6th PCNE Working Symposium 2018, Fuengirola, Spain
Seamless Pharmaceutical Care - Supporting the Pharmacists' contribution to seamless transitions between care setttings
2-3 February 2018
This PCNE Working Symposium was in Andalusia, the south of Spain. It is here where Don Quixote, the Ingenious Knight of La Mancha, was supposed to be engendered by Cervantes’s experience in prison. From time to time we might have a similar feeling of ‘fighting the windmills’, but hopefully, the science and evidence based approaches will keep us sane. The Symposium in Fuengirola has enabled us to see reality more clearly and we developped a more fruitful narrative than the one of Don Quixote.
The topic of the symposium was seamless pharmaceutical care, supporting the worldwide trend in healthcare reform towards an integrated, coordinated and streamlined approach.
Seamless care describes an optimal situation where there is continuity in healthcare provision, even in the presence of many transitions. Pharmacists typically refer to the transition of patients from hospital to the ambulatory setting or vice versa, i.e. linking different levels of care (primary, secondary and tertiary). Integration of care can also, however, be seen at the horizontal level, involving multiprofessional collaboration within a single setting. There was much to explore within the seamless care framework.
Mitja Kos (PCNE Chairman) and Nejc Horvat (PCNE Secretary)
University of Ljubljana, Faculty of pharmacy, Slovenia
The final program can be downloaded here
Workshop reports are available under the tab 'Workshops'
The Oral communication award (made available by the Förderinitiative Pharmazeutische Betreuung) during this symposium was awarded to Lise-Marie Kinnaer from Leuven University, Belgium.
The shared poster award (made available by the Consejo General de Colegios Oficiales de Farmacéuticos de España) was won by the Grupo de Investigación en Atención Farmacéutica. Cátedra María José Faus Dáder de Atención Farmacéutica (GIAF-CUGRAF), Universidad de Granada with their poster 'conSIGUE Impact and Implementation: experience, different phases, and results'. And by SEFAC, Madrid with the title: 'Determination of irregular pulse in Spanish community pharmacy, as screening for atrial fibrillation. Project Know your pulse.'.
EXTRA SYMPOSIUM
Pharmaceutical care thrives best when it is provided as a remunerated service. In some European countries, this is already the case. Therefore, the day before the PCNE conference, SEFAC and PCNE organised a 2 hour symposium, with the title
Overcoming barriers when implementing new pharmacy services
The symposium aimed to provide participants with the background knowledge and tools that are needed to successfully plan the implementation of new services in community pharmacy.
The symposium started with an overview of successful cases of cognitive pharmaceutical services implementation in some countries. Then one selected service and country was chosen as an example to introduce some management and planning tools that participants used throughout the workshop. Subgroups were created for the practical part of the workshop.
This conference was organised with support from SEFAC (Sociedad Española de Farmacia Familiar y Comunitaria) and other Spanish PCNE members:
- Consejo General de Colegios Oficiales de Farmacéuticos de España, Madrid
- Pharmaceutical Care Foundation España, Barcelona
- Universidad de Granada, Facultad de Farmacia, Research group Pharmaceutical Care, Granada
- Universidad de Barcelona, Clinical Pharmacy and Pharmacotherapy Unit, Barcelona
More sponsors are:
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Bidafarma was a Golden Sponsor, and we thank that organisation for the generous contribution.
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Pharmacist role in seamless care in community pharmacy. Dr. Rik Ensing, the Netherlands Abstract Information on medication changes during hospitalization is often poorly documented and poorly transferred to the next health care provider at the time of hospital discharge. Furthermore, these changes are frequently unaccompanied by adequate patient counselling which leaves patients confused, vulnerable and at risk of drug-related problems (DRPs) post-discharge. The impact of discontinuity of pharmaceutical care at time of hospital discharge can be serious, as DRPs may result in an array of adverse outcomes ranging from patients’ discomfort or dissatisfaction to increased health care utilisation or readmission. This poses challenges for the community pharmacist, who is responsible for the pharmaceutical care at home. It also affects patients since they abruptly need to resume their self-management post-discharge to familiarise themselves with changes in their medication regimen. Post-discharge follow-up is therefore crucial in establishing continuity of care (Figure 1) and should be part of the medication reconciliation and review process. This follow-up can be conducted over the telephone or at the patients’ home, for instance. During this lecture Dr. Ensing will consider the transfer from patients back to the community, the completeness of the necessary information at different time points and the challenges with implementing a post-discharge follow-up home visit in everyday community pharmacy.
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Pharmacist role in seamless care in the hospital. Dr. Markus Lampert, Switzerland Abstract The body of evidence has been growing over the last few years showing that pharmaceutical activities initiated in hospitals are effective in reducing drug-related problems at discharge but also rehospitalisation due to poor drug therapy management after discharge. In parallel also the awareness in the hospitals increases that transitions of care, in particular hospital discharge, are critical steps in a patient’s journey and that there is a responsibility for the hospitals to improve this process. Reimbursement systems with penalties for too early readmissions may trigger such developments. Different models how to support discharge from a pharmaceutical perspective have been proposed and implemented ranging from pure cognitive services to services with drug dispensing at discharge. A critical overview of these models will be given. But also hospital admission represents a challenge. To get the “best possible medication history” is still a difficult but crucial task. Without the proper medication list at admission it is hardly possible to establish a correct and comprehensive drug therapy plan or even a pharmaceutical care plan at discharge. Medication reconciliation (MedRec) is mandatory in some European countries but not in all. Barriers and facilitators to implement MedRec will be discussed. The lecture will also focus on how hospital and ambulatory pharmaceutical care can be linked to reach really seamless care. We will propose the MOSAIC framework for research and practice in this topic (Medicines Management Optimisation by Structured Assessment in Integrated Care). We will show and discuss the tools for risk stratification of patients and for seamless documentation of pharmaceutical interventions which were elaborated within this framework. |
This symposium has two times four workshops, each lasting 4 hours. The second set of workshops (on Saturday) will build on what the previous group has done.
The aim of the workshops is:
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WS1 |
Medication review after discharge Facilitators: Jacqueline Hugtenburg - Rik Ensing The most implemented service is currently the medication review, including reconciliation, at the transfer between care settings; in this case typically at hospital admission and discharge. What needs to be done in what order? What is the aim of this review? What is the role of other health care professionals besides the pharmacist, such as doctors and nurses? |
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WS2 |
Using the PCNE DRP-classification at transitions between care settings Facilitators: Nejc Horvat - Foppe van Mil With additional support from Dr. Markus Lampert and Dr. Tommy Westerlund In the transition of patients between care settings (home-hospital-nursing home etc.), much information tends to gets lost. This often results in problems with the medications. Can the PCNE-DRP classification be used in these situations? Does it offer coding options for all types of problems that may occur, or are essential DRPs and their causes missing for these situations? |
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WS3 |
Guidelines and indicatiors for seamless care Facilitators: Martina Teichert - Mitja Kos Risky processes such as transitions of vulnerable patients from one healthcare setting to another need clear structures en processes to provide optimal care in an efficient way. To this guidelines are needed with recommendations for the optimal organisation of hospital discharge and transition into primary care. Together with these guidelines indicators should be developed that monitor and stimulate the implemenation of guideline recommendations into daily practice. This workshop focusses on relevant structures and processes within seamless care, defined by the workshop participants. Together we will identify meaningful aspects and translate these into indicators that are valid, reliable, mesurable and sensitive for improvements. This basic set of structures and processes with indicators can help the participants to develop guidelines within their own settings. |
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WS 4 |
Core outcome Set (COS) usable at hospital discharge Facilitators: Veerle Foulon - Charlotte Rossing There are many activities under development that that aim to optimize continuity of the management of medication at patient discharge from hospital. Interventions at discharge of a patient from hospital to home are ultimately meant to improve the quality of life of a patient, decrease readmissions and the financial burden on the health care system. But, what other outcomes of interventions at hospital discharge are important? Is it possible to define a Core Outcome Set, that will help to measure the impact of interventions at hospital discharge on the patient and his or her environment? |
A paper (PDF for print) version can be downloaded here
The preliminary program looks as follows:
Program Thursday 1 February 2018 |
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17.00-19.00h |
SEFAC-PCNE symposium (extra registration fee) Remunerated pharmacy services in Europe Organisation: Dr. Filipa Alves da Costa, Dr. Lola Murillo |
Program Friday 2 February 2018 |
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8.00-10.00 |
Registration |
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10.00-10.15 |
Opening |
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10.15-10.45 |
Plenary lecture: Pharmacist role in seamless care in community pharmacy. Dr. Rik Ensing, the Netherlands. See tab 'Lectures' for the abstract. |
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10.45-11.15 |
Plenary lecture: Pharmacist role in seamless care in the hospital. Dr. Markus Lampert, Switzerland. See tab 'Lectures for the abstract. |
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11.15-11.30 |
Coffee break |
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11.30-13.00 |
Oral communications (Chair Dr. Ana Molinero) |
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13.00-15.00 |
Lunch & posters (and PCNE Soapbox only for PCNE members) |
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15.00-19.00 |
Workshops series 1-4 WS1: Medication review after hospital discharge WS2: Use of PCNE DRP-classification at transition WS3: Guidelines and indicators for seamless care WS4: Core outcome Set (COS) usable at discharge |
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19.00-19.30 |
Break |
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19.30-23.00 |
PCNE Social event (dinner and flamenco show at a Caseta de Feria) (Separate registration) |
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Program Saturday 3 February 2018 |
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9.00-13.00 |
Workshops series 1-4 (repeated) WS1: Medication review after hospital discharge WS2: Use of PCNE DRP-classification at transition WS3: Guidelines and indicators for seamless care WS4: Core outcome Set (COS) usable at discharge |
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13.00-13.30 |
Presentation of Workshop results and discussion. Program ends for non PCNE members |
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13.30-15.00 |
Possibility for Lunch |
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14.30-17.30 |
PCNE General Assembly (members only) |
Following abstracts are accepted for an oral communication (Friday 2nd February 11.00-12.30h)
| Validation of a Patient-Filled Stratification Tool on Risks for Drug-Related Problems: Five Items Differentiate Between High and Low Risk | Dominik Stämpfli | Pharmaceutical Care Research Group, University of Basel, Switzerland | ||
| Predictive modeling in pharmacy practice, application on hospital readmissions and drug-related problems | Ghaith M Al-Taani | Faculty of Pharmacy, Yarmouk University, Irbid-Jordan | ||
| Concilia Medicamentos pilot study: analysis of discrepancies | Amaro Cendon, Luis | General Pharmaceutical Council of Spain | ||
| Validation of a measure and development of a model of general practitioner frequency of and attitudes towards collaboration with community pharmacists in Germany | Anna Dähne | Clinical Pharmacy, Institute of Pharmacy, Ernst-Moritz-Arndt-University Greifswald, Germany | ||
| Seamless care for patients treated with oral anticancer drugs | Lise-Marie Kinnaer | KU Leuven | ||
| A meta-analysis of pharmaceutical care components for diabetes patients provided by community pharmacists | Maira Deters | Heinrich-Heine-Universität Düsseldorf, Germany |
List of accepted abstracts (click on the title to see the abstract)
Speakers and Chairs
Dr. Rik Ensing, the Netherlands
Rik Ensing was born in 1982 in Emmen, the Netherlands. He started studying pharmacy at the Rijksuniversiteit Groningen in 2000. During his master, he performed his pharmacy research internship at Apotheek Stevenshof, Leiden. In 2007, he obtained his Master of Science in Pharmacy, with distinction. After his graduation, he started his post-academic educational program to become a specialist in community pharmacy at Apotheek Nieuw Sloten, Amsterdam, which he completed in 2009. As from 2009 he combined his work in the pharmacy with a position in the SIG Product Care and Compounding of the Royal Dutch Pharmaceutical Society (KNMP) and as an editorial writer for Pharma Selecta, a Dutch drug bulletin. During a short period as interim pharmacist he became interested in outpatient pharmacy and in 2010 he started in his recent position as an outpatient pharmacist at De Brug Pharmacy in Almere. In 2011, he finished a master class in Pharmacy Practice Research with fellow outpatient pharmacists at the SIR Institute for Pharmacy Practice and Policy, Leiden.
In his work as an outpatient pharmacist he frequently encountered patients who experienced difficulties with their medication at hospital discharge. Moreover, due to his affiliation with the community pharmacists and general practitioners of Zorggroep Almere he was well-aware of their problems with continuity of care. This motivated him to initiate his thesis in 2012 (alongside his work in the pharmacy) with the main objective: 'Readmission to primary care, the role of community pharmacists post-discharge'. As part of his PhD training he followed courses on epidemiology organised by EpidM, VuMC and presented results of his thesis at both national and international conferences, e.g. PRISMA, European Society of Clinical Pharmacy (ESCP) and Pharmaceutical Care Network Europe (PCNE).
After completing his PhD in 2017, he continues to combine his work as a pharmacist with pharmacy practice research focusing on improving pharmaceutical care for his patients.
Dr. Marcus Lampert, Switzerland
Markus Lampert studied pharmacy at the University of Basel graduating in 1992 (federal diploma) and 1997 (PhD). He specialized in hospital and clinical pharmacy and is a recognized teacher in clinical pharmacy by the Swiss Federation of Pharmacy (FPH). Since 2016 he is head of clinical pharmacy in the Solothurner Spitaeler where he has successfully introduced new services. He is a honorary senior research associate of the Pharmaceutical Care Research Group at University of Basel, and a lecturer for clinical pharmacy. He shares his expertise in working committees of the Swiss Society of Health Administration and Hospital Pharmacists (GSASA) e.g. the Quality and Safety Cmmittee and in experts panels of the Swiss Patient Safety Foundation. He was president of the European Society for Clinical Pharmacy from 2014-16.
In his research he focuses particularly on the optimisation of clinical pharmacy services: sreening of patients to asssess their risk to develop drug-related problems, documentation and classification of pharmaceutical interventions and their impact, development and evaluation of tools and services to facilitate continuity of pharmaceutical care at transitions.
Dr. Ana Molinero
Ana is a Community Pharmacist in Fuenlabrada (Madrid), and Associate Lecturer for Pharmaceutical Practice at Alcalá de Henares University. She is currently vice-president of SEFAC (Spanish Society of Family and Community Pharmacy) and is responsible for overseeing the society’s scientific research projects.
Ana first specialized in Clinical Analysis and earned her PhD from Complutense University (Madrid) in 1987; she has since completed three Masters in Community Pharmacy Management, Smoking Cessation and in Strategic Management and Organization of Medical Scientific Societies. Ana’s research interests centre on patient care. Over the past 15 years she has undertaken projects on medication reconciliation, medicine use review and counselling, pharmaceutical services implementation, Alzheimer disease, blood pressure in adolescents and antibiotics, among others.
Workshop facilitators
Dr. Charlotte Rossing, Denmark
Dr. Foppe van Mil, the Netherlands
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Foppe van Mil (16 July 1950) was registered community pharmacist from 1978 till 2000 in a rural area of the Netherlands. Since 2000 he is pharmacy consultant on PPR and Pharmaceutical Care. In January 2000 he concluded his PhD at the working group Social Pharmacy and Pharmacoepidemiology of the University Centre of Pharmacy in Groningen on the concept of Pharmaceutical Care. In 1985 he founded Pharma Selecta, an independent and critical Dutch drug bulletin. Between 1994 and 2002 he was member of the Committee for continuing professional education of the section Community Pharmacy of FIP. Between 1996 and 1999 he was Chairman of the Pharmaceutical Care Network Europe (PCNE), and currently he is the professional secretary of that association. He also (co-)organises the conferences for PCNE. Since 2000 he is Editor-in-Chief of the International Journal for Clinical Pharmacy. He currently teaches medication review, community pharmacy practice, and the writing of scientific papers and abstracts in several national and international continuing education programs and conferences. Since 2012 he is a fellow of the ESCP and since 2017 he is a honorary member of PCNE. |
Dr. Jacqueline Hugtenburg, the Netherlands
Dr. Martina Teichert, the Netherlands
Prof. Mitja Kos, Slovenia
Dr. Nejc Horvat, Slovenia
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Nejc Horvat graduated in 2007 with theme titled: “Development of a questionnaire measuring patient satisfaction with pharmacy services”. In 2014, he defended his doctoral thesis titled: “Evaluation of pharmacy services from the patient and expert perspective”. Currently, he is a member of the Chair of Social Pharmacy at University of Ljubljana, Faculty of Pharmacy, Slovenia. He is also a board member of the PCNE from 2014 onwards. His research focus is primarily the outcomes research particularly evaluation of pharmacy services, drug related problems and medication literacy. |
Dr. Tommy Westerlund
Prof. Dr. Veerle Foulon, Belgium
Prof. Foulon is vice-dean of the Faculty of Pharmaceutical Sciences of the KU Leuven, and board member of Pharmaceutical Care Network Europe (PCNE). Prof. Foulon teaches communication skills, pharmacotherapy and self-medication, and coordinates different internship programs at the Leuven University. She is also promotor of master theses in Pharmaceutical Care, and is involved in postgraduate training.
The research of Veerle Foulon (°1974; PharmD 1997; PhD 2001) mainly focuses on the role of the pharmacist in the rational use of drugs in the ambulatory setting (pharmaceutical care). This includes studies on the impact of collaborative practice and of (electronic) tools on patient safety and continuity in medication management.
The day before the official PCNE Working Symposium, a small Pre-Symposium was held, organised by PCNE and SEFAC. You can find the lectures below.
Overcoming barriers when implementing new pharmacy services
Implementation of advanced pharmaceutical services in Europe. Dr. Filipa Alves da Costa, Portugal
Implementation of a new pharmacy care service. Dr. Foppe van Mil, the Netherlands
Picturebook
