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  Issue 4 (2001)

Extemporaneous Preparations
GD-Department Extemporaneous Preparations
Interdisciplinary Cooperation is the Patent Solution

During her several years' activity in a public pharmacy in Krefeld, Michaela Tünnermann developed particular interest in the extemporaneous preparation. Meanwhile Ms. Tünnermann heads the department Extemporaneous Preparations within the Gesellschaft für Dermopharmazie (Society for Dermopharmacy). DermoTopics learnt in a conversation with the committed pharmacist why it is worthwhile to devote special attention to dermatics prepared according to prescription and that one prescription does not necessarily equal another prescription.

Since March 2001 you head the department Extemporaneous Preparations within the GD. How did that come about?

Frau Tünnermann:
Since 1998 I have been working in a public pharmacy in Krefeld. In this pharmacy there is a high occurrence of dermatological prescriptions. This is what has roused my interest to concentrate on this topic. On the search for further professional education I got to know about the Gesellschaft für Dermopharmazie. Thereupon I became member of the GD and attended for the first time a meeting of the department Extemporaneous Preparations in the frame of the GD's 3rd Annual Meeting 1999 in Berlin. My colleague, Dr. Bernd Hünerbein, had to cease the quite time-consuming function of a department head due to reasons of time after two terms and then I was elected by the department members as his successor. The projects initiated and dealt with by Dr. Hünerbein will be continued and I am very glad that he will assist the department by word and deed in future. I would like to express special thanks to my deputies, professor Dr. med. Max Gloor of the Hautklinik am Städtischen Klinikum Karlsruhe (Dermatological Clinic at the Municipal Clinical Center) and pharmacist Rosemarie Eifler-Bollen of the Laboratorium des Neuen Rezeptur-Formulariums (NRF) (Laboratory of the New Prescription Formulatory) in Eschborn, equally recently elected, who actively assist me in executing of my duty.

What are the essential objectives in the department headed by you?

Pharmacist Michaela Tünnermann - at her place of work in a public pharmacy in Krefeld - recently elected head of the GD department Extemporaneous Preparations.

Ms. Tünnermann:
The department's target can be recognized by the composition of the department. The department members are pharmacists from clinical pharmacies and public pharmacies, dermatologists from clinics and practices as well as industry representatives. It is their common goal to maintain the extemporaneous preparation in German pharmacies as institution of the pharmacist and thus further allow the dermatologist the prescribing of individual drugs for external application. The extemporaneous preparation which is hardly known in European countries at the time being holds a special position in Germany. The department's work aims at a standardization of the extemporaneous preparation and ensuring of its quality.

A first major project was the establishing of guidelines with principles regarding the prescribing, preparing and dispensing of dermatological prescriptions which were adopted end of 1998 on the occasion of an interdisciplinary consensus conference. These guidelines deal for instance with the question according to which criteria prescriptions should be drawn up and what should be considered from the dermatologist's and pharmacist's point of view regarding the quality and application safety. In the same way, the industry providing prescription bases or offering prescription collections is to be integrated. The department has very well succeeded in doing so.

In a further project, hygiene guidelines for the producing of non-sterile preparations in pharmacies have been established. These guidelines have meanwhile been adopted in extracts into the guidelines of the Bundesapothekerkammer (Federal Pharmacist Chamber). All dermatologists and pharmacists have been informed about these two position papers of the GD in detail via the NRF as well as the dermatological and pharmaceutical expert press. By the way, both papers can be looked up at the GD-homepage ( in the Internet where they are very frequently retrieved.

The extemporaneous preparation represents an interface between dermatologists and pharmacists. What is of special importance in this context?

Ms. Tünnermann:
A good cooperation between the prescribing dermatologist and 'his' pharmacy is of particular importance. A prescription assignment of a physician to a certain pharmacy is in fact not permitted but a contact priority already results due to the local vicinity. Therefore, in my opinion it is important that the therapy concept chosen by the physician is clearly evident by the pharmacist.

As pharmacist responsible for the preparation of prescriptions I also see my task in this context in advising patients and explaining the correct application of the prescription. Knowing the therapy concept I am able to respond much better to the special wishes of the dermatologist concering auxiliaries or preservations. By the way, the compliance of the patients treated with dermatological prescriptions is very satisfactory and represents both for the dermatologist and the pharmacy an important instrument of the patient and customer bond. The possibility of a current preparation of individual drugs distinctly differentiates the public pharmacy from the mail-order business.

The quality assurance of dermatological prescriptions is of major importance. What is particularly important?

Ms. Tünnermann:
A crucial quality criterion is the composition of the prescription. Do the active ingredients correspond to each other and to the other ingredients? Are the active ingredients in the respective base stable? Do they come up to the latest standards? Is the chosen base therapeutically useful? Sometimes checkbacks by pharmacists with the prescribing physician or a coordination between physician and pharmacist are necessary. According to my experience this coordination has significantly improved in recent times. Meanwhile inquiries by dermatologists reach us pharmacists more and more frequently whether and how certain prescriptions can be qualitatively optimally prepared. In our region North-Rhine this is certainly due to an interdisciplinary series of further education which took place in the year 2000 and was organized in coordination with the GD jointly by the Professional Association of the German Dermatologists (BVDD) and the Pharmacist Association North-Rhine. DermoTopics has informed in detail about this event in the March-edition of the year 2001.

Furthermore, it should be mentioned that extemporaneous preparations may absolutely be innovative and modern. If available new active substances or new therapy principles may be applied what is often not possible with ready-to-use drugs. The NRF also takes this development into account; current therapy concepts are realized in quality-optimized, standardized prescriptions.

Do you have any personal goals for your future work as a department head?

Ms. Tünnermann:
I was elected for a term of office of three years Within this time I would like to succeed in the accepting of the established guidelines and implementation by the basis, i.e. both by the prescribing dermatologists and the pharmacists dealing with the preparing of extemporaneous preparations. I attach special importance on an excellent interdisciplinary cooperation without mutual apportioning of blame if case problems occur. On the part of the GD we will motivate the professional associations of dermatologists and pharmacists to equally implement the interdisciplinary professional education concept which has been successfully tested in North-Rhine in other regions. Perhaps we will also succeed in further promoting the art of prescribing already in the specialist education of dermatologists by appropriate educative measures.

How many members are there in the department Extemporaneous Preparations, how frequently do they meet and how are the tasks shared within the group?

The ensuring of the pharmaceutical quality is the most important requirement in the preparing of prescriptions in pharmacies. For this purpose modern techniques and current packing materials are applied.

Ms. Tünnermann:
The department consists at present of approximately 30 members, resident all over Germany as well as Austria and Switzerland. Within the department there are different working groups dealing with the priorities guidelines, hygiene guidelines, cosmetics as prescription bases and professional further education. The realization of the different projects requires a close cooperation which is effected both by means of correspondence and in personal meetings. The meetings take place as required or also in the frame of events - as for instance recently on the occasion of the GD symposium "Effects of Dermocosmetics" in Düsseldorf on 17 October 2001.

The working group further professional education deals at present with the preparation of a workshop entitled "Practice-oriented prescription in the 3rd millenium" which will take place on Wednesday, 20 March in the time from 13.00 to 17.00 hours on the occasion of 6th GD-Annual Meeting in Hamburg. The group has established a program for this interactive workshop which in my opinion is equally interesting for dermatologists and pharmacist and is not to address GD members only (please refer to the scientific program of the GD's 6th Annual Meeting in DermoTopics no. 3). The workshop has been certified by the Deutsche Dermatologische Akademie (German Dermatological Academia) with four points for further education.

Who can actively cooperate in this department and which conditions have to be met?

Ms. Tünnermann:
The only condition for an active cooperation in the department is the ordinary membership in the GD. Member of the GD can become every physician, pharmacist or other natural scientists interested in the topics of dermopharmacy or active in this field. Approximately 100 of the presently 270 GD members are by the way dermatologists. The membership fee amounts to only 25,56 € and includes the regular obtaining of DermoTopics as well as benefits regarding the participation fees of GD events. Persons interested in becoming a member should get in contact with the GD offices in Eschborn and express their intention in an active cooperation in the department extemporaneous preparations (for address please refer to the box).

Ms. Tünnermann, we thank you for this conversation (ghw).

GD Gesellschaft für
Dermopharmazie e.V.
Carl-Mannich-Straße 20
D-65760 Eschborn
Tel.: +0049/6196/928-328
Fax: +0049/6196/928-329




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