1. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien In the last ten years, two new professionnal services have been developped in Switzerland: Consultant pharmacist in Quality Circles formed with GP’s, focused on medecines’ prescription. Accepted and paid by Insurance Companies Consultant pharmacist in Nursing Home Recognized by the law and paid by Insurance Companies

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 prescrition’s 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 1. Prescription data (benchmarking per physician and therapeutic class) 2. Education on guidelines, evidence base medecine and pharmacoeconomy. 3. Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market 4. Consensus of each quality circle 5. Application of the consensus 6. Implementation of the consensus 7. Assessment of the results and improvements Work process Continous development of the prescription Michel Buchmann Dr pharmacien

4. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien 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 Evaluation of the results

5. AU European Forum, Divonne 11-12 mars 2004 Evolution of the number of pharmacists and doctors involved in QC on 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 Schweizerischer Apothekerverband Société Suisse des Pharmaciens Società Svizzera dei Farmacisti Evolution (index) of the report cost/pat due to the prescriptions of the firstdoctors active in the first Quality circles(1997-2003) (LS+taxes) O.Bugnon / 2004 Source de données brutes : OFAC (2003)

7. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien Money Saving between 1999-2002 Medicines’ costs for 24 doctors « pionniers » en 2002: Fr. 12’941’039.60 for 25’101 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. 48’528.90 of saving per physician = Fr. 46.40 per patient Source de données brutes : OFAC (2003)

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 Michel Buchmann Dr pharmacien 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.

10. AU European Forum, Divonne 11-12 mars 2004 Impact study 2000-2002 Evolution of the NAIDS Generics prescription O.Bugnon / 2004 Source de données brutes : OFAC (2003) Schweizerischer Apothekerverband Société Suisse des Pharmaciens Società Svizzera dei Farmacisti

11. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien

12. AU European Forum, Divonne 11-12 mars 2004 Impact study 2000-2002 Evolution of the prescription of the NAIDS undergroup Coxibes O.Bugnon / 2004 Source de données brutes : OFAC (2003) Schweizerischer Apothekerverband Société Suisse des Pharmaciens Società Svizzera dei Farmacisti

13. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien

14. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien 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)

15. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien 1.Single payment for drugs and medical supply (6 Euros/patient/day) 2. Financing of the pharmaceutical service (67 Euro Cent/patient/day) 3.Each institution declares its annual results with transparency 4.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 Assistance pharmaceutique/ Buchmann, Bugnon (SSPh) 2001 Tarif agreement

16. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien Evolution of the cost/pat in 2 nursing homes working with a consultant pharmacist since 1995 0 500 1000 1500 2000 2500 199519961997199819992000200120021er sem 03x2 Coût eff/pat [fr] RsMCotNDSiv Total: 110 patients

17. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien 1803.00 2007.00 2185.00 2427.00 2329.00 2648.00 1000.00 1200.00 1400.00 1600.00 1800.00 2000.00 2200.00 2400.00 2600.00 2800.00 19981999200020012002 Coût médicaments annuel moyen par résident [Fr] Comptes AFIPA Projection AFIPA +11.3% +8.9% +11.1% - 4.1% 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%

18. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien « 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 Added Value message:

19. AU European Forum, Divonne 11-12 mars 2004 Michel Buchmann Dr pharmacien « 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