Table of Content

1. The role of community pharmaciesin integrated careExample: Disease Management Diabetes Mellitus Type II

2. Table of Content • Public disease Diabetes Mellitus Type II • 2) What is Disease Management? • 3) Disease Management Programs for Diabetes patients in Austria • 4) The strenghts of community pharmacies • 5) Current and future role of community pharmacies in disease management programs • 6) Diabetes Scores

3. Public disease Diabetes Mellitus Type II • According to a recent study commissioned by the Austrian Diabetes Society there are about 600.000 people suffering from diabetes in Austria, 420.000 of which are diagnosed1. • This means that 180.000 diabetics are currently unknown and are therefore not treated! • Each year, the number of diabetics increases by about 10,000. • Early detection and structured therapy programs reduce patient discomfort and costs for the healthcare system 1 GfK Austria on behalf of the Austrian Diabetes Initiative (2009): Diabetes in Austria. Study carried out among 4.000 Austrians representative of the whole population.

4. Chronic Disease Management Diabetes The goal of effective diabetes disease management must be to stabilize the disease progression, both to preserve the wellbeing of those affected and to avoid very expensive intramural treatments.Through their position and expertise, pharmacists are able to contribute significantly. Prevention General Practitioner Internist Hospital & Rehab RenalDialysis Diagnosis HealthyDiet, exerciseandsport,awareness, screenings Amputations, blindness, heart attack or bypass, stroke,kidney transplantation A dialysis patient in Austria annually costs, around € 65.000,- There are about 56 Million diagnosed diabetics in Europe. 2030: 70 Mio. Structured care provides proven therapeutic and economic value! Regular transfers by the family doctor as part of structured care is absolutely essential! EXTRAMURAL INTRAMURAL Adviceand Education Screening Recommendation Networking & Communication WHAT PHARMACIESCAN DO?

5. What is Disease Management? • Chronic diseases such as diabetes are among the biggest challenges for the Austrian health system. • Disease Management Programs (DMP) were established worldwide in recent years as a new and patient-centered treatment approach. • The Diabetes Disease Management Program in Austria was established in 2002. OBJECTIVES OF DISEASE MANAGEMENT PROGRAMS • Determination at the national, regional or institutional level. • Reliable collection of information and comprehensive data exchange between all participants. • Adjustment of care to the individual patient needs. • Focusing on risk factors and measures of disease prevention • Promotion of self-help. • Inclusion of a variety of stakeholders, including non-medical professionals, clinicians, the private sector and public service

6. Disease Management Programme Diabetes in Austria In 2007 “Therapie Aktiv“ was launched as the first disease management program in Austria intended to create DMPs for other diseases such as Asthma, COPD and Dementia.Since 2002, Upper Austria has its own programme - "DIALA" - Structured diabetes care in rural areas“, which generally is comparable to “Therapie Aktiv”. Factbox „Therapie Aktiy“ • supported by all major institutions (Ministry etc.) • quality checked training scheme • about 600 participating practitioners • about 20.000 registered diabetics • proven longterm success „Therapie Aktiv“ rolled out Transfer regional program to „Therapie Aktiv“ Negotiations ongoing Negotiations planned DIALA was established on initiative of the Upper-Austrian Government, the OÖGKK (public insurance) and the Upper Austrian Society of General Practitioners.A long-term DIALA-study showed a clear improvement of individual health conditions. Moreover, significant cost-savings (€ 780,--/patient/year) for the Austrian healthcare system could be demonstrated Average improvements/scores of diabetes indicators • Weight: < 1 kg • HbA1c: 6,5% • Blood Glucosis: 7% • Blood pressure systolic: 3,5% • Blood pressure diastolic: 4,2%

7. The strenghts of community pharmacies EASY ACCESS & HIGH CUSTOMER TRAFFIC • Many people ask the pharmacist for advice before they consult a doctor or a hospital, Pharmacists have thousands of patient-contacts every day. • We have: Knowledge about the health of customers • We can: provide support & prevent drug interactions • We give: a better understanding for medical prescriptions. • We support: patients in their individual responsibility HIGH QUALITY CUSTOMER CARE • Pharmacies are the first choice to receive qualified and transparent information on health issues. • Permanent and high quality advice • no appointment needed • Pharmaceutical expertise HIGH CONFIDENTIAL & LOCAL PROVIDER • Many pharmacies are closely interconnected with the local healthcare network of general practitioners, local health facilities and different healthcare providers. This network should be focused in future even more. • Pharmacists are considered one of the most trustful professional group. It is essential to maintain and strengthen this position.

8. Possible roles of community pharmacies in disease management programs • A clearly defined portfolio for pharmacists is essential in order to carry out qualified additional services within a disease management program. • Each pharmacist qualified in diabetology receives special training to ensure high-quality patient care CORE SERVICES BY PHARMACIST OPTIONAL SERVICES • Risk-screening • Measurement of important parameters such as waist-to-hip ratio, BMI, blood pressure, bloodglucose, etc. • Recommendation, recruitment and motivation for preventive measures for each risk factor and provision of individual consulting services (structured integration in routine preventive checkups in the pharmacy). • Health check assignment and communication with responsible doctors. • Continuous documentation of patient information and medication data; development of medication profile; regular chart review • Support patients’ personal responsibility (and thus increasing the compliance) and agree on individual health targets. • Monitoring and surveillance of drug therapy based on evidence-based guidelines • Prevention of unintentional drug interactions in cooperation with the local doctor • Individualized information and trainings (nutrition, smoking cessation, etc.) • Evaluation and performance measurement: evaluation of target parameters with the patient, cooperation with or communication to all health providers involved. • Further development of the programs.

9. Important Diabetes Scores • Belly Circumference • A waist circumference - for women over 80 cm, men over 94cm, is considered as an important factor relating to risk of diabetes • Body Mass Index (BMI) • People with a BMI above 27 have a significantly higher risk of developing diabetes type II. • According to a study, a BMI of 27.2 already increases the risk of diabetes by 100%, a BMI of 29.4 even by 300%!

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