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Results of a ten years experience Martine Ruggli Pharmacist FPH pharmaSuisse

Results of a ten years experience Martine Ruggli Pharmacist FPH pharmaSuisse Switzerland. Physicians-pharmacists quality circles. Concept of physicians - pharmacists quality circles:.

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Results of a ten years experience Martine Ruggli Pharmacist FPH pharmaSuisse

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  1. Results of a ten years experience Martine Ruggli Pharmacist FPH pharmaSuisse Switzerland Physicians-pharmacists quality circles

  2. Concept of physicians - pharmacists quality circles: a stable group of 4 to 10 physicians with 1 (or more) pharmacist as a moderator who meet 4 to 5 times a year. Their goal: a continuous quality improvement of prescribing practices, thanks to education on guidelines, evidence-based medicine and pharmacoeconomy.

  3. Physicians - pharmacists quality circles: how does it work? 1.Prescription data (benchmarking per physician and therapeutic class) 7. Assessment of the results and improvements 2.Education on guidelines and Evidence-based medecine 6.Check on the impact of the consensus 3.Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market 5.Application of the consensus 4.Consensus of each quality circle Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  4. Prescription data 1.Prescription data (benchmarking per physician and therapeutic class) Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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. Prescription data of the antidiabetics during the years 2006-2007: physician XXX

  6. Prescription data of the antidiabetics during the years 2006-2007: control group

  7. Physicians - pharmacists quality circles: how does it work? 2.Education on guidelines and Evidence-based medecine Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  8. Education The scientific group of pharmaSuisse, the Swiss association of pharmacists Study of the documents and the preparation of the quality circle Preparation of documents 4-6 times a year, the pharmacist has a ½ day course of postgraduate education Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  9. Priority to get the information • Independant sources (like Prescrire, Cochrane Library, EBM, Drug and Therapy Perspectives) • Guidelines (NIH, NICE, SIGN, ICSI, american, europeen and swiss societies of medicine) • Oficial agency (FDA, Swissmedic, Bulletin OFSP, OFAS….) • Follow-up of the actuality via the net (pharmavista, Medscape, DrugInfozone, pharmacists’ letter….) • Follow-up of the common medicine litterature (Revue médicale suisse, Medical Letter, Bulletin des Médecins suisses, Pharma-Flash, Pharmakritik, Managed Care, Arzneimitteltherapie, Arzneimittelbrief, Arznei-Telegram, Swiss Medical Weekly ) • Analyse and critics of various publicities for medicines • Articles from Chest,Lancet, JAMA, BMJ, N Engl Journal of medicine

  10. Prescription's practices analysed systematicly • 19 therapeutic classes like: • Antibiotics and the diseases they are used for • Painkiller and diseases • All the medicines used for the cardiovascular diseases (for example hypertension, heart failure, anticoagulation, heart attack…) • Lipids lowering medicines • Antidiabetics • All the medicines used for the psychiatric diseases (depression, sleep trouble, anxiety, schizophrenia…) • Antiasthmatics, medicines for COPD • Medicines used for the gastric and gut problems • News (for example osteoporosis, parkinson…)

  11. Physicians - pharmacists quality circles: how does it work? 3.Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  12. Daily cost comparison of a treatment • with metformine, glitazone or gliptine

  13. Physicians - pharmacists quality circles: • how does it work? 4.Consensus of each quality circle Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  14. Which consensus is adopted by the quality circle ?

  15. Physicians - pharmacists quality circles: how does it work? 7. Assessment of the results and improvements 6.Check on the impact of the consensus 5.Application of the consensus Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  16. Physicians - pharmacists quality circles: how does it work? 1.Prescription data (benchmarking per physician and therapeutic class) 7. Assessment of the results and improvements 2.Education on guidelines and Evidence-based medecine 6.Check on the impact of the consensus 3.Analysis of prescription attitudes in comparison with scientific and economic data and search for alternatives in drug market 5.Application of the consensus 4.Consensus of each quality circle Work processContinous quality improvement of prescription 1.Prescription data (benchmarking per physician and therapeutic class) 7.Assessment of the results and improvements 6.Check on the impact of the consensus 2.Education on guidelines, Evidence-based medecine and pharmacoeconomy. 5.Application of the consensus 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

  17. Results from the ten year experience in Fribourg The quality circle started in Fribourg with the pioneer group (24 physicians and 6 pharmacists)

  18. Pilot project 2004-2006 in Fribourg and Valais • New pilot project: monitoring during 2004 to 2006 of • The pioneer group of Fribourg • The new QC group of Fribourg (58 physicians and 8 pharmacists) • The QC group of the Valais (36 physicians and 8 pharmacists The pioneer group of Fribourg (24 physicians and 6 pharmacists)since 1997 66 new circles with 420 physicians

  19. Results from the ten year experience in Fribourg 120’000 € per physician

  20. Results of the newer quality circles in Fribourg 35’000 € per physician

  21. Results of the quality circles in Valais 50’000 € per physician

  22. Savings Savings for these 118 physicians: between 2004 and 2006 about 3.5 millions € since the beginning of the project over 12 millions €

  23. "circle effect": better generics penetration Relation between the generics’ penetration in the 3 QC with the one of the control group. A bigger value than 1 indicates a generics penetration higher than the one of the control group Fig. 4: Relation between the generics’ penetration in the 3 QC with the one of the CG. A bigger value than 1 indicates a generics penetration higher than the one of the CP Fig. 4: Relation between the generics’ penetration in the 3 QC with the one of the CG. A bigger value than 1 indicates a generics penetration higher than the one of the CP

  24. "Circle effect": more balanced attitude towards marketing strategies Relationship between the mean annual cost of a diabetic patient treated with antidiabetica (yellow) and some criteria that could influence it: generics penetration (% of packages) (blue), glitazones penetration (% of packages)(red) and the economic impact (% of the costs) of the insulin analoga glargine and detemir (purple)

  25. "Circle effect": more balanced attitude towards marketing strategies Evolution of the proportion of prescribed packages of sartans (A2A) in the therapeutic class 02.07 ( ACE inhibitors, sartans, association of antihypertensiva)

  26. Conclusion • Confirmation of the sustainable effectiveness of this interdisciplinary approach . • Negotiation about remuneration • Enlargement of this new type of pharmaceutical service.

  27. Thank you for your attention And enjoy your stay in Switzerland!

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