Terveyspalveluita vai myyntityötä : Apteekkien toiminnan strateginen kehittäminen muuttuvassa toimintaympäristössä

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http://urn.fi/URN:ISBN:978-951-51-5837-6
Title: Terveyspalveluita vai myyntityötä : Apteekkien toiminnan strateginen kehittäminen muuttuvassa toimintaympäristössä
Author: Jokinen, Lenita
Contributor: University of Helsinki, Faculty of Pharmacy
Doctoral Programme in Drug Research
Publisher: Helsingin yliopisto
Date: 2020-03-06
URI: http://urn.fi/URN:ISBN:978-951-51-5837-6
http://hdl.handle.net/10138/311636
Thesis level: Doctoral dissertation (article-based)
Abstract: The operating environment of community pharmacies is changing in Finland as a result of changes in society. Societal changes, such as municipal and service restructuring, and demographic changes, affect the operation of pharmacies. Pharmacies have expertise in implementing drug therapies that could be used more effectively as part of healthcare. Recent health and medicines policy developments in Finland allow pharmacies to expand their services and roles in healthcare. At the same time, the pharmacies' economy is influenced by past changes that have led pharmacies to streamline their operations and increase active product sales to secure their profitability. Little research has focused on the extent to which community pharmacy owners responsible for the operation and economy of pharmacies are committed to medicines policy. Pharmacy owners play a key role in influencing the strategic direction of the pharmacy business by deciding on their business as a private entrepreneur within the limits set by law. This doctoral dissertation explored the strategic work that guides the operation of community pharmacies, in particular the orientation towards health services and active product sales, and the factors involved. The study was carried out from the perspective of community pharmacy owners (studies 1-3) and key social and health care actors (study 4). The study was divided into four sub-studies. In 2013, data for the studies 1-3 were collected as a nationwide survey, targeting all private community pharmacy owners that were members of the Association of Finnish Pharmacies (n=581). The aim of the study 1 was to examine pharmacy owners' views on the strategic development of community pharmacy activities by 2020. The survey mapped the supply of pharmacy services at the time of the study (2013) and the pharmacy owners' views on future pharmacy services (2020). Two sum scales were compiled of the Likert-scale statements that examined the strategic orientation toward health services (13 statements, Cronbach's alpha 0.836) and active product sales (8 statements, Cronbach's alpha 0.699). The internal consistency of the sum scales was determined by using reliability analysis. The second study examined the strategy work of pharmacies and association between strategic planning and active product sales and healthcare service orientation. Responses were divided into two groups based on whether the responding pharmacy had a strategy or not. The relationship between strategy work and pharmacies' orientation towards health services and active product sales was investigated using the two sum scales created in the study 1. In addition, the relationship between strategy work and the background variables related to the pharmacy owner and pharmacy business was investigated. The third study investigated factors related to product sales and healthcare orientation in pharmacies using sum scales. Both sum scales were classified dichotomously by dividing pharmacies into either strongly or weakly oriented towards active drug sales, and strongly or weakly oriented towards health services. The relationship between the dichotomous sum scales obtained and the pharmacy background information and the actual pharmacy service offering was examined by cross-tabulation between the two variables. For the purposes of the analysis, the actual supply of pharmacy services at the time of the survey was also transformed into a sum scale consisting of ten services listed in the questionnaire. The aim of the fourth study was to determine the role and functional position of pharmacies in the future social and health service structure from the perspective of key social and health care actors. The data of study 4 were collected in late 2016 as a survey focused on the Ministry of Social Affairs and Health Steering Group for the Planning of Rational Pharmacotherapy Action Plan, including members, deputies and experts (n=149). A total of 198 pharmacy owners (34% response rate) responded to the nationwide survey. According to the responding pharmacy owners, the main task of community pharmacies was to operate as part of the healthcare service chain. The views were the same regardless of the characteristics of the pharmacy owner and their pharmacy business. Of the healthcare-oriented services available at the time of the study, the most common type of service was automated dose dispensing (77% of respondents' pharmacies). Of the pharmacies 21% provided comprehensive medication reviews (CMR). More than half (52%) of the responding pharmacy owners would have been prepared to increase the number of pharmacists with special qualifications (such as comprehensive medication reviews) if the service were to receive national quality criteria and funding. At the same time, the majority (90%) of respondents said they would invest in active additional sales, but few pharmacists (10%) saw their pharmacy primarily as a commercial company. In addition, almost all respondents (92%) fully or partially agreed that it is necessary for pharmacies to expand their product range to free-trade products in order to safeguard the pharmacy economy. Almost two-thirds (63%) of pharmacy owners reported they had a strategy. Strategy work (strategy/no strategy) had no influence on healthcare orientation but was linked to the pharmacy's active product sales orientation. Pharmacies where strategy work was carried out were clearly more likely to have active sales promotion than other pharmacies. The pharmacies that worked on the strategy were also interested in new services to ensure medication safety, such as the comprehensive medication reviews. Strategy work had no impact on other health care-oriented variables. The most common strategy work was in pharmacies with an owner of at least 10 years of pharmacy owner experience, a pharmacy with a large prescription volume and turnover. The actual provision of services by community pharmacies was investigated using sum scales. Of the ten potential services to be offered by pharmacies at the time of the study, 66% of pharmacy owners reported having up to two different services available at their pharmacy. The results showed a significant difference between the actual service provision and the intent of pharmacies. Pharmacy owners clearly saw the pharmacy as health-oriented and were interested in providing services, but in reality, very few pharmacies offered more than one or two services. According to this study, large pharmacies located in supermarkets and belonging to a marketing chain were clearly more focused on product sales than other pharmacies. Pharmacy owner and pharmacy-related background factors had no association with the healthcare orientation. The questionnaire sent to social and health care providers received 43 responses (29 % response rate). Respondents saw evidence-based self-medication counseling as one of the most important tasks of pharmacies (88 % of respondents). A significantly smaller proportion of respondents would be prepared to expand the range of non-prescription drug assortment (75 %). The most important services to be provided by pharmacies in the future were automated dose dispensing (93 %), medication reviews (82 %) and comprehensive medication reviews (80 %). According to the results of the study, pharmacy owners have a desire to develop healthcare-oriented services, but in practice, the activity has focused on active product sales to safeguard the pharmacy's economy. There is a big gap between willingness to provide services and actual delivery. The service offering is focused on services that can be implemented easily and with little investment, such as automated dose dispensing. Pharmacies should be supported through medicines policy in the development of services requiring larger and more long-term investments, which are of social and public health importance through the promotion of rational pharmacotherapy. Keywords: community pharmacies, pharmacy services, strategic development, healthcare, medicines policy, rational pharmacotherapyYhteiskunnassa tapahtuvat muutokset, kuten kunta- ja palvelurakenneuudistukset sekä väestörakenteen ja -keskittymien muutokset vaikuttavat apteekkien toimintaan. Apteekeissa on lääkehoitojen toteutukseen liittyvää osaamista, jota voisi hyödyntää osana sosiaali- ja terveyspalvelujärjestelmää nykyistä tehokkaammin. Väitöskirjan kirjallisuuskatsauksessa on kuvattu strategiatyön periaatteita, apteekkitoiminnan strategisia linjauksia Suomessa sekä vertailtu alan sisäisiä ja viranomaisten tekemiä lääkepoliittisia linjauksia. Lisäksi tarkasteltiin apteekkitoiminnan pitkäjänteiseen kehittämiseen liittyvää kansainvälistä tutkimusta. Kansainvälisten tutkimusten mukaan apteekin rooli on muuttumassa yhä potilaskeskeisemmäksi. Lääkehoidon onnistumiseen tähtäävien palveluiden kehittäminen vaatii muutoksia terveydenhuoltojärjestelmään ja apteekkien palvelut tulisi hyväksyä kiinteäksi osaksi terveydenhuoltoa. Väitöskirjan tutkimusosan tavoitteena oli löytää strategisia kehittämissuuntia apteekkitoiminnalle apteekkien toiminnasta ja taloudesta vastaavien apteekkareiden näkökulmasta. Tutkimus toteutettiin kahtena poikittaisena kyselytutkimuksena. Päätutkimuksena oli valtakunnallinen apteekkareille suunnattu kysely. Kyselyn avulla tutkittiin missä määrin apteekkarit ovat sitoutuneet lääkepoliittisiin linjauksiin lääkehuollon toimimisesta osana sosiaali- ja terveyspalvelujärjestelmää ja missä määrin aktiiviseen tuotemyyntiin. Täydentävänä tutkimuksena tehtiin kysely Hallitusohjelman (2015) mukaisen Rationaalisen lääkehoidon toimeenpano-ohjelman laatineelle asiantuntijajoukolle. Kyselyllä kartoitettiin suuntalinjoja apteekkien toimimisesta osana sosiaali- ja terveyspalvelujärjestelmää. Apteekkien tärkeimpänä tehtävänä nähtiin toimiminen osana terveydenhuollon palveluketjua. Näkemys oli sama riippumatta apteekkarin ja apteekkitoiminnan ominaisuuksista. Sosiaali- ja terveydenhuollon toimijoille lähetetyssä kyselyssä vastaajat näkivät yhdeksi apteekkien merkittävimmistä tehtävistä itselääkityksen ohjauksen. Tutkimuksen tulosten perusteella apteekeilla on halu kehittää terveydenhuoltoon suuntautuneita palveluja. Tutkimuksen mukaan palvelutarjonta on keskittynyt helposti ja pienin investoinnein toteutettavissa oleviin palveluihin, kuten koneelliseen annosjakeluun. Apteekkeja tulisi lääkepoliittisin keinoin tukea erityisesti isompia ja pitkäjänteisempiä investointeja edellyttävien palvelujen kehittämisessä, joilla on yhteiskunnallista ja kansanterveydellistä merkitystä rationaalisen lääkehoidon edistämisessä.
Subject: farmasia
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