Patient-centered care and rational use of medicines: The case of hypertension
Management of hypertension is recognized as the most effective way to prevent target organ damages and to reduce the cardiovascular mortality. Even though there is extensive evidence on benefits of lifestyle modification and antihypertensive treatment, many patients with hypertension do not reach therapy goals. There might be many reasons behind poor blood pressure control as problems in changing lifestyle like adapting the diet or achieving weight loss. Problems around medication may beinadequate dosing, lack of intensification of treatment, drug costs, drug availability, lack of adherence. Other factors may include medical inertia. Patient-centered care and rational use of medicines are key components in good pharmaceutical care for patients with hypertension.
In this workshop we will focus on the role of the pharmacist in caring for patients with hypertension. In short presentations, we will follow a patient’s story with hypertension over 20 years, from the first diagnosis of hypertension to being an older patient with multiple co-morbidities.
The main part of the workshop will consist of work in small groups and plenary discussions. Participants will reflect on the role of the pharmacist for patients with hypertension over time. This will address questions such as: What is the role of the pharmacist in life-style modification? How can you best give advice when dispensing antihypertensives for the first time? What is the role of the pharmacist in deprescribing medication in hypertension patients in old age? How can new services for hypertension patients be implemented in daily pharmacy practice?
A pharmacist, researcher at Vilnius University, Lithuania and PhD candidate at Groningen University, Netherlands. Got a Pharm M diploma at Lithuanian Health Science University in 2005. For 12 years worked as the head of a small pharmacy chain and practicing pharmacist. In 2014 completed second master in international marketing. From 2017 responsible for Pharmacy undergraduate program at Vilnius University. Board member of Lithuanian Pharmaceutical Association, EuroDurg Executive Committee member, COST ENABLE MC-substitute member. Research interests: hypertension, drug utilization and pharmacy services.
Professor of pharmacotherapy and clinical pharmacy and programme director of the master of pharmacy at the University of Groningen in the Netherlands. She obtained a degree in pharmacy from University of Hamburg in Germany, an MSc and a PhD in clinical pharmacy at The School of Pharmacy, University College London (UCL), UK. She is currently chair of the European network on drug utilization research, EuroDURG. Her research focuses on the development and evaluation of interventions to improve medication use in practice. Current research includes the EU funded Happy Patient project, where she is workpackage leader exploring the role of the pharmacist in antibiotic dispensing. She is also work package leader of the EIT Health funded project on developing a communication course for community pharmacists using mentalizing.
Patient safety – how to implement, measure and improve activities
Patient safety is a fundamental principle that targets avoiding any harm to patients during their care and treatment. I will present examples of systems, processes, and activities which can help to minimize the likelihood of errors and maximize the likelihood of intercepting them when they occur. We will discuss the identification, analysis, and management of patient-related risks and incidents, in order to make patient care safer and minimize the harm to patients. Also, there will be time for doctors, pharmacists, nurses, and other health professionals to discuss how the activities described in the workshop can be supported and implemented in their home institutions.
My educational background is nurse and nursing educator. I have a clinical background in surgical and intensive care nursing. For several years I have worked as a nursing manager at the South Estonia Hospital and also in the private sector, where I was responsible for personnel development and personnel leadership. In 2012 I got my master’s degree in Nursing Science and my Master’s Thesis was about the needs of the patients’ relatives and meeting their needs in adult intensive care.
Since 2012 I have been working at the University of Tartu, Faculty of Medicine, Institute of Family Medicine and Public Health, Department of Nursing Science. My position now is a program director of the Nursing Science Master Curriculum and a Junior Lecturer. My key work is curriculum administration and development, teaching future nursing managers and educators, and supervising master-level research. I am a PhD candidate and my research focuses on patient safety incidents reporting and learning systems, their utilization, and outcomes.
Additional risk minimisation measures – the role of the pharmacist in improving medication safety
Ensuring that medicines are used with minimum risks may be a challenge for those involved in prescribing, dispensing and using medicines. Risk minimisation measures (routine and additional) help to support the safe and effective use of medicines.
Routine risk minimisation measures apply to all medicinal products and are included in product information (SPC) and the package leaflet (PIL). It is usually adequate to address safety concerns relating to medicinal products by applying these ‘routine’ risk minimisation measures. Product information is updated in case new safety/efficacy information is introduced.
Additional risk minimisation measures (aRMM) are considered necessary in case new safety data is important to a degree that ignoring it will place the patient’s health at risk. Examples of additional risk minimisation measures include Direct Healthcare Professional Communications (DHPC), educational programmes/ materials, pregnancy prevention programmes and controlled access systems for certain medicines. The aim of these additional measures is to further support the safe and optimal use of a medicinal product in clinical practice.
Several studies have underlined that the aRMM-s are not followed in practice in Estonia and thus patients might be in greater risk posed by medicines’ adverse events than need be. This seminar discusses the role of the pharmacist in the promotion of and compliance to the aRMM-s and potential solutions to increasing their uptake by healthcare professionals.
Katrin graduated with an MSc in pharmacy in 2009 from the University of Tartu. After graduation, Katrin worked for a short time in a community pharmacy. Since 2012, she has been working at the Estonian State Agency of Medicines. At first, she was involved in compiling drug consumption statistics. In recent years, she has been engaged with medicinal products’ safety information and risk minimisation measures. Katrin has also improved her skills in data science. She has many years of experience in research in drug utilization and effectiveness of risk minimisation measures. Several of her works have been published in national and international journals. In this autumn, Katrin started her doctoral studies in public health on the usage of benzodiazepines and benzodiazepine-like medicines and related harm in Estonia at the University of Tartu.
Ott is working at the State Agency of Medicines in the field of medication safety and rational use of medicines. He has been working at the agency since 2008. First at the Bureau of Drug Statistics, later at the Department of Medicinal Products and now at the Department of Post-authorisation Safety. He graduated from Tartu University as a pharmacist and defended his PhD thesis, which was on the primary and secondary medication adherence of Estonian citizens using the consumption of osteoporosis drugs as an example, in the same university.
Ott is a member of the Estonian medicines reimbursement committee, the community pharmacy quality guidelines working group and pharmacy terminology expert group. He is also a member of international organizations EuroDurg and PIPERSKA Group that both promote the rational use of medicines. Ott teaches pharmacoeconomics to pharmacy students at Tartu University.
A digital example promoting a patient-centred approach in health behaviour change: The Train4Health project
Adherence to medication and beneficial lifestyle changes in prevalent chronic diseases are often unsatisfactory, leading to health complications and increased costs that threaten the sustainability of health systems. In the broader context of self-care, supporting the self-management of chronic patients is critical to achieving better health outcomes. Self-management involves adhering to medication, a diet or engaging in physical activity, which is intrinsically linked to behaviour change.
Health professionals are expected to deliver behaviour change support to people with chronic diseases. However, the scientific literature indicates that students and professionals present a skill gap in behaviour change support, resulting from education insufficiencies and limited training opportunities. Improving students’ and professionals’ on behaviour change support to effectively promote self-care in people with chronic diseases is the aim of the Train4Health project.
This presentation aims to provide the basic concepts on behaviour-change interventions as well as hands-on experience in patient-centred support through a digital resource. Participants will use their smartphones for interacting with virtual patients and improving their counselling skills.
Afonso Miguel Cavaco holds a PhD in Pharmacy Practice and Policy from UCL (UK), a post-doc in Health Communication from Johns Hopkins University (USA) as a Fulbright Fellow, and a Docent title from Helsinki University (Finland). He is currently an associated professor and R&D developer in social pharmacy at the University of Lisbon, Faculty of Pharmacy (Portugal). He is a visiting scholar at Vilnius (Lithuania) and Tartu (Estonia) Universities.
Afonso is actively involved in interdisciplinary practice research and contributing to the education of pre and postgrad pharmacists and nurses. Scientific outputs comprise book chapters and over 85 articles published in indexed journals with impact factor. Afonso also presents in science and professional-related events, including plenary sessions by invitation, workshops leading, and oral communications. Educational deliverables comprise the implementation of innovative pedagogical approaches, such as pharmacy practice simulation. His international profile encompasses active roles in European scientific associations (e.g. EACH) and international events organization (e.g. ISPW).