Políticas de cada Estrategia

Current status

Currently in Qatar, there is unnecessary crowding at hospital pharmacies. This is due to (1) only public sector hospital pharmacies carrying the full spectrum of drugs, (2) availability of subsidised drugs at public sector pharmacies, and (3) providers prescribing insufficient refills. To access certain drugs only available at HMC, private providers need to refer patients to the public sector for care. This situation negatively impacts patients’ satisfaction and system efficiency. Giving community pharmacies a stronger role could help to address these issues. Qatar can leverage the potential of community pharmacies to improve efficiency and access in the community.

Best practice—UK / Australia

Community pharmacies play a critical role in the dispensation of drugs in the UK: they handle 89 per cent (2005) of the prescriptions and are places of work for 73 per cent of active pharmacists. There are 10,475 community pharmacies in England; this amounts to approximately one for every 5,000 residents. The NHS has driven for increasing the importance of community pharmacies on two fronts: (1) expanding public access to medicines, and (2) enhancing the role of pharmacists to provide more care in community.

The NHS views community pharmacies as key to increasing the public’s choice of when, where, and how to get medicines. To drive this agenda further, the NHS implemented an initiative to freeing up restrictions in England on locations of new pharmacies, easing bureaucracy around repeat prescriptions, and expanding the range of medicines that can be provided without prescription.

More recently the NHS has been pushing to change the role of the community pharmacist by increasing their contribution to primary healthcare.19 To achieve this change, the NHS developed a new pharmacy contractual framework. This framework has three tiers of services: essential, advanced, and enhanced services. Essential services include the traditional dispensing role of !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

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pharmacies. Advanced and enhanced services are intended to change the role of the pharmacists. Under advanced services pharmacists can offer medicinal usage review, in which they undertake a review (of both prescribed and nonprescribed medicines) with patients receiving medicines for long-term conditions in order to establish a picture of their use of the medicines. This will help patients understand why the medicines are prescribed for them, and will identify side effects to which they may be exposed. Enhanced services aim to better use pharmacists’ skills. Two examples are (1) a minor ailment scheme that includes treatment for conditions such as athlete’s foot, earache, constipation, hay fever, and cystitis, and (2) a supplementary prescribing scheme, including repeat prescribing, where the idea is to reduce the general practitioner’s (GP’s) load (currently 75 per cent of GPs’ prescriptions are for repeat medicine).

Similarly, in Australia, community pharmacies have been active in the field of health promotion. The Pharmacy Guild of Australia conducted a nationwide campaign on safe alcohol consumption in 2004. As of May 2005, more than 60 per cent of Australian community pharmacies were offering weight management services through the “Lifeweight” program. Research has also demonstrated the increased effectiveness of smoking cessation programs with the involvement of community pharmacies. Given the high proportion of the population that visits community pharmacies, they are viewed as a valuable health promotion setting.

New directions

Qatar should encourage a stronger role for community pharmacies. This will involve: 1. Assessing needs for, and developing a model of, a community pharmacy network 2. Enacting appropriate policy changes to support the implementation of the new model 3. Ensuring all drugs are available at community pharmacies

4. Increasing utilization of community pharmacies by providers

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Sector goal 2—Integrated system of healthcare

“An integrated system of healthcare offering high-quality services through public and private institutions” (QNV 2030)

The future Qatar healthcare system must provide a full continuum of care whereby patients experience and benefit from the system’s cohesiveness and connectedness. Integration is vital to achieving this outcome. Integration creates coherence and synergy among various parts of the healthcare system so that efficiency, quality of care, and patient experience are improved. Figure 8 highlights some of the methods and tools that can be utilised across the different levels.20

Currently the healthcare system in Qatar has limited coordination and standardization, which can lead to fragmentation of care and inefficiencies. A concerted effort is needed to integrate Qatar’s healthcare. This will involve some of the methods shown in Figure 6.

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20 _{Adapted into the diagram from Kodner, D.L., and Spreeuwenberg, C. 2002. “Integrated Care: Meaning, Logic,}

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Quality improvement

! Establish a culture of continuous quality enhancement throughout the healthcare system, and a framework for clinical process improvement.

! Define and disseminate evidence-based national clinical guidelines, patient pathways, and standard procedures for referral and discharge.

! Establish performance agreements with healthcare providers, which link outcomes to accountabilities.

Disease management programs

! To improve health outcomes, establish a system of coordinated healthcare interventions that address the full range of needs for individuals with priority chronic conditions such as diabetes or cardiovascular illnesses.

! Emphasize prevention of exacerbations and prevention of co-morbidities and complications through the use of evidence-based practice guidelines, patient empowerment strategies, and regular monitoring of patients.

Healthcare data program

! Access to accurate information is vital for health sector planning, as well as for measuring and monitoring the quality, safety and effectiveness of the healthcare system and population outcomes.

! There must be a program in place that defines data requirements, enables stakeholders to meet the requirements, and mandates reporting of these data.

E-health establishment

! Establish an effective and integrated national e-health system, with a clear governance framework to drive improvements in quality, safety, efficiency, and patients’ experience of healthcare in Qatar, ensuring full compatibility across all levels of care.

Private sector involvement

! Healthy competition is likely to have a beneficial impact on the quality, choice, and efficiency of healthcare, and the private sector can play an important role in assuming appropriate regulation and quality assurance.

! A private sector engagement strategy will enable greater involvement by the private sector in providing healthcare services in Qatar.

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