Browsing by Subject "perusterveydenhuolto"
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(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.
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(2015)Medication safety is safety related to the use of medicines. Medication errors are drug treatment related events which can lead to medication safety incidents. Medication process is multi-professional teamwork which contains a risk of medication error on every step. It is important to identify potential safety risks in order to prevent the risk events. Medication errors can occur for example during the transfer of the prescription information in to the medication list. It is important that medication lists are accurate and up to date so that patient's medication therapy is optimal. The aim of this study was to assess whether the primary health care medication lists are up to date, accurate and easy to read. The aim was also to identify what kind of information in medication lists was open to interpretation. In one of the municipalities, the medication lists at home were compared to the medication lists at primary care to see whether both lists had identical information on the medication. The data of this study consisted of 240 medication lists from primary care units in three Finnish municipalities. The lists contained altogether 3062 medications. Most of the lists were printed from the patient information systems. Some of the lists were copied from the home medication lists. All medication lists were systematically reviewed and issues open to interpretation were documented in a structured Microsoft Excel table. The data were transferred to SPSS 20 Program for statistical analysis. Most (73%, n=174) of the medication lists (n=240) were incomplete. One-fifth (n=612) of the medications in use (n=3062) contained missing information on medicines. The total number of discrepancies was 807 (mean 3.4 discrepancies per medication list). The most common discrepancies were related to the time of administration (n=277) and dosages (n=241). Duplicate medications included a lot of confusing information. Discontinued medications were not always clearly marked. In only one of the municipalities the medication lists had a space for marking the indication. There were some differences between home medication lists (n=62) and primary care medication lists. ™ Based on this study medication lists have a lot of discrepancies and ambiguities in their information content. The medication lists do not always accurately tell the patient's current medication. Interpretation of inaccurate medication lists consumes unnecessarily doctors' and nursing staff's time. Inaccurate medication lists are a risk to patient safety. It is also important that the medication lists would be similar in all health care units. Electronic prescriptions, the National Health Archive and medication list developed by Information Management Service of Healthcare are expected to solve at least some of the problems related to medication lists.
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(2019)Pitkäaikaiset lääkitykset lisääntyvät jatkuvasti kroonisten sairauksien yleistymisen ja väestön ikääntymisen takia. Pitkäaikaisten sairauksien hoidossa lääkehoitojen rationaalisuus korostuu, mutta WHO:n arvioiden mukaan noin puolet lääkkeiden määräämisestä, toimittamisesta, käytöstä ja myynnistä toteutuu epärationaalisesti. Tämä lisää terveydenhuollon ammattilaisten vastuuta lääkehoidon vaikutusten seurannassa ja potilaan hoitoon sitouttamisessa myös reseptien uudistamisessa. Reseptien uudistamiskäytäntöjä on kuitenkin tutkittu vähän niin Suomessa kuin maailmanlaajuisesti. Tässä pro gradu -tutkielmassa tavoitteena oli tarkastella nykyisiä reseptien uudistamiskäytäntöjä perusterveydenhuollon lääkäreiden näkökulmasta. Tavoitteena oli tarkastella, minkälaiset tekijät vaikuttavat lääkäreiden työskentelyyn sekä potilaan lääkehoidon kokonaisuuden hallintaan ja turvallisuuteen reseptien uudistamistilanteissa. Lisäksi kartoitettiin lääkäreiden ratkaisuehdotuksia uudistamiskäytäntöjen kehittämiseksi. Tutkimus toteutettiin laadullisena monimenetelmätutkimuksena Kirkkonummen terveysasemilla. Tutkimuksessa hyödynnettiin triangulaatiota ja tutkimusaineisto koostui reseptien uudistamistilanteiden varjostuksesta sekä kahdesta lääkäreiden ryhmähaastattelusta. Tutkimukseen osallistui yhteensä 12 lääkäriä, joista viisi osallistui varjostusvaiheeseen ja seitsemän haastatteluvaiheeseen. Aineisto kerättiin huhti-heinäkuun 2019 aikana. Tutkimuksen teoreettisena viitekehyksenä oli inhimillisen erehdyksen teoriaan perustuva järjestelmälähtöinen näkökulma. Tutkimusaineisto analysoitiin aineistolähtöisellä sisällönanalyysillä, jossa varjostus- ja haastatteluaineistosta etsittiin tutkimuksen tavoitteiden kannalta merkittäviä ilmaisuja. Reseptien uudistaminen on lääkäreiden näkökulmasta monivaiheinen prosessi. Prosessiin vaikuttivat useat uudistamista helpottavat ja vaikeuttavat järjestelmä-, potilas- ja lääkelähtöiset tekijät. Lääkärit tunnistivat ongelmakohtia uudistamisprosessin jokaisesta vaiheesta. Lääkäreiden mukaan etenkin tietojärjestelmien epäkäytännölliset ominaisuudet ja tekniset ongelmat sekä ajantasaisten lääkitystietojen ja tiedonkulun puutteet olivat uudistamistilanteissa ongelmallisia ja tekivät uudistamisesta työlästä. Myös kiire ja uudistettavien reseptien suuri määrä vaikeuttivat uudistamista. Ongelmien takia lääkärit kokivat, ettei lääkehoitojen seurantaa voitu tehdä uudistamistilanteessa perusteellisesti. Lääkäreiden ehdotuksia uudistamisprosessin kehittämiseen olivat uudistamisen parempi koordinointi, tietojärjestelmien ja tiedonvälityksen kehittäminen sekä moniammatillisen yhteistyön ja potilaan osallistamisen lisääminen.
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