National survey on preparations for outpatients
14 October 2019E.Reallon1, M.Wasiak1, P.Chenell1,2, M.Jouannet1, V.Sautou1,2
1 : CHU Clermont-Ferrand, Pôle Pharmacie, F-63003 Clermont-Ferrand, France
2 : Université Clermont Auvergne, Institut de Chimie de Clermont- Ferrand. UMR CNRS 6296, F-63000 Clermont-Ferrand, France
Hospital prescribed preparations’ payment by the social security system for outpatients is not well defined: does it come under the officinal or the hospital pharmacy channel? The main objective is to realise an exact overview of production and liberation practices for these preparations in France.
Two questionnaires have been emailed to director pharmacists of 35 hospital dispensary (HD) and 26 town dispensary (TD) all around France. The issues raised concern preparations payment in town dispensary and communication hospital-town. Pharmacists were asked if they would favour town channel or hospital channel to realise 4 different preparations for an outpatient.
24 HD (69%) and 13 TD (50%) have respond to our survey with an equal territory repartition. For both, preparation reimbursement in town depends mainly on the explicit doctor’s mention on the prescription and the lack of available proprietary medicine. In case of any doubt about reimbursement, HD consults the TD pharmacist and TD contacts the social security system. 54% of the TD report reimbursement refusal (mainly for melatonin preparation). TD is rarely (62%) or never (23%) advised of the hospitalization discharge of a patient in need of preparation. Town channel is favoured by 60% of the HD and 100% of the TD to product Spironolactone capsules for children under 12 years old and by 78% of the HD and 100% of the TD to product folic acid capsules for anaemia of prematurity. This choice is justified by the raw material availability and the ARS authorization for these types of preparation. Conversely, HD production is favoured by 67% of the HD and 84% of the PO for Sirolimus ointment and by 73% of the HD and 85% of the PO for Cyclophosphamide oral solution. This choice is justified by the raw material unavailability and the lack of adapted device. 75% of the HD systematically check if a preparation may be product in town (by calling the TD pharmacist), however 75% of the HD also admitted that they already have retrocede a feasible town preparation (continuity of care, no relay with TD or loss of confidence in the TD production capacity and quality).
Even if HD and TD opinions converge about the channel production to favour for each preparation, the TD production capacity seems to be underestimating by HD. That is why it is necessary to harmonize practices in order to ensure continuity of care. If a TD is allowed by ARS to product a preparation for an outpatient, is HD still authorized to retrocede it? National recommendation would be needed.