Teaching clinical pharmacy and pharmaceutical care - a Swiss experience

1. Institute for Postgraduate Training in Clinical Pharmacy, Prague Teaching clinical pharmacy and pharmaceutical care - a Swiss experience Prof. Dr. Kurt E. Hersberger Pharmaceutical Care Research Group Klingelbergstrasse 50 CH-4056 Basel Kurt.hersberger@unibas.ch

2. The pharmacist is situated at the junction of the logistical supply process (industry,wholesaler,pharmacy) and the cognitive care process(symptoms, diagnosis, prescription, pharmacy).

3. Bologna ! Federal diploma Master in Pharmacy (120ECP) Bachelor in Pharmaceutical Sciences (180 ECP)

4. Aufbaustudium II Aufbaustudium I Grundstudium Master thesis and defence -> 34 KP Basics of clinical pharmacy (IR, PC) -> 26 KP Pharmacy Curriculum Master Pharmacy / Federal Examination • Hospital Pharmacy • Clinical pharmacy • Community pharmacy Postgraduate education organised by professional organisations Specialisation Federal exam based on a national catalogue of learning objectives Federal diploma Externship (community pharmacy and/or hospital pharmacy -> 30 KP Teaching & training pharm. care -> 30 KP Master in Pharmacy Bachelor in Pharmaceutical Sciences

5. Teaching pharmaceuticalcare • Discussion of case studies  methods used in pharmaceutical care • Different requests – different approaches • SOAP • Patient assessment

6. Patient assessment in the pharmacy • Medical condition / history • Individual needs • Perception(s) • Willingness to follow changes • Adherence

7. Performance Point of Sale vs. Counselling area • Structured (protocol) • Privacy • Documentation • Pharmaceutical Care • Performance risks to be poor • Fulfilment of at least „WWHAM“ is difficult

8. Teaching pharmaceuticalcare • Discussion of case studies  methods used in pharmaceutical care • Different requests – different approaches • SOAP • Patient assessment • Pharmaceutical care issues • Medication review

9. Types of Medication Review (PCNE) • „simple“ Medication Review • based on the medication history in the pharmacy • „intermediate“ Medication Review • Based on medication history + patient interview • MUR, Polymedikations-Check • „Brown Bag“-Methode • „advanced“ Medication Review • medication history +patient interview + clinical data • Clinical Medication Review

10. Workflow dose dispensing service Medication Review Identificationof non-adherence Selectionofadequateinterventions Other adherenceinterventions Hersberger KE et al. Expert Rev. Clin. Pharmacol. 2013;6(4):413-421 • Dose dispensingservice • Configurationofregimen • Selectionof dose dispensingaid • Productionofindividualised dose dispensingaidfor a periodof x days • Instruction& counsellingofpatient / caregiver • Follow-up

11. Teaching pharmaceuticalcare • Discussion of case studies  methods used in pharmaceutical care • Different requests – different approaches • SOAP • Patient assessment • Pharmaceutical care issues • Medication review • Clinical training / guidelines for practice • Involvement of other healthcare providers as teacher-practitioner

12. Smoking cessation: Model of a well developed setting • Fagerstöm Questions • Prochaska-Model to assess motivation • Introduction into Motivational Interviewing • Role plays • Sinclair HK, Bond CM, Stead LF. Cochrane Review 2004 • Dent et al. Pharmacotherapy 2007;27(7):1040–1051

13. Teaching scinjectiontherapy • Basics of heparin therapy • Videos with errors • Training with phantom • Injection of NaCl 0.9% • Workshop in small groups (n=10) • 1 h for Insulin • 1 h for heparin

14. Emergency hormonal contraception: • Introduced 2002 as „pharmacist only“ in Switzerland Repeated evaluations show: • Structured, well evaluated protocols are crucial • Pharmacists perform exhaustive assessments (only 3.0% missing data) • Women are ready to pay a fee for service • High satisfaction with service provision Arnet I et al. EurJ ContraceptReprod Health Care. 2009;14(5):349-56.

15. Teaching pharmaceuticalcare • Discussion of case studies  methods used in pharmaceutical care • Different requests – different approaches • SOAP • Patient assessment • Pharmaceutical care issues • Medication review • Clinical training / guidelines for practice • Involvement of other healthcare providers as teacher-practitioner • Portfolio with individual feedback • Case studies, home visits, involvement in surveys (research)

16. Prevalence of medication-related risk factors A convenient sample of chronically ill patients on >4 medications Home visits (n=51) Risk factors adapted from: Sorensen L.J ClinPharmTher, 2006;3:485-91 Eichenberger P et al. IntJ Clin Pharm. 2011;33(5):815-23

17. Assessment of clinical skills /competences /performance Direct observation/supervision „on the job“ Portfolio OSCE (objective structured clinical examination) Role plays Case studies Oral examination Case studies Short answer questions Does Shows Oral examination Multiple choice (MC) Short answer questions Knows How Knows Miller, GE. Acad Med;1990;65(9):s63-s67.

18. Objective Structured Clinical Examination (OSCE) • first conceptualized in 1975 by Harden R 1 • Developed to assess the complex notion of clinical competences / skills 2 • Multiple stations (n=8-12) with different tasks (e.g. triage of minor symptoms, prescription validation, instruction of a device, patient education, writing a comment/fax to a GP) • Use of standardized patients and evaluation checklists • Rating by pseudo-patients and/or observer • Used in medicine, pharmacy and nursing Harden R, Stevenson M, Downie WW, Wilson GM. Clinical competence in using objective structured examination. Br Med J 1975;1:447-51 Turner JL, Dankosky ME. FamMed 2008;40(8):574-8

19. OSCE in Basel • Training of students • Two sessions with in total 4 cases • Only short, immediate feedback • Discussion of the cases and major difficulties, mistakes in a plenary session • Final federal exam (BS, ZH, GE) • Preparation/selection of cases • Blueprint for balancing issues/indications/settings • Pilot testing • Translation • Briefing of pseudopatients/examiners

20. Organisation is a challenge • This year: 70 candidates • 2 days with 5 stations each (total 10 different stations) • Approx. 35 persons involved • Pseudopatients and examiner = pharmacists P5 1 5 P1 10:40- 13.30h in Quarantäne P4 8:30-10:30 2 4 P2 P3 3

21. Universities of Basel, Geneva and Zürich (ETHZ) Federal exams

22. Cases in 2013

23. Case pediatrics • Measles or chicken pox ? • Patient assessment • Red flags • Vaccination scheme • OTC treatment or referral? • Therapy plan • Follow-up • Communication

24. Evaluation form “pediatrics”

25. Story board for briefing “pediatrics”

26. Cystitis • Women 19 years • First episode • Fewer 38.1° ResultatUrintest - Leukozyten: ++ - Nitrit: ++ - Protein: + - Glucose: 0 - Erythrozyten: +

27. Methotrexat

28. Teaching clinicalpharmacy Does Shows Knows How Knows

29. Thankyou ! Isabelle Arnet Vera Bernhardt Esther Spinatsch Markus Lampert Karen Maes Markus Messerli FabienneBöni Carole Kaufmann Philipp Walter Samuel Allemann