Changes in Pattern of Community Pharmacy Services in the

Changes in Pattern of

Community Pharmacy Services

in the Philippines for

Sustainable Health

FAPA 25th Congress, Kota Kinabalu, Sabah

Malaysia, October 10, 2014

Leonila M. Ocampo, RPh, M.S. President, Asia Pacific Institute for Medication Management, Inc.

Immediate Past President, Philippine Pharmacists Association

Outline of the Presentation

• A Glimpse of the Philippines

• The Philippines Pharmacy Practice (Community)

> Actual vs. Ideal/Expected Practices

• Initiatives to Improve the Services for Sustainability

• Collaboration to Ensure Sustainability of Improved Pharmacy Services

• Future of the Pharmacy Profession in the Philippines

Sustainability

For the purpose of this presentation, it will refer to:

1. Sustaining health of the individual and the community - prevention or avoidance of ADE and optimizing outcomes for better health.

2. Sustaining the viability of the pharmacy operation or business to better or improve the services.

Philippine Demographics

• Total population (2010):

92,337,852

• Pop’ Growth Rate/year: 1.89%

• Dependency Rate: 60.52

• Literacy Rate: 88.9%

• Poor: Lowest 30% per capita

income

• Average per capita income/mo:

Php10,750 or US$238

National Statistics Office. Philippine Yearbook 2011

Health Statistics

• Life expectancy: 73.14 (Female), 67.61 years (Male)

• Infant Mortality Rate: 12.6/1000 live births

• Maternal Mortality Rate: 96.4 /1000 live births

National Statistics Office. Philippine Yearbook 2011

Leading Causes of Morbidity (2007-10) Leading Causes of Mortality (2007-10)

ALRTI and Pneumonia Diseases of the Heart

Bronchitis/Bronchiolitis Cerebrovascular diseases

Hypertension Malignant neoplasms

Urinary Tract Infection Pneumonia

Acute Watery Diarrhea Tuberculosis (all forms)

Influenza Chronic lower respiratory diseases

Tuberculosis Diabetes mellitus

Leprosy Assault (homecide)

Injuries Conditions originating in perinatal period

Acute Febrile Illness Nephritis, nephrotic syndrome, nephrosis

Total Health Expenditure

The Philippines Pharmaceutical

Market

• P138.63 B total market – US $ 3.08 B (IMS Health, 2013)

• High out-of-pocket payments

- no reimbursement of outpatient drugs - limited inpatient drug coverage Medicines is - 40% of total health expenditures - 30% of Philippine Health Insurance Corporation Reimbursement (PHIC) - 10% of Department of Health (DOH) budget - 10-12% Public sector share of the market

Philippine Pharmacy Services Community Pharmacy

- is dominated by chain pharmacy operation where 58% is contributed by just 1 single chain with more than 900 outlets

- 70 % of the 42% is from other top 5 chain pharmacy operations

Practice is mainly dispensing with minimal patient medication counselling or Practice has

stagnated to mere transactional in nature.

Pharmacists for Better Health Outcomes 8

Philippine Pharmacy Services Hospital Pharmacy

while a number of big hospitals are into

Clinical Pharmacy services; majority are

still into the plain distributive work.


Actual vs. Expected Practices

ACTUAL

• Poor i ple e tatio of o prescription, no dispensing policy

• Poor storage practices

• Medication counselling not practiced in most dispensing sites

• Sale of medicines unsupervised by pharmacists in both traditional (ghost pharmacists) and non-traditional medicine outlets

EXPECTED

• Strict implementation of Pharmacy Law and related regulations

• Adoption of Good Pharmacy Practice standards

• Medication counselling as part of dispensing

• Inclusion of the pharmacist in all levels of health care


MISALIGNMENT BETWEEN EDUCATION and PRACTICE


PHILIPPINES

INITIATIVES

TO IMPROVE

PHARMACY

SERVICES

PHILIPPINE INITIATIVES

are aimed at improving pharmacy services of:

1. Future Pharmacists, Pharmacy Support Workforce and Pharmacists

2. Patients and Patient Caregivers

3. Other Health Professionals


Initiatives aimed at . . .

• EDUCATION – reviewed and develop to align

to the Asian and Global Framework of

Education.

• PRACTICE – develop and implement standards

in all practice settings

• RESEARCH – encourage practice researches


STUDENTS. . . FUTURE PHARMACISTS

1. Curriculum revision towards patient-oriented practice ; to become Outcome-based curriculum (OBE) – proposed 5 years for mandatory implementation in 2018

2. Improve internship of students with defined competencies outcomes; only in accredited pharmacies and other health facilities – increased to 1200 hours

3. Greater involvement of pharmacy students in activities on national pharmacy issues and community-based programs


STUDENTS. . . FUTURE PHARMACISTS

1. YPG introduced the White Coat Ceremony in Colleges of Pharmacy (2010) – professionalism and image building

2. YPG-initiated Patient Counselling Event (PCE) – to gauge the counselling skills of graduating pharmacy students


Pharmacy Support Workforce

• Pharmacy Assistant training regulation and curriculum (Technical Education and Skills

Development Authority) – done and for implementation in 2015

• Registration and Certification of Pharmacy Assistant – soon be mandatory

• Requirement of Continuing education in the renewal of the Certification of Pharmacy Assistant

• Development of the Pharmacy Technician TR and Curriculum


PHARMACISTS - Relevant (CPD)

• Competency Enhancement

– Regular CPE seminars and

workshops conducted under the

New CPD guidelines of the

Professional Regulation Commission

– Improved Practice exposures

Pharmacists to embrace the value of

life-long learning


PHARMACISTS

Special Trainings

– One-Month Clinical Pharmacy Training

– Clinical Pharmacy Certification Program (with ACCP)

– 2-day Medication Safety Seminar and Workshop

– Counterfeit Drugs Awareness Program

– Community Externship Program

– Affiliate-initiated Trainings and Specialty Trainings


PATIENTS AND CAREGIVERS

- Educate them on the value of the pharmacist and the services

he /she can offer to clients

-Empower patients on responsible self-care and educate them in the

responsible use of medicines

Important because Patients have no expectation of the Pharmacists but

provide the medicines


Other Professionals : Doctors and Nurses,

Hospital Administrators

• Seminars and Workshops facilitated by the

Philippine Pharmacists Association

- Drug delivery systems

- Counterfeit medicines

- Polypharmacy, among others

* Today almost complete with the modules on

Collaborative Patient Management

Pharmacists for Better Health Outcomes 21 Pharmacists for Better Health Outcomes 21

OTHER

INITIATIVES

TO IMPROVE

PHARMACY SERVICES

Policy Formulation and Issuance

• Lobbying for the Passage of the New Pharmacy Law

• Policy Review, Changes and Formulation of the DOH, FDA A.Os.

• Formulation of the National Antimicrobial Use Guidelines

• Vaccination by Pharmacists


Training and Practice Model Development

• Partnered with Chain Pharmacies/Hospital

Pharmacies • Cognitive Pharmacy Services (Medication Counseing)

• Medication Review (Regular Chronic Patients)

• Compliance Program (Reminder, Compliance Packs)

• Promote the Continuity of Care


Training and Practice Model

Development

• Non-Traditional Outlets for Medicines

Training of village store owners

(Botica ng Barangay) and

staff of retail outlets for

non-prescription drugs on

Medicines 101 and the ABC in Dispensing OTC medicines

STRATEGIES ENSURE SUSTAINABILITY . .

COLLABORATION

1. CPE/CPD in partnership with selected pharmaceutical companies and government agencies

2. Consumer/Patient Education in partnership with Civic and Patient/Consumer Organizations, Government and Non-government organizations and the Media


Collaboration . .

3. Strengthen Image of the

Pharmacists and promote

the Phar acists’ advocacies. Partnered with the largest Television/

Radio Network, ABS-CBN

4. Faculty Training

Philippine Association of Colleges

of Pharmacy.


Collaboration . . 5. Policies and Administrative Orders - Department of Health, Food and

Drug Administration and the Board of Pharmacy

Need for Phar acist’s supervisio i RONPD Improved Medicine Management System across supply chain

Monitoring of drug outlets

Pharmacies as vaccination centers

Accreditation of Pharmacies for Outpatient Benefits of Medicines


In summary, the pattern of change

1. Hospitals and Community Pharmacies are strengthening their operations embarking to start Clinical Pharmacy Services

2. Major Chain Community Pharmacies are seeking assistance to develop programs that will improve their services and efficiency of operations

3. The Department of Health (DOH) in partnership with PPhA is re-training their Pharmacists and staff to better serve the public.


In summary,

4. PHILHEALTH, the Government Insurance

System had PPhA co-developed the Pharmacy

Benchbook for Community – reimburse only

medicines withdrawn from accredited

pharmacies

5. PPhA is a member of the DOH Council for

Healthcare and is involved in policy

formulation and development relative to the

use of medicines.

What do we need?

Pharmacy bill to be passed into law, to serve as

the legal framework to support all the changes

in services happening now.

Why will it be this strategy?

• Introducing and implementing CHANGE needs for the Change Leader to consider every single element that may affect and will be affected in the process of Change.

• Policies to serve as the Legal Framework must be in place

• Change Leader must work well with CHANGE CHAMPIONS; only then is

CHANGE SUSTAINABILITY IS ASSURED !


The Future we see,

The Philippine Pharmacists Association leading the way to

IMPROVE THE PHARMACY SERVICES OF THE COUNTRY not only for the PATIENTS

but also to

IMPROVE THE IMAGE OF THE FILIPINO PHARMACIST;

STRENGTHENING ITS ROLE IN THE HEALTH CARE SYSTEM.

Filipino Pharmacists who can turn

to the …

Professional Heart Business Heart


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Changes in Pattern of Community Pharmacy Services in the