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THE FUTURE OF PHARMACY

VOL 28, NO.1 - JUNE 2012

T h e Cent e r is a l s o r e s p o n s i b l e fo r r e p o r t i n g t h e r e s u l t s of t hi s pil o t p r o j e c t t o BNHI. Commun i t y p h a r m a c i s t s h a v e t o go t hr o u g h t h e t r a i n i n g p r o c e s s s e t by t h e Cent e r t o p r o v e t h a t t h e y ha v e t h e a b i l i t i e s t o p r o v i d e p r o p e r p h a r m a c e u t i c a l c a r e b e f o r e t h e y c a n p a r t i c i p a t e in t h e p r o j e c t . T h e p r o c e s s in c l u d e s a s e r i e s of cl a s s e s t o b ui l d up p h a r m a c i s t s ’ a b i l i t i e s t o a s s e s s p a t i e nt s ’ co n d i t i o n a n d a ll m e d i c a t i o n s cur r e nt l y r e c e i v e d , 3 , 9 id e nt i f y dr u g t h e r a p y p r o b l e m s a n d r e s o l v e t h e p r o b l e m s , im p l e m e nt c a r e p l a n s a n d fo ll o w - u p e v a l u a t i o n of p a t i e nt o ut c o m e s ( s e e Fig . 1 ) .

S i n c e t h e int r o d u c t i o n of t h e co n c e p t a n d im p l e m e nt a t i o n of p h a r m a c e u t i c a l c a r e in USA, 1 , 2 , 3 t h e FIP/ WHO is a ls o p r o m o t - i n g t h e p h a r m a c y p r a c t i c e t o fo c u s o n dir e c t p a t i e nt c a r e . 4 , 5 In 2 0 0 7, t h e a m e n d m e nt of Pha r m a c i s t Act in Ta i w a n a d d e d o n e r e s p o n s i b i l i t y of p h a r m a c i s t t o p r o v i d e p h a r m a c e u t i c a l c a r e r e l a t e d a c t i v i t i e s . 6

T h e Natio n a l Healt h In s u r a n c e (NHI) s y s t e m in Ta i w a n w a s la u n c h e d in 19 9 5 a n d is co v e r i n g a ll cit i z e n s f r o m bir t h . It is b ui l t o n t h e co n c e p t of mut u a l a s s i s t a n c e a n d d e p e n d s o n t h e in s u r e d p a y i n g t h e i r p r e m i u m s a c c o r d i n g t o r e g u l a t i o n s . Wh e n p e o p l e f a ll ill , t h e go v e r n m e nt us e s t h e p r e m i u m s it r e c e i v e s t o h e lp p a t i e nt s p a y la r g e p o r t i o n of t h e i r m e d i c a l r e s o u r c e s e x p e n d i t u r e s t o co nt r a c t e d h e a l t h c a r e p r o v i d e r s . In ot h e r wo r d s , by p a y i n g t h e i r m o nt h l y NHI pr e m i u m s o n t im e , p a r t i c i p a nt s a r e n ot o nl y h e lp i n g t h e m s e l v e s b ut a r e a l s o r e c e i v i n g t h e h e lp of ot h e r p r e m i u m p a y e r s . Pat i e nt s c a n s e l e c t wh e r e , wh o a n d wh e n t h e y wa nt t o go fo r m e d i c a l c a r e . B e c a u s e of t h e co n v e n i e n c e of m e d i c a l s e r v i c e s a n d t h e ge n e r o u s co v e r a g e of NHI, so m e in s u r e d s t a r t t o t a k e a d v a n - t a g e of t h e s y s t e m .

Acco r d i n g t o t h e s t a t i s t i c s f r o m Janu a r y t o Jun e 2 0 0 9 , t h e B ur e a u of Natio n a l Healt h In s u r a n c e (BNHI) dis c o v e r e d a b o u t 1 ,9 2 6 p e o p l e wh o ut i l i z e d o ut p a t i e nt s e r v i c e s fo r m o r e t h a n 5 0 v i s i t s p e r s e a s o n . T h e t ot a l h e a l t h c a r e e x p e n d i t u r e s ( in c l u d i n g dr u g co s t s) fo r t h e s e hig h us e r s of out p a t i e nt s e r v i c e s we r e a b o u t NT$ 3 0 9 , 5 1 6 , 8 74 (e q u a l s t o $ 97 5 , 3 2 0 US do ll a r s) fo r a ye a r ( int e r n a l d o c u m e nt ) . B e s i d e s p r o v i d i n g e x t r a c a r e a n d p e r s u a s i o n t o t h e s e hig h us e r s in e x p e c t i n g c h a n g e of b e h a v i o u r, t h e BNHI fe e l s t h a t it is m o r e im p o r - t a nt t o p r o v i d e t h e m wit h p r of e s s i o n a l h e lp a n d p e r s o n a l at t e nt i o n in or d e r t o imp r o v e t h e i r h e a l t h a n d r e d u c e t h e i r m e d i c a l r e s o u r c e s ut i l i z a t i o n . At thi s m o m e nt , p h a r m a c i s t s s t e p up a n d p r o m i s e t o h e lp .

Alt h o u g h p h a r m a c i s t s in Ta i w a n c a n p r o v i d e p h a r m a c e u t i c a l c a r e a c c o r d i n g t o t h e p h a r m a c i s t law sin c e 2 0 0 7, cur r e nt l y t h e s e r v i c e s a r e r a r e a n d us u a l l y n ot p a i d fo r. St a r t i n g Janu a r y 2 0 1 0 , t h e BNHI is re im b u r s i n g co m m u n i t y p h a r m a - c i s t s in Ta i p e i a n d K a o p i n g D i s t r i c t s t o p r o v i d e h o m e c a r e t o hig h us e r s of out p a t i e nt s e r v i c e s a s a pil ot p r o j e c t . T h e go a l of t h e p r o j e c t is t o de c r e a s e t h e ye a r l y t ot a l h e a l t h c a r e e x p e n d i t u r e s ( in p a t i e nt a n d o ut p a t i e nt s e r v i c e s) o n t h e s e IJHIVTFSTGPSNPSFUIBO$PNNVOJUZQIBSNBDJTUTXIP m e t t h e cr i t e r i a fo r h o m e c a r e p h a r m a c i s t s s e t by t h e Ta i w a n Pha r m a c i s t Ass o c i a t i o n ( TPA) may a p p l y t o p a r t i c i p a t e in t h e p r o j e c t .

Method TPA es t a b l i s h e d Cent e r fo r Pha r m a c e u t i c a l Care D e v e l o p - m e nt in Nove mb e r 2 0 0 9 a n d t h e p ur p o s e s a r e t o e du c a t e p h a r m a c i s t s a b o u t co n c e p t s a n d im p l e m e nt a t i o n of p h a r m a - c e u t i c a l c a r e a n d p r o v i d e p h a r m a c i s t s o p p o r t u n i t i e s t o le a r n co nt i n u o u s l y, t o de v e l o p d o c u m e nt a t i o n m e t h o d s , t o e s t a - b l i s h a c a d e m i c sup p o r t s y s t e m f r o m h o s p i t a l p h a r m a c i s t s , to pr o v i d e p a t i e nt e du c a t i o n m a t e r i a l s a n d p a t i e nt e v a l u - a t i o n t o o l s , a n d t o m o n i t o r a n d im p r o v e p r o j e c t pr o c e s s . 7, 8

Pass the written exam

Four-day training course (31 hrs) to establish the capacity on assessment , care plan,

follow-up evaluation

Five cases internship at hospital or nursing home facility directed by preceptor and practice to write

a report for each case

Oral present two cases as oral exam arranged by Taiwan Pharmacist Association (TPA)

Pass the oral exam

Send application form to Bureau of National Health Insurance (BNHI) for ”home care practice”

TPA give a badge to approved pharmacists, sign a commitment form, then select the cases of high users from the list provided by the BNHI

Fig. 1. The process of pharmacists become a care giver

T h e hig h us e r s of out p a t i e nt s e r v i c e s a r e d e fi n e d a s p e o p l e wh o v i s i t e d o ut p a t i e nt c li n i c s m o r e t h a n 2 0 0 t im e s in t h e ye a r of 2 0 0 9 , m o r e t h a n 5 0 t im e s p e r s e a s o n f r o m t h e fo u r t h s e a s o n of 2 0 0 8 t o t h e t hi r d s e a s o n of 2 0 0 9 , o r m o r e t h a n 2 0 t im e s e a c h m o nt h . T h e y us u a l l y h a v e “d o c t o r sh o p p i n g ” b e h a v i o u r. T h e y wo u l d v i s i t m o r e t h a n 6 ho s p i t a l s o r clin i c s in s e a r c h of o ut p a t i e nt s e r v i c e s . T h e p a t i e nt m a y v i s i t dif f e r e nt p hy s i c i a n s wh o unk n o w i n g l y p r e s c r i b e dr u g s t h a t int e r a c t wit h e a c h ot h e r, h a v e co nt r a i n d i c a t i o n s , o r dup l i c a t e e a c h ot h e r in t h e s a m e cl a s s o r e v e n t h e s a m e dr u g s . T h e s e p a t i e nt s us u a l l y d o n ’ t fill t h e i r p r e s c r i p t i o n s at t h e s a m e p h a r m a c y, t h e r e f o r e n o on e c a n ch e c k a n d b a l a n c e a ll m e d i - c a t i o n us e d fo r t h e m . B y v i s i t i n g t h e s e p a t i e nt s at h o m e a n d t a lk i n g t o t h e m f a c e t o f a c e , p h a r m a c i s t s c a n h e lp t h e m s e t up s e v e n - d a y m e d i c a t i o n o r g a n i z e r s t o imp r o v e co m p l i a n c e , id e nt i f y dr u g t h e r a p y p r o b l e m s a n d r e s o l v e t h e p r o b l e m s by e du c a t i n g t h e p a t i e nt s a n d /o r co m m u n i c a t i n g wit h t h e i r p hy s i c i a n s . Pha r m a c i s t s a r e a l s o r e s p o n s i b l e fo r a s s e s s i n g