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Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton

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Abstract

Objective The aim of this study was to assess the implementation process and economic impact of a new pharmaceutical care service provided since 2002 by pharmacists in Swiss nursing homes. Setting The setting was 42 nursing homes located in the canton of Fribourg, Switzerland under the responsibility of 22 pharmacists. Method We developed different facilitators, such as a monitoring system, a coaching program, and a research project, to help pharmacists change their practice and to improve implementation of this new service. We evaluated the implementation rate of the service delivered in nursing homes. We assessed the economic impact of the service since its start in 2002 using statistical evaluation (Chow test) with retrospective analysis of the annual drug costs per resident over an 8-year period (1998–2005). Main outcome measures The description of the facilitators and their implications in implementation of the service; the economic impact of the service since its start in 2002. Results In 2005, after a 4-year implementation period supported by the introduction of facilitators of practice change, all 42 nursing homes (2,214 residents) had implemented the pharmaceutical care service. The annual drug costs per resident decreased by about 16.4% between 2002 and 2005; this change proved to be highly significant. The performance of the pharmacists continuously improved using a specific coaching program including an annual expert comparative report, working groups, interdisciplinary continuing education symposia, and individual feedback. This research project also determined priorities to develop practice guidelines to prevent drug-related problems in nursing homes, especially in relation to the use of psychotropic drugs. Conclusion The pharmaceutical care service was fully and successfully implemented in Fribourg’s nursing homes within a period of 4 years. These findings highlight the importance of facilitators designed to assist pharmacists in the implementation of practice changes. The economic impact was confirmed on a large scale, and priorities for clinical and pharmacoeconomic research were identified in order to continue to improve the quality of integrated care for the elderly.

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Acknowledgements

We sincerely thank the directors, nurses and physicians of the Fribourg nursing homes, the AFIPA, the Fribourg Insurers Association (santésuisse Fribourg), the participating pharmacists, the Fribourg Pharmacists Association and the Swiss Association of Pharmacists for their active roles.

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Authors and Affiliations

  1. Community Pharmacy Practice Research Unit, Universities of Lausanne and Geneva, Pharmacie de la PMU, Rue du Bugnon 44, 1011, Lausanne, Switzerland

    Jean-François Locca & Olivier Bugnon

  2. PharmaSuisse, Swiss Association of Pharmacists, 3097, Bern-Liebefeld, Switzerland

    Martine Ruggli

  3. Community Pharmacy Tête Noire, 1680, Romont, Switzerland

    Michel Buchmann

  4. Institute of Health Economics and Management, University of Lausanne, 1015, Lausanne, Switzerland

    Jacques Huguenin

Authors
  1. Jean-François Locca
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  2. Martine Ruggli
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  3. Michel Buchmann
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  4. Jacques Huguenin
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  5. Olivier Bugnon
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Correspondence to Olivier Bugnon.

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Locca, JF., Ruggli, M., Buchmann, M. et al. Development of pharmaceutical care services in nursing homes: practice and research in a Swiss canton. Pharm World Sci 31, 165–173 (2009). https://doi.org/10.1007/s11096-008-9273-9

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  • DOI: https://doi.org/10.1007/s11096-008-9273-9

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