2018 Hong Kong Pharmacy Conference. Strategic Planning for Pharmaceutical Services , Hospital Authority of Hong Kong

Transcription

1 2018 Hong Kong Pharmacy Conference Strategic Planning for Pharmaceutical Services , Hospital Authority of Hong Kong Ms Anna LEE Chief Pharmacist Hospital Authority Hong Kong 10 March 2018

2 Hospital Authority Statistics 16/17 Hospitals 醫院 Number of general outpatient clinics 普通科門診診所數目 Number of beds 病床數目 Patient discharges 出院病人數目 A&E attendances 急症室就診人次 Specialist outpatient attendances (clinical) 專科門診就診人次 ( 臨床服務 ) General outpatient attendances 普通科門診就診人次 73 28,126 1,760,420 2,231,951 7,601,143 6,120,999 Drug Expenditure ( 藥物支出 ) $6,156 M Data Source: HA Annual Report

3 HA Strategic Plan Strategic Framework on Patient Care Strategic Goals Improve service quality Strategic Directions Enhance access & efficiency Improve safety & effectiveness Modernise HA Promote partnerships with patients Optimise demand management Enhance staff T&D Raise the capacity of priority services of HA Share out the demand Strengthen training governance & policy Improve training quality

4 Missions for HA Pharmaceutical Services To deliver pharmaceutical care to patients in a safe, efficient and costeffective manner for the purpose of achieving definite outcomes that improve the patient's quality of life. To collaborate with members of other healthcare professions in the process of delivering pharmaceutical care. To encourage and harness the support of the community as partners in health and to involve them in the caring process. To pursue up-to-date pharmaceutical knowledge and developments in order to maintain and enhance professional competence. To fulfill continuing professional development programs for pharmacy staff for service improvement and career enrichment. 4

5 VISION OF PHARMACY SERVICES IN 2022 Drug information service After-hr support to non-acute hospitals Cluster hospitals IPMOE Automated drug cabinet IN-PATIENT SERVICES Centralized automated unit-dose dispensing BCMA Patients Real-time medication review via IPMOE Decentralized medication management model Multi-disciplinary ward-based services PEOPLE - Enhance knowledge, skill and competency of pharmacists & dispensers OUT-PATIENT SERVICES Refill Service Patients Advanced dispensing system with track and trace Patients RCHE Monitored Dosage System Residents Medication Therapy Management Drug information Personalized medication management

6 I N P A T I E N T DRUG DISTRIBUTION MODEL since 13/14 In-patient Medication Order Entry (IPMOE) Automation (Automatic Medication Unit Dose Dispensing System AMUDDS) Electronic Health Record (ehr) since 2016 All acute hospitals by 2018 Private hospitals Non-acute hospitals 18/19-21/22 Public-private Medication safety After-hour healthcare / urgent dose linkage Territory-wide Closed-loop medication drug standard process for drugrelated prescribing, from Unit records Pack dispensing sharing (e.g. to allergy, ADR) administration Complete Medication decision support Automated smart drug cabinet profile Multidrug Support - Cluster-based Prompts advanced pt-specific after-hour drug public-private allergy profile support Medication Electronic - Unit Guided prescribing Alerts Generate Dose medication Administration drug selection Verify for suspected reports processes accuracy AMUDDS dispensing for of documentation dispensing error detected

7 Comprehensive Clinical Pharmacy Service Inpatient Centre of Excellence Vision Clinical Service Research Training Ambulatory Care service 4Q 2018 In-patient service 1Q 2019

8 Comprehensive Clinical Pharmacy Service Inpatient Comprehensive direct patient care bundle Medication reconciliation on admission Pharmaceutical care plan Active participation in interprofessional patient care rounds Patient education Medication reconciliation at discharge Ward Pharmacist Clinical service, training, research Patient Education Specialty Haematology / Oncology Nutrition Support NICU / PICU / Paed SUR Therapeutic Drug monitoring Nephrology Regional hospitals Cardiology

9 PHARMACY SERVICE TRANSFORMATION 2014 TouchMed push notification for drug collection Outpatient Service Model HA s outpatient pharmacy initiatives to:- address long waiting time enhance medication therapy management empower patients for better self-care 2016 Express Queue for ONE single item (60-75% improvement) start to explore NEW outpatient service model New / redevelop sites layout & design Policy consideration Smart system & logistics Automation vs manual Patients Journey PPP model

10 O U T P A T I E N T Concerns o Quality & safety o Noncompliance o o Drug wastage Vicious cycle

11 S E R V I C E D E M A N D Age (60-yr-old or above) Enhance Medication Therapy Management Targeted high-risk patients Shorten duration of drug supply & refill prescription Face-to-face counseling + comprehensive medication reconciliation between refill Pave the way for new collaborative service model Polypharmacy (5 drugs or above) Specific clinical specialty (M&G) HIGH RISK PATIENT GROUP Multiple attendance / admission

12 Drug Refill Services Pilot Programme Tag-along Service Model Development Corporate programme launched in 2 pilot sites in December 2017 Pilot on high risk patients with structured patients selection criteria Refill Rx in phases with pharmacist review, and medication reconciliation before the next refill Plan to rollout to all SOPCs in phases in HA Corporate shared-care model - Pharmacist Clinics Drug Refill Management System Pharmacy support call telephony system Big data analytics for patients selection Various drug delivery service models under exploration 12

13 P A T I E N T E M P O W E R M E N T Access of drug information LABEL ENHANCEMENT

14 S H A R E D - C A R E CLINICAL MODEL ( 1 ) Usual Medical Care Anti-coagulant Therapy Management in HA Stable control Suboptimal INRs Stable control Suboptimal INRs FU interval per protocol 1-4 weeks FU (Max 12 weeks) Relatively long follow-up interval (up to weeks in some clinics) 1-4 weeks FU 2-8 weeks FU 8-24 weeks FU 2-8 weeks FU Pharmacist Clinic FU interval per protocol (Max 12 weeks) 8-12 weeks FU

15 S H A R E D - C A R E CLINICAL MODEL ( 2 ) Pharmacist Doctor 1 st Consultation Vast number new chemotherapy agents Treatment Selection Counseling on Pros and Cons of different Regimen Treatment Follow-ups / Side Effects Monitoring Treatment Follow-ups / Side Effects Monitoring Increased complexity of chemotherapy Save time for oncologists to handle more cases! 6 Clinic Sessions by Oncologists NEW service model 6 Clinic Sessions by Pharmacists 6 Clinic Sessions by Nurses Example of new collaborative care model for breast cancer therapy Novel oral chemo-therapy agents Choice of Regimens

16 P E O P L E OTHER PROFESSIONAL T&D HA collaboration with Academia, e.g. ward-based/ clinic-based teaching clinical/ practice-based research Structured competence training & rotation scheme Clinical attachment (overseas and local e.g HKCH) No. of Pharmacist in HA (610) Master Degree or Above ~80% BPS Credentials and Advanced Specialty Training Board of Pharmacy Specialties Certification ~20% Enhance the role of clinical pharmacist in hospitals Competence-based, Career-linked Training and Development Curriculum for Pharmaceutical Staff

17 C O L L A B O R A T I O N PHARMACY SERVICES IN ELDERLY HOMES SIZE Large-scale RCHE w/ Enhanced medical & pharmacy support SAFETY Personnel, technologies and equipment for medication safety Rising demand Manual process Medication safety Staff turnover SERVICE Opportunities Various options of the drug distribution model evolving Mature technology supporting Monitored Dosage System ± BCMA (Barcode Medication Administration) Launching of the ehr sharing platform in HK SYSTEM Multiple system interface to facilitate drug dispensing, administration, and fees and charges

18 C O L L A B O R A T I O N PHARMACEUTICAL INDUSTRY Business and Supply Chain MEET SERVICE NEEDS : Identification & Standardization Track & trace to point of use In-patient Out-patient Pre-set pack sizes x7 in blister or original pack EXPLORATION : Automation (strip pack / boxes) Automated processes Supplier Inventory movement Scheduled delivery of outer or pallet Point of use Simplified ordering and receipt process

19 C O L L A B O R A T I O N PATIENT ACCESS PROGRAM EARLY ACCESS TO INNOVATIVE MEDICINES Drug programme management Finance arrangement Patient empowerment PUBLIC Government Hospital Authority Complex Expensive PRIVATE Pharmaceutical Industry Community

20 PATIENT EMPOWERMENT HOSPITAL AUTHORITY Service model transformation Clinical service development Staff competency enhancement GOVERNMENT Policy consideration Resource planning ACADEMIA Clinical and role-based training Practice and research collaboration COLLABORATION PHARMACEUTICAL INDUSTRY Drug supply chain harmonization Innovative medicine access COMMUNITY Professional standard alignment Business model development BUSINESS INDUSTRY Advanced technology Logistics solution

21 THANK YOU