| 1. |
- Bo, Karl-Erik, et al.
(författare)
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'Illuminating determinants of implementation of non-dispensing pharmacist services in home care : a qualitative interview study'
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 41:1, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesMedication errors are leading causes of hospitalization and death in western countries and WHO encourages health care providers to implement non-dispensing pharmacist services in primary care to improve medication work. However, these services struggle to provide any impact on clinical outcomes. We wanted to explore health care professionals' views on medication work to illuminate determinants of the implementation success. The research was designed to inform and adapt implementation strategies for non-dispensing pharmacist services.DesignSemi-structured interview study with nine healthcare professionals.SettingFour Norwegian home care wards.SubjectsNine healthcare professionals working at different wards within one home care unit.Main outcome measuresDeterminants of implementation outcomes.ResultsContextual determinants of the implementation process were mainly related to characteristics of the setting such as poorly designed information systems, work overload, and chaotic work environments. The identified barriers question the innovation's appropriateness related to the setting's needs but also provide possibilities for tailoring pharmacist services to local medication work issues. The observable positive effects and the perceived advantage of the pharmacist services are likely to facilitate the implementation process.ConclusionOur study provided information on contextual elements that influence the implementation process of non-dispensing pharmacist services. Awareness of these factors can help develop strategies to help the organization succeed in in achieving program outcomes.
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| 2. |
- Havnes, Kjerstin, et al.
(författare)
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Time distribution for pharmacists conducting a randomized controlled trial - An observational time and motion study
- 2021
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Ingår i: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 16:4
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionAn expected future increase in older adults will demand changes in health care delivery, making development, implementation and evaluation of new health care models essential. The rationale for political decision-making concerning the implementation and application of interventions in health care should include cost estimations, specifically those involving clinical interventions. To provide such data knowledge of time spent on the intervention is imperative. Time and motion methodology is suitable to quantify health care personnel’s time distribution.AimTo investigate the time distribution for pharmacists conducting a randomized controlled trial (RCT) implementing a clinical intervention.Materials and methodsThe setting was an RCT with a 5-step pharmacist-intervention in collaboration with the interdisciplinary team in a geriatric ward. Two pharmacists were involved in the trial during the observation period. Pharmacist activities, classified as RCT-tasks (intervention or administrative), non-RCT tasks and social/breaks, were recorded applying the Work Observation Method By Activity Timing methodology, enabling recording of predefined work tasks as well as interruptions and multitasking. One observer collected data over eight weeks.ResultsIn total, 109.1 hours were observed resulting in 110.2 hours total task time, including multitasking. RCT tasks comprised 85.4% of the total observed time, and nearly 60% of the RCT time was spent on intervention tasks. Medication reviews was the most time consuming task, accounting for 32% of the observed time. The clinical pharmacists spent 14% of the intervention time communicating verbally, mainly with patients and healthcare professionals.ConclusionDuring the RCT, the clinical pharmacists spent about half their time performing the actual intervention. Consequently, costs for providing such a clinical pharmacist service should reflect actual time spent; otherwise, we may risk overestimating theoretical costs.
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| 3. |
- Bo, Karl-Erik, et al.
(författare)
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Barriers and facilitators of pharmacists' integration in a multidisciplinary home care team : a qualitative interview study based on the normalization process theory
- 2024
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Ingår i: BMC Health Services Research. - : BioMed Central (BMC). - 1472-6963. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is a growing recognition of multidisciplinary practices as the most rational approach to providing better and more efficient healthcare services. Pharmacists are increasingly integrated into primary care teams, but there is no universal approach to implementing pharmacist services across healthcare settings. In Norway, most pharmacists work in pharmacies, with very few employed outside this traditional setting. The home care workforce is primarily made up of nurses, assistant nurses, and healthcare assistants. General practitioners (GPs) are not based in the same location as home care staff. This study utilized the Normalization Process Theory (NPT) to conduct a process evaluation of the integration of pharmacists in a Norwegian home care setting. Our aim was to identify barriers and facilitators to optimal utilization of pharmacist services within a multidisciplinary team.MethodsSemi-structured interviews (n = 9) were conducted with home care unit leaders, ward managers, registered nurses, and pharmacists in Norway, in November 2022-February 2023. Constructs from the NPT were applied to qualitative data.ResultsFindings from this study pertain to the four constructs of the NPT. Healthcare professionals struggled to conceptualize the pharmacists' competencies and there were no collectively agreed-upon objectives of the intervention. Consequently, some participants questioned the necessity of pharmacist integration. Further, participants reported conflicting preferences regarding how to best utilize medication-optimizing services in everyday work. A lack of stakeholder empowerment was reported across all participants. Moreover, home care unit leaders and managers reported being uninformed of their roles and responsibilities related to the implementation process. However, the presence of pharmacists and their services were well received in the setting. Moreover, participants reported that pharmacists' contributions positively impacted the multidisciplinary practice.ConclusionIntroducing new work methods into clinical practice is a complex task that demands expertise in implementation. Using the NTP model helped pinpoint factors that affect how pharmacists' skills are utilized in a home care setting. Insights from this study can inform the development of tailored implementation strategies to improve pharmacist integration in a multidisciplinary team.
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| 4. |
- 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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| 5. |
- Nørgaard, Lotte Stig, et al.
(författare)
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Pharmacy internship in the nordic countries - status and future
- 2019
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Ingår i: Research in Social and Administrative Pharmacy. - : Elsevier. - 1551-7411 .- 1934-8150. ; 15:12, s. E54-E54
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- This educational workshop is a reoccurring opportunity to address best practices, content, assessment methods and research projects from pharmacy internship courses in the Nordic countries, providing a collaboration platform for development. The content components will be described and discussed in terms of development, stimulation and assessment in the different settings. The objective of the workshop is to share experiences from the pharmacy internships and related courses in the Nordic countries. We also want to investigate the opportunity to develop a platform for multicenter pharmacy practice research within the Nordic countries, aiming to improve the internship in each country. A short presentation from the Nordic countries on internship experiences will be the foundation for the discussion between the workshop participants. A possible joint project about supervisors’ skills and competences will be discussed. Prior to the workshop participants are therefore kindly asked to consider how to answer (some of the questions below:1. Have you introduced any new methods for stimulating learning activities and assessment methods at the pharmacy internship course in your country?2. What are the three most successful aspects/components of the pharmacy internship run by your university e and what is the most problematic aspect/component)3. How is the pharmacy internship evaluated in your university (and why so?) e do you have ideas for changing the evaluation? What other courses (elective/obligatory) are run in your university which builds upon the pharmacy internship (might be clinical pharmacy courses, PhD-courses etc) e and which courses do you plan to run?4. What are the skills, experiences and competencies of the supervisors today e and what are the competencies needed in the future? Our discussions on this issue will take the starting point from a pre-developed questionnaire that the workshop leaders plan to distribute in all the Nordic countries. The learning outcomes for the workshop are the following:The participants will learn about pharmacy internships and related courses in the Nordic countries in terms of current and planned learning outcomes and formal and summative evaluation.The participants will discuss and potentially develop a platform for a multicenter pharmacy practice research studies within the Nordic countries (on supervisor skills and training)
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| 6. |
- Robinson, Eirin Guldsten, et al.
(författare)
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A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults.
- 2023
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Ingår i: Drugs & aging. - 1179-1969. ; 40:12, s. 1143-1155
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Tidskriftsartikel (refereegranskat)abstract
- Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes.We aimed to investigate the cost effectiveness of a medication optimization intervention compared to standard care in acutely hospitalized older adults.A cost-utility analysis including 285 adults aged ≥70 years was carried out alongside the IMMENSE study. Quality-adjusted lifeyears (QALYs) were derived using the EuroQol 5-Dimension 3-Level Health State Questionnaire (EQ-5D-3L). Patient-level data for healthcare use and costs were obtained from administrative registers, taking a healthcare perspective. The incremental cost-effectiveness ratio was estimated for a 12-month follow-up and compared to a societal willingness-to-pay range of €/QALY 27,067-81,200 (NOK 275,000-825,000). Because of a capacity issue in a primary care resulting in extended hospital stays, a subgroup analysis was carried out for non-long and long stayers with hospitalizations <14 days or ≥14 days.Mean QALYs were 0.023 [95% confidence interval [CI] 0.022-0.025] higher and mean healthcare costs were €4429 [95% CI -1101 to 11,926] higher for the intervention group in a full population analysis. This produced an incremental cost-effectiveness ratio of €192,565/QALY. For the subgroup analysis, mean QALYs were 0.067 [95% CI 0.066-0.070, n = 222] and -0.101 [95% CI -0.035 to 0.048, n = 63] for the intervention group in the non-long stayers and long stayers, respectively. Corresponding mean costs were €-824 [95% CI -3869 to 2066] and €1992 [95% CI -17,964 to 18,811], respectively. The intervention dominated standard care for the non-long stayers with a probability of cost effectiveness of 93.1-99.2% for the whole willingness-to-pay range and 67.8% at a zero willingness to pay. Hospitalizations were the main cost driver, and readmissions contributed the most to the cost difference between the groups.According to societal willingness-to-pay thresholds, the medication optimization intervention was not cost effective compared to standard care for the full population. The intervention dominated standard care for the non-long stayers, with a high probability of cost effectiveness.The IMMENSE trial was registered in ClinicalTrials.gov on 28 June, 2016 before enrolment started (NCT02816086).
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| 7. |
- Robinson, Eirin Guldsten, et al.
(författare)
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Health-related quality of life among older adults following acute hospitalization: longitudinal analysis of a randomized controlled trial
- 2024
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Ingår i: QUALITY OF LIFE RESEARCH. - 0962-9343 .- 1573-2649. ; 33, s. 2219-2233
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Tidskriftsartikel (refereegranskat)abstract
- Purpose To describe the longitudinal change of health-related quality of life (HRQoL) over 12 months from acute hospitalization in older adults >= 70 years (IMMENSE study), and associated factors, to investigate how a medication optimization intervention influenced this change. Methods The EQ-5D-3L was used at discharge and 1, 6 and 12 months after discharge during a randomized controlled trial including 285 participants. Multilevel logistic (EQ-5D-3L dimensions) and mixed model regression (EQ-5D-3L index scores, EQ-VAS) were used to explore the longitudinal change with/without the intervention, and associations with medications, comorbidities, and socioeconomic variables. Subgroup analyses were performed for non-long and long stayers with hospitalizations < or >= 14 days. Results EQ-5D-3L index scores significantly declined after 12 months (beta -0.06 [95% confidence interval (CI:) -0.10--0.02], p = 0.003). Non-long stayers showed significant improvement 1 month from discharge (beta 0.05 [0.00-0.09], p = 0.040). The number of medications and receiving home-care services were the main factors associated with reduced HRQoL. Being home-dwelling was the main factor associated with higher HRQoL. Non-long stayers of the intervention group reported significantly higher EQ-VAS than the control group (beta 4.02 [0.11-7.93], p = 0.044). Conclusion We observed no significant difference in the longitudinal change in HRQoL between the two IMMENSE study groups over 12 months after hospitalization. However, the non-long stayer subgroup analysis indicates that the intervention may have had a long-term effect on HRQoL in some of intervention patients. The number of medications and the ability to live and care for oneself should be taken into consideration when planning future patient care and health-care services.
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