| 1. |
- Frisk, Pia, et al.
(författare)
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Competence, competition and collaboration : Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research.
- 2019
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 0961-7671 .- 2042-7174. ; 27:4, s. 346-354
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Creating evidence of effectiveness is an important part of service development. In an ongoing research project Swedish community pharmacists participate in services research by recruiting patients initiated on statins to an adherence-promoting cognitive pharmaceutical service, jointly run by nurses and pharmacists.AIMS: To explore the pharmacists' experiences of providing part of the service and their views regarding future participation in practice research aiming at developing cognitive pharmaceutical services.METHODS: Focus group interviews were conducted with community pharmacists from pharmacies participating in the project. A semi-structured interview guide was developed, based on the aim and earlier research.RESULTS: The domains identified were the service itself, operative conditions, the pharmacists' role/profession and stakeholders. The research project was thought to promote the local pharmacy to customers, increase job satisfaction and contribute to service development. However, a perceived lack of competence among pharmacists affected both patient communication and project involvement. Additional resources and strengthened collaboration with other local healthcare were requested. Competition among pharmacy chains was identified as a barrier to patient-centred service provision and research.CONCLUSION: The current operative conditions in Swedish community pharmacies were perceived by pharmacists as hampering cognitive pharmaceutical services provision and research. Additional resources, improved communication skills and research competence, and increased collaboration with other healthcare and across pharmacy chains are necessary changes. A stronger patient-centred perspective among all stakeholders is required.
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| 2. |
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| 3. |
- Andersson, Marine L., et al.
(författare)
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Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX
- 2015
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Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 84:5, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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| 4. |
- Bastholm Rahmner, Pia
(författare)
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Doctors and drugs : how Swedish emergency and family physicians understand drug prescribing
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Drug prescribing is increasing, making prescribing one of the most common interventions in healthcare. The beneficial effects of drugs are manifold, but drug use also involves risks of drug-drug interaction (DDI), side effects and other drug-related problems. Despite research, a gap remains in our knowledge about the variation in physicians understanding of drug prescribing. Knowledge of how physicians think about and understand drug prescribing might make it possible to influence their behaviour, and thus improve drug treatment. Aims: The overall aim of this thesis is to explore how physicians understand drug prescribing. Two groups of physicians were studied: emergency room physicians (ERs) and general practitioners (GPs). The specific aims were to (I) identify ERs perception of possibilities and obstacles in the implementation of a computerised prescribing support system; (II) explore how ERs view their work with patient drug treatment; (III) identify ways of understanding drug prescribing among GPs; and (IV) explore GPs understandings of who bears responsibility for a patient s drug list and how this responsibility is managed. Methods: An inductive qualitative approach was used in order to gain deeper knowledge about physicians experiences. Data were collected by means of semi-structured face-toface interviews (Studies I, III-IV) and focus group discussions (Study II). Thematic (Studies I-II) and phenomenographic methods (Studies III-IV) were used in analysing data. Findings: Variations were found between ERs and GPs in their views of drug prescribing, as well as within the group of GPs. The ERs expressed a need for more pharmacological training and support in working with patients drug treatment. They wanted access to current patient drug lists in order to make the diagnosis safely and quickly. A lack of follow-up appointments forces ERs to refrain from making changes to a patient s drug regime. ERs perform their work in the here and now . The GPs demonstrated how they understood drug prescribing in five ways, each of which had different foci: the biomedical aspects, the patient and society. Each GP had access to more than one view, but none included all five ways. The GPs also demonstrated a variation in understanding about responsibility for patient drug lists, and in particular about how they use different strategies to manage this responsibility. These strategies were described in five ways: imposed responsibility; responsibility for own prescriptions; responsibility for all drugs; different but shared responsibility; and patient responsibility for transferring drug information between healthcare providers. Implications: The question of responsibility for current patient drug lists and communication between settings is of utmost importance. In Sweden, a new law was passed in 2008 allowing the sharing of patient-specific information between databases. In this thesis, we see how ERs and GPs understand the responsibility for current patient drug lists in different ways. These different ways indicate that information sharing between healthcare providers is insufficient to remove potential hazards in prescribing. In order to support physicians in moving towards a comprehensive approach to prescribing, there is a need for a parallel development in: 1) physicians competence in drug prescribing; 2) patients understandings of drug use; and 3) technological solutions to facilitate a shared understanding between different physicians and patients in drug prescribing/drug therapy.
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| 5. |
- Bastholm Rahmner, Pia, et al.
(författare)
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"Limit work to here and now" : A focus group study on how emergency physicians view their work in relation to patients' drug treatment
- 2008
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Ingår i: International Journal of Qualitative Studies on Helath and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 3:3, s. 155-164
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Tidskriftsartikel (refereegranskat)abstract
- Patients come to the emergency department (ED) with complex medication and some patients present symptoms of adverse drug effects. Drug treatment is a complex process for physicians to handle. The aim of this study was to explore how a group of ED physicians view their work in relation to patients’ drug treatment. Three semi-structured focus group discussions with 12 physicians in an ED in Sweden were conducted and analysed thematically. The core theme was ‘‘limit work to here and now’’. Three descriptive themes were identified in relation to the main theme; (1) focussing to cope with work; (2) decision making on limited patient-specific information; and (3) actively seeking learning moments. The findings show that the physicians actively seek learning moments in work. Signing their own notes in the computerized medical record is a way of getting feedback on the treatment they have initiated and it was seen as a large part of their clinical education. If we want to support the physicians with new technology for safer drug treatment, such as a computerized drug prescribing support system, the support system should be adapted to the different learning styles and needs.
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| 6. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system
- 2004
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Ingår i: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 17:4, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.
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| 7. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Physicians' reported needs of drug information at point of care in Sweden
- 2012
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley. - 0306-5251 .- 1365-2125. ; 73:1, s. 115-125
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Tidskriftsartikel (refereegranskat)abstract
- AIMS Relevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODS We recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTS Physicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONS The results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility.
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| 8. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Variations in understanding the drug-prescribing process : a qualitative study among Swedish GPs
- 2009
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 26:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
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| 9. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Whose job is it anyway? : Swedish general practitioners' perception of their responsibility for the patient's drug list.
- 2010
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Ingår i: Annals of Family Medicine. - : Annals of Family Medicine. - 1544-1709 .- 1544-1717. ; 8:1, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
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