From responsible medicine use to complex patients: pharmacists take the lead
- Correspondence to Myriah Lesko, Bsc Pharm, BSc, Manager, Media and Publications, International Pharmaceutical Federation (FIP), PO Box 84200, 2508AE The Hague, The Netherlands;
- Received 19 December 2012
- Accepted 20 December 2012
- Published Online First 19 January 2013
Looking back: the FIP Centennial
In 2012 the International Pharmaceutical Federation (FIP) celebrated 100 years of existence and marked the occasion with the FIP Centennial Congress in Amsterdam, The Netherlands in October. The Centennial was more than just a Congress; it was an entire event that encompassed all that FIP and the pharmacy profession had accomplished over the past 100 years and set the stage for the future, all under the theme of ‘Improving health through responsible medicines use’ (Figure 1).
The Congress sessions were complemented and supported by key events never before seen at a FIP Congress, yet set a precedent for ground-breaking initiatives that will continue in years to follow. This is especially true of the FIP Stakeholder Roundtables, which brought together influential stakeholders from around the world and from a cross-section of sectors to discuss current and relevant issues facing the development and delivery of healthcare now and in the coming era.
The first series of Roundtables focused on the themes of ‘The right medicine to the right patient’, ‘Adherence’ and ‘The transformative power of shared information within health systems’ and were a source of strategies and solutions that were presented to a following Ministers’ Summit on ‘The benefits of responsible use of medicines: setting policies for better and cost effective healthcare’ organised by the Dutch Ministry of Health. The Summit convened Health Ministers and influential officials to dissect the issue of how investing more in the responsible use of medicines can positively influence health and, in turn, health spending.
Discussions within the Summit were based on the outcomes of the FIP Stakeholder Roundtables and two reports, one from the WHO entitled ‘The pursuit of responsible use of medicines: sharing and learning from country experiences’ and one from the IMS Institute for Health Informatics entitled ‘Advancing the responsible use of medicines’, the latter stating that US$500 billion could be avoided annually with more responsible medicines use and listed increasing the role of the pharmacist as a top solution. This was followed up with a Roundtable on Innovation, which sought a practical long-term strategy for increasing responsible medicines use.
More information on the FIP Stakeholder Roundtables and the Ministers’ Summit can be found on the FIP Centennial website (http://www.fip.org/centennial).
Another major point of pride for the FIP during this time was the signing of the FIP Declaration—Improving Global Health by Closing Gaps in Development, Distribution and Responsible Use of Medicines. This Declaration was signed by all FIP Council Members including Roberto Frontini, President of the European Association of Hospital Pharmacists, and solidifies a global commitment to better medicines use worldwide.
The activities of the FIP Centennial served a dual purpose—to look back on past accomplishments but, as stated, to steer FIP, its members and the world's pharmacists and pharmaceutical scientists on a path to future success. In 2013 the FIP Congress in Dublin, Ireland will build on the work done at the FIP Centennial and, at an inaugural meeting for Chief Pharmacists, aims to develop concrete solutions to those issues discussed throughout the FIP Stakeholder Roundtables and Ministers’ Summit.
The year to come will also offer extraordinary opportunities for pharmacists within all practice areas to increase their awareness of issues affecting the health of patients worldwide. On the heels of in-depth discussion on responsible medicines use, FIP is going one step further to look at all factors—cultural, economic, medical and biological—that may affect both medicines use and patient health in general, and is putting the care of ‘complex patients’ at the top of the agenda for 2013.
Who are your complex patients?
The issue of complex patients is one that has been addressed by healthcare professionals for some time. Yet, as the general population ages and chronic disease becomes more prevalent, it is an issue that continues to escalate. It is difficult to define a complex patient, yet it is generally understood that the term applies to those who require an extra amount of care and consideration as a consequence of complicated and extensive medicine regimes compounded by physical and mental limitations.
Current statistics suggest that complex patients comprise upwards of 25% of individuals in primary care practices who fulfil one or more of the following criteria (Figure 2):
Multiple well-defined chronic illnesses with various complications
Highly complicated treatment involving invasive procedures both for diagnosis and therapy
A peculiar combination of resiliency and fragility
Unexpected responses to common medications and minor illnesses
Longevity (living highly functional lives into the 80s and 90s)
With complex patient management demanding an ever-increasing multidisciplinary approach, the pharmacist's main focus is medicines management in the face of other complexities.
A future vision for complex patients
The 2013 FIP World Congress of Pharmacy and Pharmaceutical Sciences to be held in Dublin has adopted the theme of complex patients and will examine the issue from all standpoints: biological (emphasising the current development of systems biology), medical (demographics, genetics, smoking, alcohol, diet and multiple diseases), socioeconomic (availability of resources, literacy) and cultural (beliefs, traditions, religion) (Figure 3). Pharmacists have the ability and opportunity to support patients in every aspect of complexity.
In delivering the overall message, Programme Chairs Professors Geoff Tucker and Phil Schneider emphasise that patients are likely to become increasingly complex as they grow older and develop multiple diseases requiring treatment with several medicines. In turn, this creates the need for integrated care across medical specialties and effective collaboration within a team of health professionals. The pharmacist is an important member of this team, with an important role to play in understanding and managing the complex patient, especially with respect to the responsible use of medicines.
Having considered why patients are complex, sessions within the Congress will address the needs of complex patients, how these needs are currently being met, and emerging and future strategies for treating these patients. By providing evidence-based scientific information and embracing collaborative practice, the pharmacist should have a critical role in dealing with complexity in patient care.
The challenges of complexity: finding solutions at the FIP Congress
It is imperative that complexity is also considered from the perspective of the patients, who may or may not consider themselves ‘complex’. For each person, the primary concern is how their illness and—secondary to that—their medicine will affect their daily lives. With that in mind, the FIP Congress will address complex patients also from illness perspectives.
Dr Timothy Chen, Associate Professor at the University of Sydney specialising in mental health, says that it is known, for example, that pharmacists often feel more comfortable and confident contributing to the management of physical conditions such as cardiovascular disorders than mental disorders. He explains that the global disease burden arising from mental illness is immense. Although there are different modes of management for mental disorders (eg, psychotherapy), drug therapy is the major modality of treatment for many conditions such as depression, bipolar disorder and schizophrenia. Pharmacists, as experts in pharmacotherapy, should therefore have a major role in the management of mental illness.
Equally, there are many other factors that can make the management of patients with a mental illness more complex. Examples include the high rate of medication non-adherence (estimated to be approximately 50%) in patients prescribed antidepressant and other psychotropic medicines and the burden of managing significant adverse effects such as diabetes, weight gain and dyslipidaemia. Although there are many challenges in the management of mental illness, pharmacists should and do have a major role to play in the delivery of effective healthcare. In a session in Dublin Dr Chen will address factors contributing to the complexity of mental health patients and how pharmacists may best support these patients in the community.
Taking the issue of complexity from the perspective of life-threatening diseases and the medicines that treat them (both current and emerging), Professor Ross McKinnon will be leading a series of lectures that address the complexities of the cancer patient. Key factors to consider in such discussions are that cancer does not discriminate and cancer is also a disease of ageing. This means that, for many, cancer is diagnosed in the presence of a range of comorbidities including chronic conditions such as diabetes, cardiovascular disease and musculoskeletal conditions.
Pharmacological management in these circumstances is challenging with a host of issues including the number of medications required, the risk of drug–drug interactions and the need to minimise drug toxicity. In parallel with these pharmacological challenges, significant psychosocial issues raised by the diagnosis of cancer add further complexity. The issues are perhaps brought into sharp focus in patients with advanced cancer where surgical options are limited and drug therapy is necessarily intense and the risk of toxicity high.
Nowhere do pharmacists interact with complex patients more than in the community. Ms Karin Graf supports the goal that pharmacists should be at the core of partnerships when it comes to managing diseases in the community such as asthma—monitoring patients, performing triage, advising about treatment options and preventing additional complexities. More than 300 million individuals worldwide have asthma and they often receive care and counselling from pharmacists. Ms Graf's session in Dublin will focus on how both the health and economic burdens of asthma can be reduced through these patient–pharmacist relationships.
The examples given above illustrate only a fraction of the topics that will be addressed at the 2013 FIP Congress in Dublin, all centred on how the pharmacist is ideally skilled and positioned to ensure that complex patients receive the best care possible. Thousands of pharmacists from all over the world and from all areas of pharmacy practice and science will convene in Dublin to work towards a future in which multidisciplinary approaches maximise healthcare contributions for the full benefit of patients, despite their wide range of social, cultural, medical and biological diversity.
For more information on the FIP Congress in Dublin and its perspective on complex patients please visit the website at http://www.fip.org/dublin2013.
Competing interests None.
Provenance and peer review Not commissioned; internally peer reviewed.