JMIR Publications

ABSTRACT

Background:

The European cross-border e-prescription (CBEP) system was first implemented in January 2019 when it became possible to purchase medications from community pharmacies in Estonia using a Finnish e-prescription. In 2020, Estonian e-prescriptions became available to be dispensed in Finnish pharmacies. The CBEP is an important milestone in increasing access to medicines across the European Union and it has been unstudied to date.

Objective:

To investigate Estonian and Finnish pharmacists’ experiences in factors influencing access to and dispensing of CBEPs.

Methods:

An online survey was conducted among Estonian and Finnish pharmacists in the spring of 2021. The survey was distributed to all community pharmacies in Estonia (n=289) and Finland (n=375) where CBEPs had been dispensed in 2020. Structured Likert scales and open-ended questions were used in the questionnaire to cover the availability of prescribed medication/s, ambiguities or errors in CBEPs, experiences with using the CBEP dispensing system, and guidelines and training received to dispense CBEPs. The data were analyzed using frequencies and a chi-square test. Answers to open-ended questions were categorized using content analysis and then analyzed by frequency.

Results:

In total, 84 responses from Estonia and 154 responses from Finland were included in the study. The majority of Estonian (88.1%) and Finnish (81.8%) respondents agreed that CBEPs have improved patients’ access to medications. Problems with the availability of medications when dispensing CBEPs were reported by 76.2% of Estonian and 35.1% of Finnish respondents. However, most of the respondents reporting availability issues had encountered the problems rarely. In Estonia, the most commonly reported availability problems were same active ingredient (58.3%) and same strength (57.1%) of the medication not being available on the market, whereas in Finland, the most common issue was the unavailability of equivalent package size on the market (19.5%). Encountering ambiguities or errors in the CBEPs was reported by 60.7% of Estonian and 42.8% of Finnish respondents. Mostly, these ambiguities or errors were encountered rarely. The most commonly encountered ambiguities or errors were incorrect pharmaceutical form (27.4%) in Estonia and incorrect total amount of medication (13.6%) in Finland. Technical problems with using the CBEP system were reported by 57.1% of Estonian and 40.2% of Finnish respondents. Most of the Estonian and Finnish respondents (63.1% and 86.4%, respectively) had access to guidelines for dispensing CBEPs. More than half of the Estonian (61.9%) and Finnish (61.7%) respondents felt they had received sufficient training on dispensing CBEPs.

Conclusions:

Pharmacists in both Estonia and Finland agreed that the CBEPs improve access to medications. However, the interfering factors, such as ambiguities or errors in the CBEPs and technical problems in the CBEP system, can reduce access to medications. Most of the respondents had received sufficient training and were informed of the guidelines, although, the content of the guidelines could be improved.