| 1. |
- Berg Skoog, Jessica, et al.
(författare)
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An intervention model with self-assessment and subsequent multi-professional review might be effective and feasible to improve drug safety in primary healthcare. A survey-based evaluation of SÄKLÄK2.
- 2020
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Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley. - 1365-2753 .- 1356-1294. ; 26:1, s. 125-133
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims, and objectivesDrug‐related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi‐professional intervention model aiming at improving drug safety in primary health care. The objective of this study was to elucidate the perceptions of the participants' regarding the efficiency of the intervention and the feasibility to introduce this model widely.MethodSÄKLÄK2 is a multi‐professional intervention model in primary health care in Sweden that consisted of self‐assessment, peer‐review, written feedback, and agreements for change. Web‐based surveys were sent to both the management of participating primary health care centres (PHC) and to reviewers. The participating PHCs were fairly well‐staffed and had a high interest in improvement work. Descriptive analysis and content analysis was used.ResultsFor the PHC management, the following categories were formed: Comprehensive project, Time‐consuming, Multi‐professional character, Relevant action agreements, and Feasible to implement. For the reviewers, the following categories were formed: Multi‐professional character, Relevant action agreements, Feasible to implement, Useful self‐assessment questionnaire, and Valuable visit at the PHC. There was a high degree of consistency between the PHC management and the reviewers' answers, especially regarding the efficiency of the model to improve drug safety and the feasibility to implement it on a broad front.ConclusionSÄKLÄK2, a model with self‐assessment, peer review, written feedback, and the formation of action agreements was considered by both the participating heads of the PHC centres and the reviewers to be effective to improve drug safety in primary health care. Though time‐consuming, this multi‐professional model was considered to be feasible to implement on a broad front and might thereby be one way of working with quality improvement regarding drug safety.
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| 2. |
- Bergmark, Anders, et al.
(författare)
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Att förstå socialt arbete : om Bengt Börjeson som forskare, praktiker och debattör
- 2015
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Bengt Börjeson (1932-2012) var under nära ett halvt sekel en av de tongivande aktörerna på det sociala området i Sverige. Han stod för en radikal samhälls- och människosyn och en progressiv socialvård, för människornas skull.Den 8 november 2014 hölls ett seminarium i Stockholm med rubriken ”Att förstå socialt arbete. Ett seminarium om Bengt Börjeson som forskare, praktiker och debattör”. I seminariet medverkade en rad medarbetare till Bengt Börjeson, på olika sätt verksamma inom det sociala fältet, både tidigare och idag. Bidragen i den här rapporten bygger på ett urval av anförandena vid seminariet.
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| 3. |
- Dobszai, Annika, et al.
(författare)
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Clinical impact of medication reviews for community-dwelling patients in primary healthcare
- 2023
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Ingår i: BMC Primary Care. - 2731-4553. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent on the process. We aimed to evaluate medication reviews for community-dwelling patients regarding the clinical relevance of the pharmacists’ recommendations, and their implementation by general practitioners. We also wanted to investigate if the general practitioners’ tendency to act on drug-related problems was correlated to different factors of the process. Methods: This was a cohort study, where patients in primary healthcare considered in need of a medication review were selected. Pharmacists identified drug-related problems and gave written recommendations on how to solve the problems to the general practitioner, via the medical record, and in addition in some cases via verbal communication. The clinical relevance of the recommendations was graded according to the Hatoum scale, ranging from one (adverse significance) to six (extremely significant). Descriptive statistics were used regarding the clinical relevance and the general practitioners´ tendency to act on drug-related problems. Multiple logistic regression analysis was used to examine the association between the tendency to act and different factors of the process. Results: A total of 96.1% of the 384 assessed recommendations from the pharmacists were graded as significant or more for the patient (Hatoum grade 3 or higher). The general practitioners acted on 63.8% of the drug-related problems. Fewer recommendations per patient, as well as verbal communication in addition to written contact, significantly increased the general practitioners’ tendency to act on a drug-related problem. No significant association was seen between the tendency to act and the clinical relevance of the recommendation. Conclusions: The high proportion of clinically relevant recommendations from the pharmacists in this study strengthens medication reviews as an important tool for reducing drug-related problems. Verbal communication between the pharmacist and the general practitioner is important for measures to be taken. Multiple recommendations for the same patient reduced their likelihood to of being addressed by the general practitioner.
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| 4. |
- Karlsson, Anne-Li, et al.
(författare)
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Bet v 1 homologues in strawberry identified as IgE-binding proteins and presumptive allergens
- 2004
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Ingår i: Allergy. - : Wiley. - 1398-9995 .- 0105-4538. ; 59:12, s. 1277-1284
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Tidskriftsartikel (refereegranskat)abstract
- Background: No strawberry allergen has so far been identified and characterized. Methods: Serum samples were collected from patients with a suggestive case history of adverse reactions to strawberry and other fruits. Extracts from fresh and frozen strawberries were analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis (SDS-PAGE), Western blotting and mass spectrometry. Patient blood samples were analysed for inhibition of IgE binding and basophil degranulation. Results: Several IgE-binding proteins could be detected. In more than half of the patient sera, a 20/18-kDa doublet band was observed in Western blotting. These two bands were excised and analysed by mass spectrometry showing the presence of proteins belonging to the Bet v 1 family of allergens. Inhibition of the IgE binding to the 20/18-kDa doublet was obtained by addition of two recombinantly expressed allergens belonging to the Bet v 1 family (Bet v 1 and Mal d 1) and strawberry protein extract. In a cell-based assay of patient blood samples, basophil degranulation could be induced by strawberry protein extract and by Bet v 1 and Mal d 1. Conclusions: We conclude that strawberry homologues to Bet v 1 may be allergens of importance for adverse reactions to strawberry.
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| 5. |
- Modig, Niclas, 1973-
(författare)
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Hur kan ekonomi göras begripligt? : En studie om villkor för kraftfull ekonomiundervisning i samhällskunskap
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis seeks to understand what constitutes important economics knowledge from a disciplinary perspective and how such knowledge is recontextualized in textbooks and teacher training to become teachable to social studies students in Sweden’s upper secondary schools. It consists of four substudies: two covering disciplinary economics knowledge and two covering preservice social studies teachers. The first and second substudies focus on disciplinary economics knowledge. The first substudy, which was based on an online questionnaire for Swedish economics scholars at higher education institutions, shows that six economics terms/principles are especially important for people to understand. Such knowledge may be considered powerful economics knowledge. The second substudy demonstrates that there are great variations in the extent to which powerful economics terms appear in Swedish social studies textbooks and in how the language used shifts between everyday and scientific language. There is a risk that not all learners are given equal preconditions to develop economics knowledge through social studies textbooks. The third and fourth substudies focus on how preservice social studies teachers develop the ability to teach economic knowledge and show that students’ individual pedagogical content knowledge (PCK) depends on theoretical and practical studies. Students are unconfident about their economics knowledge, which may negatively affect their willingness and ability to teach economics when they become in-service social studies teachers.Overall, there appears to be a problem with the recontextualization of economics knowledge in Swedish social studies textbooks and with economics education for preservice social studies teachers. This may negatively affect economics education. As a result, it is important to strengthen preservice social studies teachers’ economics knowledge through increased economics content during teacher training. The importance of imparting powerful economics knowledge and shifting between everyday and scientific language in textbooks and during teaching needs to be highlighted for policymakers, textbook authors, and teacher educators.
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| 6. |
- 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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| 7. |
- Modig, Sara, et al.
(författare)
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Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units
- 2016
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 17:1, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is an urgent need to improve patient safety in the area of medication treatment among the elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the agreements for change that were established within the intervention. Methods: The SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment, peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis. Results: Strengths that were identified included a committed leadership, work methods to enhance medication safety and access to consultants. Methods for securing an accurate medication list, knowledge and methods of working of the prescriber and patient's ability to contribute to medication safety were areas that gave rise to three predesigned categories for improvement needs on a local level. Another category became apparent during the analysis; namely learning from mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further education in geriatrics and pharmacotherapy and lack of information on indication and maximum dosage. An increased number of medication reviews were among the most common agreements for change seen. Conclusions: This study identified substantial shortcomings, like poorly updated medication lists, which affected medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in other primary care units in the country. Working together multi-professionally, including performing medication reviews, could be one way of improving medication safety. On the other hand, the individual physician must possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions. Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of medication errors.
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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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