Sightseeing pharmacy practice The way forward Thinking together with you Dr Th(Dick)FJ Tromp Flevowijk Pharmacy, Kampen, NL Quality Institute for Pharmaceutical Care, Kampen, NL

EuroPharm Forum October 2007

Overview Community pharmacies today Trends Options for future practice Impact on our behaviour

Community pharmacies today

Trends

Options for future practice

Impact on our behaviour

Pharmacies today (in community) Shops Please your customer and sell what they ask for First objective: making money Practices Support your patients and advice them to make best use of their medication First objective: provide care

Shops

Please your customer and sell what they ask for

First objective: making money

Practices

Support your patients and advice them to make best use of their medication

First objective: provide care

Some trends Science Technology Globalisation of economies Patient characteristics

Science

Technology

Globalisation of economies

Patient characteristics

Trends in Science New medications Pipeline is rather dry Impacting the human genome Pharmacogenetics Tailored use of the “old” medicines The use of biomarkers Personalised medicines New delivery systems Nanotechnology Disconnection between the intrinsic quality of medication and the quality of usage Quality chasm between science and practice

New medications

Pipeline is rather dry

Impacting the human genome

Pharmacogenetics

Tailored use of the “old” medicines

The use of biomarkers

Personalised medicines

New delivery systems

Nanotechnology

Disconnection between the intrinsic quality of medication and the quality of usage

Quality chasm between science and practice

Outcomes of the Pharmacy System as a consequence of bad usage To err is human -> 90.000 †††††† in USA (per annum) (Crossing the quality chasm. A new health system for the 21st century) Hospitalization by Medication Use 41.000 per year in NL Older people more chance 56% is preventable Dutch HARM study 2006 Billons and billions $$$ or €€€ costs as a consequence of drug use

To err is human

-> 90.000 †††††† in USA (per annum)

(Crossing the quality chasm. A new health system for the 21st century)

Hospitalization by Medication Use

41.000 per year in NL

Older people more chance

56% is preventable

Dutch HARM study 2006

Billons and billions $$$ or €€€ costs as a consequence of drug use

Trends in Technology Robots in pharmacy practice Databases for patient care Medication-safety-cards Networking in health care system (including the reimbursement system) World wide web Collaborative practice

Robots in pharmacy practice

Databases for patient care

Medication-safety-cards

Networking in health care system (including the reimbursement system)

World wide web

Collaborative practice

Trends in Globalisation of Economies Complex Quality Chain Substandard medication Counterfeit Internet pharmacy Reimbursement systems crossing borders Workforce migration; brain drain and brain gain

Complex Quality Chain

Substandard medication

Counterfeit

Internet pharmacy

Reimbursement systems crossing borders

Workforce migration; brain drain and brain gain

Trends in Patient Characteristics Consumerism Obsession about safety Overreacting political systems and media Alarming increase in antimicrobial resistance Longer life expectancy

Consumerism

Obsession about safety

Overreacting political systems and media

Alarming increase in antimicrobial resistance

Longer life expectancy

The future “ We cannot make the future!” “ We cannot predict!” “ We will be a victim of what will happen”

“ We cannot make the future!”

“ We cannot predict!”

“ We will be a victim of what will happen”

But We can prepare ourselves to the future; we are part of history, the basis for the future Together we are strong and can influence policy makers We can consider some options to help us thinking and making choices

We can prepare ourselves to the future; we are part of history, the basis for the future

Together we are strong and can influence policy makers

We can consider some options to help us thinking and making choices

Some options for community practice Shop Commercial chain MacPharmacy or PharmacyKing Professional Practice Clinic with other health professionals

Shop

Commercial chain

MacPharmacy or PharmacyKing

Professional Practice

Clinic with other health professionals

To consider What fits best to your professional emotions? What will be realistic and sustainable? If this happens, how will it work out? Are we responsible for the survival of the profession and its value to the people?

What fits best to your professional emotions?

What will be realistic and sustainable?

If this happens, how will it work out?

Are we responsible for the survival of the profession and its value to the people?

Characteristics of a shop Many OTC’s No interventions on prescriptions Pharmacy offers no complex professional services Rather small Few technicians Local homepage Owner invests in local network Quickly responding to changes in environment The pharmacist is overqualified The pharmacist bears financial risks

Many OTC’s

No interventions on prescriptions

Pharmacy offers no complex professional services

Rather small

Few technicians

Local homepage

Owner invests in local network

Quickly responding to changes in environment

The pharmacist is overqualified

The pharmacist bears financial risks

Questions to ask yourself How does this option help people? What is impact on education and degree? What is impact on respect by population and our image? What will be the impact on the monopoly of the profession?

How does this option help people?

What is impact on education and degree?

What is impact on respect by population and our image?

What will be the impact on the monopoly of the profession?

Characteristics of a commercial chain Many OTC’s No interventions on prescriptions Except in “professional services” Pharmacy offers no complex professional services, but refers to a specialised colleague in the chain Large enterprise Many technicians Central homepage Owner has no local network Following directives of the top The pharmacist is overqualified The pharmacists is employed

Many OTC’s

No interventions on prescriptions

Except in “professional services”

Pharmacy offers no complex professional services, but refers to a specialised colleague in the chain

Large enterprise

Many technicians

Central homepage

Owner has no local network

Following directives of the top

The pharmacist is overqualified

The pharmacists is employed

Questions to ask yourself How does this option help people? What is impact on education and degree? What is impact on respect by population and our image? What will be the impact on the monopoly of the profession?

How does this option help people?

What is impact on education and degree?

What is impact on respect by population and our image?

What will be the impact on the monopoly of the profession?

Characteristics of MacPharmacy or PharmacyKing Many OTC’s Fast movers only (Rx) Central (international) homepage or internet pharmacy No interventions on prescriptions Pharmacy offers no complex professional services at all Many technicians No local network Following directives of the (international) top The pharmacist is overqualified The pharmacists is employed

Many OTC’s

Fast movers only (Rx)

Central (international) homepage or internet pharmacy

No interventions on prescriptions

Pharmacy offers no complex professional services at all

Many technicians

No local network

Following directives of the (international) top

The pharmacist is overqualified

The pharmacists is employed

Questions to ask yourself How does this option help people? What is impact on education and degree? What is impact on respect by population and our image? What will be the impact on the monopoly of the profession?

How does this option help people?

What is impact on education and degree?

What is impact on respect by population and our image?

What will be the impact on the monopoly of the profession?

Characteristics of a professional practice Small number of OTC’s No cosmetics, toys, etc Interventions on prescriptions (Medication Therapy Management and Pharmaceutical Care) Patient oriented Physician oriented Moderate size of practice with >1 pharmacist Moderate number of technicians (qualified) Pharmacy offers complex professional services or refers to colleagues Local network with other health care providers Professional interactions with hospital pharmacists The pharmacist is sufficiently qualified The pharmacist bears financial risks

Small number of OTC’s

No cosmetics, toys, etc

Interventions on prescriptions

(Medication Therapy Management and Pharmaceutical Care)

Patient oriented

Physician oriented

Moderate size of practice with >1 pharmacist

Moderate number of technicians (qualified)

Pharmacy offers complex professional services or refers to colleagues

Local network with other health care providers

Professional interactions with hospital pharmacists

The pharmacist is sufficiently qualified

The pharmacist bears financial risks

Questions to ask yourself How does this option help people? What is impact on education and degree? What is impact on respect by population and our image? What will be the impact on the monopoly of the profession?

How does this option help people?

What is impact on education and degree?

What is impact on respect by population and our image?

What will be the impact on the monopoly of the profession?

Characteristics of a Clinic (with other health professionals) Very small number of OTC’s, if any Many interactions with physicians and patients (Medication Therapy Management and Pharmaceutical Care) Pharmacy offers complex professional services Moderate size of practice with >>1 pharmacist Moderate number of qualified technicians Clinic placed in network with other health care providers and clinics and hospital (pharmacy) The pharmacists needs to become more specialised The pharmacists is employed by the clinic

Very small number of OTC’s, if any

Many interactions with physicians and patients

(Medication Therapy Management and Pharmaceutical Care)

Pharmacy offers complex professional services

Moderate size of practice with >>1 pharmacist

Moderate number of qualified technicians

Clinic placed in network with other health care providers and clinics and hospital (pharmacy)

The pharmacists needs to become more specialised

The pharmacists is employed by the clinic

Questions to ask yourself How does this option help people? What is impact on education and degree? What is impact on respect by population and our image? What will be the impact on the monopoly of the profession?

How does this option help people?

What is impact on education and degree?

What is impact on respect by population and our image?

What will be the impact on the monopoly of the profession?

More considerations Should all community pharmacies have the same characteristics? …… . …… .

Should all community pharmacies have the same characteristics?

…… .

…… .

What to do? Scan the horizon Make choices Do not victimise yourself Show leadership Manage yourself, consistently and wise

Scan the horizon

Make choices

Do not victimise yourself

Show leadership

Manage yourself, consistently and wise

EuroPharm Forum … a CD-ROM toolbox for professional management World Health Organization Regional Office for Europe Scherfigsvej 8 DK-2100 Copenhagen Ø Denmark Tel.: +45 39 17 17 17. Fax: +45 39 17 18 18. E-mail: postmaster@euro.who.int Web site: www.euro.who.int The WHO Regional Office for Europe The World Health Organization (WHO) is a specialized agency of the United Nations created in 1948 with the primary responsibility for international health matters and public health. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health conditions of the countries it serves. Member States Albania Andorra Armenia Austria Azerbaijan Belarus Belgium Bosnia and Herzegovina Bulgaria Croatia Cyprus Czech Republic Denmark Estonia Finland France Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia and Montenegro Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom Uzbekistan EUR/04/5049476 WHOLIS number:E84689 Original: English

Change management in an approach to new practice models Implementing a project means changing behaviour! Implementing a project needs small steps and celebration of small successes!

Implementing a project means changing behaviour!

Implementing a project needs small steps and celebration of small successes!

Training to better using the toolbox Characteristics of a project Why do projects fail Project management, stepwise Get support from the leadership Form a broad taskforce Managing a broad taskforce Define the project goals Define implementation barriers Risk analysis Risk management Activity plan

Characteristics of a project

Why do projects fail

Project management, stepwise

Get support from the leadership

Form a broad taskforce

Managing a broad taskforce

Define the project goals

Define implementation barriers

Risk analysis

Risk management

Activity plan

Thank you