药房的未来（英文版）.pdf

1SANDRA CAREYPresident  McCann Pharmacy InitiativeMARK WORMANGlobal Marketing DirectorMcCann HealthWHITE PAPER SERIES2PHARMACYS GLOBAL TRANSFORMATION IS PHARMAS OPPORTUNITYMarch 2017OUR HEALTHY FUTURE DEPENDS ON OUR ABILITYto interpret these new roles and relationships between Pharmacists, consumers, and health professionals and to facilitate the development of meaningful relationships that will drive health improvements and commercial outcomes for Pharmacy and the Pharmaceutical industry alike.It is a paradox that healthcares most-trusted and -accessible healthcare professional has also been its most undervalued and underutilized.1Pharmacy remains an untapped frontier in modern healthcarewe have not yet availed ourselves of its rich potentialbut times, and indeed healthcare models, are changing. As health systems buckle under the pressure of rising demand and diminishing resources, governments are increasingly pursuing models of integrated care to maximize expertise across a multidisciplinary healthcare workforce. In the process, the Pharmacistmarginalized for so longis being recognized as a key player on the healthcare stage and a main protagonist in the delivery of effective, outcomes-based care.It is vital that the Pharmaceutical industry take notice and, for the common good, recognize Pharmacy in its new role as a primary health interventionist.The transformation of Pharmacy is, without question, a global movement, endorsed top-down by national governments and health-policy makers and inspired by initiatives from NGOs like the International Pharmaceutical Federation (FIP), which represents a skilled healthcare workforce of some 3 million Pharmacists and Pharmaceutical Scientists, their 139 national organizations, and academic and institutional memberships. These initiatives are designed to prepare Pharmacy for the future. While the speed and mode of Pharmacy evolution differs around the world, the direction of travel is only one way. As health systems buckle under the pressure of rising demand and diminishing resources, governments are increasingly pursuing models of integrated care to maximize expertise across a multidisciplinary healthcare workforce. Pharmacy is at the center of a community healthcare redistribution, driven by an information-empowered, self-care-inclined consumer on the demand side and Pharmacy innovation, with escalating standards for quality of service (Good Pharmacy Practice) on the supply side. The Pharmacist, for many, is already the consumers most-trusted health expert, but Pharmacy is also moving fast to establish its role as health innovator, problem solver, health advocate, and primary health interventionist. 3These development stages are characterized by the maturity of healthcare markets, health infrastructure investment, population health, and socioeconomic challenges, but the trend is clear.IT IS VITAL THAT THE PHARMACEUTICAL INDUSTRY RECOGNIZE PHARMACY IN ITS NEW ROLE AS A PRIMARY HEALTH INTERVENTIONISTDEVELOPING MARKETSEMERGING MARKETSRAPIDLY EMERGING MARKETSDEVELOPED MARKETSHYPER- DEVELOPED MARKETSINDIA TURKEY JAPAN UK AUSTRALIACHINA BRAZIL ITALY GERMANY CANADAEGYPT RUSSIA NETHERLANDS HONG KONG USA4AROUND THE WORLD, Pharmacys role is expanding from supply chain to primary care, from intermediary and retailer to expert advisor in health and wellness. From the developing nations of India and China to more-developed markets like the UK, this evolution is accelerating, with Pharmacists poised to emerge as primary-care interventionists amidst a confluence of health providers. In developing markets such as Egypt, international collaboration has enabled new initiatives to enhance the contribution of Pharmacies to improve health metrics (see Figure 1). In  hyper-developed markets like Australia and Canada, Pharmacy is also reflecting a shift from illness to wellness, fueled by health awareness, technology, and health empowerment, and is establishing itself as a one-stop health-and-wellness destination.So what does all this mean? The implications for Pharmacy, of course, are considerable. We will witness the modernization of infrastructure while our experience in Pharmacy, as health consumers, will expand engagement with the Pharmacist, from dispenser to proactive health-and-wellness manager. Health protection, disease prevention, early disease management, and even gatekeeping for the treatment of escalating chronic disease will define Pharmacy practice in the near future. The implications for industry are equally consequential. Pharmas engagement with Pharmacy historically has not optimized Pharmacys true potential, with most companies choosing to focus their commercial investments on other healthcare professionals within the primary-care establishment. Pharma has typically underutilized Pharmacys knowledge and expertise, undervalued its emotional connection with patients, and underinvested in its potential to manage health outcomes. However, as this global movement gathers greater momentum, Pharma must move beyond the myopia of Pharmacist as shopkeeper to recognize Pharmacys greater potential. To reflect this, it must change the terms of engagement with Pharmacy while thinking more progressively about how it approaches Pharmacy and build greater salience into educational and promotional communications.It must also be said that we overlook the significant commitments that Pharmacy has already made to improving global health by advancing Pharmacy practice and science to enable better discovery and development of, access to, and safe use of appropriate, cost-effective, and quality medicines worldwide and, at the community level, to building a stronger fabric of health management and illness prevention, improving the quality and delivery of health in community practice, and supporting consumer self-care.As Pharmacy presses forward with this mission to play a leading role in the delivery of person-centered, outcomes-based care, Pharma is well advised to acknowledge these commitments and align with Pharmacy to work collaboratively in support of our health systems goals. The benefits are both marked and mutual. Not only will better engagement make a positive contribution to health outcomes in developed and developing countries, but it can also act as a vector for change in industry by building new partnerships, greater trust, and a stronger system that will drive commercial gains, a win-win for Pharmacy, Pharma, policy makers, and, crucially, the consumer. But the time to act is now.PHARMAS ENGAGEMENT WITH PHARMACY HISTORICALLY HAS NOT OPTIMIZED PHARMACYS TRUE POTENTIAL5FIGURE 1 SAHETAK THARWETAK, OR YOUR HEALTH IS YOUR WEALTHThe metrics for improved health outcomes demonstrate some of the benefits. Malnutrition among infants under two years of age has dropped from 36% to 2%. The percentage of women receiving prenatal care increased from 54% to 67%. Medical-assisted deliveries have increased from 70% to 95%, and 79% of new mothers now use family-planning techniques, up from 50%. To use the title of the campaigns family-planning pamphlets, “Mabrouk!,” or “Congratulations!”More than 1.28 million people were reached through an integrated campaign of printed pamphlets, television programs, publicized mass-wedding events, and community-based components, supported by health providers and “Ask, Consult”-affiliated pharmacies. Ninety-eight percent of the nationwide pharmacy network was reached by CHLs integrated campaign, and community engagement projects were run in 120 villages throughout Egypt.“Health metrics represent the true state of our nations,” observed John Cahill, CEO of McCann Health. Take the Communication for Healthy Living (CHL) “Ask, Consult” campaign to appreciate the contribution of pharmacies to improved health metrics in Egypt.Founded by the Johns Hopkins University Center for Communication Programs and funded by the United States Agency for International Development (USAID), CHL branded all its messages and activities with “Sahetak tharwetak,” or “Your health is your wealth.” Using marriage as the entry point for its communication strategy, CHL collaborated with 30,000 private companies to manage a network of physicians, pharma companies, and privately owned pharmacies to encourage behavior change related to family planning, prenatal and postnatal care, mother-and-child health, immunization, and breast feeding.6DRIVERS OF CHANGEWhy Pharmacy and why now? A variety of factors are stimulating this global transformation. The rising incidence and cost of acute and chronic disease, along with an aging population, have forced governments to reimagine healthcare delivery. New approaches look to integrate different healthcare providers and leverage expertise far beyond the physician, with collaborative practiceconnecting the full, multidisciplinary scope of our health professionsidentified as the best hope for sustainable care. At the same time, national policy makers are sharpening their focus on health promotion, health protection, and disease prevention as viable and more cost-effective alternatives to disease management. Society is changing. In a more wired, consumer-oriented world where patients are becoming active participants in their own health management, consumer expectations of health services are expanding with advances in technology. This is demanding greater flexibility in the design and delivery of healthcare services, as well as health education, and driving new models of self-care.According to Carmen Pena, President of FIP, “Todays patients have new demands. New needs. They are increasing in number and age. Many of our health systems were created in the 20th century for a society of patients with acute illness, but nowadays we live in a society of patients with chronic illness, many of whom require poly-medication.” The shift is precipitating a responsive redefinition of the role of Pharmacy and giving us a clearer line of sight on the Pharmacy of the future. It is stimulating the professions greater involvement in home care, healthcare, and self-care and driving the need for policies that enable cooperation and care coordination between healthcare practitioners.With 75% of all healthcare costs spent on the treatment of chronic disease, Pharmacys role in enabling cost containment while assuring the quality use of medicines is more important than ever.2Moreover, in the shift to wellness, Pharmacys role as expert advisor, coupled with its ability to help consumers make sense of an ever-expanding portfolio of over-the-counter (OTC) products, can advance cost-effective health outcomes.This holds true around the world. In India, a shortage of physicians is pushing community Pharmacists to the center of patient care. In Brazil, Pharmacy is increasingly being included in multidisciplinary primary-care support teams. In Japan, a market where Pharmacy has very much resided at the lower rungs of the health profession, an attempt to move patient care from hospitals and into the community has seen Pharmacists included as medication experts within multidisciplinary teams, as well as key providers of home-care services and patient education, via pharmacist-managed clinics (see further details in Figure 2). Regulation separating drug prescribing and dispensing, or bungyo, is further expanding Pharmacys role in patient engagement.NEW APPROACHES LOOK TO INTEGRATE DIFFERENT HEALTHCARE PROVIDERS7FIGURE 2 THE LATEST PRACTICE FROM JAPAN: THE FUTURE IS ALMOST HEREHowever, it is not just physical location that has brought PMCs closer to hospitals and their services. More services traditionally supplied by physicians are being managed by pharmacists, with new payment processes for those who counsel patients, obtain medical records, explore drug interactions, detect duplicate prescriptions, and deliver home-based pharmaceutical care services. Much of this is enabled through closer integration with other PMCs, physicians offices, and hospitals, thus allowing access to diagnostic data and patient medication history to ensure a personal approach in the full knowledge of a patients range of health challenges.This has to represent a sense of direction for less-developed marketsa first-line, patient-oriented pharmacy space providing many services above and beyond dispensing and delivering system cost savings, increased adherence to medicines, and improved health outcomes.The Global Dispensing Pharmacy in Ogimachi, Japan:  designed to present a confidential, professional, and caring environment for patientsThe first pharmacist-managed clinic (PMC) in Japan was established in 2000 at the Nagoya University Hospital for the management of anticoagulation therapy. Since then, PMCs have expanded into respiratory disease, Alzheimers disease, hypercholesterolemia, chronic hepatitis C, palliative care, chronic kidney disease, and ambulatory hemodialysis. Most recently, since 2014, the number of PMCs for cancer chemotherapy has increased, as pharmacy services have become more integrated with other elements in the healthcare system, most notably through inclusion in universal health coverage and extending the services provided by pharmacists, in close association with physicians and hospital infrastructure.All of this is based on the simple premise that education, counseling, and pharmacotherapy management are optimized in a familiar, accessible space that ensures privacy and the opportunity to engage in confidential communication. Indeed, much effort has been made to employ eco- and patient-friendly and high-tech design, with 70% of PMCs located in, or near, a hospital.8This global trend toward Pharmacy involvement in multidisciplinary primary-care teams can be seen right across the map and is evident in health economies as diverse as Turkey, China, and Russia and Germany, Italy, and South Africa.As health systems seek to leverage Pharmacys expertise, Pharmacists are incrementally assuming responsibility for a wider range of primary-care services. Vaccination services show prodigious growth. It is no surprise. According to FIP, at least 940 million people live in countries where over 193,000 community Pharmacies can potentially offer access to vaccination services. The European Pharmacists Forum has identified five key areas where Pharmacist expertise can be maximized to improve population health: medicine adherence; vaccination; screening; self-care; and disease prevention. In the United States and Australia, retail clinics are providing a similar range of patient-care services to manage chronic disease and overall health, leveraging digital innovation to promote wellness and enhance consumer/Pharmacist engagement. In Switzerland, for example, the netCare initiative enables more of the initial patient consultation responsibilities to move from primary-care physicians to Pharmacists (for further details, see Figure 3).In addition, Pharmacy is