L'unité d'œuvre Pharma face aux enjeux de la coopération pharmaceutique inter-établissements et du déploiement des activités de pharmacie clinique en psychiatrie.

In a previous article [1]), our team highlighted the interest and limitations of the Pharma Work Unit (UO) [2] in the accounting reprocessing of hospital pharmacies (PUI). The aim of this study is to highlight the interest and limitations of the UO within the framework of inter-establishment pharmaceutical cooperations on the one hand, and within the framework of the deployment of clinical pharmacy activities (APC) on the other hand. This is a retrospective observational study on data. The data comes from an external audit report from 2019 (unpublished), annual activity reports of the PUIs from 2019 to 2023 [3] , and hospitalization data from 2021 to 2023 [4, 5]. These were analysed using SPSS software (v.29.0.1). In 2019, the data collected during an audit commissioned by hospital management highlighted a budgeted number of beds and places relative to the paramedical staff that was three times higher at the PUI of the Centre hospitalier Fondation Vallée (CHFV) compared to that of the PUI of the Groupe hospitalier Paul Guiraud (GHPG). On the contrary, the activity data revealed an activity 5 to 100 times higher in the GHPG PUI. This resulted in a UO 26 times higher at GHPG and medical and paramedical human resources expenses relative to the UO almost 2 times lower. Between 2021 and 2023, whilst management was common, and the two PUIs initially dispersed over three sites were transformed into two PUIs on two sites. During this period, we observed a decrease in the pharma UO (-4%) associated with a fall in the number of beds (-24%) and a decrease in full-time hospitalization days (-10%). To explain this discrepancy between the evolution of the UO and that of hospitalization, it is necessary to consider all the weighted activities of the PUI on the one hand, but also the deployment of the APC on the other hand. The number of shared activities between the two PUIs is decreasing (global dispensation by reduction of capacity). However, the weighted activities of clinical pharmacy are increasing by 16%, and their share in the UO grew by 19%. This growth results from the redeployment of clinical pharmacists (PC) to care units (US) which were open but were not previously covered, the intensification of PC presence in these US - generating new requests for pharmaceutical interventions - as well as an innovative registration of a clinical pharmacist in ambulatory units. In the case of cooperation, the UO helps to inform on the impact of a reorganization and is useful for deciding on the fusion/closure of a PUI. Finally, regarding the APC, this lever must be clarified in terms of new processes for different activities customized for each and every patient, pathways, and treatments and when coordination is necessary between traditional professions and new professions such as advanced practice nurses or peer helpers. [ABSTRACT FROM AUTHOR]