Doctoral Programme in Drug Research, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014, Helsinki, Finland.
Clinical Pharmacy Group, Division of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, 00014, Helsinki, Finland.
BMC Geriatr. 2021 Nov 23;21(1):663. doi: 10.1186/s12877-021-02607-x.
Automated dose dispensing (ADD) services have been implemented in many health care systems internationally. However, the ADD service itself is a logistic process that requires integration with medication risk management interventions to ensure safe and appropriate medication use. National policies and regulations guiding ADD in Finland have recommended medication reconciliation, review, and follow-up for suitable risk management interventions. This implementation study aimed to develop a medication management process integrating these recommended risk management interventions into a regular ADD service for older home care clients.
This study applied an action research method and was carried out in a home care setting, part of primary care in the City of Lahti, Finland. The systems-approach to risk management was applied as a theoretical framework.
The outcome of the systems-based development process was a comprehensive medication management procedure. The medication risk management interventions of medication reconciliation, review and follow-up were integrated into the medication management process while implementing the ADD service. The tasks and responsibilities of each health care professional involved in the care team became more explicitly defined, and available resources were utilized more effectively. In particular, the hospital pharmacists became members of the care team where collaboration between physicians, pharmacists, and nurses shifted from parallel working towards close collaboration. More efforts are needed to integrate community pharmacists into the care team.
The transition to the ADD service allows implementation of the effective medication risk management interventions within regular home care practice. These systemic defenses should be considered when national ADD guidelines are implemented locally. The same applies to situations in which public home care organizations responsible for services e.g., municipalities, purchase ADD services from private service providers.
自动化剂量配药（ADD）服务已在许多国际医疗保健系统中实施。然而，ADD 服务本身是一个物流过程，需要与药物风险管理干预措施相结合，以确保安全和适当的药物使用。指导芬兰 ADD 的国家政策和法规建议进行药物重整、审查和随访，以进行适当的风险管理干预。这项实施研究旨在开发一种药物管理流程，将这些推荐的风险管理干预措施整合到为老年家庭护理客户提供的常规 ADD 服务中。
本研究采用行动研究方法，在芬兰拉赫蒂市的初级保健的家庭护理环境中进行。风险管理的系统方法被用作理论框架。
基于系统的开发过程的结果是一个全面的药物管理程序。药物重整、审查和随访的药物风险管理干预措施被整合到药物管理流程中，同时实施 ADD 服务。护理团队中每个医疗保健专业人员的任务和责任变得更加明确，可用资源得到更有效的利用。特别是，医院药剂师成为护理团队的成员，医生、药剂师和护士之间的协作从平行工作转变为密切合作。需要更多的努力将社区药剂师整合到护理团队中。
向 ADD 服务的过渡允许在常规家庭护理实践中实施有效的药物风险管理干预措施。在当地实施国家 ADD 指南时，应考虑这些系统防御措施。当负责服务的公共家庭护理组织（例如市政府）从私人服务提供商购买 ADD 服务时，同样适用。
