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Pharmacy clients need increasingly personalised medication counselling

The extensive reform of pharmaceutical matters in Finland may bring clarity to how pharmacies implement medication counselling.

“There is no concrete definition of what statutory medication counselling should involve,” Professor Katri Hämeen-Anttila says.

This September, Katri Hämeen-Anttila started as Professor of Social Pharmacy, and especially Pharmaceutical Policy, in the School of Pharmacy at the 91����.

“This is an opportune moment for this kind of a professorship. There is a great need for research into pharmaceutical policy due to, for example, the ongoing reform of pharmaceutical matters. This is the most intensive period in pharmaceutical policy I’ve witnessed in my career.”

The aim of the pharmaceutical matters reform is to improve the cost-effectiveness of pharmacotherapy, to ensure medication safety and counselling, and to safeguard the smoothness, availability and accessibility of services. Spanning over several government terms, the areas of development pertain to three entities: guidance and funding of pharmacotherapy, pharmaceutical economy and distribution of medicines, and information management and digital tools. Research is needed not only to support reforms but also to demonstrate their impact.

Hämeen-Anttila, who’s worked for the Finnish Medicines Agency Fimea in various research and development roles for a long time, has studied pharmacies’ medication counselling in particular. According to the Medicines Act, a pharmacy must, when dispensing a medicine, ensure that the client knows how to use it correctly and safely.

“Surveys show that Finns are satisfied with the medication counselling they receive and consider pharmacies to be a reliable source of information.”

However, there is also room for improvement in medication counselling. For example, mystery client studies have shown that counselling related to over-the-counter medicines is realised well when the client asks for a medicine for a particular symptom.

“However, if the client asks for a painkiller by its product name, counselling is often superficial.”

“Medication counselling is often too product-oriented and the individual situation of the client is not really focused on. A client who has just been diagnosed needs different kind of information than a client who is refilling their prescription and is possibly dealing with problems that have arisen when using the medicine over a longer period of time.”

According to a yet to be published study commissioned by the Ministry of Social Affairs and Health, medication counselling should be defined more accurately and in more concrete terms in legislation.

“This would give pharmacies clear objectives for developing their activities and, on the other hand, better possibilities to steer and monitor the performance of pharmacies in this task,” says Hämeen-Anttila, who led the investigation.

According to her, pharmacies could also play a greater role in monitoring the success of pharmacotherapy, together with other health care providers.

“Physicians may renew prescriptions for their chronically ill patients without seeing them. Yet, patients will visit a pharmacy on a regular basis, and there, a comprehensive picture of their use of medicines, including OTC ones, can be formed. An important question is how pharmacies could become better at recognising problems with pharmacotherapy, resolve them with the patient, and also communicate them to the treating physician.”

“It is also possible to develop communication channels in this context in connection with the Kanta medication list.”

To be introduced in the near future, the Kanta medication list will gather up-to-date information on the medicines used by the patient. It will be available to the patient in My Kanta Pages, and it will also be visible to everyone involved in the patient’s care.

The planned generic substitution of biological medicines in pharmacies may also contribute to closer contacts between pharmacies and health care. Expensive biological medicinal products are used for the treatment of diseases such as rheumatoid arthritis, cancer and inflammatory bowel diseases, and insulin used by diabetics is also regarded as a biological medicine. Hämeen-Anttila has examined the views of patients and other stakeholders on bringing them within the scope of generic substitution in pharmacies, and the answers have highlighted the importance of appropriate medication counselling.

“Many biological medicines are injectable and substituting them for a cheaper biosimilar in a pharmacy would require patient guidance in, for example, the use of a new administration device. If this reform is implemented, it will be interesting to study not only the cost benefits it brings but also the success of medication counselling and the use of medicines.”

The challenging nature of pharmaceutical policy reforms is illustrated by the fact that while considering potential new tasks for pharmacies, a reduction of their profit margins is also proposed.

“Both are linked to the policies of the pharmaceutical matter reform and to the Government Programme of Marin’s Government but integrating these two is a challenge.”

A more active role for patients in both pharmacotherapy and research

The foundations for the reform of pharmaceutical matters were laid down in the Rational Pharmacotherapy Action Plan, with Hämeen-Anttila serving as the secretary of the steering group. She has also been responsible for drawing up the first national medicines information strategy and, to implement it, for setting up a Medicines Information Network.

“Enhancing the patient’s involvement in their care is a key objective of pharmaceutical policy and one that has been recognised both in Finland and more globally. It is also a topic that is close to my heart.”

According to Hämeen-Anttila, health care professionals should increasingly encourage patients to participate, for example, in the choice of a medicine that is suitable for their daily life.

“I would also otherwise encourage patients to be active in their own pharmacotherapy. Only they know what medicines they are actually using. Everyone should keep a list of the medicines they use, for what purpose, how often and at what doses, and also show this list to their physician.”

“The patient perspective is also needed for the development of patient and medication safety. It would be important for patients to report any safety incidents they come across especially in hospitals and institutions, even though this may take some courage.”

“In my own future research, I will try to address the entire care pathway: for example, how patients experience the role of different professionals in pharmacotherapy, who they listen to if the medicines information provided by different parties is conflicting, and where they might need more information.”

“In recent years, there has been increasing talk about of patient involvement in research, including the choice of research themes, objectives and methods. I am very pleased to have a patient member in my own pharmaceutical policy research group, participating in the group’s research,” Hämeen-Anttila says.

She also brings up the idea of setting up a research patient panel at the university, for example in collaboration with Kuopio University Hospital.

“In order to increase the involvement of patients in research, it makes sense for research organisations to create structures to support it. To genuinely participate and take a stand, patients also need training and compensation for their time. Patient organisations are important partners, but they alone cannot meet the needs of all research.”

According to Hämeen-Anttila, the School of Pharmacy at the 91���� has a long track record of high-level research into pharmaceutical policy.

“For a new professor, this is an excellent setting to continue from with the research team, and we are currently drafting a research strategy for the coming years.”

“The effects of generic substitution and the introduction of electronic prescription have been extensively studied here, and the effects of pharmaceutical policy decisions will continue to be an important theme of research. Research will also continue to focus on the patient perspective and involvement, rational pharmacotherapy and pharmacy services. Another important and topical issue is the environmental impact of medicines.”

“I think it is important for there always to be a need for research, and users for research findings. In pharmaceutical policy research, close collaboration with, for example, the Finnish Medicines Agency Fimea, the Social Insurance Institution of Finland Kela, the Finnish Institute for Health and Welfare THL, and the Ministry of Social Affairs and Health, is essential.”

From her years at Fimea, Hämeen-Anttila has extensive networks with various stakeholders, and now she seeks to find new networks for research.

“The 91���� a good setting for this, for example, in the Research Community on the Effectiveness of Social and Health Services, and in the Faculty of Health Sciences, where all actors and educators involved in the pharmacotherapy process are represented.”

In pharmacy education, Hämeen-Anttila is responsible for a course in pharmaceutical policy in particular.

“However, many pharmaceutical policy reforms are more widely reflected, for example, in the teaching of community pharmacy and medication counselling, as professionals working in pharmacies must master the changes immediately in their practical work.”  

Katri Hämeen-Anttila

• Professor of Social Pharmacy, especially Medicines Policy, 91����, 1 August 2022–
• Title of Docent in Social Pharmacy, 2010, University of Helsinki
• Bachelor of Pharmacy 1996, Master of Pharmacy 1999, and Doctor of Pharmacy 2006, University of Kuopio
• Specialist Vocational Qualification in Management 2019, Savo Vocational College

KEY ROLES

• Head of Research and Development, Fimea, 2016–2022
• Development Manager, Fimea, 2010–2016
• Researcher, Postdoctoral Researcher, Professor (fixed-term) and Senior Assistant roles, University of Kuopio and 91����, 1999–2011