Terveyspalveluita vai myyntityötä : Apteekkien toiminnan strateginen kehittäminen muuttuvassa toimintaympäristössä

The operating environment of community pharmacies is changing in Finland as a result of changes in society. Societal changes, such as municipal and service restructuring, and demographic changes, affect the operation of pharmacies. Pharmacies have expertise in implementing drug therapies that could be used more effectively as part of healthcare. Recent health and medicines policy developments in Finland allow pharmacies to expand their services and roles in healthcare. At the same time, the pharmacies' economy is influenced by past changes that have led pharmacies to streamline their operations and increase active product sales to secure their profitability. Little research has focused on the extent to which community pharmacy owners responsible for the operation and economy of pharmacies are committed to medicines policy. Pharmacy owners play a key role in influencing the strategic direction of the pharmacy business by deciding on their business as a private entrepreneur within the limits set by law. This doctoral dissertation explored the strategic work that guides the operation of community pharmacies, in particular the orientation towards health services and active product sales, and the factors involved. The study was carried out from the perspective of community pharmacy owners (studies 1-3) and key social and health care actors (study 4). The study was divided into four sub-studies. In 2013, data for the studies 1-3 were collected as a nationwide survey, targeting all private community pharmacy owners that were members of the Association of Finnish Pharmacies (n=581). The aim of the study 1 was to examine pharmacy owners' views on the strategic development of community pharmacy activities by 2020. The survey mapped the supply of pharmacy services at the time of the study (2013) and the pharmacy owners' views on future pharmacy services (2020). Two sum scales were compiled of the Likert-scale statements that examined the strategic orientation toward health services (13 statements, Cronbach's alpha 0.836) and active product sales (8 statements, Cronbach's alpha 0.699). The internal consistency of the sum scales was determined by using reliability analysis. The second study examined the strategy work of pharmacies and association between strategic planning and active product sales and healthcare service orientation. Responses were divided into two groups based on whether the responding pharmacy had a strategy or not. The relationship between strategy work and pharmacies' orientation towards health services and active product sales was investigated using the two sum scales created in the study 1. In addition, the relationship between strategy work and the background variables related to the pharmacy owner and pharmacy business was investigated. The third study investigated factors related to product sales and healthcare orientation in pharmacies using sum scales. Both sum scales were classified dichotomously by dividing pharmacies into either strongly or weakly oriented towards active drug sales, and strongly or weakly oriented towards health services. The relationship between the dichotomous sum scales obtained and the pharmacy background information and the actual pharmacy service offering was examined by cross-tabulation between the two variables. For the purposes of the analysis, the actual supply of pharmacy services at the time of the survey was also transformed into a sum scale consisting of ten services listed in the questionnaire. The aim of the fourth study was to determine the role and functional position of pharmacies in the future social and health service structure from the perspective of key social and health care actors. The data of study 4 were collected in late 2016 as a survey focused on the Ministry of Social Affairs and Health Steering Group for the Planning of Rational Pharmacotherapy Action Plan, including members, deputies and experts (n=149). A total of 198 pharmacy owners (34% response rate) responded to the nationwide survey. According to the responding pharmacy owners, the main task of community pharmacies was to operate as part of the healthcare service chain. The views were the same regardless of the characteristics of the pharmacy owner and their pharmacy business. Of the healthcare-oriented services available at the time of the study, the most common type of service was automated dose dispensing (77% of respondents' pharmacies). Of the pharmacies 21% provided comprehensive medication reviews (CMR). More than half (52%) of the responding pharmacy owners would have been prepared to increase the number of pharmacists with special qualifications (such as comprehensive medication reviews) if the service were to receive national quality criteria and funding. At the same time, the majority (90%) of respondents said they would invest in active additional sales, but few pharmacists (10%) saw their pharmacy primarily as a commercial company. In addition, almost all respondents (92%) fully or partially agreed that it is necessary for pharmacies to expand their product range to free-trade products in order to safeguard the pharmacy economy. Almost two-thirds (63%) of pharmacy owners reported they had a strategy. Strategy work (strategy/no strategy) had no influence on healthcare orientation but was linked to the pharmacy's active product sales orientation. Pharmacies where strategy work was carried out were clearly more likely to have active sales promotion than other pharmacies. The pharmacies that worked on the strategy were also interested in new services to ensure medication safety, such as the comprehensive medication reviews. Strategy work had no impact on other health care-oriented variables. The most common strategy work was in pharmacies with an owner of at least 10 years of pharmacy owner experience, a pharmacy with a large prescription volume and turnover. The actual provision of services by community pharmacies was investigated using sum scales. Of the ten potential services to be offered by pharmacies at the time of the study, 66% of pharmacy owners reported having up to two different services available at their pharmacy. The results showed a significant difference between the actual service provision and the intent of pharmacies. Pharmacy owners clearly saw the pharmacy as health-oriented and were interested in providing services, but in reality, very few pharmacies offered more than one or two services. According to this study, large pharmacies located in supermarkets and belonging to a marketing chain were clearly more focused on product sales than other pharmacies. Pharmacy owner and pharmacy-related background factors had no association with the healthcare orientation. The questionnaire sent to social and health care providers received 43 responses (29 % response rate). Respondents saw evidence-based self-medication counseling as one of the most important tasks of pharmacies (88 % of respondents). A significantly smaller proportion of respondents would be prepared to expand the range of non-prescription drug assortment (75 %). The most important services to be provided by pharmacies in the future were automated dose dispensing (93 %), medication reviews (82 %) and comprehensive medication reviews (80 %). According to the results of the study, pharmacy owners have a desire to develop healthcare-oriented services, but in practice, the activity has focused on active product sales to safeguard the pharmacy's economy. There is a big gap between willingness to provide services and actual delivery. The service offering is focused on services that can be implemented easily and with little investment, such as automated dose dispensing. Pharmacies should be supported through medicines policy in the development of services requiring larger and more long-term investments, which are of social and public health importance through the promotion of rational pharmacotherapy. Keywords: community pharmacies, pharmacy services, strategic development, healthcare, medicines policy, rational pharmacotherapyYhteiskunnassa tapahtuvat muutokset, kuten kunta- ja palvelurakenneuudistukset sekä väestörakenteen ja -keskittymien muutokset vaikuttavat apteekkien toimintaan. Apteekeissa on lääkehoitojen toteutukseen liittyvää osaamista, jota voisi hyödyntää osana sosiaali- ja terveyspalvelujärjestelmää nykyistä tehokkaammin. Väitöskirjan kirjallisuuskatsauksessa on kuvattu strategiatyön periaatteita, apteekkitoiminnan strategisia linjauksia Suomessa sekä vertailtu alan sisäisiä ja viranomaisten tekemiä lääkepoliittisia linjauksia. Lisäksi tarkasteltiin apteekkitoiminnan pitkäjänteiseen kehittämiseen liittyvää kansainvälistä tutkimusta. Kansainvälisten tutkimusten mukaan apteekin rooli on muuttumassa yhä potilaskeskeisemmäksi. Lääkehoidon onnistumiseen tähtäävien palveluiden kehittäminen vaatii muutoksia terveydenhuoltojärjestelmään ja apteekkien palvelut tulisi hyväksyä kiinteäksi osaksi terveydenhuoltoa. Väitöskirjan tutkimusosan tavoitteena oli löytää strategisia kehittämissuuntia apteekkitoiminnalle apteekkien toiminnasta ja taloudesta vastaavien apteekkareiden näkökulmasta. Tutkimus toteutettiin kahtena poikittaisena kyselytutkimuksena. Päätutkimuksena oli valtakunnallinen apteekkareille suunnattu kysely. Kyselyn avulla tutkittiin missä määrin apteekkarit ovat sitoutuneet lääkepoliittisiin linjauksiin lääkehuollon toimimisesta osana sosiaali- ja terveyspalvelujärjestelmää ja missä määrin aktiiviseen tuotemyyntiin. Täydentävänä tutkimuksena tehtiin kysely Hallitusohjelman (2015) mukaisen Rationaalisen lääkehoidon toimeenpano-ohjelman laatineelle asiantuntijajoukolle. Kyselyllä kartoitettiin suuntalinjoja apteekkien toimimisesta osana sosiaali- ja terveyspalvelujärjestelmää. Apteekkien tärkeimpänä tehtävänä nähtiin toimiminen osana terveydenhuollon palveluketjua. Näkemys oli sama riippumatta apteekkarin ja apteekkitoiminnan ominaisuuksista. Sosiaali- ja terveydenhuollon toimijoille lähetetyssä kyselyssä vastaajat näkivät yhdeksi apteekkien merkittävimmistä tehtävistä itselääkityksen ohjauksen. Tutkimuksen tulosten perusteella apteekeilla on halu kehittää terveydenhuoltoon suuntautuneita palveluja. Tutkimuksen mukaan palvelutarjonta on keskittynyt helposti ja pienin investoinnein toteutettavissa oleviin palveluihin, kuten koneelliseen annosjakeluun. Apteekkeja tulisi lääkepoliittisin keinoin tukea erityisesti isompia ja pitkäjänteisempiä investointeja edellyttävien palvelujen kehittämisessä, joilla on yhteiskunnallista ja kansanterveydellistä merkitystä rationaalisen lääkehoidon edistämisessä

Apteekkitoiminnan kehittäminen : apteekkareiden näkemyksiä

Apteekkifarmasian erikoistumisopinnot proviisoreille, PD ProjektityöApteekkien toimintaympäristö on muuttumassa yhteiskunnassa tapahtuvien muutosten myötä. Tämänhetkiset apteekkitoiminnan uusimmat linjaukset löytyvät Lääkepolitiikka 2020-asiakirjasta sekä Apteekkariliiton Ammattiapteekkistrategiasta. Apteekkien toimintaa on kehitetty suunnitelmallisesti eteenpäin jo pitkään. Viranomaismääräysten ohella farmasian ala on omaehtoisesti panostanut erityisesti asiantuntijuuteen perustuvaan neuvontatyöhön. Lääkekustannusten hillitsemiseksi tehdyt toimenpiteet ovat vaikuttaneet apteekkien talouden kehitykseen. Laadukkaiden apteekkipalveluiden turvaamiseksi apteekit joutuvat tehostamaan toimintojaan sekä kehittämään uusia palveluita. Tehostamalla toimintoja tuodaan myös laadunhallintaa organisaatioon ja voidaan tarvittaessa tehdä nopeitakin tilanteen vaatimia muutoksia toimintakyvyn säilyttämiseksi ja ylläpitämiseksi. Muuttuva toimintaympäristö tarjoaa apteekeille mahdollisuuksia laajentaa ja syventää asemaansa terveydenhuollon toimijana. Nykypäivän kiristynyt kilpailu on johtanut lisäksi siihen, että apteekit tekevät paljon erilaisia kampanjoita ja markkinointia. Apteekkien välisessä kilpailussa pärjätäkseen yhä useampi apteekki on liittynyt apteekkiketjuun. Ketjun apteekeilla on yhteisiä markkinointikampanjoita ja koulutustoimintaa. Ketjut antavat apteekeille valmiin toimintamallin myynnin ja markkinoinnin kehittämiseen. Apteekin palveluille on yhteistä niiden kytkeytyminen lääkkeisiin tai laajemmin terveyteen tai terveyden edistämiseen. Moniammatillinen yhteistyö on tarpeen suunnitelmallisen ja pitkäjänteisen toiminnan varmistamiseksi. Tämän tutkimuksen tarkoituksena oli selvittää apteekkareiden näkökulmasta apteekkitoiminnan kehittämistarpeita. Apteekkareilta kysyttiin, minkälaisia toimintastrategioita apteekit ovat muuttuneessa ympäristössä luoneet. Lisäksi selvitettiin näkemyksiä apteekkiketjuista ja kampanjoinnista. Tavoitteena oli kartoittaa apteekkareiden mielipiteitä apteekkipalveluiden kehittämisestä ja tuotteistamisesta. Tutkimus tehtiin sähköisenä kyselynä Hämeen ja Varsinais-Suomen apteekkariyhdistysten jäsenille. Tutkimuksesta käy ilmi, että apteekkarit haluavat pitää yllä vahvaan farmaseuttiseen osaamiseen perustuvaa ammattiapteekkia. Apteekkarit uskovat, että tulevaisuudessa apteekkien on suunniteltava toimintaansa enemmän kuin tällä hetkellä. Strategiatyön merkitys tulee kasvamaan. Mikäli apteekkien taloudelliset toimintaedellytykset heikkenevät nykyisestä, hyvällä toiminnan suunnittelulla pystytään jossain määrin vaikuttamaan apteekin menestymiseen. Todennäköisesti tulevaisuudessa apteekkien on markkinoitava enemmän kuin nyt. Lisäksi markkinoinnin on oltava suunnitelmallisempaa. Apteekkarit uskovat, että apteekkiketjujen merkitys tulee tulevaisuudessa kasvamaan. Moniammatillisen yhteistyön kehittäminen on tärkeä kehittämiskohde, jotta apteekkien ammatilliset ohjelmat sekä farmaseuttinen osaaminen saataisiin kunnolla hyötykäyttöön

Factors associated with health service orientation and active product marketing orientation in Finnish community pharmacies : a nationwide study among private pharmacy owners

BackgroundLittle is known about pharmacy owners' commitment to public health and health policy goals in the strategic planning of their business. The aim of this study was to explore factors associated with health service orientation and active product marketing orientation of Finnish community pharmacy owners.MethodsA national cross-sectional e-mail survey was sent to private community pharmacy owners in Finland (n = 581) in 2013. Based on the structured, Likert-type survey instrument, two sum scales measuring strategic orientation towards health service provision (13 items, score range 0-26) and active product marketing (8 items, score range 0-16) were developed (Cronbach's Alpha 0.836 and 0.699, respectively). Characteristics of the pharmacy owners and their pharmacy business as well as actual service provision were used as background variables.ResultsConcerning health service orientation, 50% of the respondents received at least 20 points out of the maximum 26 points (score range: 0-26). For active product marketing orientation, 75% of the pharmacy owners had at least 14 points and 44% received full 16 points (score range: 0-16). The score distribution was skewed towards strong health service orientation, but the actual service score was heavily skewed towards few services or no services. Two-thirds of the pharmacy owners reported having available 2 or less services. The health service orientation was not influenced by any of the background variables used, but three of them influenced active product marketing orientation, namely business location, annual prescription volume and belonging to a marketing chain of individual community pharmacies.ConclusionLarge pharmacies located close to rivals and belonging to marketing chains of individual community pharmacies differentiated as those having a high product marketing orientation. The health service orientation was not influenced by any of the explanatory variables used in this study. The discrepancy between high health service orientation scores and low actual service provision scores needs further investigation. The contradiction that exists between pharmaceutical policy goals and the generation of income of pharmacies should also be examined as a contributing factor in this respect.Peer reviewe

Factors associated with health service orientation and active product marketing orientation in Finnish community pharmacies: a nationwide study among private pharmacy owners

Abstract Background Little is known about pharmacy owners’ commitment to public health and health policy goals in the strategic planning of their business. The aim of this study was to explore factors associated with health service orientation and active product marketing orientation of Finnish community pharmacy owners. Methods A national cross-sectional e-mail survey was sent to private community pharmacy owners in Finland (n = 581) in 2013. Based on the structured, Likert-type survey instrument, two sum scales measuring strategic orientation towards health service provision (13 items, score range 0–26) and active product marketing (8 items, score range 0–16) were developed (Cronbach’s Alpha 0.836 and 0.699, respectively). Characteristics of the pharmacy owners and their pharmacy business as well as actual service provision were used as background variables. Results Concerning health service orientation, 50% of the respondents received at least 20 points out of the maximum 26 points (score range: 0–26). For active product marketing orientation, 75% of the pharmacy owners had at least 14 points and 44% received full 16 points (score range: 0–16). The score distribution was skewed towards strong health service orientation, but the actual service score was heavily skewed towards few services or no services. Two-thirds of the pharmacy owners reported having available 2 or less services. The health service orientation was not influenced by any of the background variables used, but three of them influenced active product marketing orientation, namely business location, annual prescription volume and belonging to a marketing chain of individual community pharmacies. Conclusion Large pharmacies located close to rivals and belonging to marketing chains of individual community pharmacies differentiated as those having a high product marketing orientation. The health service orientation was not influenced by any of the explanatory variables used in this study. The discrepancy between high health service orientation scores and low actual service provision scores needs further investigation. The contradiction that exists between pharmaceutical policy goals and the generation of income of pharmacies should also be examined as a contributing factor in this respect

Apteekkien lääkityksen tarkistuspalvelussa tunnistetut asiakkaiden itsehoitovalmisteiden käyttöön liittyvät ongelmat lääkehoidoissa

English summaryPeer reviewe

Influence of strategic planning on product marketing and health service orientation of community pharmacies-A national survey in Finland

The aim of this study was to explore pharmacy owners' views on the strategic development of community pharmacies, particularly how strategic planning at the pharmacy level influences on product marketing and health service orientation of individual community pharmacies. The study was carried out as a national cross-sectional e-mail survey sent to all privately-owned Finnish community pharmacies (n = 581) in March 2013 (response rate 34%, n = 198). The pharmacy owners were asked about their strategy, product marketing and health services activities at the time of the survey and what they regarded as potential strategic developments by 2020. Of the responding pharmacy owners (n = 198), 63% reported their pharmacy had a strategy. The strategy was more common if the pharmacy owner had >10 years of experience as a pharmacy owner, the pharmacy had a high prescription volume (annually >100,000 prescriptions) and sales volume (annual turnover >5 million euros). Pharmacy owners' strategic vision by 2020 concerning health service orientation was the same regardless of having a strategy. Having a strategy was associated with the following variables indicating active product marketing orientation: the pharmacy had a person responsible for marketing campaigns and monitoring their success, and the pharmacy actively invested in add-on sales. Economic uncertainty of community pharmacies is an unresolved issue driving them towards active product marketing even they strategically prioritized health service orientation. (C) 2019 Elsevier B.V. All rights reserved.Peer reviewe

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

Finland’s community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists’ role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs.publishedVersionPeer reviewe

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

Finland’s community pharmacy system provides an example of a privately-owned regulated system being proactively developed by the profession and its stakeholders. Community pharmacists have a legal duty to promote safe and rational medicine use in outpatient care. The development of professionally oriented practice has been nationally coordinated since the 1990s with the support of a national steering group consisting of professional bodies, authorities, pharmacy schools and continuing education centers. The primary focus has been in patient counseling services and public health programs. The services have extended towards prospective medication risk management applying evidence-based tools, databases and digitalization. Research has been essential in informing progress by indicating high-risk patients, medications, practices and processes needing improvement. Despite the commitment of the profession and pharmacy owners, large-scale implementation of services has been challenging because of lack of remuneration, the pharmacy income still consisting primarily of sale of prescription and nonprescription medicines. Policy documents by the Ministry of Social Affairs and Health have supported the extension of the community pharmacists’ role beyond traditional dispensing to promote rational pharmacotherapy. The current roadmap by the Ministry of Social Affairs and Health emphasizes ensuring adequate regional availability and accessibility of medicines, regardless of the future pharmacy system. It also emphasizes the importance of strong regulation on pharmacy business operations and sale of medicines to ensure medication safety. At the same time, the roadmap requires that the regulation must enable implementation of new patient-oriented services and procedures, and further promote digitalization in service provision. Competition and balance of funding should be enhanced, e.g., through price competition, but the risk of pharmaceutical market concentration should be managed. The regulation should also consider influence of the new social and health care system on drug delivery. Year 2021 will be crucial for making long-term political decisions on the future direction of tasks and finances of Finnish community pharmacies in this framework. Government-funded studies are underway to guide decision making. Ongoing Covid-19 crisis has demonstrated the readiness of Finnish community pharmacies to adapt fast to meet the changing societal needs