| 1. |
- Almkvist, Henrik, et al.
(författare)
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Kvalitetsbokslut minskade läkemedelskostnaderna i primärvården : Stockholms läns landstings modell för decentraliserat kostnadsansvar
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:42, s. 2930-2934
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Tidskriftsartikel (refereegranskat)abstract
- Increasing drug expenditures have resulted in various models to increase cost consciousness among prescribing doctors. In the County of Stockholm, Sweden, a model for quality assessment of prescribing was introduced in 2006. In all, 139 of 154 primary healthcare centres (PHCs) signed a contract linking extra payment to the adherence to the Drug and Therapeutics Committee guidelines if they analysed their prescribing behaviour in an annual quality report. During the first year, the adherence to guidelines increased from 80 to 83%, substantially higher than the 0-2% annual increase that had been observed previous years. The increase was similar for those PHCs not participating in the program. Qualitative analyses of all written quality reports indicate that the incentive scheme has resulted in an increased interest in quality assessment of drug prescribing. In total, 20 million SEK was spent on incentives, with estimated savings of 100 million SEK on drug expenditures.
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| 2. |
- Andersson, Marine L., et al.
(författare)
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Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX
- 2015
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Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 84:5, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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| 3. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Physicians' reported needs of drug information at point of care in Sweden
- 2012
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley. - 0306-5251 .- 1365-2125. ; 73:1, s. 115-125
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Tidskriftsartikel (refereegranskat)abstract
- AIMS Relevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODS We recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTS Physicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONS The results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility.
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| 4. |
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| 5. |
- Holmström, Inger, et al.
(författare)
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Educating Swedish telenurses to improve caller experience : Reflections on a pilot study
- 2014
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Ingår i: Clinical Nursing Studies. - : Sciedu Press. - 2324-7959 .- 2324-7940. ; 2:2, s. 61-73
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Tidskriftsartikel (refereegranskat)abstract
- Telenurses employed at Swedish Healthcare Direct offer triage recommendations and self-care advice to the general public over the telephone on a wide range of health problems. Their understanding of work and ability to communicate are essential for callers’ adherence to recommendations and satisfaction with the service. This paper presents and reflects upon an educational intervention for Swedish telenurses which aimed to improve caller experience. Twelve telenurses participated. Six were randomised to an intervention group, the other six to a reference group. The nurses in the intervention group individually listened to, and reflected on their authentic calls together with one of the researchers on five to six separate occasions. Callers’ experiences were surveyed using a postal questionnaire sent within 48 hours of their call, both before and after the intervention. Descriptive and comparative statistics as well as content analysis were used in the analysis of the questionnaires. The most striking finding was that the educational intervention did not seem to have any effect on outcomes of the telenurses calls. Other findings revealed that a large group of callers, about 20%, did not find the call useful and only 50% to 60% of the callers reported that they had learned something from the call. Callers’ most frequent unfulfilled expectations centred on not being referred to a physician, and a perceived low level of competence among telenurses. The modest impact of the intervention on the services of telenursing may have been due to the participating nurses, the organisation, or the design of the intervention. Lessons have been learned that need to be taken into account in future and more large scale studies.
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| 6. |
- Jalali, Amin, et al.
(författare)
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dfgcompare : a library to support process variant analysis through Markov models
- 2021
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Data-driven process analysis is an important area that relies on software support. Process variant analysis is a sort of analysis technique in which analysts compare executed process variants, a.k.a. process cohorts. This comparison can help to identify insights for improving processes. There are a few software supports to enable process cohort comparison based on the frequencies of process activities and performance metrics. These metrics are effective in cohort analysis, but they cannot support cohort comparison based on the probability of transitions among states, which is an important enabler for cohort analysis in healthcare.Results: This paper defines an approach to compare process cohorts using Markov models. The approach is formalized, and it is implemented as an open-source python library, named dfgcompare. This library can be used by other researchers to compare process cohorts. The implementation is also used to compare caregivers' behavior when prescribing drugs in the Stockholm Region. The result shows that the approach enables the comparison of process cohorts in practice.Conclusions: We conclude that dfgcompare supports identifying differences among process cohorts.
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| 7. |
- Jalali, Amin, et al.
(författare)
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Evaluating a Clinical Decision Support System for Drug-Drug Interactions
- 2019
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Ingår i: MEDINFO 2019. - : IOS Press. - 9781643680026 - 9781643680033 ; , s. 1500-1501
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Konferensbidrag (refereegranskat)abstract
- Janusmed is a clinical decision support system, developed by the Stockholm County Council that supports physicians in identifying drug-drug interactions. To determine how Janusmed is used in and affects the clinical practice, an evaluation study is currently being carried out that analyzes multiple data sources through descriptive statistics. The study focuses on how Janusmed affects the behavior of the physicians, in particular, to what extent physicians reconsider their prescription decisions based on warnings from Janusmed.
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| 8. |
- Sarkadi, Anna, et al.
(författare)
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The influence of participant's self-perceived role on metabolic outcomes in a diabetes group education program
- 2005
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 58:2, s. 137-145
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Tidskriftsartikel (refereegranskat)abstract
- We investigated the demographic, biomedical, and perceptional factors influencing HbA(1c) 2 years after baseline in an educational program for persons with type 2 diabetes. Patients (N = 259) participated in a year-long group educational program led by specially trained pharmacists. There was a significant reduction of HbA(1c) (-0.15% unit; p < 0.05) on the group level after 24 months. Answers to open-ended questions on self-perceived role in diabetes management and occasions for testing blood glucose were analyzed qualitatively and used in a regression equation. Belonging to the "active" category of self-perceived role in diabetes management was associated with better outcomes compared to having a "passive" role. In addition, testing blood glucose levels for different purposes identified by the respondents was better than not to test blood glucose levels at all. The influence of these variables was striking; of the range of demographic and biomedical factors tested, only initial HbA(1c) and treatment entered the model.
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| 9. |
- Shemeikka, Tero, et al.
(författare)
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A health record integrated clinical decision support system to support prescriptions of pharmaceutical drugs in patients with reduced renal function : Design, development and proof of concept
- 2015
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 84:6, s. 387-395
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To develop and verify proof of concept for a clinical decision support system (CDSS) to support prescriptions of pharmaceutical drugs in patients with reduced renal function, integrated in an electronic health record system (EHR) used in both hospitals and primary care. Methods: A pilot study in one geriatric clinic, one internal medicine admission ward and two outpatient healthcare centers was evaluated with a questionnaire focusing on the usefulness of the CDSS. The usage of the system was followed in a log. Results: The CDSS is considered to increase the attention on patients with impaired renal function, provides a better understanding of dosing and is time saving. The calculated glomerular filtration rate (eGFR) and the dosing recommendation classification were perceived useful while the recommendation texts and background had been used to a lesser extent. Discussion: Few previous systems are used in primary care and cover this number of drugs. The global assessment of the CDSS scored high but some elements were used to a limited extent possibly due to accessibility or that texts were considered difficult to absorb. Choosing a formula for the calculation of eGFR in a CDSS may be problematic. Conclusions: A real-time CDSS to support kidney-related drug prescribing in both hospital and outpatient settings is valuable to the physicians. It has the potential to improve quality of drug prescribing by increasing the attention on patients with renal insufficiency and the knowledge of their drug dosing.
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| 10. |
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| 11. |
- Vég, Anikó, et al.
(författare)
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Self-management profiles and metabolic outcomes in type 2 diabetes
- 2006
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 56:1, s. 44-54
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Tidskriftsartikel (refereegranskat)abstract
- Aim. This paper reports a study whose aims were (1) to examine whether it is possible to determine participants' self-management profiles using three open-ended questions about their self-perceived role in diabetes management; and (2) to analyse whether such self-management profiles have any bearing on haemoglobin A1c levels. Background. The behavioural and educational aspects of self-management in type 2 diabetes have been the topic of a number of investigations. The individual's role in maintaining health and a satisfying everyday life with chronic conditions is increasingly becoming the focus of secondary prevention. Method. Participants (n = 259) were recruited from those attending a year-long health educational programme for people with type 2 diabetes at Swedish pharmacies. A questionnaire was distributed 24 months after baseline. The health outcome, haemoglobin A1c was measured on four occasions. Three open-ended questions were used to explore self-management profiles based on perceived role, goal, and need of support in treatment. Data were collected during the period 1997–2002. Findings. The following profiles of participants emerged: Disease Manager, Compliant, and Disheartened, with no initial differences in metabolic control. However, during the programme Disease Managers achieved good glycaemic control and succeeded in maintaining the reduction in their blood glucose for a longer period than those in other categories: their haemoglobin A1c level was reduced by −0·35 at 6 months (P = 0·000), −0·30 at 12 months (P = 0·001), and −0·28 at 24 months (P = 0·001) after baseline. Compliant participants had a good everyday routine and a −0·18 reduction at 6 months (P = 0·028) but no statistically significant haemoglobin A1c level reduction later. A smaller group of people, the Disheartened, reported difficulties in living with diabetes and did not succeed in decreasing their haemoglobin A1c by statistically significant amounts. Conclusion. Healthcare professionals could use our three open-ended questions to assist in understanding people's views of their role in disease management so that health promotion and education can be tailored to individual needs.
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| 12. |
- Vég, Anikó, 1974-
(författare)
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Teaching and Learning in Type 2 Diabetes : The Importance of Self-Perceived Roles in Disease Management
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The major part of care in type 2 diabetes is in the hands of the patient so the focus of educational interventions should be on the person behind the disease. An experience-based group education programme that actively promotes participants’ reflection and understanding has been designed and implemented in cooperation with the Swedish Pharmacy. The regression model presented in Paper I revealed the importance of self-perceived role in diabetes management. Blood glucose control two years after baseline was improved for participants who described themselves as having an active role in their treatment, compared to those taking on a passive or a compliant role. Paper II described the resulting categories from content analysis of three open-ended questions about participants’ role, goal and support needs in diabetes management. The people taking care of diabetes most effectively and needing least support were called Disease Managers; those following the health professionals’ orders and depending on regular controls were categorised as Compliant, whereas the Disheartened had difficulties in achieving good metabolic control and often described both medical and social obstacles. These three self-management profiles were strongly correlated to metabolic outcomes. In Paper III perceptions of diabetes management were reassessed: perceptions were only stable in approximately half of participants, thus providing evidence for a dynamic model of learning self-management in diabetes. The three self-management profiles still correlated with metabolic outcomes. In paper IV the long-term metabolic outcome (HbA1c) of the study population was investigated. Metabolic control was stable up to seven years following the intervention, in contrast to the metabolic deterioration often present in diabetes. The main message of this thesis is that participants’ self-perceived role had a major influence on metabolic outcomes. Assessing self-management profiles both in diabetes and possibly other chronic conditions can help health care providers to tailor their educational efforts accordingly. Furthermore, this experience-based patient education programme outside the framework of routine diabetes care has the potential to stabilise metabolic control on the long run effectively.
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| 13. |
- Vég, Anikó, et al.
(författare)
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Variation of patients’ views on Type 2 diabetes management over time
- 2007
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 24:4, s. 408-414
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Tidskriftsartikel (refereegranskat)abstract
- Aims The aim of the study was to examine the relationship between participants' views about their role in diabetes treatment and their glycaemic control 3–7 years after having entered an educational intervention, and to investigate whether people's attitudes towards diabetes management change over an extended period of time. Methods The present study is a long-term follow-up analysis of data collected from 193 persons with Type 2 diabetes. A qualitative content analysis of three open-ended questions about participants' self-perceived role in diabetes treatment was used. The related outcome measure was haemoglobin A1c (HbA1c). Results The way people viewed their role in diabetes management affected glycaemic control. Individuals in the Disease Manager or Compliant categories had significantly lower HbA1c compared with those in the Disheartened category. Furthermore, in people whose attitudes towards diabetes treatment was variable, weight and age influenced why participants changed their views and thus switched categories. Paradoxically, when people changed their views, this change did not produce a change in blood glucose control, which would have been expected. Conclusions From the health-care provider's perspective, it is important to know how the person with diabetes perceives his/her role in disease management and to determine if a change in perception would be followed by intervention to adjust glycaemic control. Consequently, individuals' perception of disease management should be incorporated in patient education programmes and routine diabetes care to enable customized care and prevent stagnation in negative roles.
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| 14. |
- Wass, Sofie, et al.
(författare)
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Exploring the effects of eHealth service innovation
- 2015
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Ingår i: Health Systems. - : PALGRAVE MACMILLAN LTD. - 2047-6965 .- 2047-6973. ; 4:3, s. 212-223
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Tidskriftsartikel (refereegranskat)abstract
- To analyse the impact of implementation and use of eHealth services is fraught with difficulty, and there is often a gap between expected and identified outcomes. In this paper, we identify innovation effects of an eHealth service by applying a framework that focusses on the expected coherent impacts of implementing an IT innovation and contributes to the body of knowledge on tracking innovation effects of services in eHealth. A case study examines four different care units in a government-funded health-care setting. The results show that the effects in the first two contexts of the framework, the micro level and intra-/interorganisational level, could be clearly identified with regard to the physicians and the organisation. However, effects were lacking in the virtual context when looking beyond the involvement of the stakeholders in the eHealth service. The connections between effects for societal groups and larger societal systems simply could not be made in a satisfactory manner.
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| 15. |
- Wettermark, B, et al.
(författare)
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Financial incentives linked to self-assessment of prescribing patterns : a new approach for quality improvement of drug prescribing in primary care.
- 2009
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Ingår i: Quality in Primary Care. - 1479-1072 .- 1479-1064. ; 17:3, s. 179-189
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Financial incentives have been suggested to be effective in increasing the quality and efficiency of drug prescribing. Concern has been raised in relation to potential negative consequences on the quality of care. AIMS To describe and analyse the impact of an incentives model linking payment with adherence to drug and therapeutics committee (DTC) guidelines and self-reflection of prescribing pattern in a 'prescribing quality report'. METHODS The study was performed in the county of Stockholm, Sweden, with 139 (out of 154) primary healthcare centres (PHCs) participating in the project and 15 PHCs not participating. The study consisted of two parts: a quantitative observational study of prescribing patterns and a qualitative analysis of the submitted prescribing quality reports. All prescriptions issued from PHCs and dispensed at pharmacies during October to December 2005 and October to December 2006 were analysed, using adherence to the regional DTC guidelines as the main outcome measure. Adherence was assessed using the drug utilisation 90% methodology, i.e. focusing on drugs constituting 90% of the prescribed volume and the proportion of drugs included in the guidelines. The qualitative analysis focused on reports on the quality of drug prescribing submitted by each PHC in early 2007. RESULTS The 139 PHCs participating in the programme accounted for 85% of all prescriptions issued in primary care during October to December 2006. Mean adherence to guidelines increased among participating practices by 3.3 percentage units (95% confidence interval (CI) 2.9-3.7%) to 83% (82.6-83.7%) during the year. The adherence among practices not participating increased by 3.1 percentage units (95% CI 1.7-4.4%) to 78.8% (95% CI 76.7-80.9%). The higher adherence achieved during the year corresponded to savings estimated at five times greater than the cost of running the programme including the financial incentives. In addition, many areas for improving prescribing were identified, such as limiting the prescribing of drugs with uncertain safety profiles and documentation as well as reporting adverse drug reactions. CONCLUSION Although no causal effect can be attributed without a control group, we have shown the feasibility of a model linking payment to DTC adherence. This approach with its own quality assessment and goal setting offers an example to other regions and countries of how to increase the quality and efficiency of drug prescribing within limited resources.
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| 16. |
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