Download Albania - Pain & Policy Studies Group

Action Plan for:
ALBANIA
Prepared by:
Kristo Huta
Sokol Morina
Snezana Bosnjak
Jody Moen
10 August 2012
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
1: State the 3-5 problems that lead to inadequate patient access to
opioid analgesics – Be as specific as you can
Problem 1:
• Unbalanced policies exist for prescribing, dispensing and reimbursement.
Problem 2:
• Unavailability of IR morphine and low range of doses of SR morphine
Problem 3:
• Lack of knowledge and negative attitudes about opioids
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
PROBLEM 1
A: State the problem that leads to inadequate patient access to opioid
analgesics (What?) – Be as specific as you can in stating one problem
• Unbalanced policies exist for prescribing,
dispensing and reimbursement.
– Limits to duration of therapy per prescription (7 days)
– The amount of money allocated medications restricts the number or amount of prescriptions to
patients, consequently creating a barrier to treatment
– Limits to diagnosis/stage of disease: only cancer patients in the terminal phase can receive
opioids (HIV/AIDS are excluded)
– Restrictions to maximum daily dose of morphine that may be prescribed by a GP(100 mg/day)
– Restricted authority to prescribe opioids to specifically licensed physicians
– Few pharmacies stock opioids(only one per region)
• a special license is required to dispense opioids
• Cost-related factors
• Fear of theft / diversion
– The range of reimbursed opioids is limited (Tramadol, transdermal Fentanyl, Methadone not
reimbursed)
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
B: State the objective(s) that would address the problem. Which
objectives are the top priorities? (What?)
1.
2.
3.
4.
To amend the law and change the regulations in accordance with
the principle of balance
Achieve access to cancer pain management for patients
regardless of the stage of their disease
Negotiate with the Health Insurance Fund to increase the
reimbursement allocation to physicians, thereby educating them
on the need
Negotiate with the MOH to increase the number of pharmacies
that dispense opioids
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
C: What action steps are needed to achieve the objectives? (How?)
–
Based on the National Cancer Control Program and the Palliative Care Strategy, the Palliative Care working group will:
• propose to the MOH to amend the law from 7 up to 28 days in treatment duration
• propose to the MOH to change the regulation to allow opioid prescription for non cancer patients with moderate to severe
pain
• propose to the Health Insurance Institute to remove the limit daily dose of morphine that may be prescribed
• propose to the MOH to increase the number of physicians allowed to acquire a license to prescribe (after appropriate
education and training in effective and safe prescribing)
• Implement a survey to pharmacists regarding their knowledge and attitudes on stocking opioids, collect the results, and
then share them with the MoH (No need to create a survey! Use the one prepared by PPSG, Aaron proposed that in the
discussion) Jody will share this
• propose to the MOH an increase in the number of licensed pharmacies and then obligate those pharmacies to dispense
opioids.(one in each town)
• propose to the Health Insurance Fund to cover the cost of morphine as an Essential WHO medication ,with reference to
pain relief as a human rights issue (provide 2008 Letter to CND from Special UN Rapporteurs)
D: List those who have the authority and/or responsibility to take the necessary action; and
with whom they should collaborate. (Who?)
1.
2.
3.
4.
5.
6.
7.
Palliative Care working group
MOH – Directory of Pharmacy
Health Insurance Institute
Pharmacy Association
IPPF mentors
Members of Health Parliamentary Commission
PPSG for survey for pharmacists
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
E: Timeline for completion of action steps. (When?)
1.
One year (end of August 2014)
F: What assistance (technical, financial) will be needed to achieve each
objective under part “B”? (How much?)
1.
2.
3.
4.
5.
6.
Attendance of IPPF mentor Stephen Connor at meetings with MoH and HII (pending financial
support)
Collaboration with Chief of Oncology Dept in University Center in Tirana
Local WHO representative
Resources from PPSG and IEC
Commitment from Palliative Care working group
Seek funds from SOROS, to implement objectives
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
G: Expected outputs, and how measured
1.
2.
3.
4.
Survey to pharmacies and results
Letters and proposals to MoH, HII, and pharmacies
Report summaries from each meeting
Parliament passes the law
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
PROBLEM 2
A: State the problem that leads to inadequate patient access to opioid
analgesics (What?) – Be as specific as you can in stating one problem
1. Unavailability of IR morphine and low range of
doses of SR morphine
– Only 10mg SR morphine is available, 30mg
and 60mg SR morphine are needed
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
B: State the objective(s) that would address the problem. Which
objectives are the top priorities? (What?)
1. Register 10 mg IR Morphine
2. Register 30mg and 60mg SR Morphine
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
C: What action steps are needed to achieve the objectives? (How?)
1.
2.
3.
4.
Inform decision-makers that oral IR Morphine is indispensable for treatment of cancer pain
Raise interest Albtrade Pharma company to register IR Morphine and other dosage forms of
SR Morphine
Explore options to import morphine tablets
Calculate the need for IR and SR Morphine for a 3-year time period
D: List those who have the authority and/or responsibility to take the
necessary action; and with whom they should collaborate. (Who?)
1.
2.
3.
4.
5.
6.
7.
MOH
Pharmaceutical company (Albtrade Pharma)
Drug Control Agency
Health Insurance Institute
Local WHO office
Members of Health Parliamentary Commission
Addiction office
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
E: Timeline for completion of action steps. (When?)
1.
2 years
F: What assistance (technical, financial) will be needed to achieve each
objective under part “B”? (How much?)
1.
2.
3.
4.
5.
Collaboration with International Expert – IPPF mentor Stephen Connor
Advice from Martha Maurer in how to calculate estimate
Palliative Care working group
Sign and use Morphine Manifesto as an advocacy tool (PC members)
Working group of Palliative Care new law
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
G: Expected outputs, and how measured
1.
2.
3.
4.
Oral IR and SR morphine available and accessible for cancer pain and palliative care
Calculation of the need for oral morphine for cancer pain treatment
Calculation of the need for IR and SR morphine
Report to the MOH about the need for IR and SR (30mg and 60mg) based on the WHO
Essential Medicines list.
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
PROBLEM 3
A: State the problem that leads to inadequate patient access to opioid
analgesics (What?) – Be as specific as you can in stating one problem
1. Lack of knowledge and negative attitudes
among health care professionals about opioids.
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
B: State the objective(s) that would address the problem. Which
objectives are the top priorities? (What?)
1. Educate health care professionals about the
indispensability, efficacy and safety of
morphine for moderate and severe cancer pain
and palliative care
2. Change negative/wrong attitudes
3. Educate pharmacies on the obligation to
ensure adequate availability of opioids
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
C: What action steps are needed to achieve the objectives? (How?)
1.
2.
3.
4.
5.
Translate and adapt international clinical practice guidelines (CPGs) on cancer pain
management in collaboration with QKSCA
Organize and conduct lectures, professional meetings, round table discussions, etc on cancer
pain management and palliative care
Disseminate translated guidelines to health care professionals at the above-mentioned events
Prepare pre- and post-tests to evaluate knowledge acquired
To present to guidelines to all stakeholders
D: List those who have the authority and/or responsibility to take the
necessary action; and with whom they should collaborate. (Who?)
1.
2.
3.
4.
5.
6.
7.
8.
9.
MoH (pharmaceutical dept. and drug issues dept.)
Health Insurance Institute
Palliative Care working group
GPs
Oncology associations
Albanian Association for Pain
Albanian Association for Palliative Care
Potential funding organizations
Members of Health Parliamentary Commission
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
E: Timeline for completion of action steps. (When?)
1.
Ongoing throughout 2 year period
F: What assistance (technical, financial) will be needed to achieve each
objective under part “B”? (How much?)
1.
2.
3.
4.
Translation services
Publication costs
Dissemination costs
Cost of meeting ,workshops, round tables
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care
G: Expected outputs, and how measured
1.
2.
3.
4.
5.
Translated/published guideline
Prepared slide presentations from various meetings, lectures, discussions, etc
Number of meetings
Number of meeting participants
Pre- and post-test results
University of Wisconsin Pain & Policy Studies Group
World Health Organization Collaborating Center for
Pain Policy and Palliative Care