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Podcast – #CoEUP: 1×3: The Nurses voice on #BiosimilarMedicines. An opportunity for integrated care

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Conversations on EU #Pharma is back with a third episode we will explore the role played by specialised nurses in delivering positive patient outcomes with biologic therapies and the development of integrated care for patients living with Non-Communicable Diseases (#NDC), starting with an overview on the impacts of Covid-19 on the nursing community.

Hello and welcome to conversations on eu pharma a podcast by medicines for europe where we discuss the challenges opportunities and solutions for better health and better access for patients in europe today we’re discussing the role of biosimilar medicines and how that can assist patient care and those with non-communicable diseases which are very prevalent and very

Burdensome in europe i’m very pleased to be joined by two experts from the nursing community today who i lost to introduce themselves so maybe adriano would you like to say a word of introduction well hello everyone my name is adriano fragano which i’m a president of the european specialist nursing organization i’m a critical care nurse i work at the university of

Applied health sciences and university hospital centers agreb as a head nurse of department of anesthesiology and intensive care i have a phd in public health and i also serve as a president of the world federation critical care nurses i’m very happy to be here today with you please thank you adriano and hanukkah hello everyone i’m hanukkah fournifeld i work as a

Nurse practitioner in an outpatient clinic in the netherlands within the field of rheumatology and we do a lot of work with biologics and biosimilars and we did some research on changing from originators to biosimilars so i’m very pleased to be part of this conversation thank you uncle i’m very happy to have both of you with us today i think if we jump straight in

I’d like to maybe start both of you are practicing nurses within a hospital in your respective countries and i’d really like to start by asking you know from the nursing perspective how is the situation in the hospitals now from you know recovering from the pandemic and trying to rebuild patient care how has this period of time impacted the nursing community from

Your experience maybe adriano could i start with you there yes of course well covid-19 pandemic changed the world and closed us in our primary settings countries cities hospitals pandemic had a great influence to all healthcare systems whether developed or not developed due to the fact that we didn’t know a lot of about the virus there was a fear among healthcare

Workers and that complicated things nurses were at the front line and we were forced to educate non-critical care staff to provide critical care for respiratory patients as as no a nursing organizations we try to share knowledge and to help each other because even we are close the only thing we could do was to share knowledge and shared information among us to

Assure adequate resources for caring the patients even we were shut down even we were closed we helped each other to survive this crisis covid-19 definitely will have a long-term consequences to mental health of the nurses and there are some studies ongoing and conducted and for the future we have to take care of this on the other hand because of the pressure of

In fact patient there was a lack of time and human resources for non-covet patients and that will also be challenged for the future and maybe long-term consequences for the health care yes that’s very interesting also in the role of the european organization in that time to really collect information and to share although you could not connect in person across

Europe so that’s also very interesting hanukkah from your perspective has the pandemic maybe triggered some changes in your practice or were there let’s say disruptions at the time in your care of patients with rheumatology diseases well a lot changed in the past two years of course there was a lot of nursing shortness so some of my colleagues had to work in other

Words normally we work in the outpatient clinic but they had to assist on the icu or on the coffee towards because there were not enough nurses or nurses got sick and we at the outpatient clinic had less nurses to do the work for our rheumatology patients and not all our patients could come or dare to come to the hospital so we changed to telephone consultations and

Try to give our patients confidence that we could give the best care we got a lot of questions from patients using immune suppressive medication like biologics or biosimilars if they could keep on going with their medication because of the covet and they were afraid to get more sick and later in the covert pandemic we got problems with shortage of medication yeah

That’s really interesting and i think another thing that really stuck out to me and i think it also relates to what you said there about the patient rights is that you both mentioned i think issues around shortages either shortages of colleagues and staff shortages of medicines of things that you needed to be able to treat your patients and so i think what i hear

From both of you is that there’s more and more and more intense pressure on the resources that you have or maybe you’re expected to do more with less resources is that fair adriano from your perspective well from my personal experience we didn’t have that kind of problem because i work at the largest hospital in the croatia and we were very supplied maybe there’s

A problem with the nurses staff and sometimes we couldn’t have enough nurses educated for the critical care patients but to other hospitals in croatia and regarding my informations around the europe there was a problem with supplies and the staff as well and of course it’s not fair because we had to provide quality of care and take care about that yeah perfect and

So i think maybe moving on from the covet experience i think some of the issues that you’ve experienced through this time are probably maybe some that have been facing your community beforehand but certainly you know requires some attention in the future i think one thing that stands out to me is that the role and the tasks of the nursing community expand far beyond

Say managing the patient care or the patients treatment or working exclusively with the doctor the traditional role of the nurse has really evolved beyond what we would think of before so how do you both see that evolution of the profession and how is it moving forward do you think maybe adriano i would start with you from my perspective future of the healthcare

Will be in the nursing specialization it would be impossible in the future to educate generic nurse there’s also some challenges and the needs for adequate recognition within the european society and european union yeah thank you and hanukkah your perspective on the evolving role of the nurse over time what i see in the netherlands is that nurses show leadership

By empowering patients and we see more news-led clinics coming up especially with nurse practitioners who are in the lead and nurses are more accessible for patients than the doctor is yeah that’s very interesting and i think for us that medicine for europe we work a lot on policies and health policies around the use of of patent medicines and the opportunities

That that brings to patients and i think it’s something we’ve seen over the years that where either hospitals or health systems have adopted off patents either generic or biosimilar medicines that has generated savings for the system and where we have seen the let’s say successful policies has really been where savings are told through and invested back into the

System and so we’ve seen a lot of examples from around europe where the savings used or generated through the use of biosimilar medicines are invested let’s say into hiring more nurses or into improving hospital equipment or setting up programs or clinics that can support the patient or their families and so have you experienced this kind of let’s say reinvestment or

Reallocation of resources is back into the system that ultimately can support you then i know hanukkah you said in your rheumatology clinic you have a lot of experience with biosimilar medicines throughout the year so is this something that you’ve seen or that you’ve discussed in your practice well it’s something we have discussed but we haven’t seen results let me

Say that i think it’s not clear what nurses do in this change to biosimilar nurses are doing all the work that it’s not seen by the insurance companies they only say well we see this medication is getting cheaper so we pay less and we don’t see the money come back to the hospital or the outpatient clinic get more nurses but we had a lot of work for it to do because

We had to inform patients and help them with the other devices or devices which looks different or talk with them and they had questions so there was a lot of work for the nurses but it’s not and nowadays in our hospital and i think in the most hospitals in netherlands we don’t see any reimbursement on it unfortunately yes that’s interesting because it seems to me

Then maybe the different actors are operating in silos maybe by themselves not connected between the pair community the nursing community and the broader medical community and also the patients of course and so what changes do you see that maybe could connect those different perspectives or how could let’s say the different actors partner together to really value

The work of the nursing done there with regards to bio similar medicines and also to encourage their use so that the situation can improve yeah well what we see is that nurses are more informed and well we do a lot of education and we get education sometimes from the pharmaceutical companies but also from nursing schools or nursing organizations so that’s what we

See and what we see is that they are able to treat more patients so that’s also a benefit from the change from biologics to biosimilus and i think when i look back at one of the first biologics for rumor came on the market it was about 1999 i think those days we had to do a lot of work for before we treat a patient with this mitigation and nowadays there is the

Confidence that nurses and doctors do not prescribe biologics for patients who are not allowed to have them so we don’t have to do all this paperwork so the paperwork was is game easier and we can treat more patients because of there are more fields where this medication can be used so that’s a benefit face yes i see this at disconnect let’s say from the challenges

And the opportunities so maybe those two are not meeting in the middle adriano would you like to comment on this i must agree with the hanukkah regarding lately there is no increasing resources for nurses but there is increasing work for nurses and if we want we want to achieve sustainable health care we need to invest in creating healthy work environment and we

Undergone some studies with the critical care and wages were not on the top of the nurse’s priority it was a good collective it was a enough supplies and then wage is worse but if we assure enough nurses and enough supplies to provide the quality of care nurses are happy and what is really important is respected nursing autonomy yes i can imagine so and i think

Given you know all of the juices that you’ve both described to us earlier in this discussion i think that’s very understandable also i’m thinking you know we’ve talked a little bit about health policy uh we’ve also mentioned the role of the european specialist nurses organization as no uh that you’re both a part of so you know how is esno been maybe tackling some

Of these issues either in terms of resourcing and the evolution of the profession but also around biosimilar medicines and helping to spread some good practices or some good ideas or policy issues there what’s been the role of your european work your collective european work well asthma worked a lot in the past period together with the medicine for europe in a

Promotion of the biosimilars and our communication guide for switching patient to buy similar was the first step and i think it was that huge attention among our members in between i published a paper together with professor vulner about the nursing education and biosimilars and we started the revision process of the guide and conducted a study within the project

Which brought us the result of nurses knowledge about biosimilars we published that paper in the international journal of environmental and public health and the sample was 866 nurses from 11 countries and our conclusions were that the biosimilar are not so popular and often topics among nurses and the bicimulus should be of interest to future education initiatives

And as as now and nurse we are not satisfied with the nursing education and there is still so much to do in this field a promotion biosimilar and etiquette nurses of advantages of using biosimilars yeah hanukkah we are now working on the biosimilar guide i think it’s very important that a lot of nurses know about this guide because even if you are not working

In a field where a lot of biologics are used i think it’s important for nurses to know or what biosimilars are and how people are treated and why we switch from originator to biosimulus i get a lot of males and questions from nurses from other departments about these things and i think it’s very important that we spread information about this medication to all

Nurses we try to do that to inform nurses by conferences doing post presentations and that kind of things about the guide so we hope to inform a lot of nurses about the different possibilities and how to inform patients about biosimilus yes for sure and i know from our work at medicine for europe as well how valuable that is so i would thank also both of you and

As know for that contribution within your community and so i think maybe more you know moving now to the conclusions of this discussion i think some of the topics that we’ve raised have been very interesting in terms of the challenges for the community and the health workforce more broadly that are very acute now let’s say following a intense phase of pandemic and

Shifting ways of working and supporting one another and sharing information i think from the policy perspective we often are involved in discussions about what can be done more what needs to be done on top let’s think of a new law a new policy a new measure that we can introduce but maybe sometimes the easiest is to focus on the existing resources that we have and to

Think about how we build on those and so in that sense is there anything you think that we’re doing in the health field that maybe we should pause and think about or rethink and maybe change the way we do things if there’s one thing that would come to your mind i think that we have to continue on this path with promotion of biosimilars and share it to among nurses

I think that’s really important we have to work with university regarding the curriculums of nursing education and implement biosimilars as obligatory and we have to find a way how to show the benefits of biosimilar in saving hospital budget and redirecting that budget to other patients and other hospital issues if we aim to have a health for all we have to find

A way to reduce the costs without reducing quality of treatment and i think that biosimilar leads us to this direction thank you and hanukkah i think i didn’t know is right with what he says but i think we also should take interest in well prescribed all patients the dose which is researched when they try to get it on the market with a lot of patients can use less

Dose and get even and they don’t get a flare so when we talk about savings we can also do more research at the value of this medication we do now do research to stretching the medication from once a week to two weeks and people are happy with it so i think that’s also important to give patients the confidence that their medication is also working when we’re giving

Them lower doses and i think nurse have a big role in keeping patients confidence and help them with their self-management support yes i think that’s very true and also very evident from this discussion i think this has been very enlightening and really a pleasure to hear from both of you from your perspectives how the profession and how your role has evolved also

Through i mean arguably one of the most challenging times in the healthcare sphere over the past couple of years i think i would like to thank you of course for your contribution to this discussion but also more broadly for your work and your advocacy at the eu level it’s really impactful and it’s really our pleasure to partner with you on bringing better health

Policy to patients so i’d like to thank you for that and also for sharing your discussions with us today so thank you very much and we hope to hear more from you in the future thank you for the limitation thank you foreign

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Podcast – #CoEUP: 1×3: The Nurses’ voice on #BiosimilarMedicines. An opportunity for integrated care By Medicines for Europe