| 1. |
- Milos, Veronica, et al.
(författare)
-
Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study
- 2013
-
Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 30:4, s. 235-246
-
Tidskriftsartikel (refereegranskat)abstract
- Background Polypharmacy in the Swedish elderly population is currently a prioritised area of research Objective This study aimed to assess a structured model for pharmacist-led medication reviews in Methods This study was a randomised controlled clinical trial performed in a group of patients aged >= Results A total of 369 patients were included: 182 in the intervention group and 187 in the control Conclusions Medication reviews involving pharmacists in primary health care appear to be a feasible
|
|
| 2. |
- Hellström, Lina, et al.
(författare)
-
Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits.
- 2011
-
Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 67:7, s. 741-752
-
Tidskriftsartikel (refereegranskat)abstract
- PurposeTo examine the impact of systematic medication reconciliations when admitted to hospital, and medication review while in hospital, on the number of inappropriate medications and unscheduled drug-related hospital revisits in elderly patients.MethodsA prospective, controlled study in 210 patients, aged 65 years or older, who were admitted to one of three internal medicine wards at a University Hospital in Sweden. Patients received either standard care or care according to the Lund Integrated Medicines Management (LIMM) model. A multi-professional team, including a clinical pharmacist, provided medication reconciliations on admission and medication reviews during the hospital stay for the LIMM group. Blinded reviewers evaluated the appropriateness of the prescribing (using the Medication Appropriateness Index) on admission and discharge, and assessed the probability that a drug-related problem was the reason for any patient readmitted to hospital or visiting the emergency department within three months of discharge (using WHO causality criteria).ResultsThere was a greater decrease in the number of inappropriate drugs in the intervention group than in the control group for both the intention-to-treat population (51% [95% CI 43-58%] versus 39% [95% CI 30-48%], p=0.0446) and the per-protocol population (60% [95% CI 51-67%] versus 44% [95% CI 34-52 %], p=0.0106). There were 6 revisits to hospital in the intervention group which were judged as ‘possibly, probably or certainly drug-related’, compared with 12 in the control group (p=0.0469).ConclusionIn this study, medication reconciliation and reviews provided by a clinical pharmacist in a multi-professional team significantly reduced the number of inappropriate drugs and unscheduled drug-related hospital revisits for elderly patients.
|
|
| 3. |
- Bondesson, Åsa ÅB, et al.
(författare)
-
A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data
- 2009
-
Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 15:4, s. 713-723
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE, AIMS AND OBJECTIVE: The objectives were to describe and evaluate the structured medication questionnaire and to improve data handling of results from the Morisky four-item scale for patient compliance and Beliefs about Medicines Questionnaire-specific (BMQ-specific). METHODS: A questionnaire was developed with the purpose of being used when identifying medication errors and assessing patient compliance to and beliefs about medicines. RESULTS: A majority of the respondents (62%; CI 45-77%) had at least one medication error. Assuming that all items are equally important in the Morisky four-item scale we presented four alternative ways to create a unidimensional global scale. A two-dimensional global scale was also constructed. The results from the BMQ-specific were presented in different ways, all taking into account that the scale has ordered verbal categories: at the level addressing each specific question, at the sub-scales 'concern' and 'necessity' level and at the global level. CONCLUSIONS: The structured medication questionnaire can be used in daily practice as a tool to identify drug-related problems. The choice of how to use and present data from those scales in research depends on patient characteristics and how discriminating one would like the scales to be.
|
|
| 4. |
- Hellström, Lina, 1975-, et al.
(författare)
-
Errors in medication history at hospital admission: prevalence and predicting factors
- 2012
-
Ingår i: BMC Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1472-6904. ; 12, s. Article ID: 9-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors.Methods:A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors.Results: The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06 - 1.14; p<0.0001) and the patient living in their own home without any care services (OR1.58; 95% CI 1.02 - 2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists' medication reconciliation carried out on days 4 - 11 compared to days 0 - 1 = 0.52; 95% CI 0.30 - 0.91; p = 0.021).Conclusions: Clinical pharmacists conducting LIMM-based medication reconciliations have a high potential for correcting errors in medication history for all patients. In an older Swedish population, those prescribed many drugs seem to benefit most from admission medication reconciliation.
|
|
| 5. |
- Johansson Östbring, Malin, 1980-
(författare)
-
Pharmaceutical care in coronary heart disease
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In coronary heart disease (CHD), pharmaceutical care implies that health care professionals cooperate with the patient to optimize drug therapy primarily for secondary prevention. Low adherence and discontinuation of drugs are common among patients with CHD, and this is associated with increased morbidity and mortality. The achievement of guidelines-recommended treatment goals for risk factors is disappointingly low in secondary prevention.Aim: To study clinical and patient related aspects of pharmaceutical care for secondary prevention in patients with CHD.Method: A pharmacist used medication review and motivational interviewing to impact patients’ beliefs about medicines and adherence in a pilot study. This intervention was further developed and tested in a randomized controlled trial (RCT) in 316 patients with verified CHD who were planned for follow-up at the cardiology clinic in Kalmar. The primary study outcome was the proportion ofpatients who reached the treatment goal for low-density lipoprotein (LDL)cholesterol. Patients’ adherence to cholesterol-lowering drugs according to a combination of refilled prescriptions and self-report was the key secondary outcome. In the RCT, pharmacists individualized both the dose and the content of thesupport based on the patient’s need. A process evaluation was planned alongside the trial to investigate implementation and mechanisms of impact such as pharmacists’ actions and effects on patients’ medication beliefs. In a separate qualitative study, we interviewed patients with CHD who had used their medicines for at least 12 months.Results: At 15 months follow-up of the RCT, the primary outcome measure did not differ between groups. The intervention improved patient adherence to cholesterol-lowering medicines; 88% vs 77% of the patients were adherent, possibly because the intervention lowered patients’ concerns about medicines. In 84% of the intervention patients at least one actual drug-related problem (DRP) was identified, and for 90% of those DRPs actions were taken to resolve the problems. Analyses of the interviews with patients revealed that patients´ experiences with medicines varied greatly - from trivial to troublesome – and these were classified into one of seven categories: a sense of security, unproblematic, learning to live with it, taking responsibility for it, somewhat uncertain, troublesome, or distressing.Conclusion: Pharmaceutical care improved the patients’ use of medicines in CHD but did not increase treatment goal achievement for LDL-cholesterol. Overall, the findings of this thesis emphasize that when support in managing medications is offered to patients, it should encompass various aspects of medicine-taking: safety, knowledge, beliefs, practical handling, impact on day-to-day life, and the patient’s medication experience.
|
|
| 6. |
- Midlöv, Patrik, et al.
(författare)
-
Medication errors when transferring elderly patients between primary health care and hospital care
- 2005
-
Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 27:2, s. 116-120
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care. Method: Elderly primary health care patients (> 65 years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital. Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not. Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added. Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients' medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.
|
|
| 7. |
- Hellström, Lina, 1975-, et al.
(författare)
-
Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all cause emergency department revisits
- 2012
-
Ingår i: Journal of Clinical Pharmacy and Therapeutics. - : Hindawi Limited. - 0269-4727 .- 1365-2710. ; 37:6, s. 686-692
-
Tidskriftsartikel (refereegranskat)abstract
- What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death.Methods: This prospective, controlled study included all patients hospitalised in three internal medicine wards in a university hospital, between January 1 2006 and May 31 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n=1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n=2758) attended the wards before implementation of the intervention. Results: No impact of medication reconciliation and reviews on ED revisits (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.86-1.04) or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared to 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalisation or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (p<0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (p=0.608).What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, rehospitalisations or mortality over six months' follow-up.
|
|
| 8. |
- Waleij, Leila, et al.
(författare)
-
The rate and nature of medication errors among elderly upon admission to hospital after implementation of clinical pharmacist-led medication reconciliation
- 2014
-
Ingår i: European Journal of Hospital Pharmacy: Science and Practice. - : BMJ. - 2047-9964 .- 2047-9956. ; 21:3, s. 156-160
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To determine the frequency and nature of erroneous transfer of medication information (medication errors) upon admission to hospital and to study the effect of medication reconciliation. Methods Included patients were 65years of age or older, were living in nursing homes or in their own home with care provided by the community nursing system and had been admitted to hospital. The patients' medication lists from the community were compared with the hospital medication lists upon admission in order to study the discrepancies between the lists. The proportion of errors that were corrected by day 4 of hospitalisation was also studied as a measure of the effect of medication reconciliation conducted by clinical pharmacists who aimed to identify the patients' accurate and complete medication history. Results A total of 149 patients were included over a 10-month period. In 68 (46%) patients, there occurred at least one medication error, with an average of 0.95 errors per patient. Overall, 8.0% of all drug transfers were found to be incorrect. The clinical pharmacists detected all medication errors upon admission and 43% of them were corrected before day 4 of hospitalisation. Conclusions Medication errors upon admission to hospital are common; use of clinical pharmacists in the admission medication reconciliation process appears to be a useful method to reduce medication errors, but since our study lacked a control group further studies are needed to show the actual impact of pharmacist-led medication reconciliation upon admission to hospital. Furthermore, more actions are needed to enhance the safety and quality of medication information transfers.
|
|
| 9. |
- Johansson Östbring, Malin, 1980-, et al.
(författare)
-
Effects of a pharmaceutical care intervention on clinical outcomes and patient adherence in coronary heart disease : the MIMeRiC randomized controlled trial
- 2021
-
Ingår i: BMC Cardiovascular Disorders. - : BioMed Central. - 1471-2261 .- 1471-2261. ; 21:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the treatment of coronary heart disease, secondary prevention goals are still often unmet and poor adherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomes and patient adherence.METHODS: This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the intervention group were seen by a clinical pharmacist two to five times as required over seven months. Pharmacists were trained to use motivational interviewing in the consultations and they tailored their support to each patient's clinical needs and beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patient adherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the effects on patient adherence to other preventive drugs, systolic blood pressure, disease-specific quality of life, and healthcare use.RESULTS: 316 patients were included. The proportion of patients who reached the target for low-density lipoprotein cholesterol were 37.0% in the intervention group and 44.2% in the control group (P = .263). More intervention than control patients were adherent to cholesterol-lowering drugs (88 vs 77%; P = .033) and aspirin (97 vs 91%; P = .036) but not to beta-blocking agents or renin-angiotensin-aldosterone system inhibitors.CONCLUSIONS: Our intervention had no positive effects on risk factors for CHD, but it increased patient adherence. Further investigation of the intervention process is needed to explore the difference in results between patient adherence and medication effects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful effect on patient health.TRIAL REGISTRATION: ClinicalTrials.gov NCT02102503, 03/04/2014 retrospectively registered.
|
|
| 10. |
|
|
