Proposition 53K0268

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

General information ¶

Authors

CD&V Sonja Becq, Nahima Lanjri, Nathalie Muylle, Inge Vervotte

Submission date

Oct. 4, 2010

Official page

Visit

Status

Adopted

Requirement

Simple

Subjects

elderly person medicinal product health policy pharmaceutical expenses resolution of parliament

Voting ¶

Voted to adopt

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

Party dissidents ¶

• Rita De Bont (VB) abstained from voting.

Contact form ¶

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Discussion ¶

July 19, 2011 | Plenary session (Chamber of representatives)

Full source

Since Ms. Maya Detiège is not present, I refer to her written report.

I will be brief because the time is moving forward.

The text presented to us today aims at a rational consumption of medicines in rest and care homes. This resolution is inspired by various studies, including that of the 2006 Federal Centre of Expertise, the main recommendations of which are presented here.

I would like to draw attention to the fact that the appointment of a counseling coordinating physician should be encouraged to ⁇ better collaboration among all caregivers. But, for us, it is also important that each resident can continue to freely choose his/her doctor who should play a central role in taking care of his/her patient.

It is also necessary to orient the training of nurses and pharmacists towards a new role in medication management in healthcare institutions. Improved pharmacological training of nursing personnel and improved communication with the pharmacist and doctor are likely to improve the quality of medication in rest and care homes.

The use of the pharmaceutical form should, of course, also be encouraged. That being said, this form should not be specifically a tool designed to replace the free choice of the doctor that remains the number one priority. This is a reference tool for prescribing medicines to elderly people, but in no case should the choice be limiting.

Finally, I would like to point out that in point 6, the resolution provides for the inclusion, in the guide, of equivalent generic drugs and of cheaper alternative brands. The common usage, coupled with the various discussions we are currently conducting on the subject, would have preferred to be a question of cheap medicines, which is a term that brings together the whole class of these discounted medicines.

We naturally support this project that aims to encourage, within the framework of the medication and distribution policy, the use of medicines packaged individually for each patient.

These are the comments I wanted to make.

As the initiator of this resolution, I would like to thank my colleagues for their constructive attitude towards this proposal.

Many amendments have been submitted by various political groups, which also mean an improvement of the text. We have tried to take all these amendments into account as much as possible. The fact that the committee unanimously approved the proposal shows that the discussion went constructively.

At the same time, the approval of the text in the committee shows that there is a lot of concern on the subject among the various political groups. The text is in fact the extension of a draft resolution submitted a few years ago by colleagues Detiège and De Meyer. We must note that in recent years there has been very little happening in this area. Today we are actually facing a ⁇ identical draft resolution in Parliament. That means something.

In fact, the draft resolution has been updated for a part. The CM conducted a study on this subject in 2004 and this year, 2011, again released results of a similar analysis concerning antidepressants. The Knowledge Centre already pointed out in its study in 2006 that there is a problem in this connection.

Specifically, studies specifically show that with the daily administration of an average of eight different medicines at three different administration moments, the medication is not always stored or administered correctly. It also shows that thirty percent of rest home residents receive at least one medication from the Beerslist, a list of medicines with potential negative consequences for older people. Ten to thirty percent of hospitalizations of rest home residents are due to drug-related problems.

These are sufficient reasons to question the drug policy and consequently the prescription behavior of doctors.

It was also found that the CRA, the advisory and coordinating rest home doctor, treats only 24% of the number of residents in rest homes. The majority of the residents still retain their own home doctor. In the future, therefore, a large and important role has been played for the CRA to ensure that it, together with the general physician, can oversee the drug policy in rest homes as well as the timing of administration and storage of the medicines. The CRA will also have to examine whether it can prescribe cheaper, generic or alternative medicines. Colleagues, such rational prescription behavior benefits the patient, in the first instance, his family, as well as the government.

Collega Van Den Ende, Mrs Lanjri, colleague Becq and I have questioned several ROBs and RVTs in Wallonia, Antwerp, Flemish Brabant and West Flanders, respectively, and we have found the same.

I am sorry that the minister is not here, because it is still time to open the debate a little. Indeed, the survey shows that the institutions concerned still have difficulties in finding qualified personnel and recognize the need for staff training.

It has become very clear that the institutions are really looking for new instruments to handle medicines in a more rational way. However, they are very strongly in favour of a more coordinating role for the coordinating physician, who together with the pharmacist can develop a good drug policy for the resting house, as well as training of the staff.

The CRA must therefore really become a pivotal figure, for nurses and nurses, especially in RVTs and ROBs.

We emphasized this in our proposal for a resolution, as well as the need for a pharmaceutical policy, education, information and informatization. This is nothing new; the problem has existed for years and is confirmed by very recent study materials.

I can only hope that the Minister will take our plea to heart. We will continue to remember her, colleagues, I am sure. I really hope that the Minister will incorporate the text as an instrument in its policy towards the rest homes, because there is still a long way to go in terms of the use of medicines.

Finally, I would like to thank those who are still here for the constructive cooperation.

Mr. Speaker, Mr. Muylle has just explained this, there is indeed still a lot of work to be done in the store in relation to the rational use of medicines in hospitals. It is hopeful that there is a huge difference between rest houses in this regard. That is to say that in rest homes where effective work is done of rational use of drugs, the figures are much better than in institutions where this does not happen.

That should give us hope. We must try to extend the rational use of medicines to all institutions as far as possible, which is both in the benefit of the sick and his family and in the benefit of the health insurance.

In the first session, two amendments were submitted. As the previous speaker just noted, they are both included in a new proposal, for which I thank you.

A third amendment was approved at the last meeting of the committee. This is the role of the supplier pharmacist. I wish I had stopped for a moment on that topic.

In fact, the role of the pharmacist should, in my opinion, evolve more from a regular supplier of pharmaceutical packaging to a healthcare provider. We believe that he should be involved, much more than it is now, in the use of medicines. Why can’t he play a kind of role as a clinical pharmacist, for example? Why can’t he help, for example, with the medical reviews?

This requires training. Our amendment aims to assign this task to the delivering pharmacist.

If, however, more services must be provided by the delivering pharmacist and more time must be stopped in the follow-up work, this also means that there will have to be a limitation of the number of beds per pharmacist. It cannot, when a pharmacist puts more time in his follow-up work, that the number of beds served by that particular pharmacist is unlimited. I think there should be a certain limitation in this regard.

There is also a jurisdiction conflict regarding honorary. Based on the remuneration system introduced in 2010, the pharmacist is remunerated on the basis of the delivery of a medicinal product and much less for the effective cost of the medicinal product, which, in my opinion, is a very good evolution. Nevertheless, the pharmacist is still reimbursed for delivering the drug. When a pharmacist must make an evaluation of the use of the drug, it is contradictory that, on the one hand, he must make an evaluation, but, on the other hand, is paid per delivered product. In this regard, I would like to advise considering the payment of a compensation for a care benefit to the pharmacist in rest homes, rather than merely a compensation for his distribution function.

Finally, we also fully support all other points proposed here by the other speakers, such as the very important, central role of the coordinating and counseling physician or CRA, the further encouragement of the use of the form, which is now too little happening, the broader training of nurses and the further informatization.

I would like to thank the applicant for her willing support to include our amendments in the draft resolution, and to thank the colleagues for their cooperation and wish them a good holiday.