1. 15.6.2004 Quality and efficiency in the pharmacy profession Quality throughout the professional life The Finnish Experience Eeva Teräsalmi president, WHO EuroPharm Forum MS in Pharm, pharmacy owner Apple pharmacy, Virkkala, Siuntio, Routio

2. 15.6.2004 HEALTHCARE 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

3. 15.6.2004 Association of Finnish Pharmacies 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

4. 15.6.2004 The 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

5. 15.6.2004 DEVELOPMENT IN FINLAND - 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)

6. 15.6.2004 DEVELOPMENT IN FINLAND –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 Forums Questions about Your Medicines Campaign

7. 15.6.2004 1997: A STRATEGY FOR PROFESSIONAL PHARMACY PRACTICE 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)

8. 15.6.2004 KEY ISSUES OF THE STRATEGY 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)

9. 15.6.2004 TIPPA-project 2000 - 2003 TIPPA-project 2000 - 2003 A four-year national joint project to promote patient counselling by community pharmacists Supports the professional strategy Period: 2000 - 2003

10. 15.6.2004 The proper information from the pharmacy to the patients benefit

11. 15.6.2004 PARTIES INVOLVED 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

12. 15.6.2004 HEALTH POLICY GOALS OF 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

13. 15.6.2004 OPERATIONAL GOALS OF TIPPA 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

14. 15.6.2004 REACHING THE GOALS By an extensive development process in pharmacies focusing on –Leadership –Attitudes –Behavior patterns –Communication skills –Professional skills

15. 15.6.2004 THE DEVELOPMENT PROCESS WAS SUPPORTED BY Leadership training Continuing education on pharmacotherapy and communication skills Providing resources for drug information Measuring quality of performance

16. 15.6.2004 TIPPA 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)www.usp.org Manual for evaluation of councelling (tippa tavaksi)

17. 15.6.2004 EXTENDING QUALITY MEASURES TO PATIENT INFORMATION 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)

18. 15.6.2004 EVALUATION OF THE PROGRESS 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

19. 15.6.2004 EVALUATION (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

20. 15.6.2004 WHAT HAVE WE ACHIEVED? Report on progress in 2000-2001 (available: www.tippa.net), final report under publication www.tippa.net 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 pharmacists perceptions of their work within 10 years (selling medicines -> experts on medicines)

21. 15.6.2004 ACHIEVEMENTS IN HEALTH POLICY 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

22. 15.6.2004 A CHALLENGE How to measure the monetary impact of patient counselling on drug costs? How to measure the impact of pharmacists intervention on health outcomes/quality of life?

23. 15.6.2004 THE NEXT FINNISH MOVEMENT continuous 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

24. 15.6.2004 ROLE OF LEADERSHIP IN THE PROCESS Quality Professional strategy Leadership

25. 15.6.2004 FUTURE 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

26. 15.6.2004 THANK YOU for your attention! Thanks also to Marja Airaksinen, Ph.D Tippa –project manager who has produced some of these slides