Presentation on theme: "A Global Strategic Plan for Hospital Pharmacy Practice"— Presentation transcript:
1 A Global Strategic Plan for Hospital Pharmacy Practice
2 OverviewBrief introduction to FIP, the International Pharmaceutical FederationDescribe the FIP Global Survey of Hospital Pharmacy PracticeDescribe the FIP Global Conference on the Future of Hospital PharmacyThe Basel Statements on the Future of Hospital Pharmacy
3 International Pharmaceutical Federation (FIP) Comprised of 120 member organizations in 82 countriesIn total, represents 2 million pharmacists, world-wideOver 4000 individual membersHeadquarters, The Hague, The NetherlandsOff-site office in Geneva, SwitzerlandRelatively 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.”
5 Summary of Structure of FIP Bureau, the FIP board of directorsChair, FIP President, Kamal Midha (Canada)Executive CommitteePresident, Scientific Secretary (Vinod Shah, India) and Professional Secretary (Henri Manasse, USA)General Secretary, CEO of FIPTon 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
6 FIP Global Representation of Pharmacy FIP serves as liaison between pharmacy and other NGOsIn ‘official relations’ with WHOIn ‘working relations’ with UNESCORecent achievementsWHO UNESCO FIP: Global Tripartite Education Action Plan 2008 – 2010FIP Collaborating Center for Pharmacy and Health, School of Pharmacy, University of London
7 FIP Global Representation of Pharmacy Recent achievementsA Core Competency Framework for International Health Consultants (publication)BE AWARE: Helping to Fight Counterfeit Medicines, Keeping Patients Safer (publication)
8 Current FIP Activities WHO International Medical Products Anti-Counterfeiting Taskforce (IMPACT)Global Network of Pharmacists Against TobaccoInternational Alliance for Patient SafetyGood Pharmacy Practice Guidelines and implementation initiativesAnnual Congress2008, Basel, Switzerland2009, Istanbul, Turkey2010, Lisbon, PortugalEach sections within BPP has active agenda, programming, etc.
9 FIP Global Survey of Hospital Pharmacy Practice FIP Board of Pharmaceutical Practice Special ProjectSupport from Cardinal Health also acknowledgedObjectivesConduct an exhaustive survey of hospital pharmacy practice describing and measuring the breadth and scope of hospital pharmacy practice worldwideEstablish a global comparative benchmark for hospital pharmacy practicesProvide background information for the Global Conference and future HPS programming
10 MethodsSurvey methods developed in collaboration with Global Conference Steering Committee and HPS officersDrew from regional, national and international surveys from Europe (EAHP), UK, USA (ASHP) and AustraliaSample frame was national respondents from every United Nations-member countrySought broadest representation in sample, with understanding that depth of response would be lackingWaiver of approval granted by Human Subjects Committee at University of Wisconsin – Madison, USAPrincipal Investigators, Lee Vermeulen and Fred Doloresco, University of Wisconsin – Madison and UW Hospital and Clinics
11 Methods, continued Draft instrument developed and reviewed extensively Questions drawn from previous surveys, Joint Commission International accreditation standards and other sourcesDefinitions of terms developed and included with surveyDesigned to inform all 6 Global Conference working group themesInstrument pilot tested by respondents who were native speakers of English, French, Spanish, and MandarinFinal instrument included 75 questions examining scope and breadth of hospital pharmacy practiceSurvey instrument translated from English to French and Spanish
12 Methods, continuedSurvey evaluated aspects of practice in 2 dimensionsScope of practiceActivity is not in the scope of hospital pharmacy practice in my countryThis activity is in the scope of hospital pharmacy practice in my country but is not a requirementThis is within the scope of pharmacy and is a legal/ regulatory requirement in my countryBreadth of practice; how common is the practice?<3% (very few) of hospitals3 – 40% (few) of hospitals41 – 60% (some) of hospitals61 – 97% (most) of hospitals>97% (nearly all) of hospitals
13 Methods, continued Respondents were recruited to complete the survey FIP member organizations initiallyHPS membersWidespread recruitment effort with support of EAHP and many other organizations and individualsRespondents agreeing to participate in survey were sent instrument for completionRecruitment and response collection occured from July 2007 to April 2008Analysis included comparisons of responses by geographic region, WHO region and level of economic development (HDI)
14 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 sampleApproximately 1/3 of countries from each of the World Health Organization regionsRange of population size, from 40,000 to 1.3 billionApproximately 1/3 of countries from each Human Development Index classification
15 Results - Respondent Nations AlgeriaArgentinaAustraliaAustriaBahamasBelgiumBosnia and HerzegovinaBrazilBrunei DarussalamCanadaChadChinaChina-TaiwanCosta RicaCôte d'IvoireCroatiaCzech RepublicDemocratic Republic of the CongoDenmarkEcuadorEritreaEstoniaEthiopiaFinlandFranceGermanyGhanaGreeceGuyanaIndiaIndonesiaIran (Islamic Republic of)Iraq
16 Results - Respondent Nations PakistanParaguayPeruPhilippinesPolandPortugalQatarRepublic of KoreaRomaniaRussian FederationRwandaSaint Kitts and NevisSerbiaSierra LeoneSingaporeSlovakiaSloveniaIrelandJapanKenyaLatviaLebanonLesothoLuxembourgMadagascarMaltaMexicoNamibiaNepalNetherlandsNew ZealandNigeriaNorway
17 Results - Respondent Nations South AfricaSpainSudanSurinameSwedenSwitzerlandThailandThe former Yugoslav Republic of MacedoniaTimor-LesteTrinidad and TobagoTurkeyUgandaUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited Republic of TanzaniaUnited States of AmericaUruguayVenezuela (Bolivarian Republic of)Viet Nam
19 Results: Practice Model Pharmacist practice model used in hospitals in respondent nations
20 Results: Spending on HIV Spending Proportion of the nation’s total (pharmacy and non-pharmacy) healthcare budget spent on HIV care
21 Results: Spending on Tuberculosis Proportion of the nation’s total healthcare budget spent on tuberculosis care
22 Results: Spending on Malaria Proportion of the nation’s 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.
24 Results: Gender Mix of Pharmacists Please describe the percentage of female pharmacists in hospitals in your country.
25 Results: Technician Workforce The pharmacy department includes technical staff in addition to pharmacists.The use of technicians to augment the pharmacy workforce is widespread.
26 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 medicationsAFRO and EMRO nations reported difficulties in obtaining medications
27 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 dispensingA third of low HDI nations report using unit dose dispensing in >97% of hospitals
28 Results: Access to Medical Records Pharmacists in hospitals have access to patient files (such as the medical chart or record).Little variation across HDI categorySimilar results for population and WHO region
29 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
30 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
31 Survey LimitationsDifficult for any one respondent to reflect upon the nature of pharmacy practice in an entire countryFuture HPS should include national sub-samples for more accurate representation of practice patternsDefinitions that we all sometimes take for granted are often not consistent from country to country (not simply a language issue!)
32 Next Steps for the Global Survey Targeted survey results will be used to inform discussion of consensus statements during Global ConferenceResults will provide guidance to HPS leadership in developing future programming for Section sessions in years to comeFull technical report to be made available and manuscript will be part of Global Conference proceedingsIstanbul 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
34 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 MeetingCommon concerns were observed, common global standard of practice was missingThe FIP Hospital Pharmacy Section was chosen as host for global consensus conferenceA steering committee was formedSeveral subcommittees started to workMeeting took place 30 – 31 August 2008 in Basel
35 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.
36 Global Conference Leadership Honorary Conference Co-ChairsJacqueline Surugue (France), EAHPHenri Manasse (USA), ASHPSteering CommitteeLee Vermeulen (USA), ChairWilliam A. Zellmer (USA), Vice ChairSatu Siiskonen (The Netherlands), Conference staffToby Clark (USA), Chair, Finance SubcommitteeStephen Curtis (UK)Andy Gray (South Africa), HPS President, Chair, Delegate Selection SubcommitteeStefan Mühlebach (Switzerland)Philip J. Schneider (USA), ex officio BPP representativeThomas S. Thielke (USA)Dick Tromp (The Netherlands ), ex officio BPP representativeArnold G. Vulto (The Netherlands), Chair, Programming SubcommitteeEduardo Savio (Uruguay)Zhu Zhu (China)
37 Global Conference Structure and Faculty Six facilitators were recruited for one of six themes, each focused on a different components of hospital pharmacy practiceLiterature reviews writtenDevelop draft consensus statementsLead working groups via internet and “live” at the conferenceFacilitator 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)
38 Global Conference Process Fundraising and scholarshipsRecruitment and selection of official representatives (delegates)Initial development of literature reviews and draft consensus statementsPreliminary consensus development amongst working groups began Summer 2008Conference occurred 30th - 31st August, 2008, Basel SwitzerlandNearly 350 delegates (22 scholarship recipients) attended from over 90 countriesOver 80 countries were represented by official representativesPlenary sessionWorking group sessionsEditing of statementsVoting process for consensus statements
39 B = I agree with the statement C = I disagree with the statement Voting ScaleAs each consensus statement is read, official representatives voted using audience response systemThe voting scale used as follows:A = I strongly agree with the statementB = I agree with the statementC = I disagree with the statementD = I strongly disagree with the statement
40 Voting ProcessA consensus statement was read by the facilitator for the group that developed the statement, and if necessary, brief comments were also madeOfficial representatives were be asked to vote on the statement and the results of the vote were shownIf a clear consensus was reached (simple majority of votes are A (“strongly agree”) or B (agree), the statement was accepted
41 Results! A total of 74 consensus statements were developed Overarching statementsStatements from each working groupA total of 82 countries cast a vote on at least 1 statementAcross all statements, an average of 64.1 votes per statement were castAll statements were approved with consensusAcross all statements, the average level of consensus (proportion of votes cast as “strongly agree” or “agree”) was 97.5%Of 5,259 votes cast3,821 (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”)
42 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.
43 Next StepsFeedback forms provided to gather additional written comments on any consensus statements, additional statements and final editing underway now (17th September 2008)Draft Basel Statements atFull proceedings to be published in American Journal of Health-System Pharmacy in February 2009 with free, open access worldwideFuture programming planned for HPS, including additional survey activity and action plan to implement Basel Statements