Medication adherence: a review of pharmacy education, research, practice and policy in Finland

Main Article Content

J. Simon Bell
Hannes Enlund
Kristi Vainio

Keywords

Medication Adherence, Pharmacists, Education, Pharmacy, Finland

Abstract

Aims: To describe pharmacy education, research, practice and policy related to medication adherence in Finland since the year 2000.


Methods: The three universities that provide pharmacy education (Åbo Akademi, University of Eastern Finland, and University of Helsinki) completed a structured pro-forma questionnaire regarding education related to medication adherence. A MEDLINE and EMBASE literature search was performed to identify English language peer-reviewed research that reported medication compliance, adherence or persistence. The Ministry of Social Affairs and Health was invited to nominate policies and documents related to medication adherence. A narrative review of medication counselling practices and professional service delivery through Finnish community pharmacies was undertaken.


Results: Medication adherence was a theme integrated into obligatory and elective courses for bachelors and masters degree students. The literature search identified 33 English language peer-reviewed research articles reporting medication compliance, adherence or persistence published since the year 2000. Policy documents of the Ministry of Social Affairs and Health recognise that poor medication adherence may lead to sub-optimal treatment outcomes, and encourage patient participation in treatment decision making. Adherence practice in Finnish pharmacies has been strongly linked to the development of medication counselling services.


Conclusions: Adherence research and education has focused on understanding and addressing the contextual factors that contribute to medication non-adherence. Adherence practice in community pharmacies has tended to focus on medication counselling and programs specific to particular disease states. Medication adherence is a topic that is integrated into courses for bachelor’s and master’s level pharmacy students in Finland.

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References

1. van Dulmen S, Sluijs E, van Dijk L, de Ridder D, Heerdink ER, Bensing J. Patient adherence to medical treatment: a review of reviews. BMC Health Serv Res. 2007;7:55.

2. World Health Organization. Adherence to long term therapies: evidence for action. 2003 Available from: http://www.who.int/chp/knowledge/publications/adherence_report/en/ [Accessed 15 May 2010]

3. Ministry of Social Affairs and Health. Pharmaceutical Policy 2010. 2003 Available from: http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-3623.pdf&title=Laakepolitiikka_2010__tiivistelma_fi.pdf [Accessed 15 May 2010]

4. Simpson SH, Eurich DT, Majumdar SR, Padwal RS, Tsuyuki RT, Varney J, Johnson JA. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15-20.

5. Horne R, Weinman J, Barber N, Elliott R, Morgan M. Concordance, adherence and compliance in medicine taking. 2005 Available from: http://www.medslearning.leeds.ac.uk/pages/documents/useful_docs/76-final-report%5B1%5D.pdf [Accessed 10 July 2010]

6. Aronson JK. Compliance, concordance, adherence. Br J Clin Pharmacol. 2007;63:383-384.

7. Cramer JA, Roy A, Burrell A, Fairchild CJ, Fuldeore MJ, Ollendorf DA, Wong PK. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11:44-47.

8. Caetano PA, Lam JM, Morgan SG. Toward a standard definition and measurement of persistence with drug therapy: Examples from research on statin and antihypertensive utilization. Clin Ther. 2006;28:1411-1424.

9. Hess LM, Raebel MA, Conner DA, Malone DC. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmacother. 2006;40:1280-1288.

10. Kyngäs H, Duffy ME, Kroll T. Conceptual analysis of compliance. J Clin Nurs. 2001;9:5-12.

11. Enlund H, Tuomilehto J, Turakka H. Patient report validated against prescription records for measuring use of and compliance with antihypertensive drugs. Acta Med Scand. 1981;209:271-275.

12. Tuomilehto J, Enlund H, Salonen JT, Nissinen A. Alcohol, patient compliance and blood pressure control in hypertensive patients. Scand J Soc Med. 1982;12:177-181.

13. Enlund H. Measuring patient compliance in antihypertensive therapy-some methodological aspects. J Clin Pharm Ther. 1982;7:43-51.

14. Enlund H, Poston JW. Impact of non-compliance on drug costs. J Soc Adm Pharm. 1987;4:105-111.

15. Hemminki E, Heikkila J. Elderly people’s compliance with prescriptions and quality of medication. Scand J Soc Med. 1975;3:87-92.

16. Turakka H, Enlund H. Drug use and prescription compliance by elderly patients. J Clin Pharm Ther. 1978;3:103-112.

17. Bell JS, Airaksinen MS, Lyles A, Chen TF, Aslani P. Concordance is not synonymous with compliance or adherence. Br J Clin Pharmacol. 2007;64:710-711.

18. Furu K, Wettermark B, Andersen M, Martikainen JE, Almarsdottir AB, Sørensen HT. The Nordic countries as a cohort for pharmacoepidemiological research. Basic Clin Pharmacol Toxicol. 2010;106:86-94.

19. National Institute for Health and Welfare. Finnish Information Centre for Register Research. 2009 Available from: http://retki.stakes.fi/EN/index.htm [Accessed 10 July 2010]

20. Korhonen T, Huttunen JK, Aro A, Hentinen M, Ihalainen O, Majander H, Siitonen O, Uusitupa M, Pyörälä K. A controlled trial on the effects of patient education in the treatment of insulin-dependent diabetes. Diabetes Care. 1983;6:256-261.

21. Närhi U, Airaksinen M, Enlund H. Pharmacists solving problems in asthma management - experiences from a one-year intervention programme in Finland. Int J Pharm Pract. 2002;10:55-59.

22. Takala J, Niemela N, Rosti J, Sievers K. Improving compliance with therapeutic regimens in hypertensive patients in a community health center. Circulation. 1979;59:540-543.

23. Varis J, Karjalainen S, Korhonen K, Viigimaa M, Port K, Kantola I. Experiences of telemedicine-aided hypertension control in the follow-up of Finnish hypertensive patients. Telemed J E Health. 2009;15:764-769.

24. Joffe G, Takala P, Tchoukhine E, Hakko H, Raidma M, Putkonen H, Eronen M, Räsänen P. Orlistat in clozapine- or olanzapine-treated patients with overweight or obesity: a 16-week randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2008;69:706-711.

25. Ringe JD, Christodoulakos GE, Mellstrom D, Petto H, Nickelsen T, Marin F, Pavo I. Patient compliance with alendronate, risedronate and raloxifene for the treatment of osteoporosis in postmenopausal women. Curr Med Res Opin. 2007;23:2677-2687.

26. Ministry of Social Affairs and Health. The Ministry of Social Affairs and Health and its administrative sector 2010 Available from: http://www.stm.fi/en/ministry [Accessed 10 August 2010]

27. Bell JS, Väänänen M, Ovaskainen H, Närhi U, Airaksinen MS. Providing patient care in community pharmacies: practice and research in Finland. Ann Pharmacother. 2007;41:1039-1046.

28. Katajavuori N, Hakkarainen K, Kuosa T, Airaksinen M, Hirvonen J, Holm Y. Curriculum reform in Finnish pharmacy education. Am J Pharm Educ. 2009;73:151.

29. Hautamäki M, Hirvonen J, Airaksinen M. The early years of a pharmacist's career [in Finnish]. Dosis. 2006;22:193-204.

30. Confederation of Unions for Professional and Managerial Staff in Finland (Akava). Professionals of Akava in the job market [in Finnish]. 2009 Available from: http://www.akava.fi/files/67/atm2009nettiin.pdf [Accessed 9 August 2010]

31. Rickles NM, Brown TA, McGivney MS, Snyder ME, White KA. Adherence: a review of education, research, practice and policy in the United States. Pharm Pract (Internet). 2010;8(1):1-17.

32. Aslani P, Krass I. Adherence: a review of education, research, practice and policy in Australia. Pharm Pract (Internet). 2009;7(1):1-10.

33. Noyce PR. Providing patient care through community pharmacies in the UK: policy, practice, and research. Ann Pharmacother. 2007;41:861-868.

34. European Parliament & Council of the European Union. Directive 2005/36/EC of the European Parliament and of the Council of 7 September 2005 on the recognition of professional qualifications. European Parliament and Council of the European Union. 2005 Available from: http://eur-lex.europa.eu/LexUriServ/site/en/oj/2005/l_255/l_25520050930en00220142.pdf [Accessed 10 July 2010]

35. Katajavuori N, Lindblom-Ylänne S, Hirvonen J. Pharmacy mentors' views of practical training. Res Sci Educ. 2005;35:323-445.

36. Katajavuori N, Lindblom-Ylänne S, Hirvonen J. The significance of practical training in linking theoretical studies with practice. Higher Educ. 2006;51:439-464.

37. Leikola SN, Tuomainen L, Ovaskainen H, Peura S, Sevón-Vilkman N, Tanskanen P, Airaksinen MS. Continuing education course to attain collaborative comprehensive medication review competencies. Am J Pharm Educ. 2009;73:108.

38. Helin-Salmivaara A, Lavikainen P, Korhonen MJ, Halava H, Junnila SY, Kettunen R, Neuvonen PJ, Martikainen JE, Ruokoniemi P, Saastamoinen LK, Virta L, Huupponen R. Long-term persistence with statin therapy: a nationwide register study in Finland. Clin Ther. 2008;30:2228-2240.

39. Helin-Salmivaara A, Lavikainen P, Ruokoniemi P, Korhonen M, Huupponen R. Persistence with statin therapy in diabetic and non-diabetic persons: a nation-wide register study in 1995-2005 in Finland. Diabetes Res Clin Pract. 2009;84:e9-e11.

40. Helin-Salmivaara A, Lavikainen PT, Korhonen MJ, Halava H, Martikainen JE, Saastamoinen LK, Virta L, Klaukka T, Huupponen R. Pattern of statin use among 10 cohorts of new users from 1995 to 2004: a register-based nationwide study. Am J Manag Care. 2010;16:116-122.

41. Nabi H, Vahtera J, Singh-Manoux A, Pentti J, Oksanen T, Gimeno D, Elovainio M, Virtanen M, Klaukka T, Kivimaki M. Do psychological attributes matter for adherence to antihypertensive medication? The Finnish Public Sector Cohort Study. J Hypertens. 2008;26:2236-2243.

42. Pitkala KH, Strandberg TE, Tilvis RS. Interest in healthy lifestyle and adherence to medications: Impact on mortality among elderly cardiovascular patients in the DEBATE Study. Patient Educ Couns. 2007;67:44-49.

43. Enlund H, Jokisalo E, Wallenius S, Korhonen M. Patient-perceived problems, compliance, and the outcome of hypertension treatment. Pharm World Sci. 2001;23:60-64.

44. Jokisalo E, Enlund H, Halonen P, Takala J, Kumpusalo E. Factors related to poor control of blood pressure with antihypertensive drug therapy. Blood Press. 2003;12:49-55.

45. Jokisalo E, Kumpusalo E, Enlund H, Halonen P, Takala J. Factors related to non-compliance with antihypertensive drug therapy. J Hum Hypertens. 2002;16:577-583.

46. Jokisalo E, Kumpusalo E, Enlund H, Takala J. Patients' perceived problems with hypertension and attitudes towards medical treatment. J Hum Hypertens. 2001;15:755-761.

47. Salomaa V, Paakkonen R, Hamalainen H, Niemi M, Klaukka T. Use of secondary preventive medications after the first attack of acute coronary syndrome. Eur J Cardiovasc Prev Rehabil. 2007;14:386-391.

48. Lahdenpera TS, Kyngas HA. Levels of compliance shown by hypertensive patients and their attitude toward their illness. J Adv Nurs. 2001;34:189-195.

49. Lahdenpera TS, Wright CC, Kyngas HA, Lahdenpera TS, Wright CC, Kyngas HA. Development of a scale to assess the compliance of hypertensive patients. Int J Nurs Stud. 2003;40:677-684.

50. Meretoja A, Roine RO, Kaste M, Erilä T, Hillbom M, Juntunen M, Linna M, Marttila R, Rissanen A, Sivenius J, Häkkinen U. Use and cost of prescription medication before and after ischemic stroke in Finland. Cerebrovasc Dis. 2009;27:232-233.

51. Tacke U, Uosukainen H, Kananen M, Kontra K, Pentikänen H. A pilot study about the feasibility and cost-effectiveness of electronic compliance monitoring in substitution treatment with buprenorphine-naloxone combination. J Opiod Manag. 2009;5:321-329.

52. Keranen T, Tuhkasaari M, Kuusisto H. Long-term retention rate of pramipexole in the treatment of Parkinson's disease. Eur J Clin Pharmacol. 2009;65:955-956.

53. Holma IA, Holma KM, Melartin TK, Isometsä ET. Maintenance pharmacotherapy for recurrent major depressive disorder: 5-year follow-up study. Br J Psychiatry. 2008;193:163-164.

54. Melartin TK, Rytsala HJ, Leskela US, Lestela-Mielonen PS, Sokero TP, Isometsa ET. Continuity is the main challenge in treating major depressive disorder in psychiatric care. J Clin Psychiatry. 2005;66:220-227.

55. Kampman O, Laippala P, Vaananen J, Koivisto E, Kiviniemi P, Kilkku N, Lehtinen K. Indicators of medication compliance in first-episode psychosis. Psychiatry Res. 2002;110:39-48.

56. Kyngäs H. Predictors of good compliance in adolescents with epilepsy. Seizure. 2001;10:549-553.

57. Kyngäs H. Compliance with health regimens of adolescents with epilepsy. Seizure. 2000;9:598-604.

58. Sokero P, Melartin T, Rytsälä H, Leskelä U, Lestelä-Mielonen P, Isometsä E. Adequacy of, attitudes toward, and adherence to treatments by suicidal and nonsuicidal depressed patients. J Nerv Ment Dis. 2008;196:223-922.

59. Foulon V, Svala A, Koskinen H, Chen TF, Saastamoinen LK, Bell JS. Impact of regulatory safety warnings on the use of antidepressants among children and adolescents in Finland. J Child Adolesc Psychopharmacol. 2010;20:145-150.

60. Pohjanoksa-Mäntylä M, Saari JK, Närhi U, Pylkkänen K, Airaksinen MS, Bell JS. How and why do people with depression access and utilize online drug information: a qualitative study. J Affect Disord. 2009;114:333-339.

61. Kampman O, Lehtinen K, Lassila V. The reliability of compliance assessments performed by doctors and patients during neuroleptic treatment: a comparison of compliance ratings. Acta Psychiatr Scand. 2001;104:299-304.

62. Kyngäs H, Rissanen M. Support as a crucial predictor of good compliance of adolescents with chronic disease. J Clin Nurs. 2001;10:767-774.

63. Lunnela J, Kääriäinen M, Kyngäs H. The views of compliant glaucoma patients on counselling and social support. Scand J Caring Sci. 2010;Mar 3 [Epub ahead of print] DOI 10.1111/j.1471-6712.2009.00739.x:

64. Kyngäs H. Predictors of good adherence of adolescents with diabetes (insulin-dependent diabetes mellitus). Chronic Illn. 2007;3:20-28.

65. Kyngäs H. Compliance of adolescents with diabetes. J Pediatr Nurs. 2000;15:260-267.

66. Toljamo M, Hentinen M. Adherence to self-care and social support. J Clin Nurs. 2001;10:618-627.

67. Toljamo M, Hentinen M. Adherence to self-care and glycaemic control among people with insulin-dependent diabetes mellitus. J Adv Nurs. 2001;34:780-786.

68. Kneckt MC, Keinänen-Kiukaanniemi SM, Knuuttila ML, Syrjälä AM. Self-esteem as a characteristic of adherence to diabetes and dental self-care regimens. J Clin Periodontol. 2001;28:175-180.

69. Kyngäs H. Compliance of adolescents with rheumatoid arthritis. Int J Nurs Pract. 2000;6:261-267.

70. Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986;24:67-74.

71. Mahler C, Hermann K, Horne R, Ludt S, Haefeli WE, Szecsenyi J, Jank S. Assessing reported adherence to pharmacological treatment recommendations. Translation and evaluation of the Medication Adherence Report Scale (MARS) in Germany. J Eval Clin Pract. 2010;16:574-579.

72. Ministry of Social Affairs and Health. Safe pharmacotherapy. National guide for pharmacotherapy in social and health care. 2006 Available from: http://www.stm.fi/c/document_library/get_file?folderId=28707&name=DLFE-4090.pdf&title=Turvallinen_laakehoito_fi.pdf [Accessed 15 May 2010]

73. Aalto-Setälä V, Kanerva R, Bell JS. Drug cost development of citalopram and fluoxetine following the introduction of generic substitution in Finland. Int J Pharm Med. 2007;21:363-368.

74. Timonen J, Karttunen P, Bengtström M, Ahonen R. The impact of generic substitution on the turnover and gross margin of pharmaceutical companies a survey 1 year and 5 years after the introduction of generic substitution in Finland. Healthy Policy. 2009;92:116-123.

75. Airaksinen M, Ahonen R, Enlund H. Drug information from pharmacies: desire for more spontaneous information. Med Care. 1993;31:846-850.

76. Airaksinen MS, Vainio KK, Koistinen J, Ahonen R, Wallenius S, Enlund H. Do the public and pharmacists share opinions about drug information. Int Pharm J. 1994;8:168-171.

77. Tanskanen P, Airaksinen M, Tanskanen A, Enlund H. Counselling patients on psychotropic medication: physicians' opinions on the role of community pharmacists. Pharm World Sci. 2000;22:59-61.

78. Kurko T, Linden K, Vasama M, Pietilä K, Airaksinen M. Nicotine replacement therapy practices in Finland one year after deregulation of the product sales - has anything changed from the community pharmacy perspective? Health Policy. 2009;91:277-285.

79. Airaksinen M, Ahonen R, Enlund H. The "questions to ask about your medicines" campaign: an evaluation of pharmacists and the public's response. Med Care. 1998;36:422-427.

80. Kansanaho H, Puumalainen I, Varunki M, Ahonen R, Airaksinen MS. Implementation of a professional program in Finnish community pharmacies in 2000-2002. Patient Educ Couns. 2005;57:272-279.

81. Kansanaho HM, Puumalainen I, Varunki M, Airaksinen MSA, Aslani P. Attitudes of Finnish community pharmacists toward concordance. Ann Pharmacother. 2004;38:1946-1953.

82. Vainio KK, Airaksinen M, Hyykky TT, Enlund H. Effect of therapeutic class on counselling in community pharmacies. Ann Pharmacother. 2002;36:781-786.

83. Pohjanoksa-Mäntylä MK, Kulovaara H, Bell JS, Enäkoski M, Airaksinen MS. Email medication counseling services provided by Finnish community pharmacies. Ann Pharmacother. 2008;42:1782-1790.

84. Haahtela T, Klaukka T, Koskela K, Erhola M, Laitinen LA. Asthma programme in Finland: a community problem needs community solutions. Thorax. 2001;56:806-814.

85. Parkkamäki S, Ritsilä A-L. Impact of a multi-professional local program on the prevention and care of type 2 diabetes in the Haukivuori community [in Finnish]. Dosis. 2004;20:163-171.

86. Peura S, Ovaskainen H, Lehtonen A, Wiberg I, Airaksinen MS, Hakkarainen K, Tanskanen P, Sevon-Vilkman N, Tuomainen L. Comprehensive medication review involving collaboration between pharmacists and physicians - experiences developing the procedure in Finland [in Finnish]. Dosis. 2007;23:20-28.

87. EuroPharm Forum and World Health Organization Regional Office for Europe. Pharmacy-based asthma services - protocol and guidelines. 1998. Copenhagen, Denmark.

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