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Browsing by discipline "Sosiaalifarmasia"

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  • Salminen, Sanna (2011)
    The background of this study is increase in the ageing population and in medication use. Aged-related changes in pharmacodynamics and pharmacokinetics may change medication response in elderly patients and lead to adverse reactions. For elderly people the risk of being hospitalized due to adverse drug reactions is four times higher than for younger people. Many of these problems could be prevented by avoiding the use of certain drugs in the elderly. Several criteria have been developed to assess medication appropriateness in the elderly. The aim of this study was to develop a new Finnish Medication Risk Assessment (MRA) tool to be used by trained nurses to assess the presence of risks related to use of medicines in outpatients aged 65 years and older. A preliminary tool was developed through a comprehensive literature review of tools to indicate appropriateness and risks of elderly medications, and through expert opinions. The tool was then validated by using three-round Delphi-method. Delphi-method is a qualitative consensus method which is based on group judgement of a subject matter. The first and the second Delphi-rounds measured the tool's suitability and the third Delphi-round measured the importance of the items of the tool in estimating risks related to the use of medications of elderly patients. In this study, 33 expert geriatric panelists were approached of whom 11 physicians, three pharmacists MSc (Pharm.) and four nurses agreed to participate. The results from the Delphi-rounds were evaluated both quantitatively and qualitatively. Through the three-round Delphi-method was developed a MRA -tool that contains 19 items. According to the panelists the items of the tool are either important or moderately important. This indicates that the tool is valid to estimating medication risks in use of medications in this population. Further studies are needed to test the tool among nurses and patients. The MRA -tool was primary developed for estimating risks in medication use, but it could also be used for educational purposes. In the future, it is possible to implement safer and more appropriate pharmaceutical treatment for elderly patients by using this Medication Risk Assessment -tool.
  • Niskanen, Anna (2013)
    Polypharmacy and age-related changes in pharmacodynamics and pharmacocinetics may lead to drug-related problems in elderly patients. Accurate medication reconciliation and medication review on admission may help to control drug-related problems and optimize drug therapy in elderly patients. Several models have been developed to reconciliate and review medications at this point of care. A Finnish model can be developed on the basis of the se models. The aim of this study was to develop a tool for medication reconciliation and medication review on admission for ward pharmacists’ use in the Lahti city hospital. The tool was developed with an action research method in cooperation with the multiprofessional study group. A preliminary tool was developed through doctors’ (n = 2), nurses’ (n = 3) and ward pharmacists’ (n = 2) interviews, a literature review and the expertise of the multiprofessional study group. The preliminary tool was piloted twice in the Lahti city hospital. After the first pilot a view changes were made to the too l by the experiences of the ward pharmacists. Doctors (n = 3) who worked at the study ward during the first pilot were interviewed to find out their views on the medication reconciliation and medication review process so that their views could be taken into consideration in the development of the final version of the tool. After second pilot ward Pharmacists (n = 2), researchers (n = 2) and an expert of geriatrics from the study group took part in a group conversation. Through the group conversation and doctors’ interviews was developed the final version of the tool. The developed tool contains sections for patient’s background information, patient interview, medication reconciliation, drug-related problems, proposed medication changes and doctor’s decisions on the proposed changes. Also instructions of the medication reconciliation and medication review process were developed for ward pharmacists. The developed tool will be used in an intervention study in the Lahti city hospital. In the future a new version of the tool could also be developed to be used in other hospitals in Finland to reconciliate and review medications at the time of hospital admission.
  • Wikman, Essi (2019)
    Streptococcus pneumoniae is a bacterium that causes invasive pneumococcal disease (IPD) such as bacteraemia and meningitis, and pneumonia. The prevalence of pneumococcal diseases is high in infants and in ≥65-year-olds. Also, the incidence of pneumococcal disease is higher in medical risk groups compared to the base population. Pneumococcal diseases can be prevented by vaccinations and since 2010 pneumococcal vaccine PCV10 has been in the national vaccination programme for infants in Finland. The aim for this study is to evaluate the cost-effectiveness of pneumococcal vaccinations in national vaccination programme for the 65-year-olds in medical risk groups (diabetes, chronic coronary artery disease, asthma and COPD). Secondary aim is to examine uncertainty factors that are related to economic evaluations of pneumococcal vaccinations in the elderly. Cost-utility analysis was used as the economic evaluation method. It is a method where health gains are measured by quality-adjusted life years (QALYs). Static multicohort model was chosen for the modelling. Some of the used parameters were acquired from the literature and most of the epidemiology and cost parameters were acquired from research reports and articles published by National Institute for Health and Welfare. Analyses were made for both pneumococcal vaccines that are registered for adults (PCV13 and PPV23) and in 2 different scenarios: Finland’s present situation where PCV10 is in the vaccination programme for infants (scenario A), and hypothetical situation where PCV13 would be in the vaccination programme for infants (scenario B). Based on the analysis, when PCV10 was in the vaccination programme for infants (scenario A), vaccinating 65-year-olds in medical risk groups was cost saving intervention in the health care perspective for both vaccines in chronic coronary artery disease and asthma and COPD risk groups. In diabetes risk group the costs per QALY’s gained were 2 100 € in scenario A. When PCV13 was in the vaccination programme for infants (scenario B), costs per QALY’s gained for PCV13 vaccinations were: diabetes 52 400 €, chronic coronary artery disease 35 900 € and asthma and COPD 22 000 €. The uncertainty of results was tested with deterministic and probabilistic sensitive analysis. In scenario B the results were sensitive for the waning of the PCV13 produced immune protection, the price of the vaccine, the proportion of pneumonia caused by S. pneumoniae, the changes in the pneumococcal disease incidences and the effect that pneumonia has for the health related quality of life. The cost-effectiveness of vaccinating 65-year-olds with pneumococcal vaccines was different depending on the risk group and on which pneumococcal vaccine is in the vaccination programme for infants. In addition, there are several uncertainty factors that have an impact on the results of economic evaluation of pneumococcal vaccinations.
  • Aaltonen, Kalle (2010)
    Rheumatoid arthritis is an inflammatory autoimmune disease with prevalence of 0,8 per cent of Finnish people. Rheumatoid arthritis may lead to immobility and premature death. Treatment of Rheumatoid Arthritis includes disease modifying anti-rheumatic drugs and surgery. TNF-blockers are efficacious new drugs, which halt the progression of joint destruction caused by inflammation. The first TNF-blocker to receive permission of the national agency for medicines was Infliximab in 1999. Since then Infliximab has been followed by Etanercept, Adalimumab, Golimumab and Certolizumab. TNF-blockers have been found to be more efficacious than placebo in both clinical trials and register studies. In addition they are considered to be safe enough for clinical use despite the increased risk for tuberculosis and certain cancers. The number of patients annually treated with TNF-blockers in Finland increased threefold between 2004 and 2008. In 2008 the medication costs per patient were 11 669€ for Etanercept and 13 074€ for adalimumab. Systematic literature review is a study, which searches, identifies and combines individual studies. Usually Systematic reviews include a meta-analysis, which uses statistical methods to combine the results of the studies. Meta-analysis aims for increasing power and generalisibility of the studies and reducing the potential bias in individual studies. In order not to introduce bias by itself the systematic review must be done following the methods approved by the scientific community. In addition the process must be documented in detail. Following a predefined search strategy the systematic literature search found 5308 references. After a process involving the evaluation of the patients, intervention, control, outcomes, study design and the risk of bias 27 studies were selected to be included in the systematic review and meta-analysis. Of the included studies, nine had adalimumab, six had etanercept, five had infliximab, four had golimumab and three certolizumab as intervention. TNF-blocker was used either alone or in combination with methotrexate whereas control was either placebo or methotrexate. Altogether, there were 11 533 patients in the intervention group and 9027 in the control group. The results of the meta-analysis indicate reveal that the patients treated with TNF-blockers are twice as likely to reach a 20 % increase on ACR criteria compared to control patients. The likelihood to reach improvements of 50 and 70 % was 3 and 3.5 times higher, respectively. There were no statistically significant differences in efficacy between individual TNFblockers. Increasing the dosage of a TNF-blocker did not increase efficacy. However, combination of TNF-blocker and methotrexate was superior to monotreatment of TNF-blocker without increasing the likelihood of discontinuation of treatment. There were no statistically significant differences between the efficacy of TNF-blocker monotherapy and methotrexate. Adalimumab, infliximab and certolizumab lead more often to treatment discontinuation compared to etanercept and golimumab, which do not differ from control. This systematic review probably found all studies that investigated the efficacy of TNF-blockers in a randomized controlled trial. Study selection and evaluation were based on widely accepted methods. This study has two weaknesses. Firstly, literature search and study selection and evaluation were done only by a single researcher. Secondly, unpublished studies and study results were not actively obtained outside electronic databases.
  • Pakarinen, Tiina (2014)
    Clinical pharmacy is defined as a service which a pharmacist provides for example to a ward or a medical center. In Finland clinical pharmacy (or ward pharmacy) was started in the 1980s but it hasn't expanded widely until at the end of the 2010s. Need for cost-effectiveness research has been under discussion because of increasing health care costs. This kind of research helps to choose the most effective services. Naturally also clinical pharmacy is under effectiveness consideration. A systematic review was conducted considering the cost-effectiveness research of clinical pharmacy. The aim of this review was to find clinical pharmacy interventions which have been proven costeffective. Literature research found 7 articles. Three of these studied pharmacokinetic patient surveillance and in the rest four articles pharmacist worked as a part of multidisciplinary team. In six studies the cost savings were greater than the costs. The other part of this study was about clinical pharmacy in the hospital district of Helsinki and Uusimaa (HUS). Data was collected from Helsinki University Central Hospital (HUCH) wards which had had clinical pharmacy services during the years 2009-2012. Collected data included clinical pharmacy costs and amount of work gained with those costs, drug consumption, drug waste amounts, amounts of drugs returned to HUS-pharmacy and amounts of HaiPro-reports. Collected data was presented as a time series. The costs of clinical pharmacy had followed the trend of other health care costs during 2009-2012. Wards with clinical pharmacy had somewhat larger amount of drug waste than the other wards. Amounts of drugs returned to the pharmacy were greater in the wards with clinical pharmacy. The amount of HaiPro-reports grew by a factor of 15 from 2009 to 2012. Especially amounts of drug administration errors and errors in writing down prescriptions were greater in clinical pharmacy wards. The data in this thesis describes only a small part of clinical pharmacists' work in the HUCH area. Making final conclusions about the cost-effectiveness of clinical pharmacy isn't possible with this data. The systematic review can give ideas to improve clinical pharmacy in HUS in a more cost-effective direction.
  • Korkeamäki, Laura (2013)
    The status of herbal products has changed over time and due to changes in medicines legislation in Finland. The study period starts from 1964, when marketing authorisation procedure became obligatory for medicinal products. In 1994 medicines regulation introduced the term "herbal remedy" and in 2005 the terms "herbal medicinal product" and "traditional herbal medicinal product". In recent years there has been an increasing interest in medicines information regarding children. For example in 2007 a new paediatric medicines regulation was given by the EU. In Finland a new medicines information strategy was published in 2012 by the Finnish Medicines Agency. The aim of this study was to find out how the medicines information of herbal products regarding children has changed over time and changes in legislation. The material of this study were the documents of herbal products under medicines regulation in Finland 1964 - 2012. The information was gathered from summary of product characteristics, package leaflets, labellings and their predecessors. In total there were 195 products of which 189 had relevant documents for this study. The method of this study was content analysis. The information was collected from the documents to data sheets. The analysis was based on the legislative periods. Medicines information has become more accurate during the study period 1964 - 2012. Information was less accurate between years 1988 and 1995. The amount of medicines information has increased after the term "herbal remedy" and terms "herbal medicinal product" and "traditional herbal medicinal product" were introduced. Some of the changes in medicines information could be tracked to specific regulatory changes. The study gives historical perspective on the changes in medicines information of herbal products in Finland. It is clear that the legislative changes have limited effect on medicines information, if the amount of paediatric scientific studies is not increased. In the future there is a need to study the prevalence of the use of herbal medicinal products and traditional herbal medicinal products in children and in other population groups. There is also a need to study how the medicine information differs in herbal medicinal products and traditional herbal medicinal products and what are the differences compared to the information on dietary supplements.
  • Niittynen, Ilona (2018)
    Medication-related events are a significant cause of in-hospital adverse events. Intravenous medication errors occur more frequently and are more likely to result in serious harm than other medication therapies. Closed loop medication management which seamlessly integrates automated and intelligent systems barriers, is used for reducing medication errors. The aim of this systematic review was to identify what kind of scientific studies exist regarding closed loop medication in intravenous medication therapy and barriers related to it. This study is part of a larger systematic review. The literature search indentified 2292 scientific papers. Of these, only 57 were included in the larger review since most of the references were excluded based on titles, abstracts or full-texts. Of these, 21 studies regarding closed loop medication management in intravenous medication therapy were included in this thesis. The studies conserned intelligent infusion devices, computerized physician order entries, clinical decision support systems, automated workflow management systems reducing compounding errors and bar-code confirmation of drugs and patients. According to this review, closed loop medication management potentially reduces medication errors related to intravenous medication therapy. It seems to be more effective to seamlessly integrate the closed loop medication management barriers to each other and to the medication management process than to implement the barriers separately. It’s important to plan the implementation carefully by a multidisciplinary team. In addition, the latest care guidelines need to be taken in to account. Significant resources must be allocated to training and engaging employees and to systematically maintaining and developing the process to manage the successful implementation of the process. This review provides valuable information for Finnish hospitals implementing the closed loop medication management since the concept is not yet well-known in Finland.
  • 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.
  • Nurmi, Tuomas (2020)
    Automated dispensing cabinets can improve patient safety by reducing medication errors, and consequently, the incidence of adverse drug events, as well as reduce the number of outdated drugs and the size of ward inventory. They can reduce the amount of time nurses and other staff spend on distribution and ordering of medicines, and time spent on taking inventory. In conjunction with an electronic narcotics registry, they may significantly reduce the time needed for filling, checking and correcting narcotics registry forms. This study evaluated the impact of automated dispensing cabinets on the amount of time nurses spend on selecting and picking doses for patients, as well as its effect on the size of ward inventory and wastage of drugs. The amount of time nurses, pharmacists, and technical staff spent on narcotics registry related activities in the hospital ward and hospital pharmacy was also measured. No evidence was found to support the conclusion that automated dispensing cabinets speed up selection and picking of doses, and they may in fact slow it down. With current number of narcotics distributed in the hospital annually, the overall time taken by narcotics registry activities can be 10.9 full time equivalents. Most of this time, roughly 8.7 FTE, consists of nurses filling narcotics registry forms while administering drugs, though only a tiny proportion of each nurses’ time is spent on this activity. On average, it the cost of labor needed to fill one form is 9.3 €. An electronic narcotics registry in combination with and ADC could reduce this down to 0.36 € - 1.16 € per narcotics package by removing the need to fill redundant information in different registries.
  • 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.
  • Karasti, Eveliina (2019)
    The amount of informal caregiving has increased in Finland, with a growing emphasis on the older adults. Although the medication management process in informal caregiving has been studied and is known to have significant risks, research data focusing on the older adults is still limited. The aim of this study was to describe the medication management process of informal carers and care recipients of at least 65 years old. The aim was to identify medication errors and medication risks in the medication management process and to find out how the caregivers manage them. In addition, the study examined the informal carers and care recipients own development proposals to improve medication management process. A total of 21 volunteer informal carers and care recipients living in the Helsinki metropolitan area were recruited to this study. The study was conducted as a qualitative interview survey in the homes of the participants. The interviews were a combination of semi-structured interviews and narrative approach. The material to this study was collected during spring and summer 2018. The study was analysed with abductive content analysis combining both deductive and inductive approach. The aim was to find repetitive elements by encoding and grouping expressions. The results of this study were compared with previous theory and the results were supplemented with a picture of the medication management process and a fishbone diagram was drawn from the risk factors and contributing factors of the medication management process. The families had medication errors in all stages of the medication management process. The most frequent medication errors were found in counselling, medication administration and in medication treatment monitoring. As a contributing factor, the healthcare professionals’ haste and the responsibility of the caregiver recurred in the background of the medication errors. Family caregivers and care recipients wish to have more counselling, more monitoring of medication and better interaction with health care. Carers often felt left alone to take care of another person's medications and felt they lack support from healthcare. By facilitating access to a physician, improving the availability of a physician, increasing the amount of counseling and support provided by healthcare, including pharmacies, could the safety of medication management at home be improved.
  • 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.
  • Tikkanen, Johanna (2020)
    Between 5% and 57% of patients experience an adverse drug event during their hospitalization. Reducing medication errors can help prevent adverse drug events. A particular risk for medication errors arises when a patient moves between home and care centers if accurate medication information is not transferred with the patient. Medication reconciliation is a process to ensure accurate and comprehensive medication information across transitions of care. The aim of the study was to find out how many and what kind of discrepancies can be detected by performing medication reconciliation in a primary care unit. In addition, pharmacists and nurses experiences of the medication reconciliation process and the medication reconciliation form were examined. Both quantitative and qualitative data were used in the study. Quantitative study data consisted of all Medication reconciliation forms (PASQ) completed in January-June 2014. Data were analyzed using quantitative descriptive methods. The qualitative research material consisted of six individual interviews conducted in June 2014. The material was subjected to inductive thematic content analysis. Patients (n = 117) had a mean age of 81 years and almost all (n = 105) had at least six regularly used medications after medications were reconciled. Almost every patient (n = 115, 98.3%) had at least one discrepancy in their medication compared to the patient information system. On average, patients had seven discrepancies in their medication lists. The most discrepancies were associated with psycholeptics (9.5% of all discrepncies). The most common types of discrepancies were new drug (45.4% of all discrepancies) and discontinued drug (19.6%). Nurses and pharmacists saw the medication reconciliation process as an important part of successful patient care. Challenges associated with reconciling medications were caused by lack of time, the fragmentation of information systems and the health status of patients (information given by patients could not be trusted). Only one-third of the patients were interviewed, although international publications on medication reconciliation strongly emphasize patient involvement. The results of this study are in line with previous research and confirm the view that medication reconciliation should always be done across all transitions in care. The role of the patient as part of the medication reconciliation process should be further emphasized in the future, as only interviewing the patient can provide a true picture of the patient's medication.
  • 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.