Pharmaceutical care

Report
„International Research Project
on Financing
Quality in Health Care”
InterQuality
WP3
WP3 objectives
• The objective of WP3 is to validate pharmaceutical benefit financing
(pricing and reimbursement) models, used in:
– Tax or social health insurance systems,
– Private or mixed health insurance systems.
• Specific objectives are:
– In the case of both systems, financing models effect on medicines
distribution costs, quality of pharmaceutical care, utilization of
resources, cost-efficiency and equity of access will be explored and
addressed taking into account the needs of different patient groups
– On the basis of comparative analysis of existing financing models,
recommended pharmaceutical benefit financing model will be proposed.
WP3 Tasks description
Task 3.1. Comparative analysis of
pharmaceutical benefit financing models
Task 3.2. Financing access to medicines
Task 3.3. Drug distribution financing
models
Task 3.4. Pharmaceutical Care
Task 3.5. Development of recommended
model of Pharmaceutical Care
Task 3.1. Comparative analysis of
pharmaceutical benefit financing models
Based on results of a literature review (WP2) key
quality dimensions in pricing & reimbursement
financing model will be defined
QUALITY
EQUITY
x%
EFFECTIVENESS
x%
Task 3.1. Comparative analysis of
pharmaceutical benefit financing models
• Perform a literature research to define quality
dimensions in tax and social or private insurance
jurisdictions
– How do we measure effectiveness?
• QALY, LYG, DALY, primary vs. secondary endpoints
– How do we measure equity?
• Kakwani index, Fairness in Financial Contribution,
catastrophic healthcare payments etc.
– How do we find equity- efficiency trade off?
• Social welfare function, fairness weights, a rank-dependent
QALY model
Input from collaborative partners: detailed characteristics of equity principle
perceived by NICE (UK), IQWIG (Ger), AHTAPol (PL), US, others (?)
Task 3.1. Comparative analysis of
pharmaceutical benefit financing models
• Conduct a survey to elicit views/attitudes of general
public towards equity-efficiency trade-off in pricing and
reimbursement decision making in tax and social or
private insurance jurisdictions
– How the role of equity principle is perceived in P&R decision
making process by general public?
– How the role of principle of maximalization of health outcomesis
perceived in P&R decision making process by general public?
– How general public reacts to equity-efficiency trade offs
challenges?
Task 3.2. Financing access to medicines
Based on a literature review (WP2) a preliminary checklist for assessment of financing
access models from a quality perspective will be developed (also including
prescription patterns, referral systems, treatment guidelines, co-pay threshold vs.
purchasing power, social coverage, end life therapies, rare and ultra- rare
diseases and others)
QUALITY
Private
$
x%
Public
$
x%
Task 3.2. Financing access to medicines
1.
Define the role of public and private expenditures in tax and social
or private insurance jurisdictions
•
payment models restricting moral hazard (DK)
•
pharmaceutical pricing regulating schemes (PPRS)
•
value-based pricing (based on UK experiences)
•
risk-sharing agreements (mainly based on US input)
•
comparative effectiveness (US)
•
HTA
•
BIA (Ger)
Input from collaborative partners: a retrospective database study on the
impact of different financing schemes on quality of healthcare
Task 3.3. Pharmaceutical distribution
financing models
1.
Consortium partners (all) will be asked to execute, in the
framework of collaborative work, systematic reviews of
publications, regarding cost effectiveness of pharmaceutical
distribution models
The objective is to compare various models of drug distribution,
including their impact on: availability of drugs, prices, patient
compliance and access to pharmaceutical care
Knowledge gained from research should provide answers to
important questions, ie.:
2.
3.
1.
2.
3.
4.
What are the costs and benefits of direct deliveries?
What are the risks and advantages of internet trade in pharmaceuticals?
Identification of independent experts , who could answer questionnaires in two or more rounds to be
executed according to Delphi method , in the second phase of research
Special attention will be paid to comparative analysis of
effectiveness of different distribution cost control models: PPRS,
government regulated vs. negotiated mark-ups, monitoring and
regulation of trade rebates, granted to wholesalers and
pharmacists, etc.
Task 3.4. Pharmaceutical Care
1.
The survey study on the pharmaceutical care financing models in EU and
US
(budget spendings on pharmaceutical care, quality assurance required, services
granted, pharmacists preparing)
2.
The literature review of pharmaceutical care effectiveness of
pharmaceutical care in EU and US
The objective is to provide the comparison of financing models and to
assess expected effectiveness of pharmaceutical care.
The knowledge gained from the research should provide answer to
important questions, ie.:
3.
4.
1.
2.
Is the effectiveness of pharmaceutical care connected to the financing model
Which pharmaceutical sevices grants the best health care performance
Input from collaborative partners: The survey study on the pharmaceutical
care financing and functioning models is recommended
Task 3.4. Pharmaceutical Care
Definition of pharmaceutical care
•
•
•
Pharmaceutical care is the responsible provision of drug therapy for the
purpose of achieving definite outcomes that improve a patient's quality of
life . These outcomes are:
–
–
–
–
cure of a disease;
elimination or reduction of a patient's symptomatology;
arresting or slowing of a disease process; or
preventing a disease or symptomatology.
Pharmaceutical care involves the process through which a pharmacist
cooperates with a patient and other professionals in designing,
implementing, and monitoring a therapeutic plan that will produce specific
therapeutic outcomes for the patient. This in turn involves three major
functions:
– identifying potential and actual drug-related problems;
– resolving actual drug-related problems; and
– preventing drug-related problems
Pharmaceutical care is a necessary element of health care and should be
integrated with other elements. Pharmaceutical care is, however, provided
for the direct benefit of the patient, and the pharmacist is responsible
directly to the patient for the quality of that care
Reference: Helper, D.D. & Strand, L.M., Opportunities and Responsibilities in Pharmaceutical Care,
Am.J. Pharm.Educ., 53, 7S-15S(1989)
Pharmaceutical care - recommendations
from the Council of Europe / EDQM
•
•
•
•
•
•
•
•
•
•
•
A better public understanding of pharmaceutical care definition
Added value of pharmaceutical care should be clearly demonstrated
Cooperation structures are needed to support the multidisciplinary character of
pharmaceutical care activities (e.g. information sharing)
A list of indicators should be developed (on areas already covered by indicators and
on others not yet covered) and on outcomes
Consideration should be given to supplementing existing medical coding standards
with extensions for pharmaceutical care.
Harmonisation of underlying data collection methods is essential to have quality
indicators comparable between countries.
Patient participation and commitment must be improved (with possibly an indicator
to measure it)
Medication-related health literacy should be promoted within the general public
National healthcare authorities could provide a legal basis for removing the various
barriers to the implementation of pharmaceutical care
Involvement of different stakeholders in the implementation of pharmaceutical care
Healthcare systems need to take account of pharmaceutical care as a working
methods for the promotion of the safety and quality of medication use
Reference: Pharmaceutical Care: Where do we stand – where should we go? EDQM, 2009 (Pharmaceutical
Care Summary of a survey from the Council of Europe)
Pharmaceutical care- a practical example of
diabetes
• Rational
–
–
–
–
–
–
–
–
T1DM and T2DM are complicated chronic conditions that place multiple demands on patients
as well as on healthcare providers
diabetic population is diverse in terms of age, gender, ethnic origins and socioeconomic status
variety of pharmaceutical products are used to manage diabetes by healthcare providers and
patients
necessity of using more than one kind of insulin and adjusting insulin dosages in between
appointments with physicians
complications and co-morbidities may involve additional pharmaceutical treatments
self-monitoring blood glucose levels and obtaining glucometers and the supplies (‘strips’) from
pharmacies
people with diabetes tend to see pharmacists more frequently than physicians or other
healthcare professionals
disseminating in pharmacies information about T2DM that could aid in primary prevention
• Evidence of pharmaceutical care effectiveness
–
–
overall improvement in HbA1C (1)
multifaceted professional interventions can enhance the performance of health professionals in
managing patients with diabetes. The addition of patient-oriented interventions can lead to
improved patient health outcomes. interventions that improve regular prompted recall and
review of patients (central computerised tracking systems or nurses who regularly contact the
patient) can improve diabetes management. (2)
1.
Wubben DP, Vivian EM. Effects of pharmacist outpatient interventions on adults with diabetes mellitus: a systematic
review. Pharmacotherapy. 2008 Apr;28(4):421-36
2.
Renders CM, Valk GD, Griffin S, Wagner EH, Eijk JT, Assendelft WJ. Interventions to improve the management of
diabetes mellitus in primary care, outpatient and community settings. Cochrane Database Syst Rev.
2001;(1):CD001481
Task 3.5. Development of recommended
model of Pharmaceutical Care
1.
2.
3.
Which pharmaceutical services are essential to
guarantee the best performance of pharmaceutical
care in health care system?
Fee for service or pay for performance? What is the
most profitable financing model of pharmaceutical
care?
What is the optimal balance between pharmacists
training and authorities supervision to assure the best
quality of pharmaceutical care?
Task 3.5. Development of recommended
model of Pharmaceutical Care
1.
2.
3.
Is QALY the best measure of quality of healthcare in
tax, social and private insurance pricing and
reimbursement models ?
Are there any needs for equity weights to be
introduced in QALY?
What is the optimal balance between private vs. public
expenditure in tax, social and private insurance pricing
financing access models?
Task 3.5. Development of recommended
model of Pharmaceutical Care
1.
2.
3.
4.
Does the distribution model impact access to
medicines?
Does the direct distribution improves compliance or
leads to decreased prices of medicines?
Does the introduction of direct distribution limits the
parallel import?
Does the introduction of direct distribution reduces
pharmaceutical companies expenditures?
Task 3.5. Development of recommended
model of Pharmaceutical Care
- assumptions
• Online adjudication of pharmacy claims
• Electronic health record (EHR)
– dispersed databases (Denmark)
– centralized databases (US – PBM, PDP)

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