Finnish Community Pharmacies Research Articles

Crisis management in community pharmacies during a pandemic

BackgroundAlthough the COVID-19 pandemic required community pharmacies to implement several adaptation strategies to ensure medicines' and services’ availability, related empirical research based on crisis management theory is lacking. ObjectiveThis study sought to holistically depict crisis management in Finnish community pharmacies and explore whether (1) pre-existing crisis plans, (2) crisis teams, (3) shared decision-making or (4) collaboration and communication with external stakeholders can protect staff resilience, pharmacy owners' resilience, organisational cohesion (‘team spirit’) and pharmacies' resources or finances during the pandemic. MethodsA cross-sectional survey was developed based on the crisis management process model and sent to Finnish community pharmacy owners (n = 602) during the pandemic's second wave in October–November 2020. Descriptive statistics were calculated, and logistic regression analysis was performed to explore effects of crisis management efforts. Open-field responses were analysed qualitatively using deductive content analysis. ResultsIn total, 221 (36.7 %) pharmacy owners participated in the study. Pharmacies responded to the pandemic with increased order volumes and new suppliers, home deliveries and remote consultations, hand sanitiser production and additional customer counselling concerning the COVID-19. Shared decision-making with pharmacy colleagues (p = 0.025) and collaboration with peers or stakeholders in the supply chain (p = 0.015) protected pharmacy owners' resilience during the pandemic. Additionally, shared decision-making protected pharmacies' finances (p = 0.040). Crisis teams or collaboration with social and healthcare operators did not provide advantage to pharmacies. However, pre-existing pandemic plans associated with reduction of pharmacies’ resources (p = 0.006). ConclusionsCommunity pharmacies responded to the COVID-19 pandemic with several measures to ensure the continuity of pharmaceutical services and care and the availability of medicines, disinfectants and personal protective equipment. Developing shared decision-making in pharmacies and active collaboration with peers and supply-chain stakeholders could improve pharmacies' finances and their owners’ resilience in future crises.

Trends in dispensing errors reported in Finnish community pharmacies in 2015–2020: a national retrospective register-based study

BackgroundCommunity pharmacies are responsible for dispensing of medicines and related counselling in outpatient care. Dispensing practices have remarkably changed over time, but little is known about how the changes have influenced medication safety. This national study investigated trends in dispensing errors (DEs) related to prescribed medicines, which were reported in Finnish community pharmacies within a 6-year period.MethodsThis national retrospective register study included all DEs reported to a nationally coordinated voluntary DE reporting system by Finnish community pharmacies during 2015–2020. DE rates, DE types, prescription types, individuals who detected DEs and contributing factors to DEs were quantified as frequencies and percentages. Poisson regression was used to assess the statistical significance of the changes in annual DE rates by type.ResultsDuring the study period, altogether 19 550 DEs were reported, and the annual number of error reports showed a decreasing trend (n = 3 913 in 2015 vs. n = 2 117 in 2020, RR 0.54, p < 0.001). The greatest decrease in reported DEs occurred in 2019 after the national implementation of the Medicines Verification System (MVS) and the additional safety feature integrated into the MVS process. The most common error type was wrong dispensed strength (50% of all DEs), followed by wrong quantity or pack size (13%). The annual number of almost all DE types decreased, of which wrong strength errors decreased the most (n = 2121 in 2015 vs. n = 926 in 2020). Throughout the study period, DEs were most commonly detected by patients (50% of all DEs) and pharmacy personnel (30%). The most reported contributing factors were factors related to employees (36% of all DEs), similar packaging (26%) and similar names (21%) of medicinal products.ConclusionsAn overall decreasing trend was identified in the reported DEs and almost all DE types. These changes seem to be associated with digitalisation and new technologies implemented in the dispensing process in Finnish community pharmacies, particularly, the implementation of the MVS and the safety feature integrated into the MVS process. The role of patients and pharmacy personnel in detecting DEs has remained central regardless of changes in dispensing practices.

Promoting veterinary medication safety – Exploring the competencies of community pharmacy professionals in veterinary pharmacotherapy

The science of veterinary medicine is currently lacking studies on medication safety, although its importance in protecting animals from medication errors is central. Pharmacy professionals have an important role in ensuring medication safety of both prescription and over-the-counter medications of animals. However, this requires adequate competencies of pharmacy professionals in veterinary pharmacotherapy. The present study aimed to explore the competencies of pharmaceutical staff in community pharmacies in veterinary pharmacotherapy, which factors influence these competencies and what kind of information sources they typically use on veterinary pharmacotherapy.The study was conducted as a cross-sectional online survey targeted to pharmacy professionals in the Finnish community pharmacies, providing 596 responses. Less than half of the respondents (41%, n = 246) are considered to possess good competencies in veterinary pharmacotherapy. A third of the respondents (35%, n = 211) would dispense an anti-inflammatory drug for an animal off-label, whereas 24% (n = 145) would not interview the pet owner to discover the need for internal parasite medication before dispensing the drug. A small proportion (<1%, n = 5) would have dispensed a broad-spectrum internal parasite medication. Approximately a quarter of the respondents (27%, n = 159) stated that they acquired information on pharmacotherapy only from the material produced by the manufacturers of veterinary drugs.The competencies of pharmacy professionals in veterinary pharmacotherapy need to be strengthened in many areas to better promote veterinary medication safety. It should also be ensured that pharmacy professionals can access and use independent, high-quality information on veterinary pharmacotherapy.

Are there differences in the patient-reported medication-related problems among asthma and allergy patients? A community pharmacy survey in Finland

BackgroundA medication-related problem is an event involving medication that interferes with desired health outcomes. Those are largely studied among asthma patients, but little is known about medication-related problems among allergy patients. The objective of this study was to determine the most common patient-reported medication-related problems among asthma patients compared to allergy patients during the self-management of diseases. The other objective was to identify how demographic variables and the received treatment information influence reported problems.MethodsA nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016. The survey targeted patients buying prescription medicines for asthma or allergy.ResultsResponses were received from 46% of targeted pharmacies from 956 respondents. At least one medication problem was reported by 24% of asthma patients and 12% of allergy patients. The most common problems among asthma patients were having problems taking medicines on time (16%), problems in the administration technique (7%) and in the use of the inhaler (4%). Among allergy patients, 10% reported problems remembering to take medicines on time. Severe asthma and allergy increased the risk for medication-related problems (OR 1.20, 95% CI 1.04–1.40 and OR 1.17, 95% CI 1.0–1.37). A higher age and less education were associated with fewer reported medication-related problems among both patient groups.ConclusionsAsthma patients reported more medication-related problems than allergy patients. Among both investigated patient groups, remembering to take medicines on time was the most common. Health care professionals should educate younger patients but also older and less educated asthma and allergy patients to recognize and, to solve medication-related problems. In addition, severe asthma patients still need medication counseling.

Electronic prescription as a driver for digitalization in Finnish pharmacies

BackgroundFinnish community pharmacies have undergone digitalization during the past decade. The introduction of the electronic prescription has had a significant impact on pharmacy workflows, such as the dispensing process. This inevitably has significant sociotechnical implications. We examine the impact of digitalization on the dispensing process and the sociotechnical orientation of a pharmacy.MethodsWe utilize data collected in customer service situations in Finnish community pharmacies at two points in time: in the traditional workflow, when electronic prescriptions were not in use, and in the new direct dispensing workflow, which is the usual delivery model in the case of electronic prescriptions. We analyze this data in terms of changes in workflow efficiency. We also draw on existing literature to build a conceptual model for digitalization in the pharmacy sector from a sociotechnical standpoint.ResultsIn the Finnish environment, the results, based on our study sample, show that with electronic prescriptions and the direct dispensing model, the delivery time for a single medication over the counter was reduced by 13%. The results also indicate that the process has become more predictable, as the variation in terms of the workflow lead time has decreased.ConclusionsThe results indicate that the dispensing process has become more efficient in terms of time and throughput as well as more technically oriented and predictable. From a sociotechnical perspective, the results indicate that the technical subsystem has strengthened, and pharmacies have adapted to the new technology in the dispensing process.

Are there differences in the treatment information received to support guided self-management between asthma and allergy patients?: A community pharmacy survey in Finland

BackgroundGuided self-management of asthma supported by health care professionals is a well-established approach. For allergy patients, there is less guidelines and evidence for guided self-management than for asthma patients. ObjectiveThe objective of this study was to find out how commonly asthma and allergy patients receive written action plans, how much and from which sources they receive treatment information to support their self-management, and to identify associated factors that may influence the support of guided self-management, and if there are any differences between these patients. MethodsA nationwide survey was conducted in Finnish community pharmacies (n = 785) in September 2016 targeting patients buying prescription medicines for asthma or allergies. ResultsResponses were received from 46% of targeted pharmacies. Around 73% of the asthma patients, 61% of patients at risk of anaphylaxis, and less than 50% of the other allergy patients had received a written action plan. The most common source of treatment information for both patient groups was pharmacists. Allergy patients sought information more from written sources than asthma patients. Older males and patients with lower education received less treatment information. About 10% of both asthma and allergy patients did not report receiving any treatment information. ConclusionThe majority of asthma patients and allergy patients at risk of anaphylaxis had received a written action plan, while fewer than half of other allergy patients had received a written action plan. For both asthma and allergy patients, community pharmacists are the most common source of treatment information. Allergy patients seek more information from written sources than asthma patients. Pharmacists have a crucial role in the support of self-management for these patients.

Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs.

Finland’s community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists’ role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs.

Factors associated with health service orientation and active product marketing orientation in Finnish community pharmacies: a nationwide study among private pharmacy owners

BackgroundLittle is known about pharmacy owners’ commitment to public health and health policy goals in the strategic planning of their business. The aim of this study was to explore factors associated with health service orientation and active product marketing orientation of Finnish community pharmacy owners.MethodsA national cross-sectional e-mail survey was sent to private community pharmacy owners in Finland (n = 581) in 2013. Based on the structured, Likert-type survey instrument, two sum scales measuring strategic orientation towards health service provision (13 items, score range 0–26) and active product marketing (8 items, score range 0–16) were developed (Cronbach’s Alpha 0.836 and 0.699, respectively). Characteristics of the pharmacy owners and their pharmacy business as well as actual service provision were used as background variables.ResultsConcerning health service orientation, 50% of the respondents received at least 20 points out of the maximum 26 points (score range: 0–26). For active product marketing orientation, 75% of the pharmacy owners had at least 14 points and 44% received full 16 points (score range: 0–16). The score distribution was skewed towards strong health service orientation, but the actual service score was heavily skewed towards few services or no services. Two-thirds of the pharmacy owners reported having available 2 or less services. The health service orientation was not influenced by any of the background variables used, but three of them influenced active product marketing orientation, namely business location, annual prescription volume and belonging to a marketing chain of individual community pharmacies.ConclusionLarge pharmacies located close to rivals and belonging to marketing chains of individual community pharmacies differentiated as those having a high product marketing orientation. The health service orientation was not influenced by any of the explanatory variables used in this study. The discrepancy between high health service orientation scores and low actual service provision scores needs further investigation. The contradiction that exists between pharmaceutical policy goals and the generation of income of pharmacies should also be examined as a contributing factor in this respect.

Reasons for allowing and refusing generic substitution and factors determining the choice of an interchangeable prescription medicine: a survey among pharmacy customers in Finland

BackgroundGeneric substitution (GS) was introduced in Finland in 2003 and supplemented with a reference price system (RPS) in 2009. Patients play a vital role in the acceptance of GS and the use of less expensive generic medicines. The objective of this study was to explore Finnish pharmacy customers’ experience with allowing and refusing GS. Specific aims were to investigate the reasons for (1) allowing and (2) refusing GS and (3) to determine the prescription medicine-related factors influencing the customer’s choice of an interchangeable prescription medicine.MethodsA questionnaire survey was conducted in February 2018. Questionnaires were handed out from 18 community pharmacies across Finland to customers ≥18 years who purchased for themselves a prescription medicine included in the RPS. A descriptive approach was used in the analysis using frequencies, the Chi-square test and Fisher’s exact test.ResultsThe final study material consisted of 1043 questionnaires (response rate 40.0%). Of the customers, 47.9% had both allowed and refused GS, 41.2% had only allowed GS and 6.0% had only refused GS. Customers had allowed GS because they wanted to lower their medicine expenses (75.5%), or because the prescribed medicine (30.8%) or medicine they had used before (27.4%) was unavailable at the pharmacy. The main reasons for refusing GS were an insignificant price difference between interchangeable medicines (63.3%) and satisfaction with the medicine used before (60.2%). The main factors influencing customers’ choice of an interchangeable prescription medicine were price (81.1%), familiarity (38.4%) and availability (32.8%). Customers who had allowed GS chose the medicine based on price. Customers who had only refused GS appreciated familiarity more than the price of the medicine.ConclusionsGS is a common practice in Finnish community pharmacies. The price of the medicine was the most important factor affecting customers’ decision to allow or refuse GS and the choice of an interchangeable prescription medicine. Thus, customers should receive information about medicine prices at the pharmacy in order to help them make their decision. However, individual needs should also be taken into account in counselling because customers regard several factors as important in their choice of an interchangeable medicine.

The content of patient counseling about interchangeable medicines and generic substitution in Finnish community pharmacies\xa0- a survey of dispensers

BackgroundGeneric substitution aims to increase the use of more affordable generic preparations and restrain the growth of medicine expenditures. Pharmaceutical staff plays an important role in generic substitution by implementing substitution and counseling customers. The aim of this study was to explore how Finnish dispensers inform pharmacy customers about interchangeable medicines and generic substitution and what customers ask dispensers about generic substitution and the reference price system.MethodsA questionnaire was sent to a random sample of dispensers (n = 1054) working in community pharmacies in spring 2018. The data was analyzed using frequencies, percentages and the Chi-square test and Fisher’s exact test. The open-ended questions were analyzed first using inductive content analysis and later with the quantitative methods mentioned above.ResultsThe final study material consisted of 498 questionnaires (response rate 51%). The main topics dispensers always informed customers about were the physician’s record in the prescription not to substitute the medicine (69%) and that the prescribed or purchased interchangeable medicine did not belong in the reference price band (59%). Topics mentioned often by dispensers dealt with customer’s chance to choose their medicine from among several alternative products (68%) and the manufacturer of the interchangeable medicines (66%). Differences in appearance (33%) or in composition (28%) of interchangeable products were the most common topics mentioned only when the customer asked about them. Of the respondents 17.6% always and 51.4% often informed the customer about the least expensive interchangeable product at the point of dispensing. Customers’ questions about the generic substitution and reference price system most commonly (82.4%) concerned the similarity of interchangeable medicines.ConclusionsFinnish dispensers provide customers with a wide range of information about different subjects when dispensing interchangeable medicines. Patient counseling generally meets the legislative requirements, except for price counseling. In future, information about generic substitution and interchangeable medicines should continuously be provided to customers both at pharmacies and elsewhere, e.g. through educational campaigns.

Influence of strategic planning on product marketing and health service orientation of community pharmacies—A national survey in Finland

The aim of this study was to explore pharmacy owners’ views on the strategic development of community pharmacies, particularly how strategic planning at the pharmacy level influences on product marketing and health service orientation of individual community pharmacies.The study was carried out as a national cross-sectional e-mail survey sent to all privately-owned Finnish community pharmacies (n = 581) in March 2013 (response rate 34%, n = 198). The pharmacy owners were asked about their strategy, product marketing and health services activities at the time of the survey and what they regarded as potential strategic developments by 2020.Of the responding pharmacy owners (n = 198), 63% reported their pharmacy had a strategy. The strategy was more common if the pharmacy owner had >10 years of experience as a pharmacy owner, the pharmacy had a high prescription volume (annually >100,000 prescriptions) and sales volume (annual turnover >5 million euros). Pharmacy owners’ strategic vision by 2020 concerning health service orientation was the same regardless of having a strategy. Having a strategy was associated with the following variables indicating active product marketing orientation: the pharmacy had a person responsible for marketing campaigns and monitoring their success, and the pharmacy actively invested in add-on sales. Economic uncertainty of community pharmacies is an unresolved issue driving them towards active product marketing even they strategically prioritized health service orientation.

Electronic prescription anomalies – A study of frequencies, types, and effects in Finnish community pharmacies

Early hospital readmissions are a challenging and costly experience for both patients and the healthcare service. Reducing hospital readmission rates is a priority for health services globally and this is evident with the establishment of multiple outpatient services to promote early follow-up and to initiate secondary preventative care measures. One such intervention has been the introduction of a pharmacist-led, Hospital Outreach Medication Review (HOMR) service. However, the demand for the service has meant reaching this target has become an increasingly ambitious goal within allocated resources.To validate a risk-stratification tool to identify low-risk patients in whom a telephone medication review would be a safe and effective alternative to a home-based review.A risk tool was derived and applied to a retrospective sample to act as the parent cohort. A prospective cohort was stratified into low and high-risk based on this tool, and received either a telephone or a traditional home medication review respectively.235 patients were included in final analysis (n = 113 prospective, n = 122 baseline controls). High-risk patients were more likely to be readmitted at 60 and 90 days in the baseline cohort (9/38 vs 7/84, p = 0.04 and 11/38 vs 9/84, p = 0.02 respectively), with a trend towards increased readmissions at 30 days (5/38 vs 3/84, p = 0.11). Logistic regression identified the risk tool as an independent predictor of hospital readmission (IRR 1.18, p = 0.04), whereas age and Charlson comorbidity were not (p = 0.80 and 0.31 respectively). There was no significant difference between the new model (incorporating phone reviews) and the parent cohort (p = 0.25).Our risk score was able to identify those at highest risk of hospital readmission at 60 and 90 days. Utilising this risk score, a telephone HOMR for low-risk patients was a safe and efficient alternative to a traditional home review.

Community pharmacists' knowledge of COPD, and practices and perceptions of medication counseling of COPD patients.

Background and purposeCOPD is one of the leading causes of morbidity and mortality worldwide. Although medication counseling interventions by pharmacists have been found to support the management of COPD, little is known about pharmacists’ knowledge concerning COPD and regular practices and perceptions concerning medication counseling of COPD patients. The purpose of this study was to research these topics among Finnish community pharmacists.Materials and methodsIn January 2017, an electronic survey was e-mailed to Finnish community pharmacies (n=741) via the Association of the Finnish Pharmacies. One pharmacist from each pharmacy, preferably a specialist in asthma, was invited to answer the survey.ResultsCompleted responses were received from 263 pharmacists (response rate =35%), of whom 196 pharmacists were specialists in asthma. Response rate among asthma pharmacists was 42%. Pharmacists were positive about their role in medication counseling and in support of the self-management of COPD patients. COPD-related knowledge was self-assessed as being good and was on a good level in respect of basic facts. However, almost half (46%) of the pharmacists did not know that COPD is considered a national public health issue, and ~50% of the pharmacists were not familiar with the current care guideline on COPD. Medication counseling was found to be more medicinal product-driven and less advisory concerning lifestyle changes such as smoking cessation and physical exercise.ConclusionAlthough the pharmacists’ knowledge of COPD was good on general topics, there were some gaps in their knowledge on the current care guideline and status of the disease. Pharmacists should more systematically individually target medication counseling according to patients’ needs. In addition, lifestyle treatments, including smoking cessation and physical exercise, should be part of the medication counseling.

Electronic prescription anomalies: a study of frequencies, clarification and effects in Finnish community pharmacies

Electronic prescription anomalies: a study of frequencies, clarification and effects in Finnish community pharmacies

The impact of electronic prescriptions on the medicine dispensing process in Finnish community pharmacies - a survey of pharmacists

Objective To explore the impact of electronic prescriptions (ePrescriptions) on the dispensing process in Finnish community pharmacies. Methods A survey of a random sample of dispensers (B.Sc. in Pharmacy) (n = 1004) and pharmacists (M.Sc. in Pharmacy) (n = 228) was conducted in 2014. Key findings Altogether, 778 questionnaires were analysed, giving response rates of 64% (n = 635) for dispensers and 65% (n = 143) for pharmacists. According to the respondents, prescription renewal (75%), transferring prescription data into the pharmacy data system (75%), receiving a prescription (73%), checking prescription information (62%) and making dispensing entries concerning the prescription (58%) have become easier with ePrescriptions. However, correcting dispensing entries afterwards (78%), correcting one's own processing errors made during dispensing (77%), correcting errors on the prescription caused by the physician (73%) and cancellation of medicine dispensing (64%) have been hindered. Technical problems in using ePrescriptions were most often experienced less than once a month. Conclusions Some parts of the dispensing process have become easier, whereas making corrections to the prescription has been hindered with ePrescriptions. Thus, the ePrescription system needs further development to ensure the easy and efficient use of ePrescriptions in the future.

Characteristics of first-time varenicline users \u2013 A cross-sectional study in Finnish quitters

BackgroundVarenicline is an efficacious medicine for smoking cessation (SC) but little is known about the characteristics of varenicline users. This study examined the characteristics of first-time (naïve) varenicline users in Finland and compared those who had previously used SC pharmacotherapy to those who were trying SC pharmacotherapy for the first time.MethodsA cross-sectional survey was conducted in Finnish community pharmacies between February 2014 and January 2015. Pharmacy customers purchasing a varenicline starter package for the first time ever were asked to complete a questionnaire or to participate in a structured interview conducted by the pharmacist (identical questions). The questionnaire included questions about demographic characteristics, smoking habits, previous cessation attempts and factors associated with varenicline use.ResultsAltogether 98 people completed the survey. The majority were daily smokers (96%, n = 94), with a history of over 10 years of regular smoking (94%, n = 92), and a strong/very strong nicotine dependence (67%, n = 66). Half of the participants (54%, n = 53) were trying a SC pharmacotherapy for the first time. Demographic characteristics and smoking habits were similar between first-time and previous users of SC medications (p > 0.05). Health centers (42%, n = 41) and occupational health care clinics (37%, n = 36) were the most common sources of varenicline prescriptions. The majority of participants received the prescription for varenicline after mentioning their desire for quitting to a physician (70%, n = 69).ConclusionsConsidering the relatively large proportion of SC naïve medicine users among new users of varenicline, smokers who have previously been reluctant to quit smoking, to use other pharmacological SC interventions, or perhaps unaware of these options may be interested in attempting cessation with varenicline. Most participants made the initiative to discuss their smoking with the physician, which led to varenicline prescribing. This suggests that physicians may not satisfactorily recognize their patients’ nicotine dependence and desire to quit, and they should more actively support patients’ smoking cessation.

The impact of electronic prescriptions on medication safety in Finnish community pharmacies: A survey of pharmacists

ObjectivesThe purpose was to explore pharmacists’ opinions regarding the impacts of electronic prescriptions (ePrescriptions) on medication safety in Finnish community pharmacies. Further objectives were to explore how often and what kinds of ambiguities or errors pharmacists have perceived in ePrescriptions. MethodA survey of randomly selected dispensers (n=1004) and pharmacists (n=228) was conducted in 2014. ResultsAltogether 778 questionnaires were returned, yielding response rates of 64% (n=635) for dispensers and 65% (n=143) for pharmacists. The respondents felt that ePrescriptions improve medication safety in many areas: they lower the number of prescription forgeries, reduce the risk of dispensing errors, promote better management of the patient’s overall medication, facilitate monitoring of duplicative therapy and drug interactions, and lessen the risk of incorrect interpretation of prescriptions. Many respondents (32%) reported that they had weekly found ambiguities or errors in ePrescriptions that required clarification during the dispensing process. Of the respondents, 18.6% had found such ambiguities or errors daily or almost daily. The three most common ambiguities or errors in ePrescriptions were incorrect total amount of medication (79.0%), missing notation of exceptional dosage instructions or exceptional purpose of use (SIC!) (69.0%), and unclear or incorrect dosage instructions (65.4%). Incorrect strength (14.9%) and incorrect pharmaceutical form (14.2%) were also commonly experienced problems. ConclusionsAccording to Finnish community pharmacists, the introduction of ePrescriptions has promoted medication safety in many areas. However, ambiguities and errors are common in ePrescriptions. Some of these can delay dispensing of the medicine, whereas others can cause serious risks to medication safety.

Preceptors' Need For Support In Tutoring Pharmacy Students in Finnish Community Pharmacies

A pharmacy degree in Finland includes a six-month obligatory internship. The internship is integrated with theoretical studies and adds up to 30 European Credit Transfer and Accumulation System (ECTS) credits of the BSc (Pharm) degree. Learning is supported by reflective assignments from the university. The preceptors have an important role in organizing the internship and tutoring students successfully in community pharmacy settings.&#x0D; Objective: to assess whether the preceptors of University of Helsinki’s teaching pharmacies need pedagogic support in tutoring and if so, in which core pharmaceutical tasks or tutoring skills.&#x0D; Methods: The survey was sent to all preceptors of University of Helsinki´s teaching pharmacies (n=326) in 2011 (response rate 58%, n=190). The data was analyzed statistically using Excel (version 12.3.6). The open-ended questions were analyzed by qualitative content analysis.&#x0D; Results: The majority of preceptors found their skills in tutoring the students mainly good. However, assessment of learning (27% of the respondents), giving feedback (23%) and organizing the learning situations supportive for learning (23%) were the areas in which the preceptors mostly indicated a need for support. Teaching current care guidelines and pharmaceutical care (36%) and multi-professional collaboration (28%) were the areas in which the preceptors expressed that they needed to update their skills.&#x0D; Conclusions: The faculty should focus the support on the pedagogic skills of preceptors, particularly in improving their skills in assessment of learning and in reflective dialogue. In addition, their skills in teaching clinical and patient care aspects of pharmacy practice should be enhanced.&#x0D; Conflict of Interest&#x0D; We declare no conflicts of interest or financial interests that the authors or members of their immediate families have in any product or service discussed in the manuscript, including grants (pending or received), employment, gifts, stock holdings or options, honoraria, consultancies, expert testimony, patents and royalties&#x0D; &#x0D; Type: Original Research&#x0D;

Using pharmacy quality measures in Medicaid drug utilization review programs

Drug–drug interactions (DDIs) are a significant cause for adverse drug events (ADEs). DDIs are often predictable and preventable, but their prevention and management require systematic service development. Most DDI studies focus on interaction rates in hospitalized patients. Less is known of DDIs in outpatients, particularly how community pharmacists could contribute to DDI management by applying their surveillance systems for identifying high-risk medications.The study was related to the implementation of the first online DDI surveillance system in Finnish community pharmacies. The goal was to demonstrate how community pharmacies can utilize their prospective surveillance system 1) for identifying high risk medications causing potential DDIs in outpatients, 2) for collaborative service development with local physicians, and 3) for academic risk management research purposes.All DDI alerts given by the online surveillance system were collected during a one-month period in 16 out of 17 University Pharmacy outlets in Finland, covering approximately 10% of the national outpatient prescription volume. The surveillance system was based on the FASS database, which categorizes DDIs into four classes (A–D) according to their clinical significance.Potential drug–drug DDIs were analyzed for 276,891 dispensed community pharmacy prescriptions. Potential DDIs were associated with 10.8%, or 31,110 of these prescriptions. Clinically significant interaction alerts categorized as FASS classes D (most severe, should be avoided) and C (clinically significant but controllable) were associated with 0.5% and 7.0% of the prescriptions, respectively.Methotrexate and warfarin had the highest risk of causing potentially serious (class D) interactions. These interaction alerts were most frequently between methotrexate and NSAIDs and warfarin and NSAIDs. In general, NSAIDs were the most commonly interacting drugs in this study.This study demonstrates that community pharmacies can actively contribute to DDI risk management and systematically use their surveillance systems for identifying patients having clinically significant DDIs. The findings also indicate that the majority of potentially serious interactions in outpatients involve a limited number of drugs, particularly NSAIDs, warfarin and methotrexate. Further research should focus on community pharmacists' involvement in DDI risk management in collaboration with local health care providers.

Impact of electronic prescription on the job descriptions of community pharmacy staff in Finland - a survey of pharmacy owners

Objectives A fully operational and nationwide electronic prescription (ePrescription) system has been implemented by law in Finland. The aim was to explore the impact of ePrescription on the job descriptions of pharmaceutical and technical staff in Finnish community pharmacies from the pharmacy owners’ perspective. The effects of ePrescription on measures related to equipment and furnishings in pharmacies were also explored. Methods A postal survey was conducted among a random sample of Finnish pharmacy owners (n = 191) in 2014. Descriptive statistical analyses were performed. Key findings The final study material consisted of 155 questionnaires (81% response rate). In many pharmacies the use of ePrescription had affected the job descriptions of technical (73.9%) and pharmaceutical staff (47.4%), and the pharmacy owner's own use of time (44.4%). Prescription processing had decreased among technical staff (92.9%) and increased among pharmaceutical staff (42.3%). Prescription processing and dispensing had become quicker. The implementation of ePrescription had not affected the size of the staff in most of the pharmacies (72.1%). ePrescription had resulted in measures related to furnishings and/or equipment in 60.6% of the pharmacies. Most often, computer equipment had been updated (66.0%) or more computers had been purchased (59.6%). Conclusions The implementation of ePrescription has had an impact on the job descriptions of pharmacy staff in Finnish community pharmacies. Particularly affected has been the job description of technical staff, who now process fewer prescriptions. The transition to the new technology has also necessitated investment in computer equipment and furnishings for dispensing work at pharmacies.