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

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

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

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

DEVELOPMENT IN FINLAND : 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)

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 – : Asthma TOM pilot in four pharmacies – : WHO EuroPharm Forums Questions about Your Medicines Campaign

: 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)

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)

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

The proper information from the pharmacy to the patients benefit

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

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

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

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

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

TIPPA RESOURCES Electronic database on prescription medicines (Tietotippa) Handbook on self-medication ( Handbook on communication skills USP Medication Counseling Behavior Guidelines ( Manual for evaluation of councelling (tippa tavaksi)

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)

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

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

WHAT HAVE WE ACHIEVED? Report on progress in (available: final report under publication : 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)

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

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?

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

ROLE OF LEADERSHIP IN THE PROCESS Quality Professional strategy Leadership

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

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