015*(1.1. – )

12. Workplace of the respondents
2014* (1.4. – ); 2015*(1.1. – )

13. Group meetings continuation
2014* (1.4. – ); 2015*(1.1. – )

14. Weekly afternoon sessions continuation
2014* (1.4. – ); 2015*(1.1. – )

15. Independent information on medicines
2014* (1.4. – ); 2015*(1.1. – )

16. Lessons learned
Local organization is convenient and well accepted by all participants including patients.
Availability of clinical documentation enables more accurate pharmacotherapy reviews.
Regular meetings of physicians and clinical pharmacist were in the survey among participants rated as necessary.
Obvious benefits for individual patients (No of X and D interactions found).

17. Systemic implementation of clinical pharmacist on primary care level
Partners in General agreement have agreed about the gradual implementation across Slovenia:
During in regions Murska Sobota, Ljubljana, Maribor,
During 2017 in regions Kranj, Celje, Ravne na Koroškem,
During 2018 in regions Novo mesto, Krško, Nova Gorica, Koper.
According to General agreement - clinical pharmacists will be employees of Health Community Centers with the possibility of having session in private clinic with concessions.
After completion of the implementation there should be 17,57 field territory equivalents (FTE) of clinical pharmacists :
Yearly costs of Euro per FTE per year or
Euro per year all together.

18. Thank you for your attention!