BY HELPING PEOPLE MY DREAM IS BECOMING TRUE

By helping people my dream is coming true A community pharmacist, the Story Dr. Herbert Cabana

Topics

Introduction

Cases

Can our wo r k influence public health?

What polls say about our reputation

Summary

Topics

Introduction

Cases

Can our work influence public health?

Summary

Introduction

Before I started with my studies my dream was:

As a pharmacist to support people to stay healthy and help them very effective when they are ill.

Introduction

At university

I realised that we had to learn quite a lot of physics, botany, chemistry, pharmacology and pharmaceutical technology.

At that time I could not imagine how my knowledge of university studies once could be combined with my imagination of the pharmacist profession.

Introduction

In the community pharmacy:

How I experience my life as pharmacist to day I will show you by means of some cases.

Topics

Introduction

Cases

Summary

Case history one The Patient

66 years old

male

He wants a remedy for dizziness

Case history one the first conversation

Do you have tabletts against hypertention at home?

Do you think your blood pressure is high?

Good morning. How can I help you?

Do you suffer from hypertention?

Very often I am so dizzy. Please give me some tabletts.

Yes .

Yes .

Yes.

Cabana Patient

But please give me some tablets against dizziness!

Case history one What – for example – can cause dizziness:

High blood pressure

Low blood pressure

Shortsightedness – Longsightedness

Problems with the spinal column

Ear problems

Tumour

Endocrinology problems

Etc. Etc. Etc. .....

Case history one Results of the first conversation

What did he tell me?

He suffers from dizziness

He suffers from hypertension

His hypertension is treated with tablets

He thinks his bloodpressure is high

I suspected

Hypertension might cause the dizziness

My action:

Measurement of blood pressure

Case history one

Result of measurement:

Blood pressure = OK

My decision:

My patient told me, he was under medical treatment, so

I planned to give him

an antivertiginosum and

detailed advice

Case history one the second conversation

I will give you something against your dizziness.

Would you like anything else?

Yes; fulfil this prescription please

Cabana Patient Prescription Name Hubert Miller Date of birth: 24.12.1937 Insurance WGKK RP) Diamicron 80 mg I OP Dr. John Helpful Common Practitioner Gliclazid (Antidiabeticum; Sulfonylurea)

A new situation occur r ed!

He is diabetic!!!

My action:

Measurement of blood sugar

He is diabetic!!!

My action:

He is diabetic!!!

My action:

He is diabetic!!!

My action:

The result:

Glucose much higher then 200 !

Yes

When did you take your diamicron lately?

No. I mean when did you take your dimicron lately?

When did you take your dimicron lately?

Sorry?

I ran out of the tabletts

Cabana Patient

Please te l l me when did your dizziness start

I see.

That was Friday so it was about 10 days ago

When was that?

When did you run out of di a micron?

When did your dizziness start?

Yes

2 we e ks ago

Yes

Cabana Patient

Case history one Results of the second conversation

Again I got new information:

He is not only diabetic but

He also is hard of hearing

I revised my decision!

Case history one

I simply fulfilled the prescription

Diamicron

Gave detailed advise to my customer

not only verbal

but also written

Told him to visit the doctor

Asked him to come back after a week

Case history one One week later

He really came back

Told me that

He did not visit the doctor but

Took his tablets regular l y and

Checked his blood sugar by himself

His dizziness became much better

Case history one Reflection

Was my approach the best possible one?

Was there something I could have done better?

Did I loose sight of something?

Remember the first conversation!

How were my questions?

The questions were „closed questions“

How were the answers of my patient?

He nearly always answered : yes

Were these answers logical?

Yes they were.

Therefore I could not notice that he was hard of hearing

Remember the first conversation!

I thought I got the right information from the patient (that he suffers from hypertension).

But I did double check it by monitoring the blood pressure.

I didn`t bear in mind that there are much more possible reasons for dizziness in this special case.

I thought I had all necessary information.

Without having all information I made my 1 th decision.

Remember the second conversation

How were my questions?

I used open questions

How were the answers of my patient?

Again he nearly always answered : yes

Were these answers logical?

No they were not.

So I had the chance to recognise his disability:

hardness of hearing

Case history one Conclusion

Using closed questions makes it very difficult to recognise weather a customer has really got what we wanted to bring forward

That can lead to severe mistakes

Therefore:

Use open questions whenever you can !!

Bare in mind as many causes as possible!!

Case history two The Patient

39 years old

female

She hands me over her prescription

Case history two

Case history two Prescription Name Mary Taylor Date of birth: 24.12.19 68 Insurance WGKK RP) Beloc Tbl 50mg 50 St I OP Marcoumar Tbl 3 mg 100 St I OP Diovan Ftbl 80 mg 28 St I OP Sedacoron Tbl 200 mg 50 St I OP Dr. John Helpful Common Practitioner

Case history two Composition: Metoprolol Pharmaceutical form: Tabletts Clinical data: cardiac insufficiency (slight) RR  etc. Dosage Warning notices

Case history two

Case history two Field of application: hypertonia c ardiac insufficiency (slight) Mode of application ; unchewed Dosage : 100-200mg Contraindication : hypotension c ardiac insufficiency (severe) Gravidity and breastfeeding Composition: Metoprolol

Case history two Side effects Interactions Warnings

Case history two

Case history two Phenprocoumon

Case history two Anticoagulans

Case history two

Case history two Valsartan

Case history two Angiotensin II Receptor Antagonist

Case history two

Case history two Amiodaron HCl

Case history two Gravidity : Contra indication!!! 1 year contraception !!!

Case history two Avoid insolation !!!

Case history two Reflection

We have information concerning

4 drugs

Each of it with

Effects

Side effects

Adverse reactions

Interactions

Etc., etc.

Sidestep interactions:

Sidestep interactions: Additive cardiodepressiv effect increased effect of the anticoag. Risk of bleeding

Sidestep interactions (IA):

There is nearly no combination of drugs without IA!

How can we deal with this situation in the pharmacy?

An IA does not basically mean that a combination is forbidden.

Check the importance of IA for the individual patient.

In some cases (severe IA) we should avoid combination s

In frequent cases we should give detailed advice.

We should keep in mind that normally GP`s are aware of IA and accept them as the minor problem.

Sidestep interactions (IA):

There is nearly no combination of drugs without IA!

How can we deal with this situation in the pharmacy?

An IA does not basically mean that a combination is forbidden.

Check the importance of IA for the individual patient.

In some cases (severe IA) we should avoid combination

In frequent cases we should give detailed advice.

We should keep in mind that normally GP`s are aware of IA and accept them as the minor problem.

A good pharmacist never blames the doctor for ignoring an important IA! If necessary we contact the doctor with a proposal on a proper solution!

Case history two Problem

The number of information is huge

We cannot convey more then 3 facts

Case history two Solution

We have to check all information and

Try to find the t h ree most important facts

Case history two Solution

For our lady that could be:

„ Be shure that you take your medicine regularly“

„ Beware of glare of the sun! It will burn your skin!“

„ Be sure that you use safe contraception!“

Case history two

Case history three The patient

Age: 30 years

Sex: female

Her problem: She suffers from vomiting attacs and wanted to have her bloodpressure checked

Case history three The next step

I asked my assistant to check the blood pressure

Case history three A problem occured

My assistant informed me that she always got an error message on the device

I tried it myself and got the same result -> „error“

Then I made a n acouophonia measurement

Then I made a n acouophonia measurement

The result I found:

Diastolic parameter:

270 mm Hg

Systolic parameter:

150 mm Hg

Case history three What could be done ?

It is an emergency situation!

So time is an important factor!

If you have no chance to get a doctor quickly you could help the patient for example by

Let her chew a NIFEDIPIN capsule or

Use a NITRO spray

Watch the patient carefully

Try to get a doctor as soon as possible

Case history three My decision

I called the ambulance

I prepared to give her a nitro spray

Then the ambulance arrived within a few minutes

The emergency physician told me that my results were right

She injected a calcium antagonist and brought the patient to the hospital immediately

Case history three Conclusion

If my assistant would have told the patient that there is a failure in the device and sent her home she might have passed away

But my assistant noticed that the ladies skin was extremely pale and

My assistant was very familiar with the blood pressure unity

Case history three Conclusion

Sometimes patient`s problems are not directly drug related

Never trust a technical device if something looks strange

Always use your broad knowledge combined with your experience of life

Be proactive if necessary

Topics

Introduction

Cases

Can our woo r k influence public health?

Summary

Can our work influence public health? 3 examples

Blood pressure under control?

Disease prevention starts inside your head!

10 Minutes for my health

Can our work influence public health? 3 examples

A project of community pharmacists, general practitioners and the City of Villach

Starting position Patients unaware of their hypertonia

Our activities:

Measurement of blood pressure

Supported by

Regional GP`s and

City officials

Advantage:

Access to the 75 % of hypertonia patients who are not treated

Drafting of risk profiles

Targeted prevention campaigns

„On-medication“ – Study (Adherence)

Raising awareness of the public

Result:

We could satisfy the expectations

Health Promotion - joint initiatives

A project of the Chamber of Pharmacists and the Chamber of Medical Doctors in Vienna

Starting position

More than half of all deaths in Austria result from cardio-vascular diseases

About 50 % of cardio-vascular diseases are due to risk factors that could be reduced by prevention

Every Austrian citizen is entitled to an annual medical check-up paid by social insurance

Only 12 % throughout Austria, in Vienna only 7,9 % made use of this opportunity in 1999

Aims

Motivate patients to make their annual medical check-up

Raise patient awareness and responsibility

Early detection of risk factors and hidden diseases

Early treatment of cardio-vascular diseases

How it worked

Pharmacists and GPs promoted

“quick-check” of weight, blood pressure, blood sugar and cholesterol in pharmacies

referral to the doctor if results were above / below standard

referral to the doctor for the regular annual check-up

Results

The number of patients who made use of their right to an annual medical check-up increased by 36 % within half a year

Public awareness of community pharmacist´s health promotion projects increased

Scientific evaluation by University

Health Promotion - joint initiatives

A project of the Chamber of Pharmacists and the Chamber of Medical Doctors in Vienna

10 Minutes for my health Preventing screening campaign in pharmacies

„ 10 minutes for my health“

In 2006 nearly all 1200 pharmacies all over Austria r a n a campaign offering a free health check

Intensive PR efforts result ed in about 130 media reports in the first month alone

Some proponents of the Medical Chamber were not really amused about the pharmacy campaign

Pharmacies became visible in the area of „preventive checks“

„ 10 minutes for my health“ Measurement of health parameters

The preventive screening includes:

weight,

abdominal girth,

blood sugar,

cholesterol and

blood pressure

„ 10 minutes for my health“ Results:

68.000 persons were checked whereof more than 1/3 were males.

54 % of the screened persons were referred to a physician due to their alarming health parameters.

In 2 out of 100 persons manifest diabetes was detected.

More than half is overweight.

Every third is suffering from elevated blood pressure.

„ 10 minutes for my health“

After the campaign has finished :

The screening is continued in community pharmacies

With campaigns like these we proved that our work in community pharmacies is an important contribution to public health

Can our wo r k influence public health? Yes!

Topics

Introduction

Cases

Can our work influence public health?

Summary

Poll by Reader`s Digest 2006 [2005] (2004)

Question: How much do you trust in the following professions:

Very much

Quite a lot

A little

Not very much

Not at all

The table shows the percentage of respondents who trust in the several professions „very much“ and „quite a lot“.

(In Brakets the results of 200 5 and 2004 )

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 92 [ 90 ] (90) 97 [ 95 ] (90) Pilots (aircraft) 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 92 [ 90 ] (90) 97 [ 95 ] (90) Pilots (aircraft) 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen 89 [ 89 ] (89) 96 [ 96 ] (93) Pharmacists Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 86 [ 88 ] (88) 94 [ 98 ] (93) Nurses 92 [ 90 ] (90) 97 [ 95 ] (90) Pilots (aircraft) 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen 89 [ 89 ] (89) 96 [ 96 ] (93) Pharmacists Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 86 [ 88 ] (88) 94 [ 98 ] (93) Nurses 92 [ 90 ] (90) 97 [ 95 ] (90) Pilots (aircraft) 85 [ 83 ] (83) 91 [ 91 ] (88) Physicians 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen 89 [ 89 ] (89) 96 [ 96 ] (93) Pharmacists Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 2006 [2005] (2004) 2006 [2005] (2004) 86 [ 88 ] (88) 94 [ 98 ] (93) Nurses 92 [ 90 ] (90) 97 [ 95 ] (90) Pilots (aircraft) 7 [ 9 ] (10) 8 [ 12 ] (11) Polititians 85 [ 83 ] (83) 91 [ 91 ] (88) Physicians 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen 89 [ 89 ] (89) 96 [ 96 ] (93) Pharmacists Europe Austria

What polls say about our reputation Source: Reader`s Digest European Trusted Brands 2005 Reputation of community pharmacists is excellent ! 2006 [2005] (2004) 2006 [2005] (2004) 86 [ 88 ] (88) 94 [ 98 ] (93) Nurses 92 [ 90 [ (90) 97 [ 95 ] (90) Pilots (aircraft) 7 [ 9 ] (10) 8 [ 12 ] (11) Polititians 85 [ 83 ] (83) 91 [ 91 ] (88) Physicians 95 [ 95 ] (95) 97 [ 100 ] (97) Firemen 89 [ 89 ] (89) 96 [ 96 ] (93) Pharmacists Europe Austria

Topics