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Browsing by study line "Social pharmacy"

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  • Mäkinen, Heljä (2022)
    Municipal case management is an activity that assesses various functional capacity indicators, utilizing the elderly’s state of health and coping in everyday life. The goal of case management is to refer clients to suitable services, such as home care or a doctor's visit. The problems related to drug treatments are only superficially reviewed. The involvement of a pharmacist in the assessment of case management would provide an opportunity to address the problems of pharmacotherapy and to provide adequate support for the implementation of pharmacotherapy. In this thesis, a remote service of a pharmacist was piloted for new clients over the age of 65 living at home as part of case management. Pharmacist reviewed medications remotely using medication risk management checklist LOTTA. The study examined the suitability of the LOTTA for medication reviews and the problems associated with medications of the elderly participating in case management. In addition, the suitability of pharmacovigilance assessments as a remote service as part of a comprehensive assessment of functional capacity and coping with everyday life was examined. The research material was collected at the case management unit of the city of Turku. The study involved 50 volunteer Finnish-speaking customers over the age of 65, for whom were assessed for a case management at Turku's case management unit. In addition to the assessment of normal case management, two pharmacists with comprehensive medication review qualifications reviewed medications using the medication risk management checklist LOTTA. Subjects were interviewed by telephone. If the pharmacist estimates that the subject will benefit from a multi-professional comprehensive medication review, the physician and pharmacist collaborated to conduct a review using a videophone application. Subjects background information, responses, observations made by pharmacists, and actions taken by physicians were recorded on an electronic form and analyzed. The mean age of the study participants (n = 50) was 82 years (range 67–98). Of these, 36 were women (72%) and 14 were men (28%). Most subjects were multidrug-treated (average medication 10.3, range 3–28). Each subject had at least one drug can be used with consideration for use in the elderly, as defined in the Fimea Drug 75 + database (Class C). 30% of subjects did not have a medication list and 34% reported lack of regular medication monitoring. 96% of the subjects had experienced a symptom on the LOTTA list that repeatedly interferes with their lives. The most common of these were problems such as constipation (54%). Pharmacists proposed changes for medication for 96 % of subjects. The most common proposed change was a change in the time of dosing (46%). Pharmacists estimated that 14 (28%) subjects would benefit from a multi-professional comprehensive medication review. In these cases, pharmacists made an average of 8.1 proposed changes for the physician, and the physician made an average of 6.9 changes for each subject. The most common challenges in coping with medication were symptom, which may be due to adverse drug reactions, a lack of follow-up to medication, and the absence of a treating physician. The results suggest that medication should be reviewed during the case management. The LOTTA list made it possible to identify and address the pharmacological problems of the elderly. The participation of a pharmacist in the assessment of the need for a multi-professional service remotely was possible, but it must be further developed. More research is needed on the benefits of multi-professional case management with a larger sample size.
  • Jalonen, Milla (2020)
    There are significant inter-individual differences in the effects of drugs. These differences can be caused by, for example, other diseases, adherence to treatment, or drug-drug interactions. A drug-drug interaction can lead to an increase in the concentration of the active substance in the circulation (pharmacokinetic interactions) or a change in the effect of the drug without changes in plasma concentration (pharmacodynamic interactions). A drug-drug interaction can change the efficacy of a drug or affect the adverse drug reaction profile. The individual’s genetic background, such as diversity in drug-modifying enzymes (polymorphism), also has an effect on the efficacy and the risk for adverse drug reactions of some drugs. A pharmacogenetic test can be used to study how genetic factors affect drug treatments. The aim of this master's thesis was to examine the possibilities of personalized migraine pharmacotherapy from the perspective of pharmacogenomics and drug-drug interactions. Four online drug-drug interaction databases available in Finland were compared. Inxbase is the most widely used interaction database by physicians in Finland and it is also integrated into Finnish pharmacy systems. Other databases used in this study were the international professional database Micromedex as well as Medscape Drug Interaction Checker and Drugs.com Drug Interactions Checker. The latter two are open-access databases available for healthcare professionals and patients. Interaction searches were conducted in the selected databases between acute and prophylactic drugs used for the treatment of migraine (e.g. bisoprolol-sumatriptan). Fourteen acute and 12 prophylactic drugs were selected for this study based on the Current Care Guidelines in Finland (Käypä hoito), and the data were collected in Excel spreadsheets. The first search was completed in December 2019 and the second search in March 2020. In this study, many potential interactions were found between acute and prophylactic drugs used to treat migraine in Finland. For more than half of the drug pairs studied, a potential interaction was found in at least one of the databases. There were significant differences between the interaction databases regarding which interactions the database contains and how the severity of the interactions was classified. Of the interactions found, only 45% were found in all four databases, and each database contained interactions that were not found in the other databases. Even very serious interactions or drug pairs classified as contraindicated were not found to be consistently presented across all four databases. When selecting drug treatment for a migraine patient, potential drug-drug interactions between acute and prophylactic drugs as well as the patient's genetic background should be considered. Individualizing migraine treatment to achieve the best efficacy and to reduce the risk for adverse drug reactions is important because migraine as a disease causes a heavy burden on individuals, healthcare, and society. Pharmacogenetic tests particularly developed to help choosing migraine treatment are not yet available, but tests are available for few other indications in both public and private healthcare. The use of these tests in clinical practice will increase as physicians’ pharmacogenetic knowledge and scientific evidence on pharmacogenetic tests increase. Utilization of pharmacogenetic data requires that test results are stored in electronic health records so that they are available in the future, when changes are made to drug treatment of individuals. More studies are warranted to better understand the clinical impact of pharmacogenomics and drug-drug interactions in migraine care.
  • Muurman, Tuulikki (2021)
    Background: Poor health literacy (HL) is associated to increased hospitalization and decreased seeking for screenings. Shared decision making can increase patient knowledge, decrease anxiety over the care process, improve health outcomes and reduce health care costs. Little is known about factors influencing health literacy and participation in treatment decision making in different population groups. Objectives: To investigate factors predicting HL and participation in the treatment decision making. Methods: A cross-sectional population online survey conducted in Finland in 2019 by Finnish Medicines Agency. Both health literacy and participation in the decision making were assessed by three statements that sum variables were created with score 1-5 (Cronbach’s alpha value 0.584 and 0.810). Age, gender, education, household income and most common chronic diseases were chosen as possible predicting factors. Two-variable Pearson’s chi-squared test was first used to find significant factors followed by logistic regression analysis to take into account several variables. Results: Of all the respondents (n=2104) 76.5% had good HL and 73.4% had willingness to participate in the treatment decision making. In the two-variable test older age (p<0.001), lower education (p<0.001), lower household income (p=0.001), higher number of chronic diseases (p=0.003), having cardiovascular diseases (p=0.003), diabetes (p=0.029) and cancer (p=0.001) predicted poorer health literacy. Male gender (p=0.001), not having chronic diseases (p=0.001), not having a musculoskeletal disorder (p=0.050) or mental health disorders (p<0.001) predicted poorer participation in the treatment decision making. In the logistic regression analysis older age and having cancer predicted poorer health literacy. Male gender and not having mental health disorders predicted less willingness to participate in the decision making. Conclusions: Older age and cancer predicts poorer health literacy and male gender poorer willingness to participate in the decision making. Further research should focus on investigating more in detail the contributing factors to these findings, and how health literacy in elderly and men’s involvement to the decision making could be improved.
  • Valve, Kiia (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.
  • Hahl, Eveliina (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.
  • Puro, Valtteri (2024)
    Syöpäsairaudet tai niiden hoito aiheuttavat potilaille usein huomattavaa fyysistä ja psyykkistä taakkaa. Merkittävien fysiologisten muutosten lisäksi hoidot johtavat usein voimakkaaseen ahdistuneisuuteen, psyykkisiin liitännäissairauksiin ja heikentyneeseen yleiseen elämänlaatuun. Näiden oireiden kasaantuessa ne heikentävät merkittävästi potilaiden elämänlaatua, arjen toimintakyvyn ja henkisen jaksamisen madaltuessa. Syöpäpotilaiden monet subjektiiviset oireet jäävät kuitenkin usein alihoidetuiksi tai hoitavalta taholta tunnistamattomiksi. Hoitoihin tai sairauteen liittyvien oireiden piiloon jääminen saattaa johtaa madaltuneeseen hoitoon sitoutumiseen, korkeampiin kuolleisuuslukuihin ja on terveydenhuollon tuottajan näkökulmasta tehotonta. Rutiininomainen ja spesifisti kohdennettu oireiden seuranta on tärkeää niiden oikea-aikaista ja tehokasta esilletuontia varten ja se on yhdistetty parantuneeseen hoitovasteeseen syöpäpotilailla. Kliinisten tulosten seurannan tueksi hoidon onnistumista voidaan seurata validoiduilla potilaslähtöisillä mittareilla (vointimittarit, PROM ja potilaskokemusmittarit PREM). Niillä voidaan saada oikein käytettynä riippumatonta ja reaaliaikaista tietoa potilaiden kokemasta terveydentilasta. Potilaskeskeisen (arvoperustaisen) terveydenhuollon kehitystyön edistyessä tutkimustieto hoidon vaikuttavuuden mittaamisesta potilaiden itse raportoimien tulosten avulla perinteisten kliinisten mittareiden lisäksi tulee korostumaan. Syöpähoitoja tarvitsevien määrän kasvu ja uusien, kalliiden pienmolekyylisten, biologisten, ja geeniterapiahoitojen markkinoille tuleminen, tuottavat taloudellisen paineen kestäville ja arkikäytössä vaikuttaville ratkaisumalleille hoidon toteutuksen tutkimukselle. Modernien viestintäjärjestelmien käyttö potilaiden raportoimien tulosten esilletuonnissa ja tallentamisessa voi tarjota mahdollisuuden parantaa vaikuttavuuden mittaamisen toteutusta kliinisessä arjessa. Tutkielman yhteistyöorganisaatio Istekki oy pyrkii kehittämään terveysteknologisia ratkaisuja julkisen terveydenhuollon käyttöön. Kartoittavan katsauksen periaatteiden mukaisesti, tutkimalla järjestelmällisesti olemassa olevaa kirjallisuutta selvitettiin, minkälaisia mittareita erilaisissa syöpähoitoja tarjoavissa ympäristöissä on käytetty. Katsauksen aineisto koostui 20 vertaisarvioidusta alkuperäistutkimuksesta, jotka keskittyivät potilaslähtöisten mittareiden käyttöön onkologisessa ympäristössä. Näistä saatiin tarkasteluun 28 erilaista validoitua potilaslähtöistä mittaria. Digitaalisten alustojen käyttö mittareiden käyttöympäristönä korostui kaikissa tutkimuksissa. Oikein käytettynä potilaslähtöiset mittarit edistivät potilaiden ja hoitohenkilökunnan välistä kommunikaatiota, potilastyytyväisyyttä ja mahdollistivat hoidon vaikutusten reaaliaikaisen seurannan potilasnäkökulmasta. Kuitenkin tekniset, kulttuuriset ja organisatoriset esteet, kuten koulutuksen puute, resurssien niukkuus ja tiedon puute (asenteet), ovat haasteita, jotka hidastavat mittareiden käyttöönottoa kliiniseen arkeen. Vointimittareiden tehokas hyödyntäminen edellyttää kattavaa koulutusta, selkeitä käyttöönotto- ja reagointistrategioita, sekä hyvin saatavissa olevaa teknistä tukea niin potilaille, kuin henkilökunnallekin.
  • Huhtanen, Elina (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.
  • Porru, Anna (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.
  • Leinonen, Mira (2024)
    In Finland, an increasing number of older adults who need around-the-clock assistance in their daily activities are taken care of in an intensive service housing unit, i.e., in a nursing home. The care organized in a nursing home also includes the resident's medical treatment and care. Medication safety and medication management processes have been widely studied in healthcare units, but there is a lack of similar research data from social care units. The topic is current because problems have arisen within the medication management process of the nursing homes, to which system-oriented solutions are needed. To develop risk management, additional information is needed on the risk points occurring in the medication management process of nursing homes. The study aimed to produce information on what kind of medication errors can be detected in the practical implementation of medication in a nursing home and in which stages of the medication management process they occur. The study was based on participatory observation data collected in a nursing home. The data was analyzed using quantitative and qualitative content analysis methods. The study’s theoretical framework was James Reason's human error theory and the Swiss cheese model. It was found that medication errors were common in the observed nursing home, as almost every fourth observed situation contained at least one medication error. Medication errors were detected at almost every stage of the medication management process. Storage errors (28 %) and medication administration errors (19 %) were detected more often than other types of errors. Detected storage errors were mostly related to not locking the medicine storage facilities or leaving medicines without monitoring. The most frequent administration error was medication omission. After storage and administration errors, the most commonly detected medication error types were error in cleaning or tidiness (7 %), ordering error (7 %) and error in medication administration checks (6 %). Other types of medication errors represented less than 5 % of the data. Almost a quarter of the errors were found to have happened to the resident, causing a medication safety incident. Actual adverse events could not be identified based on the data. About a fifth of the errors were near misses. Although about half of the errors did not happen directly to the residents, they were identified as medication, client, and patient safety risks. Pharmaceutical information was found to function as a good barrier in the medication management process, as some of the possible adverse events were prevented with the help of medical advice given to nurses. The medication management process of nursing homes could be developed by considering unit-specific risk factors and utilizing pharmaceutical expertise in the implementation of medical treatment. Through observation, it would also be possible to identify contributing factors of medication errors, enabling risk management activities to be targeted at the risk points of the medication management process. The study results offer valuable information about medication errors in nursing homes, which can be used in developing the medication management process.
  • Riihimäki, Viivi (2024)
    Falls are common in older people, some of which result in serious injuries. Falls are a burden on the health care system and preventing them could reduce the burden. Risk factors for falls include impaired vision, certain chronic diseases, female gender, old age, alcohol consumption, foot problems and environmental factors. Certain medications also increase the risk of falls. Drugs affecting the central nervous system and drugs affecting the cardiovascular system are the main drugs that increase the risk of falls, known as fall-risk-increasing drugs (FRIDs). The aim of the thesis was to analyze the medication lists of patients who had fallen or were at risk of falling and who were living at home and were transported by the emergency services to the HUS emergency unit in Jorvi. The aim of the study was to investigate whether the medication lists of patients (n=216) included fall-risk-increasing drugs, potentially inappropriate medication, adverse risks associated with the risk of falling and drug-drug interactions. The study also compared three groups of patients with different fall statuses. Group 1 consisted of patients who had fallen and patients at risk of falling (n=79). Group 2 consisted of patients at risk of falling who had not fallen (n=85). Group 3 included patients who had fallen but were not at risk of falling (n=52). Microsoft Excel and IBM SPSS Statistics were used to analyze the data. In the data 52.3% of patients were on polypharmacy. Patients in group 3 had fewer regular medications than patients in group 1 (p=0.001) and group 2 (p=0.010). Almost half (46.3%) of the patients in the data set had at least one FRID medication in regular use. Group 1 patients had the highest number of FRIDs in use and Group 3 patients the lowest. The most frequently used FRID was furosemide (n=54). According to the Med75+ database, about a quarter of patients (27.3%) and almost half (48.6%) of patients according to the Beers criteria were regularly using potentially inappropriate medication (PIM) in older people. Level D adverse events associated with risk of falls were present in 28.2% (n=62) of patients in the whole dataset when considering regular medication use. Multiple patients were taking risperidone, amitriptyline and tramadol, which belong to FRIDs and PIMs medicine and are associated with D-level adverse risks. In the whole dataset, only a few patients (n=12) were found to have a category D interaction with regular medications. Class C interactions were found in 38.9% of patients. The falls risk assessment performed by emergency medical services was reasonably good at predicting medical risk factors associated with falls. Particular attention should be paid to patients at risk of falling who have not fallen yet. The reduction of medication factors that increase the risk of falls could potentially prevent falls in the future. Once patients at risk of falls have been identified, pharmacists could be used in the emergency department to identify and possibly unwind medication factors that increase the risk of falls in the older people, in collaboration with physicians. The knowledge of pharmacists could also be utilized to review medication risks associated with falls in community pharmacies.
  • Rossi, Vilma (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.
  • Kouvonen, Sonja (2024)
    To develop a closed-loop medication management process, monitoring the effects of medication should be integrated into patient information systems through structured recording methods. Sufficient documentation of medication monitoring is a prerequisite for implementing effective medication management and ensuring good quality, individualized care for patients. Medication management for patients with intellectual disabilities on the autism spectrum can be extremely challenging. The characteristics of intellectual disabilities and autism spectrum disorders, comorbidities, and polypharmacy make medication management and monitoring challenging. This study focused on patients with difficult behavioural symptoms. The study aimed to identify the most important symptoms to monitor in assessing the effects of medication in patients with intellectual disabilities on the autism spectrum. Additionally, it defined the time points from the initiation of medication when the effects should be assessed. The study was conducted as a two-round study using the Delphi consensus method in January-February 2024. The expert panel consisted of 12 experts in intellectual disabilities, autism spectrum disorders or in the field of medicine. Lists of behavioural symptoms, other symptoms, and monitoring time points were compiled for the study based on literature and the expertise of the research group. Experts were presented with a list of symptoms, and in the first round, symptoms that exceeded a consensus threshold of 50% proceeded to the second round. In the second round, experts ranked symptoms based on their importance for monitoring using Likert-scale questions. The data were analysed using quantitative and qualitative methods. Experts considered 9 behavioural symptoms and 22 other symptoms as highly important or important to monitor. The experts identified severe symptoms indicating self-harm or harm to others as the most critical behavioural symptoms to monitor. The most important other monitored symptoms included common comorbidities and symptoms within the patient group or adverse effects of medication. The effects of medication should be evaluated regularly, at least at the 4-week mark after initiating medication and after 3 months evaluations should be conducted at intervals of every 6 months. Monitoring the effects of medication was perceived to pose many challenges, and monitoring is not always carried out at a sufficient level. Many different symptoms should be monitored because patients are individual and present a variety of symptoms. It is essential to have a good understanding of the patient's condition before starting medication to assess the medication's impact on the patient's behaviour or other symptoms. The study highlighted the lack of structured monitoring forms and the need for monitoring tools.
  • Heininen, Susanna (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.
  • Niemi, Matias (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.
  • Hietanen, Jannemarkus (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.
  • Mikkola, Heidi (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.
  • Lias, Noora (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.
  • Lindholm, Tanja (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.
  • Luoma, Elisa (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.
  • Saavalainen, Anu (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.