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
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