April 2019

1. FIP ReferencePaperBeating non-communicable diseases in the community: The contribution of pharmacists April 2019

2. A comprehensive reference paper by the International Pharmaceutical Federation showcasing evidence, best practice and policy options to harness and improve the roles of community pharmacists in the prevention, screening and management of non-communicable diseases (NCDs) — such as cardiovascular, asthma/COPD, diabetes and cancer — and in the referral and optimisation of treatment of patients with NCDs. Available at www.fip.org/publications as of 7 April 2019

3. Non-communicable diseases (NCDs): World view As per the World Health Organization (WHO)1: • More than 36 million people die annually from non-communicable diseases (NCDs) • Over 60% of deaths worldwide • 15 million of these deaths are before the age of 70 years Prevention and control of NCDs require: • Effective, cost-effective, affordable and feasible interventions • National policies framed within these interventions and in line with NCD and risk factor indicators • Improving equity in health care • Targeting population for improved health outcomes Priority NCDs : cardiovascular disease (CVD), diabetes, asthma/COPD and cancer 1https://bit.ly/2Vc1ckT

4. Pharmacists are an asset in the fight against NCDs • They are the most frequently visited health professionals • They ensure safe and high-quality primary care services in pharmacies • They have regular interactions with patients, even with people who do not often see a physician • They encourage preventive measures and support adequate prescribing • They improve patients’ adherence and safety of treatments • They provide early screening and point-of-care testing, customised counselling and long-term disease management NCDs are an opportunity to strengthen pharmacists’ commitment to patients and the community, towards sustainable and better use of health resources

5. WHO - Global dialogue on financing the prevention and control of NCDs, 2018 “Pharmacies can play an important role as primary healthcare network, providing early screening and testing, advanced counselling and long-term chronic disease management…” “Increased cooperation between the successive specialists involved in chronic disease management can be both beneficial for the patients and cost-effective.” Policy recommendations and innovative solutions “Reimbursed NCD-related care provided by pharmacists…” “…increased cooperation between doctors and pharmacists for NCD-related care.”

6. Challenges for Sustainable Development Goals to control NCDs • Reinforcing prevention strategies • Reducing the prevalence and impact of risk factors • Working towards equitative and universal access to healthcare • Including patients in all health processes • Having enough specialised health workforce Contributing to sustainable outcomes Providing for sustainable human and economic growth • Pharmacists may take on a more prominent role in NCDs • Essential role in counseling and managing chronic conditions • Pharmacies as a gateway to health care systems

7. 1. Prevention and screening Assessment of patient conditions (symptoms and point-of-care testing: BMI, blood pressure, glycaemia, cholesterol) Healthy life styles recommendations Protocols for professional intervention (using tests andreferral to physician if needed) 2. Therapy and disease management Assessment of patients (based on point of care measurements) Therapy management (including support for correct use of devices, self-administration or self-monitoring); Disease management programmes (cardiovascular diseases, asthma, chronic obstructive pulmonary disease and diabetes) 3. Collaboration with other health professionals International trends in pharmacists’ scope of practice

8. Key messages: Collaborative approaches • Optimising health-related NCD outcomes requires collaborative care models, involving all health professionals, as well as patients and caregivers. • Community pharmacists remain universally one of the most accessible primary healthcare professionals, offering quick and qualified support to patient needs. • Pharmacists are embedded within communities, and can be used to improve the health outcomes of patients with NCDs. • Pharmacists use their expertise as a valuable part of the multidisciplinary healthcare team, adding unique contributions to the clinical outcomes of medicines therapy and to patients’ quality of life. • Pharmacists working in the community and across care transitions can act as care coordinators assisting in the delivery of public health interventions.

9. Key messages: Prevention, screening and referral • Pharmacists are ideally placed to be involved in tackling NCDs, especially through prevention (with interventions such as tobacco cessation and weight management) and promoting healthier lifestyles. • Pharmacist-led screening programmes targeting high-risk individuals ensure appropriate resource management in healthcare systems through symptom assessment and point-of-care measurement for adequate and timely referrals to physicians. • Access to pharmacist screening services in community pharmacies may be limited in some countries due to lack of clear remuneration models or unnecessarily difficult public health laws. The elimination of such barriers is an important step towards ensuring optimal patient care. • It is important that pharmacists ensure that devices and point-of-care testing equipment used in the screening and monitoring of NCDs are of appropriate, regulated quality.

10. Key messages: Better treatment outcomes • Pharmacists can encourage preventive measures, support adequate prescribing and improve patient adherence to and safety of treatments, both pharmacological and non-pharmacological. • Pharmacist-led medicines adherence needs to be prioritised, both in terms of treatment outcomes and the economic consequences of non-adherence, highlighting the need for pharmacists to consolidate their role in this area. • Community pharmacists play a key role in promoting the responsible use of medicines for NCDs, adding to patients’ knowledge and ability to manage their therapy autonomously or with the support of caregivers. • Pharmacists have a crucial role in therapy management, including medication review, assisting with correct use of devices and disease management programmes. • Patients can play a major role in managing their own health and preventing NCDs, and pharmacists can actively encourage patient and caregiver engagement and empowerment through education.

11. Key messages: Barriers and challenges to the full use of pharmacists in NCD care • In some countries, lack of adequate access to pharmacists due to severe workforce shortage is jeopardising the health of patients with NCDs, and government action is necessary to increase the supply of well-qualified pharmacists. • Pharmacist interventions supported by evidence-based professional protocols contribute to ensuring that care pathways are informed by results of screening assessments and tests. • Evidence is strong concerning the value of pharmacists’ contribution to NCD prevention and management, and the quality use of medicines. Adequate recognition and remuneration of such contributions by both public and private third-party payers could lead to the consolidation of these roles.

12. Why community pharmacies? • Underused healthcare resource • Qualified healthcare professionals • Patients’ trust • Extended coverage (hours and locations) • Network capabilities Pharmacists and pharmacies are committed with the sustainability of health systems

13. Recommendations and conclusions The reference paper recommends: • Developing strategies to incorporate pharmacists in health programmes, and securing appropriate remuneration models • Engaging with health authorities to include pharmaceutical expertise in primary healthcare efforts • Increasing the integration of community pharmacies within the primary care network. • Using the evidence and case studies in this report • Collaborating with other health professional associations to implement collaborative interprofessional strategies • Developing competency frameworks to support appropriate pharmacist workforce development NCDs demand new answers and require innovative and creative solutions Pharmacists can improve patient engagement to achieve better outcomes in the global fight against NCDs

14. Thank you for your attention We hope to see youat the next FIP congress in Abu Dhabi!