Jojph luisetto m. rethinking the hospital pharmacist service centralized logistics ict systems and clinical pharmaceutical care,#management,#healthcare, 5 years observation,HIGH,#logistics,SEMANTIC SCHOLAR,2019, PUBLON, GOOGLE SCHOLAR
Market access database with more than 2,000 reports that provide companies with a roadmap regarding the steps to follow to succeed in the Spanish market
Value-based healthcare in Germany: From free price-setting to a regulated market is a report by The Economist Intelligence Unit (EIU), commissioned by Gilead Sciences. It looks at the evolution of health technology assessment and pharmaceutical pricing reform in Germany and examines the new focus on providers and health outcomes
The International Pharmaceutical Federation (FIP) first adopted the guidelines for Good Pharmaceutical Practice in 1993. These guidelines were developed as a reference to be used by national pharmaceutical organisations, governments, and international pharmaceutical organizations to set up nationally accepted standards of Good Pharmacy Practice.
A revised version of this document was endorsed by WHO in 1997 and subsequently approved by the FIP Council in 1997.
In 2011, FIP and WHO adopted an updated version of Good Pharmacy Practice entitled "Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy services".
Full reference: Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy services. WHO Technical Report Series, No. 961, 2011. Geneva: World Health Organization, 2011.
In this document, the aim of pharmacy practice aim is defined as to "contribute to health improvement and to help patients with health problems to make the best use of their medicines."
GPP is defined as "the practice of pharmacy that responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care. To support this practice it is essential that there be an established national framework of quality standards and guidelines."
The 2011 GPP document underlines the requirements of Good Pharmacy Practice and how to set standards required for GPP, (which also imply a quality management framework and a strategic plan for developing services).
GPP are organised around 4 major roles for pharmacists
Role 1: Prepare, obtain, store, secure, distribute, administer, dispense and dispose of medical products
Role 2: Provide effective medication therapy management
Role 3: Maintain and improve professional performance
Role 4: Contribute to improve effectiveness of the health-care system and public health
Each function is structured in several roles, and for each role, a list of minimum national standards to be established have been set.
WHO/FIP GPP should serve as a guidance document for the development of specific standards of GPP at national levels by national pharmacists associations and other related stakeholders.
When establishing minimum standards on GPP, it is important to define the roles played by pharmacists, as expected
by patients and society. Secondly, relevant functions for which pharmacists have direct responsibility and accountability need to be determined within each role. Thirdly, minimum national standards should then be established, based upon the need to demonstrate competency in a set of activities supporting each function and role.
Source of info: http://www.fip.org/good_pharmacy_practice
Health products and technologies Dr. Julius Ogato, Ministry of Health. Head...Emmanuel Mosoti Machani
Dr. Julius Ogato was aming the Ministry of Health Departmental Heads presenting at the 3rd HSDPF.
The presentation elicited interest from counties keen on adopting a single-use policy for health products and commodities.
Market access database with more than 2,000 reports that provide companies with a roadmap regarding the steps to follow to succeed in the Spanish market
Value-based healthcare in Germany: From free price-setting to a regulated market is a report by The Economist Intelligence Unit (EIU), commissioned by Gilead Sciences. It looks at the evolution of health technology assessment and pharmaceutical pricing reform in Germany and examines the new focus on providers and health outcomes
The International Pharmaceutical Federation (FIP) first adopted the guidelines for Good Pharmaceutical Practice in 1993. These guidelines were developed as a reference to be used by national pharmaceutical organisations, governments, and international pharmaceutical organizations to set up nationally accepted standards of Good Pharmacy Practice.
A revised version of this document was endorsed by WHO in 1997 and subsequently approved by the FIP Council in 1997.
In 2011, FIP and WHO adopted an updated version of Good Pharmacy Practice entitled "Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy services".
Full reference: Joint FIP/WHO guidelines on good pharmacy practice: standards for quality of pharmacy services. WHO Technical Report Series, No. 961, 2011. Geneva: World Health Organization, 2011.
In this document, the aim of pharmacy practice aim is defined as to "contribute to health improvement and to help patients with health problems to make the best use of their medicines."
GPP is defined as "the practice of pharmacy that responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care. To support this practice it is essential that there be an established national framework of quality standards and guidelines."
The 2011 GPP document underlines the requirements of Good Pharmacy Practice and how to set standards required for GPP, (which also imply a quality management framework and a strategic plan for developing services).
GPP are organised around 4 major roles for pharmacists
Role 1: Prepare, obtain, store, secure, distribute, administer, dispense and dispose of medical products
Role 2: Provide effective medication therapy management
Role 3: Maintain and improve professional performance
Role 4: Contribute to improve effectiveness of the health-care system and public health
Each function is structured in several roles, and for each role, a list of minimum national standards to be established have been set.
WHO/FIP GPP should serve as a guidance document for the development of specific standards of GPP at national levels by national pharmacists associations and other related stakeholders.
When establishing minimum standards on GPP, it is important to define the roles played by pharmacists, as expected
by patients and society. Secondly, relevant functions for which pharmacists have direct responsibility and accountability need to be determined within each role. Thirdly, minimum national standards should then be established, based upon the need to demonstrate competency in a set of activities supporting each function and role.
Source of info: http://www.fip.org/good_pharmacy_practice
Health products and technologies Dr. Julius Ogato, Ministry of Health. Head...Emmanuel Mosoti Machani
Dr. Julius Ogato was aming the Ministry of Health Departmental Heads presenting at the 3rd HSDPF.
The presentation elicited interest from counties keen on adopting a single-use policy for health products and commodities.
Jens Heisterberg - Patient involvement in drug development and licensing
Similar to Jojph luisetto m. rethinking the hospital pharmacist service centralized logistics ict systems and clinical pharmaceutical care,#management,#healthcare, 5 years observation,HIGH,#logistics,SEMANTIC SCHOLAR,2019, PUBLON, GOOGLE SCHOLAR
PAGE 1State Pharmacy BrazilnamePracticum in Health Administ.docxalfred4lewis58146
PAGE
1State Pharmacy Brazil
namePracticum in Health Administration
MHA 690Pfeiffer University
November 7, 2013
Professor:
Table of Contents
Introduction ………………………………………………………………
Brazilian Health Care System………………………………………………………….14
The State Pharmacy Exceptional Drugs ……………………………………….…20
Activities…………………………………………………………………………………24
I. Participation in Activities Developed in Sector Screening and Social Services ………………………………………………………………...33
II. Participation in the Passwords Distribution ………………………………………………………………34
III. Participation in the Activities of Pre-Dispensation:……………………………………………………………....35
IV. Participation in the Activities Performed in Pharmaceutical Care ……………………………………………………………36
V. Participation in the Activities of the Internal Pharmacy after the Service
Conclusion………………………………………………………………………38
Bibliography………………………………………………………………….………….……..39
1. INTRODUCTION
The internship was in the State Pharmacy of Curitiba – Brazil. The internship aims to enter the student in daily SUS to analyze the role of the pharmacist in this system with the opportunity to combine theory with practice, to develop time responsibility and competence expected of the pharmacist, and improve theoretical, technical, ethical, and political understanding for the student.
Brazilian Health Care System
The public health system (SUS) is one of the largest public health systems in the world. It ensures universal, comprehensive health care and it is free to the entire population of the country. The public health system was created in 1988 by the Brazilian federal constitution to be the health care for all Brazilians. Besides offering consultations, tests, and hospitalizations, the system also promotes vaccination campaigns, prevention, and sanitary surveillance.
The SUS was created to provide equal service and care, and promote the health of the entire population. The system is a unique social project that materializes through health promotion, prevention, and Brazilians' health care.
For nearly 22 years of existence, the National Health System (SUS) has established itself as a major public policy in Brazil promoting social inclusion and seeking to continuously strengthen their basic pillars of full health care, and universal and equal access. It is the only access to health services for 160 million Brazilians (80% of the population), SUS is developing mechanisms to improve management and expand its scope. In 2009, it performed 3 billion outpatient visits, 380 million medical visits, 280,000 heart surgeries, and 10 million procedures in radiotherapy and chemotherapy. In addition, SUS is one of the largest public organ transplant programs in the world, won international recognition for the success of mass vaccination campaigns, and is the only developing country to guarantee free comprehensive treatment for people with HIV (Brasil, pp 11-13).
The Unified Health System (SUS) was creat.
Government cost containment methods in Asia-Pacific markets are as diverse as the cultures represented in the region, so what lessons are the markets leveraging from cost containment experiences? And what, in the end, are pharmaceutical companies supposed to do about it?
Similar to Jojph luisetto m. rethinking the hospital pharmacist service centralized logistics ict systems and clinical pharmaceutical care,#management,#healthcare, 5 years observation,HIGH,#logistics,SEMANTIC SCHOLAR,2019, PUBLON, GOOGLE SCHOLAR (20)
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Jojph luisetto m. rethinking the hospital pharmacist service centralized logistics ict systems and clinical pharmaceutical care,#management,#healthcare, 5 years observation,HIGH,#logistics,SEMANTIC SCHOLAR,2019, PUBLON, GOOGLE SCHOLAR
2. How to cite this article: Luisetto M. Rethinking the Hospital Pharmacist Service: Centralized Logistics– Ict Systems and Clinical Pharmaceutical Care
Strategies as a Management Opportunity for Public and Private Institutions. JOJ Pub Health. 2017; 2(3): 555589. DOI: 10.19080/JOJPH.2017.02.555589.
002
Juniper Online Journal of Public Health
high expertise by the clinical hosp. pharmacist To rationalize the
systems without error: right classification of critical drugs and
an efficacy risk management system to prevent dis- functions
(root cause analysis, FMEA approach, total quality management
and other strategy). We can say that the clinical pharmacists
works must be an edge between ward the hosp. pharmacy and
the hub. (ICT mediated). Other instrument to manage at the right
level can be Dose unit drug systems, informative prescription
with applied software, oncologic unit’s sterile robot, emergency
drugs cabinet systems and some other. All this rationalize the
hospital global request of drugs and med devices but also reduce
in high way therapy error. ICT technologies provide scurrility
system to transfer patient and other data. The total knowledge
is increased using these ICT systems. (Biomedical database for
prevent interactions, contraindications and other).
But what is relevant in this new process is the active role
of hospital clinical pharmacist in more consultant activity
versus the classic logistic Functions. (A cultural changes)
from the classic logistic function towards more clinical new
pharmaceutical consultant functions. This make possible in
the same time to adequately monitoring the healthcare costs
(drugs and med. devices) containing medical and therapy error,
improving also the clinical outcomes [2]. The application of
clinical pharmacist presence in stabile way in medical team
results in about 35 % cost reduction (drugs, med dev.), costs due
by medical errors, reducing recovery days. In example, an Italian
practical experience: health ministerial project: “Ward clinical
pharmacists in oncology”[29]. A collaboration of: SIFO (Italian
Society Hospital Pharmacy), Italian Federation of professional
Pharmacists’ Orders, Italian assoc. Of Medical Oncology), EAHP
(European Association of Hosp. Pharmacist), a multi-center
experience involving 5 public hospitals with the presence of
clinical pharmacists in the oncology wards. The result was a
reduction of ward drug and MD stokes from 32% to 88% and
30% less of drugs therapy errors [29].
Related to these results. The managerial competences
and skills and knowledge of the clinical pharmacist are often
requested by general manager office and by physician’s director
of the many discipline to monitoring and control the global
buying systems [5]. Antimicrobial stewardship [7] , med.
Gases pharmacy management , high cost drugs management ,
medical dev.high competencies ,Toxicological equip with hosp.
pharmacists presence ,oncology lab ,ICU, nutrition team service
, pain management medical equip , and other involving clinical
pharmacist create an high synergy. Other relevant role can be
played in surgery field [23] nephrology, heart disease and many
other .In ex. the total cost for innovative drug therapy are under
an high increase (therapy of hepatitis c ) , antimicrobials meet
great resistance ,oncology therapy do not present equal efficacy
towards all neo plastic tissue the same .“The economic aspect
is relevant on cost of drugs and payment by government and
institution or insurance. (In example 35.000 euro/USD/ patient
for some biological MABS).Even ministry of health in some
countries (ITALY) not pay all some new innovative drugs but use
a system that verify the results obtained. (Payment by results or
risk sharing et other procedure)” [6]. This problems need a deep
and continuous high activity by clinical pharmacist to create a
more rational decision making systems in today therapy world.
Material and Methods
In this observational and research work we report some
relevant publications ( in our opinion ) involved in this change
and related to the results we have find we submit to healthcare
institution a new systems to efficacy control and reduce the
healthcare costs improving clinical outcomes .We observe the
hospital pharmacy organization in different countries in order
to verify The organizational way of works .We describe also
a practical research experience involved in management of
emergency drug in hospital setting [24]. Then after this research
we analyze the total costs involved in this kind of organization
change and the advantages that can be obtained.
Results
Observing the hosp. pharmacy organization in many
countries we can say that the pharmacy service is more oriented
to the classic function as logistic, galenic lab, nutrition lab,
dispensing activities and other.
But only few hosp. pharmacy service are highly oriented to
advancedclinicalfunctionasadvancedcenterusuallydothesame
the university course involved in hospital pharmacy are more
focused on the classic pharmacist function and only in recent
decades towards more clinical Functions.(only few cases really
involved in improving the clinical outcomes in medical team and
not only with monitoring tasks). Also technology applications
are not equally available to all hospital places. (Small – large
hospitals, rural or city et other). From literature we have find
this results: “During 1930 to 2016 a progressive development of
clinical pharmacy and pharmaceutical care was developed. We
have observed a “general positive influence of the pharmacist’s
presence as a part of the medical equip, on public health in
various clinical outcomes”; this according to systematic reviews,
clinical trials and meta-analysis” [8]. “The model of clinical
pharmacy practice adopted by many pharmacy department
hospitals is no longer appropriate for the demands of today’s
health-care services. Reviews many new models proposed for
clinical pharmacy practice including an integrated model for
providing a pharmaceutical care management approach in the
health-care system. This model is a response to the failures of
traditional drug and pharmacological therapy.
It is an idea about how health professionals should integrate
their professional work to obtain clinical outcomes important
to patients and clinicians” [9]. “Hospital information system is
widely used to improve efficiency of china hospitals. A novel
clinical pharmacy management system developed by our hosp.
wasintroducedtoimproveworkefficiencyofclinicalpharmacists,
by providing pharmacy information services and promoting
3. How to cite this article: Luisetto M. Rethinking the Hospital Pharmacist Service: Centralized Logistics– Ict Systems and Clinical Pharmaceutical Care
Strategies as a Management Opportunity for Public and Private Institutions. JOJ Pub Health. 2017; 2(3): 555589. DOI: 10.19080/JOJPH.2017.02.555589.
003
Juniper Online Journal of Public Health
rational pharmacological drug use. Taking prescription review
in the dep. of surgery, work efficiency of clinical pharmacists,
quality and qualified rates of prescriptions before and after
utilizing clinical pharmacy management system were compared.
Qualified rates of both the inpatient and outpatient prescriptions
of the general surgery department increased, antibiotics use
decreased. This system apparently improved work efficiency
standardized the level and accuracy of drug use, which will
improve the rational drug use and pharmacy info service in our
place. The utilization of prophylactic antibiotics for the aseptic
operations reduced” [10].
“Clinical Pharmaceutical Care “as a new discipline, to
improve clinical and economic endpoint in pharmacological
therapy reducing therapy errors with a more rational use of
resource in medical team. This new approach take advantages
by Management discipline and ICT principles. Core training
must include Management, ICT new social media, psychological
behavior and other skills and attitudes for team working added
to the classic clinical pharmacy core programs. The knowledge in
field of diagnostic discipline gives great advantages in this field
for the high relationship with much drug therapy [11]. “Based
on the results of this study, the observed achievements were due
to medical lab.
And imaging knowledge and competencies of the clinical
pharmacist, as part of the equipe in a hospital setting. Such
expertise of the clinical pharmacist has resulted in a significant
impact on therapy. For patients’ safety and health and cost
reduction and for clinical pharmaceutical care purposes, it
is incumbent upon the hospitals to engage and demand an
active role from clinical pharmacists, especially in fields such
as diagnostics (med. Lab. and imaging) [12]. “to obtain more
efficient results in improving some clinical outcomes the clinical
pharmacist must have an expert skill in the field of psychological
and behavior aspects to use a practical settings when member of
medical team .Rotation in different wards provide a a real good
experience. This skill and attitudes is useful in pharmacists-
patients’ relationship in order to have high patient’s compliance
level...” [13]. Reduction of medication therapy errors is needed
and demanded by: patients, health authorities, government,
insurances companies. “Multi professional healthcare team
is the right way of work in health care today. A WARD clinical
pharmacist today contributes in many fields: hematology
oncology, toxicology, infectious diseases, emergency med.,
nephrology, nutrition pharmacy service, pain management and
others” [11].
The clinical endpoints depend also by the med. device used
and pharmacist specialist represents a great resource in cost
containment in every level (to use the right one in every different
situation) in this specific use. Ph. care principles can correctly
be applied in themed. Devices dedicated to the single patient.
Consultant activities in properties, classification, legislation,
Alternative products, logistic are the working filed in which
hospital pharmacist play a relevant roles in medical equipe”
[14]. “The innovation introduced with biomed. Databases and
searching engine motors improved research works with rapid
ways in all kind of scientific areas Internet, and professional
social media have brought a great development in rapidly
connecting with professionals. The researchers in last 3 decades
has been great possibility to share their practical experience
more than past with improving results.
They are playing a crucial and relevant role today working
field through this rapid development. LinkedIn, Slide share,
Research gate, Pub Med, you tube NCBI, Facebook, and other etc.
The possibility to create new bridge researchers; with similar
interests, discipline with more rapid development ,never seen in
last 3 decades”[15]. “In ICU we can see reduction in mortality rate
when pharmacist takes really part of the equip. [12]. “Clinical Ph
care required more use also of social media to meet researcher
in more efficient way. In the same time clinical pharmacist can be
a scientific edge between professional in therapy filed. PH care
management can be useful tools to have more rational therapy
systems.
Drugs are registered for specifically indication, and at the
same time every drug to be a rational therapy need a rational
decision making system that require a multidisciplinary equipe
that can cover all aspect of Pharmaceutical and pharmacological
molecular metabolism (also kinetics andPharmacodynamics)
this have great possibility for clinical pharmacist but it must
increase expertise in field of diagnostic (lab medicine and
imaging) for the high relationship whit pharmacological drug
therapy. The old algorithm was “physicians - patients - classic
pharmacist and drugs “today it must be “patient physicians -
clinical pharmacists (as consultant) and drug [16].
“Physicians alone cannot cover all aspect of the
pharmacological treatment (for example in the field of drug
therapy monitoring, interactions, adverse drug reaction ADR,
toxicology, novel delivery systems, immune globulin-based)
therapeutics and other innovative drugs and medical devices
systems, which have their pharmaceutical specific worlds. This
article likes to improve the ph. care application in countries with
an advanced healthcare system to provide more rational drug
therapy to patients. When not possible, it would be a good idea
using ph. care, in particular populations such as: severe disease,
critically ill, patients with multiple illnesses, transplants,
immunosuppressant, oncology or other serious conditions, at
least when the treatments cost a lot” [2]. Using sharing economy
instruments we can reduce healthcare costs about 38 -40 % and
obtain this results in more rapid way .The results obtained with
sharing economy time can be applied in healthcare: sharing of
knowledge“ICT systems can reduce errors and waste materials,
rotation drugs and med. devices stokes and reducing costs: Dose
unit systems and programs reduce costs about 10-15% and ward
clinical pharmacist presence in stabile way in medical team can
reduce cost about 25-30%.” (8)In a lancet infection disease
meta-analysis was reported” Our findings of beneficial effects
on outcomes with nine antimicrobial stewardship objectives
4. How to cite this article: Luisetto M. Rethinking the Hospital Pharmacist Service: Centralized Logistics– Ict Systems and Clinical Pharmaceutical Care
Strategies as a Management Opportunity for Public and Private Institutions. JOJ Pub Health. 2017; 2(3): 555589. DOI: 10.19080/JOJPH.2017.02.555589.
004
Juniper Online Journal of Public Health
suggest they can guide stewardship teams in their efforts to
improve the quality of antibiotic use in hospitals [17].
According to last editorial The Clinical Pharmacists Main
Focus. J Appl Pharma 9: e114 we can see that one of the main
focus of the clinical pharmacist “must be applied in priority way
to the most critical patients in order to achieve the best results
available [12]. In this condition even benefit of 1 life achieved
in mortality rate is a real golden endpoint (we can think for
example to a pediatric poisoning, or severe infectious disease in
pregnancy or the effect of inefficacy immunosuppressive therapy
in transplanted et other) [13]. This can be considered in example
as reduction in NNT to improve a therapeutic strategy” [18].
We have also see in some practical experience that the
introduce in daily works of some technologies make possible
a right management (reducing total costs and with safety) in
example in emergency drug cabinet systems [7] “no near miss
event or other patient risk or even fatal event was observed
and was covered the the emergency need of drugs in the 99%
of cases, and only 1 time was necessary the central pharmacy
call.” (The same results we have observed during One year), we
can have also a reduction in total costs providing an efficacy
system .( about 50.000 euro in 5 years in an Italian public
hospital 700 beds) [24]. Other ICT instruments are in examples
dose unit system to provide single Unit of drugs (preventing
waste or expiration of pharmacological therapies- full therapy
traceability), informatics prescription software (to detect
interactions, allergy, toxicity ),Informatics management of
narcotic drugs or antidotes for right logistics and other.
Discussion
Analyzing the literature reported in this work and the
results of a specific practical experience [24,28] we can say that
using drugs central logistics (hub and spoke pharmacy system)
added to ICT instrument and clinical pharmaceutical care and
amore clinical pharmacy approach we can have reduced costs
about 40%.This result not only due by drugs and med. devices
costs rationalized but also by the reducing of med. errors, days
of recovery and especially by improving clinical outcomes. In
example the costs for an expensive transplant can be lost easy
if not applied efficacy pharmacological drug therapy .(the same
thinking about complex cardiac surgery or other critical and
expensive patients situation).The pharmacist competences/
skills added to ADVANCED ICT INTRUMENTS can improve the
global clinical results .This is the reason to shift from the classic
logistic competences and skills of clinical pharmacist towards
more and deep clinical tasks and to make an intensive ICT use
as requested today.
Conclusion
We think that this kind of change in pharmaceutical dep.
is today needed and this shift of hosp. pharmacist competence
from the classic logistic roles towards more clinical /economic
management tasks.gives reduction of 35-40%in healthcare
total costs The application of clinical pharmacist to strictly
control the prescription of drugs an M .DEV. (according
protocols, guidelines, central - local rules ) make possible an
great appropriateness verify [17,18]. We think that the efficacy
instruments to the clinical pharmacist and healthcare institution
to manage healthcare costs can be:
a) Management principles and TQM
b) Clinical Pharmaceutical care (new health care
discipline) [19]
c) ICT technologies
d) Sharing economy principles of applications
The total costs involved in this change in working activities
of hospital pharmacist are included in the costs rationalized by
this new management system.(we can say that is not a cost but a
resource.)Pharmacy must be considered not only like a definite
fiscal place but a complex world where the consultant clinical
activities can make the difference in patient outcomes (clinical,
economic, quality of life)The core process must be a rethinking
in hospital pharmacy competences enhancing the clinical
competences level and time dedicated to this specific tasks. This
kind of process must involve politics stakeholders institution,
healthcare org., decision making hospital general managers,
universities and the same all healthcare Professional [20-25].
The principal goal is obtained if this change is accepted
by all. The actors and professionals involved in healthcare
management agree with this new approach. But is crucial that
the same hosp. pharmacist know that in this new organization
system other specific kind of responsibility are involved in direct
patient clinical pharmacy and pharmaceutical care works .The
experience we have see [7] can be usefully transferred to other
hospital and other situations giving good results [26,27].
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DOI:10.19080/JOJPH.2017.02.555589