Browsing by Subject "lääkehoito"

The number of home-dwelling aged is increasing in Finland. Rational medication use is one of the factors, which ensures the good functional abilities needed for independent or assisted living at home. No timely research on the medication use of the home-dwelling aged in Finland is published. Research on their medication use makes it possible to identify the drug related problems. Identifying drug related problems and rationalizing or deprescribing medications belong to risk management which aims at avoiding adverse drug events that might impair functional abilities. The aim of this Master's Thesis was to describe the medications used by the home services assisted home-dwelling aged, to study the prevalence of potentially inappropriate medication use (PIM) and clinically significant (SFINX Class D) drug-drug interactions and to study anticholinergic and serotonergic loads of medications used. Additionally, correlation between the use of PIMs according to Beers criteria and functional abilities measured by RAVA™ was studied. This study was conducted as a part of a larger interventional and randomized study in Town of Lohja, 'Development of a Coordinated, Community-Based Medication Management Model for Home-Dwelling Aged in Primary Care'. The cross-sectional baseline data was collected in autumn 2015. The study cohort (n=188) consisted of home-dwelling aged who were assisted by home services aged 65 or older and living in Lohja. They were randomized into intervention (n=101) and control groups (n=87). Majority of them were women (69%) and their mean age was 83 years. The mean number of medications used was 13. Data on prescription drugs (both regular and irregular) was collected from their medication lists. Most severe, class D drug interactions were checked out from reports of SFINX database. Potentially inappropriate medication (Beers 2015), anticholinergic load and serotonergic load were checked out from reports of Salko database. Medications were analyzed in both groups separately. RAVA evaluation was conducted by home care nurses and practical nurses. Pearson's correlation coefficient was calculated to analyse the associations between the amount of potentially inappropriate medication and functional ability in addition on crosstabs. The most commonly used drug classes were central nervous system medications (n=184, 98 %) and cardiovascular medications (n=176, 94 %). The most common drug was paracetamol (n=155, 82 %). Benzodiazepines and related drugs was used by 43 % (n=80) and antipsychotics 17 % (n=32) participants. At least one anticholinergic medication (two or three points) according to Salko database was used by 27 % participants; 13 % had concomitantly more than one serotonergic drugs. Prevalence of the clinical significant drug-drug interaction was 8 %. Almost four out of five had potentially inappropriate medications according to the Beers 2015 criteria of which the most common drug was pantoprazol (n=60, 21 %). The number of the PIMs used by the study participants did not correlate between the functional ability measured by RAVA class (Pearson correlation coefficient 0.024). Aged among home care services are highly medicated and the potentially inpropriate medication use is common. Coordinated models and interprofessional medication reviews are needed to ensure rational and safe medication therapy of the aged. However, correlation between functional ability measured by RAVA class and Beers medicines use was not shown.

The aim of this Master's Thesis was to assess experiences of access to medications and follow up services. The aspects studied were: access to medications from the public's perspective, also in relation to availability of follow-up services and support for self-management in long-term medications, and difficulty to buy necessary medicines due to economic reasons. The respondents were also asked to identify needs for developing new customer-oriented services for follow up of treatments. The data were collected during December 2013 and January 2014 by an email survey to those registered in the loyal customer program of University Pharmacy. The data were analyzed by using the statistical programme SPSS. Responses to open-ended questions were analyzed (a preliminary analysis). Respondents' age, gender, area of residency and financial situation were used as background variables. 606 responses were received (84% women, 16% men). The mean age of the respondents was 53.5 years and 91% had at least one disease or symptom diagnosed by a doctor. Almost all (93%) used some medicine or vitamin product. Eleven percent of the respondents reported that they had not been able to purchase a medicine they needed due to poor personal financial situation. A majority (85%) of the respondents perceived their health status as good. The average number of visits at the doctor during a one year period was 5.5. About 22 % of the respondents reported that they were not able to get an appointment when they needed it. About half of the respondents had regular health controls by a doctor. The respondents indicated a wish that getting the appointment regularly should be easier and that there should be time to have a holistic discussion on one's care. About half had a personal doctor and 42% had a medication card. The most common ways to self-monitor one's care were by observing general health status, measuring blood pressure and weight. Almost two-thirds (63%) discussed the monitoring results with their doctor. Many respondents reported in the open comments that they did not have instructions for self-monitoring and there was no healthcare provider to share the results with. The respondents wanted have more information concerning the reasons to use medicines, and the benefits of a long-term medicine use. They also wanted to know more about adverse effects and interactions, as well as about non-pharmacological treatment options. The prescriptions were most commonly renewed at the doctor's office (47%).The respondents also expressed a wish to have more options to contact their healthcare providers, e.g., though electronic services (online doctor, email counselling). There are limitations in the Finnish health care system from the medication management's perspective. Aspects needing improvement include access to regular controls and follow-up services, having more options to contact healthcare providers, also through electronic services, having better access to information on diseases and medication, and finally, improve caring for people's health concerns in a holistic way.