APOTEKER PADA ERA DISRUPTIVE INNOVATION - PowerPoint Presentation

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APOTEKER PADA ERA DISRUPTIVE INNOVATION

SUWALDI MARTODIHARDJOFAKULTAS FARMASIUNIVERSITAS GADJAH MADA

19/05/2018

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“The transformation

of pharmacy practice from a dispensing model to a patient care

model”

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Pharmacists’ Evolving Role

From Dispensing Services……to a clinical service provider

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* Professor of Business Administration at the Harvard Business School7

Christensen* originated the theory of disruptive innovation:

the process by which a product or service takes root initially in simple applications at the bottom of a market and then moves relentlessly “up market,” eventually displacing established competitors.

He

first outlined the concept in the seminal 1997 book 

The Innovator’s Dilemma

.

In

the 2009

book 

The Innovator’s Prescription

, Christensen and his coauthors (Jerome Grossman and Jason Hwang) applied

the principles of disruptive innovation

to the problems facing the U.S. health care system. 

The

Innovator’s Prescription

 provides a comprehensive analysis of strategies that would improve health care and make it affordable

.

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19/05/20188In almost every industry

, the products or services that are offered initially are so complicated and expensive that only people with a great deal of money or skill can afford or use them.

Then

at some point, the industry is transformed;

the products or services become

simpler

,

easier to use

, and much more

convenient

and

affordable

.

The

agent of this transformation is disruptive innovation.

Disruptive

innovations create new markets for products or services, or they reshape existing markets.

The

end result is that

an entirely new population of consumers

gains access to the products or services.

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19/05/20189Disruptive innovations have three key

components:Technological enabler.This

is a simplifying technology that transforms a fundamental problem from something complicated that requires deep training and expertise to resolve, into something simple that can be addressed by people with less training or skill in a predictable, rules-based

way.

2.

Business

model innovation.

 

The

simplifying technology has to be embedded in a business model that can deliver the resulting lower-cost solution to customers profitably, in ways that make the solution affordable and conveniently

accessible.

3. Value

network. 

The

business model in turn has to become part of a network or system whose constituents (e.g., suppliers, distributors) can respond together profitably to the common needs of a class of customers.

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19/05/201810Lessons and implications for pharmacy

Pharmacists should not try to effect change by educating people outside the pharmacy profession (e.g., patients, other health care professionals) about the value of pharmacist services. Instead, pharmacists should learn about and employ the principles of disruptive innovation. These principles provide the knowledge needed to disrupt the system from the inside out.

How do pharmacists avoid going head-to-head with other health care practitioners for the same business?

By focusing on what pharmacists know and do best: drug therapy

.

Pharmacists offer a solution to medication therapy problems that

no other practitioner can provide

.

Pharmacists

should be willing to assume some risk by beginning with smaller solutions that may not bring in much money at first. Later, pharmacists can expand their offerings and negotiate better payment structures as the value becomes apparent.

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19/05/201811Target areas of nonconsumption

A shift in mindset may be needed, because many pharmacists do not want to be considered ancillary personnel or physician

extenders—

they

want to be considered at the same “level” as physicians.

Pharmacists

need to define a

separate performance

measure that reflects their value to the customer (patients).

Consider

that Harvard University likely views itself as superior to the “second-class citizen” online universities, and this undoubtedly is true if the performance measure is research (which informs national rankings).

However

, online universities are being shown to offer superior teaching. Which is of greater importance to the customer (students)?

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19/05/201812Adherence counseling may be the perfect “Sony space” of nonconsumption for pharmacists. The job is important, and no other health care providers are stepping forward to embrace it.

Emerging data reveal that a majority of consumers (~75%) want someone to talk with them about their medication, yet relatively few report ever having had a conversation with a pharmacist about their medication.

The

opportunity to capitalize on

this—

to focus on moving pharmacists toward face-to-face discussions with patients

, adding the element of adherence—seems ripe.

Target areas of

nonconsumption (cont’d)

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19/05/201813Other possible nonconsumption markets

include: adults with aging parents, (

2) patients who do not have health insurance,

(3) elementary school children participating in sports leagues, (4) patients with multiple chronic conditions and medications

from

multiple prescribers, and

(

5) hospitals discharging patients to home settings.

Any

of these markets might be willing to pay on a cash basis for medication use consultations, with the length and price of the consultation based on the complexity of the problem.

For

example, adults with aging parents might be willing to pay a higher fee for the peace of mind associated with knowing that someone is helping their parents avoid problems; hospitals might be willing to pay a higher fee to avoid medication-related readmissions.

Target areas of

nonconsumption (cont’d)

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19/05/201814Help potential customers understand what pharmacists are selling

Pharmacists need to partner with physicians at all levels.

Physicians

do not have time to do everything they need or want to do; pharmacists can help physicians focus on what they do best if physicians delegate some duties to pharmacists.

This

is already occurring in specialty practice areas where pharmacist specialists (e.g., pediatric pharmacists) work as part of a team with medical specialists.

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19/05/201815Help potential customers understand what pharmacists are selling

The requirement for specifiability, measurability, and predictability of pharmacist-delivered patient care services provides a strong argument for standards and accreditation.

For

example, the Center for Pharmacy Practice Accreditation (CPPA)—a partnership between APhA and the National Association of Boards of Pharmacy—is developing principles, policies, and standards that will offer the general public and users of pharmacy services a means of identifying pharmacies that satisfy the accreditation criteria and are focused on advancing patient care, safety, and quality

.

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19/05/201816Stake a role in chronic care

The pharmacy profession must take responsibility for adherence.

It

is the most basic medication therapy management service; pharmacists serve as a mechanism for monitoring what patients are doing and holding them accountable for adhering to prescribed therapies and behavior changes.

Pharmacists

need a business model to facilitate adherence counseling and interventions.

It

may be valuable for pharmacy associations to form a coalition with the Pharmaceutical Research and Manufacturers of America (PhRMA) and others to seek provider status for pharmacists.

The

hope is that provider status would lead to increased adherence because pharmacists could get paid for providing those services.

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19/05/201817Figure out who has a job to be done

Pharmacists need to consider all of the jobs that all of the parties involved are trying to do, then show why pharmacists should be hired to do those jobs.

For

example, self-insured employers were crucial to the success of programs such as the Asheville Project and the Diabetes Ten City Challenge.

Pharmacists

might approach hospital CEOs and say, “You are struggling with the challenge of improving your performance on quality measures that are advertised to the public.

Pharmacists

can help you by….” The pharmaceutical industry and patients’ families both have a strong incentive to improve medication adherence.

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Aims of Pharmaceutical Care

Effective drug therapy

Safe drug therapy

Economic drug therapy

Improve quality of life

Will the patient take the therapy?

What does the patient view as an improved quality of life?

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Good Pharmcy Pactice (GPP) by WHO and FIP 2011The definition of GPP: The practice of pharmacy that

responds to the needs of the people who use the pharmacists’ services to provide optimal, evidence-based care.19/05/2018

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THE MISSION OF PHARMACY PRACTICETo contribute to health improvement

and to help patients with health problems to make the best use of their medicines19/05/2018

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The six components of the mission of Pharmacy Practice: 1.

being readily available to patients with or without an appointment 2. identifying and managing or triaging health- related problems

3. health promotion 4. assuring effectiveness of medicines

5. preventing harm from medicines 6.

making responsible use of limited health-

care resources

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Four main roles of Pharmacist to serve the societyPrepare, obtain, store, secure, distribute, administer, dispense and dispose of medical products

Provide effective medication therapy management

Maintain and improve professional performance

Contribute to improve effectiveness of the health care system and public health

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Role 2. Provide effective

medication therapy

management (

MTM)

Function A

: Assess patient health status and needs

Pharmacists should ensure that health management, disease prevention, and

lifestyle behavior

are incorporated into the patient assessment and care process

Function B:

Manage patient medication therapy

Pharmacist should have access to, contribute to and use all necessary clinical and patient data to coordinate effective medication therapy management, especially when multiple health-care practitioners are involved in the patient’s medication therapy, and intervene if necessary

Function C

: Monitor patient progress and outcomes

Pharmacists consider

patient diagnosis

and

patient specific needs

when assessing patient response to medicine therapy and intervene if necessary

Function D:

Provide information about medicines and health-related issues

Pharmacists provide

sufficient health, disease, and medicine specific information

to patients

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PERATURAN PEMERINTAH NOMOR 51 TAHUN 2009 TENTANG PEKERJAAN KEFARMASIAN

Pelayanan Kefarmasian:

Suatu pelayanan langsung dan bertanggung jawab kepada pasien yang berkaitan dengan sediaan farmasi dengan maksud mencapai hasil yang pasti untuk meningkatkan mutu kehidupan pasien

Pelayanan Kefarmasian:

Pelayanan komprehensif dilakukan oleh apoteker kepada pasien

Aktivitas-aktivitas praktek kefarmasian:

1. melakukan dispensing obat dan

sediaan farmasi lainnya

2.

mencegah dan mengatasi problema terapi obat

3.

promosi kesehatan dan mencegah penyakit

4.

managing health systems

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Drug Therapy Cycle

Patient’ Complaint

↓ ↑

Diagnosis

Undesired

Desired

↓

↑

↑

Modes of therapy

Clinical Response

↓ ↑

Drug Therapy

Drug Usage

↓ ↑

Prescription →

Dispensing

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Kebutuhan Pasien dan Problema Terapi Obat

Kebutuhan Pasien akan Terapi Obat

Problema Terapi Obat

Indikasi tepat

Terapi obat tidak sesuai indikasi/obat

tidak sesuai indikasi

Efektif

Obat tidak

/

kurang tepat

Dosis terlalu kecil

Interaksi obat

Aman

Reaksi obat tidak dikehendaki (ROTD)

Dosis terlalu besar

Interaksi obat

Bersesuaian dengan pasien

(

Compliance

, adherence, concordance

)

Terapi obat tidak bersesuaian dgn

pasien (kondisi fisik, patologis,

psikologis, finansial)

Ada indikasi belum diterapi, memerlukan tambahan terapi obat

Tambahan terapi untuk indikasi belum

diberi terapi

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What Determines Our Health?Attitude about ourselves and healthDaily nutrition – eating habitsExercise habits

Stress management/coping skillsSelf talk and overall mental attitudeRelationship with our higher self – divineSocial relationships and outlets

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APA YANG MENYEBABKAN KITA SAKIT?

NUTRACEUTICALS: Let Food be Your Medicine

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Well Balanced Diet, Prerequisite to Good Health19/05/2018

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Well Balanced Diet, Prerequisite to Good Health

Keep a well balanced diet,

 in

order to maintain the acid and

alkali

equilibrium

of the body fluids.

Relieve stress

,



to keep a stable mental state for maintaining the

equilibrium

of the autonomic nervous system.

Keeping in mind that our human bodies are mostly fluid, in order to function at their best, our bodies need to always be in that neutral, balanced place. 

On the pH scale, we should be striving to maintain a pH balance of about 7.4.

There isn’t much wiggle room either way. 

If your pH balance drops

below 6.8

or goes

above 7.8

your “gong” would stop ringing altogether and

you’d die

. 

That’s a very narrow range to maintain.

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Here's a picture of healthy red blood cells:

Blood cells have a negative charge on the outside and a positive charge inside; this is what keeps them healthy and far apart from each other.

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Here's a picture of red blood cells in over-acidic blood:

When your body is over-acidic, the acid strips your blood of it's negative charge. Your

blood cells no longer have the same repelling force and

clump together.

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Maintaining health or Curing a disease

The suggested diet is 80% of alkaline food and 20% of acid food.HIGHLY ACID  FOODS:

   

egg

yolk,

cheese

, sweets

in which white

sugar is

used,

dried bonito,

oyster

, and herring roe.

MODERATELY

ACID  FOODS: 

ham

, bacon,

horse meat

,

chicken, tuna

, pork, white bread,

beef,

wheat

,  butter, and

eel

.

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Maintaining health or Curing a diseaseSLIGHTLY

ACID  FOODS:   rice, peanuts, octopus, clams, liver

, fried bean curd, and beer.

SLIGHTLY ALKALINE  FOODS:   

             

red

beans,

onions

,

cabbage

,

Japanese

radishes,

apples

, a kind of

chinese

cabbage, and bean curd.

 

MODERATELY

ALKALINE FOODS:      

   

raisins

, soybeans, cucumbers,

carrots

, tomatoes, spinach,

banana, tangerines

, pumpkins, strawberries,

honeywort

, white of egg, pickled

plums

, and lemon.

 

HIGHLY

ALKALINE  FOODS: 

seaweed

, grapes,

tea

, and wine.

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Illnesses caused by improper nutrient consumption

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Illnesses caused by improper nutrient consumption

Nutrients

Deficiency

Excess

Energy

starvation

,

marasmus

obesity

,

diabetes mellitus

,

cardiovascular disease

Simple carbohydrates

none

diabetes mellitus

,

obesity

Complex carbohydrates

none

obesity

Saturated fat

low sex hormone levels

cardiovascular

disease

Trans fat

none

cardiovascular disease

Unsaturated fat

none

obesity

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Fatmalabsorption of fat-soluble vitamins,

rabbit starvation

(if protein intake is high), during development: stunted brain development and reduced brain weight.

cardiovascular

disease

Omega-3 fats

cardiovascular disease

bleeding, hemorrhages

Omega-6 fats

none

cardiovascular disease

,

cancer

Cholesterol

during development: deficiencies in myelinization of the brain

.

cardiovascular

disease

Protein

kwashiorkor

rabbit starvation

Sodium

hyponatremia

hypernatremia

,

hypertension

Iron

anemia

cirrhosis

,

cardiovascular disease

Iodine

goiter

,

hypothyroidism

Iodine toxicity

(goiter, hypothyroidism)

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Vitamin Axerophthalmia

and night blindness, low testosterone levels

hypervitaminosis A

(cirrhosis, hair loss)

Vitamin B

1

beriberi

Vitamin B

2

cracking of skin and corneal unclearation

Niacin

pellagra

dyspepsia

,

cardiac arrhythmias

, birth defects

Vitamin B

12

pernicious anemia

Vitamin C

scurvy

diarrhea

causing

dehydration

Vitamin D

rickets

hypervitaminosis D

(dehydration, vomiting, constipation)

Vitamin E

nervous disorders

hypervitaminosis E

(anticoagulant: excessive bleeding)

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Vitamin K

hemorrhage

Calcium

osteoporosis

,

tetany

,

carpopedal spasm

,

laryngospasm

,

cardiac arrhythmias

fatigue

,

depression

,

confusion

,

anorexia

,

nausea

,

vomiting

,

constipation

,

pancreatitis

,

increased urination

Magnesium

hypertension

weakness, nausea, vomiting, impaired breathing, and

hypotension

Potassium

hypokalemia

,

cardiac arrhythmias

hyperkalemia

,

palpitations

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DRUGS MAY CAUSE NUTRITION DEPLETIONWITH SOME EXAMPLES

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Drug-Induced Nutrient DepletionAbout half the drugs used in clinical practice have documented nutrient depleting effects.

Co-enzyme Q10, folic acid, B2, B6, Mg, Zn are nutrients most likely to be depleted

.

Mechanisms include impaired absorption

or

bioactivation

or

increased excretion.

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Co-enzyme Q10 DepletionStatin-induced co-Q depletion impairs mitochondrial function, raising the serum lactate/

pyruvate ratio. Simvastatin but not atorvastatin depletes myofibrillar co-Q.

Supplemental co-Q,

100 mg/day

, prevents the decline in serum co-Q levels without impairment of the lipid-lowering effect of statins

and

may reverse symptoms of statin

myopathy

.

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NUTRIENT-DRUG AND DRUG-NUTRIENT INTERACTIONS

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Co-enzyme Q10 Depletion (cont’d)Statin-induced Co-Q depletion is increased by vitamin E (700 IU/day).

Co-Q is consumed in recycling tocopheryl-quinones back to tocopherols.

Thiazides, some beta-blockers

and

many older psychotropic drugs have been shown to

interfere with co-Q dependent enzymes

, creating a possible

need for co-Q supplementation

in patients receiving them.

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Clinically Significant Depletions-1Adriamycin depletes co-enzyme Q10.

Cardiotoxicity is reduced by co-Q10 and proprionyl-L-carnitine.

Cisplatin

depletes Mg.

Nephtrotoxicity

is reduced by i.v. and oral Mg (160 mg

tid

).

Thiazides and 5-ASA derivatives deplete folate,

raising

homocysteine

concentration



may cause

atherosclerosis

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Clinically Significant Depletions-2Loop diuretics increase excretion of K, Ca, Mg, Zn, vit

B1, B6, and C. Correcting B1 deficit improves cardiac function of CHF patients.

Cephalosporins (parenteral) can deplete vitamin K, causing hemorrhage.

Steroids deplete Ca and Mg, causing bone loss.

Reversible with calcium and

vit

amin

D3.

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Antiretroviral Nutrient DepletionAZT depletes muscle carnitine and increases lymphocyte apoptosis.

Reversed with carnitine supplementation.AZT is associated with decreased serum zinc and copper;

Zinc 200 mg/day reduced Candida and Pneumocystis infections in patients taking AZT.

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Phenytoin-induced DepletionsPhenytoin may deplete biotin, folate, thiamine,

vitamin D (causing hypocalcemia and osteomalacia and vitamin K. Memory impairment is associated with reduced RBC folate.

Folic acid, 1 mg/day, prevents deficiency without adversely affecting phenytoin metabolism.

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NUTRIENT-DRUG AND DRUG-NUTRIENT INTERACTIONS

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Valproic Acid DepletionsValproate depletes carnitine, raising ammonia; reversed with carnitine 2 g/day.

Valproate acid lowers serum folate, raising homocysteine; reversed with 400 mcg

of folate, 120 mg

of B6 and 75 mg of

B2.

Valproate

inhibits biotinidase.

Biotin

of

10 mg/day

reverses valproate-associated

hair loss and dermatitis

in children

.

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NUTRIENT-DRUG AND DRUG-NUTRIENT INTERACTIONS

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KESIMPULANApoteker, seharusnya, mempunyai peranan penting dalam menjaga kesehatan pasien

Perilaku pasien, seperti pola makan, berpengaruh pada kesehatannyaObat dapat menimbulkan deplesi nutrisi dan menimbulkan kelainan pada kesehatan pasien

Konseling oleh apoteker pada pasien sangat diperlukan dalam rangka pengubahan perilaku pasien sehingga perubahan perilaku itu dapat memperbaiki kesehatan pasien

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