Quality throughout the professional life

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

2. 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. 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. 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. 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. 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 Forum’s ”Questions about Your Medicines” Campaign

7. 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. 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. 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. The proper information from the pharmacy to the patients benefit

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

15. 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. 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)

17. 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. 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. 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. WHAT HAVE WE 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)

21. 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. 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?

23. THE NEXT FINNISH MOVEMENTcontinuous 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. Professional strategy Quality ROLE OF LEADERSHIP IN THE PROCESS Leadership

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