Pharmacy Services Part 1 (5.1)

● To tailor and meet the needs of the patients/clients

that we serve

● To expand the business and maintain sustainability

through a variety of service, aside from the goods

sold

● To encourage more clients, which improves

business outcomes

WHY OFFER PHARMACY SERVICES

Point of care services, Monitoring and screening services, Wellness/Health Promotion programs, Disease-state management, Case management

TYPES OF PHARMACY SERVICES

Point of care services

pharmacy services that are directly

given to the patients such as in the dispensing

or prescription processing. (e.g. allergy testing)

Monitoring and screening services

Require drug visits (e.g. blood glucose, blood sugar monitoring)

Wellness/Health Promotion programs

Non-pharmacologic services (e.g. smoking cessations, weight

reduction programs)

Disease-state management

the pharmacist can optimize medication therapy for a long term (e.g. diabetes)

Case management

Involves assessment and planning and care

coordination of the needs of the patients. (e.g. malaria)

● Data collection

● Pharmacy-based laboratory screening or monitoring

services

● Medication management

● Patient education

● Outcomes measurement

COMPONENTS OF PHARMACY SERVICES

• Product-centered → Patient-centered

• Provision of medicines does not always equate to effective treatment outcomes

• Distribution of medicines to ensure safe and efficacious use

ROLE OF THE PHARMACIST

demographics, socio-economic situation, technological situation, health scenario

factors involved in SITUATIONAL ANALYSIS for BUSINESS CONCEPT AND STRATEGY

1. FDA License to Operate as Drugstore (took a month to obtain)

2. Certificate of Business Name Registration (either DTI/SEC)

3. Barangay Clearance

4. Mayor’s Business Permit

5. Sanitary Permit

6. Fire Safety Inspection Certificate

7. BIR Registration Certificate

LEGAL REQUIREMENTS FOR AN INDEPENDENT PHARMACY

• Accomplished e-Application Form with Declaration of Undertaking. Include the following:

  ○ Location plan

  ○ GPS coordinates

  ○ Name of Qualified Person

• For pharmacist: PRC ID and cert for seminars

• Proof of Business Name Registration;

• Proof of Income (Latest Audited Financial Statement

  with Balance Sheet)

• Payment of Fees

AO 2020-0017, the following are the

requirements for initial LTO application:

1. Overall

management

and operations

of the pharmacy

2. Dispenses Rx

drugs

3. Supervises staff

4. Creates SOPs

5. Fulfills regulatory

compliance

activity

6. Purchases

pharmacy

inventories

7. Supervises

inventory

management

8. Handles human

resource

activities

9. Manages

security in the

establishment

10. Manages patient

profiles and

conducts patient

counseling

11. Marketing plan

and activities

12. Pricing

Pharmacist-owner roles in a chain or independent drugstore

1. Implements

SOPs

2. Cashier

3. Manages

security in the

establishment

4. Assists the

pharmacist-

owner in

dispensing

activities

5. Performs

inventory

management

6. Performs

marketing

activities

7. Performs

other activities

as assigned

by

pharmacist-owner

Store manager roles in a chain or independent drugstore

1. Assists in the

dispensing of

medicines

2. Housekeeping

3. Performs

inventory

count

4. Performs

other activities

as assigned

by

pharmacist-owner

Pharmacy assistant roles in a chain or independent drugstore

• Philippine Drug Price Reference Index

• Margin the owners would want to generate as the

  net profit + (OPEX) + (CAPEX)

Consider the following when deciding for the price of

products:

OPEX

estimated or projected expenses from operating expense; includes:

➢ Salaries

➢ Monthly rent

➢ Electricity and water bills.

➢ Supplies

➢ Taxes.

➢ Inventory

➢ Traveling expenses

➢ Meal allowance

CAPEX

the amortization of the capital expenditure

includes

➢ Rent for space (Advance and deposit) /

➢ Renovation

➢ Marketing (Panaflex signage)

➢ Fixtures and Equipment.

➢ Supplies

➢ Licenses

➢ Inventories

➢ Others

PROFESSIONAL REGULATORY BOARD OF

PHARMACY RESOLUTION NO. 05

SERIES OF 2021

Accrediting Philippine Pharmacists Association,

Inc (PPhA) as the Training Provider to Conduct

the “IMMUNIZING PHARMACIST CERTIFICATION

PROGRAM”

• as training provider

• accredit the program entitled “Immunizing Pharmacist Certification Program”

• to issue a Certificate of

  Training to every pharmacist

• to submit a list of

  pharmacists who were conferred with a

  Certificate of Training within ten (10) days

  after the end of the program - submit the list of participants w/in 10 days

• a list of Certified

  Immunizing Pharmacists

The PRC Board hereby recommends PPhA to be the ff:

w/in FDA-license pharmaceutical outlet

only outside when: 1) during public health emergencies, 2) vaccination programs initiated by the government

when to administer adult vaccines?

• public health emergency

• within 3 yrs from conferment

accreditation of PPhA shall be valid when:

● Prescription for Vaccine

● Verification of Patient Identity

● Patient Screening Vaccine Information Statement

(VIS)

● Consent Form

● Vaccine Preparation

● Patient Identity Verification Vs Vaccine

Requested

● Vaccine administration

● Used syringe disposal

● Aftercare Instructions

● AEFI monitoring

THE IMMUNIZATION PROCESS

Vaccine Information Statement (VIS)

pieces of information that the patient

should know before the patient could get the

vaccine; these include:

• allergies

• why does the patient need the vaccine

• precautions

Adverse Events Following Immunization (AEFI)

procedure in which patient is given instructions to remain in the

pharmacy for at least 15 mins so that you would

know the condition of the patient after the

administration of the vaccine

● Educator

● Advocate

● Facilitator

● Supply and storage

● Vaccine Administration

● Vaccine Records

WHAT A COMMUNITY PHARMACIST IS IN

IMMUNIZATION

● Gather: px info

● Evaluate: vaxx needs

● Provide: px education and vaxx info statement

● Administer: obtain px consent and adminsiter

● Document: vaccine that was adminstered

● Follow-up: AEFI monitoring

WHAT A COMMUNITY PHARMACIST DOES IN

IMMUNIZATION

● Patient/Parent Education

● Medical and Office Protocols

● Vaccine Preparation

● Administering Vaccines

● Records Procedures

COMPETENCIES OF AN IMMUNIZING PHARMACIST

Communication skills, Crtical thinking and decision-making, Organizational skills, Personal responsibility, Technical Skills

PATIENT PARENT EDUCATION comprises of the ff:

VACCINE PREPARATION SKILLS

Observe of aseptic techniques, including proper

hand hygiene for immunization

● Communication skills

● Vaccine administration skills

● Waste management

● Critical Thinking and Decision-making

VACCINE ADMINISTRATION/ ADMINISTERING VACCINES comprises of the ff:

RECORDS AND PROCEDURES

Documentation and record keeping that includes maintaining the documents of the ff:

■ SOPS

■ VIS

■ Vaccine Administration Forms

SCREEN (px), PREPARE (vaxx), INJECT, DOCUMENT

(SPID)

how to vaccinate

RA 11036: Mental Health Act of 2017

Law based on PHARMACIST’S ROLE IN PROVIDING MENTAL HEALTH SERVICES

RA 11036: Mental Health Act of 2017

An Act Establishing a National Mental Health Policy

for the Purpose of Enhancing the Delivery of

Integrated Mental Health Services, Promoting and

Protecting the Rights of Persons Utilizing

Psychosocial Health Services, Appropriating Funds

Therefore and Other Purposes

The Philippine Council for Mental Health

herein referred to as the Council, is hereby established as a policy-making planning, coordinating and advisory

body, attached to the DOH to oversee the

implementation of this Act. (Mental Health Act of 2017)

mental health

“state of well-being in

which an individual realizes his or her own

abilities, can cope with the normal stresses of life,

can work productively and is able to make a

contribution to his or her community”

Diagnostic and Statistical Manual of Mental Disorders – 5th Edition (DSM-5)

Mental health disorders are

defined by the ?

Mental health disorders

“a syndrome characterised by clinically significant

disturbance in an individual’s cognition, emotion

regulation, or behaviour that reflects a dysfunction

in the psychological, biological, or developmental

processes underlying mental functioning.”

Substance Abuse and Mental Health

Services Administration (SAMHSA)

An organization that defined the 10 Essential Values for

Responding to A Mental Health Crises

● Avoiding harm

● Intervening in person-centered ways

● Shared responsibility

● Addressing trauma

● Establishing feelings of personal safety: sense of security

● Based on strengths

● The whole person

● The person as credible source : do not be dismissive

● Recovery, resilience and natural supports

● Prevention

10 Essential Values for

Responding to A Mental Health Crises (SAMHSA)

safe, effective, patient-centered, timely, efficient, equitable

Institute of Medicine’s six domains of health care

quality (SEPTEE)

Safe

Avoiding harm to patients from the care that

is intended to help them

Effective

Providing services based on scientific

knowledge to all who could benefit and

refraining from providing services to those not

likely to benefit (avoiding underuse and

misuse, respectively).

Patient-Centred

Providing care that is respectful of and

responsive to individual patient preferences,

needs, and values and ensuring that patient

values guide all clinical decisions.

Timely

Reducing waits and sometimes harmful

delays for both those who receive and those

who give care

Efficient

Avoiding waste, including waste of

equipment, supplies, ideas and energy.

Equitable

Providing care that does not vary in quality

because of personal characteristics such as

gender, ethnicity, geographic location and

socioeconomic status.

● Relationship-based culture

● Coordinated infrastructure

● Bi-directional communication

● Ongoing needs assessment

● Responsive solutions

ICSI (Institute for Clinical Systems Improvement)

identified five foundational elements for supporting

the well-being of the healthcare workforce: (RCBOR)

Institute for Clinical Systems Improvement

ICSI is known as

Relationship-based culture

Foster a culture where positive relationships

between staff at all levels are the cornerstone

of the organization.

Coordinated infrastructure

Coordination of expertise and services that

may traditionally operate in silos with the aim

of supporting staff.

Bi-directional communication

Develop a strong internal communications

strategy that enables direct and frequent

“top-down” as well as “bottom-up”

engagement to support your staff. (top-down communication, bottom-up engagement)

Ongoing needs assessment

Continually evaluate the needs of staff,

paying attention to particular stressors of

different work units.

Responsive solutions

Offer systems-driven interventions (e.g.,

policies, protocols, and programmes) and

staff self-directed interventions (e.g.,

podcasts, apps), and have an ongoing plan

for evaluation.

Limited time

Remuneration

Lack of access to medical records

Privacy concerns

Models of care

BARRIERS AND FACILITATORS TO PROVIDING

MENTAL HEALTH CARE SERVICES

Medicine Access Program for Mental Health (MAP-MH)

based on AO 2021-0012;

started in 2012 by the Pharmaceutical

Division and operationalized by the National Center

for Mental Health was designed to ensure availability

of mental health drugs in the community.

Pharmacotherapeutic Guidelines

under the MAP-MH and will serve as

the basis for clinical intervention in the primary and

secondary health facilities in the community.

Anxiety Disorders,

Mood Disorders, Psychosis, Dementia, Epilepsy

and Substance Abuse Disorders.

The guideline (Pharmacotherapeutic Guidelines) focuses on 6

mental health disorders, namely:

Access site

refers to a health facility where needed

essential medicines for MNS disorders are being

provided for enrolled service users.

Enrolled service user

refers to a service user with

any MNS disorder who 1s in the community and is

seeking regular consultation in an identified access

site as a beneficiary of the MAP-MH.

Medicine Access Program for Mental Health

(MAP-MH)

refers to a medicine access program

designed to provide needed essential medicines for

all enrolled service users with MNS disorders who are

in the community and are seeking regular

consultation in an identified access site.

Mental Health Gap Action Programme (mhGAP)

refers to a training program developed by the World

Health Organization (WHO) for primary care

practitioners in nonspecialized settings as an

intervention guide in the treatment and management

of MNS disorders and adapted for use in the

Philippine context.

National Drug Policy Compliance Officer (NDPCO)

refers to pharmacists under CHDs or MOH-BARMM

that are designated to oversee the implementation of

all programs and activities

National Mental Health Program (NMHP)

program offering a wide range of promotive,

preventive, curative, and rehabilitative services for

persons who suffer from MNS disorders.

Wellness of Daily Living, Extreme

Life Experience, Mental Disorders, Neurologic

Disorders, and Substance Abuse and other Forms of

Addiction.

NMHP has five (5) components:

6 months

Near expiry medicine refers to a medicine that is

_____ prior to expiration date.

Starter kit

refers to a set of essential medicines

provided initially to a health facility whose primary

care physician has been newly trained in mhGAP.

Pharmaceutical Division (PD)

National Drug Policy Compliance Officer (NDPCO)

these are responsible for provide technical assistance and monitoring support to NMHP in the procurement, distribution, and utilization of procured essential medicines for MAP-MH.

Knowledge Management and Information Technology Service (KMITS)

in collaboration with the NMHP shall develop a functional electronic

information management system for MAP-MH.

Philippine Health Insurance Corporation (PhilHealth)

shall develop and implement an outpatient benefit package for MNS disorders.

a. Identify health facilities to be identified as access

sites for MAP-MH.

b. Monitor and supervise the implementation of

MAP-MH in the identified access

sites in their regions.

c. Collect, consolidate, and analyze the reports from

access sites.

d. Prepare a summary of reports collected from

access sites and submit this to NVHP with

recommendations on improving the implementation.

e. Resolve issues and other concerns needing

actions on the operationalization of the program.

f. Enforce a mechanism of moving stocks of

medicines among access sites with low

levels of utilization in coordination with other access

sites.

Centers for Health Development (CHDs) shall:

a. Receive the goods from the local suppliers

according to the quantity and

specification stated in the Purchase Order.

b. Prepare reports such as Arrival Report to End-user,

Request of Inspection and Acceptance to End-User,

Notice of Delivery to COA, Request of Inspection to

FDA, and Request of Inspection.

c. Oversee the inspection of medicines together with

the end-user.

d. Manage the warehousing, packaging, and

distribution of medicines to the identified access sites

The Supply Chain Management Service (SCMS)

shall:

Ordinance No. 3158 S-2022

An Ordinance Institutionalizing the Quezon City

Comprehensive Mental Health Programs and

Services and for Other Purposes, in which pharmacists are

included in the health professionals trained on

basic mental health.

○ Benzodiazepines

○ Zolpidem

○ Esketamine

○ Methylphenidate

FOUR psych meds/classes need S2 (BZEM)