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Responsible use of Medicines

IPSF congress 2013
by

Marien Rouchon

on 31 July 2013

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Transcript of Responsible use of Medicines

Technological Related Innovations
Technological Related
Innovations

Human Related Innovations
Conclusion
Responsible use of medicine?
Right medicine
Right Patient
Right time
Right disease
Right cost

“Medicine use is rational (appropriate, proper, correct) when patients receive the appropriate medicines, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost both to them and the community. Irrational (inappropriate, improper, incorrect) use of medicines is when one or more of these conditions are not met.”

(WHO World Medicines Report, 2011).
But why should we use drugs responsibly?
Source: IMS Institute
Health expenses: 856 billions in 2006 to 1200 billions in 2016
can be saved by improving responsible use of medicine
8%
Innovation and
Responsible use of Medicine

2 main parts:
Human Related Innovations
Questions ??
Thanks for your attention !
marien.rouchon@gmail.com
thuy@novonordisk.com
Electronic patient record (EPR)
Packaging
Track and trace system
Specific needs for specific populations
Physicians / pharmacists relations
Pharmacist behavior
Molecular biology
Patients behavior

The outer / visible part of a medicine
The first contact with the drug
Respect strict regulatory constraints
Main goal:
Protect the drug
Inform the patient
Improve the right use of the drug and the adherence to the treatment
Treatment Adherence / Compliance
« Compliance is the extent to which the patient’s behaviour, in terms of taking medications, following diets or executing life style changes, coincides with the clinical prescription. »
Haynes et Sackett 1979
Kind of bad compliance to the treatment:
Non-adherence
Under-adherence
Over-adherence
Variable adherence
Reasons ?
Age, treatment itself, sides effects...
Examples of innovative packaging
Birth Control Pill
Intuidose by Pfizer
Glow Cap
Actonel Combi
Developed in Europe to simplify the treatment against osteoporosis
Risedronate + calcium and vitamin D
Difficulties? polypharmacy and different frequency of administration
The packaging contains: 4 weekly boxes and each box contains a weekly blister with a tablet of 35 mg risedronate, 6 bags of 1000 mg of calcium and 880 IU of vitamin D together with a patient information leaflet.
Treatment of opioid dependence
Intelligent packaging contains an electronic chip to record when the tablets are taken from the blister packaging in a lockable box.
The chip also retains information about the daily symptoms of patients.

The Compliance Monitoring Package for Suboxone,
Compliance In a Bottle - CIAB
Particularly robust and portable

Convenient to daily and long term

Integrates four weeks of treatment in a package the size of a small wallet

Opening easy for adults and seniors, but child proof: Push, Slide and Pull
Push-through system
Weekly/daily pictographs
Information leaflet ( more information depending to the drug. Ex: Toviaz)
Visual signal
Sound signal
Connected to phone and computer
Connected to the pharmacist
European example:
ESM "European Stakeholder Model"
Project leads by:
EFPIA (European Federation of Pharmaceutical Industries and Associations)
GIRP (European Association of Pharmaceutical Full-line Wholesalers)
PGEU (Pharmaceutical Group of the European Union)
EAEPC (European Association of Euro Pharmaceutical Companies)
Goal: implementing the requirements of the EU Falsified Medicines Directive at the lowest cost.
Based on a 2D data matrix barcode, containing an unique serial number.
Advantages
System connected to an European hub
Interoperable between countries
End-to-end and real-time verification tool
For
ALL
healthcare professionals through the supply chain: wholesalers, pharmacists, dispensing doctors...
Costs / benefits ratio
Insurance to have a safe drug
Implemented in already a lot of countries: Australia, Austria, Canada, Saudi Arabia, Estonia (First country in the world !!)
Benefits
Increase patient safety by reducing or correcting errors

Improve shared decision making

Improve feelings of empowerment and move away from paternalistic National Health System (in the case that the patient has access to the record)

More efficient/accurate transferability of record
Access is an issue, safeguards must be made against unwanted third party access

Data protection and enabling secure access is a significant issue when implementing any such system

Must have effective staff and patient trust and buy in to be of use

Reservations exist in terms of security and privacy around holding all personal health information on a central database
Risks
Also called Electronic medical record (EMR) or Electronic Health Record (EHR)
Collects data from the patient:
Treatments
Surgery
OTC
Other healthcare events
Diagnostic Tools
Pregnancy test exemple:
easy to use
cheap
based on lateral-flow technology
Implementation of routine tests
Diagnose the disease earlier
Decrease costs of long term treatments or surgery
Pharmacy
Hospital
Physician
HIV (CD4 and Virus load)
Malaria (better quality of rapid diagnostic tests)
TB (identification of M.tb and resistant strains)
Point-of-care diagnostics :
Treatments
"Personalized Treatments"
Genetic profiling
Biomarkers
Again benefits / risks / cost are the priorities
Treatment for cancer
Vemurafenib : treatment of patients with melanoma with a mutation in the BRAF V600 codon
Crizotinib : for patients with a lung cancer whose tumor present translocated ALK gene.
Children
Pneumonia, diarrhea and malaria are the lead killers for 43% of under 5 deaths in 2008.
New vaccines?
Easier to use, to transport...
Environment for children's development is more important than specific drugs
But: Different metabolism -> Different effect
Many drugs used for children in hospital:
Unlicensed
Off label
Aging Population
Specific need related to specific diseases:
Alzheimer, Parkinson...
Growing population
High pressure on healthcare systems
Biggest challenges? Non-adherence and misuse
Also one of the biggest for
community pharmacists!
New market: Home care
Home care
Wholesalers
Hospital pharmacists
Researchers
Community pharmacists
Students... You !!
Rouchon Marien
Huynh Thanh

Examples of Responsible Use of Medicines on a specific level :
Atovaquone + Proguanil : Used in case of chloroquin-resistant and/or resistance to other antimalarial treatment.
Caspofungin : Used in case of treatment failure for invasive aspergillosis.
Spironolactone: Used in case of disabling severe heart failure despite basis treatment.
Research :
delivery system
compound
methodology...
Industry:
Production
Quality
Distribution
Marketing/sales
Market access
Pharmacovigilance
Health economics
Pharmacovigilance
Community
Pharmacy
NGOs
PATIENT
Hospital pharmacy
Physicians, and other healthcare professionals
http://www.kinderformularium.nl
Treatment failure
Wasting
Lifestyle
FTO: pharmacotherapeutic meeting
FTTO: transmural
Physicians / industry behavior
Hand in hand
Industry
NGOs
And now?
Full transcript