Browsing by Subject "medication review"

Pharmaceutical services refer to services in community pharmacies which are based on knowledge and skills of the pharmaceutical personnel. Pharmaceutical services can be divided into basic and special services. Pharmaceutical basic services relate to community pharmacy's legislative functions, while pharmaceutical special services try more proactively contribute to consumers' health.. Automated dose dispensing is pharmaceutical special service. Dose dispensing means that the patient's medication are packed in disposable bags corresponding to the dose that he or she needs to take during the course of one day. When a new patient starts to use the automated dose dispensing service, his medication is reviewed to assure there would not be severe interactions or unnecessary drugs The drugs suitability to the service and the timing of the medication is noted when the service is started. Automated dose dispensing service produces a medication list of customer's medication. The survey studied the level of the checks made to patient's medication and how can the medication history be explaned. In the survey were also interested in the level of review that was done to patient's medication. Information of patient's medication was also collected with a questionnaire. Background information showed how well the results of the survey can be generalized to pharmacies offering services and customers using the service. The questionnaire was sent to all pharmacies that ordered automated dose dispensing as contract manufacturing from Espoonlahti Pharmacy in September 2010. In the semi structured questionnaire was multiple choice and open-ended questions. Response rate in this study was 45. Background information showed that questionnaires were returned from pharmacies all around the Finland and all sizes of pharmacies. Mostly the patients starting the automated dose dispensing service are aged, homecare patients, nursing home residents or service home residents. Medication cards are used in collecting the information of patient's medication, but information to the medication card can be updated from other sources too. Medication review to patient's medication is made usually in multi-professional cooperation. Changes made to patient's medication are mainly caused by generic substitutions, selection of the dispensing machine or avoidance to halving. Medications have only few interactions that lead into discontinuing use of some medicine. Checking the medication has only little effect on the amount of drugs used by the patient. New patients starting the automated dose dispensing service have on the average 11 medicines in use, from which 7 medicines are taken to automated dose dispensing. The most widely used ATC groups are cardiovascular and nervous system medicines. Each new patient uses an average of three preparations in both groups before and after the initiation of automated dose dispensing service.

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.

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.