Browsing by study line "Social pharmacy"

The medication-use process in hospitals includes several risks which can lead to medication errors. Medication errors can be prevented and managed by adding automation and technology solutions to the medication-use process, such as clinical decision support system (CDSS) integrated into electronic medication administration record (eMAR), unit dose drug distribution system (UDDDS), automated dispensing cabinet (ADC) and bar-code medication administration (BCMA). A closed loop medication management process can be created by integrating different methods and technologies seamlessly. It improves medication safety by decreasing human errors and allows the access to the patient’s medication information in real time. The closed loop medication management process is not yet fully in use in any Finnish hospital, but parts of it have already been implemented. Helsinki University Hospital (HUS) wants to improve the closed loop medication management process by piloting the use of unit dose (UD) bags in the medication- use process and to study its effects on medication safety. The aim of the study was to determine the incidence of the medication dispensing errors and procedural errors, the working time of the nurses, and the nurses' opinions on the current drug dispensing model in a hospital ward before the introduction of the unit dose drug distribution system. The study was conducted as a mixed-method study, which utilized an observational method and an online survey. The data were collected at HUS internal medicine inpatient ward by observing the dispensing of morning medicines for ten days and through an electronic survey sent to the ward’s nurses. The overall incidence of dispensing errors in the current drug dispensing process was 40,1 % (553/1379). Of these, 3,2 % (44/1379) were medication dispensing errors, and after the excluding prescribing errors (n=22), the incidence was 1,6 %. These prescription errors were mainly related to prescribing medications outside the hospital's formulary. In addition, the incidence of procedural errors was 37 % (509/1379). Of the procedural errors, 57 % (292/509) were related to the unattached or missing barcodes and 37 % (186/509) to hygiene deficiencies in drug dispensing. On average, nurses spent 4,5 minutes per patient on medication dispensing and patients had 7 morning medications. The results of the survey also revealed problems related to barcodes as well as hygiene deficiencies, which supported the results of the observations. Significant safety risks, such as unattached barcodes, missing barcodes, and deficiencies in hygiene were identified in the current drug dispensing process. The study indicates that system-based risk management approach is not yet fully understood in hospital units. The root cause of procedural errors should be investigated more and review the ward's instructions with staff, to reduce their incidence in the future. At the end of 2021 a unit dose drug distribution model will be piloted in the ward, which may be one possible way to reduce errors related barcodes and hygiene. In addition, to improve the medication safety, physicians should order medications from hospital's formulary, so that generic substitution would no longer need to be made at the distribution stage. It would be useful to include a category of incorrect orders in the future research setups that investigate medication errors in the dispensing phase to identify such potential risk situations.

The price competition of biological medicines induced by biosimilars has started slower than expected in Europe. One of the main reasons has been the differences in physicians’ attitudes toward biosimilars. Switching biological medicines to clinically comparable alternatives is an important way to enhance the cost-effectiveness of using biological medicines. The focus of the conversation has shifted from the general similarity of biosimilars and the originators to whether frequent switching involves additional risks. The purpose of this master’s thesis was to investigate factors influencing physicians’ prescribing of biological medicines. In addition, their perceptions of the automatic substitution of biological medicines in Finland were explored. The study was based on structured personal interviews of rheumatologists and gastroenterologists including specialising physicians who work at HUS Helsinki University Hospital in the Hospital District of Helsinki and Uusimaa (n=48). They had a chance to comment on their responses at any time freely. The interview consisted of four sections: demographics, general attitudes toward biosimilars, factors affecting prescribing biological medicines, and perceptions of the automatic substitution of biological medicines. Study participants had a chance to comment on their structured responses during the interview. The interviews were recorded for further analysis of the comments. The results are based on a descriptive quantitative analysis and an inductive analysis of the comments. The interviewed physicians’ (n=27, response rate 56,3%) attitudes toward biosimilars were highly positive. Most of the physicians (21/27, 78%) also strive to motivate patients to switch biological medicines to clinically comparable but lower-cost options despite the challenges associated with switching, for example the differences in the administration devices. Of the previously determined factors, the ones affecting prescribing biological medicines the most were the willingness to support the price competition between the biological medicines, reimbursement status, and the hospital’s drug formulary when initiating the biological treatment in the hospital. The attitudes toward the automatic substitution of the biological medicines were positive among 13/27 (48 %) physicians. Our study results are in line with the results of earlier studies, but the open responses especially to the automatic substitution of biological medicines might indicate more positive perceptions on the subject among physicians in Finland.

Medication reviews can be used to assess the appropriateness of a patient’s medication and to identify and resolve clinically significant drug-related problems. Medication reviews have been highlighted in several health and medicines policy documents as ways to improve medication safety in older adults. Collaborative practices and their development are key strategies in promoting the coordinated care of patients. Medication reviews have been previously defined from a multi-professional perspective but no definition based on multi-professional consensus has been established. The aim of this study was to harmonize the definition of medication review from a multi-professional perspective to suit various healthcare contexts in Finland. The goal was to create a shared understanding for physicians, nurses, pharmacists, information management professionals for their collaboration in reviewing medications. Furthermore, the aim was to define the tasks and responsibilities of different professional groups in collaborative medication reviews in order to support its implementation. The study was conducted as a 3-round survey using the Delphi method. The Delphi method is a qualitative consensus method based on the views of experts aiming at reaching consensus on the studied subject. The Delphi rounds were conducted as electronic surveys in September-December 2020. Expert panelists assessed the proposed definition of a collaborative medication review and the tasks and responsibilities of health care professionals involved in conducting it. The expert panel consisted of 41 participants: 12 physicians, 13 pharmacists, 10 nurses, and 6 information management professionals. The results of the study were analyzed both quantitatively and qualitatively. Consensus was reached on the definition of medication review from a multi-professional perspective, while no consensus was reached on most of the responsibilities and tasks of different healthcare professionals involved. Most challenging was to define patient groups benefiting from medication reviews and the situations in which medication reviews should be performed. Therefore, further research is needed to define the division of responsibilities between care team members, for example by defining separately the responsibilities and tasks in different healthcare contexts. This is the most comprehensive attempt taken in Finland to define medication review as a concept from a multi-professional perspective. The results of the study imply to the development and harmonizing of medication review practices and standardizing patient data documentation. The expected outcomes relate to enhanced patient and medication safety, improved coordination in medication management with integrated medication reviews.

Family caregiving refers to the organization of home care for an older adult, disabled or sick person with the assistance of a relative or other close person. The number of elderly carers (> 65 years) of all family garegivers is significant. There are challenges concerning family caregiving for the older adults, due to increased age is in connection with decreased physical performance and increased number of medications and polypharmacy. Despite these factors, there has been little research on the medication safety in the family caregiving among older adults. The aim of this Master's thesis was to identify factors influencing the ability of a caregiver to cope with the medication management of the older adults. These factors were divided into subgategories: factors associated a family caregiver, associated a care recipient and system-oriented factors. The research was conducted as a method triangulation, in which the data were collected through two interviews with home visits (n = 21) and related questionnaires. The questionnaire data were quantitatively analyzed by calculating the frequencies and relative frequencies. The transcribed interviews were analyzed by abductive content analysis, combining both deductive and inductive approach. James Reason's theory of human error was used as the theoretical framework. Caregiving families participating in this research were very different compared with each other. Some family caregivers and care recipients were in good physical condition while others were severely disabled. However, the situation of the families was not individually considered when considering appropriate support services for the families. The workload of family caregivers due to the pain and the absence of days off contributed to the difficulty of medication management. The foremost system-oriented challenges in the management of the medications were: 1) difficult for the families to reach the physician and 2) for those families where assisted home care helped the caregiver, the families were not satisfied with its functioning. Due to the poor availability of physicians and the lack of a family physician, there was no one in control of the medication as a whole and there was inadequate monitoring of the medication. In the assisted home care, challenges were caused by the fact that home care visits were conducted over a wide period of time, which created challenges for giving the medications. Carers do not receive sufficient support from the society for the management of the medications. The medication safety of the older adults in the family caregiving is particularly affected by the difficulty of reaching a physician, the inadequacy of support from the assisted home care, the failure to recognize the individuality of caregiving families, and the caregivers’ burden due to pain and lack of days off. Support for caregivers must be at the forefront of society in the future, so that caregivers can cope with heavy nursing care and complicated medications, even without excessive self-activity.

Safety of pharmacotherapies is an essential part of patient safety that promotes and supports rational use of medicines. Safety of pharmacotherapies can be divided into two areas; Drug safety and medication safety. Drug safety refers to the safety of a medicine as a product, such as the pharmacological properties and the quality of the manufacturing process. Medication safety ensures the safety of a drug therapy process preventing patients from harm during the course of using medicines. Significant inconsistencies have been identified in the terminology related to drug and medication safety. Challenges to terminology are posed by varying synonyms, ambiguity or overlap of concepts, and misclassification of events in the scientific literature. The primary objective of this study was to scope recent peer-reviewed literature related to the drug safety and medication safety terminology from the period pf 2010-2022. A secondary objective was to examine the relationship between the concepts as presented in the literature, including overlaps and differences between the terms. The study was conducted as a scoping review by using Scopus and Ovid Medline databases. The literature search covered studies from January 2010 to January 2022. The search was conducted by using the following phrases; "("medication safety" OR "drug safety" OR pharmacovigilance) W/5 (definition* OR terminology*)" in Scopus and "("medication safety" OR "drug safety" OR pharmacovigilance) ADJ/6 (definition* OR terminology*)" in Ovid Medline. The references of the included articles were reviewed for any additional material. The relevant material was selected by two researchers. A total of 71 articles were identified from the databases, of which two articles met the predefined inclusion criteria. In addition, one article was included in the study from outside the actual search. Two of the included articles were based on drug safety terminology whereas one article was based on medication safety terminology. The results revealed that there is still a considerable heterogeneity of the terms in the literature. The literature shows several terms and definitions for the same phenomenon and no noticeable consistency in the terms. It would be important to define what a uniform and systematically used terminology would require and to establish a commonly accepted guidelines for its use.

The Finnish medicine reimbursement system is complex and several different conditions required by the Health Insurance Act (1224/2004) and the Social Insurance Institution of Finland (Kela) must be met in order to receive medicine reimbursement. The understanding of medicine reimbursement criteria from the perspective of medicine users has not been studied in Finland before, and little research has been done on the subject internationally. Medicine user-oriented research on the medicine reimbursement system, both in Finland and internationally, has largely focused on the financial opportunities of medicine users to purchase medicines and their opinions on the fairness of medicine reimbursements. The aim of this study was to obtain information on the understanding of medicine reimbursement criteria and the background factors affecting it, the implementation of price, generic substitution and medicine reimbursement counselling in pharmacies, seeking advice on medicine reimbursement, and the financial difficulties of buying prescription medicines. The material used in this study was from the population survey (n=1650), which examined the activation of price competition for pharmaceutical products and customers' expectations of pharmacy operations. The understanding of medicine reimbursement criteria, the price counselling provided in a pharmacy, the effect of financial challenges on the non-buying of medicines and the use of sources of advice related to the medicine reimbursement were described as frequency distributions. The effect of background factors on the understanding of medicine reimbursement criteria was compared using the chi-square test and logistic regression analysis. About a third (31%) of respondents told that they do not understand the basis on which medicine reimbursement is usually received for prescription medicines, and 13% had unclear why they had not been reimbursed for their prescription medicine in the past year. Especially younger age, low income, low medication use, depression and other mental health problems, lack of long-term illness, and insufficient medicine reimbursement counselling in a pharmacy were found to be associated with poorer understanding of medicine reimbursement. 72% of the participants in the study felt that they usually receive sufficient information about the prices of medicines and 61% about the reimbursement of medicines when buying prescription medicines from a pharmacy. Less than half (47%) of respondents felt that they have usually received sufficient information about how the amount of reimbursement for medicines is determined. Slightly over 70% of respondents said that they are usually told about the cheapest medicine available when buying a prescription medicine and/or are suggested to switch to a cheaper one. About 60% were usually told about the difference between the two interchangeable medicines. 88% of respondents would seek information about medicine reimbursement primarily from a pharmacy or pharmacy´s online services. About 3% of all respondents in the study had not bought a medicine prescribed by a doctor for financial reasons in the last six months. Based on the study, about a third of medicine users have remained unclear regarding medicine reimbursements, and not everyone feels that they have received sufficient counselling and information about medicine prices and medicine reimbursements when buying prescription medicines from a pharmacy. Counselling from a pharmacy was found to be related to understanding of medicine reimbursement criteria. Advise on the pricing, medicine reimbursement and generic substitution should continue to be actively provided to medicine users, so that the counselling meets the requirements of the law and the knowledge of the reimbursement system of medicine users can be improved. Based on the results of this study, counselling should be targeted in particular at younger, low-income and from mental health problems suffering medicine users, as well as those who are less familiar with reimbursement issues, for example due to low morbidity or medicine use.

Lääkkeiden saatavuushäiriöt ovat yleistyneet Suomessa ja muualla maailmassa aiheuttaen lisätyötä ja -kustannuksia lääkealan toimijoille. Saatavuushäiriöt voivat aiheuttaa katkoksia lääkehoitoon tai saatetaan joutua turvautumaan muihin hoitovaihtoehtoihin, mikä voi johtaa potilasturvallisuuden vaarantumiseen. Tämän tutkimuksen tavoitteena oli antaa yleiskuva saatavuushäiriöistä ja saatavuushäiriövalmisteiden ominaispiirteistä Suomessa keväällä 2020. Tutkittaviin ominaispiirteisiin kuuluivat mm. lääkkeen terapiaryhmä, myyntiluvan haltija, häiriön kesto, valmisteen hintaluokka, kuuluminen velvoitevarastoitavien valmisteiden tai Maailman terveysjärjestö WHO:n välttämättömien lääkkeiden luetteloon ja myyntiluvan myöntövuoteen perustuva lääkkeen elinkaarivaihe. Saatavuushäiriövalmisteiden (n=879) tiedot kerättiin myyntiluvan haltijoiden Lääkealan turvallisuus- ja kehittämiskeskus Fimealle kahden kuukauden aikana (14.2.–15.4.2020) toimittamista tai voimassa olevista saatavuushäiriöilmoituksista. Aineistoa täydennettiin hinta- ja korvattavuustiedoilla Kansaneläkelaitoksen lääketietokannasta sekä tiedoilla muista markkinoilla olevista pakkauskoista, vahvuuksista ja vaihtokelpoisista lääkevalmisteista. Aineistosta tehtiin kuvaileva tilastollinen analyysi käyttäen perustunnuslukuja ja -jakaumia. Analyysissä keskityttiin pääasiassa avohoidossa käytettäviin reseptivalmisteisiin (n=654). Ihmislääkkeiden saatavuushäiriöt (n=829) koskivat etenkin sairausvakuutuksesta korvattavia reseptivalmisteita (65 % kaikista saatavuushäiriöistä), ja ne keskittyivät suurten potilasryhmien käyttämiin lääkkeisiin, kuten sydän- ja verisuonisairauksien lääkkeisiin (31 %) ja hermostoon vaikuttaviin lääkeaineisiin (28 %). Avohoidon reseptivalmisteiden häiriöistä yli puolet (53 %) kohdistui rinnakkaisvalmisteisiin. Häiriövalmisteet kuuluivat elinkaarivaiheeltaan vanhempiin ja hintaluokaltaan edullisempiin valmisteisiin. Viidennes valmisteista (19 %) kuului velvoitevarastoitavien tai WHO:n välttämättömien lääkkeiden luetteloon. Rinnakkaisvalmiste löytyi 73 prosentille häiriövalmisteista. Vain kolme prosenttia myyntiluvan haltijoista oli tehnyt ilmoituksen saatavuushäiriöstä Fimealle vaadittua kahta kuukautta ennen myynnin keskeytymistä saatavuushäiriön vuoksi. Tulosten perusteella saatavuushäiriöt Suomessa koskevat samankaltaisia lääkevalmisteita kuin muuallakin maailmassa. Tämän osoitti myös tutkielman kirjallisuusosassa toteutettu kansainvälistä empiiristä saatavuushäiriötutkimusta koskenut systemaattinen kirjallisuushaku. Valtaosaan saatavuushäiriöistä on mahdollista reagoida apteekissa toimittamalla rinnakkaisvalmiste, kun taas osa vaatii yhteydenottoa lääkkeen määränneeseen lääkäriin. Saatavuushäiriötiedon linkittämistä sähköiseen reseptijärjestelmään ja lääkevaihdon laajentamista farmasian ammattilaisille voisi harkita toiminnan kehittämiseksi saatavuushäiriötilanteissa. Covid-19-pandemia on lisännyt kansainvälisiä toimia häiriötilanteiden hoitamiseksi. Tätä varten kehitetään yhteisiä toimintatapoja muun muassa Euroopan unionissa, jossa tavoitteena on luoda kaikki jäsenmaat kattava saatavuushäiriöportaali.

Objectives To investigate distribution and causes of drug shortages in five selected countries with data from public shortage notification registers. Design Statistical retrospective analysis of national drug shortage registers Data Public shortage notification register data from the first nine months of 2020 in Finland, Sweden, Norway, Spain, and the United States, partly combined with national drug registers. Results Altogether 5132 shortage reports from Finland (n=1522), Sweden (n=890), Norway (n=800), Spain (n=814), and the United States (n=1106) published during the first nine months of 2020 were found in the study. More than half (54%) of the active ingredient level shortages (classified by ATC code) found occurred in only one country, and only 1% occurred in all five countries. On a country level, 19-41% of the shortages were found only in a given country. The distribution of shortages by ATC category and drug form was significantly different between countries, especially between the US and European countries. Injectables were found to have an especially high shortage risk in the US, much less so in European countries. On the other hand, some drug classes were in shortage almost exclusively in Europe but not in the US. Conclusions Although drug shortages are a growing global problem, drug shortages are rarely global, but typically occur only in some countries, while other countries have an uninterrupted supply of the same drug. Drug shortages should be seen not just as a problem of manufacturing disruptions, but as a question of equitable and effective distribution of drug supply on an international level. Price differences and other commercial issues could be factors behind variation of shortages found between countries.Considering the limited and probing nature of the study, further research of shortage register data is certainly warranted. International comparative register study is a meaningful and valid method for further understanding in this field.

Johdanto: Terveydenhuollon tietojärjestelmiin potilaista kertyvää tieto on hyvä esimerkki massadatasta. Se muodostuu lukuisista yksittäisistä, irrallisista tapahtumista. Potilastiedon toissijaisella hyödyntämisellä tarkoitetaan tiedon käsittelyä muuta tarkoitusta kuin potilaan terveyden edistämistä ja hoitamista varten. Toisiokäytölle on tyypillistä, että pääasiallisena kiinnostuksen kohteena ei ole yksilötason tiedon hyödyntäminen, vaan isommasta potilasjoukosta saatava summatieto, josta yksilön tunnistetiedot on poistettu. Toisiokäyttö mahdollistaa potilastiedon hyödyntämisen esimerkiksi tieteellisessä tutkimuksessa ja tietojohtamisessa. Tavoite: Tutkimuksessa selvitettiin HUSin tietoaltaasta louhitun aineiston avulla, onko tietoaltaaseen tallennetun aineiston avulla mahdollista tutkia lääkehoidon turvallisuutta ja rationaalisuutta sekä selvittää, millaisessa muodossa tietoaltaan data saadaan käyttöön ja millaisia toimenpiteitä datalle tulee tehdä, jotta sitä voidaan hyödyntää potilastiedon analysoinnissa. Aineisto ja menetelmät: Massadatan hyödyntämistä pilotoitiin rekisteritutkimuksessa, jossa esimerkkinä käytettiin opioideja. Rationaalisen lääkehoidon toteutumisen tutkimiseksi määriteltiin lääkeindikaattorit eli tunnusluvut, jotka oli tarkoitettu opioidien lääkehoidon kokonaiskuvan tarkasteluun. Indikaattoreiden avulla luotiin pohja hakuparametreille ja lausekkeille, joita tietoallashaussa käytettiin. Aineisto louhittiin tietoaltaasta maaliskuussa 2020 ja se muodostui opioideja koskevista lääkemääräysmerkinnöistä, jotka oli kirjattu potilastietojärjestelmään 1.1.2015-31.12.2019. Tulokset: Tietoallashausta saatiin 321 000 potilaan opioidimääräysdataa yhteensä noin 1,73 miljoonaa riviä. Kotiutumisen yhteydessä annetut opioidireseptit rajattiin jatkoanalyysin ulkopuolelle, sillä niitä koskeva tieto ei ollut rakenteisessa muodossa. Sairaalassa annettuja säännöllisiä opioidilääkemääräyksiä koskeva aineisto oli noin 258 000 riviä. Dataa siivottiin, järjesteltiin ja validoitiin data-analyysiä varten. Toimenpiteistä huolimatta data ei soveltunut indikaattorien laskentaan. Johtopäätökset: Tietoallasaineiston käytön mahdollisuudet rationaalisen ja turvallisen lääkehoidon tutkimukseen olivat tämän tutkimuksen perusteella rajalliset. Massadata-aineiston saattaminen tutkimuksellisesti hyödynnettävään muotoon vaatii menetelmän, joka pitää sisällään useita työvaiheita ja niiden kehittäminen vaatii tietoteknistä erityisasiantuntemusta. Vaikka dataa saatiin paljon, yksittäisen potilaan opioidilääkehoidosta ei saatu kokonaiskuvaa, koska merkittävä osa datasta oli rakenteettomassa muodossa. Potilastiedon toissijaisen hyödyntämisen kannalta aineiston rakenteisen osan merkittävimmät käytön esteet liittyivät datan laatuun ja luotettavuuteen. Jotta tietoaltaasta saatava aineisto soveltuisi toisiokäyttöön tai tieteelliseen tutkimukseen, pitää sekä potilastietojärjestelmän merkintä- ja kirjaamistapoja yhtenäistää sekä data tulisi tallentaa tietoaltaaseen yhä rakenteisemmassa muodossa.

Pitkäaikaiset lääkitykset lisääntyvät jatkuvasti kroonisten sairauksien yleistymisen ja väestön ikääntymisen takia. Pitkäaikaisten sairauksien hoidossa lääkehoitojen rationaalisuus korostuu, mutta WHO:n arvioiden mukaan noin puolet lääkkeiden määräämisestä, toimittamisesta, käytöstä ja myynnistä toteutuu epärationaalisesti. Tämä lisää terveydenhuollon ammattilaisten vastuuta lääkehoidon vaikutusten seurannassa ja potilaan hoitoon sitouttamisessa myös reseptien uudistamisessa. Reseptien uudistamiskäytäntöjä on kuitenkin tutkittu vähän niin Suomessa kuin maailmanlaajuisesti. Tässä pro gradu -tutkielmassa tavoitteena oli tarkastella nykyisiä reseptien uudistamiskäytäntöjä perusterveydenhuollon lääkäreiden näkökulmasta. Tavoitteena oli tarkastella, minkälaiset tekijät vaikuttavat lääkäreiden työskentelyyn sekä potilaan lääkehoidon kokonaisuuden hallintaan ja turvallisuuteen reseptien uudistamistilanteissa. Lisäksi kartoitettiin lääkäreiden ratkaisuehdotuksia uudistamiskäytäntöjen kehittämiseksi. Tutkimus toteutettiin laadullisena monimenetelmätutkimuksena Kirkkonummen terveysasemilla. Tutkimuksessa hyödynnettiin triangulaatiota ja tutkimusaineisto koostui reseptien uudistamistilanteiden varjostuksesta sekä kahdesta lääkäreiden ryhmähaastattelusta. Tutkimukseen osallistui yhteensä 12 lääkäriä, joista viisi osallistui varjostusvaiheeseen ja seitsemän haastatteluvaiheeseen. Aineisto kerättiin huhti-heinäkuun 2019 aikana. Tutkimuksen teoreettisena viitekehyksenä oli inhimillisen erehdyksen teoriaan perustuva järjestelmälähtöinen näkökulma. Tutkimusaineisto analysoitiin aineistolähtöisellä sisällönanalyysillä, jossa varjostus- ja haastatteluaineistosta etsittiin tutkimuksen tavoitteiden kannalta merkittäviä ilmaisuja. Reseptien uudistaminen on lääkäreiden näkökulmasta monivaiheinen prosessi. Prosessiin vaikuttivat useat uudistamista helpottavat ja vaikeuttavat järjestelmä-, potilas- ja lääkelähtöiset tekijät. Lääkärit tunnistivat ongelmakohtia uudistamisprosessin jokaisesta vaiheesta. Lääkäreiden mukaan etenkin tietojärjestelmien epäkäytännölliset ominaisuudet ja tekniset ongelmat sekä ajantasaisten lääkitystietojen ja tiedonkulun puutteet olivat uudistamistilanteissa ongelmallisia ja tekivät uudistamisesta työlästä. Myös kiire ja uudistettavien reseptien suuri määrä vaikeuttivat uudistamista. Ongelmien takia lääkärit kokivat, ettei lääkehoitojen seurantaa voitu tehdä uudistamistilanteessa perusteellisesti. Lääkäreiden ehdotuksia uudistamisprosessin kehittämiseen olivat uudistamisen parempi koordinointi, tietojärjestelmien ja tiedonvälityksen kehittäminen sekä moniammatillisen yhteistyön ja potilaan osallistamisen lisääminen.