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| 5. |
- Fagerlind, Hanna, et al.
(författare)
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Communication analysis in oncology care : Performance of a combination of a content analysis system and a global scale
- 2011
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 20:9, s. 992-1000
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim was to assess the feasibility and reliability of Velikova's Content Analysis System (VCAS) and the Medical Interaction Process System (MIPS) global scale for evaluation of communication in oncology care.Methods: Seventy routine physician consultations with gastro-intestinal (GI) cancer patients were audio-recorded. Two coders applied VCAS and MIPS global scale to the consultations. VCAS captures aspects of communication like symptoms, side effects, functional issues (e.g. emotional, social, physical), health-related quality of life and medical decision making. MIPS global scale measures the total impression of the consultation, e.g. patient centredness and psychosocial focus.Results: In total, 61 of 70 consultations were coded. The coding took twice the consultations' actual durations in minutes for VCAS. The time for coding MIPS global scale equalled the consultations length. However, the coder had then listened to the consultation twice before, coding for VCAS. Cohen's kappa for all aspects measured by VCAS varied between 0.20 and 1, mean 0.80. One category (Info on test) had a kappa of 0.20, the other categories were all above 0.60. Weighted Kappa for MIPS global scale varied between 0.25 and 0.73, mean 0.42.Conclusions: VCAS and MIPS global scale is a feasible combination of tools for evaluating patient-physician communication regarding content, medical decision making and global aspects of communication. VCAS showed high reliability. The MIPS global scale showed lower reliability, due to its sensitivity to the individual coders' unique values, common for all global scales. Further development of the combination of content and global instruments would be valuable.
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| 6. |
- Fagerlind, Hanna, et al.
(författare)
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Different perspectives on communication quality and emotional functioning during routine oncology consultations
- 2012
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 88:1, s. 16-22
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine quality of communication in routine oncology consultations from patient, physician, and observer perspectives, and to determine agreement of emotional function content in consultations from these three perspectives.Methods: In total, 69 consultations were included. Perceived quality of communication and whether or not emotional functioning had been discussed was evaluated with patient- and physician-reported questionnaires. Observer perspective was evaluated by content analysis of audio records of the consultations. Agreement between perspectives was analyzed and means compared using linear mixed models.Results: The patients' ratings of communication quality differed significantly from those of both the physician and observer. Observer and physician scores did not differ significantly. Physicians rated emotional functioning as discussed more often than was reported from patient and observer perspectives.Conclusion: The patients' view of the quality of communication differed from that of the physician and observer. Whether emotional functioning was discussed or not was also perceived differently by patients, physicians, and observer.Practice implications: The underpinnings and implications of these results need to be further explored regarding how to move toward a higher degree of shared understanding, where different perspectives are more in alignment, and how to develop more valid methods for evaluating communication.
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| 7. |
- Fagerlind, Hanna, et al.
(författare)
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Patient-physician communication during oncology consultations
- 2008
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Ingår i: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 17:10, s. 975-985
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to characterize the content of patient-physician communication in standard oncology care. METHODS: The sample consisted of 19 patients with gastrointestinal cancer. The consultations were audio-recorded, transcribed verbatim, and analyzed according to qualitative content analysis. RESULTS: The analysis resulted in seven main categories: Disease and treatment, Healthcare planning, Everyday living, Psychological well-being, Coping with disease, Expressions of concerns and feelings, and Other aspects of communication. The main focus during the consultations was on disease and treatment. Physicians tended to concentrate on response to treatment and types and severity of side effects and how to treat them. More patient-centered subjects of psychosocial character like coping and psychological well-being were discussed only briefly, if at all. CONCLUSIONS: This study adds to the information given by the existing communication analysis systems, and hence we suggest a development of the psychosocial content categories of those systems to make them more valid.
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| 8. |
- Fagerlind, Hanna, 1979-
(författare)
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Patient-Physician Communication in Oncology Care : The character of, barriers against, and ways to evaluate patient-physician communication, with focus on the psychosocial dimensions
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to characterize patient-physician communication in oncology care with focus on the content and quality of the consultations from the perspectives of patients, oncologists and observer. Further, the aim was to explore oncologists’ perceived barriers against psychosocial communication in out-patient consultations. Finally, the aim was to evaluate different methods for evaluating communication in this setting.Routine oncology out-patient consultations from two different hospitals were audio-recorded. After the consultations, patients and oncologists perceptions of the content and quality of the communication were assessed using a self-report questionnaire. A nation-wide survey was performed to assess oncologists’ perceived barriers against psychosocial communication. Finally, the audio-recorded consultations were used for evaluating inter-rater reliability and feasibility of two different communication analysis instruments.Patient-physician consultations in oncology care are focused on the physical aspects of disease and treatment, both in terms of how often these issues were discussed and in terms of the amount of time spent on discussing them. Psychosocial issues, such as the disease’s effects on patients’ emotional or social functioning, are not always discussed during consultations, and the time spent on such discussions is limited. When psychosocial issues are discussed during the medical consultations, they are most often patient-initiated. Reasons for why psychosocial aspects are seldom discussed during the medical consultations can be the barriers concerning this kind of communication perceived by a large majority (93%) of the oncologists. Barriers against psychosocial communication were identified at organizational levels (including guidelines, routines, and resources) and individual levels (including physicians’ knowledge and attitudes).Furthermore, this thesis shows that there are methods with high feasibility and reliability for evaluating the content of patient-physician communication, in large study samples in oncology care. The method (observation/self-report) and perspective (patient, physician, and observer) used when evaluating communication affects the results. This needs to be considered when choosing evaluation methods in intervention studies.There are reasons to continue to evaluate, promote and implement promising ways of achieving better communication in clinical practice. Research should focus on how to overcome barriers against psychosocial communication.
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| 9. |
- Fagerlind, Hanna, et al.
(författare)
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Patients' understanding of the concepts of health and quality of life
- 2010
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 78:1, s. 104-110
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to identify how persons' with rheumatoid arthritis (RA) understand the concepts of health and quality of life (QoL). METHODS: A phenomenograpic approach was used to gauge variations in understanding of health and QoL. Semistructured interviews were conducted with 22 persons having RA. The interviews were audiotaped, transcribed verbatim, and analyzed, resulting in a descriptive system consisting of categories and subcategories. RESULTS: Health was primarily associated with being healthy/being free from disease, being able to function normally, experiencing well-being, and having a healthy lifestyle. Two above-mentioned domains, "being healthy" and "being able to function normally" overlapped with respondents' understanding of QoL. Additional perceived domains included attitudes towards life and, social and physical environments. CONCLUSION: The results show that patients' understanding of the two concepts of health and QoL partially overlap and partially differ. PRACTICE IMPLICATIONS: Patients' understanding of the concepts is individual and diverse, which needs to be taken into account in patient-physician consultations to ensure good communication. Furthermore, the interpretation of results based on patient-reported outcomes instruments measuring health status and/or QoL needs to be further studied over time to identify possible changes in these conceptions.
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| 10. |
- Funning, Sandra, et al.
(författare)
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Quality assurance within the scope of Good Clinical Practice (GCP) - What is the cost of GCP- related activities? : A survey within the Swedish Association of the Pharmaceutical Industry (LIF)´s members
- 2009
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Ingår i: Quality Assurance Journal. - : Wiley. - 1087-8378 .- 1099-1786. ; 12:1, s. 3-7
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Tidskriftsartikel (refereegranskat)abstract
- The bureaucracy that the Good Clinical Practice (GCP) system generates, due to industryover-interpretation of documentation requirements, clinical monitoring, dataverifications etc. is substantial. The aim of this study was to estimate the percentagecost of all such GCP-related activities within phase III clinical trials performed inSweden in 2005.Method: An electronic questionnaire on ICH GCP-activities and their related costs wassent to 47 of the 60 member companies of the Swedish Association of the PharmaceuticalIndustry (LIF).Results: The number of respondents was 29, giving a response rate of 62% andcovering 97% (n5250) of phase III trials performed in Sweden in 2005. Approximately50% of the total budget for a phase III study was reported to be GCP-related.50% of the GCP-related cost was related to Source Data Verification (SDV). A vastmajority (71%) of respondents did not support the notion that these GCP-relatedactivities increase the scientific reliability of clinical trials.
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| 11. |
- Gillespie, Ulrika, et al.
(författare)
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A comprehensive pharmacist intervention to reduce morbidity in patients 80 years or older : a randomized controlled trial
- 2009
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Ingår i: Archives of Internal Medicine. - : American Medical Association (AMA). - 0003-9926 .- 1538-3679. ; 169:9, s. 894-900
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPatients 80 years or older are underrepresented in scientific studies. The objective of this study was to investigate the effectiveness of interventions performed by ward-based pharmacists in reducing morbidity and use of hospital care among older patients.METHODSA randomized controlled study of patients 80 years or older was conducted at the University Hospital of Uppsala, Uppsala, Sweden. Four hundred patients were recruited consecutively between October 1, 2005, and June 30, 2006, and were randomized to control (n = 201) and intervention (n = 199) groups. The interventions were performed by ward-based pharmacists. The control group received standard care without direct involvement of pharmacists at the ward level. The primary outcome measure was the frequency of hospital visits (emergency department and readmissions [total and drug-related]) during the 12-month follow-up period.RESULTSThree hundred sixty-eight patients (182 in the intervention group and 186 in the control group) were analyzed. For the intervention group, there was a 16% reduction in all visits to the hospital (quotient, 1.88 vs 2.24; estimate, 0.84; 95% confidence interval [CI], 0.72-0.99) and a 47% reduction in visits to the emergency department (quotient, 0.35 vs 0.66; estimate, 0.53; 95% CI, 0.37-0.75). Drug-related readmissions were reduced by 80% (quotient, 0.06 vs 0.32; estimate, 0.20; 95% CI, 0.10-0.41). After inclusion of the intervention costs, the total cost per patient in the intervention group was $230 lower than that in the control group.CONCLUSIONIf implemented on a population basis, the addition of pharmacists to health care teams would lead to major reductions in morbidity and health care costs.
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| 12. |
- Karlsson, Sara, et al.
(författare)
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Not just another evaluation : A comparative study of four educational quality projects at Swedish universities
- 2013
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Konferensbidrag (refereegranskat)abstract
- In this study, four recent self-initiated educational quality projects at Swedish universities are compared and analysed. The aim is to contribute to an increased understanding of quality management in contemporary higher education.The projects are found to be built on similar rationales linked to accountability, reputation building and strategic management, and on similar ambitions regarding raising the status of education. Although there are links to the shared external policy context, the projects differ considerably in their actual design and implementation. This is interpreted as an active adaptation to the unique internal academic norms and cultures that exist in each university.
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| 13. |
- Karlsson, Sara, et al.
(författare)
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Not just another evaluation : A comparative study of four educational quality projects at Swedish universities
- 2014
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Ingår i: Tertiary Education and Management. - : Springer Science and Business Media LLC. - 1358-3883 .- 1573-1936. ; 20:3, s. 239-251
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Tidskriftsartikel (refereegranskat)abstract
- In this study, four recent self-initiated educational quality projects at Swedish universities are compared and analyzed. The article focuses on how the universities have handled the tension between external demands and internal norms. The aim is to contribute to an improved understanding of quality management in contemporary universities. On the one hand, the projects are found to be built on similar rationales associated with accountability, reputation building and strategic management. This is interpreted as a response to the shared external policy context. They are also found to mirror similar ambitions regarding raising the status of education. On the other hand, the projects are found to differ considerably in their actual design, methodology, implementation, stakeholders and outcomes. This is interpreted as an active adaptation to the unique internal academic norms and cultures that exist in each university.
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| 16. |
- Kettis, Åsa, et al.
(författare)
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Assessment of the appropriateness of extemporaneous preparations prescribed in Swedish primary care
- 1996
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 0961-7671 .- 2042-7174. ; 4:2, s. 117-122
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Tidskriftsartikel (refereegranskat)abstract
- Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock-keeping. This study aimed to assess the prescribing of extemporaneous preparations in Swedish primary care, both therapeutically and pharmaceutically. An analysis of the extent to which alternative commercial drugs were available at the time of the prescription was also conducted.Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of physicians the details of all prescriptions they write during one week, as well as the corresponding diagnoses. The present study analysed the 1,043 extemporaneous prescriptions written during that period.The majority (62 per cent) were considered to be therapeutically appropriate in that they formed recommended treatment for the diagnosis in question according to the medical literature. Another 15 per cent were neither recommended nor questioned in the consulted sources; 20 per cent were designated as controversial because they were recommended in some sources and questioned in others. About 3.5 per cent were considered to be therapeutically inappropriate, ie, the literature suggested that their use should be abandoned. One per cent were pharmaceutically inappropriate. Many preparations probably could have been replaced by commercial alternatives, about half differing from available commercial alternatives only by strength and/or vehicle. Whether substitutions could have been made in practice would depend on the clinical picture in the individual patient case.
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| 17. |
- Kettis, Åsa, et al.
(författare)
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Factors associated with the prescribing of extemporanous preparations in Sweden
- 1995
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 0961-7671 .- 2042-7174. ; 3:2, s. 91-96
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Tidskriftsartikel (refereegranskat)abstract
- Extemporaneous preparations are drugs that are compounded for individual patients or made in larger batches for stock-keeping. This study aimed to analyse factors associated with the prescribing of such preparations in Sweden.Information was taken from the Swedish diagnosis and therapy survey for the time period October, 1986, to September, 1988, inclusive. This survey collects from a random sample of doctors the details of all prescriptions they write during one week, as well as all corresponding diagnoses. The present study analysed extemporaneous prescriptions and the characteristics of doctors issuing them.Of the 2,142 doctors who contributed prescriptions to the survey, 19 per cent wrote at least one prescription for an extemporaneous preparation. Young patients obtained such preparations more than older patients. Proportionately fewer of the youngest doctors prescribed them. Dermatologists prescribed extemporaneous preparations much more commonly than other doctors, and most of the preparations concerned were dermatologicals. The most common diagnosis for the prescribing of these preparations was contact eczema, with psoriasis second. The findings suggest that the prescribing of extemporaneous preparations is established and continuing and not just a feature of obsolete practice. However, the appropriateness of these products should be further analysed and assessed to ensure that they are clinically and pharmaceutically safe and effective.
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| 18. |
- Kettis, Åsa, et al.
(författare)
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Genetic research and donation of tissue samples to biobanks. What do potential sample donors in the Swedish general public think?
- 2006
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Ingår i: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 16:4, s. 433-440
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to identify perceptions of the general public regarding research involving human tissues; to assess the public's willingness to donate samples to biobanks; and to identify factors associated with the willingness to donate samples. Methods: Cross-sectional survey. Postal questionnaires to a random sample of the general public in Sweden, 18-80 years of age (n = 6000) in October 2002 (response rate 49.4%; n = 2928). Results: A majority of the respondents had a positive attitude towards genetic research. Their trust in authorities' capability to evaluate the risks and benefits of genetic research varied. Individual university/hospital-based researchers received the greatest trust, while the county councils (health care providers), and the Swedish Parliament received the lowest trust. Most respondents (86.0%) would donate a linked blood sample for research purposes. Another 3.0% would provide an anonymous sample. In total, 78% of the respondents would agree to both donation and storage. The most common motive was benefit of future patients. The majority was indifferent to the funding source for the research and would delegate this judgment to the research ethics committee. After adjusting for covariates, those more likely to donate a sample were middle-aged, had children, had personal experience of genetic disease, were blood donors, had a positive attitude toward genetic research, and had trust in experts/institutions. Conclusions: The majority of the general public is willing to donate a sample to a biobank. The willingness is mainly driven by altruism, and depends on the public being well-informed and having trust in experts and institutions.
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| 19. |
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| 20. |
- Kettis, Åsa
(författare)
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Kvalitet i högre utbildning och forskning
- 2011
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Ingår i: Det goda universitetet. - Uppsala : Uppsala universitet. - 9789155482077 ; , s. 169-181
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Bokkapitel (populärvet., debatt m.m.)
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| 21. |
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| 22. |
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| 23. |
- Kettis, Åsa, et al.
(författare)
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Patients'and doctors' views of using the schedule for individual quality of life in clinical practice.
- 2007
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Ingår i: JOURNAL OF SUPPORTIVE ONCOLOGY. - 1544-6794. ; 5:6, s. 281-287
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Tidskriftsartikel (refereegranskat)abstract
- This study explored patients’ and oncologists’ perceptions ofusing a computer-administered, individualized quality-of-life (QOL) in-strument to support an oncologic consultation. Twenty patients with gas-trointestinal cancer (50% female; mean age 60 years) at two hospitals inSweden completed the Schedule for the Evaluation of Individual Quality ofLife-Direct Weight (SEIQoL–DW) and the Disease-Related (DR) SEIQoL-DWand brought the results to the consultation. Afterwards, interviews wereconducted with all patients and six of eight doctors. All interviews wereaudiotaped, transcribed, and analyzed using an interpretivist approach.Most patients and doctors believed that the instrument would facilitatedetection of patients’ areas of concern and would support monitoringof patients’ QOL. This tool may empower the patient, give the doctor abroader picture of the patient, and influence clinical decision-making. TheSEIQoL-DW may be a systematic method of stimulating patient-centeredcare. It apparently encourages patients to reflect upon their own situationand allows them to be seen as whole persons. However, further quantita-tive evaluation of the intervention’s outcomes is required.
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| 24. |
- Kettis, Åsa, et al.
(författare)
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Perceptions of potential donors in the Swedish public towards information and consent procedures in relation to use of human tissue samples in biobanks : a population-based study
- 2007
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 35:2, s. 148-156
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To assess the Swedish public's preferences for information and consent procedures when being asked for permission to use previously collected tissue samples for new research studies. Methods: Cross-sectional study employing postal questionnaires to a random sample of the Swedish general public (n = 6,000) in October 2002-February 2003. The response rate was 49% (n = 2,928). This paper includes only respondents who reportedly would approve of samples being taken and stored (n = 2,122). Results: When potential tissue sample donors in the general public have to strike a balance between the values at stake, i.e. the autonomy of the donor versus the research value, most (72%) prefer general consent, i.e. where consent is asked for at the outset only. They want the research ethics committee (REC) alone to decide on the use of stored samples, and they would allow storage as long as the sample is useful for research. The minority of respondents who were in favour of specific consent were more likely to be young, well educated, have negative experiences of healthcare and low trust in healthcare authorities. Conclusions: The majority of the Swedish general public prefer general consent, and are thus willing to delegate some decisions to the RECs. However, preferences for information and consent procedures depend on the context, e.g. the risks for the donor and the purpose of the research. If feasible, procedures should be differentiated according to the preferences of individual donors, thus protecting the interests of both the minority and the majority.
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| 25. |
- Kettis, Åsa, et al.
(författare)
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Pharmacists´ attitudes towards importance of compounding to their profession
- 2000
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Ingår i: J Social and Administrative Pharmacy. - 0281-0662. ; 17:3, s. 143-150
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Tidskriftsartikel (refereegranskat)abstract
- Results of a questionnaire mailed to a random sample of 661 Swedish pharmacists in Nov 1991. 486 usable replies were received (74% response). 85% of respondents worked for the Swedish national pharmacy corporation, of whom 75% were in community pharmacies and 20% in hospital pharmacies. 60% thought that extemporaneous compounding is an important part of the pharmacy profession. The results are discussed, and compared with attitudes to the pharmacist's role found in other countries.
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| 26. |
- Kettis, Åsa, et al.
(författare)
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Pharmacists´perceptions of the Swedish compounding system
- 1996
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Ingår i: Journal of Social and Administrative Pharmacy. - 0281-0662. ; 13:3, s. 139-149
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Tidskriftsartikel (refereegranskat)abstract
- Investigation of attitudes of pharmacists in Sweden to the centralised system for extemporaneous compounding, based on questionnaires completed by 371 pharmacists (294 community and 77 hospital). There was generally felt to be a lack of information on such preparations, which meant that younger pharmacists, particularly, often found difficulty in assessing the appropriateness of prescriptions and advising patients and doctors.
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| 27. |
- Kettis, Åsa, et al.
(författare)
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Placements : an underused vehicle for quality enhancement in higher education?
- 2013
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Ingår i: Quality in Higher Education. - : Taylor & Francis Group. - 1353-8322 .- 1470-1081. ; 19:1, s. 28-40
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Tidskriftsartikel (refereegranskat)abstract
- Placements have the potential to contribute more effectively to the quality of higher education. The aim of this article is to discuss how placements can be made more worthwhile for individual students, while also contributing to the overall quality of teaching and learning at HEIs as well as to the development of workplace cultures that are conducive to learning. Work experience opportunities help students to build substantive relationships and apply what they are learning. Students’ overall view of their learning experience becomes more positive, their identification with their intended profession strengthens and academic performance improves, as do graduate employment rates. Introducing placements in the curriculum does not, however, guarantee these positive effects. Learning is likely to be greater if the experience is ‘intentional and recognised’ and tightly knit into the curriculum. Using evidence from research on workplace learning is one way to improve the quality of placements, as exemplified by a scholarly approach to the development of placements for pharmacy students at Uppsala University. HEIs’ interaction with employers through placements enriches both parties. Academics gain insights into practice which may inspire teaching on campus, e.g. by generating real life examples that trigger students’ motivation and by informing curriculum design. Practitioners supervising students on placements are often excellent educational development partners. Placements may also contribute to organisational development. Developing a reflective, deliberate approach to learning in the workplace may be as useful for the employees as for the students. Also, students may carry out projects of value to the employer, while also keeping the university informed of current practice. An increased engagement in students' work experience opportunities may improve the student experience, and contribute to bridging the academy-practice divide in a way that is as much about influencing the rest of society as being influenced by it.
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| 28. |
- Kettis, Åsa, et al.
(författare)
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Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW : a randomized study
- 2021
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer Nature. - 2509-8020. ; 5
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Tidskriftsartikel (refereegranskat)abstract
- Background: Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice.Methods: In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3-5 consultations over a period of 4-6 months. The primary outcome measure was patients' health-related QoL, as measured by FACIT-G. Patients' satisfaction with the consultation and survival were secondary outcomes.Results: There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded.Conclusions: Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.
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| 29. |
- Kettis, Åsa, et al.
(författare)
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The role of dermatologists, nurses and pharmacists in chronic dermatological treatment: patient and provider views and experiences.
- 2006
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 86:3, s. 202-8
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Tidskriftsartikel (refereegranskat)abstract
- Effectively co-ordinated treatment support from healthcare providers (doctors, nurses and pharmacists) may improve patients' adherence to treatment. The objective of this study was to identify patients' and providers' perceptions of the roles of different healthcare providers in dermatological treatment. Focus groups were used in two types of fora: patients with chronic dermatological diseases (n =2x6) and healthcare providers (n =2x6), including doctors, nurses and pharmacists working in dermatological care. Data were analysed according to the Consensual Qualitative Research approach. The respondents viewed the roles of the providers as complementary, but poorly co-ordinated. Treatment support is provided mainly by the nurse. During the doctor's appointment, diagnosis and treatment decisions are often prioritized, leaving limited time for treatment support. The pharmacist's provision of support is constrained by the lack of privacy and clinical history of individual patients. The most apparent "gap" in the chain of treatment support was between the pharmacist and the other providers. There was a wish for improved interprofessional collaboration to avoid giving conflicting advice. There is a need to improve interprofessional collaboration in dermatology, in order to optimize treatment support in clinical practice.
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| 30. |
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| 31. |
- Kjellgren, Karin I, 1950, et al.
(författare)
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To follow dermatological treatment regimens--patients' and providers' views.
- 2004
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Ingår i: Acta dermato-venereologica. - : Medical Journals Sweden AB. - 0001-5555 .- 1651-2057. ; 84:6, s. 445-50
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Tidskriftsartikel (refereegranskat)abstract
- Adherence to long-term therapy for chronic illness is on average 50%. However, regarding adherence to dermatological treatment the existing literature is limited. The aim of the study was to acquire an understanding of issues associated with adherence to dermatological therapy. Focus group interviews were used in two types of fora: patients with chronic dermatological diseases and health care providers, including doctors, nurses and pharmacists working in dermatological care. Results reveal the providers' view of a suboptimal rate of adherence. According to both providers and patients, factors affecting adherence were patients' expectations and experiences of therapeutic effect, possibilities for the patient to take active part in treatment decisions, as well as mode of administration and type of medication. Suggested strategies for improvement are individualized patient education, continuous treatment support with assessment of medication-taking behaviour and enhanced communication skills among the providers.
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| 32. |
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| 33. |
- Ljungberg, Christina, et al.
(författare)
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Hospital doctors' views of factors influencing their prescribing
- 2007
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 13:5, s. 765-771
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aim and objective Factors influencing doctors in prescribing of drugs have mostly been studied in primary care. Studies performed in hospital care have primarily focused on new drugs, not prescribing in general. An in-depth understanding of the prescribing process in the more specialized secondary care is not only important for secondary care itself, but because it also influences prescribing in primary care. The aim of this study is therefore to identify factors that secondary care doctors believe influence them in prescribing drugs, using a qualitative approach. Method Semi-structured interviews were conducted with 15 hospital doctors in different medical specialities and the interviews were analysed from an interpretivist perspective. The information gathered was on how prescribing decisions were made in general and how the doctors chose a specific drug therapy, including information sources used. Results According to our interviews, the hospital doctors took patient-specific factors and cost into consideration when prescribing, informed by different written information sources and commercial verbal information. Personal practice, colleagues and therapeutic tradition at the hospital or clinic, were influential in the prescribing of drugs. The themes identified should not to be seen as individual influences; many of them probably act in combination. Conclusions If changes in prescribing behaviour are desired, factors warranting more attention include understanding how to influence therapeutic traditions and the doctor's personal habits for prescribing. The importance of clinical experience and information exchange with colleagues should not be underestimated in providing information about drugs to hospital doctors.
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| 34. |
- 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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| 35. |
- 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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| 36. |
- 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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| 37. |
- Ljungberg, Christina, et al.
(författare)
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Secondary care doctors' perception of appropriate prescribing
- 2009
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 15:1, s. 110-115
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Tidskriftsartikel (refereegranskat)abstract
- RATIONALE, AIM AND OBJECTIVE: As the prescribing of drugs in secondary care is known to influence prescribing in primary care and because an understanding of prescribers' reasoning is essential for evaluating prescribing appropriateness, the aim of this study was to investigate secondary care doctors' views of appropriate prescribing, using qualitative individual interviews. METHOD: Qualitative, semi-structured individual interviews were conducted with 15 hospital doctors working in different medical specialities. The interviews, covering the doctors' views of the meaning of 'appropriate' prescribing, were audiotaped and analysed from an interpretivist perspective. RESULTS: Three different main themes were identified in the analysis of how the doctors perceived appropriate prescribing: 'individualization of treatment', 'cost' and 'time'. Most importantly, treatment should be adjusted to the individual patient, although cost should also be justified. Ongoing medication reviews should be carried out, to adjust to changes in patient-related factors over time. CONCLUSIONS: The hospital doctors brought up continuous review as a necessary part of appropriate prescribing. Thus, from the prescribers' point of view, this time perspective should be explicitly incorporated in definitions of appropriate prescribing, in addition to individualization of treatment and cost considerations.
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| 38. |
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| 39. |
- Montgomery, Anna, 1974-, et al.
(författare)
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Community pharmacists providing a pharmaceutical care service : Identifying counselling behaviour and content
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To characterise the counselling behaviour of practitioners providing a pharmaceutical care service in community pharmacy, and to describe the content of the consultations.Methods: Non-participant observations, including audio recording, of five practitioners counselling 16 patients, were analysed qualitatively.Results: The counselling behaviour was characterised by attempts to understand the patients’ narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug-drug-interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients’ most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient’s needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients’ achieve optimal outcomes of medical treatment.Conclusion: The practitioners provided important advice and support to patients. Focus on the computer screen limited their abilities to practise patient-centred care. Practice implications: The necessity for practitioners to develop strategies and counselling techniques to achieve patient centredness in pharmaceutical care is highlighted.
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| 40. |
- Montgomery, Anna, 1974-
(författare)
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Counselling in Swedish Community Pharmacies : Understanding the Process of a Pharmaceutical Care Service
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Community pharmacy practice is moving towards patient care and away from the mere dispensing of medicines. In this movement, which is guided by the philosophy of Pharmaceutical care (PC), new counselling services emerge. The purpose of the thesis was to add knowledge about the real-world provision of PC services by studying a defined PC service in Swedish pharmacies. Specific aims of this thesis were to investigate the experiences of professionals working with or close to the service and to describe the content of consultations, counselling behaviour and patterns of follow-up. Further aims were to characterise patients receiving the service and describe their perceived outcomes, in relation to standard service. Data were collected via focus groups, telephone interviews, observations, a patient medication record database and a cross-sectional survey. The practitioners reported greater use of their pharmaceutical knowledge and provision of more thorough patient support. Perceived barriers in delivering the service included difficulties in documenting and getting commitment from colleagues, managers and prescribers. Doctors working close to PC pharmacies held varying opinions about the service. Consultations dealt with issues potentially improving the outcomes of medical treatment, but the level of patient centredness varied and was limited by the practitioners’ focus on the computer screen. The rate of follow-up evaluations was modest, but was higher at pharmacies with a high volume of patients receiving the service. PC patients were mostly elderly and female, using about 10 prescription drugs. In comparison to patients receiving standard service, they were more worried, vulnerable and information-seeking. At the same time, their feelings of safety following the pharmacy visit were more pronounced than those of patients receiving standard service. They also felt better prepared for doctor visits. In order for community pharmacy to better meet patients’ needs and optimise PC services, increased attention should be given to implementation strategies, interprofessional collaboration and educational efforts focusing on patient centredness.
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| 41. |
- Montgomery, Anna, et al.
(författare)
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Implementation of a pharmaceutical care service : prescriptionists', pharmacists' and doctors' views
- 2007
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Ingår i: Pharmacy World & Science. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 29:6, s. 593-602
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Tidskriftsartikel (refereegranskat)abstract
- Objective To identify prescriptionists’, pharmacists’ and doctors’ perceptions and experiences of a pharmaceutical care service supported by patient medication records (PMRs). Method Qualitative study employing focus group interviews with 16 prescriptionists and five pharmacists, and semi structured telephone interviews with 11 doctors. Main outcome measures Prescriptionists’, pharmacists’ and doctors’ views, experiences and perceptions of a pharmaceutical care service on Swedish community pharmacies. Results The provision of pharmaceutical care aided by PMRs had a positive influence on the prescriptionists’ and pharmacists’ daily work, and on their view of their professional role. They assumed greater professional responsibility, and described greater use of their pharmaceutical knowledge, greater confidence in practice and an increased awareness of their counselling role. They appreciated that the pharmaceutical care service provided an over-all picture of patients’ drug use, allowed for follow-up on counselling and made the prescriptionists’ and pharmacists’ competence tangible for patients. Perceived problems with the pharmaceutical care service included being time-consuming, record keeping being difficult, difficulty in getting understanding/support from colleagues and managers, and difficulty involving doctors. The majority of the doctors reported that they had not taken an active interest in the project, and their opinions of the pharmaceutical care service varied. Conclusion When prescriptionists and pharmacists apply the pharmaceutical care concept and work with PMRs, the patients are more likely to meet confident professionals that are more aware of the individual behind the drug therapy. This will hopefully contribute to informed, motivated medicine users that feel secure in their interactions with their pharmacy and receive, not only drugs, but treatment support. For such a service to be effective, however, it is vital to ensure that the doctors are fully co-operative.
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| 42. |
- Montgomery, Anna, 1974-, et al.
(författare)
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Receiving a pharmaceutical care service compared to receiving standard pharmacy service : How do patients in Sweden differ with regard to perceptions of medicine use and the pharmacy encounter?
- 2010
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Ingår i: Research in Social and Administrative Pharmacy. - Pittsburgh : ELSEVIER. - 1551-7411 .- 1934-8150. ; 6:3, s. 185-195
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Tidskriftsartikel (refereegranskat)abstract
- Background: Qualitative research has shown that gaining control of medicine treatment, increased feelings of safety and empowerment are central concepts in patients’ perceptions of a pharmaceutical care (PC) service provided in Sweden. However, little is known about the relationship between patient-perceived outcomes and the level of community pharmacy services that they receive. Objective: To describe and compare patients who had previously received a PC service and patients who had received a standard pharmacy service (SS) with regard to their perceptions of medicine use and the pharmacy encounter. Methods: Cross-sectional survey design comparing matched groups of patients who were previously selected to receive a PC service or who had received a standard service. Patients who were 60 years or older and used 5 or more prescription medicines concomitantly were included in the survey. Questionnaires included questions about feelings of safety in drug therapy, general health, drug-related problems (DRPs), medication beliefs, adherence and experiences of pharmacy encounters. Results: Patients receiving the PC service used more prescription medicines, had poorer self-reported health, and felt less safety in their medicine therapy, than did patients in SS. PC patients reported that they felt safer with medications, felt a genuine interest from the pharmacist, received important information, and felt more prepared to see the doctor after having spoken to the pharmacist, than did patients in SS. DRPs reported to a greater extent by patients receiving the PC service included difficulties opening containers, worries about side effects, experiences of side effects, worries about drug-drug interaction and inadequate treatment effects. Adherence and medication beliefs showed no statistical difference between groups. Conclusion: Patients receiving a PC service are a worried, vulnerable and information seeking group. In comparison to patients receiving SS, the PC patients are more insecure about their medicine therapy, although talking to a pharmacist increased their self-reported feelings of safety and provided better preparation for visits to the doctor.
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| 43. |
- Montgomery, Anna T., et al.
(författare)
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Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies
- 2010
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Ingår i: Pharmacy World & Science. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 32:4, s. 455-463
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Tidskriftsartikel (refereegranskat)abstract
- Objective To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations. Setting Community pharmacies in Sweden. Methods Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach. Main outcome measure Descriptions of counselling behaviour and content of consultations. Results The counselling behaviour was characterised by attempts to understand the patients' narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug-drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients' most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient's needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients' achieve optimal outcomes of medical treatment. Conclusion The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.
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| 44. |
- Montgomery, A. T., et al.
(författare)
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Follow-up of patients receiving a pharmaceutical care service in Sweden
- 2008
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Ingår i: Journal of clinical pharmacy and therapeutics. - : Hindawi Limited. - 0269-4727 .- 1365-2710. ; 33:6, s. 653-62
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUNDPharmaceutical care (PC) services are increasingly provided in community pharmacies in the western world. Evaluations are often conducted as trials in highly controlled conditions measuring the efficacy of the service in terms of the economical, clinical and humanistic outcomes. Little is known about the real world provision of PC services and the factors associated with follow-up.OBJECTIVETo characterize patients receiving a PC service, to explore factors associated with follow-up evaluations, and to describe the results of pharmacists' interventions.METHODSA non-experimental, retrospective study using the Swedish national patient medication records data base. Patients receiving follow-up evaluations or one consultation within the service were compared using logistic regression.RESULTSA total of 3298 patients received the PC service at 240 community pharmacies. Patient characteristics included: 66.3% female, mean age 71.1 years, mean number of prescription drugs used 10.5, with 86.2% of patients using >or=1 cardiovascular drugs. A quarter (25.8%) of patients had >or=1 drug-related problems, most commonly side effects. Follow-up evaluations were carried out for 46.6% of the patients, who were more likely to use a compliance aid. Patients receiving the PC service at pharmacies that had enrolled more than the mean number of patients (13.7) had twice as high a chance of receiving follow-up than those registered with pharmacies with fewer patients (i.e. below the mean) enrolled. Followed-up interventions led to a better perceived outcome in 46.3% of cases, no change in 48.5% and a worse outcome in 5.2%.CONCLUSIONSThis study demonstrates that the total number of patients enrolled in a PC service predicts whether follow-up evaluations will take place or not more than do patient characteristics.
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| 45. |
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| 46. |
- Nordén-Hägg, Annika, et al.
(författare)
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Culture at work in Swedish pharmacies: Safety, stress, and dispensing errors
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Relationships between domains of safety culture and medical errors have been established in health care. Such an association could also be expected between safety culture domains and dispensing errors at pharmacies. The relationship has however never been studied. Methods: A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. The pharmacies were at the time of the study organised by the National Corporation of Pharmacies. All staff listed as employed in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to examine the relationship between dimensions of pharmacy climate and dispensing errors. Results: Significant relationships between SAQ dimensions safety climate, teamwork climate, job satisfaction, and stress recognition were found, when regressed onto dispensing errors. These relationships disappeared after controlling for respondent and pharmacy demographic variables. When controlling for demographic variables, only Stress Recognition was still associated with dispensing errors. Conclusion: This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of demographic variables. After controlling these variables, the relationship between safety climate and dispensing errors was rendered insignificant, while the relationship to stress recognition remained significant. The directional arrow between stress recognition and dispensing errors could not be established, but implications for future research into incident reporting, safety culture, and risk management are discussed.
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| 47. |
- Nordén-Hägg, Annika, et al.
(författare)
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Experiences of a nationwide web-based system : reporting dispensing errors in Swedish pharmacies
- 2012
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 2042-7174 .- 0961-7671. ; 20:1, s. 25-32
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To design and evaluate a national web-based dispensing error reporting system for all Swedish pharmacies, replacing the currently used paper-based system.METHODS: A working group designed the new system. The number of reports before (1999-2003) and after (2004-2005) introduction was studied in a descriptive analysis. The completeness of reports was evaluated through the study of 100 randomly selected reports from the third quarter of 2003 and 2004 from each system. Evaluation was done by chi-square analysis; P>0.05. Perceptions on introduction were collected in semi-structured interviews (working group and one assistant) and subjected to descriptive analysis.KEY FINDINGS: Reported error rate per 100,000 dispensed items was 12.9 pre- and 21.4 post implementation. Completeness-analysis revealed that information was more comprehensively reported in the new system. A significant difference existed in the extent to which incidents were described as well as details provided of the medicine and the patient. According to the interviewees, users initially found the web-based system difficult to handle. It took more than 6 months to change this perception.CONCLUSIONS: Introducing a web-based system for reporting dispensing errors had an impact on quantity of reports and completeness. Time and patience was needed to implement the changes.
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| 48. |
- Nordén Hägg, Annika, et al.
(författare)
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Exploring the relationship between safety culture and reported dispensing errors in a large sample of Swedish community pharmacies
- 2012
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Ingår i: BMC pharmacology & toxicology. - : Springer Science and Business Media LLC. - 2050-6511. ; 13, s. 4-
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Tidskriftsartikel (refereegranskat)abstract
- The potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies. A cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors. The first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors. This study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results.
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| 49. |
- Nordén-Hägg, Annika
(författare)
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Failure-Free Pharmacies? : An Exploration of Dispensing Errors and Safety Culture in Swedish Community Pharmacies
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Quality in pharmacies includes aspects such as error management and safety issues. The objective of this thesis was to explore these aspects of quality in Swedish community phar-macies. The specific aims were to compare a paper-based and a web-based reporting system for dispensing errors, regarding reporting behaviour and data quality. The impact of an intervention; a technical barrier, for preventing dispensing errors was evaluated. A survey tool, the Safety Attitudes Questionnaire (SAQ), was adapted to Swedish pharmacies and used to describe the safety culture in these pharmacies. The potential relationship between safety culture and dispensing errors was also explored. Data was retrieved from the paper- and web-based reporting systems, semi-structured interviews as well as from a survey, using SAQ. The change in reporting system for dispensing errors increased the reporting of errors and enhanced the completeness of reported data. The web-based system facilitated follow-up and identification of preventive measures, but was associated with implementation problems. The intervention was associated with a significant decrease in the overall number of dispensing errors and, specifically, reports on errors with the wrong strength, and errors caused by registration failure in the pharmacy computers. The Swedish version of the survey tool, SAQ, demonstrated satisfying psychometric properties. No correlation between the SAQ Safety Climate dimension and dispensing errors was seen, while a positive relationship between the SAQ Stress Recognition dimension and dispensing errors was established. A number of other pharmacy characteristics, such as number of dispensed prescription items and employees, displayed positive relationships with dispensing errors. Staff age demonstrated a negative relationship with dispensing errors while other demographic variables such as national education background showed a positive relationship.
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| 50. |
- Nordén-Hägg, Annika, et al.
(författare)
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Reducing dispensing errors in Swedish pharmacies : the impact of a barrier in the computer system
- 2010
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Ingår i: Quality and Safety in Healthcare. - : BMJ. - 1475-3898 .- 1470-7934. ; 19:6, s. e22-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Since 2004, a web-based reporting system enables monitoring of dispensing errors in all Swedish pharmacies. The adoption of this system was followed by an overall increase in reports, mainly explained by the dispensing of medicines of improper strength. In 2006 an intervention was implemented, aimed at reducing these errors. The objective of this study was to assess the impact of the intervention on the number of errors. METHODS: Monthly data on the reported number of dispensing errors from July 2004 until December 2007 were used. These were analysed in total and subdivided by type and cause of error. A time-series design was applied, and linear segmented regression analysis used to analyse whether changes in slope or level occurred; shifts in intercept or slope where p<0.01 were considered as statistically significant. RESULTS: The intervention coincided with a distinct decrease in error reports and a statistically significant change in slope that switched from a slight increase, 0.09, to a decrease, -0.26 (p = 0.0035). Medicines dispensed with wrong strength also displayed a significant change in slope, from 0.08 to -0.27 (p<0.0001), as well as dispensing errors caused by registration failure, that is, failure of the registration of a prescription in pharmacy computers, which changed from 0.05 to -0.29 (p<0.0001). CONCLUSION: The intervention was associated with a decrease in the number of reports on drugs dispensed with the wrong strength, but also had a decreasing effect on errors caused by registration failure and on the dispensing errors in total as well.
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