Pharmacy based metabolic syndrome management program in Hungary Antal Samu; Gyöngyvér Soós; Sándor Szabó; Péter Bánkuti; Attila Horváth-Sziklai; Balázs Hankó Hungarian National Committee of Pharmaceutical Care Budapest, Hungary, Dózsa György Street 86/b, [email protected]; www.gyogygond.hu Pharmacy based metabolic syndrome Pharmacy based metabolic syndrome management program in Hungary management program in Hungary Antal Antal Samu Samu; ; Gy Gyöngyv ngyvér So Soós; ; Sándor ndor Szab Szabó; Péter ter Bánkuti nkuti; ; Attila Attila Horv Horváth th- Sziklai Sziklai; Bal Balázs zs Hank Hankó Hungarian National Committee of Pharmaceutical Care Hungarian National Committee of Pharmaceutical Care Budapest, Hungary, D Budapest, Hungary, Dózsa Gy zsa György Street 86/b, rgy Street 86/b, ph.care ph.care@mgyk.hu mgyk.hu; ; www.gyogygond.hu www.gyogygond.hu • The general health status of Hungary 1 • the average life expectancy at birth 2007 (male: 69,2 year; female: 77,3 year) • 132 800 deaths in 2007 • 50,1% of the total death is from cardiovascular diseases (CVD) • Hungarian National Cardiovascular Program 2 • to reduce the morbidity and mortality ratio in CVD the Hungarian government have started the National Cardiovascular Program (NCP) since 2006. • the professional coordinator of the NCP is the Association of Hungarian Medical Societies • aim of the NCP is the prevention and the early identification of CVD, and to provide integrated care and rehabilitation for the patients • the Hungarian Metabolic Syndrome pharmaceutical care program is integrated into the NCP Patient with cardiovascular risk PA form, Risk evaluation, Documentation of MSP form Patient asks, pharmacist offers the metabolism parameters control Patient education Health promotion Patient gets MSP leaflet Patient education Health Prevention Patient gets MSP leaflet No Yes Patient with cardiovascular risk. Patient asks, pharmacist offers the metabolism parameters control. PA form. Risk evaluation. Documentation of MSP form. Point of care testing (Blood glucose, cholesterol, triglyceride; pressure, weight measurement) Evaluation of the measurement, and metabolic syndrome. Patient guidance. Documentation of MSP form. Direction to GP Patient information, patient gets MSP leaflet. Referral letter Contact with the GP, feedback facilitation. Patient education. Lifestyle changes Patient gets MSP leaflet. Control appointments (1year, 3 months, 1 month) No GP’s diagnosis and drug therapy Yes Patient with diagnosed cardiovascular disease, and on drug therapy PA form. Cardiovascular risk evaluation. Point of care testing. Evaluation of patient drug use. Evaluation of DRPs. Documentation of MSDM form. Direction to GP, because of metabolic parameter or/and DRP Patient information, referral letter, DRPPI form. Contact with GP, feedback facilitation. Abbreviations: PA form: Patient Approval form; MSP form: Metabolic Syndrome Prevention form; MP: Metabolism parameters; MSP leaflet: Metabolic Syndrome Patient leaflet; DRP: Drug Related problem; MSDM form: Metabolic Syndrome Drug Management form; DRPPI Form: Drug Related Problem Pharmacist Intervention form Pharmacy Based Metabolic Syndrome Program flowchart Therapeutic modification from the GP Patient education. Lifestyle and drug use recommendations. Adherence improvement. Control appointment at the next drug dispensing. No Yes Hungarian National Committee of Pharmaceutical Care • Professional coordinator, managing body • organization of the programme process • inclusion of participating pharmacies Supporting partners • Pharmacists’ Associations • The Association of Hungarian Medical Societies • Roche (Hungary), Omron Ltd • A bit of Attention Foundation National Public Health and Medical Officer Service • permission • control Pharmacy-Pharmacists • Voluntary participation • 32hours training, exam • Fulfill Staff and Technical Requirements Participant GPs • collaboration partners • feedback the outcome of the examination Patient • Level one: everybody who comes into the pharmacy • Level two: Patient with defined risk factors • Level three: Diagnosed patient Organizational Structure of the Metabolic Syndrome Program • The aims of the Metabolic Syndrome pharmaceutical care program are the followings • to provide information regarding healthy lifestyle and about the possibilities and ways to prevent or postpone MS • to increase awareness of the character of early diagnosis of MS • to recognize people exposed to high risks • to ensure a wide range of accessibility to self control products and services Pharmaceutical care developments In Hungary 3 • The three successful pilot pharmaceutical care programs led by the pharmacists associations - Pilot Pharmacy Care Study of Hypertension in Hungary (PIPACH study) - Hungarian Chamber of Pharmacists - Pharmaceutical Care Program in headache, sunburn - Hungarian Society for Pharmaceutical Sciences - Diabetes Prevention Program - Hungarian Private Pharmacists’ Association • Hungarian National Committee of Pharmaceutical Care - 2-2 representatives from the Pharmaceutical Associations governing, professional body of the pharmaceutical care programs • Development of the Metabolic Syndrome pharmaceutical care program Introduction Aims • Therapeutic outcome monitoring • DRP prevention, detection, solution • to increase treatment adherence of patients • documentation and evaluation of pharmaceutical care activities Setting and Methods Staff and technical requirements • Staff requirements - Diabetes, hypertension, dyslipidemia training seminar, successful exam - Communication skills • Technical requirements - Level one: - questionnaires, documentation forms - Written patient leaflets - Quiet area in the pharmacy - Level two: - Level one technical requirements and - Place for the secure screening - documentation forms - Referral letter to GP - Level three - Pharmacy software and documentation forms Yes N o Yes Results Conclusion • The pharmacists have a place in Metabolic Syndrome management • Both the applied risk test and the screening methods enable the pharmacist to identify individuals exposed to high risks • Allows pharmacy to tap into a growing health and lifestyle market in the community • The further steps will be - the computerization of the program - the enhancement of the feedback - the third level of the program • Participating pharmacies - December 2008 - 450 pharmacies - August 2009 - 606 pharmacies (30% of the Hungarian retail pharmacies) • Continuing professional education - 4 days – 32 hour long education - 702 participants References 1. OECD health division, Hungarian data, available: http://www.eski.hu/new3/adatok/nemzetkozi.php 2. István Kiss. The importance and possibilities of the National Cardiovascular Program. Hypertonia és Nephrologia 2009; 13 (2):69-74 3. Hungarian National Committee of Pharmaceutical Care. Metabolic Syndrome Pharmaceutical Care Program 2008.