A Global Strategic Plan for Hospital Pharmacy Practice

1
A Global Strategic Plan for Hospital Pharmacy
Practice
2
Overview

• Brief introduction to FIP, the International
  Pharmaceutical Federation
• Describe the FIP Global Survey of Hospital
  Pharmacy Practice
• Describe the FIP Global Conference on the Future
  of Hospital Pharmacy
• The Basel Statements on the Future of Hospital
  Pharmacy

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International Pharmaceutical Federation (FIP)

• Comprised of 120 member organizations in 82
  countries
• In total, represents 2 million pharmacists,
  world-wide
• Over 4000 individual members
• Headquarters, The Hague, The Netherlands
• Off-site office in Geneva, Switzerland
• Relatively small staff (12)
• FIP Mission Statement
• To improve global health by advancing pharmacy
  practice and science to enable better discovery,
  development, access to and safe use of
  appropriate, cost-effective, quality medicines
  worldwide.

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Structure of FIP
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Summary of Structure of FIP

• Bureau, the FIP board of directors
• Chair, FIP President, Kamal Midha (Canada)
• Executive Committee
• President, Scientific Secretary (Vinod Shah,
  India) and Professional Secretary (Henri Manasse,
  USA)
• General Secretary, CEO of FIP
• Ton Hoek (The Netherlands)
• Board of Pharmaceutical Science (BPS)
• Chair, Mitsuru Hashida (Japan)
• Board of Pharmaceutical Practice (BPP)
• Chair, Phil Schneider (USA)
• 9 Sections, including Hospital Pharmacy Section
  (HPS)
• Young Pharmacists Group

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FIP Global Representation of Pharmacy

• FIP serves as liaison between pharmacy and other
  NGOs
• In official relations with WHO
• In working relations with UNESCO
• Recent achievements
• WHO UNESCO FIP Global Tripartite Education
  Action Plan 2008 2010
• FIP Collaborating Center for Pharmacy and Health,
  School of Pharmacy, University of London

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FIP Global Representation of Pharmacy

• Recent achievements
• A Core Competency Framework for International
  Health Consultants (publication)
• BE AWARE Helping to Fight Counterfeit Medicines,
  Keeping Patients Safer (publication)

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Current FIP Activities

• WHO International Medical Products
  Anti-Counterfeiting Taskforce (IMPACT)
• Global Network of Pharmacists Against Tobacco
• International Alliance for Patient Safety
• Good Pharmacy Practice Guidelines and
  implementation initiatives
• Annual Congress
• 2008, Basel, Switzerland
• 2009, Istanbul, Turkey
• 2010, Lisbon, Portugal
• Each sections within BPP has active agenda,
  programming, etc.

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FIP Global Survey of Hospital Pharmacy Practice

• FIP Board of Pharmaceutical Practice Special
  Project
• Support from Cardinal Health also acknowledged
• Objectives
• Conduct an exhaustive survey of hospital pharmacy
  practice describing and measuring the breadth and
  scope of hospital pharmacy practice worldwide
• Establish a global comparative benchmark for
  hospital pharmacy practices
• Provide background information for the Global
  Conference and future HPS programming

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Methods

• Survey methods developed in collaboration with
  Global Conference Steering Committee and HPS
  officers
• Drew from regional, national and international
  surveys from Europe (EAHP), UK, USA (ASHP) and
  Australia
• Sample frame was national respondents from every
  United Nations-member country
• Sought broadest representation in sample, with
  understanding that depth of response would be
  lacking
• Waiver of approval granted by Human Subjects
  Committee at University of Wisconsin Madison,
  USA
• Principal Investigators, Lee Vermeulen and Fred
  Doloresco, University of Wisconsin Madison and
  UW Hospital and Clinics

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Methods, continued

• Draft instrument developed and reviewed
  extensively
• Questions drawn from previous surveys, Joint
  Commission International accreditation standards
  and other sources
• Definitions of terms developed and included with
  survey
• Designed to inform all 6 Global Conference
  working group themes
• Instrument pilot tested by respondents who were
  native speakers of English, French, Spanish, and
  Mandarin
• Final instrument included 75 questions examining
  scope and breadth of hospital pharmacy practice
• Survey instrument translated from English to
  French and Spanish

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Methods, continued

• Survey evaluated aspects of practice in 2
  dimensions
• Scope of practice
• Activity is not in the scope of hospital pharmacy
  practice in my country
• This activity is in the scope of hospital
  pharmacy practice in my country but is not a
  requirement
• This is within the scope of pharmacy and is a
  legal/ regulatory requirement in my country
• Breadth of practice how common is the practice?
• lt3 (very few) of hospitals
• 3 40 (few) of hospitals
• 41 60 (some) of hospitals
• 61 97 (most) of hospitals
• gt97 (nearly all) of hospitals

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Methods, continued

• Respondents were recruited to complete the survey
• FIP member organizations initially
• HPS members
• Widespread recruitment effort with support of
  EAHP and many other organizations and individuals
• Respondents agreeing to participate in survey
  were sent instrument for completion
• Recruitment and response collection occured from
  July 2007 to April 2008
• Analysis included comparisons of responses by
  geographic region, WHO region and level of
  economic development (HDI)

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Results

• Responses received from 85 of 192 UN-member
  countries (44)
• Responses received from countries representing
  5.4 billion people (83 of global population)
• Wide range of national characteristics included
  in respondent sample
• Approximately 1/3 of countries from each of the
  World Health Organization regions
• Range of population size, from 40,000 to 1.3
  billion
• Approximately 1/3 of countries from each Human
  Development Index classification

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Results - Respondent Nations

• Czech Republic
• Democratic Republic of the Congo
• Denmark
• Ecuador
• Eritrea
• Estonia
• Ethiopia
• Finland
• France
• Germany
• Ghana
• Greece
• Guyana
• India
• Indonesia
• Iran (Islamic Republic of)
• Iraq

• Algeria
• Argentina
• Australia
• Austria
• Bahamas
• Belgium
• Bosnia and Herzegovina
• Brazil
• Brunei Darussalam
• Canada
• Chad
• China
• China-Taiwan
• Costa Rica
• Côte d'Ivoire
• Croatia

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Results - Respondent Nations

• Pakistan
• Paraguay
• Peru
• Philippines
• Poland
• Portugal
• Qatar
• Republic of Korea
• Romania
• Russian Federation
• Rwanda
• Saint Kitts and Nevis
• Serbia
• Sierra Leone
• Singapore
• Slovakia
• Slovenia

• Ireland
• Japan
• Kenya
• Latvia
• Lebanon
• Lesotho
• Luxembourg
• Madagascar
• Malta
• Mexico
• Namibia
• Nepal
• Netherlands
• New Zealand
• Nigeria
• Norway

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Results - Respondent Nations

• United Republic of Tanzania
• United States of America
• Uruguay
• Venezuela (Bolivarian Republic of)
• Viet Nam

• South Africa
• Spain
• Sudan
• Suriname
• Sweden
• Switzerland
• Thailand
• The former Yugoslav Republic of Macedonia
• Timor-Leste
• Trinidad and Tobago
• Turkey
• Uganda
• United Arab Emirates
• United Kingdom of Great Britain and Northern
  Ireland

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Results Source of Response Information
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Results Practice Model

• Pharmacist practice model used in hospitals in
  respondent nations

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Results Spending on HIV Spending

• Proportion of the nations total (pharmacy and
  non-pharmacy) healthcare budget spent on HIV care

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Results Spending on Tuberculosis

• Proportion of the nations total healthcare
  budget spent on tuberculosis care

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Results Spending on Malaria

• Proportion of the nations total healthcare
  budget spent on malaria care

23
Results Pharmacist Vacancies

• There are current vacancies that cannot be filled
  with qualified pharmacists due to a lack of
  qualified individuals in my country.

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Results Gender Mix of Pharmacists

• Please describe the percentage of female
  pharmacists in hospitals in your country.

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Results Technician Workforce

• The pharmacy department includes technical staff
  in addition to pharmacists.
• The use of technicians to augment the pharmacy
  workforce is widespread.

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Results Ability to Obtain Medicines

• With the exception of limited, temporary medicine
  shortages, hospitals are able to easily obtain
  medications that are on the formulary or
  essential medicines list.
• Increasing HDI category correlates with an
  increased ability to obtain medications
• AFRO and EMRO nations reported difficulties in
  obtaining medications

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Results Unit Dose Dispensing

• Hospitals distribute the majority of medicines to
  patients in the hospital as unit doses.
• A high proportion of low HDI nations require and
  have implemented unit dose dispensing
• A third of low HDI nations report using unit dose
  dispensing in gt97 of hospitals

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Results Access to Medical Records

• Pharmacists in hospitals have access to patient
  files (such as the medical chart or record).
• Little variation across HDI category
• Similar results for population and WHO region

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Results Medical Libraries

• Pharmacists in hospitals have access to a medical
  library with medicine references while they are
  working.
• Pharmacists in a majority of hospitals in high
  HDI score nations, but not in medium or low HDI
  score nations, have access to medical libraries
  or medicine references

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Results Pharmacist Prescribing

• Pharmacists in hospitals are able to prescribe
  only under certain circumstances (such as under
  an agreement with a doctor).
• Pharmacist prescribing (with or without an
  agreement with a doctor) is not employed in a
  majority of hospitals

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Survey Limitations

• Difficult for any one respondent to reflect upon
  the nature of pharmacy practice in an entire
  country
• Future HPS should include national sub-samples
  for more accurate representation of practice
  patterns
• Definitions that we all sometimes take for
  granted are often not consistent from country to
  country (not simply a language issue!)

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Next Steps for the Global Survey

• Targeted survey results will be used to inform
  discussion of consensus statements during Global
  Conference
• Results will provide guidance to HPS leadership
  in developing future programming for Section
  sessions in years to come
• Full technical report to be made available and
  manuscript will be part of Global Conference
  proceedings
• Istanbul Congress, 2009, session to be held to
  identify future plans for more detailed survey
  efforts on targeted aspects of hospital pharmacy
  practice, and to monitor trends in practice
  development over time

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globalhosp_at_fip.org www.fip.org/globalhosp
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Background FIP Global Conference on the Future
of Hospital Pharmacy

• In December 2005 international leaders in
  hospital pharmacy met in New Orleans at the ASHP
  Midyear Clinical Meeting
• Common concerns were observed, common global
  standard of practice was missing
• The FIP Hospital Pharmacy Section was chosen as
  host for global consensus conference
• A steering committee was formed
• Several subcommittees started to work
• Meeting took place 30 31 August 2008 in Basel

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Objectives FIP Global Conference on the Future
of Hospital Pharmacy

• To build a shared vision among hospital pharmacy
  opinion leaders around the world about the
  preferred future of hospital pharmacy practice.
• To identify strategic goals for global
  advancement of hospital pharmacy that are
  relevant to the needs of each participating
  country, and to identify opportunities for global
  cooperation that will allow every country to
  achieve their goals for hospital pharmacy.
• To develop consensus statements on how to best
  prioritize practice advancements and offer
  guidance on the development of tools, timelines
  and tactics for achieving those advancements.

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Global Conference Leadership

• Honorary Conference Co-Chairs
• Jacqueline Surugue (France), EAHP
• Henri Manasse (USA), ASHP
• Steering Committee
• Lee Vermeulen (USA), Chair
• William A. Zellmer (USA), Vice Chair
• Satu Siiskonen (The Netherlands), Conference
  staff
• Toby Clark (USA), Chair, Finance Subcommittee
• Stephen Curtis (UK)
• Andy Gray (South Africa), HPS President, Chair,
  Delegate Selection Subcommittee
• Stefan Mühlebach (Switzerland)
• Philip J. Schneider (USA), ex officio BPP
  representative
• Thomas S. Thielke (USA)
• Dick Tromp (The Netherlands ), ex officio BPP
  representative
• Arnold G. Vulto (The Netherlands), Chair,
  Programming Subcommittee
• Eduardo Savio (Uruguay)
• Zhu Zhu (China)

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Global Conference Structure and Faculty

• Six facilitators were recruited for one of six
  themes, each focused on a different components of
  hospital pharmacy practice
• Literature reviews written
• Develop draft consensus statements
• Lead working groups via internet and live at
  the conference
• Facilitator assignments
• Procurement of medicines (Eva Ombaka, Kenya,
  Africa)
• Prescribing of medicines (Lisa Nissen, Brisbane,
  Australia)
• Preparation and distribution of medicines(Ryo
  Oishi, Japan)
• Administration of medicines (Rita Shane, Los
  Angeles, USA)
• Monitoring outcomes (David Cousins, UK, Europe)
• Human resources and training (Tana Wujili, FIP)

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Global Conference Process

• Fundraising and scholarships
• Recruitment and selection of official
  representatives (delegates)
• Initial development of literature reviews and
  draft consensus statements
• Preliminary consensus development amongst working
  groups began Summer 2008
• Conference occurred 30th - 31st August, 2008,
  Basel Switzerland
• Nearly 350 delegates (22 scholarship recipients)
  attended from over 90 countries
• Over 80 countries were represented by official
  representatives
• Plenary session
• Working group sessions
• Editing of statements
• Voting process for consensus statements

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Voting Scale

• As each consensus statement is read, official
  representatives voted using audience response
  system
• The voting scale used as follows
• A I strongly agree with the statement
• B I agree with the statement
• C I disagree with the statement
• D I strongly disagree with the statement

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Voting Process

• A consensus statement was read by the facilitator
  for the group that developed the statement, and
  if necessary, brief comments were also made
• Official representatives were be asked to vote on
  the statement and the results of the vote were
  shown
• If a clear consensus was reached (simple majority
  of votes are A (strongly agree) or B (agree),
  the statement was accepted

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Results!

• A total of 74 consensus statements were developed
• Overarching statements
• Statements from each working group
• A total of 82 countries cast a vote on at least 1
  statement
• Across all statements, an average of 64.1 votes
  per statement were cast
• All statements were approved with consensus
• Across all statements, the average level of
  consensus (proportion of votes cast as strongly
  agree or agree) was 97.5
• Of 5,259 votes cast
• 3,821 (62.8) were strongly agree
• 1,314 (21.7) were agree
• Only 111 were disagree and 22 were strongly
  disagree
• A total of 26 statements (35) had 100 consensus
  (strongly agree or agree)

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Themes in Basel Statements

• The definition of hospital pharmacist needs
  additional development. Current definitions vary
  worldwide, based on traditions and national
  regulations and ambitions, but in general
• Pharmacist working in a hospital
• Specialized training, generally post-graduate
  (including residency)
• The overarching goal of hospital pharmacists is
  to optimise patient outcomes through the
  judicious, safe, efficacious, appropriate and
  cost effective use of medicines.
• Hospital pharmacists should take responsibility
  for all medicine logistics in hospitals.
• Hospital pharmacists should provide orientation
  and education to nurses, physicians and other
  hospital staff regarding medication use, using
  best practice recommendations.

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Next Steps

• Feedback forms provided to gather additional
  written comments on any consensus statements,
  additional statements and final editing underway
  now (17th September 2008)
• Draft Basel Statements at www.fip.org/globalhosp
• Full proceedings to be published in American
  Journal of Health-System Pharmacy in February
  2009 with free, open access worldwide
• Future programming planned for HPS, including
  additional survey activity and action plan to
  implement Basel Statements

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The Moment
www.fip.org/globalhosp