| 1. |
- Fujita, Kenji, et al.
(författare)
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Pharmaceutical Care Network Europe definition of quality indicators for pharmaceutical care : a systematic literature review and international consensus development.
- 2024
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Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711. ; 46:1, s. 70-79
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Over the past 40 years, the tasks of pharmacists have shifted from logistic services to pharmaceutical care (PhC). Despite the increasing importance of measuring quality of care, there is no general definition of Quality Indicators (QIs) to measure PhC. Recognising this, a working group in a European association of PhC researchers, the Pharmaceutical Care Network Europe (PCNE), was established in 2020.AIM: This research aimed to review existing definitions of QIs and develop a definition of QIs for PhC.METHOD: A two-step procedure was applied. Firstly, a systematic literature review was conducted to identify existing QI definitions that were summarised. Secondly, an expert panel, comprised of 17 international experts from 14 countries, participated in two surveys and a discussion using a modified Delphi technique to develop the definition of QIs for PhC.RESULTS: A total of 182 QI definitions were identified from 174 articles. Of these, 63 QI definitions (35%) cited one of five references as the source. Sixteen aspects that construct QI definitions were derived from the identified definitions. As a result of the Delphi study, the panel reached an agreement on a one-sentence definition of QIs for PhC: "quality indicators for pharmaceutical care are validated measurement tools to monitor structures, processes or outcomes in the context of care provided by pharmacists".CONCLUSION: Building upon existing definition of QIs, an international expert panel developed the PCNE definition of QIs for PhC. This definition is intended for universal use amongst researchers and healthcare providers in PhC.
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| 2. |
- Westerlund, Tommy, et al.
(författare)
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Role of community pharmacy and pharmacists in self care in Sweden
- 2023
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Ingår i: Exploratory Research in Clinical and Social Pharmacy. - : Elsevier. - 2667-2766. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self care is an important concept, which is increasingly being applied by policy makers on a large scale. It is associated with improved health literacy and technological advances. Community pharmacy practitioners are easily accessible for self care counselling, purchase of non-prescription products and for referrals to other healthcare providers.OBJECTIVE: To describe self care policies and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy.METHODS: A search was conducted to retrieve self care policy documents and strategies in Swedish healthcare authorities, pharmaceutical organizations and community pharmacy on respective websites, as well as personal contacts with key persons in pharmaceutical organizations and community pharmacy practice.RESULTS: A new law on self care was adopted by the Swedish Parliament becoming effective in 2023. The law defines self care as a healthcare measure that has been assessed by a treating licenced healthcare practitioner to be possible to be performed by the patient him/herself. The law includes a wide range of measures. According to a Government Commission that followed Sweden's the National Pharmaceutical Strategy's Action Plan in 2018, the Medical Products Agency (MPA) was assigned to establish requirements of qualifications in self care counselling. In its report in late 2022, the MPA stated that self care counselling by community pharmacy practitioners plays an important role in society. The new requirements are expected to become effective in mid-2023. None of the four community pharmacy chains operating 97% of Sweden's community pharmacies have developed any specific self care policies, although self care counselling and sales of non-prescription products, as well as provision of some primary healthcare services, constitute important components of their operations. Furthermore, all Swedish pharmacies offer several digital self care solutions, supporting people to manage their own health. Neither the Swedish Pharmacy Association, representing most pharmacies, nor the Swedish Pharmacists Association, the trade union, have developed any self care policies. However, the Swedish Association of the Pharmaceutical Industry is promulgating Swedish self care reform using a systematic review of self care and which medicines should be over-the-counter.CONCLUSIONS: Self care is not currently established as a core pillar of a Swedish national health strategy. There are further opportunities to enable pharmacists to fulfil their potential in supporting individual wellbeing and promoting self care interventions. A new system needs to be created which fully integrates the promotion of everyday wellbeing, self care for self-treatable conditions and the management of long-term conditions.
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| 3. |
- Aria, Danish, et al.
(författare)
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Use of an electronic expert support system in a Swedish community pharmacy to identify and resolve drug-related problems
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background The Lund Integrated MedicinesManagement model offers a systematic approach forindividualising and optimising patient drug treatment.Clinical, economical and humanistic outcomes havebeen shown as well as results from the medicationreconciliation process. There is a need also to describethe medication review process.Objective To describe the frequency and types of drug-relatedproblems (DRPs) identified during medicationreviews and to evaluate the actions of the pharmacistsand the physicians regarding the identified DRPs.Method Structured medication reviews were conductedby a multi-professionalteam on top of standard care for719 patients in two internal medicine wards in a SwedishUniversity Hospital. The medication reviews were studiedretrospectively to classify DRPs and actions taken.Results A total of 573 (80%) of patients had at leastone actual DRP; an average of three DRPs per patientand in total 2164. Wrong drug and adverse drug reactionwere the most common types of DRPs. The most frequentmedication groups involved in DRPs were drugs forthe cardiovascular system and the nervous system andthe most frequent substances were warfarin, digoxin,furosemide and paracetamol. The 10 most commonmedications accounted for 27% of the actual DRPs. Ofthe identified DRPs, a total of 1740 (80%) were actedon. The three most common types of adjustments madewere withdrawal of drug therapy, change of drug therapyand initiation of drug therapy. When the pharmacistsuggested an adjustment, the physician implemented88% (1037/1174) of the recommendations.Conclusion DRPs are common among elderly patientswho are admitted to hospital. Systematic identificationof high-riskmedications and common DRP types enablestargeting of prioritised patients for medication reviews.
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| 4. |
- Westerlund, Tommy, et al.
(författare)
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Community pharmacy and primary health care in Sweden-at a crossroads
- 2020
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Ingår i: Pharmacy Practice. - : Centro Investigaciones & Publicaciones Farmaceuticas. - 1885-642X .- 1886-3655. ; 18:2, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digiphysical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business. © 2020, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved.
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| 5. |
- Costa, Filipa A., et al.
(författare)
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Provision of pharmaceutical care by community pharmacists across Europe : Is it developing and spreading?
- 2017
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Ingår i: Journal of Evaluation In Clinical Practice. - : John Wiley & Sons. - 1356-1294 .- 1365-2753. ; 23:6, s. 1336-1347
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, Aims, and Objectives: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. Method: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. Results: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n=8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. Conclusions: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.
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| 6. |
- Westerlund, Tommy, 1952, et al.
(författare)
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Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: After re-regulation of the pharmacy market
- 2017
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Ingår i: Pharmacy Practice. - : Centro de Investigaciones y Publicaciones Farmaceuticas. - 1886-3655 .- 1885-642X. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- © 2017, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved.Background: The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs.Objective: To examine the adult general public’s views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market.Methods: A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old. Results: Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals’ recommendation. Differences in how OTCs are perceived were however found with regards to respondents’ country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash. Conclusions: The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals’ recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.
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| 7. |
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| 8. |
- Milos, Veronica, et al.
(författare)
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Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care
- 2014
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged >= 75 years and who were using a multi-dose drug dispensing system. Methods: Data were collected from the patients' electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. Results: The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. Conclusions: Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.
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| 9. |
- Milos, Veronica, et al.
(författare)
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Swedish general practitioners attitudes towards treatment guidelines a qualitative study
- 2014
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Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Drug therapy in primary care is a challenge for general practitioners (GPs) and the prescribing decision is influenced by several factors. GPs obtain drug information in different ways, from evidence-based sources, their own or others? experiences, or interactions with opinion makers, patients or colleagues. The need for objective drug information sources instead of drug industry-provided information has led to the establishment of local drug and therapeutic committees. They annually produce and implement local treatment guidelines in order to promote rational drug use. This study describes Swedish GPs? attitudes towards locally developed evidence-based treatment guidelines. Methods: Three focus group interviews were performed with a total of 17 GPs working at both public and private primary health care centres in Sk?ne in southern Sweden. Transcripts were analysed by conventional content analysis. Codes, categories and themes were derived from data during the analysis. Results: We found two main themes: GP-related influencing factors and External influencing factors. The first theme emerged when we put together four main categories: Expectations and perceptions about existing local guidelines, Knowledge about evidence-based prescribing, Trust in development of guidelines, and Beliefs about adherence to guidelines. The second theme included the categories Patient-related aspects, Drug industry-related aspects, and Health economic aspects. The time-saving aspect, trust in evidence-based market-neutral guidelines and patient safety were described as key motivating factors for adherence. Patient safety was reported to be more important than adherence to guidelines or maintaining a good patient-doctor relationship. Cost containment was perceived both as a motivating factor and a barrier for adherence to guidelines. GPs expressed concerns about difficulties with adherence to guidelines when managing patients with drugs from other prescribers. GPs experienced a lack of time to self-inform and difficulties managing direct-to-consumer drug industry information. Conclusions: Patient safety, trust in development of evidence-based recommendations, the patient-doctor encounter and cost containment were found to be key factors in GPs? prescribing. Future studies should explore the need for transparency in forming and implementing guidelines, which might potentially increase adherence to evidence-based treatment guidelines in primary care.
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| 10. |
- Bardage, Cecilia, et al.
(författare)
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Non-prescription medicines for pain and fever : A comparison of recommendations and counseling from staff in pharmacy and general sales stores
- 2013
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 110:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study is to map and analyze the content and quality of theencounter when customers buy non-prescription medicines for pain and fever.Methods: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A"Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366units were selected for each scenario. There were in total 625 observers: 208 in the childwith fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancyscenario. Data collection: 21st September to 20th November 2011.Results: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnantwoman. The staff suggested in 9% of the visits a medicine that is inappropriate in latepregnancy. The corresponding percentage in pharmacies was 1%.Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies toa feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the ageof the child.General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid productwhen an acetaminophen preparation was requested. The corresponding percentage inthe pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product.Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneityof painkillers, which lead to inappropriate recommendations.
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