Transcript
A Pharmacist in Primary Care?16th of May 2013. School of Pharmacy. University of Eastern Finland
Carlos Barreda VelázquezPrimary Care Pharmacist NorWest of Madrid
E.mail: carlos.barreda@salud.madrid.org Twiter: @CarlosBarredav
NORTHWEST HEALTH DISTRICT
NORTHWEST HEALTH DISTRICT
Population: 975.400 inhabitants
40 HEALTH CENTERS
21 LOCAL SURGERIES
3 HOSPITALS
HOSPITALS PRIMARY CARE
NATIONAL HEALTH SYSTEM
PROFESSIONALS
668 Doctors 502 Nurses
334 No health Professionals
87 Other Professionals
77 Emergency Service
14 Head Office
What is a Primary Care Pharmacist?
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
EFFICACYSAFETY
ADHERENCE COST
RATIONAL USE OF DRUGS
EVIDENCE BASED MEDICINE
But, but …what is a Primary Care Pharmacist?
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
INFORMATION
INFORMATION
And Sometimes who Provides that information?
Primary Care Pharmacist give scientific, objective and corroborated information
Where do we look?
Drugs Evaluations
WRITTEN INFORMATION
Bulletins and Guides
WRITTEN INFORMATION
CLINICAL QUESTIONS
What is the evidence for lowering cholesterol and using statins in stroke patients?
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
Education and training for local prescribers and other healthcare professionals
EDUCATION
PLACE OF WORK
EDUCATION
Continued Education Programs
Education Programs to Residents and Interns (Family doctors and Hospital Pharmacists)
Patients Education Programs
FUNDACIÓN JIMÉNEZ DÍAZ
HOSPITAL PUERTA DE HIERRO
HOSPITAL DE EL ESCORIAL
CARE COORDINATION
Local Protocols
CARE COORDINATION
Rationale Use of Drugs Commission
Local Protocols
CARE COORDINATION
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1.Knowledge Management
in Drugs
HEALTH CENTER TARGETS
Ensuring that local prescribing is evidence-based and follows best practice
Prescribing indicators
PRESCRIBING INDICATORS
SAFETY
EFFICACY
EFFECTIVENESS
EFFICIENCY
DA % ARA II
Importe envase Estatina
Osteoporosis mujeres de 40 a 65 años
AINE en
anciano%NuevoACO
% PacSYSADOA
% Omepraz
DHD UPP (**) IBP
DA 42,45% 7,24 4,32% 9,64% 4,74% 10,13% 87,67% 15,21
DA 41,37% 7,74 2,95% 10,63% 6,37% 9,55% 87,72% 15,99
DA 42,79% 7,65 3,05% 8,61% 4,17% 9,43% 87,25% 14,15
DA 45,03% 9,11 4,24% 9,13% 3,94% 8,22% 83,27% 14,27
DA 39,27% 7,95 3,66% 9,68% 2,04% 6,77% 86,39% 18,37
DA 30,79% 6,23 3,25% 10,48% 2,10% 5,37% 86,96% 16,67
DA 39,38% 8,59 3,80% 11,08% 2,46% 8,62% 87,04% 17,74
A. Primaria 40,39% 7,78 3,64% 10,08% 3,89% 8,42% 86,80% 15,92
IndicatorPromote ACE inhibitors vs ARBs
Cost-effective indicator
DDD ARBs
DDD ACEI + DDDARBS
AS AN EXAMPLE…
In The 90s Primary Care Pharmacist was considered…
Educational outreach visits: Trained Professiol visit Prescriber in Healthcare
FACE TO FACE
Pharmacists have changed
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
Storehouse(Pharmacy
Service)
H.C.
H.CH.C
Supplying medicines to Health Centers
Which Medicines?
Crash Cart
Vaccines
Cares
Emergency Drugs
Which Medicines?
INSPECTION
Rational Use of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
SafeUse of Drugs
4.Drug Stock Management
3.Evaluate Prescription Indicators
2.Transfer Evidence to
Clinical Practice
1 Knowledge Management
in Drugs
RISKS…?
Polypharmacy in elderly people
IMPROVE THE QUALITY OF LIFE IN OVER 75 PATIENTS TAKING 5 OR MORE DRUGS
1) Treatment Review
+
Polypharmacy in elderly people
2) Patient Education
+
3) Adherence
INFORMATIC APPLICATIONS
INTERACTIONSMAXIMUM DOSES
Treatment should be stopped if the patient develops ischaemic heart disease, peripheral arterial disease or cerebrovascular disease or if hypertension becomes uncontrolled..
STRONTIUM RANELATE
MEDICATIONS ERRORS
MEDICATIONS ERRORS
DOSIS DEL PACIENTE
F. Organizativos y estratégicos
F. Ligados a la tarea
F. Recursos Condiciones de trabajo
F. Profesionales
Carga de trabajo?
Fatiga, cansancio ligada al turno/horario?
F. comunicación
F. Formación y conocimientos
F. Equipo y sociales F. paciente
Falta de manejo de dosis y presentacioens
Escasez de tiempo por Paciente?
OrganizaciónDe la consulta???
Falta de Comunicación del Protocolo.
Poca implicación del paciente porTratarse de un proceso agudo pocorelevante
Distracción
Falta de formació nen antimicrobianos
Falta de medidas de Adecuadas para la Implantación y Monitorización de los Protocolos
Falta de Incorporación de los Procedimientos a la Práctica Clínica
Falta de manejo de dosis y presentacioens
MEDICATIONS ERRORS
1 MEDICATION ERROR
?????????????
MEDICATIONS ERRORS
Patient Safety Good Clinical Practices
MEDICATIONS ERRORS
Woman 65 years Candida infection of the skinKetoconazol gel 2% is prescribed
MISTAKE REPORTED
Patient used the medication as a shower gel
What it happened?
Is a formal process in which healthcare providers work together in avoid Medicatio Errors origined across transitions of care
MEDICATION RECONCILATION
MEDICATION RECONCILATION
1. Develop a list of current medications; 2. Develop a list of medications to be prescribed; 3. Compare the medications on the two lists 4. Make clinical decisions based on the comparison 5. Communicate the new list to appropriate caregivers and to the patient.
NEW CHALLENGES
PRESCRIPTION CARD
TREATMENT REVIEWS
http://populationpyramid.net/WORLD/2010/
FINLANDSPAIN
THANK YOU VERY MUCH!!!!
top related