Research BriefnetCare, a new collaborative primary health care service based in Swiss community pharmacies
Introduction
As in many other countries, in addition to having increasing costs, Switzerland's health care system is facing a relative shortage of general practitioners (with half of them retiring within the next 10 years) and overload of emergency rooms.1, 2, 3
Between 2007 and 2011, outpatient departments (OPDs) of acute care hospitals in Switzerland observed a 32% increase in visits.2 Bednall et al, who analyzed emergency department visits, reported that 19% of cases could have been treated by a GP. However, 42% of those could have also been handled by a community pharmacist.4 Hammond et al found that GPs felt that 7% of their cases could have been handled by a community pharmacist.5 Therefore, primary health care would greatly benefit from a low-threshold entry into the health care system, as offered by telemedicine or pharmacies, where efficient primary triage would then treat or dispatch patients to the appropriated setting according to the severity and urgency of the cases.
Primary triage is a basic skill and is a daily task for pharmacists. Pharmacists provide information and advice related to health issues, including, if appropriate, prescribing OTC medication with guidance on their use. In specific situations, according to the Swiss legislation, the pharmacist is allowed to treat the patient with prescription medication.6 With the exception of the distribution and sale of prescription medication, the work of the pharmacist is not well documented. Furthermore, pharmacists rarely receive feedback from patients and/or physicians; therefore, they can hardly assess the validity of their primary triage. In Switzerland, there are no central health care databases with diagnostic and outcome data. Therefore, evaluations of the outcomes of triage (irrespective of the setting in which the triage was performed) are very rare in the Swiss Healthcare system.
The Swiss Pharmacists' Association (pharmaSuisse) has launched a collaborative project, netCare. Participant community pharmacists provide primary triage using a structured decision tree for 24 common conditions, and they document the findings on a standardized assessment form. As a backup, they can request a real-time video consultation with a physician. By evaluating the documented daily triage work of the pharmacist, pharmaSuisse's objective is to establish the community pharmacist as a health service provider (instead of only as a vendor of medication) who provides primary access to health care. Furthermore, the low threshold for access without the need for an appointment may contribute to efficient resource usage in a low cost setting.
The aim of the study was to evaluate the impact of this new service as well as the added value for the health care system.
Section snippets
Method
netCare's main feature is the decision-tree based triage of community pharmacists. Twenty-four decision trees were developed by pharmaSuisse and validated by senior physicians at the Swiss Centre for Telemedicine in Basel, which provides medical backup. The decision trees were chosen to focus on common ailments that are encountered in an everyday GP's practice or pharmacy, covering situations in which structured triage would be appropriate and contingent on evidence-based guidelines. The
Results
One-hundred-ninety-six pharmacies with approximately 500 community pharmacists signed up for netCare. Between April 2012 and January 2014, 4118 assessment forms from 162 pharmacies were sent in for evaluation.
The distribution of the triages among the weekdays was mostly balanced, with slightly more on Saturdays (20%). Only 4% of the netCare cases took place on Sundays, when a limited number of netCare pharmacies are open.
Three-quarters of the patients were between 20 and 65 years of age, and
Discussion
Assessments were conducted of 4118 triage cases that community pharmacists performed over a period of 21 months. The two most frequently used decision trees were cystitis and conjunctivitis, which is because they are very common disorders and require a rapid solution (based on the level of suffering from cystitis and societal pressure for the treatment of children with conjunctivitis because they are not allowed to attend day care or school). The usage frequency of the decision trees was high,
Conclusion
netCare is a new low-threshold service for managing common medical conditions based on structured decision trees with a real-time backup option with a physician. This study showed that a pharmacist could resolve a large proportion of cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system, and its efficacy, safety, cost effectiveness and acceptance by patients must be clearly established in larger trials. Given the shortage of GPs and
Acknowledgments
We thank the following individuals for their contributions: PD Dr. med. Eva Blozik MPH (University Medical Center Hamburg-Eppendorf) and †Prof. Dr. André Busato MSc (Institute of primary care University of Zürich) and Dr. Harry Telser (Polynomics AG, Olten) for their advice and input in the steering committee as well as Dominique Jordan, former president of pharmaSuisse, for assisting with and supporting the project. We thank all of our partners in the project: Medgate, Swiss
References (10)
- et al.
Nouvelles données et aperçu de la statistique médicale 2013
Bull Des Méd Suiss Schweiz Ärztezeitung
(2014) Konsultationen in Schweizer Notfallstationen. Obsan Bulletin 3/2013
(2013)- et al.
Career after successful medical board examination in general practice–a cross-sectional survey
Swiss Med Wkly
(2013) - et al.
Identification of patients attending accident and emergency who may be suitable for treatment by a pharmacist
Fam Pract
(Feb 2003) - et al.
Patients' use of GPs and community pharmacists in minor illness: a cross-sectional questionnaire-based study
Fam Pract
(2004)
Cited by (14)
Assessment of minor health disorders with decision tree-based triage in community pharmacies
2022, Research in Social and Administrative PharmacyCitation Excerpt :The triage outcomes entail management by the pharmacist (i.e., guided self-medication, self-care, and dispensing of prescription medication without confirmation from a physician), management by the pharmacist with telemedicine support, and further referral. The decision trees are externally examined for face validity by collaborating medical partners and are updated regularly.14 netCare decision trees may only be performed after completion of a one-day course and only if the pharmacy has employed a netCare pharmacist.
The legal framework of telemedicine might be associated with the analysis of medical service to patients?
2017, European Research in TelemedicineA cross-sectional investigation of acceptance of health information technology: A nationwide survey of community pharmacists in Turkey
2016, Research in Social and Administrative PharmacyCitation Excerpt :Pharmaceutical service systems can be defined as pharmaceutical technology, service application and system built upon an information and communication platform to provide health services. In the literature, there are a number of studies about pharmaceutical services including clinical practices,8 ethical studies,9,10 medical shopping,11 system development,12–14 remote services (tele-pharmacy)15 and service quality assessment.16 It is evident from the literature that pharmaceutical services have an important place in health care delivery, and the economic and practical impact on health care delivery are unquestionable.17–19
Telepharmacy and pharmaceutical care: A narrative review by International Pharmaceutical Federation
2022, Farmacia HospitalariaAssisted teleconsultation in an outpatient pharmacy: Results of a pilot study in Geneva, Switzerland
2024, Journal of Telemedicine and Telecare