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- 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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- 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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| 4. |
- Renberg, Tobias, 1977-, et al.
(författare)
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Pharmacy users' expectations of pharmacy encounters : a Q-methodological study
- 2011
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Ingår i: Health Expectations. - : Wiley. - 1369-6513 .- 1369-7625. ; 14:4, s. 361-373
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pharmacy practice is evolving according to general healthcare trends such as increased patient involvement, evidence-based practice and public health initiatives. In addition to this, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under-explored topic but crucial to understand how pharmacy practice can evolve efficiently. Objective: To identify and describe clusters of people with different normative expectations of the pharmacy encounter. Methods: Q-methodology, an approach to systematically explore subjectivity that retain complete patterns of response and organises these into factors of operant subjectivity. Setting and participants: 85 regular prescription medication users mainly recruited at Swedish community pharmacies. Results: Seven factors of operant subjectivity were identified, organised into two groups. Factors that emphasised the physical drug product as the central object of the pharmacy encounter were labelled as independent drug shopping; logistics of drug distribution; and drugs before drug use before healthcare. Factors that emphasised personal support as desirable were labelled competence as individual support; individualist professional relations, just take care of me; and practical healthcare and lifestyle support. Discussion and conclusions: The systematic q-methodological approach yielded valuable insights in how pharmacy clients construct their expectations for service encounters. They hold differentiating normative expectations for pharmacy services. Understanding these varying viewpoints is important for developing and prioritising among efficient pharmacy services. Clients’ expectations do not correspond with many of the trends that guide current pharmacy practice development. This might be a challenge for promoting or implementing services based on such trends.
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- Wallman, Andy, 1975-, et al.
(författare)
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An Exploration of How Students Learn in a Pharmacy Internship
- 2011
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Ingår i: Pharmacy Education. - 1560-2214 .- 1477-2701. ; 11:1, s. 177-182
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Tidskriftsartikel (refereegranskat)abstract
- Background - The pharmacy internship introduces students to pharmacy practice. An understanding of learning processes in the internship is vital for educators in order to develop activities that support learning. Aim - The aim was to analyse students‟ learning activities in a Swedish pharmacy internship from both students‟ and tutors‟ perspectives. Method - Interviews with pharmacy internship students (n=17) and pharmacist tutors (n=18) were performed, followed by a qualitative analysis. Results – The results showed that learning activities ranged from formal, organized activities to informal learning by participating in the professional community. There was a perceived lack of integration between formal and informal activities. Tutors and students acknowledged the influence of the context for learning and the importance of tutors for supporting learning. Conclusion - Both formal and informal learning activities have to be accepted and made explicit. Integrating formal and informal learning activities, using the full continuum of possible learning activities, can enhance learning.
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| 6. |
- Wallman, Andy, 1975-
(författare)
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Pharmacy Internship : Students’ Learning in a Professional Practice Setting
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to explore Swedish pharmacist students’ learning during pharmacy internship. Internships are meant to introduce students to professional practice. Education programs have to reflect changes in the professional role, and take into account that learning in a professional practice setting differs from organized formal education. This thesis includes both quantitative and qualitative research approaches and applies workplace learning theories. A scheme for measuring pharmacy students’ reflective ability was developed and shown to be feasible and reliable. Factors important for reflection were found to be primarily social and contextual, especially trained tutor and small pharmacy size. Notably, learning style or critical thinking did not correlate to students’ reflective ability. Tutors and students perceived that students used a wide variety of activities supporting learning of a broad repertoire of knowledge and skills, preparing them for coming professional working life. Tutors are most important to support learning. However, the current curriculum and formal activities do not address all these outcomes and learning activities used, e.g. workplace learning. The first overall conclusion is that internship plays an essential part in the pharmacist education program. The integration of formal and informal learning activities during internship, including raising awareness of incidental learning, is important to support students in learning the professional practice of pharmacy. This integration could possibly be strengthened by introducing further tutor training, different assignments, and by using portfolios. The second conclusion is that the community of practice is essential for students’ learning during internship, especially the student-tutor interaction. Hence, the entire social context has to be considered and it is important to ensure a good learning environment at pharmacies during internship. In summary, this thesis contributes to the understanding of students’ learning during pharmacy internship and introduces educational research on the Swedish undergraduate pharmacy education programs.
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| 7. |
- Wallman, Andy, et al.
(författare)
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Swedish Students and Preceptors Perceptions of What Students Learn in a Six-Month Advanced Pharmacy Practice Experience
- 2011
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Ingår i: American Journal of Pharmaceutical Education. - : American Association of Colleges of Pharmacy. - 0002-9459 .- 1553-6467. ; 75:10, s. 1-10
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. less thanbrgreater than less thanbrgreater thanMethods. Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. less thanbrgreater than less thanbrgreater thanResults. The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. less thanbrgreater than less thanbrgreater thanConclusions. Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.
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