#FAP_ICSCC Primary care pharmacists, support for patient-centred care

Josep Vidal-Alaball

For writing this post, Josep Vidal-Alaball has shared authorship with Anna Maria Bonet Esteve and Aïna Fuster Casanovas.

Health systems have always been more disease-oriented than patient-oriented. In a paternalistic way, the patient's medication has been managed, indicating what he or she has to take and how they have to do it. What consequences has this had? Discomfort in those patients for whom the medication does not suit them, with the consequent interruption of the treatment and the frustration of the professionals for not obtaining results, in addition to the high cost associated with the health system. The social profile of the Catalan population is characterized by progressive ageing and, therefore, by an increase in chronic pathology and associated comorbidities. Fragmented health care among multiple health providers in the system can complicate treatments that are already complex per se. In a context of excessive medicalization of daily life due to the use of medication as one of the main therapeutic resources in the provision of health care, there is an acute need to change the paternalistic management model to promote care that takes into account all stakeholders (1)(2).

Today, leading health systems are characterized by having a patient-centred health care model or moving towards such a model. Patient empowerment, shared decision-making and the formation of multidisciplinary teams are essential to promoting an effective and efficient health system. Precisely for this reason, we want to make you part of the incorporation of the figure of primary care pharmacists (PCF) to the primary care teams (PCT) for the improvement of the patient-centred management model in the Catalan Institute of Health of Central Catalonia.

The Pharmacy Unit and the Healthcare Directorate of Central Catalonia decided to promote the role of the pharmacist in PCTs and implement an innovative patient-centred model through the Pharmacy Unit Functional Plan approved in 2018 (2), a plan that stands out for promoting the more clinical role of PCFs with a more individualized approach to patients. Its objective is to optimize the pharmacological treatment of patients and, therefore, improve the quality of life and safety of care, contribute to the sustainability of health care and improve patient and health provider satisfaction (2). Thus, this innovative model not only complies with the three dimensions of the Triple Aim, the improvement of the patient experience, the clinical results in the population and the reduction of per capita costs but also seeks to comply with the fourth dimension that provides the Quadruple Aim: the promotion of professional satisfaction (3).

The importance of developing a plan to implement the reforms

Before putting the functional Plan into operation, the "pharmaceutical need" of each PCT was defined in a reasoned way to assimilate it into the already used "allocated quota" that other primary care professionals have. Different variables were set to calculate the estimated workload of primary care pharmacists for the performance of their functions. In this way, the assignment of PCFs to PCTs relied on the result of a synthetic index that corresponded to the weighted sum of a set of variables (dispersion, socio-economic index, assigned population, attendance, institutionalized population, number of residences places geriatric and psychiatric, number of residences, the synthetic value of the quality index of pharmaceutical prescription, percentage of polypharmacy patients, percentage of adherence to the Prescription Guide for geriatric centres, amount/resident, percentage of complex chronic patients, and drug safety incident rate). In addition, a communication plan aimed at giving visibility to the figure of the primary care pharmacist, both internally and among the reference population, with the creation of a logo and its hashtag on Twitter (#FAP_ICSCC), was added.

The Functional Plan was implemented in 2019 and was structured in two phases. The first involved the face-to-face transition of the PCFs from the primary care services, where the management and technical bodies reside, to the PCTs. Its principal role aimed to progressively transform the culture of approaching pharmacological treatment, giving more value to the structured review of medication within the framework of multidisciplinary teams. To this end, different actions were carried out, such as the creation of PCF's agendas integrated into the primary care clinical station (eCAP). Non-face-to-face visits also started to order medication reviews, prioritise multi-medicated patients and record the proposed recommendations in the patient's clinical history. In addition, the classic PCF activities focused on the population view of drug use were reorganized and a specific dashboard was defined to monitor the prioritized strategies, which are periodically updated. These strategies included the polypharmacy approach, the use of antibiotics or the treatment of anxiety or insomnia. Despite more than two years of the COVID-19 pandemic, this phase is currently the most consolidated, representing the leitmotif of the clinical role of the PCFs within the PCTs. The second phase proposed a more direct interaction with the patient and COVID-19 favoured a unique opportunity to make it operational. Although the plan included face-to-face visits with patients, especially multi-medicated patients, the start of the COVID vaccination campaign allowed the innovative interaction to be adapted to telephone contact to resolve the population's vaccine doubts. The data on the number of visits for the last two years is revealing: 2,883 visits in 2020 and 5,722 visits in 2021.

Patient-centred care, the challenge

The Pharmacy Unit of Central Catalonia has opted for the patient-centred care model, contributing in an innovative, pioneering and effective way to the multidisciplinary teams of primary care centres. Even so, the next objective is to implement face-to-face visits with patients. In this context, the growing increase in mental health problems is a challenge where the role of the PCFs can be decisive and, in this sense, they will be a reference framework with the start of a project aimed at reducing the use of benzodiazepines. Finally, we have to congratulate ourselves on the disruptive vision of the model that contemplates incorporating a PCF to each of the PCTs and that wants to be a source of inspiration for other teams.

I give thanks the PCFs of Central Catalonia: Mar Casanovas Marfà, Vanesa García Sánchez, Amanda López Ínsua, Adrián López Cortiña, Marta Massanés González, Carol Rovira Algara, Ester Vizcaíno Vilardell and Anna Bonet Esteve.

Bibliography

1. ENASPIC. Estratègia Nacional d’atenció primària i salut comunitària. :1–38. 
2. Bonet A. Pla Funcional. Unitat de Farmàcia d’Atenció Primària. Gerència Territorial Catalunya Central. 2018; 
3. Roure C. Avances en gestión clínica: From the Triple Aim to the Quadruple Aim. 2016.