Identifying Gaps in Community Pharmacists' Competence in Medication Risk Management in Routine Dispensing.

BACKGROUND: Community pharmacists increasingly contribute to medication risk management while dispensing medicines to outpatients. Their risk management actions are shifting from medication counselling towards reviewing medications and following-up their therapeutic effects and outcomes. Acquiring these more clinical tasks require more patient care-oriented competences. OBJECTIVE: To identify gaps in community pharmacists' competence in medication risk management in routine dispensing. SETTING: All community pharmacies in Finland. METHOD: A national cross-sectional online survey was conducted through the Association of Finnish Pharmacies (n=574 community pharmacies) and the university pharmacies (n=2) in 2015. One pharmacist from each pharmacy was recommended to report on behalf of their outlet. MAIN OUTCOME MEASURE: Community pharmacists' self-assessed competence to: 1) identify medication-related risks, 2) utilise electronic tools in medication risk management, and 3) identify their perceived needs for developing competence in medication risk management. RESULTS: Responses were received from 169 community pharmacies (response rate 29%). The highest proportion of good competency estimates were self-assessed in confirming doses (98% of the respondents evaluated their competence to be good) and identifying drug-drug interactions (83%). Competence to identify adverse effects, such as serotonergic load (10%) and anticholinergic load (12%), was most seldomly perceived as good. Of the wide range of electronic databases available, respondents most commonly reported using daily summaries of product characteristics (97% of the respondents), the checklist-type generic medicines information database that supports in medication counselling (85%), and the programme assisting in identifying drug-drug interactions (83%). The most commonly reported training needs were related to the identification of serotonergic load (63%), anticholinergic load (62%), and evaluating the clinical significance of drug-drug interactions (54%). CONCLUSION: The results indicate remarkable gaps in community pharmacists' current competence in medication risk management, particularly in their competence in applied and geriatric pharmacotherapy.

Medication Risk Management in Routine Dispensing in Community Pharmacies.

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.

First physical evidence for forested environment in the Arctic during MIS 3.

Old sedimentological and geochronological records can be preserved underneath the central parts of the continental ice sheets under non-erosive, cold-based subglacial conditions. Organic deposits that predate the last deglaciation are of particular value for the information held on glacial-time climate and environmental conditions. In this study, we present multiproxy data derived from a well-preserved MIS 3 interstadial (55-25 ka ago) organic layer from inside the Arctic Circle in the Finnish Lapland. Biological proxy evidence, namely coming from aquatic plant species, indicates July temperatures as high as 14.4 °C, i.e. higher than those of today for the study site. Macrofossil evidence demonstrates for the first time the presence of pines accompanied by tree birch during the MIS 3 interstadial in northern Fennoscandia. These results concur with contemporary insolation model outcomes but contradict with the previous proxy-based view of open tundra conditions during the MIS 3. The data suggest that there are highly dynamic interstadial continental ice-sheet dynamics following changes in orbital forcing. Warm climate enabled the establishment of forests on exposed landscape. Moreover, we suggest that in the light of these new data, previous MIS 3 pollen data could be re-interpreted.

Proxy comparison in ancient peat sediments: pollen, macrofossil and plant DNA.

We compared DNA, pollen and macrofossil data obtained from Weichselian interstadial (age more than 40 kyr) and Holocene (maximum age 8400 cal yr BP) peat sediments from northern Europe and used them to reconstruct contemporary floristic compositions at two sites. The majority of the samples provided plant DNA sequences of good quality with success amplification rates depending on age. DNA and sequencing analysis provided five plant taxa from the older site and nine taxa from the younger site, corresponding to 7% and 15% of the total number of taxa identified by the three proxies together. At both sites, pollen analysis detected the largest (54) and DNA the lowest (10) number of taxa, but five of the DNA taxa were not detected by pollen and macrofossils. The finding of a larger overlap between DNA and pollen than between DNA and macrofossils proxies seems to go against our previous suggestion based on lacustrine sediments that DNA originates principally from plant tissues and less from pollen. At both sites, we also detected Quercus spp. DNA, but few pollen grains were found in the record, and these are normally interpreted as long-distance dispersal. We confirm that in palaeoecological investigations, sedimentary DNA analysis is less comprehensive than classical morphological analysis, but is a complementary and important tool to obtain a more complete picture of past flora.