The situation in the healthcare sector is not rosy. Switzerland is facing major challenges; for example, the Swiss general practitioner and paediatrician workforce is over-aged. This could worsen basic outpatient care in the medium term (Work Force Study, 2020). But there is also a lot of potential for digitalisation (Thiel et al., 2023) and savings (McKinsey & Company, 2021). An important question is therefore: can pharmacies contribute to improving the situation?

Pharmacies already play a fundamental role in the Swiss healthcare system – from providing advice and dispensing medication, assisting with neutherapy, blood sampling and vaccinations, pharmaceutical care for other healthcare institutions to wound care (Brügger, 2023). The COVID pandemic has shown how versatile and flexible they can be integrated to ensure better healthcare (JRC Bern, 2021)

But now more than ever, pharmacies in Switzerland are facing the challenge of digitally transforming their services and meeting the increasing demands of patients. Health literacy will increase (Babitsch et al., 2022) and mail order is already a common practice in neighbouring countries. This leads to the question: How can conventional pharmacies remain relevant in an extensively digitalised healthcare system?

Potential innovations

Today, pharmacies are an integral part of the entire treatment process. Through interviews and a design thinking approach, solutions were identified that could support pharmacies in the areas of prevention, diagnosis, therapy support and aftercare

1. App counselling: The growing number and complexity of mHealth apps pose a challenge. Pharmacists could offer effective support with their expertise and a low-threshold, accessible approach. Pharmacies could therefore play a key role in educating and promoting the use of mHealth apps. However, this requires both further training for pharmacists and the integration of relevant training at universities in order to successfully utilise future tools.
2. Supported triage by pharmacies : Digitisation gives pharmacies access to more information and enables them to act even better as the first point of contact for health problems. They have expert knowledge, can administer initial therapies and have low-threshold access. Feedback mechanisms enable continuous improvement of the service and promote a bond with patients.
3. Drug boards: Similar to tumour boards, drug boards can use the expertise of pharmacists to optimise drug therapies. Virtual participation increases interdisciplinary collaboration and ensures that the latest scientific findings are applied. This would make pharmacists’ expertise more widely accessible to the entire healthcare system.
4. Remote assisted prescribing: The implementation of an online support process for prescriptions could simplify and optimise the validation of prescriptions by pharmacists. Medication control can be carried out independently of dispensing.
5. Printing: Printing medications directly on site, based on patient-specific information would soon be possible. Medication therapies are becoming increasingly specific. Access to relevant patient data is crucial for this process and ensures that the pharmacist can create personalised dosages. In the treatment of children, for example, specific products are often lacking and have to be dosed manually.
6. Medication analyses: Pharmacies can analyse digitised medication plans, identify at-risk patients and possibly reduce medication through deprescribing. Standardised data formats and secure areas such as the electronic patient dossier are crucial for the exchange of information. Patients need to actively participate and share their data for consultations with their preferred pharmacist.
7. Fine-tuning: Pharmacists can play a crucial role in fine-tuning medications by making dosage adjustments and preventing premature discontinuation. Access to comprehensive patient histories allows them to make targeted optimisations.
8. Swiss pharmacy knowledge database: A Swiss pharmacy knowledge database using a large language model could serve as a comprehensive source of information for the pharmacy community. Expert committees and the participation of individual pharmacies would ensure accuracy, transparency and continuous improvement of the knowledge database. The cantonal rules and regulations would be a potential addition to the knowledge source.

Expert feedback

In the discussion with pharmacists, the potential innovations were discussed to check the effectiveness and feasibility of the proposed measures. Pharmacies play a central role in protecting the public from misinformation, especially in the digital age with the abundance of health apps. By introducing app counselling, the pharmacy community could take on a more coordinating role to safeguard therapies and protect practitioners from charlatanism. The medication board concept is seen as an extremely effective service, especially when focussed on specific medication therapies. The integration of experts in specific fields, for example, is seen as promising. Coordination, medication analysis, fine-tuning and prescription support are relevant services. These could be combined into e.g. a “digital” outpatient healthcare network where patients select and authorise their experts. The 3D printing of medicines in pharmacies is viewed positively, but more likely at a later date. The added value would be above all in a regional implementation in order to specialise specifically. While the Swiss pharmacy knowledge database is seen as a valuable resource, its introduction and financing pose complex challenges. The establishment of new opportunities should begin with dedicated support and the use of mHealth apps. The data collected could then be used for further measures such as the medication board. Patient involvement is seen as crucial and low barriers, especially between all stakeholders, is key

The challenges of digitalisation for pharmacies extend across various areas. The integration of new digital solutions requires a careful balance between invasiveness and acceptance as well as complex adaptations to existing processes. The focus is on risks relating to the quality and safety of patient care, logistical hurdles when introducing new technologies such as 3D printing and the need for a balance between autonomy and collaboration. Successfully overcoming these challenges requires not only technological innovation, but also comprehensive consideration of the human, organisational and regulatory aspects of digitalisation in the healthcare sector

Prospects for Swiss pharmacies

The analysis and discussion have highlighted various approaches and opportunities for the introduction of additional services for pharmacies in Switzerland. Prioritising and defining the direction for implementation is crucial. Two perspectives should be considered

1. fast, uncomplicated implementation to gain experience
2. and addressing current needs for sustainable nationwide establishment.

Implementation must focus on the benefits from the patient’s perspective, taking into account objective and subjective perceptions. Low-threshold measures such as “app counselling” and the “Swiss pharmacy knowledge database” can be implemented in the short term in order to gather initial experience and demonstrate feasibility. However, coordination with universities is all the more important for app advice in order to provide the pharmacists of tomorrow with the skills they need. Targeted training programmes in this direction are also needed

When considering long-term prospects for pharmacies and the healthcare system, it is worth looking at existing approaches in other medical fields. One example is the successful implementation of software tools to support collaborative, virtual, multi-site molecular tumour boards in oncology (Schapranow et al., 2023). This shows that approaches similar to the “medication board” are already being used successfully in other medical disciplines, such as radiology, and can serve as a model for innovative solutions in pharmacy practice. On 28 September 2023, the National Council approved the revision of Articles 25 and 26 of the KVG, which enables pharmacists to offer cost-reducing services in interprofessional collaboration (PharmaSuisse, 2023). Digitalisation offers the opportunity to explicitly promote this interprofessional collaboration and to combine the expertise of the pharmacy profession with other disciplines

Event on the topic

The next event in the BFH Wirtschaft Digital Snack series will also deal with the topic of this article.

• • Time: 17.01.2024, 17.00-18.00 hrs
  • Place: Online, via MS Teams

The author Mauro Tschanz studied the topic as part of his degree programme at BFH Business and will present his findings on the challenges and opportunities of digital transformation. He will then discuss how digital solutions can support pharmacies in the areas of prevention, diagnosis, therapy support and aftercare with Reinhard Riedl, an expert in HealthTech at the Institute of Digital Technology Management

Click here to register

References

1. Babitsch, B., Hannemann, N., Schmidt, L., & Götz, N. A. (2022). Health Literacy and Digital Competences in Times of the Corona Pandemic. In Health liter acy (pp. 1-11). Berlin, Heidelberg: Springer Berlin Heidelberg.
2. Brügger, A. (2023). Role of pharmacies in primary healthcare. Pharmasuisse. Retrieved 2 December 2023, from https://pharmasuisse.org/de/handlungsfelder/entwicklung/rolle-der-apotheken-der-medizinischen-grundversorgung
3. JRC Bern. (2021). Pharmacy Monitor 2021-2. Retrieved 2 December 2023, from https://cockpit.gfsbern.ch/de/cockpit/apothekenmonitor-2021-2/
4. McKinsey & Company. (2021, September). Digitalisation in the healthcare sector: The CHF 8.2bn opportunity for Switzerland.
5. PharmaSuisse. (2023, 28 September). News from the Federal Parliament. pharmasuisse. https://info.pharmasuisse.org/de/news/neues-aus-dem-bundeshaus
6. Sabbagh, K., Friedrich, R., El-Darwiche, B., Singh, M., Ganediwalla, S. A. N. D. E. E. P., & Katz, R. A. U. L. (2012). Maximising the impact of digitisation. The global information technology report, 2012, 121-133.
7. Shapranov, M. P., Borchert, F., Bougatf, N., Hund, H., & Eils, R. (2023). Software-Tool Support for Collaborative, Virtual, Multi-Site Molecular Tumour Boards. SN computer science, 4(4), 358. https://doi.org/10.1007/s42979-023-01771-8
8. University Centre for Family Medicine of both Basel. (2020). Work Force Study 2020 (Issue 2/2020). mfe Haus- und Kinderärzte Schweiz.
9. Thiel, R., Deimel, L., Schmidtmann, D., Piesche, K., Hüsing, T., Rennoch, J., Stroetmann, V., & Stroetmann, K. (2023). #SmartHealthSystems: Digitisation strategies in an international context