15.6.2004 Quality and efficiency in the pharmacy profession Quality throughout the professional life The Finnish Experience Eeva Teräsalmi president, WHO.

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

15.6.2004

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