Aucun titre de diapositive

1
AU European Forum, Divonne 11-12 mars 2004

• In the last ten years, two new professionnal
  services have been
• developped in Switzerland
• Consultant pharmacist in Quality Circles formed
  with GPs,
• focused on medecines prescription.
• Accepted and paid by Insurance Companies
• Consultant pharmacist in Nursing Home
• Recognized by the law and paid by Insurance
  Companies

Michel Buchmann Dr pharmacien
2
AU European Forum, Divonne 11-12 mars 200
Definition of a Quality Circle

• A stable group of 5 to 15 doctors and pharmacist
• Acceptation to have meetings together
• Evaluation of the every day practice of
  prescription
• Based on their own and actual prescritions datas
• With the help of a moderator
• Finding ideas to optimize the practice
• Putting in place guidelines
• A continous evaluation of the success of the
  common decisions
• that have been taken
• That means that every participants are active!!
  And not sleeping!!

Michel Buchmann Dr pharmacien
3
AU European Forum, Divonne 11-12 mars 2004
Work processContinous development of the
prescription
1. Prescription data (benchmarking per physician
and therapeutic class)
7. Assessment of the results and improvements
2. Education on guidelines, evidence base
medecine and pharmacoeconomy.
6. Implementation of the consensus
3. Analysis of prescription attitudes in
comparison with scientific and economic data and
search for alternatives in drug market
5. Application of the consensus
4. Consensus of each quality circle
Michel Buchmann Dr pharmacien
4
AU European Forum, Divonne 11-12 mars 2004
Evaluation of the results

• Through the growth of the project in Switzerland
  and the personal satisfaction
• of the participants
• Through the economical impact on the costs of the
  prescription
• Through the fact that our observations could be
  recognized by politicians as
• a national benchmarking of the medical
  prescription
• a follow up of the medecines market
• an analyse of the practice compared with
  international consensus and guidelines

Michel Buchmann Dr pharmacien
5
AU European Forum, Divonne 11-12 mars 2004
Evolution of the number of pharmacists and
doctors involved in QCon a national level

• 1997 9 circles (FR), about 35 physicians, 15
  pharmacists
• 1998 6 circles (FR),about 27 physicians, 11
  pharmacists
• 2000 13 circles (new 4 in Geneva et 3 in
  Winterthur), about 90 physicians, 20 pharmacists
• 2001 23 circles (new 9 inFribourg et 1 in
  Argovie)
• 2002 More than 180 pharmacists involved in
  specialized education programs
• 2003 More than 300 physicians in about 30
  circles, more than 50 pharmacists and about 150
  pharmacists involved in continuing education, in
  7 cantons (FR, GE, ZH, AG, VS, NE, BE)
• But... only 1 signed agreement in Fribourg with 4
  companies(CSS, Helsana, Groupe Mutuel et Visana)
  and, actually, negociation on the national level
  to introduce finally a national agreement in
  2005.

Michel Buchmann Dr pharmacien
6
AU European Forum, Divonne 11-12 mars 2004
Evolution (index) of the report cost/pat due to
the prescriptions of the firstdoctors active in
the first Quality circles(1997-2003) (LStaxes)
O.Bugnon / 2004 Source de données brutes OFAC
(2003)
7
AU European Forum, Divonne 11-12 mars 2004
Money Saving between 1999-2002

• Medicines costs for 24 doctors  pionniers  en
  2002 Fr. 12941039.60 for 25101 patients
  (VAT and taxes included)
• 9 of money savings between 1999 and 2002
  compared to the evolution of a control group of
  79 french speaking doctors.
• Fr. 48528.90 of saving per physician
• Fr. 46.40 per patient

Source de données brutes OFAC (2003)
Michel Buchmann Dr pharmacien
8
AU European Forum, Divonne 11-12 mars 2004
Results related to the effective participation to
the work of the QC
Source de données brutes OFAC (2003)
Michel Buchmann Dr pharmacien
9
AU European Forum, Divonne 11-12 mars 2004
Retained principles for the payement of the work
done in QC 1. The Insurance companies are
paying to the QC half of the money saved in
a year but a maximum of Eur 14 000.- 2.
The payement of the doctors depend of their
participation to the working group (Eur
180.-/meeting) 3. The administrative costs (Eur
1000.-/an) and the impact studies are
partially taken in charge by the Insurance
companies.
Michel Buchmann Dr pharmacien
10
AU European Forum, Divonne 11-12 mars 2004
Impact study 2000-2002Evolution of the NAIDS
Generics prescription
O.Bugnon / 2004 Source de données brutes OFAC
(2003)
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AU European Forum, Divonne 11-12 mars 2004
Michel Buchmann Dr pharmacien
12
AU European Forum, Divonne 11-12 mars 2004
Impact study 2000-2002Evolution of the
prescription of the NAIDS undergroup Coxibes
O.Bugnon / 2004 Source de données brutes OFAC
(2003)
13
AU European Forum, Divonne 11-12 mars 2004
Michel Buchmann Dr pharmacien
14
AU European Forum, Divonne 11-12 mars 2004

• Consultant pharmacist in nursing home means
• A practice based on the principle of the QC but
  in a
• restricted area, in fact in nursing home.
• A practice of medication review using the datas
• written in the patient s charts
• A link with logistical work ( (buying management,
  
• stock management etc)

Michel Buchmann Dr pharmacien
15
AU European Forum, Divonne 11-12 mars 2004
Tarif agreement

• 1. Single payment for drugs and medical supply
  (6 Euros/patient/day)
• 2. Financing of the pharmaceutical service (67
  Euro Cent/patient/day)
• Each institution declares its annual results with
  transparency
• Distribution of possible benefits
• 40 of any benefits are refunded to the
  institution as an incentive and a reward for good
  management
• 60 are paid into a pool
• 5. Use of the pool to offset deficits and
  evaluate the appropriateness of the lump sum
• 6. In the event of a systematic, repeated
  deficit independent evaluation by an expert

Michel Buchmann Dr pharmacien
Assistance pharmaceutique/ Buchmann, Bugnon
(SSPh) 2001
16
AU European Forum, Divonne 11-12 mars 2004








Total 110 patients

Michel Buchmann Dr pharmacien
17
AU European Forum, Divonne 11-12 mars 2004
Evolution of the annual cost/pat forpatients
living in 30 nursing home


2002 being the first year of activity of
consultant pharmacists in nursing home, we can
see the impact
,
of their activities on the costs for 1437
patients a decrease of 4.1 in place of a growth
of about 10
Michel Buchmann Dr pharmacien
18
AU European Forum, Divonne 11-12 mars 2004

Added Value message
 As GP and member of a quality circle and as
physician active in a nursing home, I can
declare that

the informatic tools are in place

the performance is growing

the working methods are in place

the collaboration between doctors, pharmacists
and nurses
is working and becomes better every year. 
Dr Richard Nyffeler, médecin, 11.2003
Michel Buchmann Dr pharmacien
19
AU European Forum, Divonne 11-12 mars 2004

 What pharmacists understand and are
knowledgeable about, are in fact, medicines. It
is within this domain that they are
indispensable. In the future, pharmacists should
take on the selection of specific medecines,
cooperating with prescribers, thus ensuring the
safe and effective use of medicines by the
patients. There is so much to do in these
domains! Prescribing is largely irrational
and patients are facing alone their
treatment!  Philip Brown, FIP Congress The
Hague, 1998








Michel Buchmann Dr pharmacien