REPORTS | KATI HEISKANEN (ED.) | NORDIC SOCIAL PHARMACY AND HEALTH SERVICES RESEARCH... | No 24
uef.fi
PUBLICATIONS OF
THE UNIVERSITY OF EASTERN FINLAND Reports and Studies in Health Sciences
Reports and Studies in Health Sciences
PUBLICATIONS OF
THE UNIVERSITY OF EASTERN FINLAND
KATI HEISKANEN (ED.)
NORDIC SOCIAL PHARMACY AND HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Nordic Social Pharmacy and Health Services Research Conference (NSPC) 2017 is organized
by the University of Eastern Finland, School of Pharmacy. The theme of the conference is
“Designing safe and effective treatments in the era of real-world data”. The conference gathers Nordic and international researchers working in different fields of pharmacy to share
their knowledge and ideas. This book contains the program and abstracts of the conference
held in Kuopio, Finland, June 7
th–9
th, 2017.
KATI HEISKANEN (ED.)
KATI HEISKANEN (ED.)
Nordic Social Pharmacy and Health Services Research Conference
(NSPC) 2017
Kuopio, Finland, June 7
th 9
th2017
Program and Abstracts
Publications of the University of Eastern Finland Reports and Studies in Health Sciences
24
University of Eastern Finland Faculty of Health Sciences
Kuopio 2017
Series Editors:
Professor Tomi Laitinen, M.D., Ph.D.
Institute of Clinical Medicine, Clinical Physiology and Nuclear Medicine Faculty of Health Sciences
Professor Hannele Turunen, Ph.D.
Department of Nursing Science Faculty of Health Sciences Professor Kai Kaarniranta, M.D., Ph.D.
Institute of Clinical Medicine, Ophthalmology Faculty of Health Sciences
Associate Professor (Tenure Track) Tarja Malm, Ph.D.
A.I. Virtanen Institute for Molecular Sciences Faculty of Health Sciences
Lecturer Veli-Pekka Ranta, Ph.D. (pharmacy) School of Pharmacy
Faculty of Health Sciences Distributor:
University of Eastern Finland Kuopio Campus Library
P.O.Box 1627 FI-70211 Kuopio, Finland http://www.uef.fi/kirjasto ISBN: 978-952-61-2483-4 (PDF)
ISSN: 1798-5730 ISSNL: 1798-5722
Nordic Social Pharmacy and Health Services Research Conference (NSPC) 2017. Kuopio, Finland, June 7th9th 2017. Program and Abstracts. Publications of the University of Eastern Finland. Reports and Studies in Health Sciences 24. 2017. 34 p.
ISBN (pdf): 978-952-61-2483-4 ISSN (pdf): 1798-5730 ISSNL: 1798-5722
ABSTRACT
Nordic Social Pharmacy and Health Services Research Conference (NSPC) 2017 is organized by the University of Eastern Finland, School of Pharmacy. The theme of the conference is
“Designing safe and effective treatments in the era of real-world data”. The conference
gathers Nordic and international researchers working in the fields of clinical pharmacy, pharmacy education, pharmaceutical policy and practice, pharmacoeconomics, pharmacoepidemiology and drug safety and medicine information to share their knowledge and ideas.
This book contains the program and abstracts of the Nordic Social Pharmacy and Health Services Research Conference (NSPC) 2017 held in Kuopio, Finland, June 7
th9th, 2017.
National Library of Medicine Classification: QV 20.5, QV 55, QV 704, WB 330
Medical Subject Headings: Pharmacy; Pharmacy Research; Pharmacists; Pharmaceutical Services;
Pharmaceutical Preparations; Drug Therapy; Economics, Pharmaceutical; Pharmacoepidemiology; Treatment Outcome; Patient Safety; Drug Information Services; Congresses; Meeting Abstracts; Finland Yleinen suomalainen asiasanasto: farmasia; lääkkeet; lääkehoito; terveystaloustiede; epidemiologia;
Welcome
Dear Conference participants,
Welcome to the 8
thNordic Social Pharmacy and Health Services Research Conference (NSPC)! Altogether 100 participants from 10 countries are gathering in Kuopio, most of them from the Nordic countries, some from as far as Malta and China.
The theme of the conference is “Designing safe and effective treatments in the era of real- world data”.
Effectiveness of treatments is one of the emerging research areas at the University of Eastern Finland. In health care, it is a topical and extremely important issue.
I want to thank the scientific committee for brainstorming an interesting program and evaluating the abstracts. I also want to thank the keynote speakers for accepting our invitation and providing us a broad view on the effectiveness of treatments.
Research results are going to be presented in 28 traditional oral presentations and 18 Three Minute Theses (3MT
®). 3MT
®, which is an academic research communication competition, will be tried and tested instead of a poster session and we are interested in hearing your feedback of it.
Workshops have been an important part of NSPCs from the very beginning, enabling us to discuss and share ideas and experiences. Again, we are going to have 10 workshops including a pre-workshop organized by the Finnish Society of Clinical Pharmacy.
The abstracts of the oral presentations, 3MT
®s and workshops are published in two forums. The abstracts, for which the authors have wanted a wider readership, are published in RSAP, and the other abstracts you will find in this publication.
We have received financial support from the Faculty of Health Sciences to enable young researchers to participate the conference. Other supporters are The Federation of Finnish Learned Societies, The Finnish Pharmaceutical Society, Novartis, The Association of Finnish pharmacies and The Finnish Medical Society Duodecim.
On behalf of the organizing committee and the School of Pharmacy of the University of Eastern Finland, I wish you all a rewarding conference and a pleasant stay in Kuopio!
Kirsti Vainio
Chair of the organizing committee
6
Contents
PROGRAM ... 7
ORGANIZING COMMITTEE ... 10
SCIENTIFIC COMMITTEE ... 10
ABSTRACT EVALUATORS ... 10
KEYNOTE SPEAKERS ... 11
ORAL PRESENTATIONS ... 13
3MT® PRESENTATIONS ... 26
WORKSHOPS ... 33
SUPPORTERS ... 35
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Program
Wednesday, June 7
th2017
13:00–16:00 Registration and info
13:30–16:15 Pre-conference and conference workshops 16:15–16:40 Coffee break
16:40–17:00 Opening of the conference
17:00–17:45 Plenary session I: Marja Airaksinen: Research in Nordic countries in the area of safe and effective treatments
17:45–20:00 Break
20:00 Welcome get-together
8
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Thusday, June 8
th2017
7:30 RSAP Meet with the editor 8:00–20:00 Registration and info
9:00–11:45 Plenary session II: Does efficacy equal effectiveness?
9:00–10:00: Hannes Enlund: The road from evidence to better pharmaceutical care and back
10:00–11:00: Teppo Järvinen: Evidence-based and sustainable health care 11:00–11:45: Anna Birna Almarsdóttir: The patient perspective on medicines an important aspect when narrowing the efficacy-effectiveness gap
11:45–12:45 Lunch
12.45–14:35 Research topics 13 14:35–14:45 Coffee break
14:45–15:35 3MT® (Three-Minute Thesis): Academic research communication competition developed by The University of Queensland (UQ), Australia
15:35–16:00 Break 16:00–18:45 Workshops 18:45–20:00 Break
20:00 Conference dinner
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Friday, June 9
th2017
8:00–13:00 Registration and info
8:30–10:00 Plenary session III: Practical implementation of narrowing the efficacy- effectiveness gap (pharmaceutical policies, research and regulations)
8:30–9:15: Shane Desselle: Narrowing the efficacy-effectiveness gap: Mentoring for productivity and collaboration: addressing needs in policies, research, and regulations
9.15–10:00: Aukje Mantel-Teeuwisse: Narrowing the efficacy-effectiveness gap:
the role of drug regulatory science 10:00–10:15 Break
10:15–12:05 Research topics 46 12:05–13:05 Lunch
13:05–13:50 Final remarks, next conference site and organizers and announcing the winner of 3MT®
14:00 Self-acting activities
10
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Organizing committee
Heiskanen Kati, University of Eastern Finland Kauppinen Hanna, University of Eastern Finland Martikainen Janne, University of Eastern Finland Sepponen Kati, University of Eastern Finland Siitonen Piia, University of Eastern Finland
Sutinen Riitta, Aducate – Centre for Training and Development Timonen Johanna, University of Eastern Finland
Tolppanen Anna-Maija, University of Eastern Finland Vainio Kirsti, University of Eastern Finland
Scientific committee
Björnsdottir Ingunn, University of Oslo
Cantarero-Arévalo Lourdes, University of Copenhagen Halvorsen Kjell H, UiT The Arctic University of Norway Heiskanen Kati, University of Eastern Finland
Hämeen-Anttila Katri, Finnish Medicines Agency Fimea Laaksonen Raisa, University of Helsinki
Pohjanoksa-Mäntylä Marika, University of Helsinki Vainio Kirsti, University of Eastern Finland
Volmer Daisy, University of Tartu Wallman Andy, Umeå University
Abstract evaluators
Björnsdottir Ingunn, University of Oslo
Cantarero-Arévalo Lourdes, University of Copenhagen Halvorsen Kjell H, UiT The Arctic University of Norway Hämeen-Anttila Katri, Finnish Medicines Agency Fimea Laaksonen Raisa, University of Helsinki
Martikainen Janne, University of Eastern Finland Pohjanoksa-Mäntylä Marika, University of Helsinki Sepponen Kati, University of Eastern Finland Timonen Johanna, University of Eastern Finland Tolppanen Anna-Maija, University of Eastern Finland Volmer Daisy, University of Tartu
Wallman Andy, Umeå University
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
Keynote speakers
Dr. Anna Birna Almarsdóttir, Ph.D., M.S., M.Sc. (Pharm.), received her Ph.D. in Health Policy and Administration from the University of North Carolina at Chapel Hill, USA (UNC) in 1994. She is trained as a pharmacist in Iceland and holds a M.S. in Pharmacy Administration from UNC. She is Professor and Head of the Section for Social and Clinical Pharmacy at the University of Copenhagen and has previously held professorships at the University of Southern Denmark and the University of Iceland. Her research interests include drug utilization studies, developing clinical pharmacy services, and pharmaceutical policy analysis. Her methods interests are mainly questionnaire construction and triangulation of qualitative and quantitative research methods.
Shane P. Desselle, PhD, FAPhA is President of Applied Pharmacy Solutions and Professor at Touro University California College of Pharmacy. He received his B.S. in Pharmacy and Ph.D. in Pharmacy Administration from University of Louisiana at Monroe (USA). He began his academic career at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences at Long Island University in Brooklyn. He then moved on to Duquesne University where he earned tenure and founded its Office of Assessment & Educational Strategies. Dr. Desselle went on to University of Oklahoma’s College of Pharmacy where he became Chair and Associate Dean for Tulsa Programs. Dr. Desselle then assumed the role of Dean at California Northstate University’s College of Pharmacy in Sacramento, where he oversaw several successful accreditation visits, a national award for assessment, and designated national best practices in evaluation of mission effectiveness and in interdisciplinary education. Dr. Desselle’s research interests are in pharmacy labor economics, technician professionalization, migraine headache, direct-to-consumer advertising of prescription medications, and evaluation of educational strategies. He has published over 80 original research articles. He co-edits Pharmacy Management: Essentials for All Practice Settings, the most widely used pharmacy management textbook, worldwide. He is founding editor of Research in Social & Administrative Pharmacy. He is a member of the Advisory Panel for Remington: The Science and Practice of Pharmacy. Dr.
Desselle has served on the Board of Trustees on the American Association of Colleges of Pharmacy and has served on the Boards of the Northern California chapters of the Leukemia and Lymphoma Society and the American Diabetes Association. He has taught courses in social and behavioral pharmacy, pharmacy management, research methods, pharmaceutical marketing, health economics, and community health education. He has been recognized for his service as a Fellow of the American Pharmacists Association and has won university-level awards in both teaching and in research.
12 NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017 Dr Hannes Enlund received an MSc and DSc in Social Pharmacy from University of Kuopio, Finland. He spent a post-doc year at Welsh School of Pharmacy, Cardiff and was appointed full professor of Social Pharmacy at University of Kuopio in 1989. He has been visiting professor at United States Pharmacopeia, Rockville and University of Maryland at Baltimore. Dr.
Enlund also worked for International Narcotics Control Board, in Vienna on measuring the consumption of narcotics and psychotropic drugs. In 2000 he was appointed full professor of Pharmacy Practice at Kuwait University. In 2011 he was appointed Head of Research at Finnish Medicines Agency, Fimea. Dr. Enlund has served on the EU Advisory Committee on Pharmaceutical Training, Pharmacy Practice panel at USP, and on the Education and General Committees of the European Society of Clinical Pharmacy. He has evaluated pharmacy education and research at several European universities. Dr. Enlund has published some 200 scientific and practice related articles on social and behavioral aspects of drug use and prescribing, polypharmacy and the elderly, hypertension treatment, patient adherence, pharmaceutical services and the role of pharmacists, drug information and patient counseling, and management of malaria.
Teppo Järvinen is the Jane and Aatos Erkko Foundation clinical professor of Orthopaedics and Traumatology at the University of Helsinki and a Chief Surgeon at the Helsinki University Central Hospital since 2015. Dr. Järvinen has published over 100 peer-reviewed articles in international medical journals and his academic research is published regularly in the top-tier general medicine journals, such as the NEJM, Ann Intern Med, the BMJ and CMAJ.
Aukje Mantel-Teeuwisse obtained her PharmD in 1998 at Utrecht University. After a few months working as a community pharmacist in Delft (Apotheek Tanthof), she started her PhD studies at the Division of Pharmacoepidemiology and Clinical Pharmacology of Utrecht University (promotores: prof. dr. A. de Boer and prof. dr. A.J. Porsius). After completion of her thesis in 2004 she started to work as an assistant professor and later as associate professor (July 2016) at the same Division. In the period 20052010 she worked part-time at the Dutch Medicines Evaluation Board as a liaison between UU and the MEB.
Aukje has been appointed Director of the School of Pharmacy since 1 July 2014. At present, she is also the Managing Director of the WHO Collaborating Centre of Pharmaceutical Policy and Regulation. The Centre works closely together with WHO HQ, WHO EURO, the MEB and EMA, among others. Her research interests include drug regulatory science, pharmacovigilance, pharmaceutical policy analysis and variation in medicines use across countries. She is involved in the bachelor and master Pharmacy programmes as well as in the master Drug Innovation programme.
ORAL PRESENTATIONS
14 Oral presentations
1. Bekker et al.: Pharmacists’ activities to minimise medication waste: an international survey * 2. Bekker et al.: Unused medicines returned to community pharmacies: an analysis of medication
waste and possibilities for redispensing *
3. Bekker et al.: Waste of oral oncolytics and biologicals among users who discontinue therapy * 4. Druedahl & Sporrong: ADHD, medicine, and power: personal experiences in a Foucauldian
perspective *
5. Gatt et al.: An investigation into the beliefs about medicines of university students across disciplines *
6. Grånas et al.: Medication reviews in patients with mental disabilities
7. Hamina et al.: Impact of opioid initiation on antipsychotic use among persons with Alzheimer’s disease – an interrupted time series analysis
8. Heiskanen et al.: The reasons behind medicine shortages from the perspective of pharmaceutical companies and pharmaceutical wholesalers in Finland
9. Hyttinen et al.: Potentially inappropriate medication use and hip fractures in community- dwelling older persons with Alzheimer’s disease: a register-based retrospective cohort study **
10. Håkonsen & Hedenrud: Risk perceptions of OTC drug use on a reregulated Swedish pharmacy market: a population-based study
11. Koponen et al.: Antipsychotic use and the risk of hip fracture among community-dwelling persons with Alzheimer’s disease – a nationwide register-based cohort study
12. Kucukcelic et al.: Potentially inappropriate medication use in nursing homes in Northern Norway - using the Norwegian general practice - nursing home criteria *
13. Lehnbom et al.: How do Australian community pharmacists spend their time? A time and motion study
14. Lehtonen et al.: Automated dose dispensing’s effects on nurses and practical nurses’ work – a national study in Finland *
15. Lind et al.: Printing medicine: new technique and its impact on society *
16. Maksimovitš et al.: Perceptions about the use and safety aspects of medicines among schoolchildren in Tartu, Estonia *
17. Ngo & Björnsdóttir: Media coverage of diagnosis and treatment of ADHD in Norway * 18. Nørgaard et al.: Moving on from the school-medicine study *
19. Nørgaard et al.: The meeting between ethnic minorities, medicine use and the Nordic countries:
an overview of theory-based intervention studies and lessons learned *
20. Petersen et al.: Contextualizing study drugs: what general practitioners, psychiatrists and university counsellors say *
21. Saarelainen et al.: Risk of death associated with benzodiazepine and related drug use in persons with Alzheimer’s disease: a retrospective, register-based cohort study
22. Simonsen et al.: Use of low dose naltrexone and change in use of prescription drugs in patients with inflammatory bowel disease – a drug utilization cohort study based on the Norwegian prescription register *
23. Stadeløkken et al.: Drug use and drug related problems in three nursing homes in rural municipalities in Norway *
24. Taipale et al.: Antidepressant use and risk of head injuries in persons with Alzheimer’s disease – a matched cohort study
25. Vlieland et al.: Actual versus recommended storage temperatures of oral oncolytic drugs at patients’ homes
26. Vlieland et al.: Patient compliance with drug storage recommendations: multiple drugs and storage locations are associated with inadequate storage conditions
27. West et al.: Determination of medicines wastage and its association with beliefs about medicines and locus of control in patients suffering from chronic conditions – a pilot study *
28. West et al.: The association of adherence to medicines with medicines literacy, beliefs about medicines and locus of control in patients suffering from chronic conditions – a pilot study *
* Published in Research in Social and Administrative Pharmacy (RSAP) 2017;13(3). www.rsap.org
** Not included
16
MEDICATION REVIEWS IN PATIENTS WITH MENTAL DISABILITIES
Grånas Anne Gerd (a.g.granas@farmasi.uio.no) [1], Mohammed Amani Q (amani_mohammed@
hotmail.com) [2], Aanensen Julie (julie.wendelbo.aanensen@sye.oslo.kommune.no) [3], Halvorsen Kjell H (kjell.h.halvorsen@uit.no) [4], Landmark Cecilie J (cecilie.landmark@hioa.no)
[1] University of Oslo, Norway; [2] Oslo, Norway; [3] Centre for Development of Institutional and Home Care Services in Oslo, Norway; [4] UiT The Arctic University of Norway, Norway; [5] Oslo and Akershus University College of Applied Sciences, Norway
INTRODUCTION: Systematic medication reviews in multidisciplinary teams is an acknowledged method to identify potential and actual drug-related problems (DRP). Based on the lack of knowledge about DRPs in polypharmacy patients with mental disabilities, the Centre for Development of Institutional and Home Care Services in Oslo, Norway conducted medication reviews in this patient group in 2015–2016.
OBJECTIVES: The objective was to examine prescribing patterns, frequencies and types of DRP in patients with mental disabilities.
METHODS: The National Patient Safety Campaign in Norway developed the forms for medication reviews. Several network Meetings were organized for nurses/social educators to train them in medication reviews. They thereafter recruited eligible patients (>18 years, > 4 medicines), observed them, and ordered laboratory monitoring if needed. The pharmacist conducted medication reviews to identify DRPs. The multidisciplinary case conference took place at the general practitioners’ office with the nurse/social educator and the clinical pharmacist present. In some cases, patients who expressed interest in therapeutical considerations also took part. The DRP-forms containing information on the prescribed medicines, strength, dose, indication, a description of DRP, and suggested interventions to resolve them, were entered and analyzed using SPSS.
RESULTS: In total, 40 patients, aged 34–77 years, consented to have a medication review. They used on average 12 medicines (range 5–23). A total of 191 DRP were identified in 39 of the 40 patients (average 4.9, range 0–13). The multidisciplinary team acknowledged 79% of all identified DRPs. For one-third of the medicines, an action was performed to improve the prescribing. The most commonly medicines were analgesics (62%), antiepileptics (58%) and anxiolytics (52 %). The most frequent DRPs were unnecessary drug choice (24%), side effects (11 %) and too low dose (11%). DRPs were most commonly related to the use of antipsychotics (10%), antidepressants (9%) and anxiolytics (7%).
DISCUSSION AND CONCLUSIONS: Patients with mental disabilities take more medicines and have many DRPs compared to other patient groups. They are also more prone to taking combinations of CNS-active medicines and therefore more at risk of side effects and drug-drug interactions.
IMPACT OF OPIOID INITIATION ON ANTIPSYCHOTIC USE AMONG PERSONS WITH ALZHEIMER’S DISEASE – AN INTERRUPTED TIME SERIES ANALYSIS
Hamina Aleksi (hamina@student.uef.fi) [1], Taipale Heidi (heidi.taipale@uef.fi) [1], Tanskanen Antti (antti.tanskanen@ki.se) [2], Tolppanen Anna-Maija (anna-maija.tolppanen@uef.fi) [1], Lavikainen Piia (piia.lavikainen@uef.fi) [1], Tiihonen Jari (jari.tiihonen@ki.se) [2], Hartikainen Sirpa (sirpa.hartikainen@uef.fi) [1]
[1] University of Eastern Finland, Finland; [2] Karolinska Institutet, Sweden
INTRODUCTION: The ability to understand and communicate pain may be diminished among persons with Alzheimer’s disease (AD) and thus, pain may be presented as behavioral and psychological symptoms of dementia (BPSD), such as anxiety, aggression or hallucinations. Some evidence exists that BPSD could be alleviated with analgesic use. However, the impact of analgesic initiation on antipsychotic use has not been studied previously.
OBJECTIVES: To analyze the impact of opioid initiation on the prevalence of antipsychotic use among persons with AD in non-interventional settings.
METHODS: We conducted this research as a part of the Medication in Alzheimer’s disease (MEDALZ) study. The MEDALZ cohort consists of all persons diagnosed with AD in Finland between the years 2005–2011 (N = 70,718). The cohort comprises data from several nationwide registers: Prescription Register, Special Reimbursement Register and Hospital Discharge Register.
Persons with AD were identified from the Special Reimbursement Register, which for AD requires diagnosis based on the NINCDS–ADRDA and DSM-IV criteria. Drug use was modelled from purchases utilizing a novel and validated mathematical method PRE2DUP.
The prevalence of antipsychotic use in one-month time periods before opioid initiation were compared with time periods after the initiation with interrupted time series analyses. Interrupted time series analyses allow estimation of pre- and post-intervention trends and change in the level of outcome measure (i.e. antipsychotic use) after the intervention (i.e. opioid initiation). The analyses were restricted to those opioid initiators that were diagnosed in 2010 or 2011. Moreover, we utilized a six-month wash-out period for opioid use and excluded persons with long-term hospitalizations prior to opioid initiation.
RESULTS: After exclusions, 3,327 persons were included in the analyses with a mean age of 82, 68%
being women. At six months before opioid initiation, 13.2% used an antipsychotic, while the prevalence was 17.3% six months after opioid initiation. The risk of antipsychotic use increased 5.4%
(95% CI 3.0–7.8%) per month after the start of follow-up until opioid initiation. There was an additional risk increase of 15.9% (3.9–29.2) immediately after opioid initiation. One month after opioid initiation, there was a decrease of 6.9% (3.8–9.9%) per month until the end of follow-up.
DISCUSSION AND CONCLUSIONS: Opioid initiation was associated with an immediate increased risk of antipsychotic use. However, one month after opioid initiation, the risk of antipsychotic use decreased and overall opioid initiation had a small but decreasing effect on antipsychotic use among persons with AD.
18
RISK PERCEPTIONS OF OTC DRUG USE ON A REREGULATED SWEDISH PHARMACY MARKET: A POPULATION-BASED STUDY
Håkonsen Helle (helle.hakonsen@gu.se) [1], Hedenrud Tove (tove.hedenrud@socmed.gu.se) [1]
[1] University of Gothenburg, Sweden
INTRODUCTION: Sweden was the last of the Nordic countries to reregulate the pharmacy market.
In 2009, the pharmacy monopoly was ended and other retailers were permitted to sell certain OTC drugs.
OBJECTIVES: The aim of the presentation is to present results from recent studies on risk perceptions of OTC drug use in the Swedish population focusing on paracetamol and on consumer preferences for OTC retailers.
METHODS: Data was drawn from two data collections from a Swedish online panel. Participants were randomly recruited in June-July 2013 (n=2594) and October 2015 (n=3400). The samples were stratified by sex, age and education to be representative of the Swedish adult population. The questionnaires contained items on OTC drug use, retail preferences, OTC drug information, risk perceptions of OTCs, and paracetamol in particular, and sociodemographic characteristics. The studies were approved by the Regional Ethics Committee.
RESULTS: Most participants had used OTC drugs in the preceding 6 months. Almost 25% were categorised as weekly users of OTCs. Pharmacies were the preferred retailer for OTC drugs, chosen by a majority of participants due to geographical proximity, followed by product range and availability of trained staff. One in four stated that they asked the pharmacy staff for advice about OTCs. Still, one-third agreed that OTC sales should be restricted to pharmacies to decrease the risk of overuse. OTC drugs were considered completely harmless to use by 6% of the participants, and 9% stated higher use of OTCs due to increased availability. Drugs with paracetamol were considered completely harmless by 14%. Three in four could identify risks of paracetamol overdoses while 13%
stated paracetamol as less risky than other OTC painkillers (e.g. ibuprofen and aspirin). Less than 1%
reported a higher maximum dose of paracetamol than recommended. Young adults (aged 18–25 years), who were the most frequent users of OTC paracetamol, reported other purchase habits and perceived less risk associated with use compared with the older participants.
DISCUSSION AND CONCLUSIONS: The reported risk perceptions indicated responsible use of OTC drugs among most Swedes. However, it should be noted that consumers base their preferences for OTC retailers on increased availability and this can also impact the patterns of drug use.
THE REASONS BEHIND MEDICINE SHORTAGES FROM THE PERSPECTIVE OF PHARMACEUTICAL COMPANIES AND PHARMACEUTICAL WHOLESALERS IN FINLAND Heiskanen Kati (kati.heiskanen@uef.fi) [1], Ahonen Riitta (riitta.ahonen@uef.fi) [1], Kanerva Risto (risto.kanerva@apteekit.net) [2], Karttunen Pekka (pekka.karttunen@siilinapteekki.fi) [3], Timonen Johanna (johanna.timonen@uef.fi) [1]
[1] University of Eastern Finland, Finland; [2] Espoo I Tapiola Pharmacy, Finland; [3] Siilinjärvi I Pharmacy, Finland
INTRODUCTION: Medicines shortage can be defined as “a drug supply issue requiring a change that impacts patient care and requires the use of an alternative agent”. Medicine shortages cause several issues related to patient care and patient safety. They may result in medication errors, inefficiency in medical care and side effects. Furthermore, patients may suffer from delays or may not receive recommended treatment at all. Shortages may, moreover, add the workload of physicians and pharmacists and increase the costs of medical care. The research on medicine shortages is yet limited and the reasons behind medicine shortages are often left undiscovered.
OBJECTIVES: The aim of this study was to explore the reasons behind medicine shortages from the perspective of pharmaceutical companies and pharmaceutical wholesalers in Finland
METHODS: 41 companies were invited to participate the study. From pharmaceutical companies, member organizations of Pharma Industry Finland (PIF) (N=30) and Finnish Generic Pharmaceutical Association (FGPA) (N=7) were invited to participate. Additionally, one company which is a central actor in the pharmaceutical market in Finland but does not feature to PIF or FGPA, was invited. From pharmaceutical wholesalers, those with a nationwide distribution network (N=3) were invited. A total of 30 semi-structured interviews were conducted between March and June 2016. The interviews were recorded and transcribed word for word. The data were construed with qualitative thematic analysis.
Quantifying and tabulations were also used.
RESULTS: The reasons behind medicine shortages were divided into two categories: supply-related and demand-related reasons behind medicine shortages. The most common supply-related reasons behind medicine shortages in Finland were the small size of the pharmaceutical market (29/30), small stock sizes (25/30), long delivery time (23/30), long or complex production chain (23/30), dependency on foreign manufacturing (22/30) and raw material shortages (21/30). The most common demand- related reasons were abrupt or fluctuating demand (28/30), low price level or low profitability (21/30), prioritization of countries or markets (19/30) and hospital trade and tenders (18/30).
DISCUSSION AND CONCLUSIONS: The reasons behind medicine shortages were more commonly supply-related than demand-related. Yet, the reasons behind medicine shortages were often multi-faceted and no single reason was necessarily behind the shortage. Supply-related reasons behind shortages, such as small market size, commonly interfaced with country-specific characteristics of Finland, whereas demand-related reasons commonly affiliated with the predictability and attractiveness of the market. Some reasons behind medicine shortages, such as raw material shortages, were considered global and thus, effecting to other countries also.
20
ANTIPSYCHOTIC USE AND THE RISK OF HIP FRACTURE AMONG COMMUNITY- DWELLING PERSONS WITH ALZHEIMER’S DISEASE – A NATIONWIDE REGISTER-BASED COHORT STUDY
Koponen Marjaana (marjaana.koponen@uef.fi) [1], Taipale Heidi (heidi.taipale@uef.fi) [1], Lavikainen Piia (piia.lavikainen@uef.fi) [1], Tanskanen Antti (antti.tanskanen@ki.se) [2], Tiihonen Jari (jari.tiihonen@ki.se) [1,2], Tolppanen Anna-Maija (anna-maija.tolppanen@uef.fi) [1], Ahonen Riitta (riitta.ahonen@uef.fi) [1], Hartikainen Sirpa (sirpa.hartikainen@uef.fi) [1]
[1] University of Eastern Finland, Finland; [2] Karolinska Institutet, Sweden
INTRODUCTION: Both incidence of hip fractures and prevalence of antipsychotic use is high among persons with Alzheimer’s disease (AD). More information is needed on hip fracture risk in relation to duration of antipsychotic use and comparative safety of individual antipsychotic drugs.
OBJECTIVES: To study whether antipsychotic use is associated with a risk of hip fracture among individuals with AD and to compare the risk according to the duration of use and between the most frequently used antipsychotics.
METHODS: The MEDication use and ALZheimer’s disease (MEDALZ) cohort consisted of community-dwelling Finnish persons with clinically verified diagnoses of AD, including 70,718 persons newly-diagnosed according to NINCDS-ADRDA and DSM-IV criteria during 20052011.
Antipsychotic use was modelled from Prescription Register data and hip fractures were identified from the Hospital Discharge Register. The incidence of hip fractures in new users of antipsychotics was compared with time without antipsychotics, and quetiapine use was compared with risperidone.
Analyses were adjusted for age, sex, history of stroke, osteoporosis, rheumatoid arthritis, glaucoma, diabetes, cardiovascular disease, epilepsy, and use of other psychotropics and opioids.
RESULTS: Compared to nonuse, antipsychotic use was associated with an increased risk of hip fractures (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.39–1.70). The risk was increased from the first days of use and remained increased thereafter. Quetiapine was associated with a similar risk of hip fracture as risperidone for the first 2.7 years of use (aHR 0.98, 0.79–1.21).
DISCUSSION AND CONCLUSIONS: As the risk of hip fracture was increased from the first days of use, our results confirm the need for setting a high threshold for initiating antipsychotic use among persons with AD to avoid serious adverse events. If antipsychotic use is initiated, the duration of use should be limited as the risk of hip fracture does not attenuate with long-term use.
HOW DO AUSTRLIAN COMMUNITY PHARMACISTS SPEND THEIR TIME? A TIME AND MOTION STUDY
Lehnbom Elin (elin.c.lehnbom@uit.no) [1], Cavaye Diana (dacv8583@uni.sydney.edu.au) [2], Webster Ruth (rwebster@georgeinstitute.org.au) [3]
[1] University of Tromsø, Norway; [2] University of Sydney, Australia; [3] The George Institute for Global Health, Australia
INTRODUCTION: Pharmacists are a set of highly trained healthcare professionals with regular patient interactions. Pharmacy-led interventions have the potential to improve clinical outcomes thus it is important to know how community pharmacists spend their time in order to design an intervention that will not be too disruptive for community pharmacists to implement.
OBJECTIVES: To quantify how Australian community pharmacists spend their time.
METHODS: Pharmacists working in three community pharmacies in metropolitan Sydney were recruited via professional contacts and shadowed for a maximum of 2 hours at a time by a trained observer using WOMBAT (Work Observation Method By Activity Timing), an electronic data collection tool designed for direct observations. The three pharmacies included in this pilot study were different in size, staffing and clientele. De-identified information about WHAT the observed pharmacist was doing (filling prescriptions, patient counselling, etc), WITH whom (alone, with customer, etc), HOW they were performing the task (face-to-face, on a computer, etc), and WHERE they were doing it (shop front, behind a desk, etc) was collected. Collected data was downloaded from the tablet and the frequency, average duration and proportion of observed time in each task was calculated. The rates of interruptions and multi-tasking was also calculated.
RESULTS: A total of 5 pharmacists were observed for 35.4 hours in total while performing 1,408 individual tasks during weekday shifts (8.30am–6pm). The most frequently performed task was counselling (n=375 tasks, 26.6%), followed by dispensing (n=292, 20.7%) and professional management (n=235, 16.7%). Pharmacists spend the largest proportion of their time on professional management (23.2%), dispensing (23.1%) and counselling (22.8%). Pharmacists spend almost half their time (49.4%) behind the desk, 27.6% at the desk, 16.1% in the front/self-service area and 6.9% in the office. Given these results, it is not surprising that pharmacist spend a lot of time alone (54.8%).
When interacting face-to-face, it is mainly with customers (75.6%), other staff (19.3%) and others (4,1%). Pharmacists were interrupted 27 times, or approximately every 45 minutes. The total task time was 36.8 hours, which is greater than the 35.4 hours pharmacists were observed which is due to multitasking i.e. pharmacists conducting two or more tasks simultaneously. Overall, pharmacists spent 4.0% (1.4 hours) of their time multitasking.
DISCUSSION AND CONCLUSIONS: This is one of the first time and motion studies conducted in community pharmacies. The most frequently performed task was counselling but pharmacists spend a large proportion of their time alone behind the desk, indicating that interventions requiring pharmacists to spend more than a few minutes with patients may be difficult to implement successfully.
22
RISK OF DEATH ASSOCIATED WITH BENZODIAZEPINE AND RELATED DRUG USE IN PERSONS WITH ALZHEIMER’S DISEASE: A RETROSPECTIVE, REGISTER-BASED COHORT STUDY
Saarelainen Laura (laura.saarelainen@uef.fi) [1], Tolppanen Anna-Maija (anna- maija.tolppanen@uef.fi), Koponen Marjaana (marjaana.koponen@uef.fi), Tanskanen Antti, (antti.tanskanen@ki.se) [2], Sund Reijo (reijo.sund@uef.fi) [1], Lavikainen Piia (piia.lavikainen@uef.fi) [1], Tiihonen Jari (jari.tiihonen@ki.se) [2], Hartikainen Sirpa (sirpa.hartikainen@uef.fi) [1], Taipale Heidi (heidi.taipale@uef.fi) [1]
[1] University of Eastern Finland, Finland; [2] Karolinska Institutet, Sweden
INTRODUCTION: Benzodiazepines and related drugs (BZDR) are frequently used by persons with Alzheimer’s disease (AD), although the risks of BZDR use in this population are mostly unknown.
Further, the evidence on mortality associated with BZDR use in older persons is inconclusive.
OBJECTIVES: To investigate the risk of death associated with new BZDR use in a nationwide cohort of persons with AD.
METHODS: The register-based MEDication use and ALZheimer’s disease (MEDALZ) cohort included all community-dwelling Finnish persons diagnosed with AD during 2005–2011 (n=70,718).
Clinically verified data on AD diagnoses were obtained from the Special Reimbursement register.
Time-varying BZDR use, including benzodiazepines (ATC classes N05BA and N05CD) and benzodiazepine-related drugs (ATC class N05CF), was modelled from purchase data in the Prescription Register. To study new users, we excluded persons who had any BZDR use during the year preceding the AD diagnosis, leaving 48,429 persons in the study. Two nonusers were matched for each person initiating BZDR use, based on age, gender, and time since AD diagnosis.
We reported 180-day all-cause mortality during BZDR use in comparison to nonuse as adjusted hazard ratios (aHR) with 95% confidence intervals (CI), derived from Cox regression. Covariates collected from healthcare registers included chronic comorbidities, history of hip fractures, substance abuse, psychiatric disorders as well as stroke, baseline use of antidepressants, antipsychotics, and opioids, and socioeconomic position.
RESULTS: In total, 10,372 persons with AD (21.4%) initiated BZDR use during the follow-up. During BZDR use, 13.4 (12.2–14.6) deaths per 100 person-years occurred, whereas during nonuse, 7.9 (7.4–
8.5) deaths per 100 person-years occurred.
BZDR use was associated with an increased risk of mortality (aHR=1.44, 95% CI=1.25–1.67).
Considering duration of use, BZDR use was associated with an increased risk of mortality during 31- 60 days (aHR=1.57 [95% CI=1.15–2.13]) and 61-120 days (aHR=1.72 [95% CI=1.36–2.17]) of use.
DISCUSSION AND CONCLUSIONS: BZDR use was associated with an increased risk of mortality in persons with AD. Careful consideration of symptomatic treatment with BZDRs might reduce the most severe adverse event, mortality, in this vulnerable population.
ANTIDEPRESSANT USE AND RISK OF HEAD INJURIES IN PERSONS WITH ALZHEIMER’S DISEASE – A MATCHED COHORT STUDY
Taipale Heidi (heidi.taipale@uef.fi) [1], Koponen Marjaana (marjaana.koponen@uef.fi) [1], Tanskanen Antti (antti.tanskanen@ki.se) [2], Lavikainen Piia (piia.lavikainen@uef.fi) [1], Sund Reijo (reijo.sund@uef.fi) [1], Tiihonen Jari (jari.tiihonen@ki.se) [2], Hartikainen Sirpa (sirpa.hartikainen@uef.fi) [1], Tolppanen Anna-Maija (anna-maija.tolppanen@uef.fi)
[1] University of Eastern Finland, Finland; [2] Karolinska Institutet, Sweden
INTRODUCTION: The risk of head and brain injuries increases with age and previous studies also show that persons with Alzheimer’s disease frequently use antidepressants which may lead to increased risk of falling.
OBJECTIVES: Our objective was to investigate the risk of head and brain injuries associated with antidepressant use among community-dwelling persons with Alzheimer’s disease.
METHODS: A register-based matched cohort study was conducted by comparing new antidepressant users (N=10,910) with two nonusers (N=21,820) in the MEDALZ study cohort. The MEDALZ cohort includes all community-dwelling persons newly diagnosed with Alzheimer’s disease between 2005 and 2011 in Finland. Incident antidepressant users were identified based on register-based dispensing data with a one-year washout period for antidepressant use. Nonusers were matched with users based on age, gender and time since AD diagnoses. The outcome events were defined as any head injuries and traumatic brain injuries based on hospital discharge diagnoses and causes of death. Propensity score adjusted Cox proportional hazard models were utilized.
Sensitivity analyses with case-crossover design were conducted to further assess unmeasured confounding on individual level.
RESULTS: Antidepressant use was associated with an increased risk of head injuries (adjusted HR 1.35, 95% CI 1.201.52) and traumatic brain injuries (HR 1.26, 95% CI 1.06-1.50). The risk was highest during the first 30 days of use (HR 1.71, 95% CI 1.102.66 for head injuries, HR 2.06, 95% CI 1.123.82 for traumatic brain injuries) and remained on elevated level for head injuries for over 2 years of use.
In case-crossover analyses, antidepressant use was consistently associated with higher risk of head injuries.
DISCUSSION AND CONCLUSIONS: Antidepressant use was associated with an increased risk of the most severe outcomes, head and brain injuries in persons with Alzheimer’s disease.
Antidepressant use should be carefully considered.
24
ACTUAL VERSUS RECOMMENDED STORAGE TEMPERATURES OF ORAL ONCOLYTIC DRUGS AT PATIENTS’ HOMES
Vlieland Nicolaas D (N.D.Vlieland@umcutrecht.nl) [1], van den Bemt Bart J F (b.vandenbemt@maartenskliniek.nl) [2,3,4], van Riet-Nales Diana A (da.v.riet@cbg-meb.nl) [1], Bouvy Marcel L (m.l.bouvy@uu.nl) [1], Egberts Toine C (a.c.g.egberts@umcutrecht.nl) [1], Gardarsdottir Helga (h.gardarsdottir@umcutrecht.nl) [1]
[1] University Medical Center Utrecht, The Netherlands; [2] Sint Maartenskliniek, The Netherlands;
[3] Radboud Medical Center, The Netherlands; [4] Maastricht University, The Netherlands
INTRODUCTION: Substantial quantities of unused drugs are returned by patients to the pharmacy each year. Re-dispensing of these drugs would reduce drug wastage and health care costs. However, the quality of drugs stored at home is unknown.
OBJECTIVES: to investigate if home storage temperatures of oral anticancer drugs comply with the manufacturers' Summary of Product Characteristics (SmPC) recommendations.
METHODS: All adult patients from six Dutch outpatient hospital pharmacies receiving an oral anticancer drug product dispensed during March 2014–January 2015 were asked by their pharmacist or pharmacy assistant to participate in the study. Eligible patients were asked for a written informed consent. Patients received standard instructions upon dispensing by the pharmacy's personnel. Home storage temperatures were assessed by attaching a temperature logger to the original drug package measuring temperature every two minutes.
RESULTS: Ninety (81.1%) of the 111 included patients (47.8% female, mean (SD) age 65.2 (11.1) returned their temperature loggers to the pharmacy. The mean total measured storage time per patient was 64.0 days (SD; 25.3). None of the patients stored their oral anticancer drug products at a mean kinetic temperature (measure that takes into account temperature fluctuations) above 25°C, although one patient stored a product that required storage below 25°C longer than 24 hours above 25°C. Patients using products requiring storage below 30°C or not requiring any special temperature requirements did not store their products above 30°C for a consecutive period of 24 hours or longer.
DISCUSSION AND CONCLUSIONS: The majority of patients using oral anticancer drug products store their drug products according to the temperature recommendations in the SmPC. Most of the returned drug products requiring storage at room temperature are likely to be suitable for re- dispensing, although other quality criteria including light and humidity should also be assessed.
Although no additional instructions on storage, besides standard pharmacy procedure on drug dispensing, were provided, we cannot exclude that the knowledge of being observed influenced the patients home storage behavior.
PATIENT COMPLIANCE WITH DRUG STORAGE RECOMMENDATIONS: MULTIPLE DRUGS AND STORAGE LOCATIONS ARE ASSOCIATED WITH INADEQUATE STORAGE CONDITIONS
Vlieland Nicolaas D (N.D.Vlieland@umcutrecht.nl) [1], van den Bemt Bart J F (b.vandenbemt@maartenskliniek.nl) [2,3,4], Bekker Charlotte L (c.bekker@maartenskliniek.nl) [1], Bouvy Marcel L (m.l.bouvy@uu.nl) [1], Egberts Toine C (a.c.g.egberts@umcutrecht.nl) [1], Gardarsdottir Helga (h.gardarsdottir@umcutrecht.nl) [1]
[1] University Medical Center Utrecht, The Netherlands; [2) Sint Maartenskliniek, The Netherlands;
[3] Radboud Medical Center, The Netherlands; [4] Maastricht University, The Netherlands
INTRODUCTION: Elderly patients are often treated with many different drugs which can result in difficulties with adequate drug management and safe storage at home.
OBJECTIVES: We aim to investigate to what extent elderly patients store drugs according to the drug product storage recommendations.
METHODS: This cross-sectional study was performed between October 2015 and March 2016 in 44 community pharmacies in The Netherlands. In each pharmacy, four home dwelling patients aged 65 years or older and using at least one prescription drug were randomly selected and invited by the community pharmacist to participate. Drugs were considered properly stored when all of the following criteria were fulfilled: 1) storage according to drug product label storage recommendations for temperature, light, humidity; 2) expiry date not passed; 3) in the original and intact package; 4) drug product insert or information leaflet present. A multivariate logistic regression model was used to assess the associations between non-compliance with storage conditions, number of drugs stored at home and storage locations.
RESULTS: 170 patients (53.5% female, mean age 74.9 [SD 7.3]) were included in the study. Patients’
compliance with drug storage criteria could be assessed in 160 (94.1%) patients and 36.9% complied with all storage criteria [compliance with criterion 1) 64.4%; 2) 82.5%; 3) 83.8%; 4) 69.4%]. Non- compliance with one or more storage criteria was associated with having multiple drugs [≥10 drugs (ORadj)=9.0; 95% CI:(2.6, 30.7)] and having three or more storage locations at home [(ORadj)=4.4; 95%
CI:(1.2, 16.0)].
DISCUSSION AND CONCLUSIONS: Elderly patients using multiple drugs and having multiple storage locations do often not store drugs according to storage recommendations and could use advice from pharmacists to store drugs at home more adequately.
26
3MT ® PRESENTATIONS
3MT® (Three-minute thesis) presentations
1. Aziz et al.: A societal perception about community pharmacies in Pakistan: an outline of prospective investigation *
2. Bogosavljevic et al.: Pharmacological treatment approaches to ADHD in Norway and Serbia * 3. Druedahl et al.: Young ethnic minority women living with asthma: exploring the role of self-
efficacy revealing link to religion
4. Fouad et al.: Association between anti-osteoporotic drug use and quality of life (QoL) in women and men with osteoporosis-a cross sectional analysis within the Tromsø study *
5. Hämeen-Anttila et al.: Pharmacy students as agents of medicine education in schools * 6. Jedig Lech et al.: Pharmacists bridging the gap between primary and secondary care
medication *
7. Kauppinen et al.: Electronic prescriptions perceived by physicians – a semi-structured interview to primary health care physicians in Finland
8. Khong et al.: Alteration of prescription-only drug utilization by low dose naltrexone users with hypothyroidism. A cohort study based on the Norwegian prescription database from
20112015 *
9. Lehtonen et al.: Acute medication changes during automated dose dispensing – nurses and practical nurses’ perceptions *
10. Metsämuuronen et al.: Health and safety in dose dispensing of antibiotics **
11. Mølby Hansen et al.: A study on student environment, extracurricular activities, motivation and academic achievements *
12. Ntiamoah et al.: The use of bisphosphonates for treatment of osteoporosis in a general population – a cross-sectional survey analysis within the Tromsø study
13. Oinasmaa & Heiskanen et al.: Routine collection of health-related quality of life data in a hospital – is the data representative? *
14. Stojković et al.: Dispensing errors in the outpatient setting: pharmacists’ perspective
15. Stojković et al.: Economic consideration of clinical pharmacist-led service for patients on warfarin in Serbia *
16. Waaseth et al.: Self-care among diabetes patients interviewed at Norwegian pharmacies * 17. West et al.: Educational intervention based on the normalisation process theory to enhance
adherence to antibiotics – a pilot study *
18. Zekovic et al.: Periconceptional folic acid supplementation: knowledge and attitudes of pharmacy students
* Published in Research in Social and Administrative Pharmacy (RSAP) 2017;13(3). www.rsap.org
** Published in Drugs and Therapy Perspectives 2016. DOI: 10.1007/s40267-016-0307-4
28
YOUNG ETHNIC MINORITY WOMEN LIVING WITH ASTHMA: EXPLORING THE ROLE OF SELF-EFFICACY REVEALING LINK TO RELIGION
Druedahl Louise C (louise.druedahl@sund.ku.dk) [1], Cantarero-Arévalo Lourdes (lou.cantarero@sund.ku.dk) [1], Yaqub Duaa (duaa88@live.dk) [1], Nørgaard Lotte Stig (lotte.norgaard@sund.ku.dk) [1]
[1] University of Copenhagen, Copenhagen
INTRODUCTION: There have been found ethnic inequalities in Denmark regarding use of asthma medication, but the underlying reasons are unknown. However, underlying rationales for behaviour might be explained by the concept of self-efficacy (SE). Albert Bandura describes that SE is the belief and judgement of one owns ability to carry out a certain action to handle a specific situation.
OBJECTIVES: The aim of the study was to explore SE for taking asthma medication to control asthma symptoms for young ethnic minority women in the age 1424 years.
METHODS: A convenience sampling strategy was applied as well as a snowballing technique for recruiting young ethnic minority women in the age 1424 years for focus group and individual interviews. Data was deductively analysed using the theory of SE, where the theoretical constructs behaviour and outcome were ‘taking asthma medication’ and ‘control of asthma symptoms’, respectively.
RESULTS: A total of 10 interviewees participated in individual interviews, and 3 of them also in a focus group. The main results were that SE to take medication is linked to religion and religious practice, especially in relation to Ramadan, and that a possible reason for difference in use between reliever and preventive medications is low outcome expectations of preventive medication to control asthma symptoms.
DISCUSSION AND CONCLUSIONS: Young ethnic minority women living with asthma show different levels of SE. SE is also linked to their religious believes, giving for some a source of strength to live with asthma and the treatment. Health care professionals should be aware of SE in general in order to heighten self-efficacy to take medication and thereby adherence to treatments, e.g. by increasing outcome expectations of preventive medication. In addition, awareness should be raised on the impact of religion on SE to take medication during the holy month of the Ramadan in order to more fully understand the patient perspective of ethnic minorities, which can improve quality of care of asthma. By exploring SE in these ethnic minority women, it emerged that SE is a valuable explanatory term to asthma health behaviour, and importantly that there is a need for conceptualising the impact of religion in the theory of SE.
ELECTRONIC PRESCRIPTIONS PERCEIVED BY PHYSICIANS – A SEMI-STRUCTURED INTERVIEW TO PRIMARY HEALTH CARE PHYSICIANS IN FINLAND
Kauppinen Hanna (hanna.kauppinen@uef.fi) [1], Ahonen Riitta (riitta.ahonen@uef.fi) [1], Mäntyselkä Pekka (pekka.mantyselka@uef.fi) [1,2], Timonen Johanna (johanna.timonen@uef.fi)
[1] University of Eastern Finland, Finland; [2] Kuopio University Hospital, Finland
INTRODUCTION: In Finland, a fully operational and nationwide electronic prescription (ePrescription) system was implemented by law between the years 2012 and 2015. All prescriptions have to be electronic by the year 2017. At the end of 2014, over 90% of all prescriptions from the public sector were ePrescriptions. One of the aims of ePrescriptions was to facilitate prescribing and to improve medication safety in Finnish health care.
OBJECTIVES: To explore primary health care physicians’ experiences with the impacts of ePrescriptions on prescribing and medication safety.
METHODS: The data were collected by conducting 42 semi-structured telephone interviews among primary health care physicians in the spring of 2015. A convenience sample was collected from primary health care centres across five university hospital regions in Finland. The data was analysed by using qualitative content analysis. Counting and tabulation were also used to quantify regularities in the interviews.
RESULTS: Most of the physicians considered that ePrescriptions were technically easy to prescribe because of the paperless procedure or the accessibility of patients’ information. In addition, ePrescriptions have positively affected the controlling of narcotics and medicines classified as primary affecting the central nervous system (CNS medicines) because physicians were able to check patient’s medication held in the Prescription Centre. However, many physicians stated that the ePrescribing system was rigid and inflexible, especially when correcting, cancelling, or repeating ePrescriptions. For example, the system required too much “mouse clicks” and PIN entries to justify the actions made in prescriptions. The system slowness and poor connection between the physicians’
electronic patient record and the Prescription Centre was also underlined. Nonetheless, physicians stated that patients’ prescription information was better available through the Prescription Centre since physicians were able to check patients’ prescription information and prescriptions prescribed elsewhere. However, finding out patient’s current medication through the Prescription Centre was perceived difficult because prescription information was incoherent and not updated.
DISCUSSION AND CONCLUSIONS: According to the physicians, ePrescriptions have facilitated prescribing in many respects in Finnish primary health care. However, ePrescribing system still has problems and the Prescription Centre cannot be fully utilized for the patient’s overall medication management. Consequently, the aims of ePrescriptions set by law have not yet been fully achieved.
30
THE USE OF BISPHOSPHONATES FOR TREATMENT OF OSTEOPOROSIS IN A GENERAL POPULATION – A CROSS-SECTIONAL SURVEY ANALYSIS WITHIN THE TROMSØ STUDY Ntiamoah Frank Kwame (frankntiamoah@yahoo.com) [1], Bjørnerem Åshild (ashild.bjornerem@uit.no) [1], Eggen Anne Elise (anne.elise.eggen@uit.no) [1], Emaus Nina (nina.emaus@uit.no) [1], Waaseth Marit (marit.waaseth@uit.no) [1]
[1] UiT The Arctic University of Norway, Norway
INTRODUCTION: Osteoporosis is a major health issue worldwide. Norway has the world's highest incidence of hip fractures with over 9,000 hip fractures per year. Bisphosphonates are effective drugs and the first choice for prevention and treatment of osteoporosis and osteoporotic fractures.
According to Norwegian guidelines, treatment with bisphosphonates is recommended for people with osteoporosis, defined by T-score <-2.5, and people with osteopenia (T-score ≤ -1.6) combined with previous fracture. Despite this, several studies have suggested that patients are undertreated.
OBJECTIVES: To describe the use of bisphosphonates in a general population of people with osteoporosis, defined by self-report or by bone density measurement, and with or without self- reported fractures (wrist and / or hip fracture)
METHODS: A cross-sectional study was conducted based on data from the sixth survey of the Tromsø study (Tromsø 6), which took place in 20072008. The material includes information from questionnaires and clinical examinations of the entire study population (n = 12 981, 66% attendance percent), aged 3087 years, in addition to bone density measurements (dual-energy X-ray absorptiometry, DXA) from a subpopulation (n = 3663).
RESULTS: The prevalence of bisphosphonate use was 48% among participants who reported both osteoporosis and bone fractures (n = 175) and 43% among all participants that reported osteoporosis (n = 437). In the subpopulation with measured bone density (DXA), the prevalence of bisphosphonate use was 11% among participants who were eligible for treatment based on DXA measurements and self-reported fractures. Only 20% these participants were aware that they had osteoporosis.
DISCUSSION AND CONCLUSIONS: The study shows that osteoporosis is both underdiagnosed and undertreated.
DISPENSING ERRORS IN THE OUTPATIENT SETTING: PHARMACISTS’ PERSPECTIVE Stojković Tatjana (tatjana.stojkovic@pharmacy.bg.ac.rs) [1], Marinković Valentina (vmarinkovic@pharmacy.bg.ac.rs) [1], Krajnović Dušanka (dusica.krajnovic@pharmacy.bg.ac.rs) [1], Zeković Milica (zekovicmilica@gmail.com) [1], Tasić Ljiljana (ljtasic@pharmacy.bg.ac.rs)
[1] University of Belgrade, Serbia
INTRODUCTION: Medicines dispensing has been identified as an error-prone activity, carrying a considerable risk to patients’ safety. As pharmacists play a key role in this process, their perceptions of the systemic weaknesses predisposing dispensing errors occurrence as well as of the interventions that could prevent them, provide crucial guidelines for improving patient safety and service quality in pharmaceutical practice.
OBJECTIVES: To assess pharmacists’ perceptions of the causes of dispensing errors and main corrective actions to be taken in order to manage such safety incidents prospectively in the community pharmacy setting.
METHODS: From January to June 2016, a cross-sectional survey was performed by distributing an adapted and validated questionnaire to a nationwide, stratified sample of pharmacists from both state- and privately-owned community pharmacies in Serbia. The questionnaire included sections related to the participants’ socio-demographic characteristics, factors leading to the dispensing errors occurrence as well as potentially effective corrective actions. Statistical analysis was conducted using IBM SPSS Statistics 21.0 software. The study was approved by the Ethics Committee for Clinical Trials of the Faculty of Pharmacy, University of Belgrade, Serbia.
RESULTS: The study included 1,004 participants (the response rate 88.5%), mainly female (94.9%), with the mean age 41±10 years and mean registration length 14±10 years. More than third the participants (35.4%) indicated an increasing risk of dispensing errors. Additionally, almost half the respondents (49%) demonstrated awareness of dispensing errors being committed at their place of practice during the past 6 months, noticed only after the patient had already left the pharmacy. The main contributing factors identified were illegible prescriber’s handwriting (44.3%), interruptions and distractions during dispensing (39.2%), as well as pharmacists’ work overload (37.8%) and understaffed shifts (36.3%). The major corrective actions suggested included providing pharmacists with additional education related to clinical pharmacy and newly licensed medicines (71%), reducing the avoidable interruptions during dispensing (63.9%), increasing the number of pharmacy staff per shift (61.9%), and providing proper counselling to patients along with involving them more actively (60.3%).
DISCUSSION AND CONCLUSIONS: The results obtained suggest that Serbian community pharmacists are aware of the existing risk related to the dispensing process, as well as the factual errors occurrence. Additionally, the main causative factors and corrective actions have been identified, which should be further put into practice in order to manage dispensing risks prospectively, and thus, improve patient safety and service quality in community pharmacies.
32
PERICONCEPTIONAL FOLIC ACID SUPPLEMENTATION: KNOWLEDGE AND ATTITUDES OF PHARMACY STUDENTS
Zekovic Milica (zekovicmilica@gmail.com) [1], Stojkovic Tatjana (tatjana.stojkovic@
pharmacy.bg.ac.rs) [1], Glibetic Marija (mglibetic@gmail.com) [1], Tasic Ljiljana (ljiljana.tasic@pharmacy.bg.ac.rs) [1], Krajnovic Dusanka (dusica.krajnovic@pharmacy.bg.ac.rs) [1]
[1] University of Belgrade, Serbia
INTRODUCTION: The effect of periconceptional folic acid supplementation on reducing the incidence of neural tube defects (NTDs) and other adverse pregnancy outcomes is well-established.
As highly accessible health-care providers community pharmacists are ideally positioned to undertake significant public health role in raising awareness of this important issue.
OBJECTIVES: To explore final year pharmacy students’ knowledge and attitudes concerning periconceptional folic acid supplementation and to identify potential barriers to effective counseling of women of childbearing age in their future professional practice.
METHODS: A cross-sectional study was conducted at the Faculty of Pharmacy, University of Belgrade in April 2016. Participation in the study was offered to all final year students who were present at the faculty on predefined recruitment days. Comprehensive literature review, expert consultation and pre-testing were employed in the questionnaire design. Knowledge was assessed using multiple-choice question format while attitudes were captured using five-point rating Likert scale. Participation in the survey was voluntary and no incentives were offered. Questionnaires were completed anonymously and students were informed that the results will be reported only at an aggregate level. The study protocol was approved by the Ethics Committee for Clinical Trials, Faculty of Pharmacy, University of Belgrade. Data were analyzed using IBM SPSS version 21.0. Threshold of statistical significance was set a priori at conventional level of p<0.05.
RESULTS: The study included 151 students (the response rate 83.9%), mainly female (80.8%), with the mean age 24.4±2.6 years. Majority of respondents (78.2%) considered periconceptional folic acid supplementation important in ensuring healthy offspring while 77.5% stated that pharmacists should take responsibility in raising awareness on the significance of adequate folate intake. Faculty lectures in bromatology and dietetics (76.8%) were identified as the dominant source of information on this topic and 129 (85.4%) students expressed interest in attending additional lectures and educational workshops. Of 143 students who knew that folic acid may prevent NTDs and some other congenital anomalies, 64.2% correctly identified recommended daily dose. However, fewer were able to recognize the optimal timing for folic acid supplementation (57%) and the proper dose for NTD recurrence prevention (17.2%).
DISCUSSION AND CONCLUSIONS: Pharmacy students demonstrated positive attitude toward periconceptional folic acid supplementation and in general acknowledged the importance of dissemination of folic acid-related health messages. Nevertheless, modifications of educational curricula may be needed to address gaps in knowledge concerning specific aspects of folic acid nutrition (such as dosage and supplementation timing for optimal prevention of NTDs) that were identified in this study.
WORKSHOPS
34 Workshops
1. Aaltonen et al.: Workshop: How to promote cost-effective prescribing? *
2. Airaksinen & Volmer: Workshop: Doctoral training in social pharmacy - enhancing networking and sharing resources to improve quality of social pharmacy research *
3. Desselle & Almarsdóttir: A Scientific, Non-Handwaving Approach to Reading, Writing, &
Refereeing Peer-Reviewed Manuscripts **
4. Hartikainen & Ojala: Psychotropic use as risk factor for falls and fractures **
5. Inácio & Airaksinen: Latest trends in pharmacovigilance research: an insight into methods and patients' involvement *
6. Kaae et al.: Workshop – how to characterize communication at the pharmacy counter *
7. Kallio & Kiiski: Workshop: medication optimization of the aged: what is known about collaborative medication review procedures and their effectiveness *
8. Nørgaard et al.: Pharmacy internship in the Nordic countries – status and future *
9. Taipale & Hamina: Methodological challenges in pharmacoepidemiological research: register or interview-based drug exposure **
10. Traulsen et al.: Careers, professions & the organization of work in contemporary society – what does it mean for pharmacists? *
* Published in Research in Social and Administrative Pharmacy (RSAP) 2017;13(3). www.rsap.org
** Not included
NORDIC SOCIAL PHARMACY AND
HEALTH SERVICES RESEARCH CONFERENCE (NSPC) 2017
