A Global Strategic Plan for
Hospital Pharmacy Practice
Overview
• Brief introduction to FIP, the International
Pharmaceutical Federation
• Describe the FIP Global Survey of Hospital Pharmacy
Practice
• Describe the FIP Global Conference on the Future of
Hospital Pharmacy
• The Basel Statements on the Future of Hospital
Pharmacy
2
International Pharmaceutical Federation (FIP)
Comprised of 120 member organizations in 82 countries
In total, represents 2 million pharmacists, world-wide
Over 4000 individual members
Headquarters, The Hague, The Netherlands
• Off-site office in Geneva, Switzerland
• Relatively small staff (12)
• FIP Mission Statement:
• “To improve global health by advancing pharmacy practice
and science to enable better discovery, development, access
to and safe use of appropriate, cost-effective, quality
medicines worldwide.”
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Structure of FIP
4
Summary of Structure of FIP
• Bureau, the FIP board of directors
– Chair, FIP President, Kamal Midha (Canada)
• Executive Committee
– President, Scientific Secretary (Vinod Shah, India) and
Professional Secretary (Henri Manasse, USA)
• General Secretary, CEO of FIP
– Ton Hoek (The Netherlands)
• Board of Pharmaceutical Science (BPS)
– Chair, Mitsuru Hashida (Japan)
• Board of Pharmaceutical Practice (BPP)
– Chair, Phil Schneider (USA)
– 9 Sections, including Hospital Pharmacy Section (HPS)
– Young Pharmacists Group
5
FIP Global Representation of Pharmacy
• FIP serves as liaison between pharmacy and other NGOs
• In ‘official relations’ with WHO
• In ‘working relations’ with UNESCO
• Recent achievements
• WHO UNESCO FIP: Global Tripartite Education Action Plan
2008 – 2010
• FIP Collaborating Center for Pharmacy and Health, School of
Pharmacy, University of London
6
FIP Global Representation of Pharmacy
• Recent achievements
• A Core Competency Framework for International Health
Consultants (publication)
• BE AWARE: Helping to Fight Counterfeit Medicines, Keeping
Patients Safer (publication)
7
Current FIP Activities
• WHO International Medical Products Anti-Counterfeiting
Taskforce (IMPACT)
• Global Network of Pharmacists Against Tobacco
• International Alliance for Patient Safety
• Good Pharmacy Practice Guidelines and implementation
initiatives
• Annual Congress
• 2008, Basel, Switzerland
• 2009, Istanbul, Turkey
• 2010, Lisbon, Portugal
• Each sections within BPP has active agenda, programming,
etc.
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FIP Global Survey of Hospital Pharmacy Practice
• FIP Board of Pharmaceutical Practice Special Project
• Support from Cardinal Health also acknowledged
• Objectives
– Conduct an exhaustive survey of hospital pharmacy practice
describing and measuring the breadth and scope of hospital
pharmacy practice worldwide
– Establish a global comparative benchmark for hospital pharmacy
practices
– Provide background information for the Global Conference and
future HPS programming
9
Methods
• Survey methods developed in collaboration with Global
Conference Steering Committee and HPS officers
• Drew from regional, national and international surveys
from Europe (EAHP), UK, USA (ASHP) and Australia
• Sample frame was national respondents from every
United Nations-member country
– Sought broadest representation in sample, with understanding
that depth of response would be lacking
• Waiver of approval granted by Human Subjects
Committee at University of Wisconsin – Madison, USA
• Principal Investigators, Lee Vermeulen and Fred
Doloresco, University of Wisconsin – Madison and UW
Hospital and Clinics
10
Methods, continued
• Draft instrument developed and reviewed extensively
– Questions drawn from previous surveys, Joint Commission
International accreditation standards and other sources
– Definitions of terms developed and included with survey
– Designed to inform all 6 Global Conference working group
themes
• Instrument pilot tested by respondents who were native
speakers of English, French, Spanish, and Mandarin
• Final instrument included 75 questions examining scope
and breadth of hospital pharmacy practice
– Survey instrument translated from English to French and Spanish
11
Methods, continued
• Survey evaluated aspects of practice in 2 dimensions
• Scope of practice
– Activity is not in the scope of hospital pharmacy practice in my
country
– This activity is in the scope of hospital pharmacy practice in my
country but is not a requirement
– This is within the scope of pharmacy and is a legal/ regulatory
requirement in my country
• Breadth of practice; how common is the practice?
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–
–
–
–
<3% (very few) of hospitals
3 – 40% (few) of hospitals
41 – 60% (some) of hospitals
61 – 97% (most) of hospitals
>97% (nearly all) of hospitals
12
Methods, continued
• Respondents were recruited to complete the survey
– FIP member organizations initially
– HPS members
– Widespread recruitment effort with support of EAHP and many
other organizations and individuals
• Respondents agreeing to participate in survey were sent
instrument for completion
• Recruitment and response collection occured from July
2007 to April 2008
• Analysis included comparisons of responses by
geographic region, WHO region and level of economic
development (HDI)
13
Results
• Responses received from 85 of 192 UN-member
countries (44%)
– Responses received from countries representing 5.4 billion
people (83% of global population)
• Wide range of national characteristics included in
respondent sample
– Approximately 1/3 of countries from each of the World Health
Organization regions
– Range of population size, from 40,000 to 1.3 billion
– Approximately 1/3 of countries from each Human Development
Index classification
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Results - Respondent Nations
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•
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Algeria
Argentina
Australia
Austria
Bahamas
Belgium
Bosnia and Herzegovina
Brazil
Brunei Darussalam
Canada
Chad
China
China-Taiwan
Costa Rica
Côte d'Ivoire
Croatia
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Czech Republic
Democratic Republic of the Congo
Denmark
Ecuador
Eritrea
Estonia
Ethiopia
Finland
France
Germany
Ghana
Greece
Guyana
India
Indonesia
Iran (Islamic Republic of)
Iraq
15
Results - Respondent Nations
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Ireland
Japan
Kenya
Latvia
Lebanon
Lesotho
Luxembourg
Madagascar
Malta
Mexico
Namibia
Nepal
Netherlands
New Zealand
Nigeria
Norway
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Pakistan
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Republic of Korea
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Serbia
Sierra Leone
Singapore
Slovakia
Slovenia
16
Results - Respondent Nations
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•
•
•
•
•
•
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•
•
•
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South Africa
Spain
Sudan
Suriname
Sweden
Switzerland
Thailand
The former Yugoslav Republic of Macedonia
Timor-Leste
Trinidad and Tobago
Turkey
Uganda
United Arab Emirates
United Kingdom of Great Britain and
Northern Ireland
•
•
•
•
•
United Republic of Tanzania
United States of America
Uruguay
Venezuela (Bolivarian Republic of)
Viet Nam
17
Results: Source of Response Information
80
70
Number of Countries
60
50
Used
Not Used
40
30
72
67
63
65
56
20
28
10
21
17
19
12
0
Personal Impression
Other Experts
Sub-survey
Unpublished Survey
Published Survey
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Results: Practice Model
50%
40%
30%
41.2%
20%
38.3%
10%
11.1%
13.4%
Services hired out partial control
No pharmacists
0%
Staff pharmacists control Staff pharmacists - partial
medication use
control
• Pharmacist practice model used in hospitals in respondent nations
19
Results: Spending on HIV Spending
60
Number of Countries
50
40
30
52
20
10
12
6
8
4
0
<10%
10 - 20%
21 - 33%
34 - 50%
>50%
% of Total Healthcare Budget
• Proportion of the nation’s total (pharmacy and non-pharmacy)
healthcare budget spent on HIV care
20
Results: Spending on Tuberculosis
60
Number of Countries
50
40
30
51
20
10
16
8
7
1
21 - 33%
34 - 50%
>50%
0
<10%
10 - 20%
% of Total Healthcare Budget
• Proportion of the nation’s total healthcare budget spent on
tuberculosis care
21
Results: Spending on Malaria
70
60
Number of Countries
50
40
30
61
20
10
5
6
7
10 - 20%
21 - 33%
34 - 50%
0
<10%
4
>50%
% of Total Healthcare Budget
• Proportion of the nation’s total healthcare budget spent on malaria
care
22
Results: Pharmacist Vacancies
Vacancies
50
45
7
40
1
2
Number of Countries
35
30
4
15
16
25
20
5
2
15
6
10
5
10
11
5
0
Yes
No
AFRO
AMRO
EMRO
EURO
SEARO
WPRO
• There are current vacancies that cannot be filled with qualified
pharmacists due to a lack of qualified individuals in my country.
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Results: Gender Mix of Pharmacists
Female RPh %
60
7
50
2
Number of Countries
40
28
30
20
3
1
3
3
10
3
1
1
10
1
1
3
3
4
2
4
<3%
3-25%
26-40%
41-60%
>60%
5
0
AFRO
AMRO
EMRO
EURO
SEARO
WPRO
• Please describe the percentage of female pharmacists in hospitals in
your country.
24
Results: Technician Workforce
Techs - Breadth
50
45
4
1
40
Number of Countries
35
21
30
25
20
1
2
15
4
9
10
1
1
5
9
2
1
1
1
3
2
2
1
1
1
3
4
<3%
3-40%
41-60%
61-97%
3
7
0
AFRO
AMRO
EMRO
EURO
SEARO
>97%
WPRO
• The pharmacy department includes technical staff in addition to
pharmacists.
– The use of technicians to augment the pharmacy workforce is
widespread.
25
Results: Ability to Obtain Medicines
Able to obtain meds - Breadth
60
50
2
9
Number of Countries
40
30
20
37
1
10
6
4
6
2
2
3
1
3
<3%
3-40%
41-60%
6
0
High
•
Medium
61-97%
>97%
Low
With the exception of limited, temporary medicine shortages, hospitals are
able to easily obtain medications that are on the formulary or essential
medicines list.
– Increasing HDI category correlates with an increased ability to obtain
medications
–
AFRO and EMRO nations reported difficulties in obtaining medications
26
Results: Unit Dose Dispensing
Unit Dose - Scope
60
50
4
Number of Countries
40
14
30
20
1
32
6
4
10
5
10
5
0
Not in scope
In scope, not required
High
•
Medium
Required
Low
Hospitals distribute the majority of medicines to patients in the hospital as unit
doses.
–
–
A high proportion of low HDI nations require and have implemented unit dose dispensing
A third of low HDI nations report using unit dose dispensing in >97% of hospitals
27
Results: Access to Medical Records
Chart - Breadth
25
20
Number of Countries
4
1
1
15
6
8
1
5
1
2
10
5
12
5
9
10
10
6
0
<3%
3-40%
41-60%
High
•
Medium
61-97%
>97%
Low
Pharmacists in hospitals have access to patient files (such as the medical
chart or record).
– Little variation across HDI category
– Similar results for population and WHO region
28
Results: Medical Libraries
Library - Breadth
25
2
Number of Countries
20
4
15
6
3
21
10
6
8
14
5
5
6
3
3
<3%
3-40%
0
41-60%
High
•
Medium
61-97%
>97%
Low
Pharmacists in hospitals have access to a medical library with medicine
references while they are working.
– Pharmacists in a majority of hospitals in high HDI score nations, but not in
medium or low HDI score nations, have access to medical libraries or medicine
references
29
Results: Pharmacist Prescribing
RPh Dependent Prescribing - Breadth
60
3
50
23
Number of Countries
40
30
20
31
10
1
1
1
2
4
3
4
2
1
2
3-40%
41-60%
61-97%
>97%
0
<3%
High
•
Medium
Low
Pharmacists in hospitals are able to prescribe only under certain
circumstances (such as under an agreement with a doctor).
– Pharmacist prescribing (with or without an agreement with a doctor) is
not employed in a majority of hospitals
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Survey Limitations
• Difficult for any one respondent to reflect upon the
nature of pharmacy practice in an entire country
– Future HPS should include national sub-samples for more
accurate representation of practice patterns
• Definitions that we all sometimes take for granted are
often not consistent from country to country (not simply
a language issue!)
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Next Steps for the Global Survey
• Targeted survey results will be used to inform discussion
of consensus statements during Global Conference
• Results will provide guidance to HPS leadership in
developing future programming for Section sessions in
years to come
• Full technical report to be made available and
manuscript will be part of Global Conference proceedings
• Istanbul Congress, 2009, session to be held to identify
future plans for more detailed survey efforts on targeted
aspects of hospital pharmacy practice, and to monitor
trends in practice development over time
32
globalhosp@fip.org
www.fip.org/globalhosp
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Background: FIP Global Conference on
the Future of Hospital Pharmacy
• In December 2005 international leaders in hospital pharmacy
met in New Orleans at the ASHP Midyear Clinical Meeting
• Common concerns were observed, common global standard of
practice was missing
• The FIP Hospital Pharmacy Section was chosen as host for
global consensus conference
• A steering committee was formed
– Several subcommittees started to work
• Meeting took place 30 – 31 August 2008 in Basel
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Objectives: FIP Global Conference on
the Future of Hospital Pharmacy
• To build a shared vision among hospital pharmacy opinion leaders
around the world about the preferred future of hospital pharmacy
practice.
• To identify strategic goals for global advancement of hospital
pharmacy that are relevant to the needs of each participating
country, and to identify opportunities for global cooperation that
will allow every country to achieve their goals for hospital pharmacy.
• To develop consensus statements on how to best prioritize practice
advancements and offer guidance on the development of tools,
timelines and tactics for achieving those advancements.
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Global Conference Leadership
• Honorary Conference Co-Chairs
– Jacqueline Surugue (France), EAHP
– Henri Manasse (USA), ASHP
• Steering Committee
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Lee Vermeulen (USA), Chair
William A. Zellmer (USA), Vice Chair
Satu Siiskonen (The Netherlands), Conference staff
Toby Clark (USA), Chair, Finance Subcommittee
Stephen Curtis (UK)
Andy Gray (South Africa), HPS President, Chair, Delegate Selection
Subcommittee
Stefan Mühlebach (Switzerland)
Philip J. Schneider (USA), ex officio BPP representative
Thomas S. Thielke (USA)
Dick Tromp (The Netherlands ), ex officio BPP representative
Arnold G. Vulto (The Netherlands), Chair, Programming Subcommittee
Eduardo Savio (Uruguay)
Zhu Zhu (China)
36
Global Conference Structure and Faculty
• Six facilitators were recruited for one of six themes, each
focused on a different components of hospital pharmacy
practice
– Literature reviews written
– Develop draft consensus statements
– Lead working groups via internet and “live” at the conference
• Facilitator assignments:
– Procurement of medicines (Eva Ombaka, Kenya, Africa)
– Prescribing of medicines (Lisa Nissen, Brisbane, Australia)
– Preparation and distribution of medicines(Ryo Oishi, Japan)
– Administration of medicines (Rita Shane, Los Angeles, USA)
– Monitoring outcomes (David Cousins, UK, Europe)
– Human resources and training (Tana Wujili, FIP)
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Global Conference Process
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•
Fundraising and scholarships
Recruitment and selection of official representatives (delegates)
Initial development of literature reviews and draft consensus statements
Preliminary consensus development amongst working groups began
Summer 2008
• Conference occurred 30th - 31st August, 2008, Basel Switzerland
– Nearly 350 delegates (22 scholarship recipients) attended from over 90
countries
– Over 80 countries were represented by official representatives
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•
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•
Plenary session
Working group sessions
Editing of statements
Voting process for consensus statements
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Voting Scale
• As each consensus statement is read, official
representatives voted using audience response system
• The voting scale used as follows:
A = I strongly agree with the statement
B = I agree with the statement
C = I disagree with the
statement
D = I strongly disagree with the statement
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Voting Process
1.
2.
3.
A consensus statement was read by the facilitator
for the group that developed the statement, and if
necessary, brief comments were also made
Official representatives were be asked to vote on the
statement and the results of the vote were shown
If a clear consensus was reached (simple majority of
votes are A (“strongly agree”) or B (agree), the
statement was accepted
40
Results!
•
A total of 74 consensus statements were developed
•
•
•
•
•
•
•
A total of 82 countries cast a vote on at least 1 statement
Across all statements, an average of 64.1 votes per statement were
cast
All statements were approved with consensus
Across all statements, the average level of consensus (proportion of
votes cast as “strongly agree” or “agree”) was 97.5%
Of 5,259 votes cast
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•
•
•
Overarching statements
Statements from each working group
3,821 (62.8%) were “strongly agree”
1,314 (21.7%) were “agree”
Only 111 were “disagree” and 22 were “strongly disagree”
A total of 26 statements (35%) had 100% consensus (“strongly
agree” or “agree”)
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Themes in Basel Statements
•
The definition of “hospital pharmacist” needs additional
development. Current definitions vary worldwide, based on
traditions and national regulations and ambitions, but in general:
•
•
•
•
•
Pharmacist working in a hospital;
Specialized training, generally post-graduate (including residency);
The overarching goal of hospital pharmacists is to optimise patient
outcomes through the judicious, safe, efficacious, appropriate and
cost effective use of medicines.
Hospital pharmacists should take responsibility for all medicine
logistics in hospitals.
Hospital pharmacists should provide orientation and education to
nurses, physicians and other hospital staff regarding medication
use, using best practice recommendations.
42
Next Steps
•
•
•
•
Feedback forms provided to gather additional written
comments on any consensus statements, additional
statements and final editing underway now (17th
September 2008)
Draft Basel Statements at www.fip.org/globalhosp
Full proceedings to be published in American Journal
of Health-System Pharmacy in February 2009 with
free, open access worldwide
Future programming planned for HPS, including
additional survey activity and action plan to implement
Basel Statements
43
The ‘Moment’
www.fip.org/globalhosp
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