netCare, a new collaborative primary health care service based in Swiss community pharmacies

doi:10.1016/j.sapharm.2015.08.010

Research in Social and Administrative Pharmacy

Volume 12, Issue 4, July–August 2016, Pages 622-626

https://doi.org/10.1016/j.sapharm.2015.08.010 Get rights and content

Abstract

Background

The Swiss Pharmacists Association has launched a new collaborative project, netCare. Community pharmacists provide a standard form with structured triage based on decision trees and document findings. As a backup, they can collaborate with physicians via video consultation.

Objective

The aim of the study was to evaluate the impact of this service on the Swiss health care system.

Method

All pharmacists offering netCare completed two training courses, a course covering the most common medical conditions observed in primary health care and a specific course on all of the decision trees. The pharmacists were free to decide whether they would provide the usual care or offer netCare triage. The patient was also free to accept or refuse netCare. Pharmacists reported the type of ailment, procedure of the consultation, treatment, patient information and outcomes of the follow-up call on a standardized form submitted to the study center.

Results

Pharmacists from 162 pharmacies performed 4118 triages over a period of 21 months. A backup consultation was needed for 17% of the cases. In follow-up calls, 84% of the patients who were seen only by pharmacists reported complete relief or symptom reduction.

Conclusions

netCare is a low-threshold service by which pharmacists can manage common medical conditions with physician backup, if needed. This study showed that a pharmacist could resolve a large proportion of the cases. However, to be efficient and sustainable, this service must be fully integrated into the health care system.

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

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Patients' use of GPs and community pharmacists in minor illness: a cross-sectional questionnaire-based study
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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.
Triaging in community pharmacies can lower the burden of minor health disorders on other primary health care settings. The netCare service, introduced in 2012 by the Swiss association of pharmacists, provides community pharmacists with 27 decision trees for the triage of minor health disorders.
(1) to describe the utilization and symptom resolving rate of decision trees in community pharmacies; (2) to identify the need for additional decision trees.
A descriptive, explorative analysis was conducted of netCare consultations between January 2019 and March 2020, as documented in phS-net, a service platform for public pharmacies. Client characteristics, weekdays, recommended course of action, availability of a general practitioner, and hypothetical course of action if netCare would not have been available were investigated. Follow-up information was assessed for resolution of symptoms and prevention of needing additional services. Data from consultations with empty assessment forms were used to identify minor health disorders in need of an additional decision tree.
Information on 4256 performed netCare consultations were identified over a 14-month observation period, resulting in an average of 284 decision tree consultations per month in Switzerland. Customers were mainly female (n = 3253, 76.4%) with a mean age of 40.7 years (±18.5 years). Cystitis (39.5%), conjunctivitis (19.5%), and pharyngitis (10.9%) were the primary reasons for consultation. Minor health disorders were managed by pharmacists themselves (88.2%) and achieved a resolution rate of 84.7%. Eyelid inflammations were identified as in need for an additional decision tree.
Pharmacist-led structured triaging services in Switzerland led to an 84.7% resolution rate of minor health disorders, thereby identifying the potential for pharmacists to minimize the demand on other primary health care providers.
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L’exercice de la télémédecine, une pratique médicale à distance, relève dans plusieurs pays dont la France, d’un cadre réglementaire qui définit les différentes pratiques, précise les conditions de mise en œuvre et l’organisation contractée avec l’autorité sanitaire. Ce cadre réglementaire est-il suffisant pour garantir aux patients un service médical rendu (SMR) de qualité ?
Pour traiter de cette question, la méthode de la controverse est choisie le débat réunit un praticien de la télémédecine (PS), une juriste de la santé (LWP) et un conseiller de l’ordre national des médecins en charge de systèmes d’information et de la e-santé (JL). Un texte initial écrit par PS a été soumis aux deux autres participants qui ont exprimé leur point de vue.
Trois thèmes sont débattus. Le premier concerne l’existence ou non d’un SMR par les pratiques de télémédecine et quelle en serait la définition. Le deuxième thème tente de préciser si une téléconsultation apporte un SMR au patient au moins équivalent à celui d’une consultation face à face. Enfin, le troisième thème tente de préciser si le respect du cadre réglementaire est nécessaire et suffisant pour garantir un SMR aux patients au moins équivalent à celui d’une consultation en face à face. L’introduction et la conclusion sont consensuelles pour les intervenants.
Ce débat révèle des points de convergences et des interrogations. La télémédecine doit-elle s’affranchir de tout cadre réglementaire pour mieux répondre aux attentes d’une société de l’immédiateté et consumériste d’objets connectés et applications mobiles de santé ? Doit-elle ne se référer qu’à la déontologie médicale qui est censée garantir une pratique médicale humaniste au service des patients ? Autrement dit, le nouvel exercice de la médecine à l’ère numérique peut-il toujours s’appuyer sur un SMR aux patients, qui alors reposerait moins sur la recherche clinique et les données prouvées de la science médicale, mais plus sur une évolution propre à la santé numérique et à sa tendance à l’ubérisation ?
The practice of telemedicine, a remote medical practice, is addressing a legal framework in several countries including the France. A decree defines the various practices, describes the conditions of implementation and the organization contracted with the health authority. Is this legal framework sufficient to guarantee a medical service to patients (MSP).
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Three topics were debated. The first concerned the proof or not of a MSP by telemedicine practices and what might be its definition. The second topic is trying to clarify if a teleconsultation brings a MSP at least equivalent to that of a face-to-face consultation. Finally, the third topic is trying to clarify if the legal framework was necessary and sufficient to ensure a MSP at least equivalent to that of a face-to-face consultation. The introduction and conclusion were written consensually by the three contributors to debate.
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Research BriefnetCare, a new collaborative primary health care service based in Swiss community pharmacies

Abstract

Background

Objective

Method

Results

Conclusions

Introduction

Section snippets

Method

Results

Discussion

Conclusion

Acknowledgments

Nouvelles données et aperçu de la statistique médicale 2013

Bull Des Méd Suiss Schweiz Ärztezeitung

Konsultationen in Schweizer Notfallstationen. Obsan Bulletin 3/2013

Career after successful medical board examination in general practice–a cross-sectional survey

Swiss Med Wkly

Identification of patients attending accident and emergency who may be suitable for treatment by a pharmacist

Fam Pract

Patients' use of GPs and community pharmacists in minor illness: a cross-sectional questionnaire-based study

Fam Pract

Research Brief
netCare, a new collaborative primary health care service based in Swiss community pharmacies