The principles of person-centredness in quality patient care-Evaluation of the Community Pharmacy Services Quality Guidelines in Estonia.

INTRODUCTION: Person-centredness is considered a key component of quality healthcare and the core competence of all healthcare professionals. However, person-centred care (PCC) is not often considered a priority for improving the quality of healthcare. This study aimed to evaluate to what extent the PCC principles are included in the Community Pharmacy Services Quality Guidelines (CPSQG) in Estonia. METHODS: The deductive content analysis was performed using the PCC framework developed by Santana et al. RESULTS: Approximately 2/3 (n = 78) of the CPSQG indicators (n = 126) in the practical guide used in Estonian community pharmacies support PCC principles. These results demonstrate that quality service itself includes some PCC components, as it forms an integral part of quality care and is directly related to its development. More than half (61.6%) of the CPSQG indicators were divided into process (covering the interaction of pharmacists and patients), one fourth into structure (mainly represented as environment and operation topics), and one tenth into outcome category (access to care). This result is in line with the situation of pharmacies in Estonia, where the current focus is on developing and implementing quality services (e.g., quality guidelines, e-tools supporting dispensing, restructuring of counselling area for private consultations) and finding the necessary resources for described activities. CONCLUSIONS: To support a more effective application of PCC principles in the community pharmacy practice, the CPSQG should be supplemented with indicators identifying patients' individual preferences, values, and needs. Additionally, interactions with other healthcare professionals should be encouraged, and they should be engaged in developing the CPSQG.

E-solutions in Estonian community pharmacies: A literature review.

Objective: Estonian innovative electronic solutions have long been leading the way in the healthcare sector. This article aims to give an overview of all e-solutions and their usability in community pharmacies in Estonia and how they compare and operate with the wider e-health system. Methods: A comprehensive literature review was conducted on publicly accessible information regarding Estonian e-health and electronic community pharmacy solutions. Findings: While Estonian e-health system, including the e-prescription system is developed and maintained by the nationally funded Health and Wellbeing Infosystem Center, community pharmacy owners have established many noteworthy systems such as the e-pharmacist decision-support system, commodities info systems, online pharmacies, a telehealth prescription reminder service, and an automated dosage dispense system. Some pharmacies are collaborating with private healthcare service providers to allow quick and easy prescription renewal through an electronic channel. Conclusion: Different electronic systems have overall greatly improved Estonian pharmacy services, accuracy and flow of consultations, and accessibility of medicines. In some cases, more support and active involvement is still needed from government agencies for full implementation.

Experiences and Expectations of Ethnic Minorities and Majorities towards Community Pharmacy Medicines-Related Services in Estonia.

The unique professional competence of pharmacists can support the safe and effective use of medicines by patients. Additionally, it is important to acknowledge and incorporate the needs of patients with various cultural and social backgrounds. The objective of this study was to assess and compare the experiences and expectations of Russian- and Estonian-speaking pharmacy customers about medicines-related services in Estonian community pharmacies. Cross-sectional study among pharmacy customers was conducted in Estonia 2018−2020. For data analysis, an Independent t-Test was used to compare experiences and expectations of respondents towards medicines-related services. The study involved 552 pharmacy customers: 58.5% (n = 323) Estonians and 41.5% (n = 229) Russians. The majority of the total sample (78.3%) considered the pharmacist competent to help. Medicines-related concerns were more common among Russians (p = 0.037), however, they sought less contact to consult a pharmacist than Estonians (p < 0.001). Furthermore, expectations about different medicines-related services in the future were higher among Estonians than among Russians (p < 0.001). Community pharmacists in Estonia should focus more on person-centered care to better meet the expectations and needs of different ethnic groups about medicines-related services. It is also important to reduce the language barrier and to increase the recognition of cultural traditions by health professionals.

A qualitative study of the challenges in rearranging community pharmacy service provision during the COVID-19 public health emergency: The prism of social practice theory.

OBJECTIVES: While healthcare systems struggle to manage the COVID-19 pandemic, community pharmacies have changed the way in which they serve society by ensuring the availability of primary-level medical care. This study aims to examine the rearrangement of service provision at community pharmacies through the prism of social practice theory. STUDY DESIGN: Qualitative in-depth semi-structured interviews. METHODS: In total, 21 community pharmacists, 3 hospital pharmacists and 10 experts in Estonia were interviewed. For data analysis, two-dimensional thematic textual analysis was performed according to four types of practices proposed in social practice theory and based on temporal distinction. RESULTS: The findings of this study reveal that, in order to maintain and improve community pharmacy service provision during the pandemic, there have been changes to all aspects of practice elements, including practical understandings, rules and teleological structures. The majority of challenges were experienced because of necessary changes to the habitual ways of providing pharmacy services, indicating resistance to these changes and reinforcing the need to continue existing 'practice-bundles'. Limited access to healthcare services during the COVID-19 pandemic has resulted in community pharmacists becoming the primary (and only) accessible healthcare contact; thus, leading to a shift in awareness about the role of pharmacists. CONCLUSIONS: Although large-scale changes may result in the dissolvement of practice-bundles and require readiness to adjust current methods of service provision, dissolution is a gradual process. There is an urgent need to support pharmacists in managing the challenges of rearranging service provision, such as immediate organisational changes, lack of information and changing resources.

Use of Face-to-Face Assessment Methods in E-Learning-An Example of an Objective Structured Clinical Examination (OSCE) Test.

The spread of COVID-19 and social-distancing rules have increased the need for alternative learning environments with a focus on e-learning platforms. The objective of this study was to assess whether and to what extent the transition from traditional learning and assessment environment to the e-setting impacts the knowledge and skills acquired by students and their satisfaction with new e-solutions of taking the OSCE test. The study compared the results of three face-to-face (2018-2019) and one electronically conducted (2021) OSCE tests, as well as students' feedback on the content and organization of the tests. For data analysis the one-way ANOVA test and post hoc multiple comparisons were used. The results demonstrated the feasibility and effectiveness of and students' satisfaction with OSCE tests in the Zoom environment. However, more focus on communication techniques is required in a remote communication environment to better cover all patient health-related and drug communication aspects. There were identified differences between undergraduate students and practicing assistant pharmacists in assessing patients' health problems and providing corresponding counseling. This result points to the need to implement the continuous development of patient-centered counseling techniques in the lifelong learning of pharmacists and the need to use innovative digital solutions, if applicable.

Profession Driven Improvement of the Quality of Pharmacy Practice-Implementation of Community Pharmacy Services Quality Guidelines in Estonia.

Constant improvement of the quality of community pharmacy services is important in the development of contemporary patient care. A national and voluntary Community Pharmacy Services Quality Guidelines (CPSQG) was developed to formulate the principles of contemporary pharmacy services, including quality criteria for service provision. The purpose of this study was to identify the implementation of the CPSQG as a profession-driven initiative towards improving and harmonizing community pharmacy services in Estonia. Three cross-sectional electronic surveys were conducted among community pharmacies in Estonia in 2014 (N = 478 pharmacies), 2016 (N = 493), and 2019 (N = 494), and the CPSQG indicators were used for evaluation of the service quality. In this study, the aggregated data, collected in three study years were used to identify the implementation of guidelines into practice. For data analysis, the One-Way ANOVA test and Post-hoc multiple comparisons were used. The results demonstrated slow implementation of the CPSQG, but guidelines-based evaluation enabled a detailed overview of the community pharmacy activities and provided services. In order to develop community pharmacy services more efficiently, the use of implementation science principles, continuous introduction of the CPSQG to the pharmacists, and more active involvement of the state could be considered in the future.

Primary health care policy and vision for community pharmacy and pharmacists in Estonia.

Estonia, with a population of 1.3 million, is the smallest country in the three Baltic States. As a post-soviet country, Estonia over the past 30 years has built up a new health care system, including the pharmaceutical sector. The GDP allocated to cover health care costs is significantly lower in Estonia compared to the EU average. Despite this, Estonia has excelled in the development of digital e-services in healthcare at both the domestic and international levels. The development and integration of the Estonian community pharmacy sector into primary health care has been influenced and affected by the liberalization within pharmaceutical policy and the lack of cooperation with the rest of the health care sector. Community pharmacy ownership and location matters have been prevalent. The promotion of the pharmacy services has mostly taken place on the basis of a professional initiative, as cooperation with the state has not been active. Possibly the professional fragmentation of the pharmacy sector may have played a negative role. The community pharmacy network in Estonia, especially in cities, enables fast and convenient access to the pharmacy services. Community Pharmacy Service Quality Guidelines support the harmonization of the provided services and patient-centered concept to enhance the patient role and involvement in their care. In recent years, community pharmacies in Estonia have also offered various extended services that are more or less integrated with the primary health care system. New developments may be affected by frequent changes in legislation and a shortage of professional staff in community pharmacies. The ownership reform of pharmacies in 2020 has so far not had a significant impact on the operation of pharmacies or the quality of services provided.

Students' Feedback on the Development of a Competency-Based Pharmacy Education (CBPE) at the University of Tartu, Estonia.

Increasing need in society to provide collaborative and patient-centered pharmaceutical care has to be addressed in curriculum development. Principles of competency-based pharmacy education (CBPE) could be seen as one solution to the new professional challenges of pharmacists. At the University of Tartu (UT), the Pharmacy curriculum was updated in 2019 to introduce principles of CBPE. The aim of this study was to gather initial students' feedback on the development of CBPE at the UT. The survey was conducted in the spring semester of the 2019/2020 academic year to collect feedback about all curricula at the UT. All 1st, 3rd, and 5th year pharmacy students (n = 67) were invited and 70.1% (N = 47) of them also participated in this study in order to evaluate the Pharmacy curriculum. Pharmacy students were more complacent with the content and less with the fixed structure of the Pharmacy curriculum. Students emphasized more theoretical knowledge and less practical and transferable skills of the competencies developed over the studies. Initial student feedback on the development of CBPE in Estonia demonstrated that theoretical knowledge needs to be more integrated with practice throughout the curriculum. In the future, more attention should be paid to the development of transferable skills, including digital skills.

How involvement of community pharmacies improves accessibility to and awareness about flu vaccination? - An example from Estonia.

BACKGROUND: In Estonia, seasonal influenza vaccination coverage is poor, being in recent years the lowest in the older age groups. In 2018 the flu vaccination was first provided at community pharmacies in Estonia. The aims of this study were to evaluate the experience of flu vaccination at community pharmacies by pharmacy customers and to learn about the perception of community pharmacists regarding the immunization service. METHOD: Two cross-sectional surveys: among pharmacy customers after receiving flu vaccination (n = 257), and for pharmacy professionals (n = 209). Descriptive statistics were calculated in both studies. RESULTS: In the pharmacy customers` study, 54.9% received flu vaccination for the first time. Most of the respondents (96.8%) were satisfied with the quality of service. In both studies, community pharmacies were described as an accessible and convenient setting for immunization. Age and working experience of pharmacy professionals influenced the readiness to provide flu immunization, with younger pharmacists (<36 years) keener to be involved in vaccination services (p < 0.01). EXPERT OPINION: Increasing influenza vaccination in high-risk patient groups is crucial. The involvement of other healthcare professionals, such as community pharmacists, could be key to reaching these patient groups and improving access to vaccination services in general. The development of the pharmacy profession has also shifted from pharmaceutical product based to patient oriented approach with provision of more clinical services. This enables to use professional competency of pharmacists in healthcare more widely. Lack of resources (financial, healthcare professionals, etc.) and an aging population are driving new ways to deliver healthcare more efficiently with the pharmacist working with other healthcare providers taking greater responsibility for patient health outcomes. CONCLUSION: Vaccination service at community pharmacy has a great potential to expand flu immunization coverage in Estonia. Despite on pharmacy professionals are not allowed to provide vaccination service at the moment, their contribution to increase public awareness about flu vaccination is significant.

Pharmacy Practice and Education in Estonia.

The Pharmacy Education in Europe (PHARMINE) project studied pharmacy practice and education in the European Union (EU) member states. The work was carried out using an electronic survey forwarded to selected pharmacy representatives at community and hospital pharmacies, in the pharmacy industry and at drug authorities. The surveys of the individual member states are now being published as reference documents for students and staff interested in research on pharmacy education in the EU, and in mobility. This paper presents the results of the PHARMINE project on pharmacy practice and education in Estonia. In this paper, we examine the harmonisation of practice and education in Estonia with EU norms. Community pharmacies in Estonia provide traditional and extended services, of which influenza vaccination, the evaluation of the risk of diabetes, and medication use review have been introduced recently. Pharmacists (in Estonian proviisor) study at the University of Tartu for five years and graduate with a Master of Pharmacy (MSc Pharm) degree. A pharmacist can be the owner of a pharmacy, or work as a pharmacy manager or chief pharmacist in either a community or a hospital pharmacy. Assistant pharmacists (in Estonian farmatseut) study at the Tallinn Health Care College for 3 years; after graduation, they are mainly employed in community pharmacies. The University of Tartu is the only university in Estonia providing higher education in pharmacy at university level. The pharmacy curriculum is an integrated (bachelor followed by master), pharmaceutical product-oriented study programme. It was last updated in 2019. On that occasion, several changes were made such as the introduction of competency-based modules; novel methods in education and training based on the constructive alignment and the restructuring of the six-month traineeship. Several new courses focus on the concepts of clinical pharmacy and on patient-centred communication. In the current pharmacy curriculum, there is a balance between chemical and medical subjects. The traineeship is provided for six months at a community and/or hospital pharmacy in the 5th year. Currently, the pharmacy curriculum at the University of Tartu does not offer specialization in subjects such as hospital or industrial pharmacy.

The Implementation of Pharmacy Competence Teaching in Estonia.

Background: The PHAR-QA, "Quality Assurance in European Pharmacy Education and Training", project has produced the European Pharmacy Competence Framework (EPCF). The aim of this study was to evaluate the existing pharmacy programme at the University of Tartu, using the EPCF. Methods: A qualitative assessment of the pharmacy programme by a convenience sample (n = 14) representing different pharmacy stakeholders in Estonia. EPCF competency levels were determined by using a five-point scale tool adopted from the Dutch competency standards framework. Mean scores of competency levels given by academia and other pharmacy stakeholders were compared. Results: Medical and social sciences, pharmaceutical technology, and pharmacy internship were more frequent subject areas contributing to EPCF competencies. In almost all domains, the competency level was seen higher by academia than by other pharmacy stakeholders. Despite on-board theoretical knowledge, the competency level at graduation could be insufficient for independent professional practice. Other pharmacy stakeholders would improve practical implementation of theoretical knowledge, especially to increase patient care competencies. Conclusions: The EPCF was utilized to evaluate professional competencies of entry-level pharmacists who have completed a traditional pharmacy curriculum. More efficient training methods and involvement of practicing specialists were suggested to reduce the gaps of the existing pharmacy programme. Applicability of competence teaching in Estonia requires more research and collaborative communication within the pharmacy sector.