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- Ljungberg, Christina, 1978-
(författare)
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Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative. In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions. In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern. The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.
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| 2. |
- Ljungberg, Christina, 1978-, et al.
(författare)
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Primary care and hospital doctors’ experiences of prescribing information transfer using a shared electronic patient medical record system
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Rationale, aim and objective Uppsala county council has implemented a shared electronic patient medical record (e-PMR) system between primary and secondary care. Uppsala is one of the first counties in Sweden to implement such a system, and has the largest number of affiliated health care users with a shared e-PMR. The aim of this study was to investigate primary care and hospital doctors’ experiences of using the shared e-PMR, regarding information about individual patients’ drug therapies between the health care levels.Method Semi-structured focus groups were conducted. Four groups were held with hospital and four with primary care doctors. Data were analysed from an interpretivist perspective, aiming at capturing the physicians’ perspective. They were coded, categorised and similar categories grouped into themes. The constant comparative method was used; all new data were compared to earlier data and earlier analyses, and categories were formed and reformed throughout the analysis. After analysis of the data from the separate groups, a mixed focus group was held with doctors from both primary care and hospital, in which the earlier findings were discussed, to explore variations in the data. The analysis was informed by the Data-Information-Knowledge-Wisdom hierarchy, where a differentiation is made between raw facts (data) and their conversion into, for example, a useful form for a particular context (knowledge).Results The shared e-PMR was perceived as having many advantages, especially as all information was available electronically, which was convenient and time saving. The large amount of information, however, made it difficult to handle. The sought-after knowledge could be hard to retrieve in an information overload. Information about a patient’s drug therapy was not always collected in the medication list; additional information could be found in the e-PMR-notes, given by the patient or in the list of the patient’s automated medication dispensing service. Doctors did not summarize information as often, instead cross-referencing information that could be found elsewhere in the e-PMR.Conclusions The information in the e-PMR needs to be structured in a comprehensible way to facilitate reading and knowledge production. It is not just about providing information, the knowledge needs to be communicated in a good way to the next care-giver.
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| 3. |
- Ljungberg, Christina, 1978-, et al.
(författare)
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Responsibility for a patient’s drug therapy : perspectives of primary care and hospital doctors
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Health care provision is complex, with many actors, bringing difficulties in ensuring the responsibility for different health care providers is clear. Perceived lack of responsibility for a patient between primary and hospital care can lead to non-compliance with drug guidelines. The aim of this study was to investigate hospital and primary care doctors’ views of responsibility for patients’ drug therapy.Methods: Four audio-recorded focus groups were held with hospital doctors and four with primary care doctors. Fourteen hospital and 27 primary care doctors participated. The data were transcribed and analysed from an interpretivist perspective, to capture the physicians’ perspectives. Data were coded and categorised and similar categories grouped into themes. A mixed focus group was then held with 14 doctors from both primary care and hospital, who had participated in earlier focus groups. This allowed doctors from both settings to discuss the findings from the separate groups and to explore variations in the data.Results: Taking responsibility for the patient’s drug therapy was seen as being discharged when the doctors reviewed the patient’s drugs and updated the list of medications in the medical record. Nobody said they had the overall responsibility for the individual patient’s drug therapy. Secondary care doctors often only took responsibility for drugs within their own clinical area. Primary care doctors found it difficult to take overall responsibility, especially for highly specialized treatments, even though they described themselves as having a more comprehensive perspective of the patient’s drugs than the hospital doctors. Barriers to taking responsibility for both sectors included time constrains, lack of information regarding prescribing decisions by other doctors, highly specialized or expensive drugs and lack of economic incentives. Doctors from different health care levels did not routinely meet, informally or formally, and, at the time of the study, had no clear channels for communication between them. Conclusions: Taking responsibility to review the patient’s list of medications was perceived as important, but was described as difficult in daily practice.
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