Browsing by Subject "sosiaalifarmasia"

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  • Kekäle, Meri (Helsingin yliopisto, 2016)
    The establishment of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of chronic myeloid leukemia (CML) during the last fifteen years. This study explored the journey of 86 patients with CML using oral TKI treatment in Finland. The aim was to assess their adherence to TKIs and how the adherence, which is crucial for treatment outcomes, could be improved. This study applied quantitative and qualitative methods and a randomized controlled study design during 2012-2014. All patients participated in the in-person interview, which followed the idea of the patient s journey with CML from the time before diagnosis to the study point. Patient-reported adherence was evaluated using Morisky s 8-Item Medication Adherence Scale (MMAS) (I-IV). Physicians were also asked to assess their patients adherence. Patient-reported adverse drug reactions (ADRs) and quality of life (QoL) were assessed during the interview using a structured questionnaire (II, III). The patient s knowledge of the disease and TKI treatment was evaluated by asking five key questions (I, III, IV). The intervention with 9-month follow-up in Study IV was based on tailored patient education combining nurse-conducted face-to-face counseling, educational video, patient booklet, website and text message reminders. The intervention material had the following learning objectives: CML as a disease, goals for TKI treatment, the importance of taking TKI medication as prescribed, and self-management of ADRs. A total of 86 patients participated in the study (approximately 20% of all Finnish CML patients). Of the patients enrolled, 43 were randomized into the intervention group and 43 into the control group (IV). A total of 68 patients completed the study. The results show that the response to TKI treatment was high (I), with 81% of the patients showing an optimal response to their treatment according to European LeukemiaNet 2013 recommendations. The CML patients knowledge of the disease and its treatment was poor (I). Despite the high molecular response rates to TKIs, adherence was not good in most of the patients: less than a quarter (23%) showed high adherence, 56% medium adherence, and 21% low adherence (I). Adherence was not influenced by patients gender, age, education, knowledge, time from diagnosis, ADRs, number of comorbidities or number of other medications. There was a considerable difference between observed and experienced adherence: 94% of the patients were highly adherent according to the physicians assessment, compared to 23% (I). The most common reason for unintentional non-adherence was forgetting to take the medication (I, III, IV). In the interviews patients reported self-regulation of medication taking, particularly on those occasions where patients wanted to avoid ADRs (III). The incidence of patient-reported ADRs was high (II). At the time of the study 97% of the patients reported suffering from at least one ADR, most commonly muscle soreness or cramp (80%), swelling of hands, legs, feet, or around the eyes (69%), and fatigue (50%). Patient interviews indicated that ADRs were the most common barriers to adherence (III). More than half of the patients felt the ADRs had a negative influence on their daily QoL (II). Compared with the total study group, the incidences of almost all symptoms were higher among patients whose symptoms negatively affected their daily life than those who reported no such influence (II). The patient journey model developed in the study (III) identified the following critical phases in the CML patient s journey: getting the diagnosis, starting the treatment, getting continuous support for treatment self-management, and managing fear caused by perceived severity of the disease. Even though only 44% of the low-adherent patients in the study experienced the TKI treatment as inconvenient, most of the patients (94%) were willing to stop taking the medication in the future if possible (III). All CML patients in the study were lacking a treatment plan and only a few had a medication list (I, III). The knowledge test (I, III) showed that patients had a poor understanding of their disease and its treatment, while low-adherent patients indicated that understanding the consequences of not taking the medication and the goal for the treatment would be motivating factors to adhere to the medication (III). The intervention significantly improved adherence (IV). In the intervention group the MMAS score increased more often than in the control group (p=0.001). The MMAS score declined in almost half of the patients in the control group, but only in 9% of those in the intervention group (p=0.001). A majority of the patients found the intervention useful, the most useful parts being face-to-face counseling and the educational booklet. Text messages were least valued. The findings of this study suggest that non-adherence is common among Finnish CML patients and that physicians seem to be too optimistic in assessing their patients adherence. The complex interplay between symptom burden, adherence, self-regulation, managing with ADRs, response to TKI therapy, and healthcare utilization highlights the need for regular symptom burden assessment in CML as a means to identify potential adherence problems before they affect the patients response to TKI treatment. Tailored patient education improved the adherence of patients with CML after a 9-month follow-up. Without the additional support, adherence behavior tended to decline. Patients were most satisfied with face-to-face counseling by the nurse, which means they need personal support and practical aids to help them manage their medication in everyday life. Access to personal counseling and information should be systematically planned as an essential part of CML care. Appropriate and updated information in printed and electronic formats should be available for nurses and other healthcare personnel to enable them to support their patients. The findings of this study suggest that patients perceptions and preferences should be understood and taken into account when designing patient education interventions for real-life clinical practice. The findings also highlight the need to further evaluate the interventions to enhance adherence. There is a need for communication to increase patients abilities to follow their treatment plan throughout their journey, which requires real partnership between healthcare professionals and patients.
  • Kurko, Terhi (Helsingin yliopisto, 2015)
    Nicotine Replacement Therapy (NRT) products are the most commonly used smoking cessation (SC) pharmacotherapy. This study explored the deregulation of NRT products from pharmacy-only distribution to general sales in Finland which took place in 2006. The overall aim of this study was to assess the reasons for the NRT deregulation and its reflections on SC practices in Finland. NRT deregulation was explored from three perspectives: 1) policy-making; 2) community pharmacists as health care professionals providing guidance on NRT use; and 3) NRT users perceptions of NRT in SC. The NRT deregulation from the policy-making perspective was assessed by inductive content analysis of all the publicly available documents and interviews of 12 Members of the Parliament (Study I). A nationwide representative survey to every second pharmacy owner and staff pharmacist (n=2291) was conducted a year after the deregulation in 2006-2007 (Studies II and III). The NRT users perspective was assessed by inductive content analysis of smokers and quitters postings (n=24 481) in five internet discussion areas in the national SC support Forum, STUMPPI, in 2007-2012 (Study IV). The NRT deregulation was politically communicated as a safe and evidence-informed decision promoting public health by advancing SC in Finland (I). However, two of the most important motives for the deregulation, poor NRT availability and the effectiveness of sole NRT use in SC, were largely based on assumptions instead of scientific evidence. At the time of the pharmacists survey, nearly half of the respondents reported being familiar with the Finnish SC Guideline. The familiarity with the Guideline was directly reflected in the level SC actions taken by pharmacist (II). Due to the NRT deregulation, in particular pharmacy owners , motivation towards counselling NRT customers decreased (III). The analysis of smokers and quitters internet-based discussions (IV) revealed that many Finnish smokers and quitters saw NRT as less important in SC or held negative perceptions towards NRT use. From smokers and quitters perspective, the most highlighted factors of successful quitting were quitters own psychological empowerment and peer support from the discussion community. This study found a great variety of NRT usage patterns. Of these, the most commonly emerged one was the use of lower dosage or shorter period compared with the instructions on NRT use. The findings of this study suggest that the sole increased NRT use may not be so crucial for SC as suggested during the political decision-making process. This study provided also evidence that in Finland NRT products are used in a way which may not be optimal for treatment success. Therefore many smokers and quitters could benefit from personalized support for NRT use which would include behavioural components and a plan for NRT use to optimize the treatment. In future it is important to guarantee that community pharmacist are not lost as an important public health resource to provide such individualized NRT counselling and managing personalized SC plans. In addition, there is a need to develop more advanced SC services fitting to the needs of individual quitters. These services could utilize internet-based services and peer support. The findings of this study highlight the need to further evaluate the public health benefits gained from the deregulation.
  • Leikola, Saija (Helsingin yliopisto, 2012)
    Populations in Western countries are ageing. At the same time, use of medications is increasing among older people. Age-related changes in the body make the elderly vulnerable to adverse drug events. Thus, ensuring medication safety among this patient group is a growing health care concern. The aim of this study was to examine the Finnish collaborative Comprehensive Medication Review (CMR) model as a means to improve the appropriateness of pharmacotherapy among community-dwelling elderly. The specific aims were 1) to determine the prevalence of potentially inappropriate medication use according to the Beers 2003 criteria among Finnish non-institutionalized population aged ≥65 years; 2) to describe the development and assess participant satisfaction on the CMR accreditation training; 3) to describe the development of the CMR procedure and related documentation; and 4) to assess the drug-related problems (DRPs) pharmacists report to collaborating physicians during CMR and the resulting interventions among outpatients aged ≥65 years. The prevalence of potentially inappropriate drug use was studied by using the drug reimbursement register of the Social Insurance Institution covering the entire non-institutionalized population aged ≥65 years in 2007 (n=841 509, Study I). The development of the CMR procedure and accreditation training involved a review of literature and international medication review procedures, and pilot testing by 26 experienced pharmacists undergoing the CMR training in 2005 - 2006 (Studies II, III). Pharmacists satisfaction on the CMR training (n=38) and documentation (n=27) were assessed by surveys completed by CMR training participants in 2006 - 2007 (Studies II, III). The DRPs reported to the collaborating physicians were studied by a retrospective review of CMR case reports (n=121) by 26 community pharmacists attending the CMR training in 2006 - 2007 (Study IV). Approximately 15% of the non-institutionalized population aged ≥65 years used potentially inappropriate medications in 2007. The most worrying finding was the common use of benzodiazepines, particularly high-dose temazepam. The 1.5-year CMR accreditation training for practicing pharmacists combines distance learning and face-to-face learning. The participating pharmacists satisfaction with the training was high but several factors prevent them from conducting CMRs after the training. The collaborative CMR procedure involves access to clinical patient information, in-home patient interview, a case conference with the collaborating physician and standard documentation to support the process. The procedure covers four dimensions critical for safe and appropriate geriatric pharmacotherapy: Aging and Safety; Co-Morbidities; Polypharmacy; and Adherence. During CMR pharmacists reported to collaborating physicians an average of 6.5 DRPs/patient. Most common DRPs were inappropriate drug selection, especially involving psychotropics, and undertreatment. Also treatment of pain was often found to need improvement. Approximately half of the pharmacists recommendations led to medication changes, i.e., to an average of 3 changes/patient. The most common agreed change was to stop hypnotics or sedatives. The CMR procedure could be beneficial for improving pharmacotherapy among older outpatients as a large portion of DRPs identified by pharmacists led to medication changes. Actions to facilitate implementation of the model to Finnish health care system are needed. Also, further studies are needed to evaluate the effects of CMR on clinical, humanistic and economic outcomes.
  • Alaranta, Antti (Helsingin yliopisto, 2006)
    For many athletes, sport is not safe enough without medicines. Heavy physical training causes several physiological and pathophysiological changes and stress in respiratory, cardiovascular, immunologic, endocrinological, and musculoskeletal systems in highly-trained athletes. If athletes suffer from asthma, high blood pressure, or cardiac arrhythmia, sport challenges their bodies under unique stresses, which raise the likelihood of a chronic or catastrophic harm. The present study aimed at determining the use of prescribed medication and factors associated with it in a large number of elite athletes compared with a representative control sample of the general population. Of all the athletes (N = 494) financially supported by the National Olympic Committee, 446 completed a structured questionnaire (response rate 90.3%) in 2002. A control group (N = 1503, response rate 80.1%) comprised an age-matched sample from the population-based study collected by the National Public Health Institute. The use of prescribed asthma and allergy medication, non-steroidal anti-inflammatory drugs (NSAID), and oral antibiotics during the past seven days is 2-4-fold in elite athletes compared with the general population of the same age. Allergy medication is most commonly used medicine group among athletes followed by NSAIDs, asthma medication and oral antibiotics. Every fifth athlete reported of the adverse effects associated with the use of NSAIDs. The frequency of self-reported asthma medication is clearly lower than the reported occurrence of physician-diagnosed asthma in a large sample of Finnish Olympic athletes. Use of asthma medication is most frequent in endurance athletes, but no difference is found between winter and summer sport athletes. Female athletes use asthma medication more often than males. No evidence of overuse of inhaled 2-agonists is found. Treatment of airway inflammation seems unsatisfactory. Endurance athletes have physician-diagnosed allergic rhinitis and they use allergy medication more often than athletes in other events or control subjects. Female athletes use allergy medication more frequently than male athletes. Only half of the athletes reporting allergic rhinitis take allergy medication. More attention needs to be paid to the optimal management of allergic rhinitis in highly-trained athletes. All the above-mentioned medicines have potential adverse effects that may have deleterious impact on the maximum exercise performance of elite athletes. Thus, any unnecessary medicine use should be minimized in elite athletes.
  • Pohjanoksa-Mäntylä, Marika (Helsingin yliopisto, 2010)
    The range of consumer health and medicines information sources has diversified along with the increased use of the Internet. This has led to a drive to develop medicines information services and to better incorporate the Internet and e-mail into routine practice in health care and in community pharmacies. To support the development of such services more information is needed about the use of online information by consumers, particularly of those who may be the most likely to use and to benefit from the new sources and modes of medicines communication. This study explored the role and utilization of the Internet-based medicines information and information services in the context of a wider network of information sources accessible to the public in Finland. The overall aim was to gather information to develop better and more accessible sources of information for consumers and services to better meet the needs of consumers. Special focus was on the needs and information behavior among people with depression and using antidepressant medicines. This study applied both qualitative and quantitative methods. Consumer medicines information needs and sources were identified by analyzing the utilization of the University Pharmacy operated national drug information call center (Study I) and surveying Finnish adults (n=2348) use of the different medicines information sources (Study II). The utilization of the Internet as a source of antidepressant information among people with depression was explored by focus group discussions among people with depression and with current or past use of the antidepressant(s) (n=29, Studies III & IV). Pharmacy response to the needs of consumers in term of providing e-mail counseling was assessed by conducting a virtual pseudo customer study among the Finnish community pharmacies (n=161, Study V). Physicians and pharmacists were the primary sources of medicines information. People with mental disorders were more frequent users of telephone- and Internet-based medicines information sources and patient information leaflets than people without mental disorders. These sources were used to complement rather than replace information provided face-to-face by health professionals. People with depression used the Internet to seek facts about antidepressants, to share experiences with peers, and for the curiosity. They described that the access to online drug information was empowering. Some people reported lacking the skills necessary to assess the quality of online information. E-mail medication counseling services provided by community pharmacies were rare and varied in quality. Study results suggest that rather than discouraging the use of the Internet, health professionals should direct patients to use accurate and reliable sources of online medicines information. Health care providers, including community pharmacies should also seek to develop new ways of communicating information about medicines with consumers. This study determined that people with depression and using antidepressants need services enabling interactive communication not only with health care professionals, but also with peers. Further research should be focused on developing medicines information service facilitating communication among different patient and consumer groups.
  • Hämeen-Anttila, Katri; Kansanaho, Heli; Katajavuori, Nina; Kivioja, Akseli; Pohjanoksa-Mäntylä, Marika; Puumalainen, Inka; Airaksinen, Marja (Suomen farmasialiitto, 2002)
  • Parkkamäki, Stina (Helsingin yliopisto, 2013)
    The empowerment based support of type 2 diabetes self-management at the community pharmacy The number of cases of diabetes is constantly growing globally. Today Finland has half a million diabetics and their number is predicted to double over the following 10-15 years. Diabetes, a progressive chronic disease, is a burden on the individual as well as society. A health-promoting lifestyle is known to prevent complications caused by diabetes. Patients with diabetes are responsible for the day-to-day decisions concerning their care and condition. The continuous self-management of the disease is a challenge to the patients and health care professionals alike. An empowerment based local program to support the self-management of type 2 diabetes was developed. The research was conducted in an ordinary community pharmacy practice setting and the goal was to examine the outcomes of enhancing the self-management of type 2 diabetes through patient empowerment. First, a survey was conducted to all type 2 diabetes patients in the community as identified by the registry of the local health care centre s nurse (n = 438) to assess their self-management practices. The second part of the research was the controlled intervention study, which examined changes in self-management during the one year long pharmacy intervention at the Mäntyharju community pharmacy. Twenty (20) out of the 116 patients who volunteered to participate were randomly assigned to the pharmacy intervention group and twenty (20) age- and gender- matched individuals to the control group. The members of both groups were urged to attend the seven information-based public diabetes events in addition to their normal diabetes care at the local health care centre. The surveys and the results of the clinical tests were analyzed by quantitative methods using the SPSS statistical analysis software program. The pharmacy meeting discussions were analyzed by qualitative methods, mainly using content analysis guided by the theory of empowerment (Siitonen 1999). The survey s response rate for local patients with diabetes was 52 % (n = 224). A total of 83 % (n = 186) of the respondents were overweight. There were shortcomings in the patients self-management and disease control. The state of their own diabetes and the relevance of clinical measures and their meaning were unclear to some patients. Their basic knowledge of diabetes as a disease and its pharmacotherapy and medication was weak. The patients were theoretically aware of the importance of self-management. In the intervention and control groups all the participants were overweight but wanted to improve their living habits. Although they had some knowledge of self-management by a healthy lifestyle practical tools to lose weight were missing. Qualitative and quantitative changes in nutrition and exercise improved more with personal support of the pharmacy intervention group than in the control group. Weight loss (3,5 ± 6,6 kg), waistline (4,0 ± 6,0 cm) and total cholesterol reduction (0,5 ± 0,9 mmol/l) were statistically significant (p<0,05) in the pharmacy intervention group. In the control group all the mean changes except weight (0,3 ± 3,1 kg) and HDL (0,2 ± 0,11 mmol/l) developed negatively. At the beginning of the research, the empowerment process depended on the extent of the patients actual commitment to changing their life habits. The new information or a revision of prior beliefs gained during the intervention raised the levels of understanding, awareness and readiness to change self-management practices. Changing old behavioral patterns required competence, time and patience. The efficacy of participants self-management increased through encouragement, individual efforts and experience gained from repeated attempts. The pharmacist s continuous support and reinforcement based on empowerment contributed to the participants' sustained motivation. Empowerment applied to self-management supports a commitment to new patterns of behavior. Improving the diabetes patients' understanding of their condition and simultaneous long-term personal support improved the results of diabetes care outcome measures more in the pharmacy intervention group than in the control group. Services like this open new dimensions for the Finnish pharmacies to participate in the patient care.
  • Hämeen-Anttila, Katri; Katajavuori, Nina (Helsingin yliopisto, 2021)
    Teos on ainoa suomenkielinen menetelmäkirja, joka soveltaa yhteiskunta- ja kansanterveystieteen tutkimusmenetelmiä farmasian alan tutkimusaiheisiin. Teos on tarkoitettu perus-, jatko- ja erikoistumisopintoja tekeville eri alojen opiskelijoille silloin, kun tutkimusaihe linkittyy lääkealaan, -huoltoon tai -hoitoon. Teos esittelee yhteiskunnallisen lääketutkimuksen tutkimusperinnettä ja lähtökohtia. Lisäksi kirjoittajat kuvaavat keskeisiä lääketutkimuksessa käytettyjä kvantitatiivisia ja kvalitatiivisia tutkimusmenetelmiä. He antavat käytännön ideoita ja vinkkejä tutkimuksen teosta sekä siitä, mitä asioita erityisesti aloittelevan tutkijan olisi hyvä tutkimuksessaan huomioida. Kirjoittajien tavoitteena on tarjota opiskelijoille konkreettinen työväline.