ULLA NÄRHI Implementing the Philosophy of Pharmaceutical Care into Community Pharmacy Services - Experiences with Asthma Patients in Finland

The concept of quality in health services can be defined as meeting the set requirements at the lowest possible cost. Health care services need to be of good quality for achieving the desired outcomes. These principles were extended to the community pharmacy services via the philosophy of pharmaceutical care in the beginning of 1990’s. In pharmaceutical care, pharmacists take more responsibility for the outcomes of patient’s drug therapy, i.e. they become active participants of a health care team. The quality of care can be improved by identifying, resolving and preventing possible problems in patient’s drug therapy according to the principles of pharmaceutical care. Therapeutic Outcomes Monitoring (TOM) is a protocol designed to help implementation of pharmaceutical care based services. The aim of this dissertation was to examine how the principles of pharmaceutical care could be implemented into Finnish community pharmacy practice by experimenting with asthma patients. Firstly, the possibilities of community pharmacists to detect potential drug-related problems during routine dispensing were assessed in an ordinary community pharmacy. The study population consisted of the customers (n=119) who presented a prescription for an inhaled asthma medicine in the pharmacy during the study period. Community pharmacists were able to detect problems by using simple tools like prescription information and discussions with the patient. Deficiencies were found in the medications. Also instructions in the prescriptions were found to be incomplete and lacking crucial information about the type and the purpose of the medication. Therapeutic Outcomes Monitoring (TOM) protocol was applied in the implementation of the pharmaceutical care based services and to evaluate their impact on the outcomes of asthma patients. This was studied in four community pharmacies, with 28 asthmatics taking part in a one-year intervention. Significant improvements were measured in the patient clinical and process outcomes. Some of the improvements were still significant one year after the intervention. Compared to the baseline, half of the patients did not consider that they had any problems at the end of the intervention. Due to the limitations (a convenience sample and the lack of controls) of the study, the results have to be interpreted with caution. The third part of the study assessed to what extent asthma patients were trained to monitor their disease and to adjust asthma medications as recommended by the national asthma guidelines established in 1994. This was surveyed by a questionnaire targeted to all asthma patients (n=2,860) obtaining their asthma medicines from Finnish community pharmacies during a two-day period in 1998. The majority of the respondents (86%) had been instructed in one of the methods recommended by the national guidelines. The patients over 65 years and those who had been taking asthma medication more than 5 years encountered the most deficiencies in their asthma follow up. Community pharmacists can detect and solve patients’ problems in asthma medication and help them with self-management. Enhanced education, counselling and outcomes monitoring by community pharmacists can improve outcomes in the treatment. Therapeutic Outcomes Monitoring is a useful protocol for pharmacists in implementing the philosophy of pharmaceutical care. More models need to be developed and evaluated in order to find the best one for use in pharmacy practice. National Library of Medicine Classification: QV 737, W 84, WF 553, QZ 42 Medical Subject Headings: community pharmacy services; pharmacists; quality of health care; medication errors; self care; patient education; asthma; patient care team