15.6.2004 Quality and efficiency in the pharmacy profession
Quality throughout the Quality throughout the professional life professional life
The Finnish ExperienceEeva Teräsalmi
president, WHO EuroPharm ForumMS in Pharm, pharmacy owner
Apple pharmacy, Virkkala, Siuntio, Routio
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HEALTHCARE OR COMMERCEHEALTHCARE OR COMMERCE-Starting point at 1980s:-Pharmacists seen as a profession but not necessarily as a health care
profession-Pharmacies seen as shops but not necessarily as health care
settings -Position of both pharmacists and
pharmacies vulnerable while not clear
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Association of Finnish Association of Finnish PharmaciesPharmacies Understood the vulnerability of the
pharmaceutical profession in 1980s Decided to develop a professional
concept for the future development of both pharmacies and for pharmacists
Quality program, public health programs, publications, lobbying
Continuing education and changes in basic education
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The changing processThe changing process Future is done today – all decisions has to
have same direction and to support each other
To reach permanent changes in the profession every practitioner in the pharmacy needs to go through the changing process and accept the new concept of services
Process described by Prochaska-DiClemente Changing process goes very slowly
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DEVELOPMENT IN DEVELOPMENT IN FINLANDFINLAND - 1983: pharmacists’ duty to counsel
– 1986: the first computerized drug information database to produce leaflets to consumers
– 1988: a national survey on consumer expectations
– 1988: facilities to assure privacy– 1990: a more advanced drug information
database– Annually a one-week campaign to promote
pharmacists’ role in self-medication (AFP)
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DEVELOPMENT IN DEVELOPMENT IN FINLANDFINLAND
– 1992: Pharmacy 2002 (the first professional strategy by AFP)
– 1994: Patient Information Leaflets– 1994: Re-design of the pharmacy curriculum– 1995: Quality pays –program by AFP– 1993-1996: Asthma TOM pilot in four pharmacies– 1993-1996: WHO EuroPharm Forum’s ”Questions
about Your Medicines” Campaign
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1997: A STRATEGY FOR 1997: A STRATEGY FOR PROFESSIONAL PHARMACY PROFESSIONAL PHARMACY
PRACTICEPRACTICE
Established by the Association of Finnish Pharmacies (AFP)
A wide consensus on the strategy among the profession and authorities
Supported by the Ethical Codes for Community Pharmacies (1998)
Based on five booklets (basic principles, self-medication, health promotion, ethics, economy)
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KEY ISSUES OF THE KEY ISSUES OF THE STRATEGYSTRATEGY
Pharmacy services should be integrated into local health services
Pharmacy services should be evidence-based and their quality should be guaranteed
Pharmacists should take more responsibility of outcomes of drug therapy (concerns also self-medication)
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TIPPA-project 2000 - TIPPA-project 2000 - 20032003
A four-year national joint project to promote patient counselling by community pharmacists
Supports the professional strategy
Period: 2000 - 2003
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The proper information from the pharmacy to the patients benefit
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PARTIES PARTIES INVOLVEDINVOLVED
Ministry of Social Affairs and Health National Agency for Medicines Social Insurance Institution Association of Finnish Pharmacies Finnish Pharmacists’ Association University of Kuopio University of Helsinki Pharmaceutical Learning Centre University of Kuopio, Centre for Training and
Development
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HEALTH POLICY GOALS HEALTH POLICY GOALS OF TIPPAOF TIPPA
To promote rational use of medicines
To decrease negative effects of inappropriate use of medicines, including self-medication
To decrease costs by enhanced counselling
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OPERATIONAL GOALS OF OPERATIONAL GOALS OF TIPPATIPPA
To implement patient-oriented counselling practices
To facilitate self-assessment of counselling practices and processing long-term development plans
To assure quality of new practices To integrate new practices into local health
services and market them to customers
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REACHING THE REACHING THE GOALSGOALS
By an extensive development process in pharmacies focusing on– Leadership– Attitudes– Behavior patterns– Communication skills– Professional skills
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THE DEVELOPMENT THE DEVELOPMENT PROCESS WAS PROCESS WAS SUPPORTED BYSUPPORTED BY
Leadership training Continuing education on pharmacotherapy
and communication skills Providing resources for drug information Measuring quality of performance
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TIPPA RESOURCESTIPPA RESOURCES Electronic database on prescription
medicines (Tietotippa) www.tippa.net Handbook on self-medication
(www.itsehoito-opas.net) Handbook on communication skills USP Medication Counseling Behavior
Guidelines (www.usp.org) Manual for evaluation of councelling (tippa
tavaksi)
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EXTENDING QUALITY EXTENDING QUALITY MEASURES TO PATIENT MEASURES TO PATIENT
INFORMATIONINFORMATION Developing new quality measures Integrating patient information
related measures into the quality management system of the pharmacy
Regular follow-up and feedback Possibility to use external auditors
(tippatutors)
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EVALUATION OF THE EVALUATION OF THE PROGRESSPROGRESS
Regular evaluation– Performance (pseudo customers)
Studies on – Receipt of information among different patient
groups and the public– Leadership and attitudes– Implementing the resources in daily practice– Identification of problems people experience
with their medications
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EVALUATIONEVALUATION (continued) (continued) Identification of problems related to
medications – Several research projects going on
related to major health problems treated by self-medication and prescription medicines among outpatients
– Research concerns e.g. pain, hypertension, asthma, contraceptives
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WHAT HAVE WE WHAT HAVE WE ACHIEVED?ACHIEVED?
Report on progress in 2000-2001 (available: www.tippa.net), final report under publication
2001: 65% of pharmacies had set up in-house guidelines in patient counselling (proportion 31% in 2000)
More than half of the pharmacies have regular cooperation with local healthcare
A dramatic change in the pharmacist’s perceptions of their work within 10 years (selling medicines -> experts on medicines)
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ACHIEVEMENTS IN HEALTH ACHIEVEMENTS IN HEALTH POLICYPOLICY
Pharmacists received new responsibilities in self-medication (emergency hormonal contraception)
Pharmacists involved in national– therapeutic guidelines (e.g., NRT)– health programs (e.g., asthma, diabetes)
National policy on medicines up to 2010 in accordance with professional orientation
National survey on consumer expectations repeated in 2003 confirms implementation of the professional strategy
Pharmacists and pharmacies essential part of the healthcare system and pharmaceuticals defined to be sold only by pharmacies
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A CHALLENGEA CHALLENGE
How to measure the monetary impact of patient counselling on drug costs?
How to measure the impact of pharmacist’s intervention on health outcomes/quality of life?
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THE NEXT FINNISH THE NEXT FINNISH MOVEMENTMOVEMENT
continuous tippa-lifecontinuous tippa-life Actions
– to assure permanent changes in practice
– to prevent polarization of pharmacies– to support shift to more sophisticated
services, e.g.,patient medication review
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ROLE OF LEADERSHIP IN THE ROLE OF LEADERSHIP IN THE PROCESSPROCESS
Quality
Professional strategy
Leadership
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FUTUREFUTURE
must be built today good planning and leadership
needed to reach the goals there is a big probability in getting
what you want if we do not know what we want we
get the future decided by others
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THANK YOU for your THANK YOU for your attention!attention!
Thanks also to Marja Airaksinen, Ph.D
Tippa –project manager who has produced some of these
slides