| 1. |
- Caleres, Gabriella, et al.
(författare)
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A descriptive study of pain treatment and its follow-up in primary care of elderly patients after orthopaedic care
- 2020
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Ingår i: Journal of pharmaceutical health care and sciences. - : Springer Science and Business Media LLC. - 2055-0294. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pain treatment post orthopaedic care in the elderly is complicated and requires careful follow-up. Current guidelines state all patients prescribed opioids should have a plan for gradual reduction, with the treatment progressively reduced and ended if any pain remains after more than three months. How this works in primary care remains to be explored.The aim was to describe pain treatment and its follow-up in primary care of elderly patients after orthopaedic care.Methods: In this descriptive study, medical case histories were collected for patients ≥ 75 years, which were enrolled at two rural primary care units in southern Sweden, and were discharged from orthopaedic care. Pain medication follow-up plans were noted, as well as current pain medication at discharge as well as two, six and twelve weeks later.Results: We included a total of 49 community-dwelling patients with medication aid from nurses in municipality care and nursing home residents, ≥ 75 years, discharged from orthopaedic care. The proportion of patients prescribed paracetamol increased from 28/49 (57%) prior to admission, to 38/44 (82%) after 12 weeks. The proportion of patients prescribed opioids increased from 5/49 (10%) to 18/44 (41%). Primary care pain medication follow-up plans were noted for 16/49 patients (33%).Conclusions: Many patients still used pain medication 12 weeks after discharge, and follow-up plans were quite uncommon, which may reflect upon lacking follow-up of these patients in primary care.
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| 2. |
- Caleres, Gabriella, et al.
(författare)
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Drugs, distrust and dialogue : - a focus group study with Swedish GPs on discharge summary use in primary care
- 2018
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Discharge summary with medication report effectively counteracts drug-related problems due to insufficient information transfer in care transitions. The benefits of the discharge summary may be lost if it is not adequately used, and factors affecting optimal use by the GP are of interest. Since the views of Swedish GPs are unexplored, this study aimed to explore and understand GPs experiences, perceptions and feelings regarding the use of the discharge summary with medication report.METHOD: This qualitative study was based on four focus group discussion with 18 GPs and resident physicians in family medicine which were performed in 2016 and 2017. A semi-structured interview guide was used. The interviews were transcribed verbatim and analysed using qualitative content analysis.RESULTS: The analysis resulted in three final main themes: "Importance of the discharge summary", "Role of the GP" and "Create dialogue" with six categories; "Benefits for the GP and perceived benefits for the patient", "GP use of the information", "Significance of different documents", "Spider in the web", "Terminus/End station" and "Improved information transfer in care transitions". Overall, the participants described clear benefits with the discharge summary when accurate although perceived deficiencies were also quite rife.CONCLUSION: The GPs experiences and views of the discharge summary revealed clear benefits regarding mainly medication information, awareness of any plans as well as shared knowledge with the patient. However, perceived deficiencies of the discharge summary affected its use by the GP and enhanced communication was called for.
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| 3. |
- Caleres, Gabriella, et al.
(författare)
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Elderly at risk in care transitions When discharge summaries are poorly transferred and used -a descriptive study
- 2018
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Discharge summary with medication report effectively counteracts drug-related problems among elderly patients due to insufficient information transfer in care transitions. However, this requires optimal transfer and use of the discharge summaries. This study aimed to examine information transfer with discharge summaries from hospital to primary care.METHODS: A descriptive study with data consisting of discharge summaries of 115 patients, 75 years or older, using five or more drugs, collected during one week from 28 different hospital wards in Skåne county, Sweden. Two weeks after discharge, information transfer was examined via review of primary care medical records. It was noted whether the discharge summary was received (i.e. scanned to the primary care medical records), if the medication list was updated with drug changes and if a patient chart entry regarding medication or its follow-up was made in the primary care medical records. An electronic survey, which was sent to 151 primary care units in Skåne county, was used to examine experiences of the information transfer.RESULTS: Out of 115 discharge summaries, 47 (41%) were found in the primary care medical records. Patient chart entries regarding medication or its follow-up were seen in 53 (46%) cases. Drug changes during hospitalisation were seen in 51 out of 76 patients without multidose drug dispensing. In 16 (31%) out of these cases, medication lists were updated in primary care medical records. In the electronic survey, 22 (21%) out of the 107 responding primary care units reported the discharge summary was often received on the day of discharge, while 71 (66%) respondents indicated the discharge summary was always/often received but later. Medication list updates and patient chart entries in the primary care medical records were always/often done upon receipt of the discharge summary according to 61 (57%) respondents.CONCLUSION: The transfer of information was often deficient and the discharge summaries were insufficiently used. Many discharge summaries were lost, an insufficient proportion of medication lists were updated and patient chart entries were often lacking. These findings may increase the risk of medication errors and drug-related problems for elderly in care transitions.
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| 4. |
- Caleres, Gabriella
(författare)
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Information transfer and medication safety for elderly patients in care transitions
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Accurate discharge summaries counteract drug-related problems due to insufficient information transfer in care transitions, but require optimal transfer and use. Careful follow-up is often essential after hospital discharge, for example when it comes to pain management in elderly patients; a common and challenging task in primary care. Aims: To assess the transfer and use of the discharge summary for elderly patients, including the experiences and perceptions of the GPs, and to examine the presence of any discharge summary medication discrepancies and associated risk factors. In addition, to examine a common medication situation i.e. pain medication, and its follow-up in primary care after hospital discharge. Methods: Data on pain medication and any follow-up plans were collected from electronic medical records, nurses in municipality care and the multidose drug system. Community-dwelling patients with medication aid from nurses in municipality care and nursing home residents > 75 years discharged from orthopaedic care were included (paper I). Data on discharge summary medication discrepancies and related factors as well as transfer rate and the use of the discharge summary were collected from electronic medical records for patients > 75 years with > five drugs (paper II and IV). Primary care experiences of the information transfer were examined by using an electronic survey (paper II), and the views and perceptions of the GPs were further investigated by focus group discussions and analysed with qualitative content analysis (paper III). Results: The proportion of patients prescribed paracetamol and opioids increased significantly from prior to admission to after 12 weeks, and primary care pain medication follow-up plans were not very common (paper I). Transfer to primary care was noted for less than half of the discharge summaries, and one-third of the respondents of the electronic survey noted that the discharge summary was never/seldom received. Patient chart entries regarding medication or its follow-up were noted for less than half of the patients and medication lists were updated for one-third of the patients with drug changes during hospitalization, while noted as being performed to a higher extent by the survey respondents (paper II). Three final overall themes appeared: “Importance of the discharge summary”, “Role of the GP” and “Create dialogue”. The GPs viewed the discharge summary to be of considerable advantage when it was accurate, particularly regarding medication information, but also expressed great distrust due to lacking quality (paper III). Medication discrepancies were noted in more than one-third of the discharge summaries. The most common discrepancy type was unintentional addition of drug, and central nervous system drugs/analgesics were most commonly affected. Main risk factors for the presence of discrepancies were multidose drug dispensing and increasing number of drugs in the discharge summary, while an increasing number of drug changes reduced the likelihood of a discrepancy (paper IV). Conclusions: Information transfer shortcomings in the quality, transfer and use of the discharge summary were common. While accurate medication information was much appreciated by the GPs, deficits were rife and the discharge summary was often perceived to be of poor quality, which may affect its use. Overall, improving information transfer and follow-up may help increase medication safety for elderly patients in care transitions.
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| 5. |
- Caleres, Gabriella, et al.
(författare)
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Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs
- 2020
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Ingår i: Drugs - Real World Outcomes. - : Springer Science and Business Media LLC. - 2199-1154 .- 2198-9788. ; 7:1, s. 53-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE: Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients.METHODS: Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient- and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed.RESULTS: Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76-0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48-4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05-1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55-5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88-0.99).CONCLUSIONS: Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.
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| 6. |
- Chaudhri, Kanika, et al.
(författare)
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Does Collaboration between General Practitioners and Pharmacists Improve Risk Factors for Cardiovascular Disease and Diabetes? A Systematic Review and Meta-Analysis
- 2023
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Ingår i: Global heart. - : Ubiquity Press, Ltd.. - 2211-8179 .- 2211-8160. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess whether inter-professional, bidirectional collaboration between general practitioners (GPs) and pharmacists has an impact on improving cardiovascular risk outcomes among patients in the primary care setting. It also aimed to understand the different types of collaborative care models used. Study design: Systematic review and Hartung-Knapp-Sidik-Jonkman random effects meta-analyses of randomised control trials (RCTs) in inter-professional bidirectional collaboration between GP and pharmacists assessing a change of patient cardiovascular risk in the primary care setting. Data sources: MEDLINE, EMBASE, Cochrane, CINAHL and International Pharmaceutical Abstracts, scanned reference lists of relevant studies, hand searched key journals and key papers until August 2021. Data synthesis: Twenty-eight RCTs were identified. Collaboration was associated with significant reductions in systolic and diastolic blood pressure (23 studies, 5,620 participants) of -6.42 mmHg (95% confidence interval (95%CI) -7.99 to -4.84) and -2.33 mmHg (95%CI -3.76 to -0.91), respectively. Changes in other cardiovascular risk factors included total cholesterol (6 studies, 1,917 participants) -0.26 mmol/L (95%CI -0.49 to -0.03); low-density lipoprotein (8 studies, 1,817 participants) -0.16 mmol/L (95%CI -0.63 to 0.32); high-density lipoprotein (7 studies, 1,525 participants) 0.02 mmol/L (95%CI -0.02 to 0.07). Reduction in haemoglobin A1c (HbA1C) (10 studies, 2,025 participants), body mass index (8 studies, 1,708 participants) and smoking cessation (1 study, 132 participants) was observed with GP-pharmacist collaboration. Meta-analysis was not conducted for these changes. Various models of collaborative care included verbal communication (via phone calls or face to face), and written communication (emails, letters). We found that co-location was associated with positive changes in cardiovascular risk factors. Conclusion: Although it is clear that collaborative care is ideal compared to usual care, greater details in the description of the collaborative model of care in studies is required for a core comprehensive evaluation of the different models of collaboration.
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| 7. |
- Modig, Sara, et al.
(författare)
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Assessment of medication discrepancies with point prevalence measurement : how accurate are the medication lists for Swedish patients?
- 2022
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Ingår i: Drugs and Therapy Perspectives. - : Springer Science and Business Media LLC. - 1172-0360 .- 1179-1977. ; 38:4, s. 185-193
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Tidskriftsartikel (refereegranskat)abstract
- Background: Medication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements. Methods: Participants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used. Results: In total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029). Conclusion: Medication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.
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| 8. |
- Wickman, Katarina, et al.
(författare)
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Pharmacist-led medication reviews in Primary Healthcare for adult community-dwelling patients – a descriptive study charting a new target group.
- 2022
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Ingår i: BMC Primary Care. - : Springer Science and Business Media LLC. - 2731-4553.
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMedication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne county, Sweden, a well-established multi-professional model for MRs in nursing homes is practiced. However, a demand for MRs regarding community-dwelling patients has emerged. These patients may be extra vulnerable since they have less supervision from healthcare personnel.AIM: To describe the community-dwelling patients in primary healthcare considered in need of an MR, as well as the outcomes of these pharmacist-led MRs.MethodsPersonnel from 14 primary healthcare centers selected patients for the MRs. Based on electronic medical records, the symptom assessment tool PHASE-20 (PHArmacotherapeutical Symptom Evaluation 20 questions) and medication lists, pharmacists conducted MRs and communicated adjustment suggestions via the medical record to the general practitioners (GPs).ResultsA total of 109 patients were included in the study and 90.8% (n = 99) of the patients were exposed to at least one DRP, with an average of 3.9 DRPs per patient. Patients with impaired renal function (glomerular filtration rate, GFR ConclusionsOur results indicate a prioritized need for MRs for community-dwelling patients, specifically with impaired renal function or polypharmacy.
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