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A National implementation group – aligned and efficient changes of medicine and treatments nationally across hospitals

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European Statement

Introductory Statements and Governance

Why was it done?

The role of the NMC is to provide guidance about new medicines for use in public hospitals, and recommendations from the NMC can lead to changes in medical treatments. Before changes can be implemented, a variety of preparatory processes are necessary and relevant stakeholders, e.g. drug and therapeutic committees, hospital pharmacies, clinicians, and the national supply organization have to be involved.

Knowledge sharing and coordination among stakeholders are crucial to ensure efficient and nationally aligned implementation.

To undertake these tasks and support the NMC in their work, there was a need for a national group with expertise in implementation of changes of medicines in hospitals.

What was done?

The National Implementation Group was established in September 2019. The main purpose of the Group is to discuss, assess and ensure implementation of recommendations and treatment guidelines from the National Medicines Council (NMC) across regions, hence achieving national consensus on aligned medical treatment.

How was it done?

We formed the National Implementation Group with representatives from all stakeholders for swift and coordinated execution of changes of medicines. Each region designated participants directly involved in the implementation. To ensure effective knowledge sharing and coordination, the Group holds a monthly one-hour virtual meeting one week after NMC recommendations are published.

What has been achieved?

The monthly Group meetings ensure that the national implementation process takes approximately 14 days and the recommendations from the NMC are regularly discussed, assessed, and implemented efficiently and aligned at national level.

In 2022, the Group was evaluated through focus group interviews, highlighting quality and value. Results show that the Group aligns implementation nationally, offers expertise, saves regional resources, and fosters valued knowledge sharing concerning implementation of changes of medicine and adherence to recommendations.

The Group has now been successfully integrated as part of implementation at national level, emphasizing the importance of shared knowledge for efficient implementation of changes of medicines at national scale.

What next?

In future, the Group will increase its focus on identifying differences in treatments based on enhanced utilization of health data.

The Group provides the basis for knowledge sharing and can easily be transferred to other healthcare settings, both nationally and internationally.

Structured implementation to secure rapid and efficient changes of medicines: a national workflow

European Statement

Introductory Statements and Governance

Author(s)

Mikala Vasehus Holck, Jette Østergaard Rathe

Why was it done?

The role of the National Medicines Council (NMC) is to provide guidance about new medicines for use in the public hospital sector.

Recommendations from the NMC must be implemented at hospitals. Implementation of changes of medicines requires preparation and collaboration and involves numerous stakeholders, e.g. drug and therapeutic committees, hospital pharmacies, clinicians, and the national supply organization (NSO) to public hospitals. Knowledge sharing is crucial to ensure efficient implementation.

We needed a workflow focusing on knowledge sharing at national level, and thus we introduced the structured implementation workflow in September 2019.

What was done?

We have established a structured implementation workflow focusing on knowledge sharing. The workflow ensures rapid and efficient implementation of changes of medicines, and a more aligned treatment at national level.

How was it done?

To ensure knowledge sharing through the workflow, we developed:

– Implementation memo: Summarizes NMC recommendations and treatment guidelines, with information about current and upcoming tendering procedures and prices. The memo is shared with the stakeholders.

– Implementation group: The group is a mix of people with a direct connection to the implementation workflow. The group ensures that implementation of the recommendations from the NMC is regularly discussed and assessed.

– Implementation site: An intranet for the NSO and hospital pharmacies to share information and material related to the implementation of changes of medicines.

– A system to ensure that essential stakeholders receive the same information.

What has been achieved?

The structured implementation workflow has been a success and is now an integrated part of implementation. Evaluation shows that the workflow with knowledge sharing between relevant stakeholders is essential for effective implementation of changes of medicines, and it identifies discrepancies at national level.

What next?

The structured workflow is an integral part of managing the national implementation, and the workflow and outcomes will continue to undergo evaluation.

The workflow provides the basis for knowledge sharing and can easily be transferred to other healthcare settings.

PHARMACOGENETICS IS GROWING FAST

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European Statement

Clinical Pharmacy Services

Author(s)

Xando Díaz-Villamarín, Ana Pozo-Agundo, Paloma García-Navas, Celia Castaño-Amores, Alba Antunez-Rodriguez, Cristina Lucía Dávila-Fajardo

Why was it done?

Pharmacogenetics (PGx) has the potential to predict patient´s drug response. Many genetic polymorphisms have been associated with variable drug response. This has been demonstrated with the highest level of evidence in fact many of them have been included in clinical dosing guidelines such as those from the Dutch Pharmacogenomics Working Group (DPWG) and Clinical Pharmacogenetics Implementation Consortium (CPIC). Actually, many drug labels include the recommendation about genotyping specific single nucleotide polymorphisms (SNP) prior to drug prescription.

What was done?

We have implemented pharmacogenetic tests in our hospital for a total of nine drugs.

How was it done?

Our hospital provides a PGx test service according to the following workflow. Physicians order the PGx test to the Pharmacy Unit, we take a saliva sample with sterile-cotton tipped swabs and send them to the Genomic Unit at Genyo. There, we extract the DNA and genotype the variants of interest. Genetic results are reported back to the Pharmacy Unit within 48-72 hours. After genotype-phenotype-recommendation translation according to the CPIC and DPWG dosing guidelines, we upload the dosing recommendation as a PGx report to the electronic patient´s medical history.

What has been achieved?

Since 2012, 2414 patients have benefited from our PGx test service for at least one drug-gene interaction. These tests have been requested by seven hospital departments with regard to a total of nine different drugs. We have reported 932 PGx dosing recommendations: Clopidogrel with 2013 genotyped patients and 845 dosing recommendations; Azathioprine with 208 and 21; Capecitabine: 48 and 1; 5-FU: 5 patients without recommendations; Tamoxifen: 117 and 48; Trastuzumab: 34 and 15; Irinotecan: 4 and 2; Simvastatin/Atorvastatin: 2 genotyped patients and no recommendations.

What next?

Since the first PGx test in 2012, we have been able to implement PGx tests in daily clinical routine in our hospital affecting 9 drugs. 2414 patients have benefited from this service and we are working on the implementation of new polymorphisms affecting drug response to expand our services.

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