E u r o p e a n S o c i e t y o f C l i n i c a l P h a r m a c y The overall aim of the Society is to develop and promote the rational and appropriate use of medicines by the individual and by society. Welcome to the 46 th ESCP Symposium in Heidelberg (Germany) Dear colleagues, On behalf of the European Society of Clinical Pharmacy, we are delighted to invite you to the 46th Annual Symposium on Clinical Pharmacy in Heidelberg. After 18 years, Germany is proud to host ESCP’s annual meeting and welcome Europe’s most com- mitted clinical pharmacists in Heidelberg. Hotel am Kornmarkt (Heidelberg) The main theme of the conference is “Science meets practice – towards evidence-based clinical pharmacy services”. In our professional life, we are driven by the aim of improving of patient outcomes – irrespective of our back- ground as practitioners or scientists. Stadtansicht (Heidelberg) Our common goal is to maximise efficacy and safety of medicines by applying and generat- ing scientific knowledge. During the three days in Heidelberg we want to discuss the current state of the art of the most frequently applied and novel clinical pharmacy services – both from the scientists’ and the practitioners’ perspective. Which evidence-based tools are available to support our services? How can we generate sound scientific knowledge to prove their added value? How can we assure their quality? Around these questions the scientific commit- tee has compiled an exciting programme that will be both informative and stimulate the exchange of experiences with colleagues from all over Europe, and beyond. Stadthalle congress centre Plenary lectures, workshops, poster presenta- tions, poster discussion forums and a master class will offer you many possibilities for inspiration and interaction. And don’t miss the Pecha Kucha presentations… Schloss (Heidelberg) Last but not least, on top of the scientific programme we invite you to three exciting days in Heidelberg, the city hosting the oldest University in Germany that will charm you with its romantic flair. The river side, the old town, the castle, and the pharmacy museum – they all wait for you to discover. We would be delighted to meet you in Hei- delberg! You find more information in page 7 of this issue and on the programme online under: http://escpweb.org/content/46th-escp- symposium-clinical-pharmacy-heidelberg . Hanna Seidling Symposium president [email protected]and Ulrich Jaehde Symposium president [email protected]ESCP News — August 2017 — Number 176 — ISSN 1353-0321 1 A Few Words
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E u r o p e a n S o c i e t y o f C l i n i c a l P h a r m a c y The overall aim of the Society is to develop and promote the rational and appropriate use of medicines by the individual and by society.
Welcome to the 46th ESCP Symposium in Heidelberg (Germany)
Dear colleagues, On behalf of the European Society of Clinical Pharmacy, we are delighted to invite you to the 46th Annual Symposium on Clinical Pharmacy in Heidelberg. After 18 years, Germany is proud to host ESCP’s annual meeting and welcome Europe’s most com-mitted clinical pharmacists in Heidelberg.
Hotel am Kornmarkt (Heidelberg) The main theme of the conference is “Science meets practice – towards evidence-based clinical pharmacy services”. In our professional life, we are driven by the aim of improving of patient outcomes – irrespective of our back-ground as practitioners or scientists.
Stadtansicht (Heidelberg)
Our common goal is to maximise efficacy and safety of medicines by applying and generat-ing scientific knowledge. During the three days in Heidelberg we want to discuss the current state of the art of the most frequently applied and novel clinical pharmacy services – both from the scientists’ and the practitioners’ perspective. Which evidence-based tools are available to support our services? How can we generate sound scientific knowledge to prove their added value? How can we assure their quality? Around these questions the scientific commit-tee has compiled an exciting programme that will be both informative and stimulate the exchange of experiences with colleagues from all over Europe, and beyond.
Stadthalle congress centre Plenary lectures, workshops, poster presenta-tions, poster discussion forums and a master class will offer you many possibilities for
inspiration and interaction. And don’t miss the Pecha Kucha presentations…
Schloss (Heidelberg) Last but not least, on top of the scientific programme we invite you to three exciting days in Heidelberg, the city hosting the oldest University in Germany that will charm you with its romantic flair. The river side, the old town, the castle, and the pharmacy museum – they all wait for you to discover. We would be delighted to meet you in Hei-delberg! You find more information in page 7 of this issue and on the programme online under: http://escpweb.org/content/46th-escp-symposium-clinical-pharmacy-heidelberg.
Barbara Claus, born on 17th September 1978 in Belgium.
Career so far In June 2002 I obtained my hospital phar-macist’s degree. Shortly after, I started working in the hospital pharmacy of Ghent University Hospital, a dynamic environ-ment with many opportunities: clinical pharmacy, pharmaceutical compounding, formulary decisions, research and teaching. In 2003, I was involved in one of the Belgian projects piloting ward clinical pharmacy. I had the opportunity to gain experience abroad (Montréal, Canada) and gradually the intensive care unit became my second habitat. While being involved in many crucial for-mulary and individual patient treatment decisions, my interest in cost-effective choices grew, both at the individual patient as well as on the general hospital level. The fact that we have to allocate the restricted resources in the most optimal way, both considering cost and effect of treatment, is pharmacoeconomics avant la lettre. The purpose is to create more health in a population and hence opportunities to adopt the most innovative treatments in a
smart way. A dissertation in the domain of health-economics was for me the next logical step. I defended my PhD work in 2015 with the following title: The clinical and economic benefit of in-hospital clinical pharmacy in the intensive care unit. As a PhD student, I followed a course of pharmacoeconomics at the University of York, England and I joined the ISPOR (Inter-national Society for Pharmacoeconomics and Outcomes Research) student chapter which then united the health economic researchers of Ghent University in Belgium. Initially as vice-president (2011-2012) and between 2012-2014 as president. Under this presidency, the student chapter also started to recruit researchers from other Belgian universities, making it an ideal medium to discuss research and bench-mark with peers. This unique action led to a 2nd prize for best ISPOR student chapter worldwide.
Ongoing projects today & ESCP contributions Together with my interest in efficient pharmacy processes (using robotics and dose banding in oncology for example) my pharmacy work remains focused on cost-effective and evidence based drug choices. It brings me into contact with many more interesting domains related to cost-effective & clinical pharmacy care: the cost-minimization opportunity of biosimilar biotechnological drugs, the major im- portance of pharmacovigilance and even the unrevealed areas of pharmacokinetics in the intensive care unit.
As a member of the Belgian commission of drug reimbursement, I have the opportuni-ty of discussing the budget impact and cost-effectiveness of new treatments.
Topped with a sauce of evidence based practice, this is in a nutshell the contribu-tions made through my workshops and plenary lecture for the ESCP audience so far. I had the opportunity to join the SIG of Medicines Information with a first work-shop in 2010 on “how to find the best evidence in 5 minutes” (Lyon, France), updated and again fully booked in 2015 in Lisbon.
Subsequently in 2016 (Oslo): “How can we optimize clinical pharmacy efficiency with limited resources?”. In a plenary in Lisbon (2015), I highlighted “where health eco-nomics meet evidence based practice”. Since October 2016, I am responsible for the ESCP SIG of pharmacoeconomics.
Ghent University As a guest lecturer at Ghent University [Pharmaco-economics at the Faculty of Pharmaceutical Sciences], I like to bring this societal and economic dimension of phar-macy care to the final year pharmacy stu-dents. This adds to their pharmacothera-peutic education, making them profession-als prepared for a rapidly changing work environment!
Science meets practice – toward evidence-based clinical pharmacy services
The 46th ESCP Symposium on Clinical Phar-macy will take place in Heidelberg, Germany, October 9th-11th, 2017 http://escpweb.org/content/46th-escp-symposium-clinical-pharmacy-heidelberg
Theme of the Workshop: "Science meets practice - towards evidence-based clinical pharmacy services."
• How to utilise evidence in clinical pharma-cy services ‣ Are standardised guidelines and persona-lised treatment a contradiction? ‣ What are current evidence-based tools in clinical pharmacy practice and how can we apply them in our daily routine? ‣ How can medication reviews be imple-mented in different settings? • How to generate evidence for clinical
pharmacy services ‣ What evidence currently supports clinical pharmacy services? ‣ What is the added value of clinical phar-macy services and which study designs are appropriate to measure it? ‣ How do we address the challenge of im-plementation and complex interventions? ‣ What evidence is needed to support dis-semination of clinical pharmacy services? • Assuring quality in clinical pharmacy ser-vices ‣ How should we teach patient-oriented pharmacy to assure quality? ‣ How can simulation training be efficiently integrated into continuous learning and enhance learning outcomes? ‣ Which indicators are available to continu-ously and meaningfully assess the quality of
clinical pharmacy services?
A Masterclass of Excellence on Design and Implementation of Pharmacist-led Random-ised Clinical Trials on the Sunday 8th October http://www.escpweb.org/sites/escp/files/page_document/ESCP2017_Heidelberg_Masterclass_program_20161018.pdf
Submission of abstracts for oral communica-tions and posters have been done on-line through the ESCP website: www.escpweb.org. Accepted and presented abstracts will be published in the Interna-tional Journal of Clinical Pharmacy (IJCP, former PWS). Abstract submission deadline is closed since July 10th, 2017.
Background information on the ESCP Annual Symposium in Heidelberg What is the current situation of Clinical Pharmacy in Germany? In Germany, medication safety has become a nationwide concern over the past ten years. Since 2008, the Federal Ministry of Health regularly launches national action plans for enhancing medication safety.
Likewise, also Clinical Pharmacy has increas-ingly become part of clinical routine both in primary and inpatient care, with hospital pharmacists being active on wards and at interfaces of care, and community pharma-cists offering medication reviews.
Yet, compared to international standards, the number of clinical pharmacists in hospi-tal is far below average and in primary care, medication reviews are not yet established as reimbursed health care service – but indeed, many things are moving in the right direction now.
At the Universities, Clinical Pharmacy was introduced in 2001 as core discipline in the German Curriculum of Pharmacy with an additional final examination. So it has be-come part of the undergraduate Pharmacy education at all 22 German Schools of Pharmacy.
So far, about half of them have established a full or associate professor of Clinical Pharmacy which has contributed to a steady increase of patient-oriented research activities in Germany in the previous years.
Who are the two symposium presidents? Hanna Seidling and UIrich Jaehde are both involved in undergraduate and postgradu-ate education of pharmacists and a variety of research projects on medication safety and patient-oriented pharmacy.
Hanna is Head of the Cooperation Unit Clinical Phar-macy at the Uni-versity of Heidel-berg since 2011. Her research is dedicated to the optimisation of the medication pro-cess. To this end,
she conducts studies and quality improve-ment projects focusing on the implementa-tion of health IT, interprofessional coopera-tion and patient empowerment.
She is involved in societies fostering clinical pharmacy and leads the working party on medication safety in the German coalition for patient safety.
Ulrich is Professor of Clinical Pharmacy at the Institute of Phar-macy, University of Bonn since 1999. His main areas of research are medication safety of cancer and elderly patients as well as PK/PD modelling and dose individualisation in oncology. Ulrich is active in many national and inter-national societies related to pharmaceutical sciences, clinical pharmacy, patient safety, and oncology. He is member of the national coordination group on medication safety, the drug commission of the German medi-cal association (AkdÄ), and the drug com-mission of German pharmacists (AMK).
Echos from ESCP All Change at the ESCP Research Committee (RC)
There have been many recent changes to the membership of the ESCP Research Committee. Mara Pereira Guerreiro has stepped down as Committee Chair and has been replaced by Derek Stewart. Three members of the Committee, Marcel Bouvy, Martin Schulz and Lene Juel Kjeldsen have departed, and Lorna West and Daniela Fialová have joined the Committee. In this article, we give thanks to the three out-going members, welcome Derek as Chair and also Lorna and Daniela.
Thank you, Marcel, for dedicated years of service to ESCP, by Mara Guerreiro, Research Committee Chair 2014-16 Marcel Bouvy obtained his PharmD degree at the University of Groningen in 1992. He started his career in community pharmacy and he still practices at the academic com-munity pharmacy Stevenshof. Marcel pursued a PhD at the University of Utrecht (2002), researching drug therapy in heart failure, and later became a professor of pharmaceutical care at the same University
(2009). Marcel has made an outstanding contribution to clinical pharmacy practice and research, by teaching pharmacy stu-dents, supervising doctoral candidates, serving in expert committees, writing books and actively publishing research papers. He has published over 100 international peer-reviewed papers and over 200 papers in Dutch journals; additionally, he has pre-sented over 200 abstracts in international scientific meetings. Marcel also finds time to coach his son’s football team!
Marcel participated in is first ESCP meeting in Amsterdam in 1997. Since then he has attended almost all ESCP meetings, in which he has presented over 50 scientific abstracts and delivered plenary lectures. He was a member of the ESCP Research Committee between 2004 and 2016 and chaired the Committee between 2006 and 2014. During this period, he led the first steps of the initiatives that were recently implemented, such as the strategic plan and the research grant. Marcel was also
instrumental in developing masterclasses on research topics. Marcel was awarded an ESCP fellowship in 2016, in recognition for continued excellence in clinical pharmacy research and for his contribution to the advancement of clinical pharmacy. Marcel gave way to new Research Commit-tee members. Working with Marcel for more than a decade has been inspirational; his kindness and pragmatism will not be forgotten. Thank you, Marcel, for serving ESCP with great enthusiasm and for re-minding us that pharmacy is a profession of hope.
Warm thanks to Martin Schulz for his engagements in ESCP, by Gert Laekeman, Past President of ESCP Martin’s professional career is more than impressive. He graduated as a pharmacist from the University of Hamburg, Germany, in 1983. From 1983-1984, he was a hospital pharmacist, and studied Medicine at the University of Hamburg from 1984-1986.
In 1988, he obtained his PhD in Phar-macology from the University of Ham-burg.
In 1989, he was named "Expert in Pharmacol-ogy" by the German Society for Experimental and Clinical Pharmacology and Toxicology. He specialised as a “Drug Information Pharmacist” in 1993. Martin Schulz is Man-aging Director of the Federal Union of the German Association of Pharmacists. Martin was a member of the General Committee of ESCP from 2006-2012, rep-resenting Germany. Apart from his profes-sional skills, we very soon experienced the clear vision of Martin during discussions and decision-making. Martin joined also the Research Committee in 2006. He was one of the promotors of the ESCP fellow-ships. ESCP is grateful to Martin, as he took his responsibilities in the difficult time ESCP was experiencing shortly after his engage-ment in the General Committee. He did not leave the ship, but on the contrary gave all his support to our organisation, with a sense for science, management and crea-tivity. As a consequence Martin was hon-oured with the ESCP fellowship. Due to other professional commitments, Martin decided to step down from his active ESCP involvement. We will remem-ber him as an ESCP-member who collabo-rated honestly will full transparency. Thank you Martin for your engagement. We wish you all the best in your professional activ-ities and we wish you also a warm hu-man environment!
Thank you Lene!, by Siska Desplenter, Past President of ESCP Lene Juel Kjeldsen applied for member-ship of the Research Committee of ESCP in Spring 2014 and formally joined our committee at the annual symposium in Copenhagen the same year. Lene gradu-ated as a pharmacist in 1997 from the Royal Danish School of Pharmacy, Den-mark. She obtained her PhD in 2002 from the Department of Medicine, Uni-versity of Queensland, Australia. From 2003 onwards, she has been working as a researcher and clinical pharmacist in different positions in Denmark.
Throughout her membership of the Re-search Committee, Lene has been very supportive in many ways. Having an open mind, she challenged the discussions in a constructive way. Even during her stay in Japan, she took a very early start of her morning to join the evening skype meet-ings of the research committee. Thank you for your much appreciated input and for supporting the ESCP Research Committee. We wish you good luck in both your profes-sional and private life!
New Chair of the RC Derek Stewart ([email protected]) took over Chair from Mara Pereira Guer-reiro in January 2017.
Derek is Professor in Pharmacy Practice at the School of Pharmacy and Life Sciences at Robert Gordon University (RGU), Aberdeen, Scotland. He has worked at RGU since 1991 and also has experience of pharmacy practice in all healthcare set-tings. He is an executive editor of the British Journal of Clinical Pharmacology and a member of the editorial board of the Inter-national Journal of Clinical Pharmacy. He collaborates widely with individuals and groups in many other countries across the globe. He has extensive experience of peer reviewing abstracts, papers and research grant applications. Derek has been a member of the Research Committee since 2014 and also has experi-ence of presenting research and workshops at ESCP events. Derek’s research interests focus on: developing, implementing and sustaining novel models of pharmacy prac-tice; and medicines use, effectiveness and safety. He has current programs of work in broad areas of: innovations in pharmacy practice within sustainable models of inte-grated multidisciplinary care; and medicines use, effectiveness and safety. Specific areas are: pharmacist prescribing and prescribing by other non-medical healthcare profes-sionals; medication errors; pharmacovigi-lance; polypharmacy and medication adher-ence; medication wastage; complementary and alternative medicines use; and facilita-tors and barriers towards research in prac-tice. He has published over 135 peer re-viewed papers. He is committed to driving forward research within ESCP and the need for evidence of pharmacy practice.
Lorna is a principal pharmacist and is currently pursuing a post-doctoral scholar-ship within the De-partment of Clinical Pharmacology & Ther-apeutics at University of
Malta. The scholarship is partially funded by the REACH HIGH Scholars Programme – Post Doctoral Grants. The grant is part-financed by the European Union, operational Pro-gramme II – Cohesion Policy 2014 – 2020
'Investing in human capital to create more opportunities and promote the well-being of society' – European Social Fund. She has worked as a pharmacist since 2000 and has worked as a clinical pharmacist in respiratory since 2002. From 2013 till 2015 she was Head of Pharmacy at the oncology hospital. Lorna has experience of presenting research and workshops at ESCP events. Lorna’s research interests focus specifically on medication wastage. Her current pro-grams of work comprise several phases exploring and implementing medication wastage minimisation strategies. Other areas of interest are: clinical pharmacy, respiratory, oncology and systematic reviews in various fields. She has published over 15 peer reviewed papers.
Daniela Fialová, new member [email protected] Daniela is Researcher, Academic and Head of the University Educa-tional Centre in Clinical Pharmacy at the Faculty of Pharmacy, Charles University in Prague, Czech Repub-lic. She develops research works in clinical pharmacy and still partially continues in clinical pharmacy practice in geriatrics at the Department of Geriatrics and Geron-tology, 1st Faculty of Medicine, Charles University in Prague. She has worked as clinical pharmacist in geriatrics since 2001 and as academic since 2003. She has exten-sive experience in research works in clinical pharmacy in geriatrics on European level and devotes her professional effort to further development of clinical pharmacy in research, education and clinical practice. Daniela was Chair of the Scientific Commit-tee organising the 42nd ESCP Symposium on Clinical Pharmacy in Prague in 2013 entitled “Implementation of clinical pharmacy practice: research, education and man-agement”. She has a long-term experience in presenting research and workshops at ESCP events and different other scientific meetings and conferences. Daniela’s research interests include clinical pharmacy in geriatrics, evaluation of the efficacy and safety of drugs and drug regimens in the old age, changes (phar-macological, physiological) accompany-ing aging, geriatric pharmacoepidemio-logy, risk-management in pharmacother-apy, analyses of polypharmacy and com-bined drug regimens in multimorbid geriatric patients. She has published 2 monographs, 2 book chapters in foreign monographs, a themed issue on devel-opment of clinical pharmacy in different settings of care in Europe and other countries, and over 80 articles.
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Echos from ESCP All Change at the ESCP Research Committee (RC) (continued)
1. How to create a pharmacy service? - Daniel Sabater-Hernández
Current challenges in pharmacy practice include the normalisation of pharmacy services into routine healthcare practice (1). Existing frameworks for health program planning provide robust guidelines for developing, implementing and evaluating health interventions and services and so can help to overcome existing challenges (2-4).
Pharmacy services are integrated into complex systems in which a number of organisations and individuals, at different levels, take part and interact. Understand-ing the system and how contributors, activi-ties and settings influence and interact with each other, facilitates the identification of potential circumstances and factors that may reinforce or hinder the implementa-tion and/or the effect of any intervention. Thus, frameworks for health program planning adopt a holistic approach that simultaneously address the development of interventions aimed at the end-beneficiaries of the program, along with interventions and strategies to implement and evaluate the former. Importantly, these frameworks highlight the relevance and impact of the groundwork and research performed prior to the implementation and evaluation of a health service (i.e., devel-opmental work) and the involvement of key
stakeholders, on the subsequent chances of that service being effective and successfully implemented (normalised). The early de-velopmental work establishes a strong foundation for the health service, ensuring that the service emerges in response to actual needs of the community or the healthcare system; is founded in relevant theories and empirical evidence; and is piloted and optimised in a real world setting (subjected to a process evaluation) before moving into a full evaluation of the service's impact on health outcomes.
Pharmacy-related stakeholders are not solely responsible or capable of developing and integrating pharmacy services. Collabo-ration with other stakeholders is necessary to create a ‘mutually meaningful’ service. Stakeholder planning groups should include the end-beneficiaries of the service, phar-macists and individuals or groups who have responsibility, authority, influence and/or commitment to the health issue (e.g., government organisations, funders, policy makers, researchers, professional and scientific organisations, etc.). Having stake-holders working collaboratively brings several benefits to the service planning process that can eventually facilitate their adoption into practice. Generally, collabora-tive planning facilitates the analysis of the
contexts in which services will be imple-mented, fosters co-learning, nurtures net-working, develops stakeholders’ positive feelings of ownership on the planned ser-vice, and brings innovative ideas, logistical and financial support.
References 1. Mossialos E, Courtin E, Naci H, et al. From "retailers" to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy. 2015; 119(5): 628-39. 2. Bartholomew LK, Markham CM, Ruiter RAC, Fernández ME, Kok G, Parcel GS. Planning health promotion programs: An Intervention Mapping approach. Fourth ed. San Francisco, CA: Jossey-Bass; 2016. 3. Green LW, Kreuter MW. Health program planning: An educational and ecological ap-proach. 4th ed. Boston: McGraw-Hill; 2005. 4. Craig P, Dieppe P, Macintyre S, et al. Devel-oping and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008; 337: a1655.
2. Pharmacist Prescribing. - Professor Derek Stewart
Many countries have now im-plemented pharmacist prescribing and many others are scoping pre-scribing practic-
es with a view to developing pharmacist prescribing. Specific aims of pharmacist may vary from country to country but are focused generally on: improving patient care outcomes without compromising patient safety; increasing patient access to medicines; and making better use of the skills of health professionals.
For example, in the UK, there are two models of pharmacist prescribing: supple-mentary prescribing (SP) and independent prescribing (IP).
SP, introduced in 2003, is defined as a ‘voluntary partnership between an inde-pendent prescriber (doctor or dentist) and a supplementary prescriber to implement an agreed patient-specific clinical manage-
ment plan (CMP) with the patient’s agree-ment’.
A later development was the introduction in 2006 of IP, defined as ‘prescribing by a practitioner (e.g. doctor, dentist, nurse, pharmacist) responsible and accountable for the assessment of patients with undi-agnosed or diagnosed conditions and for decisions about the clinical management required, including prescribing’. Qualification as an independent prescriber now also confers supplementary prescrib-ing status. Professor Derek Stewart leads the pharma-cist prescribing research group at Robert Gordon University in Scotland, and in 2011 was awarded UK Pharmacy Practice Re-search Trust Practice Research Award for his significant contribution to pharmacy practice research in the field of pharmacist prescribing. During the plenary, Derek will describe the complexities of prescribing and the ten principles of good prescribing, as described by the Royal Pharmaceutical Society in Great Britain.
He will focus on the evidence of effective-ness and safety of pharmacist prescribing and the findings of the research conducted at RGU which have been integrated within practice and policy at national and interna-tional levels, impacting: patient care; prac-tice models of care; professional body strategies; government policies and strate-gies; educational policy statements; educa-tional strategies; and international plans and strategies for the development and implementation of pharmacist prescribing.
Focus will be placed on the Scottish Gov-ernment strategy to ensure that ‘all pa-tients, regardless of their age and setting of care, will receive high quality pharmaceuti-cal care using the clinical skills of the phar-macist to their full potential’. Prescription for Excellence: a vision and action plan for the right pharmaceutical care through integrated partnerships and innovation, was published by the Scottish Government in September 2013. The vision articulated within this document is that by 2023, ‘all pharmacists providing National Health …/…
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…/… Service (NHS) pharmaceutical care will be NHS accredited clinical pharmacist inde-pendent prescribers working in collabora-tive partnerships with medical practitioners who will continue to have overall responsi-bility for diagnosis’.
He will then challenge all attending in terms of the potential for developing and imple-menting pharmacist prescribing in their own countries.
Workshop, How to become a pre-scribing pharmacist Dr Brian Addison, Professor Derek Stewart
A prescribing workshop will be led by Dr Brian Addison, senior lecturer at RGU and Professor Derek Stewart. The aim of this workshop is to encourage pharmacy practi-tioners to consider how their practice could evolve to incorporate a role as a pharmacy
prescriber. The learn-ing objectives are that attendees will be able to: 1. Evaluate and reflect on the role of a pharmacist prescriber as a way of supporting pa-tients to use their
medicines effectively. 2. Critically appraise plans for developing pharmacist prescribing service(s). 3. Construct a personal development plan (PDP) for developing as a pharmacist pre-scriber
Brian and Derek will draw on their experi-ence and expertise of delivering pharmacist prescribing education to encourage inter-action and participation through small group based activities using a range of well-developed and tailored workshop and take home materials.
3. Developing pharmaceutical care for patients with transplantations. - Pierrick Bedouch
The development of solid organ transplan-tation (SOT) is a long story which began in the early 20th century with the develop-ment of the vascular suturing technique by the French surgeon Alexis Carrel. Over the last decades, SOT has been extensively developed worldwide. The main vital or-gans are now transplanted including kid-ney, liver, heart, lung or pancreas. Different factors have contributed to the improve-ments in graft and patient survival.
Success is in large part due to progress in the management of the therapies including very specific therapies (ie: immunosuppres-sive drugs) and supportive therapies. Successful management, therefore, ex-tends beyond the initial concern about rejection. In this context, incorporation of pharmacists into the transplant team to provide medication management has become more common.
Their roles within the multidisciplinary care model have expanded to include all phases of transplant. This lecture aimed to present the development of pharmaceutical care for patients with transplantations organ-ised in three parts: 1/ Therapeutic goals in Solid Organ Trans-plantation (SOT): What is the need for pharmaceutical care? 2/ Role of the pharmacist in SOT: an over-view. 3/ Pharmaceutical care in SOT: Experience for lung transplant patients at Grenoble Hospital.
Firstly, we presented the history of SOT, the specificity of therapies, medication adherence issues in SOT patient and their consequences. The analysis of literature clearly shows that pharmaceutical care for SOT patient integrated into the multidisci-plinary transplantation team is not only desirable but essential.
Secondly, we proposed an overview of the role of transplant pharmacist as reported in literature. Mitchell JF described for the first time in 1976 specific activities of a pharma-cist involved as a member of a renal trans-plant team (1). Since, many programs of transplant pharmacist have been described in literature providing drug therapy moni-toring, education of the other team mem-bers, and patient education and counsel-ling.
Regarding the expansion of transplant pharmacist activities in the US, a descrip-tion of the pharmacist’s role as part of the multidisciplinary transplantation team was published in 2011 (2). This article outlined the roles and responsi-bilities of the pharmacist in the inpatient, ambulatory care, and research settings and described the training required to be com-petent. Finally, we discussed the opportuni-ty to develop a specific business plan to implement and expand transplantation pharmacy services.
Thirdly, we presented the experience of pharmaceutical care for lung transplant patients in our setting at Grenoble Universi-ty Hospital, France. We developed clinical pharmacy since 1994 by incorporating pharmacy residents in wards in combina-tion to electronic prescription implementa-tion. Nowadays, clinical pharmacy is im-plemented through presence of pharmacy residents and senior pharmacists in differ-ent medical wards. In disciplines where SOT is performed, clinical pharmacists partici-pate in the patient follow-up.
We presented the most developed pro-gram performed in lung transplantation. This program has been progressively de-veloped since 2008. The pharmacist reali-ses all the activities recommended by the American College of Clinical Pharmacy (2),
including individual patient education sessions, participation in physician ward round and multidisciplinary committee, medication review (including pharmacoki-netic) to manage complex prescriptions with physicians (detection and solving of drug interactions and adverse drug events), medication reconciliation, participation to research. These activities are provided at pre- and post-transplantation period during hospitalisation but also in ambulatory care. In order to assess the impact of the lung transplant pharmacist activity, we analysed the impact of the Pharmacist Interventions (PI) performed for outpatients over a 7-year period. We performed 1569 PIs with a physician acceptation rate of 92%. The rating of clinical impact showed 37% of major impact, and 58% of moderate im-pact. Regarding the economic impact, 37% of PIs induced a cost reduction. To con-clude, pharmaceutical care in SOT has proven to be useful and specific programs should be implemented using a business plan. The future of transplant pharmacy practice is to develop outpatient education, multi- and inter-disciplinary work, and integration of pharmacogenomics into follow-up and medical decision process.
1. Mitchell JF. Pharmacist involvement as a member of a renal transplant team. Am J Hosp Pharm 1976; 33 (1): 55-8. 2. Alloway R, Dupuis R, Gabardi S, et al. Evolution of the role of the transplant pharmacist on the
multidisciplinary transplant team. Am J Transplant 2011; 11: 1576-83.
Pierrick Bedouch PBedouch@chu-
grenoble.fr
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Extended responsibilities for pharmacists in the treatment of acute & chronic conditions
4. Availability of medicines without prescriptions in the EU - Regulatory challenges of switching from Prescription only to OTC status. - Kora Doorduyn-van der Stoep A medicinal product is registered if the product has shown to have a positive risk-benefit ratio. The legal classification for supply (Prescription only or OTC) is, in principle, a national decision taken by the national competent authority and depends on the potential risk of the product (active substance, strength, pharmaceutical form, pack size) and is considered an instrument to minimise the possible risks of the prod-uct. It is also possible to switch from Prescrip-tion only to OTC EU wide via the CHMP (Committee for Human Medicinal Prod-ucts), examples: Nexium Control (esomeprazole); Alli (orlistat) and Pantoloc Control (pantoprazole).
Decisions on switching legal status should be based on new scientific information or changes in use/abuse of the product and can be initiated upon request of the holder of the marketing authorisation (MAH) or by the respective Competent Authority as a result of a potential serious safety signal.
The criteria for classification are laid down in the Directive 2001/83/EC. If the criteria for prescription only products do not apply, the OTC status can be assigned.
It is important for OTC products that the patient should be able to self-diagnose the condition and that possible risk factors, such as contra-indications and interactions, are clearly stated in the package leaflet. All OTC products are considered relatively safe when used according to the instructions in the package leaflet taking into account the responsibility of the patient/consumer.
OTC products in The Netherlands can be classified as general sales (AV), available at pharmacy and drugstore/chemist (UAD), and only available at the pharmacy (UA). UA is needed when a pharmacist needs to monitor the medication, or give special instructions or guidance. There is an im-portant role for the pharmacist to monitor medication. AV is justified when the active substance, the strength/dose and pack size are considered safe for self administration.
The AV (GS) list published on website CBG: https://english.cbg-meb.nl/documents/ directives/2016/11/24/gs-list-14.
If criteria for UA nor for AV do not apply for a product, the product will be assigned the UAD classification status. The status of the drugstore in NL is not similar to the drug-store in some other countries.
For example paracetamol is classified based upon pack size, strength and indication (cf. tab) In Europe there is a call for more OTC products and cooperation between all relevant stakeholders. The AESGP is the European Trade association on OTC prod-ucts and has performed a study on the Economic and Public Health Value of Self-Medication (http://www.aesgp.eu/media/ cms_page_media/68/2004study.pdf).
Several challenges however, need to be addressed such as that the legal classifica-tion is a national issue dependent on na-tional practices and health care systems (e.g. reimbursements), which sometimes hampers a harmonised decision in the EU. For the future new possibilities to facilitate switches from Precription only to OTC status for medicinal products will be ex-
plored by all stakeholders in Europe. Kora Doorduyn-
van der Stoep kh.doorduijn@c
bg-meb.nl
Tab. Paracetamol pack size, strength and indication
1000 mg unlimited Pain and fever Other indications are prescription only (UR)
UAD 500 mg max 50 units
AV 500 mg max 20 units
Suppositories max 1000 mg max 10 units
Children max 10 units Suspension equivalent of 10 units.
Funrun and Helge K. Strømme birthday
Participants in the funrun on Friday-morning at the Lei-den Workshop (Photo by Berry van Schaik)
Helge K. Strømme, former leader of SIG Geriatrics, and Erik Gerbrands, former director of the ESCP International Of-fice, at the party of Helge’s 70th birthday (Photo by Heidi Sørensen).
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International Workshop 15-16 June 2017, Leiden, The Netherlands
Extended responsibilities for pharmacists in the treatment of acute & chronic conditions
How to convince the physician? - Peter van Hartingsveldt and Josephine Stutterheim
To have a positive impact on patient out-comes with pharmacotherapy, pharmacists need to collaborate more closely with physicians. Several studies suggest that only a proportion of pharmacotherapy recommendations made by pharmacists to physicians are implemented. In general, poor pharmacist-physician communication leads to medication errors that can even result in death or permanent loss of func-tions for a patient. Therefore, there is a need to improve pharmacist-physician communication.
In the first part we introduced Madam Van den Broeke, a Dutch-Indonesian woman of 73 years old. She uses a handful of medi-cines for her diverse illnesses. Josephine did a perfect imitation of this typical lady. The workshop participants were then asked to identify clinically relevant drug therapy problems (DTP). This is only possible if you know the person. So during the following fifteen minutes everyone had the oppor-tunity to ask their questions in the patient interview. Participants first asked the
patient about ideas, concerns and expecta-tions of her health and medication. Phar-macists then focused on health issues, such as pain in the knees and feet, and the impact of these issues on her daily life.
Next, we explained the PIATE-tool, developed in the Netherlands by Anne Leendertse and Karin Keijzers (see figure). This tool is helpful in analysing a DTP, howto phrase the question to the physician and document the DTP. The most important step is formulating the prob-lem in terms that are relevant to the patient. The answer to the question “who’s problem is this?” should always be “itis the patient’s pro-blem”.
In small groups the participants practiced by filling in the PIATE-tool for one DTP. Extra attention was raised by the modera-tors to the evaluation of the treatment plan. Follow-up of the treatment plan is an important step in the clinical reasoning cycle.
To make the cycle complete it is essential to monitor the process and outcomes of the treatment plan and whether it answers the demand for care by the patient. After some delicious brain food during lunch, the participants came back for part two. In this part of the workshop we fo-cused on effective communication with physicians. This is where the first part connected to the subject of this workshop “how to convince the doctor”. The PIATE-tool helps with phrasing the problem in terms that matter to the patient. This is all the more important, because then you speak the same language as physicians do. When the physician agrees with you about the problem, he or she will be eager to work together for the patients’ good. Throughout the workshop the moderators provided some tips and tricks on effective communication. The participants experi-enced in role play that if you establish the common goal with the physician and pre-sent clinically relevant problems from the patients’ perspective interprofessional communication improves and collabora-tion is inevitable.
How to convince the physician? Put the problem of the patient first and start with speaking the same language!
UPTRAVI, a medicine against pul-monary hypertension can continue to be used
Uptravi is a medicine called a prostacyclin receptor agonist used for the long-term treatment of pulmonary arterial hyperten-sion. It is authorised for use in combination with other medicines called endothelin receptor antagonists (ERAs) and/or phos-phodiesterase type 5 (PDE-5) inhibitors when these medicines do not work well enough, or on its own in patients who cannot take these other treatments. The medicine was authorised centrally in the EU in May 2016.
The European Medicines Agency (EMA) has completed the review of Uptravi (selexipag)
which was initiated following 5 patient deaths in France. EMA confirms that the medicine can continue to be used by both new and existing patients, according to the current prescribing information. No chang-es to the prescribing information are con-sidered necessary following the review.
Uptravi is used to treat pulmonary arterial hypertension (PAH, a life-threatening condition involving abnormally high blood pressure in the arteries of the lungs). Dur-ing the review of the medicine, EMA’s Pharmacovigilance Risk Assessment Com-mittee (PRAC) closely examined the 5 fatal cases. In addition, the PRAC studied rele-vant safety data that have been collected since the medicine started to be marketed, as well as data from clinical trials and com-
parisons with data from other PAH medi-cines.
The PRAC concluded that the data exam-ined do not suggest any increase in mortali-ty with Uptravi, and the death rate in pa-tients taking Uptravi is in line with observa-tions for other PAH medicines.
No specific regulatory action is considered necessary for Uptravi at this time. The safety of Uptravi will continue to be moni-tored, and emerging data from ongoing and planned studies will be carefully evalu-ated as they become available.
Gert Laekeman Co-opted member of the Herbal Medicinal
The day before the 46th ESCP Symposium on Clinical Pharmacy (Heidelberg, Germany, October 9th-11th, 2017 - Theme: « Science meets practice - towards evidence-based clinical pharmacy ser-vices ») a Masterclass of Excellence on « Design and Implementation of Pharmacist-led – Rando-mised Clinical Trials » will be organised by the ESCP Research Committee in cooperation with the Department of Clinical Pharmacology and Phar
macoepidemiology, University of Heidelberg, Germany :
Sunday, 8 October 2017, 09:00-16.30 (the day before the Symposium)
« Achieving the highest evidence: How to run a RCT? » Hope to welcome you !
Programme at a glance
Plenary Lectures
Monday, October 9th 2017 Utilizing evidence in clinical pharmacy services
Scientists and practicioners – two species, same mission? - Kurt Hersberger, Switzerland
Evidence versus experience in clinical pharmacy practice. - Aude Desnoyer, France
Tools to utilize evidence in clinical pharmacy services Claudia Langebrake, Germany
Implementation of medication reviews in different settings. - Olaf Rose, Andrea Liekweg, Germany
Implementation of the STOPP/START criteria in differ-ent settings. - Cristin Ryan, Ireland
Tuesday, October 10th 2017 Generating evidence for clinical pharmacy services
Advances clinical practice in primary care. Ross Tsuyuki, Canada
What is the evidence for clinical pharmacy services in inpatient care. - Ulrika Gillespie, Sweden
Complexity in clinical pharmacy practice – conse-quences for research and evaluation Katja Taxis, The Netherlands
How to select the right study type: a tale of failures Marcel Bouvy, The Netherlands Wednesday, October 11th 2017 Assuring quality in clinical pharmacy services
How to teach patient-oriented pharmacy Lilian Azzopardi, Malta
Simulation training to enhance learning outcome Veerle Foulon, Belgium
The role of continuing education to assure quality of care. - Branislava Mikjokovic, Serbia
Quality indicators for clinical pharmacy services Dorthe Vilstrup Tomsen, Denmark
Dick Tromp passed away Friday, June 16, in the age of 70, from cancer. He was a well-respected member of ESCP, and has been very active in pharmacy world-wide.
He has been chairperson of KNMP, chair of Community Pharmacy section of FIP, one of the founding-fathers and chair of PCNE, and many more. His focus was always on quality of phar-macy for the patient.
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15 December 2016
Workshop proposals opening
15 March 2017 Workshop proposals
deadline
1st April 2017 Online-registration opening
2 May 2017 Abstract submission open-
ing
1st July 2017 Abstract submission dead-
line
31 July 2017 Early-bird registration
deadline
25 August 2017 Notification to abstract
submitters
13 Sept 2017 Early-bird registration dead-line for abstract presenters
To learn more about the pro-gramme and register, visit:
46th ESCP Symposium on Clinical Pharmacy Science meets practice – towards evidence-based clinical pharmacy service
2018
23-26 October Belfast (Northern Irland)
47th ESCP Symposium on Clinical Pharmacy
ESCP Research Committee is recruiting new members
ESCP is an international leader in advancing quality and innovation in clinical pharmacy education, practice and research. The ESCP Research Committee leads and supports all research related activities.
We are now seeking new members to work as part of this exciting committee and help ESCP in achieving its vision.
Who can apply? You need to be a member of ESCP, have an interest in clinical phar-macy and some research experience.
Do I need to have an international reputa-tion in research? No, as long as you have some experience of research in clinical pharmacy and are keen to work as part of the committee.
What would be expected of me? Mem-bers are recruited for four years. Members are expected to attend an annual face-to-face meeting which takes place during the annual symposium in October. We also have Skype calls for one hour every month. You would be expected to have input to topics under discussion, comment on any plans and proposals and also participate in review of conference abstracts. You will be supported in all of these activities.
Are there any other benefits? As well as gaining experience and working with oth-ers in the committee, ESCP supports com-mittee members by covering their registra-tion fees in the annual symposium, provi-ded they attend the scheduled meeting.
How do I apply? You should send a short CV (limited to two pages), giving details of your educational level, professional experi-ence and any research (including citations of any published papers or conference abstracts in the last two years) to the Inter-national Office, international.office@ escpweb.org. Also include a short state-ment (no more than 300 words) of why you want to become a member of the committee.
The call will close on Friday 8 September 2017. Pr. Derek Stewart, Chair of the Research Committee, [email protected]
Membership 2017
Address: http://www.escpweb.org 2017 Membership fees 1 year Full Membership ......................... € 85 3 years Full Membership........................ € 215 5 years Full Membership........................ € 340 Student Membership.............................. € 25
Dual Membership (SFPC or SIFO) SFPC: see http://sfpc.eu/fr/ SIFO : contact the italian office
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14 December 2016 Registration Opening
14 December 2016
Abstract Submission
Opening
15 March 2017
Abstract Submission
Deadline
15 March 2017
Early Bird Registration
Deadline
2 May 2017
Registration Deadline for
ESCP European Society of Clinical Pharmacy
ESCP News is published by ESCP Editor: Marie Caroline Husson (France) Page Lay-out: Corinne Tollier (France) Language editing: Ian Millar (UK)
The contents of this publication are compiled in good faith. The publisher accepts no responsibility for omissions or errors.
ESCP International Office SIR Institute for Pharmacy Practice and Policy - Theda Mans-holtstraat 5b - NL-2331 JE Leiden - The Netherlands Tel: +31 645 915 831 - Fax : +31 71 5722431 E-mail: [email protected] / [email protected] www.escpweb.org Deadline for the submission of material: for issue number 177 is 15th October 2017.
