NGO Community Pharmaceutical Care Services in Partnership. Leung Pui Hong, Eugene Pharmacist St. James Settlement Philanthropic Community Pharmacy

Transcription

1 NGO Community Pharmaceutical Care Services in Partnership Leung Pui Hong, Eugene Pharmacist St. James Settlement Philanthropic Community Pharmacy

2 Hong Kong Lion Rock Spirit

3 No Money No Talk No money No drug? No money No time?

4 NO MONEY NO TIME?

5 No Money No Time? Primary care AE? GOPC? GP? Huge patient load Man power limitation Pharmceutical Care

6 Pharmaceutical Care Dispensing and professional pharmaceutical consultation on all drugs and health related issues Patients/family come by appointment 15-30mins counselling time for each patient Isolated room ensure privacy Supervision of dispensers on dispensing for stable patients

7 Pharmaceutical Care Enhance patient awareness towards proper medication use self-management capabilities drug compliance Check for Drug Related Problem (DRP) Interventions

8 Partnership with Health Care Professional Frontline Physicans RA target therapy with High TB risk test for latent TB missing Direct communication with Physcians -Arrange blood test Delay initiation of therapy

9 Partnership with Health Care Professional Frontline Clinical Pharmacist Conversion from warfarin to apixaban: Discontinue warfarin and initiate apixaban when INR is <2(drug information lexicomp) -Unknown schedule to stop warfarin and start apixaban -Direct communication with Hospital Clinical Pharmacist -Arrange blood test

10 No time No problem? Drug Related Problem 194 Documented interventions (year of 2015) 55% success Including: Renal dose adjustment Inappropriate drug of choice Severe drug interactions Adverse effect management

11 Time for Intervention- communication with frontline health Care professionals Case 1 Dysphagia Capsule not allow to open Letter to dr. Immediate Referral Drug suggestions Case 2 Dabigatran and Rifampicin Drug interaction Dabigatran Public hospital Rifampicin Doh Clinic Urgent referral for alternative

12 Limitation Intervention difficulty -Lack of immediate, direct communication channel to prescriber -not fesible for immediate clinic follow up -some case would wait for next clinic follow up (8-16wks later) Patient Medical History -Patient self report -hardcopy -outdated -inaccurate

13 Future Patient Medical History Accurate and up-to-date lab data, patient background Justified Pharmaceutical care and suggestion Effective communication with health care professional

14 Quality Pharmaceutical Care Stand firm for 15minutes Complicated Medical treatment Educational materials Know the Medicines that they are taking

15 NO MONEY NO DRUG?

16 Hospital Authority The only and biggest public hospital organization in HK Hospital Authority Drug Formulary(HADF) introduced in July 2005 Drug Classification Description 1. General Drugs - well-established indications and effectiveness for general use - provided at standard fees and charges* 2. Special Drugs - specific clinical conditions with specific specialist authorization - provided at standard fees and charges* 3. Self-financed Items (SFI) - some supported by safety net^ * HK$15 per one kind of drug within a duration of 16 weeks or less ^ Samaritan Fund (SF) / Community Care Fund (CCF)

17 SELF-FINANCED ITEMS (SFI)

18 First non-profit community pharmacy in Hong Kong Public hospitals had been providing the same medical treatment to patients suffering from the same illness regardless of their means. (The Annual Reports, The Legislative Council ) Partnership with Charity Donor Self-financed Items (SFI) July NO MEANS NO DRUG We uphold equitable access to essential medications for the grassroots -Make available of SFI medications for chronic diseases without safety net support at a much affordable price

19 Self-financed Items (SFI) Oncology Abiraterone Alectinib Afatinib Atezolizumab Axitinib Bevacizumab Ceritinib Cetuximab Crizotinib Denosumab Enzalutamide Erlotinib Everolimus Lapatinib Palbociclib Panitumumab Pazopanib Regorafenib Sorafenib Sunitinib Tegafur,Gimeracil,Oteracil Trastuzumab Emtansine(TDM-1) Haematology Brentuximab Carfilzomib Deferasirox Desatinib Eltrombopag Ibrutinib Imatinib Lenalidomide Nilotinib Obinutuzumab Olarparib Osimertinib Ruxolitinib Medications for Chronic Diseases

20 Self-financed Items (SFI)-Abiraterone FDA 2011Apr mcrpc chemo refractory 2012Dec mcrpc chemo naïve 2012Oct 2014 Jan 2013Aug HK mcrpc SJS provide mcrpc chemo chemo -free drug support for the grassroots naïve refractory -Discount for different financial background Time line 2018Feb mcspc mcrpc chemo-naïve strict SFI until further notice HADF Gov fund 2013Apr mcrpc chemo-refractory mcrpc chemo-refractory 2012oct -2017apr-strict SFI 2017Aug mcrpc chemo naïve 2017Apr mcrpc chemo refractory

21 Partnership with Hospital Authority Risk Sharing Program Self-financed Items (SFI) - Safety Net end, relay support -Sharing risk -Sharing patient load

22 Partnership with Frontline Physicians No money No drug: the Obstacle of prescribing -Broaden the choices of drug treatment -Increase the number of patient under the treatment -Analyzed Local data passed to the Frontline Physician for the consideration of HADF/Safety Net Application New Drug! New HOPE! St James Pharmacy Government Funding (Safety Net)

23 No money No drug Long Way To Go Patient request :Long Term Government support -Safety Net Funding? Gov Budget? Policy? Health Care Reform? Government Funding (Safety Net)

24 Partnership with Media

25 Partnership with Pharmacists Over 40 volunteer pharmacists Individual medication consultation session Medication knowledge course for caregivers Specialty medication education session

26 Partnership with different professional groups Disease screening Atrial fibrillation Prostate cancer (PSA) Early screening, Early diagnosis, Early treatment, Early rehabilitation

27 Partnership with different professional groups Psychosocial Support Program Dietitian class Cooking class

28 Platform for HOPE No money No drug? No money No time? Wan Chai (2009) 2 partnered pharmaceutical companies 8 medicines available waiting time of 7-8 weeks Sham Shui Po (2014) 13 partnered pharmaceutical companies 42 medicines available waiting time of 4 weeks Kwun Tong (2016) 17 partnered pharmaceutical companies 59 medicines available waiting time of <1 week

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30 Thank you