Browsing by study line "Sosiaalifarmasia"
Now showing items 21-40 of 68
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(2021)Background and objectives: Pharmaceutical services provided by community pharmacies have the potential to improve medication safety and support the implementation of rational pharmacotherapy. The pharmaceutical services are internationally an underused resource to support functioning of social and health care services. The literature review of this Master’s thesis provides an overview of pharmaceutical services, - their funding and remuneration. The primary objective of the empirical study was to create an overview of the development of the pharmaceutical services in Finnish community pharmacies in 2010-2020. The secondary objective was to study differences in the service provision between Finnish provinces. Materials and methods: The study was carried out as a retrospective descriptive survey study annually conducted by the Association of Finnish Pharmacies. Åland was excluded from the provincial review so that individual pharmacies could not be identified. The data was analyzed using Microsoft Excel. The number of pharmacies providing pharmaceutical services annually and the annual number of customers using these services were counted at the national level. At the provincial level, the corresponding data for the prescribing review, medication review, comprehensive medication review and assessment of inhalation technique were analyzed for the years 2017-2020. Results and conclusions: The most common service with the highest number of customers was automated dose dispensing. The second most common service was prescription review. As a whole, the provision of services and the number of customers had increased during the study period in Finnish community pharmacies. Manual dose dispensing was a diminishing service. Differences were found between provinces in the prevalence of services and in the number of customers. It was possible to identify provinces with lower service provision activity, such as Lapland. The service provision prevalence and number of customers varied widely within provinces. The number of customers for a certain service in an individual pharmacy had a large effect on the provincial average, thus, the average number of customers in the provinces does not reflect the provinces' success in implementation of services. Pharmaceutical services, with the exception of the automated dose dispensing, are not well implemented.
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(2023)Introduction: European legislation on orphan medicinal products, Regulation (EC) No. 141/2000 of the European Parliament and of the Council, entered into force in April 2000. Although the prevalence of rare diseases is low according to legislation (less than 5/10,000), 18–30 million people in the European Union (EU) are affected by rare diseases. The introduction of orphan medicine legislation has increased the number of orphan medicines developed but the fairness of the legislation has also raised concern and criticism. The literature review of this Master ́s thesis provides an overview of rare diseases, orphan medicines and EU orphan medicine legislation. The aim of the empirical study was to investigate the evolution of orphan medicine selection during European legislation on orphan medicinal products in 2000–2022. In more detail, aims were to describe the evolution of orphan medicine selection, the approved indications for orphan medicines and the number of orphan medicines approved for children. Methods: The research material was orphan medicines that received a marketing authorisation during the EU orphan drug legislation. This material was collected from the European Commission's Community Register of orphan medicinal products and the European Commission's Community Register of not active orphan medicinal products. Qualitative document analysis was used as the research method, where information on orphan medicines were quantified. Results and conclusions: In the 10-year review of orphan medicine development, the number of new orphan medicine products approved for the market doubled, being 63 products between 2001 and 2010 and 127 products between 2011 and 2020. In the latter 10-year period of the review, the focus of approved indications for orphan medicines shifted slightly from orphan medicines developed for the treatment of cancers (36%) to orphan medicines developed for the treatment of inborn errors of metabolism or immune disorders (43%). In the 10-year reviews, the relative share of orphan medicines approved for children decreased from 55 percent in 2001– 2010 to 40 percent in 2011–2020. Based on the results of the study, the fairness and targeting of the benefits of the orphan medicine legislation should be further investigated. Orphan medicine legislation should encourage the development of medicines for rare diseases for which there is no treatment at all, and for the population most affected, in other words children.
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(2023)Nonadherence has been a challenge in health care since ancient times, and it is still a major source of poor therapeutic outcomes today. Various theories and theoretical models have been applied to explain adherence. So far no single theory or theoretical model has proved comprehensive, and the effects of various interventions applied have been limited. Theorizing of adherence is still incomplete. The aim of this study was to review the theoretical background of adherence so far, and to find the commonalities in theories and theoretical models, but also to discover possible trends in them. Study material comprised 20 theories and theoretical models. Material was found in reference books and documents with an aspect of adherence. Inclusion criteria involved adult outpatients with chronic diseases, excluding any special groups such as pregnant women. Emphasis was on the relevance of the theory, but comprehensive time span as well as various theory views were also considered. A chronological order was created. A qualitative content analysis was conducted, where phrases describing essential theory contents were categorised into distinctive classes. The incidence of classes and the possible trends of the incidence were analysed. Five classes emerged as commonalities in majority of the theories: Patient factors; sociocultural factors; motivation; phrases that referred to a behavioral view; and cognitive processes. Factors that diminished towards this day were the pivotality of cognitive processes in theory, and the subjective view of the health threat. Several factors were found to increase towards present-day theories and models: phrases that described the individual’s agency, such as self-efficacy or empowerment, concrete expressions of the individual’s abilities, skills and actual opportunity to the desired behavior, phrases that consisted of behavior being a function of its context or environment, and phrases where multifaceted intervention or tailoring the intervention according to the change process phase were considered. The commonalities found in the material reflect its emphasis on psychological behavior theories. The changes reflect the shift in how the patient’s agency is viewed in a patient care relationship. Newer theories also amplify the importance of viewing health behavior change as a series of phases. To achieve patient-centered care, these aspects create an increasing demand to health care professionals’ proficiency in how they encounter their patients. Moreover, there is an important signal for future intervention development in the form of a shift into multifaceted interventions and a system approach. Furthermore, a trend exists from using more general and abstract theories to a more concrete and applied approach. In the future, it is probably more fruitful to pursue knowledge-based and validated models and guidelines that are applicable to practice instead of aiming at developing a comprehensive universal theoretical approach.
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(2020)Medication-related errors have been identified as the single most important risk factor for patient safety across the world. According to previous research, medication errors are common in nursing homes. However, the existing data on medication errors in Finnish nursing homes is scarce, although the challenges and defects in nursing home care services, including drug treatments, are well known. Furthermore, nursing home residents are typically characterized by old age, multimorbidity and polypharmacy. Therefore, they are particularly vulnerable to potential adverse events caused by medication errors. The aim of this study was to investigate the rates and causes of medication errors reported in nursing homes and evaluate their impact on medication safety. Additionally, the proportions of potentially inappropriate medication (PIMs) and high-risk medication involved in the medication errors were determined. The data of the study consisted of 251 medication errors reports that were submitted to the safety incident report system (HaiPro) in nursing homes located in Central Uusimaa healthcare and social welfare joint municipal authority (Keusote) in 2019. Quantitative analysis of the data provided an overview of the medication errors that had occurred in nursing homes and the medicines most commonly involved in them. Content analysis and simplified root cause analysis enabled to study more in-depth the contributing factors of medication errors and potential risks associated with the medication process in nursing homes, as well as the possibilities of preventing similar errors in the future. James Reason's human error theory and in particular its system perspective was applied as a theoretical framework in this study. Medication errors were reported regularly in nursing homes during the follow-up period of the study. The most frequent medication error type was administration error. The majority of these errors were medication omissions, followed by the wrong time of administration and administration to the wrong patient. The most common drug classes causing medication errors were antithrombotics, opioids, antidementia drugs, diuretics, antipsychotics, antidiabetics, and antidepressants. Nearly a quarter of the reported medicines were high-risk medications, most commonly opioids, antithrombotics, or antidiabetic drugs. PIMs accounted for approximately 13% of all medications in the data. Errors were most often caused by unsafe medication practices, communication problems, and deficiencies in the work environment such as excessive workload or time pressure. A significant part of the medication errors were related to transdermal medication patches. The study also showed that the quality of medication error reporting in nursing homes is in part insufficient and should be improved so that the reports can be better used for learning purposes. The results of the study provide valuable additional information on medication errors in Finnish nursing homes and their contributing factors. The information can be used to improve medication safety practices in nursing homes. Safe and uninterrupted medication use process is a goal that should be pursued not only in health care but also in social welfare services such as nursing homes.
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(2020)Background: Inhaled therapy is the most widely used treatment for asthma and chronic obstructive pulmonary disease (COPD). Inhaled medicinal product has several advantages, including high local drug concentration in the lungs and reduced systemic adverse effects. However, the challenge with inhaled therapy is that many asthma and COPD patients do not know how to use their inhaler properly. Suboptimal inhaler use can lead to poor clinical control. The Association of Finnish Pharmacies has developed inhalation technique assessment service (ITAS) to detect and correct patients’ inhalation technique and to give information regarding the inhaler and inhaled therapy, such as drug storage and oral care. Objective: The aim of the study is to investigate whether asthma and COPD patients’ ability to prepare the Respimat inhaler and the patients’ ability to properly inhale the drug improve after receiving ITAS. The second objective is to find out what patients and pharmacists think about the service and which customer groups benefit the most from the service. Methods: The study design is an uncontrolled pre-post intervention. 33 pharmacies participated in the study. All patients who were buying a prescribed Respimat inhaler, were offered to participate in the study. Patients’ inhalation technique was assessed before (baseline) and immediately after ITAS (follow up 1). In addition, the inhalation technique was assessed the next time the patient came to pharmacy to buy Respimat inhaler (follow-up 2). Questionnaires were used to assess patients’ and pharmacists’ perceptions of ITAS. Results: 228 baseline and follow-up ITAS were performed. The results of follow-up 2 will be published later in a separate article. 14 % of the patients performed all the steps (both inhaler preparation before first inhalation and inhalation process itself) correctly at baseline. After ITAS the number increased to 77 %. At baseline 30 % of the patients had an optimal inhalation technique (all inhalation steps correct) and after ITAS the number increased to 85 %. 70 % of the patients had an acceptable technique (all critical steps correct) before and 93 % after ITAS. Both patients and pharmacists felt that the service was beneficial to the patients when thinking the proper inhaler preparation and proper inhalation technique. Overall patients’ and pharmacists’ satisfaction were high towards ITAS. Our study indicates that patients benefit from ITAS regardless of patient’s age or how long the patient have been using the Respimat inhaler. Conclusions: A pharmacist-led inhalation technique assessment service significantly improves asthma and COPD patients’ inhalation technique with Respimat inhaler. ITAS should be performed regularly as part of the delivery of the inhaled drug to the patient. Further research is needed on the effectiveness of ITAS with other inhalers.
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(2022)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.
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(2021)Yhteiskunnan digitalisaatio on lisännyt verkkopalveluiden käyttöä monilla aloilla, ja suurin osa suomalaisista käyttää internetiä esimerkiksi palveluiden tai tuotteiden hankintaan. Erilaisten digitaalisten terveyspalveluiden käyttö on kasvanut viime vuosina, ja koronapandemia on nopeuttanut muutosta. Suomessa useat apteekit ovat perustaneet viime vuosina verkkopalveluita, mutta niiden käyttö on ollut edelleen vähäistä. Tämän tutkimuksen tavoitteena oli tutkia koronapandemian vaikutuksia Yliopiston Apteekin (YA) verkkopalvelun käyttöön. Tutkimuksessa tutkittiin rekisteriaineistojen perusteella kokonais- ja reseptiasiakasmäärän sekä reseptimäärän ja asiakasprofiilin muutosta ennen koronapandemiaa ja sen aikana vuosina 2018-2020. Lisäksi tutkittiin YA:n Lääkeneuvonta- ja asiakaspalveluyksikön (Tiepa) vastaanottamien puhelin- ja chat-yhteydenottojen määrää ja sisältöä sekä kyselyaineiston perusteella apteekin verkkopalvelun käyttäjien näkemyksiä koronapandemian vaikutuksista heidän apteekin verkkopalvelun käyttöön. Monimenetelmätutkimuksessa tutkittiin apteekin verkkopalvelussa tapahtunutta muutosta apteekin asiakas- ja myyntitietojen sekä asiakaskyselyn avulla. Tutkimuksessa hyödynnettiin YA:n myynti-, asiakas-, Tiepa- ja pikanoutorekisteriaineistoja sekä YA:n toteuttaman ’’Verkkoapteekki 2020’’ -kyselytutkimuksen aineistoa. Aineistot analysoitiin kvantitatiivisesti Microsoft Excel (16.0) ja IBM SPSS (26) ja R (4.0.3) tilasto-ohjelmistoilla. Myyntiä tai asiakasmääriä mittaavia aineistoja analysoitiin indeksin pisteluvuilla. Kokonais- ja reseptiasiakasmäärälle sekä reseptiasiakkaille keskimäärin toimitettujen reseptien lukumäärälle laskettiin myös tilastollinen merkitsevyys lineaarisella regressioanalyysillä 95 % luottamusvälein. Kyselytutkimuksen lopputulosmuuttujista tehtiin kuvaileva tilastoanalyysi frekvenssijakaumien ja prosenttiosuuksien avulla. YA:n verkkopalvelun käyttö lisääntyi merkittävästi tarkastelujaksolla 2018 – 2020. Kokonais- ja reseptiasiakasmäärän muutokset koronapandemian aikana olivat tilastollisesti merkitseviä. Pandemian vaikutus verkkopalvelussa vastasi pandemiaa edeltävän lineaarisen kehityksen perusteella kokonaisasiakasmäärässä 6 kuukauden ja reseptiasiakasmäärässä yli 3 vuoden kehitystä. Apteekin verkkopalvelun käyttö ja tiettyjen koronasairauden hoitoon median mukaan soveltuvien valmisteiden myynnit lisääntyivät merkittävästi kevään 2020 aikana. Tiepan chat-palvelua käytettiin paljon terveyteen ja hyvinvointiin liittyvien kysymysten selvittämiseen. Koronapandemia lisäsi erityisesti iäkkäämpien asiakkaiden (yli 55- ja erityisesti yli 65-vuotiaiden) apteekin verkkopalvelun käyttöä. Infektioriskin vähentäminen oli tärkeä syy apteekin verkkopalvelun käyttöön. Vuoden 2020 aikana apteekin verkkopalvelussa tapahtui digiloikka. Koronapandemia lisäsi merkittävästi ja tilastollisesti merkitsevästi apteekin verkkopalvelun käyttöä ja toi sen uusiksi käyttäjiksi myös iäkkäämpiä asiakkaita. Erityisesti reseptilääkkeiden hankinta apteekin verkkopalvelusta lisääntyi. Tiepa oli tärkeä tietolähde ennen koronapandemiaa ja sen aikana. Pandemia-aikana luotettavan lääkeinformaation tarve korostuu. Jatkotutkimuksissa on tärkeä tutkia apteekin verkkopalvelun käytön ja asiakasryhmien muutoksia sekä asiakkaiden kokemuksia verkkopalvelusta osana YA:n monikanavaista apteekkipalvelua.
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(2019)The Finnish Medicines Agency, Fimea, is the authority responsible for supervision pharmacies in Finland. Recently, there has been more interest in Fimea to improve its supervision of community pharmacies. For this purpose, a questionnaire was made. Prior to the making of the questionnaire, community pharmacy supervision practices were studied in Nordic countries and in the UK. Additionally, faults found in Finnish community pharmacy inspections in 2016–2018 were classified by analysing anonymized fault lists (n=94) separated from inspection reports. When the most common faults were identified, it was possible to include questions concerning these faults into the questionnaire. A modified version of the Delphi method was used when developing the questionnaire. Comments on the applicability of the questions were given by a panel of experts consisting of inspectors of Fimea. The questionnaire was subsequently edited in accordance with the given comments. Separate versions of the questionnaire form were developed for community pharmacies and for their subsidiary pharmacies. At the end of this study, the questionnaire was sent to seven pharmacies and to three subsidiary pharmacies. After the results of the questionnaire were collected, Fimea gave feedback on the questionnaire. 25 categories were created by classifying faults found from pharmacy inspections. The most common inspection observations were faults in storage condition monitoring (97 % of pharmacies), narcotics (86 %), implementation of code of conduct (86 %), product errors (86 %) and preparation of medicines ready for use (81 %). The questionnaire begins by asking basic information about the pharmacy. Following questions concern the personnel and their further adequacy training. The questionnaire also includes several questions on the code of conduct within the pharmacy. Additionally, there are questions about storage condition monitoring, dispensary and accounting of narcotics. At the end of the questionnaire, there are also a few questions about the European Medicines Verification System (EMVS) which will be implemented by February 2019. Support from the inspectors of Fimea and studying regulations of pharmacies helped identify appropriate questions for the questionnaire. However, the perspective of the questionnaire may be limited due to the questionnaire being developed based up on faults found from inspections. The faults observed from inspections across pharmacies in Finland have been very similar with some of them being also alarmingly common. Because many of the observed faults are relatively easy to fix, simple corrective measures could be implemented to improve the situation across several pharmacies. Thus, usage of questionnaires, such as one made in this study, could be considered a feasible way of improving supervision of pharmacies.
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(2022)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.
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(2021)Pharmacotherapy plays a key role in the treatment of many conditions. Long-term medication therapy is an essential part of treatment in many common chronic conditions in Finland, such as diabetes, asthma, and cardiovascular diseases. However, medication therapy can be burdensome to patients and thus, influence their functional capacity and well-being. Therefore, patients’ lived experience of medication and its effect on their lives has a growing interest as a research area. The primary aim of this study was to test among Finnish patients with chronic conditions the consistency of a theoretical model ‘Patient’s Lived Experience with Medicine’ (PLEM) developed by a qualitative meta-synthesis by Mohammed et al. (2016). The secondary aim was to investigate the medication-related burden experienced by Finnish patients living with different chronic conditions. Based on the results of the content analysis of the focus group discussions, this study aimed to create a new, concise measure of medication-related burden to be utilized in a population-based online survey on medication use in Finland called Medicine Barometer (Lääkebarometri) by the Finnish Medicines Agency Fimea. The study was conducted as a qualitative focus group interview in summer 2020. Participated patients with chronic conditions (n=14) were recruited through four patient organizations. Focus group discussions (n=5) were held in groups of 2-3 people over Zoom. Deductive content analysis guided by PLEM model was used for data analysis. The measure of medication-related burden was formed on the grounds of the original PLEM model, content analysis of the interviews, research literature and expertise of the research group. The results of the focus group discussions (n=5) supported the functionality of the PLEM model. Study participants (n=14) described similar experiences of medication-related burden and beliefs and practices guiding the medication taking to those presented in the PLEM model. Burden caused by medication routines and healthcare system were most emphasized of the factors contributing to medication-related burden. As a new factor contributing to the burden, medication-related eco-anxiety emerged. The new measure for assessing medication-related burden consists of 13 items to be piloted by the Finnish Medicines Agency Fimea in the summer 2021. The experiences of the Finnish patients with chronic conditions are consistent with the PLEM model. Majority of the participants did not experience such burden from their medication that would significantly interfere with their daily lives. However, experiencing higher level of medication-related burden appeared to be related to independently modifying medication regimen or even neglecting the use of medicines. PLEM model and related patient interviews served as a solid foundation for developing items for the new measure to be piloted for assessing medication-related burden. The population-based survey will provide useful data for the further development of the measure and for researching the factors contributing to the burden.
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(2021)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.
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(2021)Medication reviews have been highlighted as one of the most important strategies for improving medication safety and medication management especially in older adults. Current electronic health records document and communicate e-prescriptions but their medication use related patient information content should be extended to cover e.g. medication review documentation. The documentation should be in structured format to be useful in clinical practice and evidence-informed decision-making. The aim of this study was to identify medication review related patient information and other patient data that should be in a structured form in electronic health record systems (EHRs) at a national and organizational level. The aim was also to determine which medication review related patient information should be documented in electronic health record systems. The study was conducted as 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 of the experts on the studied subject. The Delphi rounds were conducted as electronic surveys in September-December 2020. Expert panelists assessed which medication-related patient data and other data generated by healthcare providers should be documented in a structured form in EHRs and in which national digital data system services (Kanta and My Kanta Pages) the medication review related patient information should be accessible and by whom. 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 a total of 108 medication review related patient information topics that should be documented in a structured form in EHRs and that should be available for medication reviews through EHRs. Of the topics, 39 related to medication reviews in general, 25 to adverse drug reaction symptoms, 11 to the burden of adverse drug effects, 12 to laboratory tests and other test results, 12 to medication adherence and 9 to the use of intoxicants. Structuring the data was considered as important or important to some extent in most of the presented medication review related information topics. Especially, the documentation of renal function was rated by the expert panelists as a crucial piece of information to be structured. Medication adherence information and information related to the use of intoxicants were rated as less important to be documented in a structured form than other topics. Consensus was also reached on the accessibility of medication review documentation in the Kanta and My Kanta services. The expert panel of this study had a common and strong view that data related to medication reviews should be structured in EHRs. The expert panel reached a strong consensus that almost all of the data presented in the study should be structured. Based on this Delphi study, the expert panel identified the benefits of structuring and standardized recording. Because not all data can be structured at once, further prioritization of the data identified in this study is still needed. The practical implementation of the structured information could be accomplished in the form of a checklist. The study addresses a very current problem related to the shortcomings of medication information management and overall medication management.
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(2020)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.
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(2022)Medication related risks have been identified as one of the main threats to patient safety, both internationally and nationally. In Finland, implementation of pharmacotherapy in health services system is guided by the Safe pharmacotherapy -guideline. The guideline instructs work units to implement a pharmacotherapy plan, which is a statu-tory quality management document to describe the unit’s pharmacotherapy process and related responsibilities and obligations. However, there is currently limited research data available on pharmacotherapy plans and their impact on medication safety. The aim of this study was to explore the use of pharmacotherapy plans as a tool for promoting medication safety in the Finnish health services system with an emphasis on systems-based risk management. The research was con-ducted as an electronic survey in November-December 2021. The target group of the survey was health care professionals licensed as nurses and pharmacists who are working in wards or clinics or otherwise participate in drawing up or updating of pharmacotherapy plans. The study analyzed 901 responses. Most respondents (90 %) worked as licensed nurses and 10 % as pharmacists. The majority of the respondents’ units (91,5 %, n=824) had a pharmacotherapy plan. Medication safety practices were comprehensively described in pharmacotherapy plans and no significant differences observed between work environments. The multi-professional development processes of pharmacotherapy plans were not complete, only 11,6 % of the units the writing was done in multi-professional collaboration. Medication safety practices were best implemented in university hospitals (m. 3,87, sd. 0,57), with the difference being statistically significant for primary healthcare wards (m. 3,51, sd. 0,63, p<0,001) and social care housing services units (m. 3,63, sd, 0,68, p=0,018). The comprehensiveness of the content in pharmacotherapy plans and the implementation of medication safety practices were correlated (r=0,60, p<0,001). Pharmacotherapy plan is an important tool for systems-based medication safety promotion in the Finnish health services system. There is need for improvement in the multi-professional collaboration when developing the plans and in training the healthcare staff of practices described in the unit’s pharmacotherapy plans. In the future, special emphasis should be placed on the medication safety and development of primary healthcare wards and social care units.
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(2022)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.
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(2023)Rational, or prudent, use of medicines is one of the cornerstones of Finnish politics guiding the public procurement of medicines as a part of the medicines supply. The definition of rational use of medicines, however, takes into account the sustainability aspects of neither the drugs used nor the manufacturers behind them even though, according to One Health way of thinking, there is a connection between the sustainability of medicines and people's health. Motivated by this contradiction, the aim of the research was to map the different dimensions and usability of the corporate social responsibility (CSR) reports of pharmaceutical companies in promoting the sustainable public procurement of medicines. The values guiding the companies' sustainability actions and the impact of the COVID-19 pandemic on the companies were also researched. The materials consisted of CSR reports from years 2019-2020 of seven pharmaceutical companies that participated in public drug procurement in 2019. Two classification systems for sustainability and key performance indicators presented in previous research literature were used as a theoretical basis. Public procurement of medicines was used as a framework through which the research was carried out by using the means of qualitative content analysis. The CSR reports typically discussed the company, the environment, people, stakeholders, ethics and CSR reporting itself. CSR activities completed in the financial year in question consisted mostly of social sustainability. As for the environmental issues, emissions and climate issues played a great role. Governance-related CSR actions were the least reported and usually discussed risk management, research, and ethics. Success and pioneering, robustness and sustainability, and community spirit were recognized as themes uniting the values that guide CSR. As for in promoting sustainable public procurement, information about CSR activities, adoption of principles set by external stakeholders, CSR-related metadata, sustainability rankings, and management of sustainability in the supply chain, among other things, were found potential. The CSR reports of pharmaceutical companies contain comprehensive information about the companies’ operations, response to global trends and the values guiding the CSR activities. The use of CSR reports in public procurement of medicines necessitates further uniformity of CSR reporting practices in the pharmaceutical industry.
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Lääkityslista ja Omakanta lääkehoidon hallintaa tukevina työkaluina pitkäaikaissairaiden omahoidossa (2020)Current national medicines policy in Finland highlights the importance of rational use of medicines leading to effective, good quality, equal and safe medication therapy, in which the key is on well-implemented medication self-management. The aim of this study was to find out how well people with chronic diseases are in control with their own medication therapy. The special focus was on assessing whether people with chronic conditions: 1) are familiar with the therapeutic aim of their medication; 2) have medication lists of their medicines and are those lists up-to-date; and 3) utilize Omakanta-database. The aim was also: 4) to identify which factors are associated with the utilization of medication lists. A nationwide cross-sectional Internet survey was conducted among medicine users in Autumn 2017. The link for the survey was available via the Finnish Medicine Agency’s and Pharmaceutical Information Centre’s website. In addition, members of the national medicines information network forwarded the link through their own channels. Survey respondents with chronic diseases were included in this study (n=844). The majority of the people with chronic diseases (92 %) were aware about the therapeutic aims of their medication. Of the respondents, 39 % had a medication list. Availability of medication list was associated with the age of ≥ 65-years (OR 0.223; CI 0.103-0.485) and the use of multiple medicines (OR 0.218; IC 0.127-0.376). Of the medication lists used by people with chronic disease, 44 % were in the electronic form and the majority (92 %) of all the medication lists used by people with chronic disease were reported to be up-to-date. Omakanta-database was used by 93 % of the respondents. People with chronic disease are well aware of the therapeutic aims of their medication. However, the rarely have up-dated medication lists. Omakanta-database seems to be well known and utilized among people with chronic diseases. Older people using multiple medicines should be encouraged to use and supported with the up-date of their medication lists.
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(2023)Väestön ikääntyessä sairastavuus lisääntyy ja käytettyjen lääkkeiden määrä kasvaa altistaen lääkkeiden haitta- ja yhteisvaikutuksille. Iäkkäiden suuri sairastavuus, monilääkitys ja lääkkeiden aiheuttamat haitat voivat kasaantuessaan huonontaa elämänlaatua ja toimintakykyä. Lääkehoidon arviointien avulla voidaan tunnistaa ja ratkaista monilääkittyjen iäkkäiden lääkitysongelmia. Jos potilaan lääkehoidon kokonaisuutta ei arvioida säännöllisesti, lääkkeitä voidaan määrätä lisää perusteettomasti, mikä voi johtaa lääkkeiden kasautumiseen ja estettävissä olevien haittojen lisääntymiseen. Tämän tutkimuksen aineisto perustuu Lohjan kaupungin kotihoidossa vuosina 2015-2017 toteutettuun interventiotutkimukseen. Tämän tutkimuksen tavoitteena oli analysoida pseudonymisoiduissa lääkehoidon arviointiraporteissa (n=43) tunnistettuja lääkitysongelmia (drug-related problems, DRPs) 65 vuotta täyttäneillä PCNE-luokittelujärjestelmän avulla. Lisäksi tavoitteena oli tarkistaa erilaisten lääkehoidon tietokantojen ja työkalujen avulla olivatko farmasistien muutosehdotukset ja huomiot valideja ja hoitosuositusten mukaisia. Lisäksi tutkittiin, mihin ATC- pääryhmiin ja edelleen lääkeaineisiin muutosehdotukset kohdistuivat sekä miten ne toteutuivat. Muutosehdotuksille ja huomioille (n=167) yleisimmin koodattu PCNE-luokituksen mukainen ongelma (P) oli P2.1 “Lääkkeen haittatapahtuma (mahdollinen)” (65,3 % n=109). Yleisin koodattu syy (C) oli C1.1 “Epätarkoituksenmukainen lääke suhteessa suosituksiin” (34,1 %). Ehdotuksista toteutui seurannassa 37,7 % (n=63), joissa yleisimmät interventiot olivat I3.5 ”Lääkkeen lopetus tai tauotus” (n=27) ja I3.2 ”Annosmuutos” (n=23). Yleisimmin muutosehdotukset ja huomiot kohdistuivat hermostoon vaikuttaviin lääkkeisiin (43,7 %), ruuansulatuselinten sairauksien ja aineenvaihduntasairauksien lääkkeisiin (26,3 %) ja sydän- ja verisuonisairauksien lääkkeisiin (15,0 %). Muutosehdotuksista ja huomioista 37,1 % (n=62) liittyi Fimean Lääke 75+ -tietokannan mukaan iäkkäille varauksin soveltuviin (ns. C-luokka) ja 23,9 % (n=41) iäkkäillä vältettäviin lääkeaineisiin (ns. D-luokka). C-luokan lääkeaineisiin liittyneistä ehdotuksista toteutui 27,4 % ja D-luokan lääkeaineisiin liittyneistä ehdotuksista toteutui 37,5 %. Farmasistin muutosehdotuksista ja huomioista valideja oli 98,2 % (n=164/167). Farmasistien osaamista tulisikin hyödyntää enemmän lääkitysongelmien ratkomisessa, mikä tukisi lääkärien sekä muiden sosiaali- ja terveydenhuollon ammattilaisten työtä.
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(2023)Tausta: Lääkehoitoon liittyvät haittatapahtumat aiheuttavat merkittävää inhimillistä kärsimystä ja taloudellista taakkaa yhteiskunnalle. Lääkitykseen liittyviä haittatapahtumia voidaan ehkäistä tunnistamalla ja puuttumalla lääkitysriskejä aiheuttaviin tekijöihin. Tavoitteet: Tutkimuksen tavoitteena oli tutkia lääkitysriskien hallintakeinoja lääkkeen toimittamisen yhteydessä suomalaisissa avohuollon apteekeissa. Tavoitteena oli selvittää, miten apteekeissa tunnistetaan ja puututaan asiakkaan lääkehoitoon liittyviin ongelmiin ja millaista lääkitysriskien hallintaan liittyvää osaamista ja lisäkoulutustarvetta apteekeissa työskentelevillä farmaseuteilla ja proviisoreilla on. Aineisto ja menetelmät: Tutkimus oli valtakunnallinen poikkileikkaustutkimus, jonka aineisto kerättiin syksyllä 2022 sähköisellä kyselyllä. Alkuperäinen kyselylomake luotiin vuonna 2015 kirjallisuuden ja järjestelmälähtöisen riskien hallinnan teorian pohjalta ja päivitettiin tätä tutkimusta varten. Tulokset: Kyselyyn vastasi 192 apteekkia (n=610). Apteekeissa tunnistettiin ja puututtiin lääkehoito-ongelmiin, mutta toimintatavat olivat harvoin systemaattisia. Yleisin puuttumistapa oli keskustelu asiakkaan kanssa ja kehotus ottaa yhteyttä lääkäriin, näin toimi 78 % apteekeista tilanteessa, joissa asiakkaan lääkitys ei toiminut toivotulla tavalla. Suurimmalla osalla apteekeista ei ollut muun terveydenhuollon kanssa yhteisesti sovittuja toimintatapoja lääkehoito-ongelmien ratkaisemiseksi. Myös apteekin sisäiset toimintaohjeet olivat puutteellisia Johtopäätökset: Apteekkien ja muun terveydenhuollon välinen nopea viestintäkanava ja yhteisesti sovitut toimintatavat voisivat parantaa apteekkien mahdollisuuksia puuttua lääkehoito-ongelmiin. Apteekkien rooli lääkitysriskien hallinnassa tulee määritellä tarkemmin. Apteekkien ja muun terveydenhuollon välisessä yhteistyössä on paljon hyödyntämätöntä potentiaalia.
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(2023)The lack of up-to-date medication information in healthcare electronic information systems, the transfer of medication information with the patient, and the overall management of medication are key challenges in health care. The number of cancer patients in Finland will increase in the future due to the aging of the population, early detection of cancer, improvement in cancer prognosis and the development of cancer treatments. The development creates a need for operating models that improve medication safety. Medication safety of cancer patients can be improved with clinical pharmacy services, such as medication reconciliation and medication review. The aim of this study was to investigate the accuracy of the medication charts and identify the drug related problems and risks related to home medications among patients with newly diagnosed cancer in the Oncologic Outpatient Clinic of Turku University Central Hospital. This was a retrospective register-based study carried out as an operational development project to obtain information about the current operational model of pharmacist-led medication reconciliation and to further develop it. The theoretical starting point for the study was the theory of human error, according to which factors endangering patient safety can be prevented by using system-based safety defences. In the study, almost every (93 %, 69/74) patient's medication information differed from the hospital's information. A total of 392 discrepancies related to medication information and an average of 5,3 discrepancies per patient were observed in the data (range 0-15 discrepancies). High alert medications accounted for 14 % (n=53/392) of all discrepancies. It took an average of 19 minutes per patient to confirm a medication reconciliation (range 5-48 minutes). During medication reconciliation the pharmacist recorded observations for the doctor in 15 (20 %, n=15/74) patients. In the retrospectively performed medication review, a total of 183 possible drug related problems or risks related to patients’ home medications were observed in 31 (84 %, n=31/37) patients. Pharmacist-led medication reconciliation proved to be a fast and effective way to find out the patient's overall medication. In the future, the operating model should be developed to detect drug related problems, and risks related to patients’ home medications. In situations of limited resources, the clinical pharmacy services should be targeted to patients with the highest risk to drug related problems.
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