| 1. |
- Abdulkadir, Sazan Abass, et al.
(författare)
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Potential Drug-Related Problems in Pediatric Patients-Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden
- 2023
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Ingår i: Pharmacy. - : MDPI. - 2226-4787. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.
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| 2. |
- Bergman, Frida, et al.
(författare)
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Healthcare professionals' perceptions of a web-based application for using the new National Medication List in Sweden
- 2023
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Ingår i: Digital Health. - : Sage Publications. - 2055-2076. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveDuring the first stage of implementing the National Medication List in Sweden, a web-based application called Forskrivningskollen (FK) was launched. FK includes information about a patient's prescribed and dispensed medications, and it works as a backup system until the healthcare electronic health record (EHR) systems are fully integrated. The aim of this study was to examine the healthcare professionals' experiences and perceptions of FK. MethodsThe study applied a mixed methods approach, with statistics about the use of FK and a survey with open and closed questions. The respondents (n = 288) were healthcare professionals who were users or potential users of FK. ResultsOverall there was little knowledge about FK and uncertainty regarding working routines and the regulations connected to the application. Lack of interoperability with the EHRs made FK time-consuming to use. Respondents said that the information in FK was not updated, and they were concerned that using FK could lead to a false sense of security about the accuracy of the list. Most clinical pharmacists thought FK added benefit to their clinical work, while as a group, physicians were more ambivalent about FK's benefit. ConclusionsThe concerns of healthcare professionals give important insights for future implementation of shared medication lists. Working routines and regulations linked to FK need to be clarified. In Sweden, the potential value of a national shared medication list will probably not be realized until it is fully integrated into the EHR in a way that supports healthcare professionals' desired ways of working.
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| 3. |
- Eiermann, Birgit, et al.
(författare)
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Läkemedelsinformatik
- 2021
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Ingår i: Medicinsk informatik. - Stockholm : Liber. - 9789147134083 ; , s. 245-261
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Kapitlet ger en översikt av kunskapsläget inom läkemedelsinformatik, med fokus på Sverige.
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| 4. |
- Eriksson, Pär, et al.
(författare)
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Digital consultation in primary healthcare : the effects on access, efficiency and patient safety based on provider experience; a qualitative study
- 2022
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 40:4, s. 498-506
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of the study was to explore the experiences of healthcare staff working with and being part of the implementation of a digital platform for patient-provider consultation across quality dimensions of access, efficiency, and patient safety. Design The study uses qualitative design to investigate experiences and the views of healthcare professionals. Data collection combined semi-structured individual and focus-group interviews. Content analysis was used to identify categories within the content areas 'access', 'efficiency', and 'patient safety'. Setting The basis for the study was an e-consultation platform introduced in three primary healthcare centres in the County of Kalmar in southeast Sweden in 2019. Results Healthcare staff experienced that the platform offered an open channel for communication with patients in need of frequent contact. This reduced anxiety and therefore the frequency of follow-up appointments. Healthcare staff also noted that the platform offered flexibility in contact benefitting patients with mental health problems. These patients were found to make contact through the platform after closing hours when problems were more acute or intense. However, the risk of digitally illiterate groups being excluded was also noted. Efficiency gains were identified among patients with simple cases which were handled more quickly through the platform. However, low uptake and the experience that the platform did not replace, rather was added on top of other already existing functions and procedures, negatively affected the overall efficiency. Standardized questions in automated medical history-taking contributed to patient safety. Conclusion The findings suggest that text-based e-consultation platforms may bring important quality improvements to primary healthcare service in terms of access, efficiency, and patient safety. Yet, areas where e-consultation does not contribute to quality improvements puts important quality gains at risk.
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| 5. |
- Hammar, Tora, 1984-, et al.
(författare)
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Challenges with Medication Management and the National Medication List in Sweden : An Interview Study from a Human, Organizational, and Technology Perspective
- 2023
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Ingår i: Caring is Sharing – Exploiting the Value in Data for Health and Innovation. - : IOS Press. - 9781643683881 ; , s. 287-291
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Konferensbidrag (refereegranskat)abstract
- Sweden is in the process of implementing the National Medication List (NLL). The aim of this study was to explore the challenges with the medication management process, as well as expectation for NLL, from a human, organizational, and technology perspective. This study included interviews with prescribers, nurses, pharmacists, patients, and their relatives and was conducted during March to June 2020, before the implementation of NLL. Challenges were (1) feeling lost with several different medication lists, (2) spending time searching for information, (3) being frustrated at parallel information systems, (4) patients being the carriers of information, and (5) the feeling of being responsible in an indistinct process. The expectations for NLL in Sweden were high, but there were several fears.
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| 6. |
- Hammar, Tora, 1984-, et al.
(författare)
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Current Knowledge about Providing Drug–Drug Interaction Services for Patients : A Scoping Review
- 2021
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Ingår i: Pharmacy. - : MDPI. - 2226-4787. ; 9:2
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Forskningsöversikt (refereegranskat)abstract
- Drug–drug interactions (DDIs) pose a major problem to patient safety. eHealth solutions have the potential to address this problem and generally improve medication management by providing digital services for health care professionals and patients. Clinical decision support systems (CDSS) to alert physicians or pharmacists about DDIs are common, and there is an extensive body of research about CDSS for professionals. Information about DDIs is commonly requested by patients, but little is known about providing similar support to patients. The aim of this scoping review was to explore and describe current knowledge about providing digital DDI services for patients. Using a broad search strategy and an established framework for scoping reviews, 19 papers were included. The results show that although some patients want to check for DDIs themselves, there are differences between patients, in terms of demands and ability. There are numerous DDI services available, but the existence of large variations regarding service quality implies potential safety issues. The review includes suggestions about design features but also indicates a substantial knowledge gap highlighting the need for further research about how to best design and provide digital DDI to patients without risking patient safety or having other unintended consequences.
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| 7. |
- Hammar, Tora, 1984-, et al.
(författare)
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Discrepancies in patients' medication lists from pharmacies in Sweden : an interview study before the implementation of the Swedish National Medication List
- 2023
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Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711. ; 45, s. 88-96
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Tidskriftsartikel (refereegranskat)abstract
- Background Discrepancies in medication lists are common and can contribute to drug-related problems. This study was performed before the implementation of the National Medication List in Sweden, an intervention expected to improve the accuracy of medication lists. Aim The aim of the study was to examine the number and type of discrepancies in the medication list from pharmacies in Sweden. The secondary aim was to describe the information sources Swedish patients used as their medication lists and how confident they were with the information. Method Structured interviews were conducted with patients at 13 community pharmacies in Sweden during the period October 5, 2020, to April 16, 2021. The printed medication list was reviewed together with the patient to identify any discrepancies and missing information. Results A total of 327 patients were included in the study (response rate 51%). The printed medication list from pharmacies was the most common information source for patients to know which medications to use. Two thirds (n = 215) of the patients had at least one discrepancy among their prescriptions and 32% (n = 106) were missing at least one prescription medication. Among all prescriptions (n = 2567) 10% (n = 264) were non-current prescriptions, 9% (n = 238) were duplicates and 3% (n = 88) had the wrong dose. The proportion of prescriptions with discrepancies differed between drug-groups. Conclusion The discrepancies described in this study can have serious consequences, and results provide a baseline for studies after the implementation of the National Medication List.
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| 8. |
- Hammar, Tora, 1984-
(författare)
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eMedication – improving medication management using information technology
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Medication is an essential part of health care and enables the prevention andtreatment of many conditions. However, medication errors and drug-relatedproblems (DRP) are frequent and cause suffering for patients and substantial costsfor society. eMedication, defined as information technology (IT) in themedication management process, has the potential to increase quality, efficiencyand safety but can also cause new problems and risks.In this thesis, we have studied the employment of IT in different steps of themedication management process with a focus on the user's perspective. Sweden isone of the leading countries when it comes to ePrescribing, i.e. prescriptionstransferred and stored electronically. We found that ePrescribing is well acceptedand appreciated by pharmacists (Study I) and patients (Study II), but that therewas a need for improvement in several aspects. When the pharmacy market inSweden was re-regulated, four new dispensing systems were developed andimplemented. Soon after the implementation, we found weaknesses related toreliability, functionality, and usability, which could affect patient safety (StudyIII). In the last decade, several county councils in Sweden have implementedshared medication lists within the respective region. We found that physiciansperceived that a regionally shared medication list generally was more complete butoften not accurate (Study IV). Electronic expert support (EES) is a decisionsupport system which analyses patients´ electronically-stored prescriptions in orderto detect potential DRP, i.e. drug-drug interactions, therapy duplication, highdose, and inappropriate drugs for geriatric or pediatric patients. We found thatEES detected potential DRP in most patients with multi-dose drug dispensing inSweden (Study V), and that the majority of alerts were regarded as clinicallyrelevant (Study VI).For an improved eMedication, we need a holistic approach that combinestechnology, users, and organization in implementation and evaluation. The thesissuggests a need for improved sharing of information and support for decisionmaking, coordination, and education, as well as clarification of responsibilitiesamong involved actors in order to employ appropriate IT. We suggestcollaborative strategic work and that the relevant authorities establish guidelinesand requirements for IT in the medication management process.
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| 9. |
- Hammar, Tora, 1984-
(författare)
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Förändringar i informationsrisker vid övergång från lokal till gemensam läkemedelslista
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- En viktig utgångspunkt för en säker läkemedelsanvändning är att informationen om en patients ordinationer är tillgänglig, korrekt, fullständig och aktuell. Läkemedelslistor som är gemensamma för olika vårdinstanser och aktörer anges ofta som en väg för att ge en säkrare läkemedelsanvändning, en väg som många landsting valt att gå, och en väg som planeras för Sverige nationellt. Det är oklart vilka de egentliga konsekvenserna blir av att övergå från lokal till gemensam läkemedelslista. Hur förändras informationen kring läkemedelsordinationer? Vilka informationsrisker minskar, vilka ökar och vilka risker kvarstår? Syftet med denna studie var att beskriva förändringar i informationsrisker utifrån aspekterna riktighet, tillgänglighet och konfidentialitet (1) upplevda vid övergång från lokal läkemedelslista till en landstingsgemensam läkemedelslista och (2) väntade vid framtida införande av en nationell gemensam läkemedelslista. Studien gjordes som en beskrivande kvalitativ intervjustudie utifrån läkarnas perspektiv. Semistrukturerade intervjuer genomfördes med sju läkare från fyra olika landsting som varit med om en övergång från lokal till gemensam läkemedelslista.Studien visade att övergången från lokal till gemensam läkemedelslista upplevdes förbättra patientsäkerheten genom ökad tillgänglighet och potential att ge en ökad riktighet. Överlag var listorna mer fullständiga men med en ökad mängd inaktuella läkemedel, ofta orsakad av att läkare arbetar på olika sätt med läkemedelslistan. En gemensam läkemedelslista upplevdes innebära en ökad risk att kränka patienters integritet och ökade krav på IT-säkerhet för att skydda informationens konfidentialitet. Dock upplevde läkarna att få patienter fann det besvärande utan snarare var förvånade över att läkare inte alltid haft tillgång till all information. Risker för händelser som kan skapa problem med tillgängligheten fanns både före och efter införandet av gemensam läkemedelslista. Avbrotten är enligt läkarna sällsynta, men ofta saknas reservrutiner när avbrotten inträffar. Dospatienternas läkemedelsinformation var överlag något som alla läkare tog upp som särskilt problematiskt eller riskfyllt då läkemedelslistorna i journalsystemet ofta var helt felaktiga för dospatienter och att det samtidigt inte var helt tydligt i journalsystemet om en patient var dospatient. Trots att stora delar av sjukvården inom ett landsting eller en region har en gemensam lista kvarstår problemet att listan oftast inte är gemensam med kommunen, inte är gemensam med apoteken och i de flesta fall inte utgör patientens egen källa om läkemedelsordinationer.Vid övergången till en nationell läkemedelslista kunde liknande förändringar väntas som vid övergången till gemensam läkemedelslista regionalt. En stor skillnad är att det inte är hela journalen som blir gemensam. Läkarnas behov av en nationell lista varierade, liksom deras uppfattningar om hur den bäst skulle användas och implementeras. En nationell läkemedelslista har potentialen att öka patientsäkerheten men det är viktigt att vara medveten om att en gemensam läkemedelslista inte löser alla problem, behov av läkemedelsgenomgångar och kommunikation med patient och mellan vårdgivare kvarstår. För att implementeringen av en nationell läkemedelslista ska lyckas måste man utgå från professionens behov av den nationella listan i det kliniska arbetet och utifrån dem fastställa tydliga rutiner för hur listan ska föras in och användas.
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| 10. |
- Hammar, Tora, 1984-, et al.
(författare)
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Implementation of a shared medication list : physicians’ views on availability, accuracy and confidentiality
- 2014
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Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711. ; 36:5, s. 933-942
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Tidskriftsartikel (refereegranskat)abstract
- Background Physicians, patients and others involved need to have accurate information on patients’ current drug prescriptions available, and have that information protected from unauthorized access. During the past decade, many counties in Sweden have implemented regionally shared medication lists within health care. Objective The aim of this study was to describe physicians’ views on changes in accuracy, availability and confidentiality in the transition from local medication lists to a regionally shared medication list. Setting Health care units in four different counties of Sweden after the transition from local medication lists to a regionally shared medication list. The shared medication list was an integrated part of the electronic health record system in the respective counties, but the system and implementation process varied. Methods Physicians (n = 7) with experience of transition from local medication lists to a regionally shared medication list were interviewed in a semi-structured manner. Main outcome measure: Physicians’ views on changes in information risks, focusing on accuracy, availability and confidentiality. Results The transition from local medication lists to a shared medication list increased the availability of information: from being time consuming or not possible to access from other care givers to most information being available in one place. A regionally shared medication list was perceived as having the potential to provide a greater accuracy of information, but not always: the shared medication list was perceived as more complete but with more non-current drugs. On the other hand, a shared medication list implied an increased risk of violating patient privacy, placing greater demands on IT security in order to protect the confidentiality of information. Conclusion Physicians perceived a regionally shared medication list to increase the availability of information about current prescriptions and potentially the accuracy but may decrease the confidentiality of information. To implement a shared medication list, we recommend providing clear description of responsibilities and routines for normal activities as well as back-up routines, consider IT-security and data protection early, involve patients to improve the accuracy of the list as well as to monitor and evaluate the implementation.
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