Towards interprofessional networking in medication management of the aged: current challenges and potential solutions in Finland

Figures & data

Figure 1. Sequence of authority-based actions taken to influence medicine use and medication management of the aged since 2006 when the landmark report indicating the challenges was published by the Ministry of Social Affairs and Health.[2–6]

Figure 2. Illustration of the theoretical framework and networks at micro, meso and macro levels in the context of the Finnish health care system.

Table 1. The problems and challenges of interprofessional collaboration and optimising the medicines use of the aged that appeared in the interviews (N = 15).

Legislation	Limited access rights (N = 5)
	Decisions made (N = 4)
	Culture of decision-making (N = 3)
	Lack of legislation (N = 3)
Information systems	Information systems not working (N = 10)
	No common patient record system in health care (N = 7)
Resources	Everything costs, lack of money (N = 11)
	No time for solving patients’ medication problems (N = 11)
	Labour shortage or high turnover (N = 10)
	No resource for developing (N = 6)
Health care system	Primary health care not working (N = 7)
	Pharmacy is not utilised in health care (N = 5)
	Unclear responsibilities (N = 5)
	Emergency system (N = 2)
Tools and operational models	Problems related to tools (N = 8)
	Care path not working (N = 6)
	Different ways to operate (N = 5)
	No operational model (N = 2)
Education and professional skills	Level of know-how varies (N = 6)
	Weak medicinal know-how (N = 3)
	Inadequate education (N = 2)
Information transfer	Patients’ medical information is not known (N = 10)
	Professionals are not familiar with other professionals’
	know-how and services (N = 9)
Attitudes	Traditional work roles (N = 8)
	Physicians’ attitude towards collaboration and medication reviews (N = 6)
	Nurses’ attitude towards cooperation (N = 4)
	Community pharmacies’ attitude towards developing (N = 4) The patient’s relatives’ attitude (N = 3)

The number indicates in how many interviews the theme was mentioned. The figure by the table illustrates at what level of the networks the problem can be seen according to the theoretical framework.

Table 2. The development ideas and possible solutions for implementing interprofessional collaboration according to the interviews (N = 15).

Target of the development	The methods of implementing
Sharing of tasks and responsibilities (N = 11)	Developing the patient’s care path. Utilising the help of pharmaceutical technicians. Utilising the help of nurses. Utilising the help of other professionals and experts. Clear responsibilities for conducting medication reviews. Interprofessional meetings at local level.
Better exploitation of pharmaceutical knowledge (N = 8)	Municipality pharmacists Improving clinical pharmacy in hospitals. Adding pharmaceutical expertise to primary care. Adding pharmaceutical expertise to specialised medical care. Adding pharmaceutical expertise to follow-up care. Increase of personnel in hospitals’ medical centres.
Exploitation of developed tools (N = 8)	Tools for different processes in the hospital. Electronic prescription and utilisation of its record system. Compact/short medication reviews. Common local patient record system. Electrical tools to help the physician’s work. Personal chip cards with patient records.
Reforming and augmentation of education (N = 7)	Interprofessional training patient-centred education. Organisational education
Fostering the role of community pharmacies (N = 6)	Developing collaboration between community pharmacies and municipalities. Fostering the role of community pharmacies in medication information and treatment follow-up. Developing pharmaceutical services. Active marketing of pharmaceutical services and communication with municipalities. Utilising the specialists (such as asthma or diabetes specialists) of community pharmacies in cooperation with other health care professionals
Common practice (N = 4)	Briefs for home nursing. Common ways to mark patient information (such as values). A common model for information procedure. A common model for orientation of new physicians.
New practices (N = 2)	Enhanced home nursing teams to reduce the number of emergency visits. Interprofessional care planning meetings in service homes. Discharging patients throughout the day. Systematic medication reconciliation and adding of the medication list to patient record system during hospital admissions.

The number tells in how many interviews the theme was raised.