Social Pharmacy and Quality of Life

1. Social Pharmacyand QualityofLife JAMASOFT2017

2. Concepts such as follows: Medication Adherence, Compliance, Persistence, Costs and Quality of life are current and actual in patients treated with pharmacotherapy nowadays. JAMASOFT2017

3. This lecture presents current research in health-related quality of life, with a particular focus on disease and drugs. JAMASOFT2017

4. The aim of thislecture is to demonstratethe association between medication and quality of life. Drug treatment can be either the facilitator which gives the opportunities, or the opposite, an intensifier of problems by occurrence of unacceptable side effects leading to decreased QoL. JAMASOFT2017

5. Drugs Affect Quality of Life. Physicians assess treatment success by looking at numbers. Blood pressure, cholesterol, blood sugar and thyroid function are all tracked with numbers. The goal is usually to get these measurements into a normal range. Quality of life is as important as numbers on a chart. It should be measured just like blood pressure or cholesterol. Modern drugs have made large contributions to better health and quality of life. Increasing proportions of negative side effects due to extensive pharmacological treatment are however observed especially among elderly patients who have multiple health problems. JAMASOFT2017

6. What is quality of life? Quality of life (QoL) is a broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. What makes it challenging to measure is that, although the term “quality of life” has meaning for nearly everyone and every academic discipline, individuals and groups can define it differently. JAMASOFT2017

7. From the methodical point of view: The concept of quality of life (QoL) assessment has led to the development of generic and disease specific questionnaires to evaluate patient reported outcomes. (Self-monitoring method.) JAMASOFT2017

8. Pharmacists can improve the quality of drug therapy byimproving the organizational structures through which drug therapy isprovided, specifically by creating medications use systems and by regularlyevaluating their performance. Pharmaceutical care,can contribute to a strategy for improving thequality of drug therapy and QoL. JAMASOFT2017

9. Definition of QoL “The degree to which a person enjoys the important possibilities of his or her life”. JAMASOFT2017

10. Quality of life: An important consideration in pharmaceutical and medical care, quality of life refers to the patient's ability to enjoy normal life activities. Some medical treatments can seriously impair quality of life without providing appreciable benefit, while others greatly enhance quality of life. JAMASOFT2017

11. The term quality of life is used to evaluate the general well-being of individuals and societies. Standard indicators of the quality of life include not only wealth and employment, but also the built environment, physical and mental health. JAMASOFT2017

12. Outcomes from treatmentsand otherhealth-influencingactivitieshavetwobasiccomponents: • thequantityoflife • and qualityoflife. JAMASOFT2017

13. WHO definition of Health „Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity“. JAMASOFT2017

14. Although the WHO definedhealthverybroadlyaslongas a halfcenturyago, health has traditionallybeenmeasurednarrowly and from a deficit perspective, oftenusingmeasuresofmorbidity or mortality. But, healthisseen by thepublichealthcommunityas a multidimensionalconstructthatincludesphysical, mental, and socialdomains. JAMASOFT2017

15. Health is an essential part of the quality of life of citizens. Poor health can affect the general progress of society. Physical and/or mental problems also have a very detrimental effect on subjective well-being. Health conditions in Europe are mainly measured using objective health outcome indicators such as life expectancy, infant mortality, the number of healthy life years, but also more subjective indicators, such as access to healthcare and self-evaluation of one’s health. JAMASOFT2017

16. As medical and public health advanceshaveled to cures and bettertreatmentsofexistingdiseasesanddelayed mortality, itwaslogicalthatthosewhomeasurehealthoutcomeswouldbegin to assessthepopulation’shealthnotonly on thebasisofsavinglives, butalso in termsofimprovingthequalityofthem. JAMASOFT2017

17. What is health-relatedquality of life? The concept of health-related quality of life (HRQoL) and its determinants have evolved since the 1980s to encompass those aspects of overall quality of life that can be clearly shown to affect health—either physical or mental. JAMASOFT2017

18. Health-related quality of life(HRQoL) isincreasinglyacceptedasrelevantendpointin medicine and pharmacy. Thereistheimpactofpharmacistinterventions on health-relatedqualityoflife. JAMASOFT2017

19. The construct of HRQoL enables health agencies to legitimately address broader areas of healthy public policy around a common theme in collaboration with a wider circle of health partners, including social service agencies, community planners, and business groups. JAMASOFT2017

20. HRQoL questions aboutperceivedphysical and mentalhealthandfunctionhavebecomeanimportantcomponentofhealthsurveillanceand are generallyconsideredvalidindicatorsofserviceneeds and interventionoutcomes. JAMASOFT2017

21. Why is it important to track HRQoL? Focusing on HRQoLas a nationalhealthstandardcanbridgeboundariesbetweendisciplines and betweensocial, mental, and medicalservices. JAMASOFT2017

22. Measuring HRQoL can help determine the burden of preventable disease, injuries, and disabilities, and it can provide valuable new insights into the relationships between HRQoL and risk factors. JAMASOFT2017

23. Measuring HRQoL willhelp monitor progress in achievingthenation’shealthobjectives. AnalysisofHRQoLsurveillancedatacanidentifysubgroupswithrelatively poor perceivedhealth and help to guideinterventionstoimprovetheirsituations and avert more seriousconsequences. Interpretation and publicationofthesedatacanhelpidentifyneedsforhealthpoliciesandlegislation, help to allocateresourcesbased on unmetneeds, guidethedevelopmentofstrategicplans, and monitor theeffectivenessofbroadcommunityinterventions. JAMASOFT2017

24. HRQoL assessment is a particularlyimportantpublichealthtool fortheelderly in anerawhenlifeexpectancyisincreasing, withthegoalofimprovingtheadditionalyears in spite ofthecumulativehealtheffectsassociatedwithnormalaging and pathologicaldiseaseprocesses. JAMASOFT2017

25. Lifeexpectancy is a traditional measure with few problems of comparison - people are either alive or not. JAMASOFT2017

26. Life expectancy is a statistical measure of how long a person or organism may live, based on the year of their birth, their current age and other demographic factors including gender. At a given age, life expectancy is the average number of years that is likely to be lived by a group of individuals (of age x) exposed to the same mortality conditions until they die. The most commonly used measure of life expectancy is life expectancy at age zero, that is, at birth (LEB), which can be defined in two ways: while cohort LEB is the mean length of life of an actual birth cohort (all individuals born a given year) and can be computed only for cohorts that were born many decades ago, so that all their members died, period LEB is the mean length of life of a hypothetical cohort assumed to be exposed since birth until death of all their members to the mortality rates observed at a given year. JAMASOFT2017

27. How can HRQoL be measured? Several measures have been used to assess HRQoL and related concepts of functional status. Among them are the Medical Outcomes Study Short Forms (SF-12 and SF-36), the Sickness Impact Profile, and the Quality of Well-Being Scale. JAMASOFT2017

28. Attempts to measure and valuequalityoflife is a more recentinnovation, with a number ofapproachesbeingused. Particulareffort has goneintoresearchingways in whichanoverallhealth index mightbeconstructed to locate a specifichealth state on a continuumbetween, forexample, 0 (= death) and 1 (= perfecthealth). Obviouslytheportrayalofhealthlikethisisfarfromideal, since, forexample, thedefinitionofperfecthealthishighlysubjectiveand it has beenarguedthatsomehealthstates are worsethandeath. JAMASOFT2017

29. A quality-adjusted life-year (QALY) takesintoaccountboththequantityand qualityoflifegenerated by healthcareinterventions. Itisthearithmeticproductoflifeexpectancyand a measureofthequalityoftheremaininglife-years. JAMASOFT2017

30. What is the conceptbehind QALYs? The outcomes from treatments and other health-influencing activities have two basic components – the quantity and the quality of life. A QALY is the acronym for a quality adjusted life-year, which embraces both of these components and is the arithmetic product of life expectancy and a measure of the quality of the remaining life-years. The National Institute for Health and Clinical Excellence (NICE) defines the QALY as a ‘measure of a person’s length of life weighted by a valuation of their health-related quality of life’. JAMASOFT2017

31. A QALY places a weight on time in different health states. A year of perfect health is worth 1 and a year of less than perfect health isworth less than 1. Death is considered to be equivalent to 0; however,some health states may be considered worse than death and havenegative scores. JAMASOFT2017

32. QALY calculation The Quality Adjusted Life Year (QALY) has been created to combine the quantity and quality of life. The basic idea of a QALY is straightforward. It takes one year of perfect health-life expectancy to be worth 1, but regards one year of less than perfect life expectancy as less than 1. Thus an intervention which results in a patient living for an additional four years rather than dying within one year, but where quality of life fell from 1 to 0.6 on the continuum will generate: • 4 years extra life @ 0.6 quality of life values 2.4 • less 1 year @ reduced quality (1 - 0.6) 0.4 • QALYs generated by the intervention 2.0 JAMASOFT2017

33. QALYs can therefore provideanindicationofthebenefitsgainedfrom a variety ofmedicalprocedures in termsof quality and life and survivalforthepatient. JAMASOFT2017

34. QALYs are far from perfect as a measure of outcome, with a numberof technical and methodological shortcomings. Nevertheless, the useof QALYs in resource allocation decisions does mean that choicesbetween patient groups competing for medical care are made explicitand commissioners are given an insight into the likely benefits frominvesting in new technologies and therapies. JAMASOFT2017

35. Limitations of QALYs While QALYs provide an indication of thebenefits gained from a variety of medicalprocedures, in terms of quality of life andsurvival for patients, they are far from perfectas a measure of outcome. For example, theuse of QALYs as a single outcome measure foreconomic evaluation means that importanthealth consequences are excluded. QALYs alsosuffer from a lack of sensitivity whencomparing the efficacy of two competing butsimilar drugs and in the treatment of less severe health problems. JAMASOFT2017

36. Chronic diseases, where quality of life is amajor issue and survival less of an issue, aredifficult to accommodate in the QALY. context, and there is a tendency to resort to the use of disease-specific measures ofquality of life. Similarly, preventive measures,where the impact on health outcomes maynot occur for many years, may be difficult toquantify using QALYs because the importanceattached to each of the health dimensions ishighly dependent on age, life context and life responsibilities. For example, it is verydifficult to compare the health status of a potential Olympic champion who suffers ahamstring twinge in the warm-up session with that of an elderly person who has beenrestored to some measure of mobility as a result of an intervention. JAMASOFT2017

37. The QALY provides a common currency for measuring the extent of health gain that results from healthcare interventions and, when combined with the costs associated with the interventions, can be used to assess their relative worth from an economic perspective. JAMASOFT2017

38. The quantity of life, expressed in terms of survival or life expectancy, is a traditional measure that is widely accepted and has few problems of comparison – people are either alive or not. JAMASOFT2017

39. Quality of life assessment involves a class of measurements fundamental to many aspects of health care planning and outcomes research. It is relevant for associating symptoms, adverse reactions of treatment, disease progression, satisfaction with care, quality of support services unmet needs and appraisal of health and health care options. Quality of life measures that do not consistently distinguish between groups are often only weakly related to objective criteria and show little convergence across measurements perspectives. Differences in quality of life appraisal are part of human adaptation and inherent in all quality of life measurements. JAMASOFT2017

40. The patient's QoL has historically been neglected since other outcomes are judged more important. Today there are guidelines for treatment of individual diseases, but there is a lack of guidelines and goals for treatment of the elderly with many diseases. In the healthcare systems there are now established incitements and rewards for following the guidelines for drug treatment (number of patients with recommended prescriptions) while considering the patient's quality of life is subordinate. JAMASOFT2017

41. Thanks for Attention. JAMASOFT2017