Almost exactly twenty years ago, on September 19th, 1992, the inaugural meeting of the Deutsche Gesellschaft für Klinische Pharmazie e. V. took place in Heilbronn.
The society had 89 founding members and nearly everybody was present at the inaugural meeting at the „Haus des Handwerks“ in Heilbronn. The chairmen, Dr. Rüdiger Kilian, borrowed the motto of the meeting from George Bernhard Shaw, and this one reflected the reason for founding the association and its aims in a concise way.
„Progress is impossible without change,
and those who cannot change their minds
cannot change anything.“
George Bernard Shaw
What had happend first? Hospital pharmacy as well as the whole pharmaceutical profession got stuck in a crisis for several decades and, unfortunately they are still in it. At that time, nearly the complete drug production got industrialized. Therefore the self understanding of the pharmacists had to be defined newly. The process of reorientation is still not fully completed and concerns both the Offizinpharmazie (or retail pharmacy) and the hospital pharmacy. At that time hospital pharmacists defined themselves to a large extent by manufacturing and distributing drugs, too.
In addition to these problems, a demand of action to restructure the drug distribution within hospitals also existed. When in the early eighties the provision of drugs in hospitals was newly regulated by changes in § 14 of the Apothekengesetz, new chances opened for hospital pharmacies as well as retail pharmacies. All hospitals in the former Federal Republic of Germany which didn‘t run their own pharmacy were provided with drugs by some so called „Lieferapotheken“ which mostly were far away. In reality they more or less served as a kind of alibi against the drug law by sending the orders of the hospitals to the industry or the wholesaler and settle the accounts with them. Physically the goods were sent to the hospitals dispensaries directly.
The management and distribution of the drugs were done by the hospital‘s own personnel, who were almost without exception nurses or auxiliary personnel. Those who have witnessed these conditions in hospitals without their own pharmacy, know what I am talking of. These practices on the verge to mismanagement concerned both, the pharmaceutical as well as the economic results.
The expansion of the pharmaceutical responsibilities and the costs connected to them have not been welcomed by everybody in the public healthcare system. Accordingly resistance grew soon and the rising economic constraints made the situation even worse.
So it quickly became clear to us that hospital pharmacy in the future had to look like something different from what many of our older colleagues were accustomed to. The most important point in training pharmacists to drug experts is the introduction of clinical pharmacy respectively practising patient oriented pharmacy.
The development toward clinical pharmacy had occured in the Anglo-Saxon countries and in the Netherlands already two to three decades earlier and we had the chance to learn from these countries.
Many of us may remember the excellent and unique seminars in the eighties, which were organized and held by our founding president and initiator of the DGKPha, Dr. Rüdiger Kilian, in Heilbronn, Stuttgart and some other places in Germany. And many will certainly agree, that there was a kind of starting spirit. There weren‘t any other comparable seminars in Germany at that time. Just to mention only some names of speakers, I remember Prof. Soraya Dhillon, Andy Kostrzewski, Prof. Helmut Derendorf, Chris Thompson, John Cromarty, Tony Murphy, Jackie Barber, Prof. John Rotschafer, Bob Town, Jan Glerum and others.
After the repeated pushing and urging of our British colleagues, especially of Prof. Soraya Dhillon, our Deutsche Gesellschaft für Klinische Pharmazie eventually was founded.
But what for should a new association be set up, since hospital pharmacists already had a professional organisation of their own, the ADKA (Bundesverband der deutschen Krankenhausapotheker)? The idea was, that Clinical Pharmacy was not only practised in hospitals by hospital pharmacists. Therefore all pharmacists, from retail pharmacies and hospitals as well as administration and universities and other health care professionals, who were interested in clinical pharmacy should be able to join the association. Membership should also be possible for interested people from abroad. Therefore a separate association was needed.
Another aim has been and still is to establish further clinical pharmacy politically and socially as an indispensable part within the healthcare system in Germany.
The members of the first executive board consisted of Dr. Rüdiger Kilian (1st chairman), Dr. Helmut Hehenberger (2nd chairman), Hartmut Kleinjung (secretary), Dr. Anton Bär (treasurer) and Peter vom Schemm (assessor).
The aims of the association according to the statutes are the promotion of research and development of applied clinical pharmacy, especially the development of patient oriented use of drugs, patient oriented drug information and documentation. A further objective is the support of research and development in the field of drug safety and vigilance in all of its expressions.
From a present point of view two lectures should be reminded, which were given during the inauguration meeting.
Prof. Walter Schunack lectured on „Perspectives of Clinical Pharmacy in Research and Teaching at German Universities“. He postulated clear targets:
- Optimizing of drug therapy
- Providing drug safety
- Providing communicational skills for talking to physicians and other health care professionals
- Conveying scientific knowledge to the students
- Establishing research and teaching in universities
- Embedding of clinical pharmacy in the „Apothekenbetriebsordnung“ (pharmacy regulations) and in the pharmacists‘ educational regulations.
In his lecture Prof. Schunack mentioned the objectives of teaching and research in several pharmaceutical fields and called for quality assurance by the compliance with standards.
In his third part he commented on some problems of that time and postulated changes in the curriculum of the pharmaceutical education in universities as well as a decent financial support by the government. Among other things he demanded:
- correcting the lack of teaching capacity (There was exactly one chair for Clinical Pharmacy in Berlin at that time.)
- changes in the pharmaceutical curriculum
- the establishment of research at universities (i. e. chairs for clinical pharmacy)
- interdisciplinary cooperation.
There have been different priorities at universities, hospital pharmacies and retail pharmacies as well as a general lack of experience in all areas.
As you all know, quite a lot of things have happened in these 20 years that have passed. Ten years ago, the educational regulations for pharmacists were changed, the „Apothekenbetriebsordnung“ has been revised again this year, at several German universities chairs for clinical pharmacy have been implemented and endowed with staff. Unfortunatelly, the latter still aren‘t complete at all university locations yet. Especially uniform education and examination standards have not been established throughout, but these are urgently needed.
The second plenary lecture was given by Prof. Soraya Dhillon und John Cromarty about „Clinical Pharmacy in Great Britain“. In 1992 Great Britain already had a 30-year old history of development toward Clinical Pharmacy, which was accompanied by many governmental reports and „White Papers“.
Both lecturers have been to Germany many times, conveyed their experience to us and did support us in trying to establish clinical pharmacy in German hospitals.
Within the years following the founding of the association, the executive board developed many plans and some of them were realized.
I would like to remind of some seminar topics like: total parenteral nutrition, therapeutic drug monitoring, evaluation of clinical studies, evaluation of lab data, wound management and dressing, etc.
Within the 10 years after the foundation of the association there has been a rapid development towards clinical pharmacy in German hospital pharmacies, in retail pharmacies as well as in universities.
From my experience in the practical education of pharmaceutical trainees, I can say that motivated young pharmacists, who are well trained throughout are leaving the universities today.
From the activities of the Deutsche Gesellschaft für Klinische Pharmazie two important seminars developed and are columns of in-service and advanced training in clinical pharmacy:
The seminar „Pharmaceutical Care“ with Prof. Helmut Derendorf and colleagues from Gainesville, Florida in the Paracelsus-Krankenhaus in Ostfildern, which started in 1994!
And the „Zertifikatskurs Clinical Pharmacy“ at the University of Tübingen, which started in 1997.
Both seminars are nowadays organized in cooperation with the Landesapothekerkammer Baden-Württemberg. The certificate course Clinical Pharmacy in Tübingen is also supported by the Bundesverband der deutschen Krankenhausapotheker, ADKA.
Prof. Soraya Dhillon, Andy Kostrzewski and others were involved actively in the certificate course for many years.
I think, it is no overstatement, when I say, that the greater part of colleagues doing clinical pharmacy actively have visited both courses.
Celebrating twenty years Deutsche Gesellschaft für Klinische Pharmazie is a special occasion to appreciate deeply all the colleagues who carried all the efforts, the difficulties and inconveniences of the organization, the maintenance of the association and the seminars.
We are very much indebted to our British, American and Dutch colleagues for all their brilliant presentations in Germany for many years.
We are grateful to Prof. Lutz Heide from the University of Tübingen, who supported our efforts unrestricted from the beginning. He gave the certificate course a home at his department. Prof. Heide always have been underlining the importance of clinical pharmacy for the future of the pharmaceutical profession on the practical as well as on the academic level.
I would like to thank very much those persons who managed the course all the years through, that is Dr. Bernhard Schmid, Dr. Katja Taxis, now Professor for Clinical Pharmacy at the University of Groningen (The Netherlands), Dr. Yvonne Haagen and Dr. Kerstin Seeger.
The development of the health care system within the past twenty years was dominated by an unprecedented economization. Of course, hospital pharmacies were hit by this development, too, with the result that with the beginning of the nineties several, mostly smaller hospital pharmacies have been closed. Meanwhile more than 20 % of all the former hospital pharmacies have vanished. The consequences might be a development back to a state similar as that in 1982.
On the other hand there is to be seen a trend towards larger logistic units, which may not always be able to offer an adequate clinical pharmaceutical service.
I would like to show you a picture from data I collected recently, which demonstrate what have happened to hospital pharmacies in Germany in the past 30 years.
The data were taken from a paper publishes in 1982 in which chief-pharmacists answered a questionaire. Data from the following years were from the book „Krankenhausapotheken-Register“ of the corresponding years published by the ADKA.
The plotting shows the number of pharmacists in some hospital pharmacies in the years 1982, 1995, 2001 and 2011.
As you can see, most of them could improve their service and rise the number of pharmacists, which is most impressive with the larger ones. The smaller hospital pharmacies with 1 – 3 pharmacists do have more difficulties because they may be closed at any occasion, i.e.
- the pharmacist retires,
- a new manager has other ideas,
- a larger amount of investment is necessary,
- change on the political level has occured,
- the performance of the pharmacy has not been satisfactory, etc.
From the 27 hospitals that are included, 8 have been closed up to now. That are nearly 30 %! And this is around the figur, that is being expected in the next years, unless extrordinary developments occur.
Recently the insolvency of Sanicare in Bad Laer showed the dangers of a purely financial consideration of the provision of drugs to hospitals. Currently around 50 hospitals with altogether 12000 beds don‘t have a safe drug supply. And it is not yet clear to me, how this problem is going to be solved. There are neither enough hospital pharmacies nor public pharmacies in the area, which may be able to take over the drug supply immediately.
It is no question that more pharmaceutical services will be needed in every hospital of whatever size it is.
One of the most important goals will be to show the economic legitimation of clinical pharmacy and all other pharmaceutical services and eventually to succeed.
There is a growing amount of papers, showing the economic benefit of clinical pharmacists in hospitals and pharmaceutical care in the public area.
This has by far not reached the health care economists and the administrators of the hospitals.
So we are still on the way to a new system of providing drugs, drug information, drug safety and vigilance, to every single patient.
This will only be successful with scientifical support from the universities.
With this annual meeting we would like to contribute to the way foreward to this vision of pharmaceutical care we have in mind.
Dr. Anton Bär
Vortrag gehalten am 19.10.2012 bei der Jahrestagung
der Deutschen Gesellschaft für Klinische Pharmazie e.V.,
Diakonie-Klinikum Stuttgart, Rosenbergstr. 38, 70176 Stuttgart