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Browsing by Subject "moniammatillinen yhteistyö"

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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.
  • 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.
  • Nieminen, Emmi (2016)
    Adverse drug events (ADE) are a major problem which deteriorates the quality of drug therapy. They cause significant morbidity and mortality each year. ADEs are often caused by incompatible drug combinations, drug-drug interactions (DDIs). Interprosessional collaboration between health care professionals is important in improving medication safety and preventig drug interactions. The aim of this study was to investigate the most common clinically significant drug-drug interactions in outpatient care and the role of pharmacist in preventing them. The study material was an interaction data which was collected in Helsinki University Pharmacy during August 2015. DDIs and the action needed by presecribers or pharmacists to handle them were collected. Only clinically significant interactions of the SFINX interaction database i.e. D- and C-interactions were recorded. The most common D-interactions (interactions to be avoided) were fluoroquinolones or tetracyclines combined with metal ions (calcium, iron, magnesium, aluminium) (14.7 % of D-interactions) and codeine or tramadol combined with CYP2D6 enzyme inhibiting antidepressants (12.6 %). C-interactions concerned most commonly interactions between antihypertensive drugs and NSAIDs (26.2 % of C-interactions). 59.6 % of D-interactions were interactions that might result in adverse drug reactions and 40.4 % were interactions that might result in therapeutic failure. For C-interactions numbers were 49.4 % and 50.6 %, respectively. Only a few interactions (1.6 %) led to contact with the prescriber from the pharmacy, and more often (1.8 %) the pharmacist advised the patient to contact the prescriber. 32.6 % of the interactions led to pharmacist's advice. The most typical interactions which can be prevented by pharmacist's advice were chelation interactions which can be prevented by taking drugs many hours apart from each other. 59.7 % of the interactions produced no action in pharmacy. Those concerned situations where the prescriber had planned the treatment and weighed up the benefits and risks of the medication, or interactions where the drugs had been in contemporary use for a long time, and thus the pharmacist assumed that the prescriber had planned the treatment. Pharmacists should intervene in drug-drug interactions easier. To avoid unnecessary calls, communication between prescribers and community pharmacies should be developed. Pharmacists' role in preventing DDIs could be improved for example by education and by updating the operations models in collaboration with other health care. Safe and efficient drug treatment should be ensured with interprofessional collaboration, and the responsibility should not be shifted to the patient alone.