Skip to main content
Login | Suomeksi | På svenska | In English

Browsing by discipline "Social Pharmacy"

Sort by: Order: Results:

  • Ryynänen, Eeva (2013)
    During the past few decades the focus of the pharmacy profession has shifted from medicinal products towards ensuring the welfare of the patient. The concept of pharmaceutical care emphasizes that the role of the pharmacist is to ensure the quality and safety of pharmaceutical therapy in collaboration with the patient. The concept of clinical pharmacy, on the other hand, highlights that the pharmacist should take the responsibility of the efficiency, safety and cost efficiency of the patient's pharmaceutical treatment together with other health-care professionals. Patient centered pharmacy services have been increased in Finnish hospitals and health care-centers during the last 10 years, for example, in the form of pharmacy services provided on the wards. Previous studies have shown that Finnish hospital pharmacists want to develop and increase clinical pharmacy services in hospitals but feel they are not competent enough to manage them. To develop and increase the number of clinical pharmacy services it is important to ensure the pharmacy professionals have support to their continuing professional development. The General Level Framework (GLF) has been developed in the UK to support the professional development of pharmacy professionals and its value has been shown in various studies. The aim of this study was to give information of the state of Finnish hospital pharmacy and its development needs as perceived by Finnish hospital pharmacists, and to investigate how the GLF can be utilized in Finnish hospital pharmacy. The study was conducted using two different research methods: a semi-structured interview was designed to investigate hospital pharmacists' perceptions of hospital pharmacy, it's development needs and utilization of the GLF; in addition, hospital pharmacists selfassessed their clinical pharmacy related competencies using the GLF. All of the participants of the study were participants of a clinical pharmacy course by University of Helsinki. In total 11 hospital pharmacists took part in the interview. Also 41 pharmacists self-assessed their competencies in clinical pharmacy using the GLF: eight of them completed the self-assessment twice with a six month period between the assessments. The interviewed pharmacists felt that the pharmacy curriculum should focus more on the skills and competencies needed in hospital pharmacy. On the other hand, they felt that the tasks of hospital pharmacists did not necessarily allow them to use their actual knowledge of pharmacy. They perceived that the future of hospital pharmacy lies in services of clinical pharmacy, although they felt that they were not competent enough to manage them. The GLF self-assessment showed that the clinical competencies of the participants were average, and there was no change in the competence of the participants during the six month period. However, the interviewed pharmacists felt that the GLF can be used as a tool for support the hospital pharmacists' professional development and continuing professional development in clinical pharmacy. They also perceived that there is a need for further studies on the clinical pharmacy services and their benefits, and that the task distribution of health care professionals in hospitals must be re-considered. With these actions, the challenges hindering the development and increase of clinical pharmacy services in Finnish hospitals could be overcome. They described that the greatest challenges to overcome were prejudices against pharmacist working on the wards and a lack of resources. In order to develop and increase clinical pharmacy services in Finnish hospitals and other health-care organizations further reseacrh on the benefits of clinical pharmacy should be conducted. It must also be ensured that all health-care professionals and decision makers are aware of the studies already made about clinical pharmacy and its benefits. The skill-mix of health care professionals taking part in a patient's treatment must be reconsidered in order to ensure that the patient receives the best, most efficient and safest possible medicinal care. The GLF can be used as a tool to define the role of a clinical pharmacist in Finland. There is a need for more clinical pharmacy education so that Finnish pharmacists can feel competent enough to manage clinical pharmacy tasks. The GLF can be used as a tool to support the professional development and continuing professional development also in Finland.
  • Hannula, Sara (2011)
    Pharmaceutical services refer to services in community pharmacies which are based on knowledge and skills of the pharmaceutical personnel. Pharmaceutical services can be divided into basic and special services. Pharmaceutical basic services relate to community pharmacy's legislative functions, while pharmaceutical special services try more proactively contribute to consumers' health.. Automated dose dispensing is pharmaceutical special service. Dose dispensing means that the patient's medication are packed in disposable bags corresponding to the dose that he or she needs to take during the course of one day. When a new patient starts to use the automated dose dispensing service, his medication is reviewed to assure there would not be severe interactions or unnecessary drugs The drugs suitability to the service and the timing of the medication is noted when the service is started. Automated dose dispensing service produces a medication list of customer's medication. The survey studied the level of the checks made to patient's medication and how can the medication history be explaned. In the survey were also interested in the level of review that was done to patient's medication. Information of patient's medication was also collected with a questionnaire. Background information showed how well the results of the survey can be generalized to pharmacies offering services and customers using the service. The questionnaire was sent to all pharmacies that ordered automated dose dispensing as contract manufacturing from Espoonlahti Pharmacy in September 2010. In the semi structured questionnaire was multiple choice and open-ended questions. Response rate in this study was 45. Background information showed that questionnaires were returned from pharmacies all around the Finland and all sizes of pharmacies. Mostly the patients starting the automated dose dispensing service are aged, homecare patients, nursing home residents or service home residents. Medication cards are used in collecting the information of patient's medication, but information to the medication card can be updated from other sources too. Medication review to patient's medication is made usually in multi-professional cooperation. Changes made to patient's medication are mainly caused by generic substitutions, selection of the dispensing machine or avoidance to halving. Medications have only few interactions that lead into discontinuing use of some medicine. Checking the medication has only little effect on the amount of drugs used by the patient. New patients starting the automated dose dispensing service have on the average 11 medicines in use, from which 7 medicines are taken to automated dose dispensing. The most widely used ATC groups are cardiovascular and nervous system medicines. Each new patient uses an average of three preparations in both groups before and after the initiation of automated dose dispensing service.
  • Jyrkkä, Anu (2017)
    The number of home-dwelling aged is increasing in Finland. Rational medication use is one of the factors, which ensures the good functional abilities needed for independent or assisted living at home. No timely research on the medication use of the home-dwelling aged in Finland is published. Research on their medication use makes it possible to identify the drug related problems. Identifying drug related problems and rationalizing or deprescribing medications belong to risk management which aims at avoiding adverse drug events that might impair functional abilities. The aim of this Master's Thesis was to describe the medications used by the home services assisted home-dwelling aged, to study the prevalence of potentially inappropriate medication use (PIM) and clinically significant (SFINX Class D) drug-drug interactions and to study anticholinergic and serotonergic loads of medications used. Additionally, correlation between the use of PIMs according to Beers criteria and functional abilities measured by RAVA™ was studied. This study was conducted as a part of a larger interventional and randomized study in Town of Lohja, 'Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care'. The cross-sectional baseline data was collected in autumn 2015. The study cohort (n=188) consisted of home-dwelling aged who were assisted by home services aged 65 or older and living in Lohja. They were randomized into intervention (n=101) and control groups (n=87). Majority of them were women (69%) and their mean age was 83 years. The mean number of medications used was 13. Data on prescription drugs (both regular and irregular) was collected from their medication lists. Most severe, class D drug interactions were checked out from reports of SFINX database. Potentially inappropriate medication (Beers 2015), anticholinergic load and serotonergic load were checked out from reports of Salko database. Medications were analyzed in both groups separately. RAVA evaluation was conducted by home care nurses and practical nurses. Pearson's correlation coefficient was calculated to analyse the associations between the amount of potentially inappropriate medication and functional ability in addition on crosstabs. The most commonly used drug classes were central nervous system medications (n=184, 98 %) and cardiovascular medications (n=176, 94 %). The most common drug was paracetamol (n=155, 82 %). Benzodiazepines and related drugs was used by 43 % (n=80) and antipsychotics 17 % (n=32) participants. At least one anticholinergic medication (two or three points) according to Salko database was used by 27 % participants; 13 % had concomitantly more than one serotonergic drugs. Prevalence of the clinical significant drug-drug interaction was 8 %. Almost four out of five had potentially inappropriate medications according to the Beers 2015 criteria of which the most common drug was pantoprazol (n=60, 21 %). The number of the PIMs used by the study participants did not correlate between the functional ability measured by RAVA class (Pearson correlation coefficient 0.024). Aged among home care services are highly medicated and the potentially inpropriate medication use is common. Coordinated models and interprofessional medication reviews are needed to ensure rational and safe medication therapy of the aged. However, correlation between functional ability measured by RAVA class and Beers medicines use was not shown.
  • Jakola, Janne (2017)
    The incidence of wet age-related macular degeneration (AMD) is increasing with ageing. AMD leads to blindness if it is not treated properly. Common treatment is to administrate intravitreal growth factor inhibitors. An ageing population increases the number of patients which overloads the public health services and expands costs. Traditionally, injections have been administered by physicians but because of the limited recourses nurses have been trained to administer injections. In addition, injections can be administered as physician's clinical extra work to alleviate the queue and as an outsourcing service from the private sector. As the resources of the public health service are limited, it is important to evaluate used methods reliably. The target of this research was to investigate the administration costs of intravitreal injections which are administered by physicians, nurses, a physician or a nurse working extra to alleviate the queue or by a private sector. The used method was cost analysis because the effectiveness of the care is the same regardless of the administer of the injection. The source of costs was Ecomed database of HUS, the data of cost accounting and catalogue of billing from the outsourcing service. The costs were examined in perspective of the producer of the service. Based on the cost analysis, the administration costs per injection are following: administered by physicians 51,39 €, nurse-administered 51,19 €, administered by a physician to alleviate the queue 100,46 €, nurse-administered to alleviate the queue 72,87 €, administered by a physician in outsourcing service 276,19 and nurse-administered in outsourcing service 269,85 €. The annual total costs of the producer of the service were 4 563 726 €. By increasing the number of injections administered by a nurse of HUS the need for an outsourcing service can be decreased which may decrease the annual total costs by two million euro. It is important to find cost-effective solutions because the number of patients are increasing. Based on this research it is more profitable to increase the number of injections administered by a nurse of HUS than to train more nurses to administrate injections to alleviate the queue or to work in outsourcing services. The result of this research can be adapted in planning of the public health services.
  • Lipsanen, Tuomas (2010)
    Medication review is relatively new intervention in Finland that potentially promotes safe and rational use of medicines. During the recent years, the effectiveness of different kind of medication review procedures has been evaluated in many countries. The results considering the cost-effectiveness have varied and conclusions have been difficult to make. Because of the limited resources, the funders and decisionmakers need evidence-based effectiveness data to get the best possible value for the money spent in health care. The aim of the study was to gather, analyze and summarize the published data of costeffectiveness of the medication review by means of a systematic review. The aim was also to represent the medication review as a concept, procedure and study objective. This study was conducted as an analysis of study methods applied in published studies on cost-effectiveness of medication review procedures. In total, 947 references were found using a systematic literature search covering three electronic databases (Medline, CRD and IPA). Most of the references were excluded based on titles and abstracts, and 85 full-text articles were evaluated. After the duplicates were removed, 11 articles met the requested inclusion criteria and were entered to the study. There was a lot of variation between selected articles. In five articles the description of the medication review was not detailed or the intervention was not equal to the expected content level. Also the outcomes measures used in the studies varied. Most studies measured the use of medicines or the number of drug-related problems in different ways. Quality of life was applied as an outcome measure only in five studies and none of the studies were able to show statistically significant differences between intervention and control groups. Mortality was measured in four studies. In most studies the definition and calculation of the costs was limited and inadequate for proper economic evaluation. It was also common that only the direct drug costs from patient's perspective were calculated. The cost of pharmacist's working hours was taken into account in five studies. The incremental analysis was performed only in one study which also got high quality scores compared to all other studies. On the whole the economic evaluations in the selected studies were of low quality and performed in simple a way.
  • Hitonen, Heidi (2013)
    About 10 % of the patients experience an adverse event during their treatment. About 1 % of the adverse events are serious. Extrapolated from international evidence adverse events cause death of 700 - 1700 patients annually in Finland. Medication errors are the most common single preventable cause of adverse events. According to several studies about half of the adverse events and medication errors are preventable. Therefore medication safety is a central part of the Finnish Patient Safety Strategy. One of the medication safety tools in Finland is unit-based pharmacotherapy plan for which the Ministry of Social Affairs and Health gives instructions in the Safe Pharmacotherapy guide. All social and healthcare units should develop a pharmacotherapy plan which describes the medication processes in the unit. The purpose is to harmonise the principles for the provision of pharmacotherapy, to clarify the division of responsibilities related to its provision, and to define the minimum requirements that must be complied. The aim of the study was to explore how the pharmacotherapy plans were made and to evaluate their implementation and benefits in hospitals, health centres and social care units for the elderly. Pharmacotherapy plans are studied as part of the Finnish Patient Safety Strategy, focusing on medication safety. Head nurses were chosen as target group. The data was collected by phone interviews. Forty (8 %) interviews were received from a random sample that was taken from a register of head nurses held by Tehy ry. The interview was semi-structured theme interview and the data was analysed using content analysis. Most of the studied units (n= 24, 60 %) had started to formulate the pharmacotherapy plan in 2007, soon after the Safe Pharmacotherapy guide was published. Pharmacotherapy plans were drawn up on organisation and/or unit level. There was a lot of variety in the working groups' sizes and professionals taking part in them. More instructions would have been needed. The most common way (n=20, 50 %) to induct the pharmacotherapy plan to the staff was to introduce it at the unit meeting. Most commonly mentioned changes to the operations in the units were related to error reporting (n=15, 38 %), certification procedures for distribution and administration of medicines (n=9, 23 %) and task allocation (n=8, 20 %). There were several benefits of the pharmacotherapy plan of which most common were starting or developing error reporting (n=19, 48 %), clarification and better availability of instructions (n=18, 45 %), better induction of new staff members and substitutes (n=16, 40 %) and standardization of procedures (n=10, 25 %). Allocation of tasks and responsibilities was considered a challenge in developing and using the pharmacotherapy plan. Limited resources caused difficulties in implementing and using the pharmacotherapy plan. The staffs' medication education was kept more up-to date after introduction of the pharmacotherapy plan but the education was also challenging for the units. Pharmacotherapy plans made the units develop their procedures and increased understanding of medication safety. All in all the plans have worked well as part of the Patient Safety Strategy. However the systematic development of the pharmacotherapy and the use of pharmacotherapy plans in social and healthcare units requires more effort.
  • Luhtanen, Suvi (2012)
    Medicine information is an important part of a medicine and public health service. Medicine information it is tightly connected to many different functions of the medicine field and can be reviewed from several perspectives. Medicine counseling has been developed especially in the pharmacy sector but the development projects of medicine information which include the whole public health service have not been done before. According to the government proposal (74/2009) Finnish Medical Agency (Fimea), has created the national medicine information strategy which was published in February 2012. This study was conducted in order to gather background information for developing the national medicine information strategy. The aim of the study was to clarify the role of the medicine information producing quarters and the perceptions of co-ordination of operation as well as good practices, challenges and opportunities in medicine information. The material of the study consists of 29 interviews among key stakeholders. Interviews were conducted between March and September in 2011. Interviewees represented pharmaceutical industry, hospital and community pharmacies, authorities, patient organizations, education units and professional associations in the fields of medicine, nursing and pharmacy. Inductive content analysis with counting was used to analyze the qualitative data. The stakeholders brought out different sources of information (n=18) and examples of the successful forms and projects of cooperation (n=14) as good practices. According to the stakeholders, multi professional cooperation should be improved and increased in the medicine information field (n=19). The medicine information operation in public and hospital sector should be developed for example trough department pharmacy in hospitals (n=17). The information supply and skills of the health professionals are defective (n=16) and those could be improved by developing education (n=17). The medicine information targeted at consumers should be uniform regardless of the source and counseling should be individually tailored (n=15). The stakeholders told that they are cooperating with different quarters in medicine information field. The stakeholders reviewed medicine information strongly from their own point of view and they were not aware of what other quarters are doing. Medicine information operation needs both national and local co-ordination and by increasing and developing multi professional cooperation and networking, available resources and skills of quarters could be used more effectively. More reliable, balanced and individually tailored medicine information is needed. The base of good medicine information is a strong theory base and skills of health professionals so notice should be taken to the education so that it would meet the demands of the working life also in medicine information field. Consumers need tailored medicine information which should be uniform regardless of from which health unit it is given.
  • Mononen, Anna (2012)
    Herbal preparations are widely used nowadays and the information given has developed a lot during the last decades. Herbal preparations haven`t been acknowledged as medicines and therefore their efficacy and adverse effects are still often underrated. In 2005 along the changes in legislation differently legislated group of herbal preparations was retired. Nowadays herbal preparations are divided to drugs and food products. The aim of the study was to make oneself familiar with the legislation of these products and the evolution of the pharmaceutical information given. The aim also was to compare warnings, prohibitions, contraindications and their evolution to prevalent legislation. The material of the study consisted of product information summaries, patient information leaflets and labeling of herbal medicines, traditional herbal medicines and their predecessors. In addition to this there was also other legislative material. Only herbal medicines and traditional herbal medicines according to directive 2004/24/EY of the European parliament and the council`s definition were taken in to account. According to 2004/24/EY herbal medicinal products is any medicinal product, exclusively containing as active ingredients one or more herbal substances or one or more herbal preparations, or one or more such herbal substances in combination with one or more such herbal preparations. There were all together 194 products included in the study. Documentation of 184 products was found on paper in Fimea`s archives. Of the remaining five out of ten products it was found some basic information in electronic rohdos-register and of one product on an on paper final act. Data of these six products was only used partly because of its deficiencies. The data of four products wasn`t found. Under a more detailed study there was all together 184 products between 1964 and 2011. The material was divided to time periods 1964 - 1983, 1984 - 1987, 1988 - 1995, 1996 - 2005 and 2006 - 2011 by the changes in legislation. The information given of herbal preparations was the most affected by the changes in legislation in 1994 and 2005. The amount of new licenses was increasing until the time period 1988 - 1995. Licenses were granted the most during 1988 - 1955. After 1996 the amount of warnings, prohibitions and contraindications rose and many of the products that got the license in previous time period 1966 - 1955 left the market or transferred under the food legislation. As well many products with less consumption left the market because new studies demanded were expensive and cumbersome. In 2005 along the changes in legislation a clear change in attitudes came true, when a vague group of herbal preparations was removed and herbal preparations were divided into pharmaceuticals and food products. Along this change it has become easier for health care professionals to assess the risks and benefits of herbal preparations and advise the clients while making the decisions.
  • Alakoski, Anna (2012)
    Prostate cancer is the most common cancer in men in Finland. Health care costs increase annually and cost of cancer is significant to the society. Because resources are scarce more information is needed about the costs of diseases as well as treatment effectiveness. In addition to clinical effectiveness it is important to assess the value of healthcare technologies from the patient's point of view by measuring the treatment's effect on patients' quality of life. In this thesis a literature review was made on the following topics: cost of treating prostate cancer, prostate cancer patients' quality of life and cost-effectiveness of prostate cancer. The aim of the research was to determine what the drug costs are in relation to the total cost of treatment for prostate cancer in different stages of the disease and assess how the quality of life changes during the first year of treatment depending on the form of treatment. Drug costs were calculated from the health care payer's perspective in a six month cross-sectional study. The study population included a total of 629 prostate cancer patients treated in the Helsinki and Uudenmaa hospital district (HUS). The quality of life study population (N=367) was different of that used to calculate drug costs. The quality of life was measured according to an ongoing cost-effectiveness research at HUS. It was measured with 15D-instrument before receiving cancer treatment and three, six and twelve months after the beginning of treatment. Drug costs in relation to the total cost of prostate cancer treatment were significant. In patients with meta-static cancer drugs were 53 % of the total cost of cancer treatment. In remission patients the total costs of cancer treatment were the lowest compared to other diseases stages, but drug costs were still 30 % of the total costs. For patients receiving palliative treatment, local or relapse cancer patients, and patients whose cancer was just diagnosed, the total drug costs were 19%, 13% and 0%, respectively. Policlinic visits and policlinic procedures were also a significant cause of the total costs. Quality of life of prostate cancer patients is incredibly good compared to age-standardized population. However the patients' quality of life decreases statistically and clinically significantly during the first year of treatment. Before treatment 15D score was 0,91 and after 12 months it was 0,88. When assessed in different treatment groups the quality of life decreased the least in patients treated with waiting. The largest statistically significant change occurred in patients treated with radiation. The strength of the study is that the costs were calculated per patient according to real resource use. The study also had limitations. The costs of primary care were not included in the calculations. Also cancer related pain medication, depression and erectile dysfunction drugs should be included in the drug costs. The follow-up time of measuring quality of life was too short. In the future it would be important to study the cost-effectiveness of medication as well as the cost-effectiveness of the different forms of treatment in prostate cancer.
  • Kallio, Rosanna (2017)
    A large part of patient safety incidents in health care is related to medicines and medication treatment. Medication safety is an important part of patient safety. In particular, transitions of care endangers continuity of care and patient safety. A poor flow of information between health care units increases a risk of medication errors. An accurate and up-to-date medication list can improve transfer of correct medical information with the patient. In addition to the medication list other organization-level defences are important to patient and medication safety. This study is part of a larger regional development project concerning reformation of service delivery in health and social care. One of the purposes of the project is to integrate health and social services of municipalities in central Uusimaa (Hyvinkää, Mäntsälä, Pornainen, Järvenpää, Nurmijärvi and Tuusula). The aim of this study was to investigate what kinds of medication lists are available in these municipalities and to design a medication list maintained by the patient which is regionally shared. The second aim of the study was to identify defences used by the municipal healthcare systems and to develop a medication management process model for the municipalities. The material consisted of medication lists from the municipalities participating in the study. Twelve (12) lists were selected for analysis. The medication list of Lää was also included in the analysis (N=13). Data of the defences was collected by a questionnaire. In Hyvinkää the material was collected from primary health care and Hyvinkää hospital. Both the medication list and the defence data were systematically reviewed and collected in a Microsoft Excel table. The regional medication list for patients was developed based on the medication list data and the existing literature. The process model for medical treatment was developed based on the defence data. Almost every medication list contained space for personal data (n=11) and basic medication information, such as the name of the drug (n=12), strength (n=12) and dosage (n=13). Regular medication was usually separated from as-needed medication (n=8). Only two of the lists had a column for periodic medication. There were only two lists with columns for over-the-counter medicines and herbal products. Less than half of the lists (n=5) had space for indication. According to the survey, most of the defences listed in the questionnaire were used in all or almost all municipalities. According to the responses, medication lists, for example, are regularly reviewed. Some gaps in defences also emerged. Only in two municipalities high-alert medications were identified. Also only in two municipalities attention was paid to the storage of look-alike medicines. Written instructions for managing medication errors was available only in two municipalities. There are many different medication lists available in health care. A regionally shared medication list maintained by the patient can improve the transfer of the up-to-date medical information with the patient. The list must be comprehensive and easy to use. Both the patient and the healthcare professionals should be responsible for maintaining the accurate medication list. Most of the defences asked in the questionnaire have been taken into account in pharmacotherapy plans. In practice, however, the implementation of defences is unclear. For example patients' medication lists often contain errors even though lists should be reviewed regularly. There should be exact instructions as well as clearly defined roles and responsibilities for medication reconciliation. More attention should also be paid to the use of high-alert and look-alike medicines. Since errors occur despite the defenses, every health care unit should have written instructions in case of medication errors.
  • Sjöblom, Annika (2015)
    Background: Medication errors are the most important individual factor that jeopardizes patient safety in human care. The patient's medication process is a chain of successive operations which involves different health care providers and the medicine user. All the stages of the medication process are susceptible to the medication errors. Medication errors are approached from the system's point of view by James Reason`s (1990) theory of Human Error. Instead of blaming individuals the theory concentrates on developing operations models which enable identification of medication errors in the organizations. The development of medication safety culture in the human medication has led to systems which tolerate human mistakes and prevent errors. The increasing number of animals and pets and their changing status in the society have raised discussion about the medication safety in veterinary care. Little research has been conducted in this field. Objective: The objective of the study was to identify the most typical veterinary medication errors and their root causes. The medication management processes of veterinary care can be developed safer by becoming aware of the root causes of medication errors. Study design and data: All the cases investigated by the Assessment Board for Damages in Veterinary Practice in 2002-2013 considering medication errors (n=79) were analysed with the help of the structured data collection sheet by using descriptive statistics. The most typical cases were studied more in detail by using simplified Root Cause Analysis (RCA). Results: The medication errors found were related to the care of dogs (n=34), horses (n=26), bovines (n=10), cats (n=7) and pigs (n=2). The most general therapeutic groups that had caused medication errors were antibacterials for systemic use (17% of all the medicines related to the medication errors), NSAIDs and antirheumatic drugs (12%), neuroleptics and tranquillizers (12%), and analgesics (12%). Of the drugs, 39% were high alert medicines. Of the errors, 36% were related to the off label use (usage deviating from the summary of product characteristics, SPC). The error types which appeared most commonly in the cases were wrong route of administration (18% of all the medication errors), wrong dose (16%) and untreated diagnosed conditions left without the medicine by the veterinarian (15%). Because of the character of the data the majority of the medication errors occurred in the beginning of the medication process. It was estimated that 81% of the medication errors would have been preventable. Some of the root causes found were the lack of the commitment to the established care practice, environmental factors, communication problems, availability of tools, hurry and factors related to management, information and staff. Conclusion: The material of Assessment Board for Damages in Veterinary Practice gives valuable information about the veterinary medication errors. It is possible to influence the root causes of veterinary medication errors by paying attention to the management related factors and communication in veterinary care and improving access to therapeutic guidelines and electronic databases, and by expanding the electronic prescribing to veterinary care. The highest priority is to get Pharmaca Fennica Veterinaria to an electronic form.
  • Koskinen, Kati (2013)
    Ensuring patient and medication safety is a widely acknowledged challenge in health care. Key concepts in medication safety are: a patient safety incident, a safety barrier, and a medication error. A patient safety incident is an incident which has led or could have led to harm for the patient. A safety barrier is a structure built into the medication use process, and it is designed to improve medication safety. A medication error is a deviation from the medication process. The medication safety of cancer patients is especially important. Chemotherapeutic agents usually have a narrow therapeutic index and they have toxic side effects even in therapeutic doses. Accordingly, chemotherapeutic agents are classified as high alert medications. This means that they have an increased risk for patient harm if used improperly. Cancer patients are often elderly people and they have comorbid diseases. As a result, they are more susceptible to adverse drug effects. Moreover, the use of anticancer drugs varies between patients and the different indications of a drug, and supportive therapies are often needed. Thus, cancer pharmacotherapy is complicated. In this registry study, safety in the medication process of cancer treatment was studied using voluntary patient safety incident reports in one university hospital district in Finland. The aim of this study was to describe medication errors in cancer treatment, and safety barriers in the medication use process. The reported medication safety incidents were analysed by combining quantitative and qualitative methods. Altogether 176 incident reports were analysed relating to the use of anticancer drugs and supportive therapies. The most common medication errors were administration (27 %), prescribing (11 %), and ordering errors (10 %). These medication errors were typically omission errors. There were safety barriers in the medication process, such as double-checking of medicines, but they were not always fully effective. Some barriers were missing, for example, computer programs lacked important safety features. Safety barriers are needed, and should be further developed especially in the prescribing, ordering and administration phases of the process. More effective barriers would increase patient and medication safety in cancer treatment. The classification of medication errors in patient safety incidents was not always correct. Therefore, reporting and analysing of reports should be improved. The results of this study can be utilised for improving medication safety in all organisations giving cancer pharmacotherapy.
  • Kähkönen, Asta (2017)
    According to international studies, medication records are often incomplete in hospitals' patient information system. Medication reconciliation is an effective method to prevent medication errors and improve medication safety. A medication review is a useful tool in the assessment of drug-related problems (DRPs). DRPs can cause severe patient harm and even cause death. Approximately one third of Finnish people are diagnosed with cancer during their lifetime. About 16 000 patients receive cancer treatments in the Helsinki University Central Hospital Cancer Centre (HUCHCC). There are no clinical pharmacy services in the division of the solid tumors of HUCHCC. Internationally clinical pharmacy services in oncology are patient oriented and often include medication reconciliations and reviews. The clinical pharmacy services have increased patient safety also in the oncological specialty. The aim of this study was to find out the accuracy of the medication charts and identify the DRPs among 70-80-year-old patients with 6 or more medicines in uro-oncological outpatient clinic of HUCHCC. Accuracy of the medication charts was assessed by pharmacist-led medication reconciliation with patient interview. Information concerning patient's medication was also searched from the national electronical prescription centre and from the records of previous hospital visits. DRPs, such as drug-drug interactions, adverse drug reactions and overlapping medications, were identified with the pharmacist-led medication review. Special attention was paid to renal insuffiency, high-alert medications and potentially inappropriate medication for patients over 75 years old. Pharmacist discussed the DRPs with the oncology specialist. The theoretical framework of this study was the theory of human error, where patient safety hazards can be prevented by using safety defences such as medication reconciliation and medication review. Altogether 30 patients with urological cancer were included in this study. On average, they were 74.3 years old and used 12.4 medications. On average, there were 6.8 discrepancies per patient in the hospital medication chart. Only one patient had the accurate medication chart. The discrepancies were most commonly related to paracetamol (n = 10), vitamin-D (n = 9) and the combination of calcium and vitamin-D (n = 8). The most common discrepancies of high-alert medications were related to enoxaparin (n=6) and oxycodone (n=6). Of the potentially inappropriate medications for over 75 years old, the most common discrepancies were related magnesium (n=8) and metoclopramide (n=5). In the medication review process, 4 acute and 44 non-acute DRPs were identified with 22 patients (2,2 per patient). 60 % of these were regarded clinically relevant and lead to actions by the oncology specialist. Reconsidering the need or efficacy of the medication was recommended 19 times and inappropriate dose or medication with renal insufficiency were identified six times in medication reviews. DRPs were usually related to non-oncological medications such as pantoprazol (n=8), the combination of calcium and vitamin-D (n=4) ja bisoprolol (n=3). The medication reconciliation process should be developed in the urology-oncology outpatient clinic. Multiprofessional medication review can be used to detect and resolve DRPs of patients with urological cancer. The results of this study can be exploited when clinical pharmacy services will be created and developed in HUCHCC.
  • Kuitunen, Sini (2014)
    The role of community pharmacy is to ensure and promote medication safety in treatment of outpatients. In Finland a national four-year medication safety program Apila was launched in 2012. The Apila program aims to improve medication safety with pharmaceutical counselling and followup, support development and implementation of new tools and practices promoting medication safety, increase awareness of medication safety as part of patient safety and increase co-operation between community pharmacies and other social- and healthcare services. The objective of this study was to investigate medication safety situation of Finnish pharmacies in the beginning of Apila program. Research data was collected electronically at the end of 2012 by using a two structured survey instruments. Target of the study was the whole pharmaceutical staff of Finnish community pharmacies. There were two separated study samples. Survey instruments were alike for both samples with the exception of one section. One survey was sent to all independent pharmacy owners (n=593) and managers of university pharmacies (n=18). The other survey was sent to one member of pharmaceutical staff in every community pharmacy (n=618) and university pharmacies (n=17). The response-rate of pharmacy owners (O) was 39 % (n=241) and response-rate of pharmaceutical staff (S) was 29 % (n=182). Representativeness of data was good compared to standard population. According to study the barriers built into the dispensing process worked well. Verifying dose (O: 100 %, S: 98 %), interactions (O: 97 %, S: 94 %) and duplicated medications (O: 79 %, S: 70 %) was a common part of dispensing process. Over half of pharmacies had a written standard operating procedure to medication counselling given when dispensing prescribed (O: 74 %, S: 60 %) and over the counter medicines (O: 60 %, S: 60 %). About 90 % of the pharmacies had a standard operating procedure to reporting and managing dispensing errors (O: 92 %, S: 84 %). According to almost all respondents (O: 96 %, S: 91 %) medication errors were reported in their workplace. Though discussing dispensing errors with whole staff (O: 73 %, S: 53 %) and changing course of action after managing dispensing errors (O: 85 %, S: 63 %) was not as common. The respondents were of the opinion that pharmacy had closer co-operation with home care and social services than with health care services. Some pharmacies had agreed with local healthcare how to manage interactions (O: 39 %, S: 23 %), contraindications (O: 36 %, S: 19 %) and prescribing errors (O: 28 %, S: 15 %) discovered in pharmacy. The study indicates that Finnish community pharmacies have good abilities to identify medication related problems. Co-operation between community pharmacies and other social- and health care services should be promoted, because it seems to be superficial. The biggest challenges in risk management are complete invocation of data collected through error reporting and including medication safety audits into quality management. Pharmacy owners' answers to the questionnaire were more positive than staff members', which indicates that actions to promote medication safety should be made more visible. Coordination of medication safety should be emphasized both national and individual pharmacy level. Low response-rates weaken the reliability of the study, but the results are suggestive.
  • Granfors, Eija (2015)
    In hospital care many medicines should be usually prepared before they are administered to patients. In Finland Finnish Medicines Agency (Fimea) gives regulatory requirements and instructions for preparation of medicines in hospital pharmacies and action in hospital pharmacies is strictly controlled regularly by Fimea. According to Fimea's instructions hospital pharmacies should also ensure that medicines are prepared properly before they are administered to the patients in hospital wards. Preparing of medicines in hospital wards should be done in accordance with instructions given from the hospital pharmacy. Medicines should be prepared by using aseptic technique in order to protect patient safety. Aim of this study was to develop an assessment tool which can be used to assess the quality of ward- prepared medicines. The assessment tool should be suitable for self-assessment and external audit. Aim of the assessment tool is to ensure the safety of preparation of medicines in the wards and at the end improve patient safety. For the assessment tool ISMP Guidelines for safe preparation of sterile compounds were translated to Finnish. The assessment tool was then developed from the translated ISMP-guideline and other literature. The assessment tool was validated by using two-rounded Delphi-method. Delphi-method is a consensus method in which selected experts evaluate the data. At the first Delphi-round suitability and feasibility of the tool were evaluated and new items were created based on the consensus of experts. At the second round the feasibility of the tool items, which were developed by the first round, were evaluated once again. A total of 19 experts were participated to the Delphi-rounds. After the Delphi-rounds the developed assessment tool contained 64 items for safe preparing of medicines in hospital wards. The developed assessment tool reviews the entire process of preparing medicines and it can be used to identify which items are not followed in preparing of medicines before administering to patients in hospital wards. The developed assessment tool for safe preparation of medicines in hospital wards can be used widely in Finnish hospitals in order to ensure the quality of preparing medicines and detect the deficiencies and errors in preparation processes. By detecting deficiencies and errors in preparing medicines, they can be corrected and processes can be modified appropriate. In this way patient safety can be improved.
  • Pakarainen, Leena (2016)
    Healthcare professionals in patient care, including practical nurses, need medicines in-formation in their work. One strategic goal in national Medicines Information Strategy in Finland is to make sure, that healthcare professionals use reliable information sources and services. One part of the national medicines information network in Finland is work-ing group on medicines information for healthcare professionals. It's central aim is to advance availability of reliable medicines information in different environments in social- and healthcare. Objective of this study was to explore medicines information sources and needs among practical nurses. This study concentrated on practical nurses who work in atypical areas of medical care (for example at school and day care), homecare and social care and were members of The Finnish Union of Practical Nurses. Survey was made in co-operation by working group on medicines information for healthcare professionals and The Finnish Union of Practical Nurses. The survey was carried out in December 2013 - January 2014 by e-mail. The random sample consisted of 1 000 practical nurses. The material was analyzed using direct distributions, cross tabulation, Kruskal-Wallis -test and Mann-Whitney U-test. Open ended questions were analyzed by qualitative methods. The response rate was 67 (n = 666). The most commonly utilized medicines information among practical nurses were package leaflets (PL) and medical database Terveysportti. Those sources were also the most preferred ones. Practical nurses reported they would like to have additional medicines information about drug-drug interactions (86 %) and adverse effects (63 %). Information was also needed about generic drugs. The majority of practical nurses in this study were satisfied with current medicines information sources. Additional information about pharmacological treatment was needed by respondents, 14 % daily and 31 % weekly. 82 % of respondents would benefit from pharmacy's services in their work. 64 % of practical nurses had always or usually and 28 % had never mobile device for information seeking. 73 % of practical nurses took part in education concerning pharmacological care less than once in one to two years. Package leaflets and Terveysportti were the most commonly utilized and preferred medicines information sources. There is still need for detailed information about practical nurses' medicines information sources in various working environments.
  • Järvinen, Nina (2016)
    Breast cancer is the most common cancer among women, about 25 % of all cancers in women. 15 - 20 % of them are HER2 positive. HER2 is a transmembrane protein receptor with tyrosine kinase activity. When the overexpressed receptor is activated it turns on a cascade which results to activation of genes coding for for the growth of the cancer cells. Drugs against HER2 protein have significantly improved the survival of patients with HER2 positive breast cancer. In this systematic review the epidemiology, diagnostics and the principles of treatment is reviewed with focus on the treatment of HER2 positive breast cancer and anti-HER2 medications. Endpoints of clinical trials and handling the data are also reviewed. The aim of this study is to collect data of lapatinib, pertuzumab and trastuzumab emtansine in randomized clinical trials studying progression free survival, overall survival and adverse effects of patients with metastatic HER2 positive breast cancer. As a result of the literature search 22 whole text articles were found. There were 14 of randomized clinical trials, 2 of previous systematic reviews and 6 of meta-analysis. The facts and results of the selected studies were collected in tables. The quality of the studies was evaluated with CONSORT and PRISMA guidance. Lapaninib is used mainly for treatment of patients with resistanse to trastuzumab. Lapatinib improves the progression free survival and overall survival but the effect has not been as goog as expected. Lapatinib is better than chemotherapy but worse than trastuzumab in the treatment of metastatic HER2 positive breast cancer. Combinaition therapy is better than none of these alone. Lapatinib is a small molecule tyrosine kinase inhibitor. Pertuzumab and trastuzumab emtansine are monoclonal antibodies targeting HER2 receptor. In trastuzumab emtansine there is also a cytotoxic drug which is delivered into the cancer cell. Pertuzumab is effective in the treatment of metastatic HER2 positive breast cancer and it improves the survival also after treatment with trastuzumab. Pertuzumab is now approved also as neoadjuvant. Promising results has been published with trastuzmab emtansine in the treatment of heavily medicated patients with progressive disease. Adverse effects were abundant but usually manageable and reversible. The quality of the studies was mainly good. Some limitations were noticed, especially in reporting methods. Cancer therapy with targeted medication improves the effect of the treatment and decrease systemic adverse effects. It seems that the use of lapatinib is going to be mostly complementary when more promising pertuzumab and trastuzumab emtansine turned up to be more effective in the treatment of metastatic HER2 positive breast cancer. In the future there should be more clinical experience with the use of lapatinib, pertuzumab and trastuzumab emtansine. That would guarantee a cancer patient the most effective treatment, hopefully at the early stage of cancer.
  • Kallio, Varpu (2014)
    The purpose of this study is to evaluate patients' quality of life and healthcare use before and after bariatric surgery and produce new, clinical data-based information on the cost-effectiveness of bariatric surgery. Healthcare resources are limited and expenditures have grown from year to year. Therefore it is important to make cost-effectiveness evaluations so that financial resources could be allocated properly. The research population consists of patients who have undergone gastric bypass or sleeve gastrectomy in the Hospital District of Helsinki and Uusimaa, during the years 2007-2009. The study population consists of 147 gastric bypass patients and 79 sleeve gastrectomy patients. In this study the decision analytic model, used in the Finohta study "Sairaalloisen lihavuuden leikkaushoito" was updated using actual, up-to-date information. The analysis was done using a decision tree and a Markov model with a time horizon of 10 years. The cost data in this study was based on actual data for the first two years after surgery. A forecast model was used to predict the costs for the years 3-10 after surgery. Patients' quality of life scores were based on real data for the years 1 (the year of operation) to 4. Quality of life scores for the other years were predicted. In the literature review section, international studies on the cost-effectiveness of bariatric surgery and its impacts on drug therapy were evaluated. The studies showed that the use of medicines, which were used to treat obesity-related diseases were lower in the surgery group. However, drugs used to treat vitamin deficiencies, depression and gastrointestinal diseases were higher in the surgery group. Most studies found that surgery is the most cost-effective way to treat morbid obesity. This study confirms the role of the bariatric surgery in the treatment of morbid obesity in Finland. Even though the healthcare costs were increased in the first two years after the operation, the conclusions of the Finohta study didn't change. The bariatric surgery is cheaper and more effective than ordinary treatment and the most cost-effective way to treat morbid obesity. The mean costs were 30 309 € for the gastric bypass, 31 838 € for the sleeve gastectomy and 36 482 € for ordinary treatment. The mean numbers of quality-adjusted life-years were 6.919 for the gastric bypass, 6.920 for the sleeve gastrectomy and 6.661 for ordinary treatment. However, there is demand for more information for the long-term effects, benefits and risks of the surgery. How much the surgery will actually save money, will be hopefully clarified in the long-term follow-up study, which should also include an actual control group.
  • Kallio, Sonja (2014)
    Population is aging. Within aging the morbidity and the use of medicines increase. Polypharmacy and the physiologic changes related to the ageing expose to medication-related problems. This has to be taken into consideration when planning the care of the elderly. Multiprofessional cooperation is seen as a solution to optimize the medicines' use among the aged people. Finnish Medicines Agency (Fimea) has started a network with local multiprofessional health care teams. The aim of the network is to make a national guideline for multiprofessional cooperation and optimizing the medicines' use among the aged people. The objective of the study was to clarify multiprofessional working models to optimize the medicines' use that had been carried out or planned by the teams belonging to the network. The models can work as examples when creating standardized practices to multiprofessional cooperation in Finland. Factors that promote or prevent multiprofessional cooperation and the problems of optimizing the medicines' use were clarified as were the possible solutions to solve them. Factors to strengthen cooperation and its effects were clarified on the basis of experience of the multiprofessional teams. As a material of the study were the interviews (n=15) of health care professionals (n=55) invited to Fimea's multiprofessional network. Fimea had collected the material that consists of group discussions (n=10), pair interviews (n=3) and individual interviews (n=2). The interviews that had been recorded were transcribed and analyzed by using a combine of inductive and deductive content analysis. A theoretical framework in the study was multiprofessional teamwork and networking. According to the interviews, multiprofessional cooperation in optimizing the medicines' use among the aged has been carried out in Finland in both public and private health care. The interviewees think that the most important way to optimize the medicines' use is clear division of tasks and responsibilities. Adding more pharmacists to all over the public health services and fostering the role of the community pharmacies as a part of the health care are seen as solutions. Multiprofessional meetings and education can break barriers between different professionals. The most common problems are the challenges related to economic limitations and to the busy work. There are problems in IT systems and information transfer. At the individual level, the most common problems seem to be in communication and the attitudes. The interviewees' experience is that successful multiprofessional cooperation increases medication safety and improves patients' state. The work of all the professions is faciliatated and burden of the public health service decreases. Lighter medication reviews could be used to find the patients who benefit from the comprehensive medication review. Information transfer and the currency of patients' medication should be secured with functioning IT systems. The results of the study can be utilised when developing multiprofessional practices to optimize the medicines' use. More study is needed to show the profitability of medical reviews, dose dispensing and other services.
  • Sinisalo, Aino (2015)
    End stage renal disease (ESRD) burdens both society and patient trough lower quality of life and the cost of treatment, as well as through lost productivity. In 2012, the incidence of ESRD was 81 patients per one million inhabitants in Finland. Annual number of kidney transplantations range from 150 to 210. The costs of specialized medical care, adherence to medication and health related quality of life (HRQoL) of kidney transplant patients were analyzed in this study. The aim of the study was to provide research to support the improvement of the kidney transplant patients' health care process and future research on the cost-effectiveness of kidney transplantation. In addition, the aim was to produce information to support health care decision making and resource allocation. The study population included 320 patients who had received a kidney transplant in HYKS. Of the included patients, 198 answered the questionnaire and 122 formed a control population of which only cost data was available. The cost data was collected from the HUS Ecomed-database. Medication adherence was measured with the BAASIS- and VAS-instruments and the HRQoL with the generic 15D-instrument. Forty-three per cent of the patients were non-adherent. There was no statistical difference in the adherence of patients with different dialysis modalities. The correct timing of taking the immunosuppressive medication proved to be its biggest challenge. The average quality of life for kidney transplant patients was measured at 0.87. There were no statistically significant differences in the 15D scores between adherent and non-adherent patients or different dialysis modalities. Instead, there were statistically significant differences between dialysis modalities in some of the 15 dimensions. The 15D score was on average lower among patients with a higher MRCI-score or a longer dialysis period prior to transplantation. The average cost for the specialized medical care of the kidney transplant patients was 34 331 euros on the year prior to the transplant, 52 834 euros one year after the transplant and 8 537 and 7 791 euros on the second and third year after the transplant, respectively. Average costs for all three years after the transplantation combined were 68 932 euros. Based on the results of this study, non-adherence to medication proved to be a considerable issue for kidney transplant patients. The HRQoL after a kidney transplantation was moderately high, although lower than in the age standardized general population. Adherence to medication, HRQoL or the dialysis modality were not associated with cost of the specialized medical care after the kidney transplantation and there was no single factor associated with these post transplant costs. The strength of the study is a comprehensive longitudinal analysis of special care costs and the factors associated with them. On the other hand, health related quality of life is only measured once, which is a limitation. The cost analysis would have been more comprehensive if all the health care cost and other direct costs such as travel and time cost as well as indirect costs such the loss of productivity had been included.