Staff Writer, HPE
The President of the European Association of Hospital Pharmacists (EAHP) has expressed concern at the economic outlook for Europe in 2012, suggesting the situation will have a significant impact on the pharmaceutical industry.
Roberto Frontini believes that employment cuts and the reluctance of pharmaceutical giants to lower prices have led to a situation in which hospital pharmacists in Europe are finding it increasingly difficult to do their jobs.
The EAHP is celebrating its 40th birthday this year, and Dr Frontini said that over the years patient safety has become central to the organisation’s focus, but achieving optimum treatments for patients is more difficult when hospitals are short on staff and struggling financially.
“At the beginning, EAHP was an organisation speaking about hospital pharmacy and our profession,” he said.
“In the last three or four years, we are not speaking about hospital pharmacy any more; we are speaking about safety for patients and what hospital pharmacists can do to optimise the medication in hospitals, which is quite a different thing because we now consider hospital pharmacists as a tool you need to help patients to have safe medications and to have seamless care.
“But if pharmacist jobs are cut, we have more and more the problem of not enough staff to work clinically and we are forced to do more procurement, which is completely wrong – it’s not the function of the pharmacist.”
With cuts taking place across the European market, Dr Frontini believes it is important that hospitals recognise the central importance of pharmacists in advising doctors on prescribing the correct medicines for patients.
Furthermore, he suggests that, in the long run, cutting hospital pharmacist jobs is likely to result in a loss of money.
“I think that saving money means having the right professionals in the right positions, and pharmacists are people who advise doctors about efficient use of medicine,” he said, “so there shouldn’t be cuts because creating the shortage of pharmacists we are experiencing means in the end that we will spend more money than we are saving.”
Another consequence of the economic crisis, according to Dr Frontini, is an increase in counterfeit drugs, with the focus shifting from quality to price.
“Counterfeited medicine was not a problem in the past,” he said, “but now we are aware of some big problems in European hospitals and this is linked, in my opinion, at least partially with the problems of the Eurozone and austerity measures, because now people are looking more and more at prices, and looking not enough at quality.
“There is more emphasis on reduced costs, and sometimes the cheapest drug is not the right decision, but the pressure by administration to save money is enormous, and this has consequences.
“In countries like Greece, I read that Roche is not providing oncology drugs any longer to Greece because they can’t pay or they try to make prices they can’t accept.
“I think that creates an ethical problem because Greece is now experiencing real shortages – not only on lifestyle medicine, which would be OK, but on really important drugs, and that’s not acceptable in the European Union, to have this mess. And this is connected to pricing and pricing policy. So, are the Eurozone problems affecting the pharmaceutical industry? Yes, because the pricing system in Europe is based on a few countries – rich countries like Germany and France – with high prices (especially Germany), where industry is not willing to make lower prices because they are afraid if they give a lower price to Greece, all the drugs will go to Greece and come back to Germany [cheaper], and they will have a big loss.
“This is something which becomes more and more an ethical problem.”
Another issue that Dr Frontini considers to be tied to the financial situation of Europe is patient compliance, or the relative lack thereof.
“Something else I really believe we should take care of – as pharmacists in general, but also a high responsibility for hospital pharmacists – is patient adherence, or compliance,” he said.
“Because if you see that only 50% of patients on average are compliant, this means that we are spending 50% without effect, or with a reduced effect, and this is creating a lot of cost without any outcome.
“And I think that a function of pharmacists, from the very beginning historically – from the 13th Century – is to bring the active principal, the medicine, to the patient, and adherence is important in this because a poorly instructed and poorly educated patient will be less compliant and we will spend a lot of money for nothing.
“One of the things our association is trying to do is to cooperate with other groups on the hospital community interface, because I think we have to save money to use money in a proper way, and then we will have the money to spend on truly innovative drugs.”
Although the situation appears rather bleak, Dr Frontini claims that he is not worried, but is instead determined to change the situation.
“We have an important role as pharmacists in hospital, as well as pharmacists in general,” he said. “I think we should be advisors to doctors on efficient use of medicine, which means that new drugs aren’t always the best option; new drugs aren’t always really innovations. Some of them are, but we should be the people advising, independent from industry, which drugs are really innovations that we need and which are drugs that are only increasing expenditure.
“Let’s take an example; I was recently in the Former Yugoslav Republic of Macedonia (FYROM) and I saw they spent a lot of money on adapted insulins, which have a little advantage, but a really minimal one compared to human insulin.
“I think that’s crazy because they’re spending a lot of money for only a few advantages, which is maybe acceptable for a rich country, but not a poor country.
“This is the responsibility of pharmacists to advise in a proper way what is the real added value of new drugs, which is not hindering innovation – not at all – because saving money where drugs are not useful or more valuable than old ones means having money to use on the real innovating drugs by giving them to the right patient.”