Electronic prescription as a driver for digitalization in Finnish pharmacies.

BACKGROUND: Finnish 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. METHODS: We 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. RESULTS: In 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. CONCLUSIONS: The 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.

Effects of electronic prescription on pharmacy productivity.

Electronic prescriptions affect pharmacy workflows. In this study, we measure the workflow efficiency in pharmacies in 2006 and 2012: both, in traditional workflow when electronic prescription was not in use, and in new direct delivery workflow, which is the mandated workflow model in the case of electronic prescriptions.

Reduced severity and improved control of self-reported asthma in Finland during 2001-2010.

BACKGROUND: Asthma and allergies are common and cause substantial burden in symptoms and suffering, hospitalizations and medication costs. However, despite the high prevalence, asthma burden has already decreased in Finland in 2000s. OBJECTIVE: We carried out an asthma barometer survey in all Finnish pharmacies to study changes in asthma severity and control, and use of health care services from 2001 to 2010. METHODS: Asthma severity, comorbid allergic conditions, and use of medication and health care services were assessed in subjects who purchased asthma or allergy medication from the pharmacies all across the country during one week in 2001 and again in 2010. In 2001, 3,062 patients (mean age, 49 years), and in 2010, 1,114 patients (mean age, 51 years) participated. RESULTS: In 2001 90% and in 2010 73% of the respondents reported physician-diagnosed asthma and were entitled to special reimbursement for their drug costs, i.e., they needed regular maintenance treatment. In 2001, 10% of the asthmatics regarded their disease as severe, compared with 4% in 2010, while the figures for mild asthma were 45% and 62%, respectively (p < 0.001). The proportion of patients needing emergency care during the last year decreased from 34% (2001) to 14% (2010) (p < 0.001) and the need for hospitalizations from 18% to 6% (p < 0.001). Smoking reduced from 24% to 18% among asthmatics ( p = 0.002). In 2010, risk factors for severe asthma were older age, comorbid atopic eczema, and food allergy. CONCLUSION: During ten years, self-reported asthma severity has reduced and disease control improved in Finland.

Starting an automated dose dispensing service provided by community pharmacies in Finland.

BACKGROUND: In an automated dose dispensing (ADD) service, medicines are packed in unit-dose bags according to administration times. When the service is initiated, the patient's medication list is reconciled and the medication is reviewed on the basis of this list. OBJECTIVE: The aim of this national study was to investigate how the medication list was reconciled, what type of medication review was conducted, and what changes were made to the patient's medications when the ADD service is initiated. SETTING: Primary care in Finland. METHOD: All patients enrolled in the service during a 3-week period in autumn 2010 were included in the study. All community pharmacies (n = 267) purchasing unit-dose bags from Espoonlahti Pharmacy documented the actions taken in the ADD initiation process using a structured data collection sheet. MAIN OUTCOME MEASURE: Information sources needed in medication reconciliation, the type of medication review conducted and changes made to patients' medications. RESULTS: Documentation was completed for 147 out of 325 new ADD users resulting 45 % as a response rate. More than one source was needed for 63 % of the patients in medication reconciliation. The most common sources used were nursing staff (72 % of the patients) and an existing medication list (71 %). Some type of medication review, most commonly a prescription review, was conducted for the majority of the patients (96 %), usually in multi-professional collaboration. Treatment-related changes were made for 43 % of the patients and technical changes were made for 93 % of the patients. CONCLUSION: The medication list was incomplete for more than half of the patients. Some type of medication review was conducted for most of the patients. Both treatment-related changes and technical changes were made on patients' medications during the initiation process. The start-up process of the ADD service needs further development to ensure a standard procedure and optimum use of resources.

Comprehensive medication review: development of a collaborative procedure.

This commentary describes the development and evidence-base of the Comprehensive Medication Review (CMR) procedure for community and hospital settings in Finland. The development was coordinated by a national steering group. The group collaborated with 26 experienced pharmacists who developed and tested CMR procedures during a 1.5 year accreditation training for CMR. The development consisted of: (1) a literature review and inventory of medication review procedures in different countries; (2) the creation of potential procedures and related documentation; (3) integration of potential procedures into a national standard procedure; and (4) piloting the standard procedure in practice settings. The resulting comprehensive medication review procedure requires access to a patient's clinical information, an in-home patient interview and a case conference with the collaborating physician. This procedure covers the four main dimensions critical for safe and appropriate geriatric pharmacotherapy: aging and safety; co-morbidities; polypharmacy; and adherence. The CMR measures and documentation build on these dimensions.

Continuing education course to attain collaborative comprehensive medication review competencies.

OBJECTIVE: To implement a long-term continuing education course for pharmacy practitioners to acquire competency in and accreditation for conducting collaborative comprehensive medication reviews (CMRs). DESIGN: A 1(1/2)- year curriculum for practicing pharmacists that combined distance learning (using e-learning tools) and face-to-face learning was created. The training consisted of 5 modules: (1) Multidisciplinary Collaboration; (2) Clinical Pharmacy and Pharmacotherapy; (3) Rational Pharmacotherapy; (4) CMR Tools; and (5) Optional Studies. ASSESSMENT: The curriculum and participants' learning were evaluated using essays and learning diaries. At the end of the course, students submitted portfolios and completed an Internet-based survey instrument. Almost all respondents (92%) indicated their educational needs had been met by the course and 68% indicated they would conduct CMRs in their practice. The most important factors facilitating learning were working with peers and in small groups. Factors preventing learning were mostly related to time constraints. CONCLUSION: Comprehensive medication review competencies were established by a 1(1/2)- year continuing education curriculum that combined different teaching methods and experiential learning. Peer support was greatly appreciated as a facilitator of learning by course participants.