Browsing by Subject "farmasia, sosiaalifarmasia"

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  • Mononen, Niina (Helsingin yliopisto, 2020)
    Medicines information (MI) is an essential part of rational pharmacotherapy. Intensified clinical research and more matured pharmacovigilance systems have produced more information on therapeutic effects of pharmacotherapies to facilitate more detailed profiling of their benefits and risks. In turn, more open communication on medications with patients has been facilitated by drug safety issues, patients’ right to know about their treatments and by a significant increase in electronic information sources. Even though a wide variety of evidence-based MI sources for patients and consumers is currently available, the coordination between MI sources and their providers has been limited. The need for coordination has become more evident as the number of MI sources and providers has substantially increased over time. Improved communication on medicines to patients and consumers has been a strategic priority in developing MI practices in the European Union, including Finland, during the 2000s. To enhance the coordination of MI practices in Finland, the Finnish Medicines Agency Fimea published the first national MI strategy in 2012. The primary goal of the national MI strategy is to influence MI practices in all social and healthcare settings to reach the ultimate goal of well-informed patients who adhere to their medication. This thesis examines MI practices and policies in Finland during the 2000s. The primary goal of the thesis is to support the strategic development of MI and the implementation of the national MI strategy. The thesis comprises three independent studies (I–III) in which both quantitative and qualitative research methods were applied. They investigated development targets for MI practices in Finland based on a systematic review of the existing literature (I), assessed long-term trends in the receipt of MI among the Finnish adults (II), and evaluated how well the ultimate goal of the national MI strategy regarding well-informed adherent patients with chronic diseases had been achieved at the midpoint of the strategy period in 2015 (III). The systematic review on MI research conducted in Finland during 2000–2016 found 126 studies that covered a wide range of approaches applying various research methods (Study I). More than half of the studies were qualitative (54% of all studies, n=68), although surveys were the most commonly used individual method (47%, n=59). Twelve studies were interventions and only six studies applied a theory. Patient counselling in community pharmacies was the most commonly studied topic (19%, n=24). Regardless of some methodological pitfalls, MI research provides a multifaceted understanding of MI practices and their development needs in Finland. Research should shift towards larger research lines having a stronger theory base and study designs. Future research should be focused on the effectiveness of MI in different healthcare settings, along with the use of electronic MI sources and services, MI literacy, MI needs among patients and healthcare professionals (HCPs). Based on the nationally representative repeated postal survey “Health Behaviour and Health among the Finnish Adult Population” conducted by the National Institute for Health and Welfare during 1999–2014, physicians, community pharmacists and package leaflets were the main MI sources among adult medicine users aged 15–64 years (n=18862) throughout the study period (Study II). The use of the Internet as a MI source increased the most noticeably, being used by 1% of the adult medicine users in 1999 and 16% in 2014. The number of medicine users who did not receive MI from HCPs more than doubled (17% to 38%), and the number of medicine users who did not receive MI from any sources increased by sevenfold (4% to 28%) during the study period. It is necessary to continue research on trends in the receipt of MI at the population level and to identify population groups requiring special attention, such as senior citizens with multiple medications. Further evidence is also needed on factors contributing to a growing number of medicine users not receiving MI. According to the interviews among stakeholder representatives (n=79, 71%) involved in the implementation of the national MI strategy, the medication use processes for patients with chronic diseases requires development at every level of implementation (i.e., macro, meso, micro) (Study III). Medication counselling and other care advice by HCPs, particularly by community pharmacists, were the best implemented actions in general. The major actions needing development at the infrastructure level (macro) concern the coordination of care, transfer of patient information between care units, lack of reconciled medication lists, and local and national agreements on the responsibilities of patients and HCPs involved in the medication use process; at the HCP level (meso), focus on implementing the entire medication use process in primary and social care, particularly in geriatric units; and at patient level (micro), related to limited patient involvement in their care, lack of patients’ adherence to treatment and the inability of patients to retrieve information. Patients need to be better involved in implementing their treatment by improving empowerment and partnership to achieve the goal of well-informed adherent patients. KEYWORDS Medicines information, medicine user, patient, strategy, Finland