BPhD Interview with Gabriele Overwiening, President of AKWL and ABDA (Federal Union of German Associations of Pharmacists) ( BPhD, Germany

“BPHD INTERVIEW WITH GABRIELE OVERWIENING, PRESIDENT OF AKWL AND ABDA (FEDERAL UNION OF GERMAN ASSOCIATIONS OF PHARMACISTS) AMBASSADOR: ROMAN PRATZKA BPHD, GERMANY

The ABDA - Federal Union of German Associations of Pharmacists is the umbrella organisation of more than 60,000 (mostly community) pharmacists in Germany. The aim of the Berlin-based association is to join together and bring forward the common interests of this healthcare profession. AKWL = chamber of pharmacists in Westphalia-Lippe

Roman Pratzka: Ms. Overwiening, you are in charge of three pharmacies yourself. What are the everyday challenges that pharmacists face there? What challenges do you experience at work, e.g., in contact with patients?

Gabriele Overwiening: First of all, the patients are very grateful that we are there and that we are their contact persons. This is something that I have always experienced, but which is now taking on incredible proportions during the pandemic. [...] Now we are receiving tremendous gratitude with regard to the rapid antigen tests. [...] And now with digital covid vaccination certificates, I feel like we're giving people back a bit of their freedom. [...] What is exhausting is the occasional lack of appreciation of our pharmaceutical services by opinion leaders and politicians, who take our services for granted. Just like electricity from an electrical outlet. It will only be acknowledged once it is no longer available.

Roman Pratzka: Keyword digitalization: Many pharmacies still work with fax machines and are poorly equipped digitally. To what extent is this lack of digitalization and outdated communication perhaps also a problem in pharmacies?

Gabriele Overwiening: I can say with absolute certainty that only a small proportion of pharmacies have not really been digitalized well. The vast majority of pharmacies have a high digital affinity. The fact that we often still use fax machines is also due to other market players in the healthcare system.

Roman Pratzka: Keyword: interprofessional cooperation in general between physicians and pharmacists. In some cases, I see communication difficulties in the pharmacy again and again, when there is a nonplausible prescription or when certain medications are not in stock. In such cases, the doctor has to be contacted. Oftentimes, they are not available, have little understanding and little time for pharmacists. On the other hand, patients also have little patience when they have to wait at the counter for their medication. Do you also see these problems in the professional relationship between doctors and pharmacists, or is this less of a hurdle?

Gabriele Overwiening: At the moment, interprofessionalism is highly dependent on the personal relationship between local physicians and pharmacists. There are great examples where it works brilliantly, where they complement each other very well, and then there are catastrophic examples. [...] For both professions, it will be crucial that we embark on the path to a digital future together. It is important that we as health care professionals always remember: a health care system has only one objective and that is the well-being of the patients. [...] That is why I will attach great importance to advancing interprofessionalism. What counts is the health of the patients.

Roman Pratzka: Currently, it is also apparent in the case of vaccination. Vaccination in pharmacies is already being carried out in several model projects. However, doctors often give negative feedback. Many German doctors do not want vaccinations to be administered in pharmacies, even though this has long been the standard in some EU countries. How can we ensure that we collaborate for the benefit of patients and don't create the feeling that we are working against each other?

Gabriele Overwiening: I believe that we need hands-on experience to do this. I experience that in theory mostly the problems and less the opportunities are deduced. However, once we get into the practising, the doing, the implementing, we realise that it does work out in the end. And the physicians will realise that we are not taking patients about to be vaccinated away from them, but we are reaching a different clientele - our vaccination offer will be a complement. [...] We will gather a lot of experience from the model regions and use the valid results to further substantiate our vaccination offer. I am confident that we will achieve a solid collaborative approach.

Roman Pratzka: You say that experience is the key to success here and that it is very important in order to improve the relationship. What are some concrete approaches? For example, experience can already be gathered during the studies through interprofessional education between medical and pharmacy students. What approaches can you think of?

Gabriele Overwiening: You are right. This is a fundamental question for the professions of physicians and pharmacists: How do we reach our next generation? How do we ensure the follow-up of a new generation? What do our successors actually want? How do they envision their careers? When I talk to young people, I always hear from both sides that interprofessional cooperation is desired. This only diverges at a later stage. [...] Pharmacists come to the community pharmacy with a tremendous pharmacological knowledge only to be denied a say in the prescribed therapies. This is frustrating and does not foster pharmacological knowledge among pharmacists. And it would be good if we practised directly from the practical year onwards that pharmacists and physicians set out together for the well-being of the patients. [...]

Roman Pratzka: You mentioned it: Pharmacists bring an enormous amount of knowledge with them from their studies, but then we sometimes lack the competencies and the rights for certain activities. Do you see any problems there? That pharmacists should be granted more responsibilities and that more attention should be paid towards our competencies?

Gabriele Overwiening: I see it as an absolute necessity that pharmacists are given more decision-making authority in regard to patient safety (AMTS). I recognize that additional pharmaceutical services can become a foundation for this. [...] We are now doing rapid antigen tests. Why don't we want to do streptococcal tests? There are countries where that is already the case. [...] I think that decision-making authority is of great importance for professional satisfaction and the further development of pharmacological expertise. [...]

Roman Pratzka: Finally, I would like to talk about the problem of supply shortages. Especially at the beginning of the pandemic, it was noticeable in the pharmacy: medications could not be delivered due to supply shortages. Do you think this is a problem that should be addressed more intensively or has the problem been solved in the meantime? Has it improved in the meantime?

Gabriele Overwiening: Delivery shortages are a recurring problem that persists. We solve most supply shortages by switching to other preparations, other companies, other dosages, other dosage forms. This is where our expertise and creativity are called for. However, I have to admit that dealing with supply shortages also takes up a lot of time in the pharmacy. That's a huge burden because it's not just a matter of finding an alternative. The alternative must also be accepted. This requires the education of the patients. And when we talk about adherence, that's a big effort. So I think that we have to address the issue of supply shortages permanently.

Roman Pratzka: Does that also have to happen on the part of politics concerning drug production? Often, the aim now is that production should be relocated back to Europe. Is that a necessary step and is that at all realistic?

Gabriele Overwiening: I think this step is desirable. However, I still consider this step to be quite unrealistic at the moment. [...] There is a balance between safety and economic efficiency that is not easy to strike. In some cases, we are becoming dependent because we value the acute economic benefit more than the long-term safety. This is a fundamental problem in our European world: Do we have a social market economy or do we only have a market economy? Does the quality of care dictate or does the price dictate? How will we evolve in that regard? I hope that safety and quality will continue to play an important role in the future. [...] I am an advocate of the social market economy. We have to pay attention to the economy, but the economy cannot be a substitute for safety and quality; the primary focus must be on safety and quality. Otherwise, the economy will no longer serve the people.

Roman Pratzka: You've compiled the biggest problems, exactly fulfilled the goal and also mentioned many possible solutions. I don't think we are facing a major problem that seems unsolvable. Or what do you think?

Gabriele Overwiening: I can see that we have now (through COVID) once again proven how agile we are, how flexible we are, how creative we are, how resilient we are. In particular, it became clear how willing we are to change, to evolve. With the strong new generation that I see emerging, I am firm of the belief that we will take care of the problems as they come, as challenges, and as an opportunity for the German pharmaceutical community. As a result, we will continue to partially reinvent the profession so that we can continue to develop to benefit society in whatever way it develops. Roman Pratzka: Thank you very much for the interview.