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- 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. |
- Berg Skoog, Jessica
(författare)
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Analysis of factors of importance for drug use
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: There are differences in drug use depending on non-medical factors such as age, gender and socioeconomic status. The combined effect of these factors, with adjustment for multimorbidity, is highly relevant to study to ensure equality in drug use. Objectives: 1. To examine drug use related to age, gender, income and education after adjustment for multimorbidity, in an entire adult population and in a population where prescription drugs were issued only by general practitioners. 2. To analyse if gender-related morbidity explains the differences in drug use. 3. To examine to what extent the elderly may lack indication for treatment. Methods: Register-based methods were applied in all papers, using data from Östergötland County. To estimate multimorbidity the ACG-Case Mix was used in all papers. Drug use depending on age, gender, income- and educational level, after adjustment for multimorbidity, was analysed in the entire adult population in Paper I, and in the primary healthcare population in Paper III. In Paper II diseases tending to afflict females more frequently were identified, together with the prescription drugs used to treat these diseases. Drug use was analysed before and after exclusion of these identified prescription drugs. In Paper IV the proportion of patients 65 years or older having indication for a number of their prescription drugs, identified as inappropriate for elderly, was examined, with further analysis of what may affect the result. Results: Significant differences in drug use were identified depending on age, gender, income and education, despite adjustment for multimorbidity. The elderly, females and individuals with the lowest levels of income and education had higher drug use. The differences persisted when drug use in primary healthcare was examined. The gender difference in drug use decreased when prescription drugs used to treat diseases afflicting females more often were excluded from the analyses. Less than half of the patients’ prescription drugs (45.1%), studied in Paper IV had indication for treatment. The oldest patients had to the lowest extent indication for treatment. Conclusion: The patients’ age, gender, income and education affect the drug use, despite adjustment for multimorbidity. Gender-related morbidity seems to explain some of the gender difference in drug use, and lack of indication for treatment among the elderly explains some of the age difference.
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| 3. |
- Berg Skoog, Jessica, et al.
(författare)
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Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006
- 2014
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14:329
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Tidskriftsartikel (refereegranskat)abstract
- Background: It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity. Methods: Data was collected on all individuals 20 years and older in the county of Ostergotland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses. Results: The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females. Conclusion: Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.
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| 4. |
- Berg Skoog, Jessica, et al.
(författare)
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Drugs prescribed by general practitioners according to age, gender and socioeconomic status after adjustment for multimorbidity level
- 2014
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Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Age, gender and socioeconomic status have been shown to be associated with the use of prescription drugs, even after adjustment for multimorbidity. General practitioners have a holistic and patient-centred perspective and our hypothesis is that this may reflect on the prescription of drugs. In Sweden the patient may seek secondary care without a letter of referral and the liability of the prescription of drugs accompanies the patient, which makes it suitable for this type of research. In this study we examine the odds of having prescription drug use in the population and the rates of prescription drugs among patients, issued in primary health care, according to age, gender and socioeconomic status after adjustment for multimorbidity level. Method: Data were collected on all individuals above 20 years of age in Ostergotland county with about 400 000 inhabitants in year 2006. The John Hopkins ACG Case-mix was used as a proxy for multimorbidity level. Odds ratio (OR) of having prescription drugs issued in primary health care in the population and rates of prescription drug use among patients in primary health care, stated as incidence rate ratio (IRR), according to age, gender and socioeconomic status were calculated and adjusted for multimorbidity. Results: After adjustment for multimorbidity, individuals 80 years or older had higher odds ratio (OR 3.37 (CI 95% 3.22-3.52)) and incidence rate ratio (IRR 6.24 (CI 95% 5.79-6.72)) for prescription drug use. Male individuals had a lower odds ratio of having prescription drugs (OR 0.66 (CI 95% 0.64-0.69)), but among patients males had a slightly higher incidence rate of drug use (IRR 1.06 (CI 95% 1.04-1.09)). Individuals with the highest income had the lowest odds ratio of having prescription drugs and individuals with the second lowest income had the highest odds ratio of having prescription drugs (OR 1.10 (CI 95% 1.07-1.13)). Individuals with the highest education had the lowest odds ratio of having prescription drugs (OR 0.61 (CI 95% 0.54-0.67)). Conclusion: Age, gender and socioeconomic status are associated with large differences in the use of prescribed drugs in primary health care, even after adjustment for multimorbidity level.
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| 5. |
- Berg Skoog, Jessica, et al.
(författare)
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Indication for pharmacological treatment is often lacking: a cross-sectional study on the quality of drug therapy among the elderly.
- 2015
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Although the elderly have a substantially higher drug use than younger patients, even after adjustment for multimorbidity, there is limited knowledge about the elderly's indication for treatment. It is essential for elderly patients to have a well-planned drug therapy. The first step towards a correct and safe drug therapy is to ensure that the patient's drugs have an indication, i.e. correct diagnoses are linked to all of the prescription drugs. The aim of this study was to examine to what extent elderly patients have indication for a number of their prescribed drugs and, furthermore, if there are any differences in indication for treatment depending on gender, age, level of multimorbidity and income.
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| 6. |
- Thorell, Kristine, et al.
(författare)
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Licit prescription drug use in a Swedish population according to age, gender and socioeconomic status after adjusting for level of multi-morbidity
- 2012
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 12:575
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is a great variability in licit prescription drug use in the population and among patients. Factors other than purely medical ones have proven to be of importance for the prescribing of licit drugs. For example, individuals with a high age, female gender and low socioeconomic status are more likely to use licit prescription drugs. However, these results have not been adjusted for multi-morbidity level. In this study we investigate the odds of using licit prescription drugs among individuals in the population and the rate of licit prescription drug use among patients depending on gender, age and socioeconomic status after adjustment for multi-morbidity level. less thanbrgreater than less thanbrgreater thanMethods: The study was carried out on the total population aged 20 years or older in Ostergotland county with about 400 000 inhabitants in year 2006. The Johns Hopkins ACG Case-mix was used as a proxy for the individual level of multi-morbidity in the population to which we have related the odds ratio for individuals and incidence rate ratio (IRR) for patients of using licit prescription drugs, defined daily doses (DDDs) and total costs of licit prescription drugs after adjusting for age, gender and socioeconomic factors (educational and income level). less thanbrgreater than less thanbrgreater thanResults: After adjustment for multi-morbidity level male individuals had less than half the odds of using licit prescription drugs (OR 0.41 (95% CI 0.40-0.42)) compared to female individuals. Among the patients, males had higher total costs (IRR 1.14 (95% CI 1.13-1.15)). Individuals above 80 years had nine times the odds of using licit prescription drugs (OR 9.09 (95% CI 8.33-10.00)) despite adjustment for multi-morbidity. Patients in the highest education and income level had the lowest DDDs (IRR 0.78 (95% CI 0.76-0.80), IRR 0.73 (95% CI 0.71-0.74)) after adjustment for multi-morbidity level. less thanbrgreater than less thanbrgreater thanConclusions: This paper shows that there is a great variability in licit prescription drug use associated with gender, age and socioeconomic status, which is not dependent on level of multi-morbidity.
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