| 1. |
- Blondal, Anna Bryndis, et al.
(författare)
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General practitioners' perceptions of the current status and pharmacists' contribution to primary care in Iceland.
- 2017
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 39:4, s. 945-952
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Tidskriftsartikel (refereegranskat)abstract
- Background For the past several years pharmacists' responsibilities have expanded globally from traditional tasks of dispensing medications to collaborating with other health care professionals in patient care. Similar developments have not occurred in outpatient settings in Iceland. Objective The aim of this study was to explore Icelandic general practitioners' views on the current status of primary care, their perceptions of pharmacists as a health care profession, and their attitudes towards future GP-pharmacist collaboration in primary care in Iceland. Setting Twelve primary care clinics in Iceland. Methods Semi-structured in-depth interviews were conducted with general practitioners from different primary care clinics in Iceland. A purposive and snowball sampling technique was used to select participants. All interviews were recorded and transcribed verbatim. The transcripts were categorized by themes and then analyzed using conventional content analysis. Main outcome measure General practitioners' attitudes towards pharmacists. Results Twenty general practitioners from twelve different primary care clinics in Iceland were interviewed. There are several unmet needs regarding medicines and patient monitoring in the Icelandic health care system. General practitioners suggested ways in which these gaps may be addressed and pharmacist-led clinical service was one of the suggestions. Currently, their communication with pharmacists in the primary sector solely surrounds practical non-clinical issues. Due to increasing polypharmacy and multimorbidity, they suggested that pharmacists should be more involved in patient care. Conclusions General practitioners believe that pharmacist-led clinical service can increase the quality of patient therapy. To improve communication between these health care providers, pharmacists must also re-professionalize (strengthening the profession´s status through new responsibilities and tasks), not having a conflict of interest and showing that they have expertise in patient care.
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| 2. |
- Blondal, Anna Bryndis, et al.
(författare)
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Introducing Pharmaceutical Care to Primary Care in Iceland-An Action Research Study.
- 2017
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Ingår i: Pharmacy. - : MDPI AG. - 2226-4787. ; 5:2
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Tidskriftsartikel (refereegranskat)abstract
- Even though pharmaceutical care is not a new concept in pharmacy, its introduction and development has proved to be challenging. In Iceland, general practitioners are not familiar with pharmaceutical care and additionally no such service is offered in pharmacies or primary care settings. Introducing pharmaceutical care in primary care in Iceland is making great efforts to follow other countries, which are bringing the pharmacist more into patient care. General practitioners are key stakeholders in this endeavor. The aim of this study was to introduce pharmacist-led pharmaceutical care into primary care clinics in Iceland in collaboration with general practitioners by presenting different setting structures. Action research provided the framework for this research. Data was collected from pharmaceutical care interventions, whereby the pharmaceutical care practitioner ensures that each of a patient's medications is assessed to determine if it is appropriate, effective, safe, and that the patient can take medicine as expected. Sources of data included pharmaceutical care notes on patients, researcher's notes, meetings, and interviews with general practitioners over the period of the study. The study ran from September 2013 to October 2015. Three separate semi-structured in-depth interviews were conducted with five general practitioners from one primary health care clinic in Iceland at different time points throughout the study. Pharmaceutical care was provided to elderly patients (n = 125) before and between general practitioners' interviews. The study setting was a primary care clinic in the Reykjavik area and the patients' homes. Results showed that the GPs' knowledge about pharmacist competencies as healthcare providers and their potential in patient care increased. GPs would now like to have access to a pharmacist on a daily basis. Direct contact between the pharmacist and GPs is better when working in the same physical space. Pharmacist's access to medical records is necessary for optimal service. Pharmacist-led clinical service was deemed most needed in dose dispensing polypharmacy patients. This research indicated that it was essential to introduce Icelandic GPs to the potential contribution of pharmacists in patient care and that action research was a useful methodology to promote and develop a relationship between those two health care providers in primary care in Iceland.
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| 3. |
- 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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| 4. |
- Cantarero-Arevalo, Lourdes, et al.
(författare)
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A Qualitative Analysis of the Culture of Antibiotic Use for Upper Respiratory Tract Infections Among Patients in Northwest Russia
- 2022
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Ingår i: Frontiers in Pharmacology. - : Frontiers Media S.A.. - 1663-9812. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Due to the globally persistent threat of Antimicrobial Resistance (AMR), the purpose of this study was to gain an in-depth understanding of the antibiotic (AB) practices, knowledge and attitudes among patients residing in five regions in the northwest part of Russia. Given the high prevalence, this study focused on ABs for Upper Respiratory Tract Infections (URTI).Methods: The qualitative, semi-structured interviews followed a guide organized by major themes such as common symptoms, consultations with doctors and external influences in decision-making. Patient participants were recruited via convenience sampling. Fifty-five interviews were conducted among patients using ABs for URTIs purchased with or without prescription. Data was analyzed using a direct content analysis and validation rounds were conducted between interviewers and data analyzers.Results: Self-medication with ABs seemed a common practice across all five Russian regions; in some cases, patients tried to persuade pharmacists into selling them ABs without prescription. Factors, such as time spent going to the doctor, need of a sick leave or self-persuasion, influenced the decisions of whether or not to seek the doctor for symptoms of URTIs. Knowledge of ABs and AMR was generally low; however, some patients with seemingly good knowledge practiced self-medication from time to time. Family members and friends were often involved in decisions about how to handle symptoms of URTIs, especially among those patients using ABs without prescription. Few patients had noticed ABs awareness campaigns, and very few reported having learned something important from them.Conclusion: Despite enforced regulation of AB use in Russia, self-medication still exists. Knowledge is not always linked to appropriate use of AB, and the few campaigns conducted were not always noticed.
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| 5. |
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| 6. |
- Druedahl, Louise C., et al.
(författare)
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Evolving Biosimilar Clinical Requirements : A Qualitative Interview Study with Industry Experts and European National Medicines Agency Regulators
- 2021
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Ingår i: BioDrugs. - : ADIS INT LTD. - 1173-8804 .- 1179-190X. ; 35:3, s. 351-361
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Tidskriftsartikel (refereegranskat)abstract
- Background A biosimilar is a biological medicine highly similar to another already approved biological medicine (reference product). The availability of biosimilars promotes competition and subsequently lower prices. Changing the current biosimilar clinical comparability trial requirements may lead to lower biosimilar development costs that potentially could increase patients' access to biologics. Objective The aim was to determine the perceptions of industry and medicines agency regulators regarding the value, necessity, and future developments of the European biosimilar clinical comparability trial requirements for establishing biosimilarity. Methods Semi-structured interviews were conducted with eight European national medicines agency regulators and 17 pharmaceutical company employees or consultants with experience in biologics between September 2018 and August 2019. Data were subjected to content analysis. Results In general, the participants expected that clinical comparability trial requirements will continue to be reduced, in particular based on advancements in analytical testing and knowledge generated from prior biosimilar approvals. However, there are also competing issues at play, such as competition, physician's trust, and ethical considerations. Participants also reported that any new initiative to reduce or waive biosimilar clinical requirements needs to be scientifically sound and could potentially lower biosimilar development costs. Conclusion The main findings are that biosimilar clinical comparability trial requirements are likely to change in the near future. Clarity is needed on how to ensure adequate correlation between physicochemical data, pharmacokinetic/pharmacodynamic studies, and the drugs' performance in the clinic, as well as how to continue sufficient immunogenicity assessment. Obtaining this clarity can facilitate regulatory assessment of the next biosimilars.
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| 7. |
- Druedahl, Louise C., et al.
(författare)
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Interchangeability of biosimilars : A study of expert views and visions regarding the science and substitution
- 2022
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Healthcare systems have reached a critical point regarding the question of whether biosimilar substitution should become common practice. To move the discussion forward, the study objective was to investigate the views of experts from medicines agencies and the pharmaceutical industry on the science underpinning interchangeability of biosimilars. We conducted an empirical qualitative study using semi-structured interviews informed by a cross-disciplinary approach encompassing regulatory science, law, and pharmaceutical policy. In total 25 individuals with experience within biologics participated during September 2018-August 2019. Eight participants were EU national medicines authority regulators, and 17 had pharmaceutical industry background: five from two originator-only companies, four from two companies with both biosimilar and originator products, and eight from seven biosimilar-only companies. Two analysts independently conducted inductive content analysis, resulting in data-driven themes capturing the meaning of the data. The participants reported that interchangeability was more than a scientific question of likeness between biosimilar and reference products: it also pertained to regulatory practices and trust. Participants were overall confident in the science behind exchanging biosimilar products for the reference products via switching, i.e., with physician involvement. However, their opinions differed regarding the scientific risk associated with biosimilar substitution, i.e., without physician involvement. Almost all participants saw no need for additional scientific data to support substitution. Moreover, the participants did not believe that switching studies, as required in the US, were appropriate for obtaining scientific certainty due to their small size. It is unclear why biosimilar switching is viewed as scientifically safer than substitution; therefore, we expect greater policy debate on biosimilar substitution in the near future. We urge European and UK policymakers and regulators to clarify their visions for biosimilar substitution; the positions of these two frontrunners are likely to influence other jurisdictions on the future of biosimilar use.
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| 8. |
- Jacobsen, Ramune, et al.
(författare)
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Online and Blended Learning Courses for Healthcare Professionals and Policymakers on Patients' Perspectives on Medicine : A Project Report.
- 2022
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Ingår i: Pharmacy. - : MDPI AG. - 2226-4787. ; 10:2
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Tidskriftsartikel (refereegranskat)abstract
- In order for healthcare professionals to better engage with patients, they need to understand and integrate the perspectives of patients into their daily work. In this project, we developed two courses for healthcare professionals on patients' perspectives on medicine. One course was an online course that introduced the patients' perspectives on medicine and explained its importance for healthcare and health policy. The second course was a blended learning course, consisting of online modules and face-to-face webinars, which specified how to explore patients' perspectives in qualitative interviews, and how to develop implementation plans. Patients participated in the development, execution, and evaluation of both courses. Overall, more than 2000 healthcare professionals enrolled in the first course and, in just over a year, 191 participants completed the online course; 57 healthcare professionals registered in the second blended learning course and six participants completed both components of the course. The relevance of knowledge gained was positively evaluated. Participants especially appreciated the participation of patients. Based on the feedback, the second blended learning course was adapted to run online and both courses continue to be freely available to all interested healthcare professionals on the Coursera platform.
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| 9. |
- Kaae, Susanne, et al.
(författare)
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Patients', Pharmacy Staff Members', and Pharmacy Researchers' Perceptions of Central Elements in Prescription Encounters at the Pharmacy Counter.
- 2019
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Ingår i: Pharmacy. - : MDPI AG. - 2226-4787. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies suggest that the way pharmacy counselling takes place does not fully support patients in obtaining optimal medicine use. To understand the basis of current challenges in pharmacy counselling, we investigated which selected related cues, i.e., objects, sounds, or circumstances in prescription encounters, patients, and pharmacy staff notice, and how they interpret these cues. Pharmacy practice researchers' cue orientation was also investigated to explore possible differences to those of staff and patients. Methods: Twelve focus group interviews representing 5 community pharmacies (staff and patients) and 2 universities (researchers) were conducted during 2017-2018 in Denmark. A total of 20 patients, 22 pharmacy staff, and 6 pharmacy researchers participated. A theoretical analysis based on cue orientation and social appraisal was conducted. Results: Pharmacy staff, patients and researchers noticed different selected related cues in prescription encounters. Staff particularly noticed 'types of patients'. Patients were more divided and grouped into three overall categories: 'types of staff', medical content, and the situation around the encounter. Pharmacy researchers noticed multiple cues. Different emotions were integrated in the construction of the cues. Conclusion: Differences in the cue orientation between all three groups were identified. The identified types of cues and emotions can explain an underlying dissatisfaction with the encounters. Patients lack, in particular, more personal contact. Staff need to consider these aspects to provide relevant counselling.
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| 10. |
- Wilking, Nils, et al.
(författare)
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Drug utilization research in the area of cancer drugs
- 2016
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Ingår i: Drug Utilization Research: Methods and Applications. - 9781118949788 ; , s. 315-327
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Bokkapitel (refereegranskat)abstract
- Increased biological understanding of cancer diseases has resulted in a paradigm shift in the medical treatment of cancer. Despite encouraging advances, most cancer types are still incurable and cancer is the second most common cause of death in developed countries.The high price of cancer drugs is a major challenge to equal access and puts heavy strains on public health care payers. After sharp increases in the 2000s, total expenditures on cancer drugs have levelled off due to patent expiration of many expensive and widely used drugs.Cancer drug utilization studies cover a great variety of topics. Four main research areas are patient adherence, physician adherence to guidelines, effectiveness and safety (outcomes research) and access (market uptake).Most cancer drugs are classified under Anatomical Therapeutic Chemical (ATC) group L. The use of defined daily dose (DDD) as a measurement unit is feasible for oral cancer drugs. As most cancer drugs are administered as infusions or injections at hospitals, usage is commonly measured in milligrams.Drug utilization research in the area of cancer is faced with a lack of data. Comparisons are challenging, as prices and population bases vary across regions. The linkage of registries and health care databases that include cancer drug usage will create improved opportunities in the future.
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