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- Gillespie, Ulrika, et al.
(författare)
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A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older : a randomized controlled trial
- 2009
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 169:9, s. 894-900
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPatients 80 years or older are underrepresented in scientific studies. The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients.METHODSA randomized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala, Uppsala, Sweden. Four hundred patients were recruited consecutively between October 1, 2005, and June 30, 2006, and were randomized to control (n = 201) and intervention (n = 199) groups. The interventions were performed by ward-based pharmacists. The control group received standard care without direct involvement of pharmacists at the ward level. The primary outcome measure was the frequency of hospital visits (emergency department and readmissions [total and drug-related]) during the 12-month follow-up period.RESULTSThree hundred sixty-eight patients (182 in the intervention group and 186 in the control group) were analyzed. For the intervention group, there was a 16% reduction in all visits to the hospital (quotient, 1.88 vs 2.24; estimate, 0.84; 95% confidence interval [CI], 0.72-0.99) and a 47% reduction in visits to the emergency department (quotient, 0.35 vs 0.66; estimate, 0.53; 95% CI, 0.37-0.75). Drug-related readmissions were reduced by 80% (quotient, 0.06 vs 0.32; estimate, 0.20; 95% CI, 0.10-0.41). After inclusion of the intervention costs, the total cost per patient in the intervention group was $230 lower than that in the control group.CONCLUSIONIf implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.
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- Ljungberg, Christina, et al.
(författare)
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Hospital doctors' views of factors influencing their prescribing
- 2007
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 13:5, s. 765-771
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aim and objective Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in prescribing drugs, using a qualitative approach. Method Semi-structured interviews were conducted with 15 hospital doctors in different medical specialities and the interviews were analysed from an interpretivist perspective. The information gathered was on how prescribing decisions were made in general and how the doctors chose a specific drug therapy, including information sources used. Results According to our interviews, the hospital doctors took patient-specific factors and cost into consideration when prescribing, informed by different written information sources and commercial verbal information. Personal practice, colleagues and therapeutic tradition at the hospital or clinic, were influential in the prescribing of drugs. The themes identified should not to be seen as individual influences; many of them probably act in combination. Conclusions If changes in prescribing behaviour are desired, factors warranting more attention include understanding how to influence therapeutic traditions and the doctor's personal habits for prescribing. The importance of clinical experience and information exchange with colleagues should not be underestimated in providing information about drugs to hospital doctors.
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- Ljungberg, Christina, 1978-
(författare)
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Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.
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- Montgomery, Anna, 1974-
(författare)
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Counselling in Swedish Community Pharmacies : Understanding the Process of a Pharmaceutical Care Service
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Community pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.
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- Nordén-Hägg, Annika
(författare)
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Failure-Free Pharmacies? : An Exploration of Dispensing Errors and Safety Culture in Swedish Community Pharmacies
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.
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| 10. |
- Nordqvist, Ola, et al.
(författare)
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Assessing and achieving readiness to initiate HIV medication
- 2006
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 62:1, s. 21-30
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo summarise published HIV-specific research on readiness theories, factors influencing readiness, instruments to measure readiness and interventions to increase readiness for treatment.MethodsMedline and PsychInfo were searched until August 2004.ResultsTwo HIV-specific readiness theories were identified. Fear of side effects, emotions emerging from the diagnosis and lack of trust in the physician were some barriers to overcome in order to reach readiness. Of the three measurement instruments found, the index of readiness showed the most promise. Multi-step intervention programs to increase readiness for HIV treatment had been investigated.ConclusionReadiness instruments may be useful tools in clinical practice but the predictive validity of the instruments needs to be further established in the HIV-infected population.Practice implicationsReadiness instruments and practice placebo trials may serve as complements to routine care, since health care providers currently have no better than chance probability in identifying those patients who are ready to adhere.
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