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  • Virtanen, Anne (2023)
    This qualitative study was carried out as a semi-structured interview study, which was supplemented with quantitative information from centralized cytotoxic preparation units in Finland hospital pharmacies and with information about interviewees. Quantitative information was collected using questionnaires. The proportion of centralized cytotoxic preparation units that responded to the background information questionnaire was 95% (19/20) of all centralized cytotoxic preparation units in mainland Finland. In the autumn of 2022, hospital pharmacy employees (n=23) participating in the reconstitution of cancer drugs were interviewed. On average, the interviewees had 14 years of work experience in the reconstitution of anticancer medicines. They represented 75% (15/20) of the centralized cytotoxic preparation units in mainland Finland, covering centralized cytotoxic preparation units of different sizes and locations in different parts of Finland. In 2021, 88% of the anticancer medicines in all centralized cytotoxic preparation units in Finland were reconstituted at the workplaces of interviewed. According to the interviews, the reconstitution of anticancer medicinal products involves the possibility of an error in several stages of the process. An error can occur when prescribing the medicine, transferring prescription information, when selecting the raw materials, reconstituting of the cancer medicine and during transport. The interviewees identified 24 risks associated with these stages, that could lead to patient safety incidents. Safeguards have been built to avert errors or promote the detection of the errors. Based on the research data, the safeguards were classified into six categories: the development of the technology, guiding work through guidelines, strengthening competence, standardizing practices, controlled working environment and learning from deviations. In Finland, it has not previously been studied or classified with which functions and principles the centralized cytotoxic preparation units have built safeguards to prevent patient safety incidents. This study shows that reconstitution of cancer medicines is a risky process. To improve the quality of reconstituted cancer medicines and patient safety, both the system- and person-focused safeguards have been built into the risk points of the processes of the centralized cytotoxic preparation units, but their utilization varied between centralized cytotoxic preparation units. Based on comprehensive data, the research result can be generalized to centralized cytotoxic preparation units in Finland hospital pharmacies.
  • Repo, Amanda (2022)
    The use of different methods of extended reality (xR) as a support in teaching has been under research for a long time. Although the use of various xR-technologies in other fields of healthcare, such as medical and nursing education, is already common, their use in pharmacy education is not yet well established. There is evidence that xR-technology has a positive impact for example on students’ motivation and learning outcomes. On the other hand, there are limiting factors that inhibit the technology becoming widespread, such as costs as well as a lack of knowledge about the technology usability. The aim of the study was to investigate usability and advantages of the augmented reality (AR) in a laboratory course as an educational supportive tool by using AR-glasses. The aim was also to investigate the learning outcomes of the students who participated in the study in three different phases: before carrying out the laboratory work (pre), immediately after the laboratory work (post) and in the course exam (delayed). Furthermore, the motivation of the students to use new technology in their studies was studied. The research was done in a collaboration with the Centre for University Teaching and Learning (HYPE) and with Sciar Company Oy. The researchers of HYPE were responsible for the pedagogical point of view, whilst the experts from the Faculty of Pharmacy were responsible for the study measurements of laboratory work related content knowledge. The research was implemented in two laboratory courses in Bachelor of Science level pharmacy studies: Medicinal product II and Pharmaceutical biology and asepsis in the fall of 2020. The students (n=18) prepared eye drops by using AR-glasses in the Medicinal product II -course and reference group (n=14) without AR-glasses. In the course of Pharmaceutical biology and asepsis, students (n=7) used AR-glasses to study the microbiological purity of the eye drops by utilizing membrane filtration method in cleanroom and reference group (n=9) without AR-glasses. ln addition, a serial dilution method was performed on a 96-well plate using an AR mobile application. The effect on learning outcomes was evaluated by using six open-ended questions measuring the understanding of content knowledge underlying the laboratory work, that were answered by the students at three different stages of the study (pre, post, delayed). To measure the usability of the AR equipment, a five-point Likert scale questionnaire studied the experimental groups students’ opinions on whether the AR mobile application could provide sufficient guidance and feedback while performing the laboratory work. In an open question, the students had the possibility to comment on the overall user experience of the AR mobile application. There were no statistically significant differences in learning outcomes between the AR-group and the reference group in both laboratory courses. The results showed indicative differences in short-term and long-term learning, with the AR-group achieving better learning outcomes in the short-term and the reference group in the long-term. In the course of Pharmaceutical biology and asepsis, the learning outcomes were the opposite. Students’ were found to be receptivity to the new technology that together with motivation supports positively the learning process. The use of AR-hardware increased certainty and reduced nervousness about the use of AR technology. As a conclusion, the study could not demonstrate the benefit of AR-technology in student learning outcomes. The study was limited by the small sample size. However, further studies are encouraged due to students’ positive attitudes and motivation towards AR technology. Regarding further studies, it is important to take into consideration the different backgrounds and learning methods of students. Thereby, the effects of xR-technologies on learning outcomes can be assessed as objectively as possible.
  • Siltakorpi, Matleena (2021)
    Obesity is a growing health challenge in Finland. Despite the fact, that obesity is recognized as a chronic disease, it remains underdiagnosed and undertreated. In the past few years, two new anti-obesity drugs have entered the market to support the lifestyle changes Anti-obesity medication would be a natural option to support lifestyle changes, but physicians have not widely adopted the medication in their treatment patterns. The aim of this study was to understand, what are the abilities of primary care physician (PCP) to treat obesity, considering their knowledge, resources and, local care pathways. In addition, the study sought to determine the most important factors, that are involved in the initiation of anti-obesity medication. The study was conducted as a semi-structured thematic interview. A total of nine PCPs from all over Finland were interviewed for the study. Of these, three worked on the private sector and six on the public sector. The interviews were conducted during October-November 2020. The framework of the interviews was built based on the previous studies and information within a pharmaceutical company specializing in the treatment of obesity. The content was analysed with inductive content analysis. PCPs interested in the treatment of obesity raised the topic of weight quite easily in various situations and some of them mentioned that they even find it easy to bring up the subject. However, the subject is mainly brought up when the patient already has some weight-related comorbidities. Preventively, weight is less often talked about, especially because of a lack of human and time resources. Currently the most comprehensive care pathways and interdisciplinary teams are in occupational healthcare. In occupational healthcare, resources are perceived as adequate and the interdisciplinary teams works well. In most healthcare centers, a separate care pathway for the treatment of obesity had not been built. In general, knowledge of the obesity treatment was considered adequate, but education on the biological basis of obesity is needed. Most of the PCPs knew about the new anti-obesity drugs and had positive attitude towards them, but they did not prescribe the drugs themselves. The most significant barrier to prescribe the anti-obesity drugs, was the price of the products and the lack of reimbursement. In addition, experience with anti-obesity drugs is limited and the need for education is high. Currently, occupational health physicians have better abilities to treat obesity in terms of care pathways, interdisciplinary teams and, resources than PCPs in public healthcare. The conditions are also better for the implementation of pharmacotherapy as resources and care pathways enables proper lifestyle guidance alongside pharmacotherapy. Prior to reimbursement, pharmacotherapy may not be a realistic option in the public sector, and the conditions for proper lifestyle guidance alongside pharmacotherapy are not sufficient in all locations.
  • 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.
  • Korhonen, Annika (2016)
    Digital technologies have brought new prospects also in pharmaceutical industry and marketing. Communication between different interest groups has become faster and more convenient. There has also been development of new marketing methods utilizing digital technology. E-detailing, mobile applications and social media sites are examples of novel ways to market medicines and disseminate medical information. The aim of this study was to find out how doctors see electronic detailing (e-detailing). The study was carried out by electronic questionnaire, which was answered by 45 Finnish doctors. Doctors who participated in this study had attended e-detailing organized by Pfizer before. Roger's innovation diffusion model was used in drawing up the questions and as theoretical framework of this study. The results of this study showed that doctors regard e-detailing mainly positively and they intend to participate e-detailing also in the future. About one fourth of the doctors, who answered, think that e-detailing is more useful than traditional detailing. In general, doctors do not prefer e-detailing to traditional or group detailing. They also attend e-detailing more seldom than other forms of detailing. In addition, doctors see that e-detailing is more additional value than substitute for traditional detailing. According to this study e-detailing can be a useful tool for pharmaceutical companies mainly because it is a convenient and effective way to contact doctors. The biggest challenges of e-detailing are lack of personality and difficulties in changing timing of arranged detailing sessions. All in all, novel marketing methods may enable that pharmaceutical companies can take doctors' different needs into account. On the other hand, controlling the totality demands that pharmaceutical companies have a functional CRM-strategy and uniform communication.
  • Saarikko, Elina (2010)
    Biopharmaceutical Classification System (BCS) is a scientific framework for classifying drug substances based on their aqueous solubility and intestinal permeability. When combined with dissolution of the drug product, the BCS takes into account three major factors that govern the rate and extent of drug absorption. For a BCS biowaiver, the in vitro dissolution study may be used as a surrogate for in vivo bioequivalence studies. Currently, BCS I drugs are accepted as biowaiver candidates by EMEA, FDA and WHO. EMEA and WHO also accept class III drugs in some conditions. The main difficulty in classifying drugs according to BCS is the determination of permeability. Biopharmaceutics Drug Distribution Classification System (BDDCS) was introduced to provide a surrogate for permeability. If the major route of elimination is metabolism, then the drug exhibites high permeability. There are two parts in this master thesis. BCS and BDDCS are discussed and evaluated in the literature part. The focus is in the BCS III drugs. The purpose of the experimental part is to evaluate BCS III drug, hydrochlorothiazide as a biowaiver candidate. Solubility of the drug substance and dissolution of the drug product was determined. Aim of the permeability studies with Caco-2 cells were to study if hydrochlorothiazide permeates by passive diffusion across the monolayer. Importance of paracellular diffusion was evaluated by opening tight junctions with EDTA. Influence of dissolution rate was evaluated by theoretical simulation. According to the results of this study, hydrochlorothiazide has good solubility in aqueous buffer. It has been reported to diffuse passively across the epithelial cells but in this study permeability increased when concentration decreased. This may be due to active transport. Hydrochlorothiazide diffuses partially through the tight junctions. Dissolution of the hydrochlrothiazide tablet was very rapid. Drug eliminates almost entirely by metabolism, it is also BDDCS class III drug. EMEA and WHO accept BCS III drugs as biowaiver candidate if dissolution rate is very rapid. According to this, hydrochlorothiazide could be suggested as a biowaiver candidate. There are also other issues to be considered, for example excipients used in tablets. Since hydrochlorothiazide has been discovered to be absorbed in the upper part of the small intestine, the influence of excipients is especially important. This possible influence should be evaluated before the final decision of biowaiver.
  • Soini, Esa-Matti (2015)
    Posterior segment ocular diseases, such as age-related macular degeneration and diabetic retinopathy, can cause irreversible damage to the retina and visual impairments. Topical eye drop administration can be used for the treatment of anterior segment diseases, but it is not possible to get therapeutic drug concentrations in the posterior segment of the eye via topical route. Currently, intravitreal injections and implant are widely used for the treatment of posterior segment diseases. However, intravitreal administration can cause pain and discomfort, and frequent intravitreal administration can lead to, for example, retinal detachment and endophthalmitis. Therefore, safer and more patient friendly drug delivery method would be needed. After systemic administration, blood-aqueous barrier and bloodretinal barrier hinder the diffusion of drugs to the intraocular tissues. The aim of the experimental part was to develop a pharmacokinetic simulation model that could be used to predict the distribution of drugs into the eye after systemic administration. Such a model would be a very useful tool in drug development. The prediction accuracy of the model was tested with ten drugs. Concentrations in the vitreous and blood after systemic administration in rabbits has been published for these drugs. On average the prediction accuracy of the model was quite good: the simulated AUC of the drug concentration in the vitreous was 125 % and Cmax 117 % of the measured reference value. However, there was a significant amount of variation in the results. The lowest simulated AUC was 15 % and the highest simulated AUC was 403 % of the measured reference value. Therefore, the model is not yet realiable enough to be used as a tool in drug development. It might be possible to increase the prediction accuracy of the model by incorporating active transport into it and by using 2-compartment model to simulate systemic pharmacokinetics.
  • Munsterhjelm, Nina (2012)
    The liver is the major site of drug metabolism and excretion. Within the liver endogenous and exogenous compounds are eliminated through many metabolizing enzymes. Drug removal is not only dependent on metabolic enzymes, but also on transporters. Before cellular metabolism can occur, a drug must first enter the hepatocyte. Very lipophilic drugs enter the cell membrane through passive diffusion, but polar or ionized organic compounds can enter the cell membrane only by transporters. Transporters in the basolateral membrane of the hepatocyte facilitate drug entry and access to drug metabolizing enzymes. Transporters in the canalicular domain (apical) of the hepatocyte faclitate removal of drugs or metabolites from the cell interior. Recent studies have shown that transporters can mediate drug-drug interactions, and transporter genes are subject to genetic polymorphism which may affect pharmacokinetic parameters of a drug, such as absorption, distribution, and excretion. This Master's thesis consists of two parts, a literature review and an experimental section. In the literature review two transporters, OATP1B1 and MRP2, are discussed in detail. OATP1B1 is expressed on the basolateral and MRP2 on the apical membrane of the hepatocyte. These transporters are responsible for the vectorial transcellular hepatobiliary transport of various organic anions in humans. The experimental section aims at modelling vectorial hepatobiliary transport of three compounds in a double-transfected (OATP1B1/MRP2) MDCKII cell line. All three compounds studied, rosuvastatin, estrone sulphate, and estradiol glucuronide, are substrates of both transporters. Wild type (WT) MDCKII cells were used as a control. Tight junctions form a barrier between cells. This barrier regulates the paracellular passage of, for example, water, ions, large molecules, and drugs. In the experimental section the tight junctions were reversibely opened to distinguish between trans- and paracelluar routs of transport of the three compounds studied. Permeation of rosuvastatin and estradiol glucuronide in the basolateral to apical direction was faster in the double-transfected cell line compared to the MDCKII-WT cell line. Permeation of estrone sulphate, however, behaved unexpectedly in the double-transfected cell line. The permeation of this compound was almost equal in the apical to basolateral and basolateral to apical direction. The reason for this unexpected finding remains unclear. By opening the tight junctions the permeation of all compounds in both cell lines was increased, indicating that the compounds studied preferred the paracellular route and the importance of transporters were reduced. The double-transfected MDCKII cell line is a useful in vitro model of hepatic vectorial transport of organic anions in humans.
  • 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.
  • Vanhanen, Saara (2015)
    Different kind of medication reviews have been developed in different countries. In Finland comprehensive medication review was developed in the late 2000th. Only few researches of medication review exist in Finland. In other countries more studies on the subject have been done. This Master's thesis's aim in the literature review was to examine what kind of outcome measurements were used in medication review studies and what kind of results were obtained from these measurements. In many medication review studies different kind of drug related parameters were used to evaluate the effectiveness of medication review. These parameters are Drug Related Problems (DRP), Medication Appropriateness Index (MAI) and different kind of criteria's for potentially inappropriate medication for elderly. Medication reviews have showed a positive effect on these parameters. To the health-related quality of life medication reviews have not shown any statistical effect. Physical performance meters have not been used a lot in medication review studies. And results have been controversial. Omahoitosuunnitelma 2100 (OMA21) research project, that examines the effectiveness of the comprehensive medication review in Finnish health care, could potentially due to its long follow-up time produce results also from the quality of life and physical performance instruments. In the Master's thesis's experimental part the aim was to evaluate unity of the medication reviews in OMA21 research project. For four intervention patients in the OMA21 research project parallel medication reviews were done. From these reviews were examined how many of the problems found in the reviews were the same with different reviewers. There was a lot of dispersion in the problems found in the reviews. Only 17.5 % of the 40 different problems found in the reviews were the same with all the reviewers. From 12 patients medication reviews drug related problems were categorized by PCNE classification V6.2. 69 drug related problems were found from the medication reviews. Most common problem was the treatment effectiveness (P1) (37.7 %). For the problems 92 potential causes were found and the most common of them was drug selection (C1) (39.1 %). The aim was also examine whether Evidence-Based Medicine electronic Decision Support (EBMeDS) tool, developed by Duodecim Medical Publications Ltd, could be useful in the OMA21 research project. It was shown that EBMeDS have limited advantage if patients' information has not been reported right in the electronic health records. Only 30 % of the examined drugs had indication. In the future if the patients' information was reported right in the electronic health records the EBMeDS tools could be useful help in medication reviews, because EBMeDS contains many electronic databases that are often used in medication reviews.P50O48
  • Lipsanen, Tuomas (2010)
    Medication review is relatively new intervention in Finland that potentially promotes safe and rational use of medicines. During the recent years, the effectiveness of different kind of medication review procedures has been evaluated in many countries. The results considering the cost-effectiveness have varied and conclusions have been difficult to make. Because of the limited resources, the funders and decisionmakers need evidence-based effectiveness data to get the best possible value for the money spent in health care. The aim of the study was to gather, analyze and summarize the published data of costeffectiveness of the medication review by means of a systematic review. The aim was also to represent the medication review as a concept, procedure and study objective. This study was conducted as an analysis of study methods applied in published studies on cost-effectiveness of medication review procedures. In total, 947 references were found using a systematic literature search covering three electronic databases (Medline, CRD and IPA). Most of the references were excluded based on titles and abstracts, and 85 full-text articles were evaluated. After the duplicates were removed, 11 articles met the requested inclusion criteria and were entered to the study. There was a lot of variation between selected articles. In five articles the description of the medication review was not detailed or the intervention was not equal to the expected content level. Also the outcomes measures used in the studies varied. Most studies measured the use of medicines or the number of drug-related problems in different ways. Quality of life was applied as an outcome measure only in five studies and none of the studies were able to show statistically significant differences between intervention and control groups. Mortality was measured in four studies. In most studies the definition and calculation of the costs was limited and inadequate for proper economic evaluation. It was also common that only the direct drug costs from patient's perspective were calculated. The cost of pharmacist's working hours was taken into account in five studies. The incremental analysis was performed only in one study which also got high quality scores compared to all other studies. On the whole the economic evaluations in the selected studies were of low quality and performed in simple a way.
  • 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.
  • Kuosmanen, Hanna (2022)
    More and more drugs for the treatment of lung cancer are entering the market with limited research evidence and high cost. However, health care resources are limited. To provide rationale and sustainable treatment for all patients, the need for health technology assessments has increased. International value frameworks with varying uses, structures, and components have also been developed to help assess the value of drug therapies. The purpose of the study is to illustrate how physicians, authorities, and pharmaceutical industry experts define the value and the effectiveness of drug therapy. The study also aims to chart the attitudes of health care professionals towards international value assessment frameworks and to describe the current challenges in health technology assessments focusing on lung cancer therapy. In addition, the purpose of the study is to evaluate the importance of therapeutic and economic evaluation of lung cancer therapies. The research material includes interviews with physicians (n=2), authorities (n=3), and pharmaceutical industry experts (n=5). The interviews were conducted as an individual (n=8) and pair interviews (n=1). The interview method used was a semi-structured thematic interview. The interviews were analyzed by using inductive and abductive content analysis and theming. The theoretical framework in the study was related to the challenges of assessing the therapeutic and economic value of pharmacotherapies. According to the study, the value and effectiveness of drug therapy are determined in a varied and perspective-dependent manner. The value of drug therapy can be divided into three dimensions, which were therapeutic, social, and economic impact. Treatment’s effectiveness was primarily determined by the health benefits gained and by the effects the therapy has on patients, society and care pathways. Based on the data, the current challenges of the therapeutic and economic evaluation of pharmacotherapies are related to the implementation methods and criteria of evaluation and decision-making, resources, cooperation needs, scientific evidence, ethics, the structure of the health care system and legislation. Based on the results, physicians, authorities, and pharmaceutical industry experts have different opinions of the need for cooperation. The interviewees also evaluated differently the status of the current development activities and the importance of international evaluations. There were also differences in the opinions on how important the therapeutic and economic evaluation of lung cancer therapies was considered. If the importance was considered low, the importance of the evaluations was expected to increase only after the refinement of treatment recommendations and guidelines. According to the data, the international value frameworks are not actively used in Finland and their significance will be considered insignificant in the future as well. The usefulness of the value frameworks was primarily limited due to structural factors, the assessment of reliability and the current evaluation system in Finland. The benefits of the value frameworks were primarily related to the coherence of the evaluation process, easing the evaluation process and improving patient equality.
  • Karasti, Eveliina (2019)
    The amount of informal caregiving has increased in Finland, with a growing emphasis on the older adults. Although the medication management process in informal caregiving has been studied and is known to have significant risks, research data focusing on the older adults is still limited. The aim of this study was to describe the medication management process of informal carers and care recipients of at least 65 years old. The aim was to identify medication errors and medication risks in the medication management process and to find out how the caregivers manage them. In addition, the study examined the informal carers and care recipients own development proposals to improve medication management process. A total of 21 volunteer informal carers and care recipients living in the Helsinki metropolitan area were recruited to this study. The study was conducted as a qualitative interview survey in the homes of the participants. The interviews were a combination of semi-structured interviews and narrative approach. The material to this study was collected during spring and summer 2018. The study was analysed with abductive content analysis combining both deductive and inductive approach. The aim was to find repetitive elements by encoding and grouping expressions. The results of this study were compared with previous theory and the results were supplemented with a picture of the medication management process and a fishbone diagram was drawn from the risk factors and contributing factors of the medication management process. The families had medication errors in all stages of the medication management process. The most frequent medication errors were found in counselling, medication administration and in medication treatment monitoring. As a contributing factor, the healthcare professionals’ haste and the responsibility of the caregiver recurred in the background of the medication errors. Family caregivers and care recipients wish to have more counselling, more monitoring of medication and better interaction with health care. Carers often felt left alone to take care of another person's medications and felt they lack support from healthcare. By facilitating access to a physician, improving the availability of a physician, increasing the amount of counseling and support provided by healthcare, including pharmacies, could the safety of medication management at home be improved.
  • 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.
  • Hitonen, Heidi (2013)
    About 10 % of the patients experience an adverse event during their treatment. About 1 % of the adverse events are serious. Extrapolated from international evidence adverse events cause death of 700 - 1700 patients annually in Finland. Medication errors are the most common single preventable cause of adverse events. According to several studies about half of the adverse events and medication errors are preventable. Therefore medication safety is a central part of the Finnish Patient Safety Strategy. One of the medication safety tools in Finland is unit-based pharmacotherapy plan for which the Ministry of Social Affairs and Health gives instructions in the Safe Pharmacotherapy guide. All social and healthcare units should develop a pharmacotherapy plan which describes the medication processes in the unit. The purpose is to harmonise the principles for the provision of pharmacotherapy, to clarify the division of responsibilities related to its provision, and to define the minimum requirements that must be complied. The aim of the study was to explore how the pharmacotherapy plans were made and to evaluate their implementation and benefits in hospitals, health centres and social care units for the elderly. Pharmacotherapy plans are studied as part of the Finnish Patient Safety Strategy, focusing on medication safety. Head nurses were chosen as target group. The data was collected by phone interviews. Forty (8 %) interviews were received from a random sample that was taken from a register of head nurses held by Tehy ry. The interview was semi-structured theme interview and the data was analysed using content analysis. Most of the studied units (n= 24, 60 %) had started to formulate the pharmacotherapy plan in 2007, soon after the Safe Pharmacotherapy guide was published. Pharmacotherapy plans were drawn up on organisation and/or unit level. There was a lot of variety in the working groups' sizes and professionals taking part in them. More instructions would have been needed. The most common way (n=20, 50 %) to induct the pharmacotherapy plan to the staff was to introduce it at the unit meeting. Most commonly mentioned changes to the operations in the units were related to error reporting (n=15, 38 %), certification procedures for distribution and administration of medicines (n=9, 23 %) and task allocation (n=8, 20 %). There were several benefits of the pharmacotherapy plan of which most common were starting or developing error reporting (n=19, 48 %), clarification and better availability of instructions (n=18, 45 %), better induction of new staff members and substitutes (n=16, 40 %) and standardization of procedures (n=10, 25 %). Allocation of tasks and responsibilities was considered a challenge in developing and using the pharmacotherapy plan. Limited resources caused difficulties in implementing and using the pharmacotherapy plan. The staffs' medication education was kept more up-to date after introduction of the pharmacotherapy plan but the education was also challenging for the units. Pharmacotherapy plans made the units develop their procedures and increased understanding of medication safety. All in all the plans have worked well as part of the Patient Safety Strategy. However the systematic development of the pharmacotherapy and the use of pharmacotherapy plans in social and healthcare units requires more effort.
  • Luhtanen, Suvi (2012)
    Medicine information is an important part of a medicine and public health service. Medicine information it is tightly connected to many different functions of the medicine field and can be reviewed from several perspectives. Medicine counseling has been developed especially in the pharmacy sector but the development projects of medicine information which include the whole public health service have not been done before. According to the government proposal (74/2009) Finnish Medical Agency (Fimea), has created the national medicine information strategy which was published in February 2012. This study was conducted in order to gather background information for developing the national medicine information strategy. The aim of the study was to clarify the role of the medicine information producing quarters and the perceptions of co-ordination of operation as well as good practices, challenges and opportunities in medicine information. The material of the study consists of 29 interviews among key stakeholders. Interviews were conducted between March and September in 2011. Interviewees represented pharmaceutical industry, hospital and community pharmacies, authorities, patient organizations, education units and professional associations in the fields of medicine, nursing and pharmacy. Inductive content analysis with counting was used to analyze the qualitative data. The stakeholders brought out different sources of information (n=18) and examples of the successful forms and projects of cooperation (n=14) as good practices. According to the stakeholders, multi professional cooperation should be improved and increased in the medicine information field (n=19). The medicine information operation in public and hospital sector should be developed for example trough department pharmacy in hospitals (n=17). The information supply and skills of the health professionals are defective (n=16) and those could be improved by developing education (n=17). The medicine information targeted at consumers should be uniform regardless of the source and counseling should be individually tailored (n=15). The stakeholders told that they are cooperating with different quarters in medicine information field. The stakeholders reviewed medicine information strongly from their own point of view and they were not aware of what other quarters are doing. Medicine information operation needs both national and local co-ordination and by increasing and developing multi professional cooperation and networking, available resources and skills of quarters could be used more effectively. More reliable, balanced and individually tailored medicine information is needed. The base of good medicine information is a strong theory base and skills of health professionals so notice should be taken to the education so that it would meet the demands of the working life also in medicine information field. Consumers need tailored medicine information which should be uniform regardless of from which health unit it is given.
  • Mononen, Anna (2012)
    Herbal preparations are widely used nowadays and the information given has developed a lot during the last decades. Herbal preparations haven`t been acknowledged as medicines and therefore their efficacy and adverse effects are still often underrated. In 2005 along the changes in legislation differently legislated group of herbal preparations was retired. Nowadays herbal preparations are divided to drugs and food products. The aim of the study was to make oneself familiar with the legislation of these products and the evolution of the pharmaceutical information given. The aim also was to compare warnings, prohibitions, contraindications and their evolution to prevalent legislation. The material of the study consisted of product information summaries, patient information leaflets and labeling of herbal medicines, traditional herbal medicines and their predecessors. In addition to this there was also other legislative material. Only herbal medicines and traditional herbal medicines according to directive 2004/24/EY of the European parliament and the council`s definition were taken in to account. According to 2004/24/EY herbal medicinal products is any medicinal product, exclusively containing as active ingredients one or more herbal substances or one or more herbal preparations, or one or more such herbal substances in combination with one or more such herbal preparations. There were all together 194 products included in the study. Documentation of 184 products was found on paper in Fimea`s archives. Of the remaining five out of ten products it was found some basic information in electronic rohdos-register and of one product on an on paper final act. Data of these six products was only used partly because of its deficiencies. The data of four products wasn`t found. Under a more detailed study there was all together 184 products between 1964 and 2011. The material was divided to time periods 1964 - 1983, 1984 - 1987, 1988 - 1995, 1996 - 2005 and 2006 - 2011 by the changes in legislation. The information given of herbal preparations was the most affected by the changes in legislation in 1994 and 2005. The amount of new licenses was increasing until the time period 1988 - 1995. Licenses were granted the most during 1988 - 1955. After 1996 the amount of warnings, prohibitions and contraindications rose and many of the products that got the license in previous time period 1966 - 1955 left the market or transferred under the food legislation. As well many products with less consumption left the market because new studies demanded were expensive and cumbersome. In 2005 along the changes in legislation a clear change in attitudes came true, when a vague group of herbal preparations was removed and herbal preparations were divided into pharmaceuticals and food products. Along this change it has become easier for health care professionals to assess the risks and benefits of herbal preparations and advise the clients while making the decisions.