| 1. |
- Aria, Danish, et al.
(författare)
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Use of an electronic expert support system in a Swedish community pharmacy to identify and resolve drug-related problems
- 2020
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background The Lund Integrated MedicinesManagement model offers a systematic approach forindividualising and optimising patient drug treatment.Clinical, economical and humanistic outcomes havebeen shown as well as results from the medicationreconciliation process. There is a need also to describethe medication review process.Objective To describe the frequency and types of drug-relatedproblems (DRPs) identified during medicationreviews and to evaluate the actions of the pharmacistsand the physicians regarding the identified DRPs.Method Structured medication reviews were conductedby a multi-professionalteam on top of standard care for719 patients in two internal medicine wards in a SwedishUniversity Hospital. The medication reviews were studiedretrospectively to classify DRPs and actions taken.Results A total of 573 (80%) of patients had at leastone actual DRP; an average of three DRPs per patientand in total 2164. Wrong drug and adverse drug reactionwere the most common types of DRPs. The most frequentmedication groups involved in DRPs were drugs forthe cardiovascular system and the nervous system andthe most frequent substances were warfarin, digoxin,furosemide and paracetamol. The 10 most commonmedications accounted for 27% of the actual DRPs. Ofthe identified DRPs, a total of 1740 (80%) were actedon. The three most common types of adjustments madewere withdrawal of drug therapy, change of drug therapyand initiation of drug therapy. When the pharmacistsuggested an adjustment, the physician implemented88% (1037/1174) of the recommendations.Conclusion DRPs are common among elderly patientswho are admitted to hospital. Systematic identificationof high-riskmedications and common DRP types enablestargeting of prioritised patients for medication reviews.
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| 2. |
- Hellström, Lina, 1975-
(författare)
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Clinical pharmacy services within a multiprofessional healthcare team
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.
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| 3. |
- Milos, Veronica, et al.
(författare)
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Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study
- 2013
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Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 30:4, s. 235-246
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Tidskriftsartikel (refereegranskat)abstract
- Background Polypharmacy in the Swedish elderly population is currently a prioritised area of research Objective This study aimed to assess a structured model for pharmacist-led medication reviews in Methods This study was a randomised controlled clinical trial performed in a group of patients aged >= Results A total of 369 patients were included: 182 in the intervention group and 187 in the control Conclusions Medication reviews involving pharmacists in primary health care appear to be a feasible
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| 4. |
- Westerlund, Michael, et al.
(författare)
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Medicine-taking behaviour and drug-related problems in adolescents of a Swedish high school
- 2008
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Ingår i: Pharmacy World & Science. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 30:3, s. 243-50
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To examine (1) which over-the-counter (OTC) and prescription drugs adolescents most frequently use and for which ailments or diseases, and (2) which DRPs adolescents have experienced, as well as if and by whom these roblems were resolved. Setting: A high school in Helsingborg, Sweden. Methods: A self-completion questionnaire was designed and used in students with a median age of 17 in late 2005 and early 2006. To enable students to identify DRPs they may have experienced, the questionnaire contained a list of DRPs in lay language. The questionnaires were distributed by the teachers to be completed by the students in the classroom. Main outcome measures: Self-reported prevalence of OTC and prescription drug use and experienced drug-related problems. Results: A total of 245 students (99%) took part, 138 females and 107 males. OTCs had been used occasionally by 37.7% of the girls and 62.6% of the boys, while 10.9% and 6.5% respectively were daily users. Analgesics were the most frequently used OTCs. DRPs had been experienced by 31.1% of the female and 19.6% of the male students, the most common of which was therapy failure (too little or no effect), accounting for 46.5% of the girls’ and 38.1% of the boys’ OTC DRPs. Eighty-five percent of the problems with OTCs had been resolved, half of them by the teenagers themselves. Prescription drugs had been used occasionally by 31.9% of the female and 29.0% of the male students, while 28.3% and 26.2% respectively reported using such drugs on a daily basis. Antibiotics were the most frequently taken prescription drugs. DRPs related to prescribed drugs were reported by 32.6% of the girls and 10.3% of the boys. The most common DRPs were side effects, accounting for 34.8% of the girls’ problems, and therapy failure, experienced by 28.6% of the boys. All the boys’ DRPs were reported to be resolved, but only 75% of those of the girls. Physicians were stated to have resolved the problems in 41.4% of the cases. Conclusions: There is a need to develop the interface between pharmacy practitioners and adolescents, as the study has demonstrated frequent use of OTCs and prescription drugs as well as a high prevalence of DRPs in adolescents. The reasons for therapy failure, which was the most common problem, should be further explored and measures taken by pharmacists and physicians to minimise it.
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| 5. |
- Ax, F, et al.
(författare)
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Pharmacy counselling models: a means to improve drug use.
- 2010
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Ingår i: Journal of clinical pharmacy and therapeutics. - : Hindawi Limited. - 1365-2710 .- 0269-4727. ; 35:4, s. 439-451
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND OBJECTIVE: Failure to achieve the intended benefit of medical treatment is recognized as an immense problem. The study objective was to examine the usefulness of counselling models containing key questions to facilitate the identification of drug-related problems (DRPs), and to follow up on both pharmacy practitioner and patient experiences. METHODS: Fifty-one pharmacies in Sweden were recruited, along with matching controls. Patients of six therapeutic groups were selected for the counselling model intervention. DRPs were documented in the Swedish DRP database. A telephone follow-up with the patients and a questionnaire survey with the pharmacy practitioners were conducted. An additional follow-up was made in patients sending a representative to pick up their prescribed medications at the pharmacy. RESULTS AND DISCUSSION: In all, 880 DRPs were documented in patients with 8100 prescriptions (10·9%). The DRP documentation rates in study pharmacies were, in general, superior to the control pharmacy rates. DRPs were identified in 24·8% of the non-steroidal anti-inflammation drug (NSAID) patients using a representative to pick up their medications, compared with 9·2% in patients visiting the pharmacy themselves. Of the patients who took part in the follow-up, 94% said that they received suggestions on problem resolution, and twice as many DRPs were reported resolved vs. unresolved. Most patients and pharmacy practitioners were pleased with the new practice. CONCLUSION: The practice of counselling models appears to be a means to improve drug use. More DRPs were found in patients sending a representative to pick up their medications than in patients visiting the pharmacy themselves.
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| 6. |
- Bardage, Cecilia, et al.
(författare)
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Non-prescription medicines for pain and fever : A comparison of recommendations and counseling from staff in pharmacy and general sales stores
- 2013
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510 .- 1872-6054. ; 110:1, s. 76-83
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The purpose of this study is to map and analyze the content and quality of theencounter when customers buy non-prescription medicines for pain and fever.Methods: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A"Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366units were selected for each scenario. There were in total 625 observers: 208 in the childwith fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancyscenario. Data collection: 21st September to 20th November 2011.Results: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnantwoman. The staff suggested in 9% of the visits a medicine that is inappropriate in latepregnancy. The corresponding percentage in pharmacies was 1%.Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies toa feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the ageof the child.General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid productwhen an acetaminophen preparation was requested. The corresponding percentage inthe pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product.Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneityof painkillers, which lead to inappropriate recommendations.
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| 7. |
- Costa, Filipa A., et al.
(författare)
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Provision of pharmaceutical care by community pharmacists across Europe : Is it developing and spreading?
- 2017
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Ingår i: Journal of Evaluation In Clinical Practice. - : John Wiley & Sons. - 1356-1294 .- 1365-2753. ; 23:6, s. 1336-1347
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, Aims, and Objectives: Pharmaceutical care involves patient-centred pharmacist activity to improve medicines management by patients. The implementation of this service in a comprehensive manner, however, requires considerable organisation and effort, and indeed, it is often not fully implemented in care settings. The main objective was to assess how pharmaceutical care provision within community pharmacy has evolved over time in Europe. Method: A cross-sectional questionnaire-based survey of community pharmacies, using a modified version of the Behavioural Pharmaceutical Care Scale (BPCS) was conducted in late 2012/early 2013 within 16 European countries and compared with an earlier assessment conducted in 2006. Results: The provision of comprehensive pharmaceutical care has slightly improved in all European countries that participated in both editions of this survey (n=8) with progress being made particularly in Denmark and Switzerland. Moreover, there was a wider country uptake, indicating spread of the concept. However, due to a number of limitations, the results should be interpreted with caution. Using combined data from participating countries, the provision of pharmaceutical care was positively correlated with the participation of the community pharmacists in patient-centred activities, routine use of pharmacy software with access to clinical data, participation in multidisciplinary team meetings, and having specialized education. Conclusions: The present study demonstrated a slight evolution in self-reported provision of pharmaceutical care by community pharmacists across Europe, as measured by the BPCS. The slow progress suggests a range of barriers, which are preventing pharmacists moving beyond traditional roles. Support from professional bodies and more patient-centred community pharmacy contracts, including remuneration for pharmaceutical care services, are likely to be required if quicker progress is to be made in the future.
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| 8. |
- Ellitt, Glena R, et al.
(författare)
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Drug related problems after discharge from an Australian teaching hospital.
- 2010
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Ingår i: Pharmacy world & science : PWS. - : Springer Science and Business Media LLC. - 1573-739X .- 0928-1231. ; 32:5, s. 622-30
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Tidskriftsartikel (refereegranskat)abstract
- Abstract OBJECTIVE: To reconcile patients' medicines and to classify drug related problems identified during medication review conducted after discharge from hospital. SETTING: Patients were discharged from the cardiology unit of Westmead Hospital after recruitment into the Westmead Medicines Project which ran from 2004 to 2007. METHOD: This retrospective study involved an analysis of drugs, diseases and drug related problems in medication review reports available for 76 out of 85 patients who received a Home Medicines Review (HMR). Data sources for medication reconciliation and analyses also included hospital discharge summaries (n = 70) and GP referrals for HMR (n = 44). Comprehensive clinical profiles were constructed for the 76 subjects whose drug related problems were identified, coded, and then classified from their HMR reports. MAIN OUTCOME MEASURES: Number, type, distribution and international classification of drugs, diseases and drug-related problems. RESULTS: Patients were prescribed drugs for a broad range of cardiovascular, circulatory, endocrine, respiratory and digestive system diseases. Mean number of drugs per patient in discharge summaries: 8.7 ± SD 3.3 (range 3-19); in GP referrals: 8.9 ± SD 4.3 (range 2-23); and in HMR reports: 10.8 ± SD 4.0 (range 3-24). Mean number of diseases per patient in discharge summaries: 4.1 ± SD 2.9 (range 1-11); and in HMR reports: 4.7 ± SD 2.6 (range 1-12). A total of 398 drug related problems were identified for 71 (93.3%) patients with mean 5.6 ± SD 4.3 problems (range 1-21). The most frequently recorded problems were the patients' uncertainty about drug aim: n = 128 (32.0%); potential interactions n = 89 (22.4%); and adverse reactions n = 60 (15.1%). CONCLUSION: This study showed that patients recently discharged from a tertiary care hospital had a significant number of drug related problems. Classification of drugs and diseases revealed a broad range of non-cardiovascular medicines and conditions in the patients from an acute care cardiology unit. We found that home medicines review provided continuity of care and an opportunity for medication reconciliation which revealed marked differences in number of drugs, between hospital discharge and medicines review. The patients' uncertainly about their drugs and their diverse range of co-morbidities indicated the need for timely counselling by pharmacists in the community.
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| 9. |
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| 10. |
- 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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