Statin Adherence, Utilisation, and Prescribing Patterns. Improving effectiveness of treatment

Statins are one of the most widely studied and evidence-based medications. Randomised controlled trials have provided convincing evidence on the benefits of statin therapy in preventing cardiovascular events. Despite proven benefits, low costs, and few adverse effects, everyday effectiveness of statins is limited, since adherence to statin therapy is poor. This thesis was conducted as four pharmacoepidemiological studies using register data on statin users in real clinical care. The main purpose of the study was to evaluate prescribing patterns and to discover the lifestyle factors predicting statin nonadherence and discontinuation. This knowledge is essential in order to help physicians to motivate the adherence of their patients to treatment. In Finland, from 1998 to 2004, the number of statin initiators nearly doubled. The discovered channelling of atorvastatin and simvastatin may have affected the treatment outcomes at the public health level. It is possible that money spent on statins in Finland in 1998‒2004 could have been used in a more cost-effective way. In 2015, the percentage of patients receiving reimbursement for statins was 12% of the total population. Thus, it is a major public health and economic challenge to improve statin effectiveness and allocate therapy correctly. Among the participants with cardiovascular comorbidities, risky alcohol use or clustering of lifestyle risks were predictors of nonadherence. In addition, the prevalence of nonadherence to statins increased after retirement among both men and women. This increase in post-retirement nonadherence was highest among those receiving statins for secondary prevention. Discontinuation of statin therapy was predicted by high patient co-payment, and in women, by risky alcohol use. Recognising the predictors of nonadherence to statins is important because nonadherence is associated with an increased risk of adverse cardiovascular outcomes and higher healthcare costs. In conclusion, optimal outcomes in medical therapy require both efficacious medications and adherence to those treatments. When prescribing statins to eligible patients, the physician’s clinical expertise in recognising patients at risk of statin discontinuation and nonadherence, as well as their ability to increase adherence, may have a great effect on public health.

Identifying New Business Opportunities and Customer Value Creation: Case Vuosaari

Previously conducted research projects in the field of logistics services have emphasized the importance of value added services in customer value creation. Through value added services companies can extend their service portfolio and gain higher customer satisfaction and loyalty. In more general level service marketing has been recognized to be challenging due the intangible nature of services. This has caused issues in pricing and value perceptions. To tackle these issues scholars have suggested well–managed customer reference marketing practices. The main goal of this research work is to identify shortages in the current service offering. Additionally, the focus is on, how these shortages can be fixed. Due the low capacity utilization of warehouse premises, there is a need to find the main factors, which are causing or affecting on the current situation. The research aims to offer a set of alternatives how to come over these issues. All the potential business opportunities are evaluated and the promising prospects are discussed. The focus is on logistics value added services and how those effect on route decisions in logistics. Simultaneously the aim is to create a holistic understanding of how added value and offered services effect on logistics centralization. Moreover, customer value creation and customer references’ effectiveness in logistics service marketing are emphasized in this project. Logistics value added services have a minor effect on logistics decision. Routes are chosen on a low–cost basis. However, it is challenging to track down logistics costs and break those down into different phases. Customer value as such is a difficult concept. This causes challenges when services are sold with value–based principles. Customer references are useful for logistics service providers and this should be exploited in marketing. Those reduce the perceived risk and give credibility to the service provider.

Activity-based life cycle costing model for cost estimation and monitoring – Case: manned and autonomous dry bulk carrier

Recent developments in automation, robotics and artificial intelligence have given a push to a wider usage of these technologies in recent years, and nowadays, driverless transport systems are already state-of-the-art on certain legs of transportation. This has given a push for the maritime industry to join the advancement. The case organisation, AAWA initiative, is a joint industry-academia research consortium with the objective of developing readiness for the first commercial autonomous solutions, exploiting state-of-the-art autonomous and remote technology. The initiative develops both autonomous and remote operation technology for navigation, machinery, and all on-board operating systems. The aim of this study is to develop a model with which to estimate and forecast the operational costs, and thus enable comparisons between manned and autonomous cargo vessels. The building process of the model is also described and discussed. Furthermore, the model’s aim is to track and identify the critical success factors of the chosen ship design, and to enable monitoring and tracking of the incurred operational costs as the life cycle of the vessel progresses. The study adopts the constructive research approach, as the aim is to develop a construct to meet the needs of a case organisation. Data has been collected through discussions and meeting with consortium members and researchers, as well as through written and internal communications material. The model itself is built using activity-based life cycle costing, which enables both realistic cost estimation and forecasting, as well as the identification of critical success factors due to the process-orientation adopted from activity-based costing and the statistical nature of Monte Carlo simulation techniques. As the model was able to meet the multiple aims set for it, and the case organisation was satisfied with it, it could be argued that activity-based life cycle costing is the method with which to conduct cost estimation and forecasting in the case of autonomous cargo vessels. The model was able to perform the cost analysis and forecasting, as well as to trace the critical success factors. Later on, it also enabled, albeit hypothetically, monitoring and tracking of the incurred costs. By collecting costs this way, it was argued that the activity-based LCC model is able facilitate learning from and continuous improvement of the autonomous vessel. As with the building process of the model, an individual approach was chosen, while still using the implementation and model building steps presented in existing literature. This was due to two factors: the nature of the model and – perhaps even more importantly – the nature of the case organisation. Furthermore, the loosely organised network structure means that knowing the case organisation and its aims is of great importance when conducting a constructive research.