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 CareDr 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

Five levels of CPP have been identified from a number of models across the world

Adve

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

Deg

ree

of c

olla

bora

tion

Am

ount

of

resp

onsa

bilit

y

The pharmacist’s perspectives o f the team approach in Patient-centered Health CareDr Pharm Michel Buchmann

The five dimensions of Patient-centered careand their objectives

(A. Niquille and O. Bugnon, Niquille’s PhD Thesis 2009, Geneva University)

Quality of life

Clinical outcomes

EfficiencyPublic Health

EffectivenessSafety

Patient

Disease(s)

Health Economics and Policy

Health Care workforce

Therapy(ies)

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr Pharm Michel Buchmann

Strategy for implementation of collaborative care practice in primary care (O. Bugnon and M. Buchmann, 2010)

4Implementation in primary care

Ad

van

cem

en

t of

collab

ora

tive c

are

pra

cti

ce

EDUCATION & COACHINGEDUCATION & COACHING(transfer from research into practice)(transfer from research into practice)EDUCATION & COACHINGEDUCATION & COACHING(transfer from research into practice)(transfer from research into practice)

REGULATION

REGULATION

for carers and patie

nts

for carers and patie

nts

(health policy; re

muneration; q

uality

(health policy; re

muneration; q

uality

standards; monito

ring)

standards; monito

ring)

REGULATION

REGULATION

for carers and patie

nts

for carers and patie

nts

(health policy; re

muneration; q

uality

(health policy; re

muneration; q

uality

standards; monito

ring)

standards; monito

ring)

RE

SE

AR

CH

& D

EV

EL

OP

ME

NT

RE

SE

AR

CH

& D

EV

EL

OP

ME

NT

(( fra

mew

orks

; met

hods

and

sta

ndar

ds o

f fr

amew

orks

; met

hods

and

sta

ndar

ds o

f pr

actic

e; te

chno

logi

es; m

anag

emen

t; pr

actic

e; te

chno

logi

es; m

anag

emen

t; ou

tcom

es r

esea

rch

outc

omes

res

earc

h ))

RE

SE

AR

CH

& D

EV

EL

OP

ME

NT

RE

SE

AR

CH

& D

EV

EL

OP

ME

NT

(( fra

mew

orks

; met

hods

and

sta

ndar

ds o

f fr

amew

orks

; met

hods

and

sta

ndar

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f pr

actic

e; te

chno

logi

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anag

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t; pr

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logi

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anag

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t; ou

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outc

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Examples of community pharmacists contributing to improvement of Patient-centred medication-use process

Physicians-Pharmacists Quality Circles (PPQC)

Patient

Disease(s)

Health Economics and Policy

Health Care workforce

Therapy(ies)

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr 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 CareDr Pharm Michel Buchmann

Working process within a PPQC ?

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr Pharm Michel Buchmann

Drug cost evolution (index) in the first Swiss physicians-pharmacists quality circles (Fribourg) compared with thecontrol group between 1999 and 2007 (drugs listed in the national

formulary) / 24-25 GPs and 6 community pharmacists

121.7

130.6

139.0143.4

161.8166.9

169.9173.9

115.2

126.7130.0

132.6

140.6 138.9136.8

132.4

100.0

110.0

120.0

130.0

140.0

150.0

160.0

170.0

180.0

1999 2000 2001 2002 2003 2004 2005 2006 2007

Evo

luti

on

du

co

ût

méd

icam

en

t an

nu

el

par

pati

en

t (I

nd

ex)

Groupe Témoin

Fribourg - Pionniers

+15.2%

+10.0%

+2.6%+21.7%

+7.3%

+6.4%

+3.2%

+2.0%

+12.8%

+6.0%

-1.2%

+3.2%

n = 23 médecins

+2.3%

- 3.2%

+1.8%

-1.5%

In 2007 around 230’000 CHF savings per GP

Cercles de qualité pharmaSuisse

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 CareDr Pharm Michel Buchmann

Soulager la douleur en EMS : un projet

interdisciplinaire et un droit pour les résidents

Formation interdisciplinaire

J eudi 11 octobre 2007 (13h00- 17h30) à l’I nstitut Agricole de Grangeneuve, Posieux

Sous le patronage de la Direction de la santé et des aff aires sociales du

canton de Fribourg, de l’Association Fribourgeoise des I nstitutions pour

Personnes Agées (AFI PA), de la Société des pharmaciens du canton de

Fribourg et de la Société de Médecine du canton de Fribourg.

Les demandes d’accréditation par la SSPh, la SSMG et la SSMI sont en cours

1st axe of collaborative care practice guidelines and interdisciplinary education programmes

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr 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: 19067223

• 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):439-48.

To know more about the « Physicians-Pharmacists Quality Circles » …

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr Pharm Michel Buchmann

Examples of community pharmacists contributing to improvement of Patient-centred medication-use process

Patient adherence enhancement

programmes

Disease(s)

Health Economics and Policy

Therapy(ies)

Health Care workforce

Patient

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr 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 CareDr Pharm Michel Buchmann

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

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): 63-73

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), 10.9.2009.

• 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. 2009.

To know more about theSwiss « patient adherence programmes » …

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr 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 practicesResults in short lines...

The pharmacist’s perspectives of the team approach in Patient-centered Health CareDr 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 CareDr 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)21 314 48 42, Olivier.Bugnon@hospvd.chHead 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 CareDr Pharm Michel Buchmann