Medication Risk Management in Routine Dispensing in Community Pharmacies

Abstract

Community pharmacists have a duty to contribute to medication risk management in outpatient care. This study aimed to investigate the actions taken by pharmacists in routine dispensing to manage medication risks. The study was conducted as a national cross-sectional online survey targeted at all community pharmacies in Finland (n = 576) in October 2015. One pharmacist from each pharmacy was recommended to be the spokesperson for the outlet to describe their practices. Responses were received from 169 pharmacies (response rate of 29%). Pharmacists were oriented to solving poor adherence and technical problems in prescriptions, whereas responsibility for therapeutic risks was transferred to the patient to resolve them with the physician. Pharmacists have access to a wide range of electronic medication risk management tools, but they are rarely utilized in daily dispensing. Attention was paid to drug–drug interactions and the frequency of dispensing with regard to high-risk medicines. Pharmacies rarely had local agreements with other healthcare providers to solve medication-related risks. In routine dispensing, more attention needs to be given to the identification and solving of therapeutic risks in medications, especially those of older adults. Better participation of community pharmacists in medication risk management requires stronger integration and an explicit mandate to solve the therapeutic risks.

Policy and vision for community pharmacies in Finland: A roadmap towards enhanced integration and reduced costs

“…2 The national health portal Terveysportti ( http://www.terveysportti.fi ) is the key in implementing evidence-based practices throughout the health care, including community pharmacies. 2 , 5 , 6 The portal provides a wide range of databases and tools that assist in clinical decision-making. It also contains a comprehensive set of medication risk management tools to prospectively review individual patients’ medications.…”

“…26 All pharmacies and their subsidiaries routinely use electronic systems in prescription processing, patient data management, medication counseling, logistics, stock control, procurement, reimbursement management, administration and business planning. 5 , 6 , 26 , 27 Also, medication risk identification and medication review tools and databases are available in almost all pharmacies. 5 - 7 Their use has been made feasible by integrating the tools into pharmacy prescription processing systems.…”

“…While dispensing, community pharmacists are obliged to review the prescriptions to confirm the dose regimen and indication, identify duplicates, control overuse, particularly of psychotropic and chronic medications, and ensure the medicine user is aware of how to use the medicine safely and appropriately (Medicines Act 395/1987). 6 Pharmacists have had a duty to counsel since 1983, concerning both prescription and nonprescription medicines (Medicines Act 395/1987). 18 Medication counseling has been a priority for strategic development ever since, even more systematically since the early 1990s.…”

“… 5 , 19 , 20 , 29 , 30 , 34 - 36 , 46 , 48 , 49 , 56 The goal has been to make better use of the existing resources in care units and community pharmacies in prospective medication risk management. 5 , 6 , 12 , 15 , 22 , 29 , 30 , 33 , 34 , 37 , 38 , 48 , 49 …”

“…Community pharmacies have been actively developing new tools, services and collaborative procedures that reflect systems thinking in preventing medication-related risks (i.e., building up systemic defenses). 5 , 6 , 26 - 28 , 34 , 37 , 38 , 46 , 57 …”