1. Medication review services in primary care- experience from Slovenia
Mitja Kos
Head, Chair of Social Pharmacy
University of Ljubljana, Faculty of Pharmacy
Chairman, Pharmaceutical Care Network Europe (PCNE)

2. 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

3. 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.

4. Success?

5. Success in Slovenia ?

6. 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

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

8. Medication review
new/old?

9. 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.

10. Retrospective review => Ph. Care

11. Retrospective review => Ph. CareMR
Retrospective review of information

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

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

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

15. Two sided process

16. Two sided process
Concept
Standards
Procedures
In cooperation with:

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

18. What kind a MR in primary care?

19. Types of medication review
PCNE

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

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

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

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

24. 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

25. 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

26. 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

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

28. Remuneration ?

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

30. 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

31. 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

32. 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

33. 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

34. 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?

35. Innovative, Integrated and Individualised Care
Future
Innovative, Integrated and Individualised Care