Pharmacists and Physicians in the Value Chain

1. Pharmacists and Physicians in the Value Chain The jungle and free market existed before the nations decided to build “the law”. In those days, anybody did anything without being concerned of the common good. Therefore and in particular, all physicians played pharmacist and all pharmacists played physician. …all played the role of healers. Then came the implementation of a fundamental reform in society: thegeneral medical insurance. This happened in the forties in Europe and this is currently happening in Asia. Dr. Marcel Mesnil, General Secretary, Swiss Association of Pharmacists.

2. Pharmacists and Physicians in the Value Chain For the protection of the population against its own naivety, this regulation imposed the fixation of standards that limit the freedom in the market. The professions and products that are known will be the only ones accepted. However, creating such monopolies imposes supplementary rules to protect the interests of the public. The separation of medical and pharmaceutical activities is the basic rule. It protects, in effect, the patient against the material interests of the physician. The regulation of prices is another basic rule that also represents an indispensable protection against the abuse of the pharmacists monopoly. Dr Marcel Mesnil, General Secretary, Swiss Association of Pharmacists.

3. Pharmacists and Physicians in the Value Chain The medical and the pharmacy professions have similarities and common objectives. They share the same patients and have the same ethical duty to always have the best interest of their patients as their first consideration. They defend the patient’s right to choose their own health professionnal, the right to confidentiality, health education and the protection of vulnerable groups of patients. Both professions share a commitment to research, and experience the same opportunities brought about by globalisation and modern development. Nevertheless, they are some areas of conflict between the professions, notably the issues of dispensing by physicians and the provision of more comprehensive diagnostic and therapeutic services by pharmacists. Dr. Delon Human, General Secratary of the World Medical Association

4. Pharmacists and Physicians in the Value Chain The pharmacists have to consider Health Care as a competitive Industry looking for competitive advantage, the greatest one being in a value chain defined as a link between all the activities and functions in a chain trying to deliver the optimal value to customers. To be members of that chain, pharmacists have to work hard. It is realy time for change, to let pharmacists practice the profession of pharmacy. There is no future in counting pills. The future for pharmacists is in providing optimal value services to society. Dr Leanne LAI, pharmacoeconomist, Associate professor, Pharmacy Administration College of Pharmacy, Nova Southeastern University, Ft. Lauderdale USA.

5. Pharmacists and Physicians in the Value Chain Physicians and pharmacists in Australia have not in the past maximised their opportunities for collaboration. Australia ’s National Medicines Policy promotes an interdisciplinary approach to the quality use of medecines but this alone is not enough to change the ways in which physicians practice. One of the major barriers to collaboration between physicians and pharmacists in the past has been the lack of infrastructutre to support the implementation of policy changes at the service delivery level. The establishment of the Divisions of General Practice and their national peak body, the Australian Divisions of General Practice (ADGP), has created opportunities for overcoming this barrier. ADGP provides the national leadership and coordination and Divisions provide the infrastructure for the implementation of policies and programs involving collaboration between physicians and pharmacists. ADGP also works with two other key organisations, the National Prescribing Service and the Pharmacy Guild of Australia to increase the quality use of medicine through evidence-based and interdisciplinary programs. Dr Julie Thompson, General Practitioner, Medical Director of the Central West Gippsland Division of General Practice, Chair of the Australian Divisions of General Practice (AGDP)

6. Pharmacists and Physicians in the Value Chain Shall we be able to invent a managed care that is social and humane, or shall we let the economists and lawyers dictate the rules in a domain where they have no other competence than the knowledge of figures and algorithms. Whatever happens, we, doctors and pharmacists, have the greatest interest to participate in the implementation of new stuctures, be it only to preserve a certain decisional power and a sufficent independence to be still able us to offer quality treatment and to work in a human environment instead of being centred on profitability and cost/benefit figures. This has been our concern with the setting up of quality circles for the drugs prescription, in witch 110 physicians are working actually together with 16 pharmacists. Multiplied by all general practitionner in Switzerland, the obtained reduction of drug costs would represent a potential saving of about forty million US dollars. Dr Richard NYFFELER, physician, president of the medical association of the canton Fribourg, Switzerland

7. Pharmacists and Physicians in the Value Chain • The separation of medical professionals from drug dispensing, or the bungyo • System, has not been as readily accepted as in Western countries for the • following three reasons: • Poor infrastructures (few pharmacies able of filling prescriptions). • Exceptional permission given to physicians by the Medical Act • to dispense drugs in the following cases: • When it is necessary for medical reasons • When requested by patients • When legal prescriptions are inappropriate for medical reasons. • 3. Presence of dispensing doctors: in Japan, the notion that medecal sciences • cure diseases with medecines and that diagnosis and dispensing are • the right of physicians has been wide spread, in particular among doctors in • Chinese medicine. Tomoni Ojima and all., Japanese Pharmaceutical Assocation

8. Pharmacists and Physicians in the Value Chain What is the best medical system? To this question we may not have only one correct answer. Almost all the countries in the world, however, have selected the medical and pharmacy separation system as their basic medical care system. Korea also has been operating the separation system since July 2000 in accordance with this world-wide tendency. Now that the traditional medical care practice in Korea so far has been too much different from the separation system in many aspects, however, we have experienced lots of difficulties and conflicts after implementation of the system. ……. Dr. Soo Ja Nam, pharmacist, Executive Director of the Korean Pharmacist Assocation and Vice-President of FAPA.

9. Pharmacists and Physicians in the Value Chain Up to now after the separation of the system, it is true that all Korean people have had a real hard time to be accustomed to this new system. Within a year, 2 ministers and 7 high ranked government officials had to leave their places, the financial status of the medical insurance system was drastically jeopardized and the medical insurance premium has been sharply raised….. A lot of reform has to be done in the future but we, all the pharmacists in Korea, will overcome all the difficulties at the moment with patience and self confidence that we will have the new role and the new professionnal fonction in the future under the separated system. Dr Soo-Ja Nam, chairman of international affairs committee of the Korean Pharmaceutical Association

10. Pharmacists and Physicians in the Value Chain • It will be necessary: • To enforce regulation strictly on pharmacist licensing. • To promote pharmacist’s continuing education, • with a conditional renewal of the pharmacist license every four years. • III. To encourage physicians to prescribe and release refilled • prescriptions for chronic disease patients. • IV. To set reasonable dispensing volumes in medical center. • V.To strengthen the education of drug knowledge to the public. • VI. To improve the interactions among physicians, pharmacists and • patients Prof. Oliver Yao-Pu Hu, Ph. D., Director General, Bureau of Pharmaceutical Affairs, Department Of Health, Taiwan.

11. Pharmacists and Physicians in the Value Chain 1000 750 NUMBER AND VARIOUS REACTIONS OF PERSONS SUFFERING SOME HEALTH PROBLEM IN THE CURRENT MONTH 250 5 1 New Engl J Med 265, 885-892, 1961 Diapositive 4 Dr Michel BUCHMANN, FIP vice-president, september 2001

12. Pharmacists and Physicians in the Value Chain COUNSELLING OTC PRESCRIPTION PHARMACISTS SCREENING HEALTH PROMOTION Referring PHYSICIANS DIAGNOSIS TREATMENT VALIDATION MEDICAL CARE + PHARMACEUTICAL CARE Diapositive 5 Dr Michel BUCHMANN, FIP vice-president, september 2001

13. Pharmacists and Physicians in the Value Chain There is evidence that there are gaps between what exists and what people expect in the quality and access to health care. Pharmacists have the opportunity to close these gaps either by acting independently or in collaboration with physicians. Pharmacists can act independently by serving as an easy access point to health care. Pharmacists can work collaboratively with physicians by establishing a pharmacy and therapeutics committee to develop drug therapy policies designed to improve medication treatment. Systems that have been shown to improve medication treatment include the formulary system, clinical practice guidelines, medication use evaluation programs, physician authorized pharmacist actions and computer order prescription order entry systems. It is likely that a collaborative, team approach will be needed to achieve the best value from drug treatment by ensuring the effectiveness and safety of medication use at the most reasonable cost. Prof. Dr. Phil. Schneider, College of Pharmacy, The Ohio State University; Secretary of the Hospital Pharmacy Section of FIP

14. Pharmacists and Physicians in the Value Chain COUNSELLING OTC PRESCRIPTION PHARMACISTS SCREENING HEALTH PROMOTION Referring PHYSICIANS DIAGNOSIS TREATMENT VALIDATION MEDICAL CARE + PHARMACEUTICAL CARE Diapositive 6 Dr Michel BUCHMANN, FIP vice-president, september 2001

15. Pharmacists and Physicians in the Value Chain OTC PRESCRIPTION SCREENING PHARMACISTS REFERRING HEALTH PROMOTION PHYSICIANS DIAGNOSIS TREATMENT VALIDATION MEDICAL CARE + PHARMACEUTICAL CARE Dr Michel BUCHMANN, FIP vice-president, september 2001 Diapositive 7

16. Pharmacists and Physicians in the Value Chain What pharmacists know and understand are medicines and this is the area in which they are most usefully and profitably engaged. In future, therefore, they must become increasingly engaged from the selection of specific products, working in conjunction with prescribing doctors, through the safe and effective use of these medicines by patients. These are areas of medicines where there is much to be done: prescribing is still largely irrational and patients are still very confused. What we need are pharmacists who focus their energies and skills to solve these problems and thereby make a major contribution to heath. Dr Philip J. Brown, executive chairman, PJB Publications, 25 august 1998. Diapositive 8 Dr Michel BUCHMANN, FIP vice-president, september 2001