Transcript asamblea general y simposium anual de la pgeu

Quality throughout the
professional life
The Finnish Experience
Eeva Teräsalmi
president, WHO EuroPharm Forum
MS in Pharm, pharmacy owner
Apple pharmacy, Virkkala, Siuntio, Routio
15.6.2004
Quality and efficiency in the pharmacy profession
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
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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
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The changing process
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
 Future
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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)
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DEVELOPMENT IN FINLAND
– 1992: Pharmacy 2002 (the first professional
strategy by AFP)
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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
1997: A STRATEGY FOR
PROFESSIONAL PHARMACY PRACTICE
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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, selfmedication, health promotion, ethics, economy)
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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)
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TIPPA-project 2000 - 2003
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 INVOLVED
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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 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
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OPERATIONAL GOALS OF
TIPPA
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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
GOALS
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By an extensive development process in
pharmacies focusing on
– Leadership
– Attitudes
– Behavior patterns
– Communication skills
– Professional skills
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THE DEVELOPMENT
PROCESS WAS SUPPORTED
BY
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Leadership training
Continuing education on pharmacotherapy and
communication skills
Providing resources for drug information
Measuring quality of performance
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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)
 Manual for evaluation of councelling
(tippa tavaksi)
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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)
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EVALUATION OF THE PROGRESS
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Regular evaluation
– Performance (pseudo customers)
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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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EVALUATION (continued)
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Identification of problems related to
medications
– Several research projects going on related
to major health problems treated by selfmedication and prescription medicines
among outpatients
– Research concerns e.g. pain,
hypertension, asthma, contraceptives
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WHAT HAVE WE ACHIEVED?
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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
POLICY
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Pharmacists received new responsibilities in selfmedication (emergency hormonal contraception)
Pharmacists involved in national
– therapeutic guidelines (e.g., NRT)
– health programs (e.g., asthma, diabetes)
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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 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 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
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ROLE OF LEADERSHIP IN THE
PROCESS
Leadership
Professional
strategy
Quality
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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
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THANK YOU for your attention!
 Thanks
also to Marja Airaksinen, Ph.D
Tippa –project manager
who has produced some of these slides
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