Teaching Clinical pharmacy and pharmaceutical care - Swiss ... - IPVZ

1

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching clinical
pharmacy and pharmaceutical
care

-

a Swiss experience

Institute for Postgraduate Training in Clinical
Pharmacy,
Prague


Prof. Dr. Kurt E.
Hersberger

Pharmaceutical

Care Research Group

Klingelbergstrasse 50

CH
-
4056 Basel

Kurt.hersberger@unibas.ch

2

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

The pharmacist is situated at the junction of the
logistical supply process

(
industry,wholesaler,pharmacy
) and the

cognitive care
process

(symptoms, diagnosis,
prescription, pharmacy).

3

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Bologna !

Federal diploma

Bachelor in Pharmaceutical
Sciences (180 ECP)

Master in Pharmacy
(120ECP)

4

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Pharmacy

Curriculum
Master
Pharmacy

/ Federal
Examination

Aufbaustudium

II

Aufbaustudium

I

Grundstudium


Master thesis and defence



-
> 34 KP

Basics of clinical pharmacy (IR, PC)


-
> 26 KP

Externship (community pharmacy and/or
hospital pharmacy





-
> 30 KP

Teaching & training pharm. care


-
>
30 KP


Federal diploma

Bachelor in Pharmaceutical
Sciences

Master in Pharmacy

Federal exam based on a national catalogue of
learning objectives

Specialisation

Postgraduate education organised
by professional organisations


Hospital Pharmacy

•
Clinical pharmacy


Community pharmacy

5

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
pharmaceutical

care


Discussion of case studies


浥瑨潤猠畳敤s楮i
pharmaceutical care


Different requests
–

different approaches


SOAP


Patient assessment




6

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Patient assessment in the pharmacy


Medical condition / history


Individual
needs


Perception(s
)


Willingness to follow changes


Adherence


7

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Performance


Point of Sale

vs. Counselling area


Performance risks to be poor


Fulfilment of at least
„WWHAM“ is difficult


Structured (protocol)


Privacy


Documentation

=

Pharmaceutical Care

8

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
pharmaceutical

care


Discussion of case studies


浥瑨潤猠畳敤s楮i
pharmaceutical care


Different requests
–

different approaches


SOAP


Patient assessment


Pharmaceutical care issues


Medication review




9

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Types of Medication Review (PCNE)


Based
on medication history

+ patient
interview



MUR,
Polymedikations
-
Check



„Brown
Bag
“
-
Methode

„simple“
Medication

Review


based on the medication history in the
pharmacy

„intermediate“
Medication

Review

„
advanced
“
Medication

Review


medication history +patient
interview
+ c
linical

data


Clinical Medication Review

10

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Workflow dose dispensing service

Medication

Review

Identification

of

non
-
adherence

Selection

of

adequate

interventions

Dose
dispensing

service

•
Configuration

of

regimen

•
Selection

of

dose
dispensing

aid

•
Production

of

individualised

dose
dispensing

aid

for

a
period

of

x
days

•
Instruction

&
counselling

of

patient

/
caregiver

•
Follow
-
up

Other
adherence

intervention
s

Hersberger

KE et al
. Expert
Rev
.
Clin
.
Pharmacol
. 2013;
6(4):413
-
421

11

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
pharmaceutical

care


Discussion of case studies


浥瑨潤猠畳敤s楮i
pharmaceutical care


Different requests
–

different approaches


SOAP


Patient assessment


Pharmaceutical care issues


Medication review


Clinical training / guidelines for practice


Involvement of other healthcare providers as
teacher
-
practitioner




12

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Smoking cessation:


Model of a well developed setting


Fagerstöm

Questions


Prochaska
-
Model to assess motivation


Introduction into Motivational Interviewing


Role plays



Sinclair HK, Bond CM, Stead LF. Cochrane Review 2004

Dent et al.
Pharmacotherapy

2007;27(7):1040
–
1051

13

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
sc

injection

therapy


Basics of heparin therapy


Videos with errors


Training with phantom


Injection of
NaCl

0.9%


Workshop in small
groups (n=10)


1 h for Insulin


1 h for heparin


14

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Emergency hormonal
contraception
:

14

Introduced
2002 as „
pharmacist
only“ in Switzerland


Repeated evaluations show:


Structured,

well evaluated
protocols are crucial


Pharmacists perform exhaustive
assessments (only 3.0% missing
data)


Women are ready to pay a fee
for service


High satisfaction with service
provision



Arnet

I et al.
Eur

J
Contracept

Reprod

Health Care.
2009;14(5
):349
-
56.

15

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
pharmaceutical

care


Discussion of case studies


浥瑨潤猠畳敤s楮i
pharmaceutical care


Different requests
–

different approaches


SOAP


Patient assessment


Pharmaceutical care issues


Medication review


Clinical training / guidelines for practice


Involvement of other healthcare providers as
teacher
-
practitioner


Portfolio with individual feedback


Case studies, home visits, involvement in surveys (research)




16

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

0%
20%
40%
60%
80%
100%
Multiple medication storage locations used
Expired medicatino present
Interrupted continuous prescription
Hoarding of medications
Duplication present
No medication administration routine
Poor adherence
Confused by generic & trade names
Percent of patients

At risk
No risk
Missing
Risk factors adapted from: Sorensen L.

J
Clin

Pharm

Ther
, 2006;3:485
-
91

A convenient sample of chronically ill patients on
>
4 medications

Home visits (n=51)


Prevalence of medication
-
related risk
factors

Eichenberger

P et al.
Int

J
Clin

Pharm.
2011;33(5
):815
-
23

17

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Assessment of clinical skills /competences /performance

Does

Shows

Knows How

Knows

Direct observation/supervision „on the job“

Portfolio

OSCE

(objective structured clinical examination)

Role plays

Case studies

Oral examination

Case studies

Short answer questions

Oral examination

Multiple choice (MC)

Short answer questions

Miller, GE.
Acad

Med;1990;65(9):s63
-
s67.

18

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Objective Structured Clinical Examination (OSCE)


first conceptualized in 1975 by Harden R
1


Developed to assess the complex notion of clinical
competences / skills
2


Multiple stations (n=8
-
12) with different tasks (e.g. triage of
minor symptoms, prescription validation, instruction of a
device, patient education, writing a comment/fax to a GP)


Use of standardized patients and evaluation checklists


Rating by pseudo
-
patients and/or observer


Used in medicine, pharmacy and nursing

1)
Harden
R, Stevenson M,
Downie

WW, Wilson GM. Clinical competence
in
using objective structured examination.
Br Med J
1975;1:447
-
51

2)
Turner JL,
Dankosky

ME.
Fam

Med 2008;40(8):574
-
8

19

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

OSCE in Basel


Training of students


Two sessions with in total 4 cases


Only short, immediate feedback


Discussion of the cases and major difficulties, mistakes in
a plenary session


Final federal exam (BS, ZH, GE)


Preparation/selection of cases


Blueprint for balancing issues/indications/settings


Pilot testing


Translation


Briefing of
pseudopatients
/examiners

20

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Organisation is a challenge


This year: 70 candidates


2 days with 5 stations each (total 10 different stations)


Approx. 35 persons involved


Pseudopatients

and examiner = pharmacists

1

2

3

4

5

P5

P4

P3

P2

P1

8:30
-
10:30

10:40
-

13.30h in
Quarantäne

21

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Federal
exams

Universities of Basel, Geneva and Zürich (ETHZ)

22

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

C
ases in 2013

Diabetes

Rx / Instruction insulin pen

Neurology, geriatrics

Rx (pain management, morphine)

ORL

OTC / Common cold

Ophthalmology

Rx / error in the prescription, contra
-
indication

Gastroenterology

OTC / obstipation / counselling

Dermatology

Rx
-
Request corticoid without prescription /OTC

Cardiology

Rx / BP
-
Measurement /
Polymedication
-
Check

Pneumology

Rx COPD exacerbation / cortisone

Pediatrics

OTC / Triage

Infectiology

Rx /Request antibiotic / referral

Rheumatology

Rx /
Methotrexat

23

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Case
pediatrics


Measles or chicken pox ?


Patient assessment


Red flags


Vaccination scheme


OTC treatment or referral?


Therapy plan


Follow
-
up


Communication

24

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Evaluation form “
pediatrics
”

25

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Story board for briefing
“
pediatrics
”

26

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Cystitis


Women 19 years


First episode


Fewer 38.1
°

Resultat

Urintest

-

Leukozyten
: ++

-

Nitrit
: ++

-

Protein: +

-

Glucose: 0

-

Erythrozyten
: +

27

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Methotrexat

28

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Teaching
clinical

pharmacy

Does

Shows

Knows How

Knows

29

| |
K.Hersberger

| Teaching Clinical
Pharmacy

in
Switzerland

|
Prague

15
-
10
-
2013

Carole Kaufmann

Philipp Walter

Markus
Lampert


Isabelle
Arnet


Esther
Spinatsch

Fabienne

Böni

Thank

you

!

Markus
Messerli

Vera
Bernhardt


Karen
Maes

Samuel
Allemann