| 39921. |
- Hedberg, Charlotte, et al.
(författare)
-
Can evidence-based medicine become counter-productive?
- 2010
-
Ingår i: Scandinavian Journal of Public Health. - London, United Kingdom : Sage Publications. - 1403-4948 .- 1651-1905. ; 38:5, s. 553-4
-
Tidskriftsartikel (refereegranskat)
|
|
| 39922. |
- Hedenrud, Tove, 1967, et al.
(författare)
-
Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: A population-based study
- 2019
-
Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 0961-7671 .- 2042-7174. ; 27:1, s. 17-24
-
Tidskriftsartikel (refereegranskat)abstract
- © 2018 Royal Pharmaceutical Society. Objectives: To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. Methods: Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. Key findings: Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. Conclusions: Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.
|
|
| 39923. |
- Hedenrud, Tove, 1967, et al.
(författare)
-
Beliefs about medicines among Swedish pharmacy employees
- 2006
-
Ingår i: International Conference on Behavioral Medicine, Bangkok, November 2006..
-
Konferensbidrag (refereegranskat)abstract
- The aim was to describe beliefs about medicines among pharmacy employees. A further aim was to analyse whether these beliefs were associated with any background characteristics, such as age, professional category or medication use. The study was performed among pharmacy employees at 24 community pharmacies in Göteborg, Sweden. A majority of the 292 respondents were dispensing pharmacists. More than half of the respondents were aged 45 years or older and had worked in a pharmacy for 20 years or more. The respondents had a mean score for General Benefit of 4.31, 1.81 for General Harm and 3.49 for General Overuse. Each scale score ranged from 1 to 5. Compared to dispensing pharmacists, pharmacy technicians viewed medicines as more harmful; and compared to pharmacy technicians, pharmacists and dispensing pharmacists regarded medicines as more beneficial. Pharmacy employees with 30-34 years experience regarded medicines as less harmful compared to those who had worked 0-4 years. Compared to non-users, current users of prescription drugs regarded medicines as more beneficial. No confounders were detected for the three subscales. Pharmacy personnel expressed positive beliefs about medicines which may effect the communication with clients and, eventually, clients’ adherence to medicines. The reason for the difference between dispensing pharmacists and technicians remain unclear. Health professionals hold both professional and personal health beliefs, which could have an impact, not only on the type of information one considers important to communicate, but also the way it is communicated. With knowledge about potential differences in beliefs about medicines among pharmacy clients, pharmacy employees, doctors and nurses, we may be able to suggest measures in order to enhance adherence among users of medication.
|
|
| 39924. |
- Hedenrud, Tove, 1967, et al.
(författare)
-
Beliefs about medicines and adherence among Swedish migraineurs.
- 2007
-
Ingår i: The 13th Congress of the International Headache Society, Stockholm, juni 2007..
-
Konferensbidrag (refereegranskat)abstract
- Objective The aim was to analyze whether beliefs about medicines are associated with adherence to prophylactic medication among Swedish migraineurs. Methods A questionnaire was distributed consecutively to migraineurs attending a tertiary clinic. All participants were prescribed prophylactic medication. The questionnaire comprised e.g. background questions, beliefs about medicines (BMQ), and self-reported adherence (MARS). The General BMQ comprises three subparts: General Harm, General Overuse, and General Benefit. The specific part of the BMQ has two subparts: Specific Necessity and Specific Concerns. For the BMQ Specific, a necessity–concerns differential was calculated for each participant. A logistic regression analysis was performed to analyze the association between beliefs about medicines and adherence to prophylactic medication. Results Of the 175 participants, 15% were male and more than half of the participants were aged 45 years and over. Fifty percent had a university degree. Sixty-four percent were considered adherent. There was no significant difference in adherence between gender, age groups, or by educational level. Respondents with only compulsory school were less concerned about the long-term effects of medications and had a higher necessity–concern differential. In the logistic regression analysis, no variable was significantly associated with adherence. Conclusions The present study showed no association between beliefs about medication and adherence. We recommend that lack of adherence to migraine prophylactic drugs should be considered more often, looked for, and addressed in order to identify sufferers with an unnecessarily high migraine-associated disability. This assumes greater attention to the problem amongst both physicians and researchers in all countries.
|
|
| 39925. |
- Hellström, Lina, 1975-
(författare)
-
Clinical pharmacy services within a multiprofessional healthcare team
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.
|
|
| 39926. |
|
|
| 39927. |
- Hellström, Lina, 1975-, et al.
(författare)
-
Impact of the Lund Integrated Medicines Management model on medication appropriateness
- 2011
-
Ingår i: 39th ESCP European symposium on clinical pharmacy & 13th SFPC congress: clinical pharmacy at the front line of innovations. 21–23 October 2010, Lyon, France. - : Springer.
-
Konferensbidrag (refereegranskat)abstract
- Introduction Inappropriate prescribing among elderly patients may increase the risk for drug-related problems. The objective of this study was to examine the impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness in hospitalised patients. Materials & Methods A prospective controlled study of 210 elderly patients, from three internal medicine wards in a Swedish hospital. We compared patients receiving Medication Reviews, including Admission Medication Reconciliation, according to the LIMM-model, with patients receiving standard care. The LIMMmodel was implemented at one ward at a time between January 2007 and March 2008. We chose four dates for inclusion of patients during this period, one date before implementation and three dates about one month after implementation on the first, second and third ward, respectively. All patients who were staying at any of the wards on these dates were eligible for inclusion. The main outcome measure was the change, from admission to discharge, in the number of drugs with at least one inappropriate rating, according to the Medication Appropriateness Index (MAI). The MAI consists of 10 criteria: indication, effectiveness, dosage, correct directions, practical directions, drug-drug interactions, drug-disease interactions, duplication, duration and expense. For intervention patients, the MAI assessment at discharge was performed in two steps. Step 1, which was a blinded assessment based on information in the patient’s medical record, was used in the main analysis. In step 2, the drugs were reassessed (unblinded), by adding information from the pharmacists’ Medication Review Forms that had not been documented in the medical records. Results The control and intervention group were similar regarding baseline demographic data. The mean number of drugs with at least one inappropriate rating decreased from 3.0 at admission to 1.5 at discharge in the intervention group, and from 2.8 to 1.7 in the control group. This represented a 51% (95% CI, 43-58%) decrease in the intervention group (step 1 assessment), compared to a 39% (95% CI, 30-48%) decrease in the control group (p = 0.0446, Poisson regression). In the assessment step 2, the MAI rating was changed from ‘inappropriate’ to ‘appropriate’ in 23% of the drugs (27/117). The mean decrease per patient between step 1 and 2 in number of drugs with at least one inappropriate rating was 0.38 (95% CI 0.22–0.54). In both control and intervention patients the most common MAI problems involved ‘expense’, ‘indication’ and ‘duration’. Discussion & Conclusion This study showed that medication appropriateness at discharge from hospital improved in patients receiving Medication Reviews and Reconciliation, according to the LIMM-model. In order to take full advantage of the work done by the clinical pharmacists, the information documented in the Medication Review Forms should also be documented in the medical records.
|
|
| 39928. |
|
|
| 39929. |
- Hellström, Lina, 1975-, et al.
(författare)
-
Prospective observational study of medication reviews in internal medicine wards : evaluation of drug-related problems
- 2021
-
Ingår i: European journal of hospital pharmacy. Science and practice. - : BMJ Publishing Group Ltd. - 2047-9956 .- 2047-9964. ; 28:e1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process.OBJECTIVE: To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs.METHOD: Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken.RESULTS: A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations.CONCLUSION: DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.
|
|
| 39930. |
- Hesse, Ulrik, et al.
(författare)
-
Impact of Delisting ARBs, Apart from Losartan, on ARB Utilisation Patterns in Denmark: Implications for Other Countries.
- 2013
-
Ingår i: Applied health economics and health policy. - : Springer Science and Business Media LLC. - 1179-1896 .- 1175-5652. ; 11:6, s. 677-85
-
Tidskriftsartikel (refereegranskat)abstract
- Renin-angiotensin inhibitor drugs have been a target for health authority initiatives across Europe with the potential for substantial savings once generic angiotensin-converting enzyme inhibitors (ACEIs) became available without compromising care. Recently, losartan was the first angiotensin receptor blocker (ARB) to lose its patent. In Denmark, the authorities removed all other ARBs from the reimbursement list, apart from losartan, as they were all seen as essentially similar for the management of hypertension or congestive heart failure at appropriate doses, but more expensive. Similarly, all other ARB fixed-dose combinations (FDCs), apart from losartan, were removed from the reimbursement list.
|
|
