Counseling by prescription: A revolution in healthcare
Starting October 1st, Belgian pharmacists will be paid to provide in-depth counseling sessions to certain chronic patients about the use of their medication.
Starting October 1st, pharmacists will be paid to provide in-depth counseling sessions to certain chronic patients about the use of their medication. This is not the usual counsel lasting just a few minutes that takes place upon the purchase of a drug. It's an individual counseling session, lasting about fifteen minutes. A second session takes place three months following the initial session. It's conducted in a separate area and not at the pharmacy counter in order to ensure confidentiality. All this is free of charge to the patient!
Asthma, the condition that was selected for this innovative measure, is a grave and prevalent pathology. It affects almost 10% of all children and older people as well as 7% of adults. Its incidence has grown steadily over the past twenty-five years.
"Over 160,000 Belgians could be affected," explains Christian Elsen, the president of the Belgian Pharmaceutical Association. It has just concluded the agreement with the mutuals and Inami (the national institute for health and disability insurance). "It concerns those patients who are starting on corticosteroid inhalers - either in aerosol or dry powder form. The problem with this treatment is that it needs to be used correctly, inhaled at the right time and in the right way. Several studies have shown that some patients who are taking the treatment are receiving zero percent of the active ingredient. There is also some reluctance on the part of a few patients who are afraid it will lead to weight gain or osteoporosis. We have to be able to discuss everything".
This innovative measure targets asthma because of the specificity of the long-term control medication. "This treatment needs to be adopted when short-term treatment is no longer enough. Patients, though, don't realize its efficiency since they don't feel anything when it's working. The only time a patient becomes aware of it is when he has an attack after having stopped taking the medicine. That leads to treatment failure. It's a good idea then to explain how the treatment works to help in the fight against asthma. This disease has very high direct costs (doctors appointments, treatment, hospitalizations) and indirect costs (absenteeism) estimated at over 12.5 billion a year."
For the first time, pharmacists will be paid not to deliver medicine, but to help in its use. Could this be stepping on physician's toes? Some seem to be in favor of it. "An appointment with a specialist can last 15 to 20 minutes. There are exams, discussion the results of additional exams, diagnostics and prescriptions. Information and counsel are given then at the end of the appointment. At this point is the patient still paying attention, and is he receptive after hearing a troubling diagnosis? Probably not", explains Professor Olivier Michel, the director of the CHU Brugmann allergy and immunology department. Most of the doctor's advice is lost the second the patient leaves the office. Since the short-term treatment for asthma gives immediate relief during an attack, the long-term treatment is underestimated because it does not seem to have any short-term effect. From now on, pharmacists can explain the need to take the medicine before feeling the symptoms. This can only be positive. Asthma is treatable in a simple and balanced manner for most sufferers. However, if the disease has progressed, treatment is not only more costly but also more complex.
Roland Lemye, president of Abysm, the main physicians' union, had the same reaction. "Pharmacists are eminently qualified to explain how to take a medication correctly. We complement each other. We need to inform physicians in the field and create a climate of trust in order to keep them from being resistant to delegating this task. Conflicting messages could undermine treatment, as we have unfortunately observed when substituting generics."
If it succeeds, this Belgian innovation can be followed in other fields. In France, anticoagulants prescribed as cardiac incident preventives are the subject of similar "explanations" by the pharmacists. This might also help with the image of some pharmacies as "beauty shops" by selling products whose serious health purpose is debatable. "It's important to only stock health products whose effects are recognized," admits Christian Elsen. He insists that, "This new type of counseling is a direct contribution to the patient's health. It fits perfectly with the core of our profession. For us it's a path for the future."