Proposition 51K2236

Proposition de résolution relative à la consommation de médicaments dans les maisons de repos et dans les maisons de repos et de soins.

General information ¶

Authors

Vooruit Magda De Meyer, Maya Detiège

Submission date

Jan. 31, 2006

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

elderly person health policy pharmaceutical expenses resolution of parliament

Voting ¶

Voted to adopt

CD&V Vooruit Ecolo LE PS | SP Open Vld N-VA MR VB

Contact form ¶

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Discussion ¶

April 12, 2007 | Plenary session (Chamber of representatives)

Full source

Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker, Mr. Speaker. It should be noted that this was a very intense discussion, on an important topic. We have held several meetings in this committee. We have worked on it a little longer than on the previous one, although this is a resolution and the previous one is a bill.

In agreement with Mr Burgeon, my share in the report is the reflection of the reports of the hearings. We received a number of speakers on the use of medicines in rest homes and in rest and care homes, mainly on the problem as formulated by the presenters of the resolution, under the leadership of colleague De Meyer.

In particular, this resolution seeks to correct not only the excessive use of medicinal products in rest and care homes, but also the improper administration of medicinal products in rest and care homes. Ms. De Meyer stated in her explanatory note that she found, through studies, that she was primarily based on a study, that not only are too many medicinal products used in rest and care homes, but that, in addition, quite a few erroneous doses appear to exist.

Ms. De Meyer also emphasized that both cases are equally serious. She said that we have an excessive use of medicines, which, of course, has a huge repercussion on the health insurance budget, because everything that should not be lost, is superfluous, is not according to good medical practice and is actually wasted resources that we, of course, cannot use for other things.

Ms. De Meyer has demonstrated in detail that in rest homes the problem may also vary depending on the degree to which the patient is involved. She has demonstrated in her presentation that patients who are dementia tend to use fewer medicines than patients who are not dementia. Clearly, the need, the desire of the patients can also result in an increased use of drugs, because quite some elderly people have the idea, the impression that when they take medicines they are better helped and can have a better comfort, although sometimes it turns out that here the effectiveness can still be questioned.

That was the subject of the resolution. This was also partly the introduction given by Mrs. De Meyer on this subject.

In order to further explore the problem, we decided to invite a number of speakers. The first speaker was Dr. Robert Vander Stichele who conducted a study on behalf of the Heymans Institute of Pharmacology of the University of Gent.

Dr. Vander Stichele has done this very pertinently and well illustrated. Using slides in PowerPoint, he explained his study on the use of medicines in rest and care homes. This study was commissioned by the Knowledge Centre.

It has also been shown that what Dr. Vander Stichele has demonstrated is largely consistent with the principles of the resolution put forward by the chief applicant, Mrs. De Meyer. She delivered very meritorious work, well-founded and therefore the document was also unanimously adopted in the committee. I assume that this will be unanimously adopted in the Chamber tonight.

The study was conducted by the Heymans Institute, together with the universities of Antwerp, Gent and Louvain-la-Neuve. The aim of the study was to answer the following two questions. What is the quality of the use of medicines in Belgian rest homes? Does that quality depend on institutional characteristics of the rest house, including its size, its dome, but also the intensity of the drug policy?

In Belgium there are 708 rest homes for the elderly, with the mention that ROBs, in addition there are 970 mixed systems, ROBs and RVTs and, says doctor Vander Stichele, which have a recognition for heavy care needs. In addition, there are also 45 pure RVTs. In total, he has made the sum for us, we come out in our country on 1723 rest homes that together accommodate 126,300 patients of which there are ultimately 37% RVT patients.

Dr. Vander Stichele has honoured Mrs. De Meyer’s proposal for explaining his study thoroughly with expertise. The sample also involved a thousand rest homes located in the provinces of East Flanders, Antwerp and Henegouwen. In fact, total data has been collected on 2,510 residents, residents of rest and care homes.

I will give some findings from the study as they are included in the report. On average there are 97 residents per institution and in this sample there were actually 108. Let us say – that has been emphasized by the doctor and I would like to do so as a rapporteur – that the validity of the study in this case is actually guaranteed.

On average, 39% of Belgian RVTs are managed by the OCMW, public institutions, this while in 41% of cases participated in the study discussed. The average age of the participants in the sample was 85 years. This was also a determining, important factor in the study, as Dr. Vander Stichele stressed and thus is also emphasized in my report.

Each full-time equivalent caregiver, this is a full-time elderly caregiver or nurse, cares about an average of three residents. For an institution of an average of one hundred residents, there were, in other words, 32 visits by general doctors.

Mr. Speaker, I regret that Mr. Van der Maelen deprives the Chief Service Officer of her listening capacity. Honourably, it is Ms. De Meyer who initiated the resolution in Parliament. She has insisted that we have treated them with care and attention, Mr. Leader of the Group. It was because of her that eventually the hearings came too. It is through her workforce, her commitment, her determination that we can also present this resolution here in the House today to the Chamber Members. That was another good work. If I am too kind to your group, you have to say it, colleague Van der Maelen.

The coordinating rest home doctor – this has been very important, the red thread through the resolution just say – or abbreviated CRA (coordinating counseling doctor) which each rest home must legally have, would in fact be the pillar of good medical practice as colleague Germeaux later said, and also of drug consumption. What are we fixing? Very remarkable: in some rest homes, the CRA does not treat a single patient, so it does not oversee anyone and we can ask ourselves in how much it participates in the drug policy. In the other rest homes, 86% of the residents are cared for by the CRA, which then illustrates the very prominent role of the coordinating counseling physician. In that regard, the research thus points to a large diversity in the action of the coordinating consulting doctor.

Dr. Vander Stichele has therefore explained that 83% of the rest homes are served by officina pharmacies and 13% by hospital pharmacies. You will see later in the report, but also in the discussion that follows, that it is of very important, even determining nature, whether a rest house is lived by an officina pharmacy, say a street pharmacy, or whether this is done through a hospital pharmacy. After all, there are completely different realities, different principles of price approach and use of forms in both cases, according to Dr. Vander Stichele.

There was a price competition installed in a number of institutions, especially those of the OCMW. All this was investigated in this study. In 23% of cases this occurred through public procurement and in 33% of cases informally.

Colleagues, I may offend you a little because I summarize very briefly what Dr. Vander Stichele brought much more comprehensively in the hearing. Given the hour, I don’t think it is intended that we will beat the whole hearing here. So I limit myself to the essence, the broad lines of the various points that Dr. Vander Stichele has cited. Anyone who wants to know more should read the comprehensive report available to you.

Overall it was established that the pharmacist’s participation in the drug policy was mainly limited to the delivery of the medicines and did not have any major activities in the field of pharmaceutical care. This, however, is contrary to the third speaker at the hearing, which has just fully entered into the point of pharmaceutical care. A coordinating consulting doctor in a rest home should actually be one who also outlines the pharmaceutical care, the drug policy and thus avoids what Mrs. De Meyer wants to avoid with her resolution, namely the overuse or misuse of medicines in rest homes.

Mrs. de Meyer, colleagues, Mr. President, Mr. Minister, the Minister, of course, was not present because this was a parliamentary initiative, for which we have all understanding, and it charms him the more that he will come to listen to us tonight.

95% of the rest homes had a form. This is a key element shown in this resolution. In 79% of cases this was a national form, and according to Dr. Vander Stichele therefore a geijt form. In 25% of rest homes, a quarter, the use of the forms or good medical practice was not actively encouraged. 32% of institutions already had an electronic prescription system, half of which had a built-in presentation of the form. That is an inventory of the most commonly used medicines in rest homes, sorted by effectiveness, effectiveness and price, which actually brings one to the best choice and which by means of this brochure one can immediately know which medicinal product is best used for which indication at the best price and with the greatest therapeutic guarantee of effectiveness. This is something that should be appealed everywhere. It is already done in hospitals and rest homes. Dr. Vander Stichele says that 95% of rest homes have such a form, but it is not actively used in a quarter of cases.

In 32% of institutions there was already an electronic system.

Of the residents, 48% were dementia, 38% were depressed and 16% had both problems together. 3% of the residents were in terminal care, which also has an implication or complication to drug use.

The number of clinical diagnoses does not increase much with the years, but the health care problems do. With regard to the medication, there were an average of eight rules for each medication, seven of which were for chronic, oral or systematic medication, which had to be taken less or more times a day.

Dr. Vander Stichele’s research also showed that there is a strong correlation between the number of health problems and the number of medications. The medication does not increase with age. At 80 years, about the largest number of medicines is taken. At the age of eighty we take the largest number of medicines, according to Dr. Vander Stichele.

There is a decrease in medication in dementia elderly, but I have already indicated that. This, by the way, has also been discussed in Ms. De Meyer’s initial explanation.

The costs of medication are very important. That is, I think, also in part the reason for this resolution.

The RIZIV pays about 90 euros per resident and per month for medication. In our country, therefore, we pay back about 90 euros per resident and per rest home resident from the public funds, from the RIZIV. Multiply that by 130,000 patients, then you know approximately what it represents to the amount in terms of drug use by older people. Moreover, Ms. De Meyer found it necessary to force a resolution, a declaration of intent, a decision of the Parliament. Whether this will make sense now, so late in the legislature, is, of course, another issue.

23 euros per month is spent by the resident as a brake money for repaid medicines, 27 euros per month is spent for non-repaid medicines. That is an average of 50 euros per resident per month in expenses for medicines. So: RIZIV, 90 euros per month per resident, has doctor Vander Stichele calculated, but for the patient himself there is still also 50 euros imposition, on average, per rest home resident, times 130,000, in our country, per month.

Dr. Vander Stichele, who was the first speaker, concludes that the consumption of medicines in the Belgian rest and care homes is high. The costs for the medicines are high, both for the RIZIV and for the residents.

There are a number of quality problems, both from underuse and overuse. The search for the best way to permanently measure the quality of prescription with quality indicators has just begun.

Following the study, the Healthcare Knowledge Centre has formulated a number of recommendations, including better implementation of the form – there we are again –, strong local agreements on the choice of medicines, an adaptation of the distribution system of medicines and better pharmacology training for nursing staff.

The first speaker, Dr. Vander Stichele.

The second speaker was Mr. Froyen. If I can, Mr. Speaker, I will here make a little summary of what was said by the speakers during the hearings because otherwise the report would be too long.

I will not stop you.

Nevertheless, it is of course important what was discussed.

A colleague asks for the word.

Mrs. Roppe, I thought you would be speaking in the general discussion. Do you want to talk now?

Sorry, but my patience has limits. So far I had a lot of respect for colleague Goutry. I now see that he acts here as a reporter and makes no sense of synthesis at all. Most of the colleagues who have done so have put forward a sense of synthesis. Mr. Goutry does not show any respect for his colleagues. Fortunately, we were able to read before we arrived in Parliament.

I therefore regret this attitude, ⁇ of the representatives of a party that wants to take over government responsibility in the next majority. The grin smiles that I saw on the faces at the beginning, telkenmale as Mr. Goutry came to me, have greatly disturbed me.

I admit, Mr. Speaker, that I am tired, and I will not be the only one in this hemisphere who can say to be tired at 1.00 a.m. at night after a busy day job.

This does not show respect at all, not even for the subject that is being dealt with. And I am sure that Ms. Burgeon, who will report on the other part of the discussions, will present her report in a much more synthesized way. It had to come from my heart.

A rapporteur shall present his report in the manner in which he considers it to be presented.

Mr. Speaker, I thought it was an impressive speech held here. I suggest that our colleague within the majority once ask to move the entire agenda to next week. There is one draft on Thursday. We could reduce the agenda considerably.

We have proposed it.

I think she is right: we must stop doing this. It is now 1 hour. Let us convene the Chamber and move the rest of our agenda to the next Thursday and the case is resolved. She is right!

Mr Goutry, you continue with your report. You would make a more synthesis. We listen to you.

Mr. Roppe, you are complaining about fatigue. Okay, but I think I’ve been working a little more than you and I don’t feel tired at all. On the contrary, I’m springy, I’m fresh and I try to summarize a 70 page hearing on 4 pages, colleagues. On 4 pages!

Or should I say: am I referring to the written report? Is this parliamentary work? Do you prefer that? Since it is night, should I refer to the written report? Then we get out of it and you go home with a big thought of yourself that you have still done parliamentary work on the sale.

( ... ) : ( ... )

Come, the more you want to keep it short, the longer it will last.

Mr. Goutry, do not let you do it.

The [...]

Mrs. Roppe, come ...

I have had the privilege of being a reporter several times. I referred very exceptionally to the written report, and that was only when it was half a page. But display 4 pages in half an hour time, you shouldn’t be smart for that either.

It’s been painful from this afternoon, Mrs. Roppe...

Mr Goutry, come to me.

You’d rather take the example of your colleague De Meyer instead of criticizing something you probably don’t even know what it’s about. But I'm still smart enough to know what it's about, you don't have to be scared;

Mr. Tant, briefly, and then Mr. Goutry must decide on his report.

Mrs. Roppe, you were present this afternoon when I suggested because of the very full, excessively full agenda to advise us on shifting some points, possibly to next week. You are there...

The [...]

Yes, Mrs. Today is Thursday. The agenda was presented...

... on Friday!

Yes, already on Friday. The agenda was presented to us by the majority. You should not now complain about the fact that the opposition plays the role it should play. You are at the basis of this. And indeed...

Come, Come, Mr. Tante, Late...

Instead of moralizing the opposition, moralize the majority, which we have been accusing for months because we are treated unfairly, because we are constantly stuck in their time carcass. That is the truth.

The same applies to other subjects that will be discussed later. We were, by the way, with your complicity, Chairman, deprived of the opportunity to speak to us as a Chamber about the opportunity to address some points tonight or tonight.

Mr. Tante, in our youth we were just sitting here almost every Thursday night. You have experienced it too. We were here every Thursday night.

Ladies and gentlemen, do not be too nervous. On seven other points, I was also appointed as a rapporteur. Do not be too nervous. If you want to take a break, now is the time. We will wake you up later. Per ⁇ I will drop one report.

The second speaker was Mr Froyen, director of Ouderenzorg of the rest house Den Olm in Bonheiden. He was invited by Mrs. De Meyer.

Mr. Froyen pointed out that pilot projects are underway to positively influence pharmaceutical policy in rest homes through distribution. It must be said that he gave an impressive presentation.

For example, in the rest house Den Olm a system was introduced in which the pharmacist continues to cooperate in the distribution and has a direct interaction with the prescribing doctor. It is, of course, optimal, when the distribution can take place in cooperation with the prescribing doctor, because the medical guarantee in this case is the highest. The likelihood of mistakes is the smallest.

In the hospitals where this has already been permitted by law, the hospital pharmacists, by the way, have been doing pharmacological and pharmaceutical care for a long time. This was reflected in your resolution and in the discussion. It is one of our biggest problems in our rest homes. This, of course, has to do, as has been shown again, with the shortage of personnel.

Through the use of a robot and preparation at the moment of delivery, a patient medication system is developed.

I regret that Ms. Roppe, who just insisted on a short report, now does not even want to listen to my report at all. I continue from respect for my co-rapporteur, who, as I see, is still fully preparing and will soon, of course, also excel in her reporting.

Mr Geert Van Genechten was the next speaker. You know how short I am. Mr. Van Genechten is a supplier pharmacist in the rest house Den Olm in Bonheiden. Mr. Van Genechten also gave us a clarification.

He added that currently the medicine for distribution is being packaged by the industry. Colleagues, you know that all medicines are in blisters, all of which must be broken and sorted by prescription and by patient. Mr. Van Genechten explained to us that they are then brought together in one bag per patient, in order to have as few errors as possible in the use of medications.

The findings of Mr. Van Genechten show alarming that 23%, or 23 out of 100 rest home residents, get the wrong medication or at some point get the wrong medication.

He explained us very beautifully, also visually and even almost by schedule, how all medication is delivered and distributed by prescription, audited and controlled by the responsible people. He also explained how the blisters are broken, after which the drugs are collected per patient. Research was done before the system was used. The error load was 23%. Research was carried out after the implementation of the system. The error load was 3%, which is a profit of 20%, according to Mr. Van Genechten.

The project works with what is called multidisciplines. This means that all medicines are taken together and packed at the same time. First of all, a digital medication plan must be drawn up, where the use of the form plays an important role. That plan determines which medicines which resident should take at what time. It also contains generics.

A selected file from the medication plan is digitally sent to the pharmacy, where a device, say a robot, helps pack everything. However, the final check remains the responsibility of the pharmacist himself. The advantage of such an automated patient-medication system is that a patient gets a set of bags packed chronologically, per day, because the medication is not the same every day, Mr. van Genechten explained. Certain medications may need to be taken on Monday, Wednesday and Friday, other medications every day and other medications once a week. So everything is put together in a bag, but it is watched that the intake occurs at the right time, otherwise we would of course not reduce our burden of error, ⁇ when sorting the medicines, but not when using. This was the statement of the Lord of Geneva.

The result of such an automated system is that the patient is treated more safely. In this way, there is also a daily supply to the RVT from the pharmacy, which once again reduces the error load and there is also much less surplus of medicines. As you know, one of the major problems of our health policy and social security, in addition to the spending in the pharmaceutical policy, is that very many medicines are thrown away.

Legally speaking, the pharmacist can fraction medicines since the law of 1 May amending the revision of the pharmaceutical legislation. Since last year, every pharmacist can actually legally serve you on a scale. For example, the doctor could prescribe 16 pills, while there are normally 25 pills in a package. The pharmacist will then have to deliver 16 of them in a dose, which, of course, would counter a huge waste. So far, of course, the producers do not respond favorably to this.

I take together. My part of the hearings is then processed, colleagues. Mr. van Genechten has proven that through quality improvement a time gain can also be achieved. This in itself is, of course, also a milestone. It did not appear before the investigation, but afterwards.

I have to keep my commitments in all sports. I am half the report. I remember you a lot, my colleagues. I find that a little regrettable. I apologize for having to do it at such a fast pace and with omission of a lot of relevant information. It is a huge interesting topic, with which billions can be earned. Sometimes we look for a few million. This is about billions of savings that could be realized. I apologize for making the report so synoptic and synthetic, but I think it should be enough to encourage you to read the report in full.

Mr. Speaker, I would like to give you the word back; you may then give it to my co-rapporteur.

Mr. Goutry, the report I have has seven pages in one language.

The meeting was held on March 13, 20 and 27. by Mr. Goutry interviewed you on the auditions of March 13. I will inform you about the subsequent exchange of views.

Ms. De Meyer emphasized the importance of Professor Vander Stichele’s study, which also takes back the strength lines of the resolution. This is how this study confirms the importance of the form, the need to implement it and the strengthening of the role of the coordinating and advising physician.

She wondered if it was possible to fully automate the prescription system and what the cost would be. Would this automation result in additional costs for the rest house or could these costs be financed otherwise?

A few years ago, Christian Mutuality conducted a study on this problem. It turned out that a quarter of the medication was ineffective. Does the study of Professor Vander Stichele confirm this finding?

Do generics occupy a place in the form? As for the administration of half-tablets and quarter-tablets, are these administered as part of the project that is currently being set up in the Den Olm rest house? What is the cost of this system? What is the cost of increasing the responsibility of the pharmacist?

by Mr. Luc Goutry intervened and considered that the proposed project evoked an ideal situation. The achievement of some of the objectives contained in this project would already be very positive.

Using a good form is the key to success. This form will, in addition, have to be implemented by the Coordinating and Counseling Doctor (MCC) which is currently not subject to sufficient attention. The MCC often lacks effectiveness in practice because it is not sufficiently associated with decisions. He asked what was the added value of the MCC and how, in general, to highlight its role. In the future, the pharmacist should be more involved in the consultation.

The consumption of medications is lower in people with dementia. This situation is actually related to the patient’s attitude. The behavior of the patient thus apparently plays a role in the same way as that of the prescriber. He therefore wondered whether it would not be interesting to also invest in reference nurses, as is the case in the field of palliative care.

by Mr. Robert Vander Stichele of the University of Ghent highlighted the existence of a thousand MRSs in Belgium, but that only a few software companies wanted to develop applications in the sector. These companies are very actively involved in the information process that a number of rest homes are developing, as well as in the beginning of computerization of the administration of medicines. A number of activities are currently being developed. It would be good if the public authorities support, in a wise way, the development of standardization and labelling, as is the case for the offices of general physicians.

In fact, the study showed that a number of mistakes are committed in the management of medicines in rest and care homes. It would therefore be desirable that the list of medicines be checked and possibly adjusted every six months.

by Mr. Vander Stichele believed that some nurses should specialize in pharmacology. By province, a clinical pharmacist, a nurse referent and a MCC should work together to organize communication and consultation of all professional groups in the various rest homes of the province.

by Mr. Van Genechten, a pharmacist who supplies rest homes, emphasized that generic drugs have a place in the form and that they should have an even more important place there.

Since the introduction of generics, medicines have become much less recognizable for care workers. The reconditioning of the drug makes it again more recognizable.

In the case of half medicines and quarters of medicines, Mr. Van Genechten has doubts about the interest of cutting certain medicines into two because the therapeutic goal aimed by the prescribing doctor is not necessarily achieved.

Pharmacists should be encouraged to introduce this system. The cost of the package is 168,000 euros. If the only compensation for the pharmacist is an increase in his responsibility, this system will not be very successful. In addition, the use of half-tablets or quarters of tablets makes this system highly labor-intensive and of course increases the risk of error. Per ⁇ this problem could be solved by working with the industry to reduce doses by half at the industrial level.

by Mr. Froyen, director of a rest house, noted that, for residents, quality increases and costs decrease. The institution makes the savings of a full-time nurse on an annual basis.

In the Netherlands, drug abuse costs 30 million euros a year. The figures are not known for Belgium but this represents a significant burden for society that could be avoided.

Hospitals have long used an INAMI nomenclature for pharmacists and therefore it is not difficult to transpose this nomenclature for officines. It is recommended not to pay the pharmacist according to the quantities but according to the time of administration on the packaging.

To the coordinating and advising doctor is now added the coordinating and advising pharmacist, the PCC. It is absolutely necessary to bring these two people together. The nurse who takes care of the pilot project is discharged from this task and it is also noticed that the suggestion of a nurse referent is ⁇ important.

Finally, let’s go to the vote. The resolution was adopted unanimously. I thank you for your attention.

Mr. Speaker, approximately a year ago, we submitted the resolution, which is now being presented, to raise the alarm clock regarding the use of medicines in rest homes. According to us, patients swallow too many pills and are often prescribed ineffectively. There are often mistakes when administering medication. This costs a lot of money, not only to the RIZIV but also to the patient himself. When submitting this, a little co-working was done from the sector and by a number of colleagues. They wondered what we were doing, to the hell.

A year later, the Knowledge Center came out with a study that actually largely confirmed our analysis and recommendations. The Knowledge Centre said that although there is a national form, this form is actually kept available in rest homes in only 79% of cases. In addition, in a quarter of rest homes, it is actually not actively used, let alone stimulated. Only one-third of rest homes have an electronic prescription system and only half of them have an automatic presentation of that famous form.

In the study of the Knowledge Center, it was found that the analysis we had made on the basis of other studies, that the average rest home resident consumed an average of five medicines per day, was too low. It was worse, it was about an average of eight medications per day. There is therefore over-use but also under-use for certain other things. For example, today half of rest home patients are prescribed antidepressants, while in fact only in a third of cases the diagnosis of depression is made. There is also underuse of certain medications. I think of the fact that in a quarter of cases, no beta-blockers are prescribed for heart disease.

As already abundantly cited here, also by colleague Goutry, the cost per patient is not negligible. On average, each patient receives 50 euros per month from his own pocket. We are talking about averages here, which means that there are people who have to count down 100 or 150 euros per month to get the necessary medication. We were very pleased with the findings of the Knowledge Center, which largely supports our resolution.

In the resolution, we defend four major principles. First, the national form must be effectively mandatory for the rest homes. Support should also be provided to those same rest homes in order to make that form available electronically. This is especially interesting, coupled with an electronic patient file. If the receiving general practitioner prescribes a particular medication to his patient, he will immediately see on the screen which medication the national form for that condition indicates as ideal in that particular case. In this way, we can also introduce generics much easier in the resting house. We have an incredible win-win situation.

We need to make much better use of this form.

Second, as regards the purchase and distribution of medicines: the procurement procedure especially generally for all rest homes so that there is a financial gain that should also benefit the patient, not only the rest house. This can then be invested in other things. I think of ergotherapy, healthy eating, animation, mobilization and so on. I also think of a formalized drug distribution system, as the pharmacist has come to explain in the committee. These are very interesting experiments and pilot projects, with individualized doses per patient and packaged separately, with the responsibility with the pharmacist and no longer with the nurse or caregiver who must waste their time to press medication out of the blisters.

Third, more impact for the CRA, the coordinating physician, who should be able to play a much more powerful role and who should also receive solid training and re-framework for that. This should be done in consultation with the medical circles.

Last but not least, a continuous study of drug consumption in the residential sector and a good registration system of errors in pharmaceutical operations, which in the long run can be profitable not only for the rest homes, but also for home care.

I therefore sincerely hope that the resolution, as in the committee, will be unanimously adopted at this meeting.

thank you . I must say that this is an interesting report. I was allowed to read it. Mr. Goutry, you are the last speaker in the general discussion. Does no one ask the word anymore?

Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer, Mr. De Meyer. I have already said. This is a resolution that we also support from the opposition. It is not a matter of majority or opposition. We just say our thought. What is good, is good. What is wrong, is wrong. Then it was less. Now it is better.

This is a very interesting topic because it exposes at least a piece of a problem, gives a start to answer and has produced a number of experiments that – which the minister may be able to confirm – should be able to produce a savings. It is not just about saving. That is actually a welcome effect that is obtained by a much more efficient use of medicines which is important for public health. In addition, one gets a much more flawless use of medicines which is of course a very important matter for the patient.

I have also previously delved into studies and reports that indicate that we use too many medicines in elderly people in rest homes. I was aware of this, but it was a little disappointing that there is also a serious load of errors. I was really convinced that it was so. I have often talked about this with people in rest homes. I also tried to do the test on the sum.

Of course, if one gets the opportunity to discuss such a topic through the Public Health Committee and through the Parliament, that is an extraordinary opportunity. It is also a core task of our public health committee, which must always be engaged with the same principles: responsibility, efficiency, price control in short, everything that can improve public health and our health insurance budget, Mr. Minister. You will probably bear that these are important things.

Colleagues, I would briefly give a few points in connection with our vision, which CD&V develops regarding the use of medicines in rest and care homes.

We advocate, together with you, Mrs. De Meyer, and I hope with the whole Parliament, if the resolution is adopted, for an effective use of a form. We also talked about this in the replica, in the discussion after the hearings.

A form is something incredibly interesting. It is surprising how little use is sometimes made of it. After all, a form does the work for us. In fact, it is an inventory, a summary of the medicines that are effective, sorted by indication, sorted by price, so that the prescriber does not get lost in the far too large range of medicines.

Colleagues, did you know that in our country there is a supply of 26,000 different medicines? Of these, there are up to 1,700 different active substances. All the rest is the same in another package, syrup, comprimé, melting tablet and so on. It is actually too much of the same. One must come to an order in that wild growth, in that amalgam of supply.

This is too much left to a doctor. It is expected of a doctor that he can clearly see in those 26,000 types of medicines, that he can immediately extract from them the best for his patient, the most efficient, but also the cheapest. That can of course not. The result is that you pay too much.

That is one of the things that have led to the kiwi model or the whole discussion about it. It has been said that if you have 70 anti-inflammatory agents with all the same substance or 70 painkillers based on paracetamol of the same chemical, it would be much better to let those 70 compete against each other and then choose one with the lowest price – because it is all the same chemical formula – and then refund that product, for example, completely for chronic patients. The other medicines are then, of course, left on the market, which have been stamped, which have been recognized, which are safe, but would no longer be refunded. That is the core of the case.

Well, a form helps us on the way. It makes a selection, it makes an extraction of effective drugs at the best price. This is the tool available in hospitals. This is widely used in hospitals. This is also part of the good medical practice of hospitals. There is also a hospital pharmacist. It is also responsible for that management.

In a rest house, there is precisely the Achillespees, one does not have a rest house pharmacy, as in a hospital. There are nurses, caregivers. They do not have their own medical staff at home. One can only have a coordinating counseling doctor, a CRA, who would then actually apply such a form.

Mrs. De Meyer, colleagues, that brings me to the second point. This has also been extensively discussed in the discussion, namely that it is not enough to have a form, because with it a nurse can do nothing. A nurse does not write. He does not have permission to do so. This must be done by a doctor. So the form should actually be used by doctors, by prescribers. Here lies then the very important role of the CRA, the coordinating counseling physician in that rest home. This is the first important point that we all agreed on.

Mr. Minister, colleagues, a second important point is the problem of overconsumption of medicines. On average, too many medicines are used. This has been calculated. In all rest homes together, that is eight medications per day per resident. That is extremely much. This was shown in a previous study of the Christian Mutualities. They had come to the same conclusion as Mrs. De Meyer. We could read this on the first page of The Tomorrow yesterday morning. It was referred to your important work here in the Chamber.

Whether it’s sedatives, sleeping pills, or whatever, too many medicines are simply swallowed. The doctors in the room will of course be able to confirm this. They will also be able to provide the medical framework.

In previous debates on this subject, I have repeatedly held the position – I remain with it and my group contributes to it – that part of the misuse of medicines in rest homes is related to a shortage of personnel.

I am convinced that an excess of sleep medication is given to elderly residents of a rest home simply because they do not have the necessary night care staff to help the people. Half of the rest home residents – according to another study – are dementia. Half of those demented rest home residents are people who wake up at night, who have lost all orientation for time and space, and are in panic and anxiety. Then they actually need help, a little contact with a nurse staff member. This cannot be offered. In most rest homes, there are only 2 nurses per institution and this is usually for 80 to 100 patients.

There is a lack of care, especially at night. Therefore, especially sleep medications, calming medications are taken so massively in rest homes.

My position is supported by the fact that, on the one hand, the excess of medicines is the result of, among other things, a lack of care, of personnel and, on the other hand, a shortage of personnel then again causes a spiral that causes too many medicines to be taken.

Colleagues, you could say that I am not a doctor. I am only a modest member of parliament, who does my best to write good reports and occasionally hold a speech on the tribune. What could I, as a modest member of parliament, base myself on to develop this statement? After all, I am not a doctor and I look again a little at the doctors in the hall, but I got good assistance.

A very well-known geriatrist in our country, especially Dr. Baeyens, has joined my position. Dr. Baeyens has indeed said, and that is very important, that excessive use of medicines in rest homes has to do with underemployed personnel. In the same movement one could argue and come to a more efficient drug policy among residents of rest homes where the profits derived from it are converted into employment, in care, in nursing. We create very meaningful employment and we have more helping hands and hearts near the patient in the rest homes, which is ultimately the human goal of caring for our elderly people. This is our proposal on behalf of CD&V.

In short, we think it is high time that serious efforts are made to build a rational use of medicines within the rest and care homes, in addition to eliminating a staff shortage. Only in this way will rest home residents actually get the right, high-quality care, which they ultimately also deserve and which we all support.

I get together despite the nighttime and I am glad that I can still count on so much attention. That attention should actually be written directly on the account of our good colleague De Meyer, who took the initiative for this important investigation, for this important resolution and who has thus also raised the Chamber to a higher level. Because this is something that will be referred to later.

Mrs. De Meyer, you’re coming back, you’re not coming back, that’s the issue these days. In any case, even if you would not come back, which I ⁇ do not wish you, your mind, your penny spirits will survive in this Parliament. We will in any case remember you as the member of Parliament who for the first time brought the theme of overconsumption of medicines in rest homes, which can save billions, here on the tribune in this Chamber, and that will lead to a political ruling later. We will have this conscience and this will no longer be erased.

This is something we will bear in future times and in the history of our policy.

I would like to sum up for those who would have understood me less well.

First, for CD&V, the form is very important. Second, for us it is indispensable because it depends on it, the role of the CRA or coordinating counseling physician. Third, as a positive consequence, the control of overconsumption in rest homes. Fourth, the possible conversion, transfer or use of what we waste on medicines in employment through better care, more night care, and also better death accompaniment. This is something that should be developed very prominently even in rest homes.

If we can do all this together, colleague De Meyer, on the basis of this resolution with the good enthusiasm that we have been able to arouse here and the enthusiasm that we have been able to arouse with you through our demonstrations, I am convinced that the first step has been taken towards a better pharmaceutical policy in the rest and care homes. Of course, I thank you for your attention.