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1952 1990 2003
Pharmaceutical Economics
Heng-Sim Lee RPh MSDirector of Pharmacy, ChiaYi Branch, Taichung Veterans General Hospital
Clinical Nutritional Pharmacist
Council Member of Taiwan Society of Parenteral and Enteral Nutrition (TSPEN)
Professional Representative of Parenteral and Enteral Nutrition Society of Asia (PENSA)
Council Member of Chia Yi city Pharmacist Association
Lecturer of Nursing Institute, Hung Kuang University
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Pharmaceutical Care
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The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisorspecialised as a therapeutic advisor
The Pharmacist becomes more The Pharmacist becomes more specialised as a therapeutic advisorspecialised as a therapeutic advisor
Hospital Pharmacists move closer to Hospital Pharmacists move closer to Patient CarePatient Care
Hospital Pharmacists move closer to Hospital Pharmacists move closer to Patient CarePatient Care
What is Pharmaceutical Care?What is Pharmaceutical Care?What is Pharmaceutical Care?What is Pharmaceutical Care?
Changes in Pharmacy PracticeChanges in Pharmacy PracticeChanges in Pharmacy PracticeChanges in Pharmacy Practice
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Pharmaceutical CarePharmaceutical CarePharmaceutical CarePharmaceutical Care
NeedNeed GoalGoal ProcessProcess OutcomeOutcomeNeedNeed GoalGoal ProcessProcess OutcomeOutcome
Quality Assurance Quality Assurance of of
Drug TherapyDrug Therapy
Quality Assurance Quality Assurance of of
Drug TherapyDrug Therapy
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Pharmaceutical care
‘’Pharmaceutical care is the direct, responsible
provision of medication-related care for the
purpose of achieving definite outcomes that
improve a patient’s quality of life.’’
• Cure of the diseaseCure of the disease• Elimination or reductionElimination or reduction of symptomsof symptoms• Arrest or slowing of aArrest or slowing of a disease processdisease process• Prevention of disease Prevention of disease or symptomsor symptoms
Hepler CD and Strand LM (1990)Hepler CD and Strand LM (1990)
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Clinical Pharmacist Clinical Pharmacist integrates into integrates into
medical specialtiesmedical specialties
Variety of Variety of modelsmodels
Innovations inInnovations in Pharmacy Pharmacy ServicesServices
Clinical Pharmacist Clinical Pharmacist serves 60 bedsserves 60 beds
Emergence Emergence of the of the
Teacher-Teacher-PractitionePractitione
rr
Pharmacist as Pharmacist as ward visitor ward visitor serves 120serves 120
bedsbeds
1970s 1980s 1990s 2000s
Community Pharmacy Community Pharmacy Patient Patient
Medication RecordsMedication Records
Pharmacy Patient Pharmacy Patient Computer RecordsComputer Records
and Services toand Services to Elderly Nursing Elderly Nursing
HomesHomes
Primary Care Primary Care PharmacyPharmacy
Targeted Services Targeted Services
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VerifyingVerifyingTreatmentTreatment VerifyingVerifyingTreatmentTreatment
Monitoring Monitoring TreatmentTreatmentMonitoring Monitoring TreatmentTreatment
Confirming OutcomesConfirming Outcomesof Treatmentof Treatment
Confirming OutcomesConfirming Outcomesof Treatmentof Treatment
Transferring careTransferring careTransferring careTransferring care
Clinical Management Plan
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Profile of Patient’s CharacteristicsProfile of Patient’s CharacteristicsPatient Comprehension/ParticipationPatient Comprehension/Participation
Confirmation of NeedConfirmation of Need
Drug HistoryDrug HistoryContra-indications/InteractionsContra-indications/Interactions
Treatment PlanTreatment PlanConformity to GuidelinesConformity to Guidelines
Achievement of Achievement of Treatment GoalsTreatment Goals
Confirmation of SafetyConfirmation of Safety
Individualised Dose,Individualised Dose,Dose Frequency, Dose Frequency,
Means of AdministrationMeans of AdministrationAdherence Adherence
to Treatmentto Treatment
Clinical MonitoringClinical MonitoringLaboratory MarkersLaboratory Markers
VerificationVerificationConfirmationConfirmation of of
outcomesoutcomes
MonitorinMonitoringg
Unwanted SymptomsUnwanted Symptoms
Recorded Recorded Adverse ReactionAdverse Reaction
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Patient ProfilePatient Profile
Laboratory tests
Laboratory tests
MedicationMedication
Pharmaceutical care planPharmaceutical care plan
DocumentatioDocumentationn
DocumentatioDocumentationn
ResponsibilitResponsibilityy
ResponsibilitResponsibilityy
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History
• 1940~1960 Era of Expansion period• 1970~1980 Era of Cost containment• 1990~ Era of Assessment and Accountability for Health Outcome
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Definition of Pharmacoeconomics
• The process of identifying, measuring, and comparing the costs, risks, and benefits of programs, services, or therapies
• To determine which alternative produces the best health outcome for the resource invested
• Most impactful when making decisions about a population rather than individual
• “Costs vs. Consequences of Alternatives”
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Micro to Macro Applications with Pharmacoecomomics
Education in safe and effective prescribing practices. AAMC. July 2008.
From Board Room to Bedside
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Perspective of Pharmacoeconomics
• Patient perspective
• Provider perspective
• Payer perspective
• Societal perspective
1. Direct medical costs
2. Direct non medical costs
3. Indirect nonmedical costs
4. Intangible costs
5. Opportunity costs
6. Incremental costs
After selection of perspective next step cost related
measurements
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Application of Pharmacoeconomics
Clinical Pharmacy Service Evaluation• Determining the value of an existing services• Estimating the potential worth of implementing a new service• Capturing the value of a “cognitive” clinical intervention• Industry-marketing pricing, performance guarantee• Managed care – protocols, guidelines, formularies• Physicians – individual patient treatment decisions, prescribing,
payer-performance• Consumer – education, autonomy• Government – pricing, approval, formularies, policy• Institution – protocol, guidelines, formularies• Pharmacist – formularies, protocol, guideline, pharmaceutical care
service or program evaluation
Drug Therapy Evaluation –
Selective the most cost-effective drugs for an organizational formulary
Making a decision about an individual patient’s therapy
Customizing a patient’s pharmacotherapy
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