11.05.2014 Current situation „If I'm lucky, I'll be put through to the doctor “ 30% of the german population take over the counter drugs Bundesgesundheitssurvey 2003 Communication between pharmacist and physician 20 - 25% hospital admissions due to side effects Polypharmazie Report HKK 2012 One potentially serious drug interaction /day/ pharmacy Dr Guido Schmiemann PhD, MPH Scharpf 2012 PZ Department for Health Services Research Bremen University Germany Dr Guido Schmiemann Current situation Current situation Germany Country Inhabitants/ pharmacy Pharmacists 48.422 (70.2% women) Denmark 17.700 Pharmacies 20.900 Netherlands 8.300 Slovenia 6.600 United Kingdom 4.600 Physicians 138.472 (40% women) Germany 3.900 GP 60.397 (39% women) Average EU 3.200 Belgium 2.100 ABDA-Statistik 2012; other countries- last year data according to ZAEU, SFK, IPU, ÖAK, AFP, SPA Dr Guido Schmiemann Dr Guido Schmiemann ABDA-Classifikationen Who detects interactions? 1. Contraindication 6 % GP H Serious side effects documented Simvastatin - Erythromycin 2. Contraindication as a precaution 11% pharmacist Serious side effects theoreticaly possible Levodopa- Metoclopramid 3. Monitoring or adjustment needed 46 % Nurse/ 4. In defined cases Monitoring or adjustment needed 4 % relatives ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ABDA-Datenbank (3/2012): 428.000 Interaktionen Dr Guido Schmiemann Dr Guido Schmiemann 1
11.05.2014 Cross sectional study Developing communication tool „ How do pharmacists and doctors judge their interprofessional communication regarding potentially Developing questionnaire serious interactions? Survey/ Interviews (qualitativ/quantitative) „How do they judge a standardized communication tool, developed to improve their communication? “ Physicians n= 300 Pharmacist n= 50 Response 31% 54% Dr Guido Schmiemann Dr Guido Schmiemann Sample charcteristics Pharmacist (n=50) Physicians (n= 300) 31% male 59% male 65% < 50 years 65% > 50 years 40% single-handed 47% debit card 57% use interaction (0-85%) software Dr Guido Schmiemann Dr Guido Schmiemann Physicians perspective Pharmacists perspective Agree Disagree Disagree Agree „Pharmacies play in important role in the 44,1% 54,8% „Management of serious interactions is 28 / 43 % 72/56% management of potentially serious (n=41) (n=51) a relevant problem in daily practice“ interactions.“ ( Physicians ) „Communication with other physicians is 68,8% 28,0% usually uneventful.“ (n=64) (n=26) „Communication in case of serious 51,7% 48,3% interactions is usually uneventful/ „Communication between pharmacy and 37,6% 57,0% (n=15) (n=14) without problems medical practice is usually uneventful“ (n=35) (n=53) Dr Guido Schmiemann Dr Guido Schmiemann 2
11.05.2014 Pharmacists perspective Frequent problems I… Very Never 2 3 4 5 Pharmacists often „Dr not available- one can not pass the doctors assistant “ … ask the patient to confer with his/her physician „Interaction is known by the physician- not clinical relevant“ 37,9% 34,5 6,9% 6,9% 6,9% 0 % ( before handing out the drug)) Physicians … … ask the patient to confer with his/her physician ( after 58,6% 20,7 3,4% 6,9% 6,9% 0 % Definition of serious interaction is relative“ handing out the drug)) „Evaluation of interaction is incorrect“ „They mostly contact us with bit and bops“ …make a individual 31,0% 31,0% 24,1% 0% 0% 3,4% recommendation … confer with physician 3,4% 3,4% 13,8% 3,4% 34,5% 41,4% while patient is waiting Dr Guido Schmiemann Dr Guido Schmiemann In wie weit stimmen Sie den folgenden missing agree disagree Aussagen zu? Thank you „A standardized communication tool (i.e template) can improve 32/34% 65/56% 3/10% communication between pharmacies and physicians .“ „This tool can improve can 35/25% 65/67% improve communication between 0/9% pharmacies and physicians .“ schmiemann@uni-bremen.de Dr Guido Schmiemann Dr Guido Schmiemann Dr Guido Schmiemann 3
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