| 1. |
- Bergkvist, Anna, et al.
(författare)
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A multi-intervention approach on drug therapy can lead to a more appropriate drug use in the elderly. LIMM-Landskrona Integrated Medicines Management
- 2009
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Ingår i: Journal of Evaluation in Clinical Practice. - : Wiley. - 1365-2753 .- 1356-1294. ; 15:4, s. 660-667
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives To evaluate if an integrated medicines management can lead to a more appropriate drug use in elderly inpatients. Method The study was an intervention study at a department of internal medicine in southern Sweden. During the intervention period pharmacists took part in the daily work at the wards. Systematic interventions aiming to identify, solve and prevent drug-related problems (DRPs) were performed during the patient's hospital stay by multidisciplinary teams consisting of physicians, nurses and pharmacists. DRPs identified by the pharmacist were put forward to the care team and discussed. Medication Appropriateness Index (MAI) was used to evaluate the appropriateness in the patients' drug treatment at admission, discharge and 2 weeks after discharge. In total 43 patients were included, 28 patients in the intervention group and 25 patients in the group which was used as control. Results For the intervention group there was a significant decrease in the number of inappropriate drugs compared with the control group (P = 0.049). Indication, duration and expenses were the MAI-dimensions with most inappropriate ratings, and the drugs with most inappropriate ratings were anxiolytics, hypnotics and sedatives. Conclusion This kind of systematic approach on drug therapy can result in a more appropriate drug use in the elderly.
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| 2. |
- Bergkvist, Anna, et al.
(författare)
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Improved quality in the hospital discharge summary reduces medication errors-LIMM: Landskrona Integrated Medicines Management.
- 2009
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 1037-1046
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: We have developed a model for integrated medicines management, including tools and activities for medication reconciliation and medication review. In this study, we focus on improving the quality of the discharge summary including the medication report to reduce medication errors in the transition from hospital to primary and community care. METHODS: This study is a longitudinal study with an intervention group and a control group. The intervention group comprised 52 patients, who were included from 1 March 2006 until 31 December 2006, with a break during summer. Inclusion in the control group was performed in the same wards during the period 1 September 2005 until 20 December 2005, and 63 patients were included in the control group. In order to improve the quality of the medication report, clinical pharmacists reviewed and gave feedback to the physician on the discharge summary before patient discharge, using a structured checklist. Medication errors were then identified by comparing the medication list in the discharge summary with the first medication list used in the community health care after the patient had returned home. RESULTS: By improving the quality of the discharge summary, patients had on average 45% fewer medication errors per patient (P = 0.012). The proportion of patients without medication errors was 63.5% in the control group and 73.1% in the intervention group. However, this increase was not significant (P = 0.319). Patients who used a specific medication dispensing system (ApoDos) had a 5.9-fold higher risk of suffering from medication errors than those without this medication dispensing system (P < 0.001). CONCLUSION: Review and feedback on errors in the discharge summary, including the medication report and a correct medication list, reduced medication errors during the transfer of information from hospital to primary and community care.
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| 3. |
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| 4. |
- Hedblad, Bo, et al.
(författare)
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High blood pressure despite treatment: Results from a cross-sectional primary healthcare-based study in southern Sweden.
- 2006
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:4, s. 224-230
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study degree of blood pressure (BP) control in primary healthcare (PHC) treated hypertensive patients in relation to sex, age, drug treatment, and concomitant diseases. Design. Random sample of patients with hypertension. Setting. Ten PHC centres in the Region of Skane, Sweden. Subjects. All the 30- to 95-year-old patients with hypertension who during the period 12 September to 24 September 2004 attended their PHC (146 men and 229 women). Main outcome measures. Achievement of BP control (< 140/90 mmHg) according to European guidelines. Results. Some 90% had been treated > 12 months, 40% had mono-therapy, 15% >= 3 drugs. Use of diuretics was more common in women while use of ACE inhibitors and calcium channel blockers was common in men. Inadequate BP control was related to age; only 22% had BPB < 140/90 mmHg, 38% had a BP >= 160/100 mmHg. BP decline was inversely related to BP measured 12 months or more prior to the present follow-up (r = -0.64, p < 0.001, for systolic and r = -0.67, p < 0.001, for diastolic BP). The systolic or diastolic BP had in every fifth patient during treatment increased by >= 10 mmHg. No association was found between average BP decline and prescribed number of drugs. Conclusion. A minority of the patients had BP below the level (< 140/90 mmHg) recommended by European guidelines. This study illustrates the need for continued follow-up of defined groups of patients in order to improve quality of care.
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| 5. |
- Midlöv, Patrik, et al.
(författare)
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Barriers to adherence to hypertension guidelines among GPs in southern Sweden: A survey.
- 2008
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 26, s. 154-159
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To evaluate barriers to adherence to hypertension guidelines among publicly employed general practitioners (GPs). Design. Questionnaire-based survey distributed to GPs in 24 randomly selected primary care centres in the Region of Skåne in southern Sweden. Subjects. A total of 109 GPs received a self-administered questionnaire and 90 of them responded. Main outcome measures. Use of risk assessment programmes. Reasons to postpone or abstain from pharmacological treatment for the management of hypertension. Results. Reported managing of high blood pressure (BP) varied. In all, 53% (95% CI 42-64%) of the GPs used risk assessment programmes and nine out of 10 acknowledged blood pressure target levels. Only one in 10 did not inform the patients about these levels. The range for immediate initiating pharmacological treatment was a systolic BP 140-220 (median 170) mmHg and diastolic BP 90-110 (median 100) mmHg. One-third (32%; 95% CI 22-42%) of the GPs postponed or abstained from pharmacological treatment of hypertension due to a patient's advanced age. No statistically significant associations were observed between GPs' gender, professional experience (i.e. in terms of specialist family medicine and by number of years in practice), and specific reasons to postpone or abstain from pharmacological treatment of hypertension. Conclusion. These data suggest that GPs accept higher blood pressure levels than recommended in clinical guidelines. Old age of the patient seems to be an important barrier among GPs when considering pharmacological treatment for the management of hypertension.
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| 6. |
- Midlöv, Patrik, et al.
(författare)
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Clinical outcomes from the use of Medication Report when elderly patients are discharged from hospital
- 2008
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 30:6, s. 840-845
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Tidskriftsartikel (refereegranskat)abstract
- Objective The objective of this study was to investigate whether a Medication Report also can reduce the number of patients with clinical outcomes due to medication errors. Method A prospective intervention study with retrospective controls on patients at three departments at Lund University Hospital, Sweden that where transferred to primary care. The intervention group, where patients received a Medication Report at discharge, was compared with a control group with patients of the same age, who were not given a Medication Report when discharged from the same ward one year earlier. For patients with at least one medication error all contacts with hospital or primary care within 3 months after discharge were identified. For each contact it was evaluated whether this was caused by the medication error. We also compared medication errors that have been evaluated as high or moderate clinical risk with medication errors without clinical risk. Main outcome measures Need for medical care in hospital or primary care within three months after discharge from hospital. Medical care is readmission to hospital as well as visits of study population to primary and out-patient secondary health care. Results The use of Medication Report reduced the need for medical care due to medication errors. Of the patients with Medication Report 11 out of 248 (4.4%) needed medical care because of medication errors compared with 16 out of 179 (8.9%) of patients without Medication Report (p = 0.049). The use of a Medication Report significantly reduced the risk of any consequences due to medication errors, p = 0.0052. These consequences included probable and possible care due to medication error as well as administrative procedures (corrections) made by physicians in hospital or primary care. Conclusions The Medication Report seems to be an effective tool to decrease adverse clinical consequences when elderly patients are discharged from hospital care.
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| 7. |
- Midlöv, Patrik, et al.
(författare)
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Drug-related problems in the elderly
- 2009
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Bok (refereegranskat)abstract
- Drug-related problems in the elderly is intended to serve as a source of information and clinical support in geriatric pharmacotherapy for students as well as all health care professionals, e.g. physicians, nurses and pharmacists. Pharmacotherapy is of great importance to all mankind. Drugs are however powerful and must be handled appropriately. This is especially important for elderly patients. Drug-related problem is not a major subject in most university programmes in medicine or pharmacy. When there is no specific course, there is often no book covering the topic. In our view, as teachers at various university courses, there has been a shortage of literature that re ects the most important aspects of drug-related problems in the elderly. Medical practitioners, nurses and pharmacists, need to have this knowledge to be able to serve their patients in the best way. This book covers most aspects of drug-related problems in the elderly. With b- ter knowledge of drug-related dif culties and risks we hope that elderly will have fewer drug-related problems and bene t more from their pharmacotherapy.
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| 8. |
- Midlöv, Patrik
(författare)
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Drug-related problems in the elderly - Interventions to improve the quality of pharmacotherapy
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Elderly people, in particular those residing in nursing homes, often use many drugs. In general elderly patients are at greater risk of experiencing drug-related problems (DRP), as they have multiple diseases, are using many drugs and have changed physiological status. Objectives: To describe the frequency of potential drug-related problems in the elderly and to evaluate different kinds of interventions that are meant to reduce the number of potential drug-related problems in the elderly. Methods: (Paper I) All information on medication use in nursing home patients with epilepsy or Parkinson's disease was collected. A multi-speciality team evaluated nursing home patients' medication and, when appropriate, suggested changes. (Paper II) Elderly patients that had been discharged from hospital were identified. All information on their medications prior to, during and after hospital care was collected. Medication errors during transfer between care levels were identified. (Paper III) Educational outreach visits were offered General Practitioner (GP) practices. Data on prescribing of benzodiazepines and anti-psychotic drugs to elderly before and after this education was compared with a control group of GP practices. (Paper IV) Implementation of a medication report when elderly patients are discharged from hospital care. Results: Inappropriate medications are common in nursing homes. Medication errors are frequent when elderly patients are transferred between hospital and primary care (Papers II and IV). Advice from a multi-speciality team did not have any positive effects on the quality of life in nursing home patients (Paper I). Educational outreach visits are well appreciated by GPs and can affect their prescribing habits leading to a decrease in prescribing of inappropriate medications to elderly patients (Paper III). Medication Report is effective in reducing the number of medication errors when elderly patients are transferred from hospital to primary care (Paper IV). Conclusions: The research comprising this thesis has demonstrated a need for attention towards drug-related problems in the elderly. Educational outreach visits are effective in affecting GPs prescribing habits. Medication report is a simple but very effective instrument to decrease the number of medication errors when elderly patients are discharged from hospital.
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| 9. |
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| 10. |
- Midlöv, Patrik, et al.
(författare)
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Medication errors when transferring elderly patients between primary health care and hospital care
- 2005
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Ingår i: PHARMACY WORLD & SCIENCE. - : Springer Science and Business Media LLC. - 0928-1231 .- 1573-739X. ; 27:2, s. 116-120
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care. Method: Elderly primary health care patients (> 65 years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital. Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not. Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added. Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients' medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.
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