Outcomes of strategies to improve drug utilization in British Columbia

outcomes_strategies_drug_utilization

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Influencing Prescribing in Primary Care in the NHS

influencing prescribing primary care

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Medicines Information provision in the UK

medicine_information in the uk

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EVALUATION OF HEALTH OUTCOMES AFTER IMPLEMENTATION OF DIFFERENT STRATEGIES TO ACHIEVE RATIONAL USE OF DRUGS IN BRITISH COLUMBIA.

James Wright. Managing Director and Chair, Therapeutics Initiative. University of British Columbia. Vancouver (Canadá).

Background
The Therapeutics Initiative was established in 1994 with two main mandates: 1) to provide physicians and pharmacists with up-to-date, evidence-based, practical information on prescription drug therapy, and 2) to advise the Ministry of Health on the best available evidence of benefits and harms of new and existing prescription drugs. In the beginning we had the privilege of working with a small number of enlightened individuals within Pharmacare in the Ministry. Pharmacare and the Therapeutics Initiative had the common goal of optimizing use of prescription drugs and appreciated that prescribing practices in general were far from optimal.

Policies implemented
1. Therapeutics Letter 6 times per year to provide physicians and pharmacists with the best available evidence about the benefits and harms of drugs and drug classes.
2. Letters provide drug cost information for physicians.
3. Funding of new drugs was based on the best available evidence; a new drug only became a full benefit if it represented a therapeutic advantage or a cost advantage over appropriate alternatives (outcomes based coverage).
4. Reference based pricing of equivalent drugs within a drug class.
5. Restricted access with exemptions in special cases.

Reasons why the policies were successful
1. The Therapeutics Initiative did not allow anybody with a conflict of interest to participate in decision-making about assessment of evidence.
2. Setting up the questions for systematic review was an interactive process.
3. The drug assessment working group followed Cochrane methodology and improved their skills at critical appraisal and assessing risk of bias over time.
4. Independent researchers were contracted to evaluate the impact of the policies on drug utilization and health outcomes.
5. Ministry of Health personnel remained committed to outcomes based coverage despite political pressures.

Outcomes
1. The Therapeutics Initiative (TI) and Letter (TL) had a high acceptance rate based on a 2006 survey: >80% of general practitioners and >90% of pharmacists felt the TI was meeting its mandate. TL 64 Your opinions of the Therapeutics Letter. The 2006 Survey. http://www.ti.ubc.ca/letter64 full report. http://ti.ubc.ca/PDF/Survey2006Report.pdf
2. Drug utilization and drug costs are substantially lower in BC for most classes of drugs as compared to the rest of Canada. TL 72 Prescription drug costs. BC vs Canada. http://www.ti.ubc.ca/letter72
3. The different policies were shown to NOT have an adverse effect on health care utilization or health outcomes (eg. Outcomes of reference pricing of angiotensin-converting-enzyme inhibitors. N Engl J Med 2002;346:822-9)
4. Enormous pressure was put on the government to abolish the Therapeutics Initiative and drug policies.
5. No new drug classes (eg. Statins) have been subjected to the reference based pricing policy since 1998.

Conclusion
I will end my talk by a discussion of:
1. The lessons learned by the Therapeutics Initiative during the last 16 years.
2. What is wrong with the global system of prescription drug discovery, clinical drug trials, drug marketing, and drug regulation?
3. Ways in which the system could be improved.


Therapeutics Letter diciembre de 2008
The Canadian Rx Atlas
Therapeutics Letter mayo de 2007
OUTCOMES OF REFERENCE PRICING FOR ANGIOTENSIN-CONVERTING–
ENZYME INHIBITORS

Round Table 2 Lecture 2: MEDICINES INFORMATION IN THE UNITED KINGDOM

David Erskine. Director: London & South East Medicines Information Service

Background
There are around 220 medicines information centres based in hospitals in the United Kingdom. We collaborate at a regional level to achieve consistency in training materials, enquiry answering procedures, and access to information resources. The Regional Directors meet regularly to provide strategic direction in areas like IT developments, procurement of resources, and reducing duplication of effort.
Medicine information pharmacists mainly answer clinical enquiries from other healthcare professionals (both those providing services and those commissioning them). In total around 250,000 enquiries are answered every year. We also train around 1500 pharmacists every year in the skills needed to identify, interpret and communicate information about medicines.

Internet sites
We publish all our policies, training materials and support information on our website. (www.ukmi.nhs.uk). This site is intended to be used mainly by pharmacists who work in medicine information centres.
Over the last 10 years we have also created a large and very busy website called the National Electronic Library of Medicines (www.nelm.nhs.uk). This website enables anyone to access the information and advice we generate about medicines and now has over 12,000 subscribers (mainly healthcare professionals). Every year over 30 million records are downloaded from the site.
We present different types of information about medicines on the site and then link it using coding, so that for each medicine you can find the latest news, national guidelines, good quality reviews, safety information, and changes in product licence and monitoring advice. We collaborate with other centres across the country to compile this information and every day a pharmacist scans around 20 resources to identify new information, summarise it, categorise it and publish it on the site. A daily email is sent out to our registered users highlighting the new information on the website that day and users can elect to receive all the updates for that day or only ones which reflect their particular interests (e.g. oncology).
We have recently added a few communities to our site, so for example pharmacists that work in prisons can share material and communicate more easily with each other using the community section of the website. We also now support hospitals that want to post their formularies on the site so that local doctors and pharmacists can find out what medicines are used by their local specialists.

Finally we also now include literature about medicines management so that users can not only obtain evidence about the medicines themselves but also evidence about the service support needed to ensure that they are used safely, effectively and cost effectively.
By focusing our resources on proactive publication of information on this website we feel that we can maximise the impact of the work we do by influencing a much larger audience than we would otherwise be able to communicate with on a one-to-one basis.

Round Table 2 Lecture 1: Influencing prescribing in primary care in the NHS

Janice Steele. Acting Chief Pharmacist. Croydon Primary Care Trust

Background
Very historically in the United Kingdom, clinical pharmacists tended to be only based in hospitals where they were shown to have a large influence on how drugs are used. No equivalent expertise was made available to support general practitioners prescribing in primary care. However for the last 15 years pharmacists have been employed by the NHS to work with general practitioners to improve the safety and cost-effectiveness of their prescribing in the same way as clinical pharmacists work with doctors in hospitals. Over that time the expertise of primary care based prescribing advisors has increased and now these pharmacists focus on the following areas to maximise their impact:

Areas of activity for a prescribing advisor

*Data analysis: Designing a range of prescribing indicators and competencies which can be used to identify outliers and areas for improvement. There is also work underway to enable commissioners to link drug expenditure to clinical outcomes.
*Horizon scanning: Work to identify new cost pressures (e.g. new drugs coming to market) and then work with clinicians to manage those pressures. Also work with clinicians to maximise saving as drug become generic (come off patient).
Design annual Work plan to prioritise areas of activity for each general practice.
*Working at the interface: To manage the entry of new drugs into the NHS by agreeing place in therapy, where the drug will be prescribed and how it will be monitored (shared care). Also agree what drugs will be in a joint primary/secondary care formulary. And improve communication between hospitals and general practice by agreeing what information about medicines will be communicated when a patients is admitted and discharged from hospital.
*Communication of Information Pharmacists work to improve the quality of information available to prescribers using :
- newsletters
- internet sites
- practice visits sharing good practice
- links with medical education
- computer software to give messages at the point of prescribing
- use of incentive schemes
*Creating and maintaining a Trained workforce: - needs a clinically trained workforce to maintain credibility
- requires good communication skills
- requires an understanding of primary care (compared with hospital)
- needs support with evidence based messages e.g. statin packs to support therapeutic switching.
- Needs close liaison with medicines information service and clinical networks.

The future
In 2008, the NHS spent £11 billion on medicines which accounts for about 18% of the total money spent on the NHS and 70% of the drugs budget is accounted for by medicines prescribed in primary care. The NHS now employs over 1000 pharmacists working in Primary Care Trusts to help manage the risk associated with that budget and through the mechanisms described they have reduced the increase in drug spend from over 10% a year to less than 3% a year in primary care despite a large increase in the amount of drugs prescribed (especially for prevention of cardiovascular disease). In addition to ensuring drugs have been used cost effectively a number of drug safety issues have also been addressed successfully. New areas of activity now also include reducing drug related hospital admissions and reducing waste with medicines through poor compliance.

SCIENTIFIC PROGRAMME

Download programme (PDF)

WEDNESDAY 27TH OCTOBER 2010

16:00-19:00 Pre-Congress Workshops.

Workshop 1. Risk-sharing agreements: New strategies to drug reimbursement decisions.
Antoni Gilabert Perramon.
Josep Lluís Segú Tolsa.
Cristina Espinosa Tomé.

Workshop 2. Web 2.0 and internet resources: tools to manage scientific knowledge.
Ernesto Barrera Linares.
Cruz Bartolomé Moreno.

Workshop 3. Decision making: Other Evidence Based Products.
Juan Ignacio Martín Sánchez.

Workshop 4. From evidence to recommendations: the GRADE system.
Arritxu Etxeberria Agirre.
Rafael Rotaeche del Campo.

Workshop 5. Development of effectiveness indicators related to the clinical management.
Mª José Calvo Alcántara.
Olga Larrubia Muñoz.

Workshop 6. Conflict resolution strategies.
Jesús Ángel Sánchez Pérez.
20:30 Welcome reception at the Zaragoza City Hall. Cocktail.

THURSDAY 28TH OCTOBER 2010

9:00-10:30 Oral Communication session 1
Chairperson: Flora Pérez Hernández.

10:30-11:00 Opening Ceremony

11:00-11:30 Coffee Break. Poster viewing. Exhibition

11:30-13:00 Round Table 1: Challenges and opportunities of primary care pharmacy on new technologies.
Chairperson: Javier Garjón Parra.

Lecture 1: Health professionals adaptation to new technologies.
José Manuel Picas Vidal.

Lecture 2: Clinical decision support systems in clinical practice.
Eva Comín Bertrán.

Lecture 3: Clinical evaluation of prescription: One step forward.
Encarnación Cruz Martos.

Lecture 4: Pharmacotherapeutic follow-up: role of new technological tools.
Nora Izko Gartzia.

13:00-14:30 Opening Lecture: Management of illusion in changing times.
Emilio Duró Pamies.

14:30-16:00 Lunch.

16:00-17:30 Oral Communication session 2
Chairperson: Ana Mª Sangrador Rasero.

17:30–18:00 SEFAP Strategic plan presentation 2010-2013.
Arantxa Catalán Ramos. Presidenta de la SEFAP

18:00 E-Posters discussion (atended).

20:30 Guided tour: Historic center of Zaragoza and Pilar Basílic .


FRIDAY 29TH OCTOBER 2010

9:30-11:00 Oral Communication session 3
Chairperson: Luis Carlos Saiz Fernández.

11:00-11:30 Coffee Break. Poster viewing. Exhibition.

11:30-13:00 Round Table 2: National and internacional experiences: a vision to share.
Chairperson: Pilar Astier Peña.

Lecture 1: Influencing prescribing in primary care in the NHS.
Janice Steele.

Lecture 2: Medicines Information in the UK.
David Erskine.

Lecture 3: Pharmaco-epidemiological studies in partnership with BIFAP. First experiences.
Juan Erviti López.

Lecture 4: Variability on pharmaceutical prescription. Is geography destiny too?.
Enrique Bernal Delgado.

13:00-14:00 Closing Lecture: “Evaluation of health outcomes after implementation of different strategies to achieve rational use of drugs in British Columbia.
James Wright.

14:00-14:30 Closing Ceremony of XV Congress of SEFAP.

14:30-16:00 Lunch.

16:00-18:00 General Assemby of SEFAP.

21:00 Clossing Dinner. Prize giving: Oral communications and e-posters.

Available on www.sefap.org

Presentation

Dear colleagues,

From the 27th to the 29 th of October 2010, the Fifteenth Congress of the Spanish Society of Primary Care Pharmacists will be held in Zaragoza.

After 15 years of our society we want this congress to be an opportunity to celebrate and show our gratitude to everybody who has worked there for primary care pharmacy. Also, it gives us a chance to look at the present and future and reflect on what the current context provides to primary care pharmacist. Therefore, our motto we have chosen for this congress is: " Primary Care Pharmacy: Challenges and Opportunities ".

We will address issues such as the application of information and communication technologies and Web 2.0 in the improvement of drug use (prescribing support systems, reduction of medication errors, dissemination of information on medicines to professionals and patients, etc.), pharmaceutical care and health education, development of quality indicators, and explore national and international alliances with organisations involved with the rational use of drugs.

We want this congress to be a forum where all professionals can share, discuss and reflect on the challenges and opportunities of Primary Care Pharmacy, and to be a source of encouragement to build a bridge that turn difficulties into opportunities.

We are looking forward to hearing from you
Kind regards

Mª José Buisán Giral
Chair of the Organising Committee

Mª Concepción Celaya Lecea
Chair of the Scientific Committee

Presentation Video

Inscription

Inscription form

	Until 15/09/10	Until 26/10/10	On site
SEFAP members	475- €	550- €	575- €.
SEFAP non-members	525- €	575- €	600- €
Students/Residents*	250- €	325- €	375- €

(*)Applicable to Pharmacy students and Pharmacy residents. In both cases, they must provide the corresponding document of verification at the registration process. Includes coffee breaks and lunches on 28 and 29. Does not include attendance to the workshops on 27 nor the closing dinner.
REGISTRATION FEES(VAT included)
METHOD OF PAYMENT OF REGISTRATION

Bank transfer into the Z15 Congreso de la SEFAP bank account in CAJA INMACULADA, number 2086 0111 8507 0000 2440.

ACCOMMODATION IN HOTELS SELECTED BY THE ORGANIZATION. (VAT included, prices per room and night, includes breakfast).

	Double room	Double room, individual use
Hotel NH Gran Hotel 4*	138- €	122- €
Hotel Zenit Don Yo 4*	115- €	98- €
Hotel Silken Reino de Aragón 4*	111- €	99- €
Hotel Silken Zentro 4*	111- €	99- €
Hotel Oriente 3*	123- €	110- €
Hotel NH Ciudad de Zaragoza 3*	115- €	100- €

HOTEL ACCOMODATIONS ARE SUBJECT TO HOTEL AVAILABILITY AND CAPACITY AT THE TIME OF RESERVATIONS.

METHOD OF PAYMENT OF HOTEL RESERVATION
Por Bank transfer into the Z15 Congreso de la SEFAP bank account in CAJA INMACULADA, number 2086 0111 8107 0000 9447

If you have any questions, please contact the Technical Secretariat of the Congress
CAI VIAJES - CONTRABAJO
C/ CAPITAN PORTOLES, 12 1º
50.004 ZARAGOZA
TLF.- 976 71 81 81 / 976 21 80 89
FAX.- 976 71 84 38
congresos@caiviajes.es
buzon@grupocontrabajo.com

Guidelines for writing abstracts

ABSTRACT SUMMISSION FORM

GUIDELINES FOR WRITING ABSTRACTS
All members of the scientific community in the field of primary care pharmacy, who intend to participate in the XV Congress of SEFAP are invited to make submissions for adjudication by the scientific committee of the conference. The committee will accept or reject the work on the basis of the structured abstract.

INSTRUCTIONS FOR AUTHORS
1. The deadline for abstracts is 3 October 2010. The submission of a paper implies acceptance of these rules.

2. The work must be original (not have been published in any journal or presented in other congresses) and related to professional practice of Primary Care Pharmacist. Authors should not submit abstracts about quantitative studies on drug consumption, unless consumption variables are related to other parameters.

3. A link on the main website of SEFAP will be enable (http://www.near.es/Z15SEFAP/abstract_summission_form.doc), through which abstracts may be submitted. Submissions may be done downloading the form in Word format and sending it to the email address: comunicaciones@grupocontrabajo.com. Abstracts will be only accepted if they have been adjusted to these formats. Any amendments to the margins, size or font (Arial 10, single-spaced) could be a reason for not acceptance.

4. The authors’ names (maximum six) must be entered in lowercase, with the first letter in capital letters, their family name followed by initials of his name. Example: Brown, EJ.

5. The title must appear in capital letters, with all the words, no abbreviations and no period at the end. The summary will be structured including: Objective, Material and Methods, Results and Conclusions, except in the case of works dealing the implementation of projects, in which the omission of any of the preceding paragraphs could be allowed. When using abbreviations should be indicated in parentheses and the full term must precede its first use. Not include figures, graphs, tables, acknowledgements or references. Summaries shall in no case exceed 300 words nor the space provided on the type of papers.

6. It shall contain the keywords and the preference for presentation as oral or poster.

7. Submitted abstracts will be considered in the following broad topics :
- Evaluation of drug utilization
- Medication Safety
- Health outcomes
- Intervention strategies
- Implementation of projects
- Other

8. The Technical Secretariat will confirm receipt of all abstracts to sender via email. If within a period of five days you has not been answered, please contact phone +34 976 21 80 89.
9. Abstracts submitted in Word format will be identified according to the following procedure: aaabbbn.doc, which aaa correspond to the first three letters of family name, bbb to the first three letters of name, all with respect to the first author; n is a cardinal number that identifies sequentially, starting at 1, the number of different abstracts submitted by the same first author. Ex: Edward J Brown, who submit two papers in which he is the first author, must call the first paper broedw1.doc and the second broedw2.doc.

10. All notices of the Scientific Committee will be directed to the first author, which will be informed by email on the acceptance or rejection of communication, as well as of the day and time to present it.

11. The Scientific Committee will seek to conform to the presentation preference indicated by the authors, oral or poster, but reserves the right to change it. Selected submissions considered to have specially broad appeal may be assigned to an oral communication.
- The oral communication will be presented in a slide model with the format and logo of the XV Congress of SEFAP. This model will be available on the congress website in the section “Communications”.
- The poster will be displayed in electronic format in accordance with the instructions specified on the congress website in the section “Communications”.

OTHER INFORMATION OF INTEREST
1. Once accepted, the text of the abstract, will be published on the monographic issue of Farmacia de Atención Primaria dedicated to the 15th Congress of the SEFAP, so any typo, grammar, style, syntax or conceptual error will be solely attributable to the authors.

2. Once accepted, abstracts may not be amended, so that the Scientific Committee may withdraw the works that do not conform to the previously accepted abstract.

3. Congress makes four prizes for best oral communications (1,500 €, 1,100 €, 900 € and 800 €) and two prizes for the best poster (650 € and 500 €). Prizes will be awarded by an Evaluation Committee composed by the members of the Scientific Committee, which will not be eligible for a prize for his works.

COMMITTEES

ORGANISING COMMITTEE

• Chair: Mª José Buisán Giral
• Vice chair: Cristina Carcas de Benavides
• Ana Clemente Arenere
• Carmen Beltrán Calvo
• Arantxa Catalán Ramos
• Asunción Cisneros Izquierdo
• Fernando Flordelís Marco
• Juan Carlos García Aisa
• Arantzazu García Colinas
• Belen Pina Gadea
• Rita Sainz de Rozas Aparicio

SCIENTIFIC COMMITTEE

• Chair: Mª Concepción Celaya Lecea
• Vice chair: Carmen Labarta Mancho
• Esther Amado Guirado
• Virginia Arroyo Pineda
• Lourdes Asensio Asensio
• Pilar Astier Peña
• Mercedes Aza Pascual-Salcedo
• Cruz Bartolomé Moreno
• Juan Carlos Domínguez Camacho
• María Elfau Mairal
• Javier Garjón Parra
• Mª Jesús Lallana Alvarez
• Itxasne Lekue Alkorta
• Flora Pérez Hernández
• Rosa Ramos Guerrero
• Luis Carlos Saiz Fernández
• Ana Mª Sangrador Rasero
• Víctor Vallés Gállego

What is SEFAP

What is SEFAP?
The Spanish Society of Primary Care Pharmacists is a scientific and professional association founded with the aim of promoting all activities aimed at ensuring optimal use of medicines in the field of primary care.

What are the goals of the SEFAP?
To organise as a collective all healthcare professionals associated with the drug in the field of primary care.
To respond to professional needs expressed by their members.
To promote the social recognition of primary care pharmacists.
To participate in the making of decisions about drug policy that Health Administration introduces.
To enhance the professional practice of primary care pharmacist in the National Health System.
To facilitate the exchange of experiences among members of the Society.
To develop specialised postgraduate education programs.
To provide education tools for the proper professional practice of the members.
To promote and coordinate research related to the use of drugs.
To establish relationships with other health professional societies framed in primary care.

What activities are performed by SEFAP?
Establishing the necessary communication systems to facilitate the dissemination of information about education and information activities among its members.
Hearing in the procedures for preparation of pharmaceutical management laws of the Autonomous Communities.
Building relationships with the media both professional and general.
Definition and dissemination of functions of the pharmacist integrated in primary health care structures.
Definition and dissemination of postgraduate specialisation program of the primary care pharmacist.
Elaboration of Informative Series: working papers with educational purposes.
Establishment of an annual educational offer specifically oriented to primary care pharmacist.
Promotion of grants intended to facilitate access to the annual educational offer.
Promotion of research through calls for awards.
Accreditation of promotional materials and training activities specifically directed at members of society.
Making the annual congress of the society.
Organization of expert groups for the analysis of pharmaceutical policy issues in the aspects clinical, economic and social.
Organization of seminars on current issues related to activities in different territories represented on the Board.

Location and contact

The XV National Congress of SEFAP held in the city of Zaragoza, on October 27-29, 2010.

CONTACT
CAI VIAJES - CONTRABAJO
C/ CAPITAN PORTOLES, 12 1º
50.004 ZARAGOZA
TLF.- 976 71 81 81 / 976 21 80 89
FAX.- 976 71 84 38
congresos@caiviajes.es

Site location
WTC ZARAGOZA


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