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International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 345–351 | Cite as

Starting an automated dose dispensing service provided by community pharmacies in Finland

  • Juha SinnemäkiEmail author
  • Leena K. Saastamoinen
  • Sara Hannula
  • Sirpa Peura
  • Marja Airaksinen
Research Article

Abstract

Background In an automated dose dispensing (ADD) service, medicines are packed in unit-dose bags according to administration times. When the service is initiated, the patient’s medication list is reconciled and the medication is reviewed on the basis of this list. Objective The aim of this national study was to investigate how the medication list was reconciled, what type of medication review was conducted, and what changes were made to the patient’s medications when the ADD service is initiated. Setting Primary care in Finland. Method All patients enrolled in the service during a 3-week period in autumn 2010 were included in the study. All community pharmacies (n = 267) purchasing unit-dose bags from Espoonlahti Pharmacy documented the actions taken in the ADD initiation process using a structured data collection sheet. Main outcome measure Information sources needed in medication reconciliation, the type of medication review conducted and changes made to patients’ medications. Results Documentation was completed for 147 out of 325 new ADD users resulting 45 % as a response rate. More than one source was needed for 63 % of the patients in medication reconciliation. The most common sources used were nursing staff (72 % of the patients) and an existing medication list (71 %). Some type of medication review, most commonly a prescription review, was conducted for the majority of the patients (96 %), usually in multi-professional collaboration. Treatment-related changes were made for 43 % of the patients and technical changes were made for 93 % of the patients. Conclusion The medication list was incomplete for more than half of the patients. Some type of medication review was conducted for most of the patients. Both treatment-related changes and technical changes were made on patients’ medications during the initiation process. The start-up process of the ADD service needs further development to ensure a standard procedure and optimum use of resources.

Keywords

Automated dose dispensing Community pharmacy Finland Homedwelling elderly Medication review Medication safety 

Notes

Funding

The study was funded by grants from the Association of Finnish Pharmacies and the University Pharmacy.

Conflicts of interest

Juha Sinnemäki is a former employee of the Association of Finnish Pharmacies. Currently, he works at the University Pharmacy. Leena K. Saastamoinen works as a Senior Researcher at the Social Insurance Institution. The Institution reimburses the automated dose dispensing service fee for aged outpatients, according to explicit criteria. Sirpa Peura works as a Director of Pharmaceutical Affairs at the Association of Finnish Pharmacies. Marja Airaksinen is a Board Member of the University Pharmacy.

Supplementary material

11096_2013_9899_MOESM1_ESM.pdf (79 kb)
Supplementary material 1 (PDF 78 kb)

References

  1. 1.
    Classification for Drug related problems [Internet]. Pharmaceutical Care Network Europe Foundation; c2003-2010 [cited 12 Mar 2013]. http://www.pcne.org/sig/drp/documents/PCNE%20classification%20V6-2.pdf.
  2. 2.
    Bourgeois FT, Shannon MW, Valim C, Mandl KD. Adverse drug events in the outpatient setting: an 11-year national analysis. Pharmacoepidemiol Drug Saf. 2010;19:901–10.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio +75 study: a cross-sectional analysis. Drugs Aging. 2009;26:493–503.PubMedCrossRefGoogle Scholar
  4. 4.
    Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–51.PubMedCrossRefGoogle Scholar
  5. 5.
    Fialová D, Topinková E, Gambassi G, Finne-Soveri H, Jónsson PV, Carpenter I, et al. Potentially inappropriate medication use among elderly home care patients in Europe. JAMA. 2005;16:1348–58.CrossRefGoogle Scholar
  6. 6.
    Krska J, Cromarty JA, Arris F, Jamieson D, Hansford D, Duffus PR, et al. Pharmacist-led medication review in patients over 65: a randomized, controlled trial in primary care. Age Ageing. 2001;30:205–11.PubMedCrossRefGoogle Scholar
  7. 7.
    Barat I, Andreasen F, Damsgaard EMS. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol. 2001;51:615–22.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Annual Review 2003: Medicines in pre-packed doses [Internet]. The Association of Finnish Pharmacies, c2003 [cited 11 Mar 2013]. http://www.apteekkariliitto.fi/media/pdf/annual_report_2003.pdf.
  9. 9.
    Dose dispensing [Internet]. Danish Health and Medicines Authority, c2012 [cited 11 Mar 2013]. http://laegemiddelstyrelsen.dk/en/topics/retail-and-online-sale/pharmacies/dose-dispensing.
  10. 10.
    Gombos A: [Automated dose dispensing is a good system]. Tidsskr Nor Laegeforen. 2004;124:1144. Norwegian.Google Scholar
  11. 11.
    Annual report 2009 [Internet]. Apoteket AB, c2009 [cited 11 Mar 2013]. http://www.apoteket.se/privatpersoner/om/Documents/Finansiell%20information/Apoteket_2010_ENG_web%20(2).pdf.
  12. 12.
    The Medicines Act of Finland [Internet] [cited 12 Mar 2013]. http://www.finlex.fi/fi/laki/ajantasa/1987/19870395?search%5Btype%5D=pika&search%5Bpika%5D=lääkelaki.Google Scholar
  13. 13.
  14. 14.
    Sinnemäki J, Sihvo S, Isojärvi J, Blom M, Airaksinen M, Mäntylä A. Automated dose dispensing service for primary healthcare patients: a systematic review. Sys Rev. 2013;2:1.CrossRefGoogle Scholar
  15. 15.
    Sjöberg C, Ohlsson H, Wallerstedt SM. Association between multi-dose drug dispensing and drug treatment changes. Eur J Clin Pharmacol. 2012;68:1095–101.PubMedCrossRefGoogle Scholar
  16. 16.
    Sjöberg C, Edward C, Fastbom J, Johnell K, Landahl S, Narbro K, et al. Association between multi-dose drug dispensing and quality of drug treatment—A register-based study. PlosOne [Internet]. 2011 Oct [cited 12 Mar 2013];6(10):e26574. http://www.plosone.org/article/fetchObject.action?uri=info%3Adoi%2F10.1371%2Fjournal.pone.0026574&representation=PDF.
  17. 17.
    Johnell K, Fastbom J. Multi-dose drug dispensing and inappropriate drug use: a nationwide register-based study of over 700,000 elderly. Scand J Prim Health Care. 2008;26:86–91.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Olsson J, Bergman A, Carlsten A, Oké T, Bernsten C, Schmidt IK, et al. Quality of drug prescribing in elderly people in nursing homes and special care units for dementia: a cross-sectional computerized pharmacy register analysis. Clin Drug Investig. 2010;30:289–300.PubMedCrossRefGoogle Scholar
  19. 19.
    Bergman A, Olsson J, Carlsten A, Waern M, Fastbom J. Evaluation of the quality of drug therapy among elderly patients in nursing homes. Scand J Prim Health Care. 2007;25:9–14.PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Wekre LJ, Spigset O, Sletvold O, Sund JK, Grimsmo A. multidose drug dispensing and discrepancies between medication records. Qual Saf Health Care [Internet]. 2010 Aug [cited 12 Mar 2013];19(5):1–4. http://qualitysafety.bmj.com/content/19/5/e42.long.
  21. 21.
    Kwint HF, Faber A, Gussekloo J, Bouvy ML. Effects of medication review on drug-related problems in patients using automated drug-dispensing systems: a pragmatic randomized controlled study. Drugs Aging. 2011;28:305–14.PubMedCrossRefGoogle Scholar
  22. 22.
    van den Bemt PM, Idzinga JC, Robertz H, Robertz H, Kormelink DG, Pels N. Medication administration errors in nursing homes using an automated medication dispensing system. J Am Med Inform Assoc. 2009;16:486–92.PubMedCentralPubMedCrossRefGoogle Scholar
  23. 23.
    Health services [Internet]. Ministry of Social Affairs and Health; c2013 [cited 12 Mar 2013]. http://www.stm.fi/en/social_and_health_services/health_services.
  24. 24.
    Lindsröm G. Changes made to patients’ medications and reasons for them when patients are enrolled in an automated dose dispensing service [thesis]. Finland: Palmenia centre for continuing education, University of Helsinki, Helsinki; 2010.Google Scholar
  25. 25.
    Medicines Policy 2020 [Internet]. The Ministry of Social Affairs and Health, c2011 [cited 2013 Mar 12]. http://www.stm.fi/c/document_library/get_file?folderId=2765155&name=DLFE-15667.pdf.
  26. 26.
    Leikola S, Tuomainen L, Peura S, Laurikainen A, Lyles A, Airaksinen M. Comprehensive medication review: development of a collaborative procedure. Int J Clin Pharm. 2012;34:510–4.PubMedCrossRefGoogle Scholar
  27. 27.
    WHO Collaborating Centre for Drug Statistics Methodology, Guidelines for ATC classification and DDD assignment 2013. Oslo; 2012.Google Scholar
  28. 28.
    Leikola SNS, Virolainen J, Tuomainen L, Tuominen RK, Airaksinen MSA. Collaborative comprehensive medication reviews for elderly primary care patients—community pharmacists’ findings and recommendations to physicians. J Am Pharm Assoc. 2012;52:630–3.CrossRefGoogle Scholar
  29. 29.
    Teinilä T, Kaunisvesi K, Airaksinen M. Primary care physicians’ perceptions of medication errors and error prevention in cooperation with community pharmacists. Res Social Adm Pharm. 2011;7:162–79.PubMedCrossRefGoogle Scholar
  30. 30.
    Tanskanen P, Jäkälä J, Airaksinen M, Enlund H. Physicians’ views on co-operation with community pharmacist in Finland. J Soc Adm Pharm. 1997;14:220–9.Google Scholar
  31. 31.
    Stubbings J, Nutescu E, Hurley SF, Bauman JL. Payment for clinical pharmacy services revisited. Pharmacotherapy. 2012;31:1–8.CrossRefGoogle Scholar
  32. 32.
    Johnson CM, Marcy TR, Harrison DL, Young RE, Stevens LE, Shadid J. Medication reconciliation in a community pharmacy setting. J Am Pharm Assoc. 2010;50:523–6.CrossRefGoogle Scholar
  33. 33.
    Balon J, Thomas SA. Comparison of hospital admission medication lists with primary care physician and outpatient pharmacy lists. J Nurs Scholarsh. 2011;43:292–300.PubMedGoogle Scholar
  34. 34.
    Teinilä T, Grönroos V, Airaksinen M. Survey of dispensing error practices in community pharmacies in Finland: a nationwide study. J Am Pharm Assoc. 2009;49:604–10.CrossRefGoogle Scholar
  35. 35.
    Westerling AM, Hynninen JT, Haikala VE, Airaksinen MS. Opinion comparison concerning future information technology in Finnish community pharmacies. Pharm World Sci. 2010;32:787–94.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Juha Sinnemäki
    • 1
    Email author
  • Leena K. Saastamoinen
    • 2
  • Sara Hannula
    • 3
  • Sirpa Peura
    • 4
  • Marja Airaksinen
    • 1
  1. 1.Division of Social Pharmacy, Faculty of PharmacyUniversity of HelsinkiHelsinkiFinland
  2. 2.Research DepartmentThe Social Insurance InstitutionHelsinkiFinland
  3. 3.Kurikka PharmacyKurikkaFinland
  4. 4.Association of Finnish PharmaciesHelsinkiFinland

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