Creation of a new function in healthcare: home pharmacist 

Belgian pharmacists signed a multiannual framwork with the Minister of Health and Social Affairs. Key element is the introduction of the new function of Home Pharmaicst, parrelel with the GP who is responsible for the Global Medical Dossier (GMD) the function. In the very next futur (2017, 2018, ...) chronic patients will chose their home pharmacist. As a part of personalized care the home pharmacist will help these vulnerable patients to follow properly the prescribed treatment, to maximize health benefit, especially by providing up to date medication schedules  make patients understand their tratment and follow up drug related problems. 

Medication review

Medication review - the evaluation of a patient‘s medicines with the aim of optimizing the outcomes of medicine therapy. This entails identifying the risks, detecting medication-related problems and suggesting solutions – is also in Belgium a hot topic. Like in many countries the Belgian pharmacist does not dispose the clinical lab data. So, the main focus is a intermediate medication review type 2. A specific tool to perform such a medication review was developed, the GheOP³s-tool.  At this moment this is probably the most comprehensive and feasible tool to perform medication review for older polymedication patients in Belgian pharmacy. Other tools are in development.  In the meanwhile roll out of medication review with the GheOP³s-tool has started.

Bottom-up for projects  integrated chronic care to face new challenges for society 

2016: the different ministers for healthcare and social security together with the health insurance invited all health care providers and social workers all over the country to think about new game changing projects to face the reality of a growing proportion elder people. This is one step in the common plan for chronically ill 'Integrated care for better health' from the different regions all together. By 31/5/2016 projects ideas concerning integrated chronic care and projects consortia have to be submitted. By September 2016 the selected projects can start for at least 4 year period. Purpose is to change the game: within the same budget, provide better chronic care on a multidisciplinary basis. Non-effective and non-efficient care has to be replaced by effective and efficient care. Seamless care has to be included. This is building healthcare and social security bottom up. There is great enthusiasm and project-ideas and consortia are growing all over the country as fast as mushrooms. Pharmacists are involved in nearly each growing consortium and these mean a great opportunity to anchor pharmaceutical care better in primary care.

http://www.inami.fgov.be/fr/professionnels/information-tous/Pages/soins-integres.aspx#.Vw_N-f1ulPA

Flanders: not only changing game for chronic care, but also restructuring primary care organization

In the northern part of Belgium not only solutions for chronic care are searched, but the authorities are also occupied with restructuring the whole primary care. This happens in concertation with the field. This also is important for the future of pharmaceutical care in Belgium. The way pharmaceutical care will be anchored in the system predicts the future chance to achieve high performance. Now already it is common ground that collaboration with general practioners and nurses will be very important.

Seamless care

For many years a lot of effort has been spent to establish good communication between the community pharmacy and the hospital, focussed on seamless care. Results were poor: in the community pharmacy no information about discharge medication is received, the general practioner receives the information often too late, in hospital the dischargesystem is to complex to guarantee that the complete medication information at discharge is given not only to the patient but also to the primary healthcare providers.

A new evolution has started: rather than focussing on the moment of discharge, communication between community pharmacists and (clinical) hospital pharmacists gives new opportunities. Different pilots are performed: from networking projects over concertation projects. Results are coming slowly. It is expected that once the shared medication overview (see below) will also be used in hospital, this will go better. Anyway, we can now already conclude that directly communicating form community pharmacist to hospital pharmacist (instead of only with front end workers like nurses and doctors), was a big step forward.   

Health promotion and disease prevention

The Flemish minister of Health has written in his policy letter that the role of the pharmacist in health promotion, disease prevention and early detection should be clarified and that pharmacists should be more involved. The profession has taken up this invitation and  works on different topics like diabetes, colorectal cancer, dementia, nutrition and exercise, cardiovascular risk management, ... To be continued.

Concertation pharmacists/general practitioners

2015: Concertation meetings between groups of local general practitioners and pharmacists are finally – after many years - recognized by the government and health authorities. There is already a lot of experience in pharmacists/general practitioners concertation meetings all over the country. From now on these are funded if 1) subject of these meetings is better collaboration between general practitioners and pharmacists or better medication use and 2) accredited packages are used. The level to get a package accredited is rather high.

http://www.inami.fgov.be/fr/themes/qualite-soins/medicaments/concertation-medico-pharmaceutique/Pages/default.aspx#.Vw_K5P1ulPA

http://www.inami.fgov.be/nl/themas/zorgkwaliteit/geneesmiddelen/medisch-farmaceutisch-overleg/Paginas/default.aspx#.Vw_OL_1ulPA

Sharing patient records between pharmacies 

Since final 2013 sharing patient’s dispensing records between pharmacies is possible on condition that patients have given their informed consent to share information. On February 15^th 2015 2580 pharmacies of 4950 use the possibility of sharing patient records on a daily basis. 4,8 million patients of 11,2 million inhabitants are uploaded. All in the patient record registered delivered drugs are visible. Problem is that still not all OTC-products are recorded. The pharmacist can read what is delivered in another pharmacy, without being able to see in which other pharmacy. Freedom of choice of the patient is in Belgium a very important value. Patients are free to chose a pharmacist at any moment. In these context the shared pharmaceutical dossier means a real added value, e.g. to manage interactions.

Sharing patient’s medication overview with other healthcare providers

Specific in Flanders a lot of effort is spent to multidisciplinary sharing of the medication review. Different access rights were determined: the general practitioner and the pharmacist are allowed to read and write, nurses are only allowed to read and also the patient can consult his medication overview on line. Roll out has started but a lot of technical bugs still have to be resolved.

Shared medication overview is one project of Vitalink, a Flemish project on a virtual primary care safe to share safely medication overview, vaccination data, … and a lot of future items. Informed consent by the patient is needed.

http://www.vitalink.be/VitaIndex.aspx?id=30620&d=zorgverlener

New Medicines Service for asthma patient

In October 2013, a New Medicines Service (NMS) was introduced in community pharmacies in Belgium to support asthma patients who are novice users of inhaler devices with corticosteroids. The protocol of this intervention was based on the results for pragmatic community pharmacy programmes in improving the therapeutic results for asthma (i) and uses the Asthma Control Test (ACT) and the Medication Adherence Report Scale (MARS) to assess asthma control and medication adherence. The NMS is the first initiative that puts advanced pharmaceutical care into practice in Belgium. A fee is provided for this NMS.

The uptake of NMS in Belgian community pharmacies still remains low (ii). Although this individualized service can be organized at the request of the general practitioner (GP), the patient or the pharmacist, the limited involvement of GP's has been identified as one of the obstacles to the successful implementation of this project. Matthé studied the attitudes and opinions of general practitioners and lung specialists about NMS. The opinions of GPs  were mixed and rather critical, while pulmonologists were somewhat more enthusiastic about the initiative. Although all physicians agree that there is room for improvement of the concept, some GPs are willing to prescribe BNM for certain patients (iii).

Special attention for embedding NMS programmes in the Belgian health care organisation  to increase the uptake of this type of service and its possible extension to other patient groups is a specifique point of attention (i). Especially for COPD this NMS and its implementation has been studied (iv) 

References:

(i) E. Mehuys, L. Van Bortel, L. De Bolle, I. Van Tongelen, L. Annemans, J.P. Remon and G. Brusselle Effectiveness of pharmacist intervention for asthma control improvement. EUR. Respir J 2008;31:790-799

(ii) Fraeyman J, Foulon V, Mehuys E, Boussery K, Saevels J, De Vriese C, Dalleur O, Housiaux M, Steurbaut S, Naegels M, De Meyer GR, De Loof H, Van Hal G, Van den Broucke S. Res Social Adm Pharm. 2016 Feb 12. pii: S1551-7411(16)00048-6. doi: 10.1016/j.sapharm.2016.02.001

(iii) Matthé E, Fraeyman J, De Loof H, De Myer G. Attitudes and opinions of general practitioners and lung specialists about a new medicines counselling service for asthma patients in community pharmacies: a qualitative study J Pharm Belg. 2015 Dec;(4):8-17

(iv) Eline Tommelein, Kathleen Tollenaere, Els Mehuys, Koen Boussery. Pharmaceutical care for patients with COPD in Belgium and views on protocol implementation. Int J Clin Pharmacy 2014, 36,4,: 697-701

(v) Eline Tommelein, Els Mehuys, Thierry Van Hees, Lucas Van Bortel, Thierry Christiaens, Inge Van Tongelen, Jean Paul Remon, KoenBoussery, Guy Bruselle. Effectiveness of pharmaceutical care for patients with chronic obstructive pulmonary disease ( PHARMACOP): a randomized controlled trial. Brit J Clin Pharmacol 2014 77(5). p.756-766doi: 10.1111/bcp.12242

Quality assurance in community pharmacy 

By 2012, an integrated QA-system became mandatory for all Belgian pharmacies. There is a legal base for this need :

http://www.fagg-afmps.be/fr/news/news_ar_21_01_2009_pharmaciens.jsp

One of the items is the writing of a quality manual. This can easily be done with an interactive tool that proposes a generic quality manual. Each pharmacist is encouraged to adapt to his pharmacy, and to act following the procedures.

Quality of medicines 

For the last 50 years, Belgian pharmacists are continuously adding extra layers of confidence to the quality of the products they dispense. Historically, the Pharmaceutical Practice Law of 1885 introduced the principle of «NO FAULT responsibility», meaning that the pharmacist has final responsibility for every product (s)he dispenses.

• Independent Quality Control Laboratory, operated by APB in conjunction with the Drug Regulatory Agency of the Ministry of Health :

o Systematic re-analysis of all registered medicines

o Financed by all Belgian pharmacies through a contribution per pack

o In case of non-conformity : centralized recall procedure

• Quality Label for cosmetics, food supplements, plant preparations, medical devices, etc.

• Authentication system at the point of dispensing – using secure technology, using existing mass serialisation to combat counterfeiting of medicines