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- Björkman, Ingeborg, et al.
(author)
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Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment : A qualitative study among primary care physicians in Sweden
- 2013
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:1, s. 50-55
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Journal article (peer-reviewed)abstract
- ObjectivesTo improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs' views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden.DesignQualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis.SettingPrimary care in Kronoberg, a county in southern Sweden.SubjectsA purposeful sample of 20 GPs from 15 of 25 health centres in the county.Main outcome measures.The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs.ResultsThree different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs' perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice.ConclusionThere was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.
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2. |
- Björkman, Ingeborg, et al.
(author)
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Health promotion at Swedish pharmacies : views of the staff
- 2008
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In: Pharmacy Practice (Internet). - 1886-3655. ; 6:4, s. 211-218
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Journal article (peer-reviewed)abstract
- The role of pharmacy has changed dramatically during the last decades, which has led to new demands on pharmacy personnel. Objective: This study aims at exploring the attitudes of Swedish pharmacy personnel on their role as public health promoters and to look at the opportunities and obstacles they identify in the efforts to widen the pharmacy remit to include a wider health approach. Method Eight focus group discussions were conducted with a strategic sample of pharmacy personnel working in two counties in Sweden. The discussions were transcribed verbatim and analysed by qualitative inductive analysis. Results Five themes were identified, “Pharmacy activities impact on public health”, “The employer, Apoteket AB”, “The new role welcomed”, “Obstacles in the new role”, and “Need of change and support”. Conclusion The concept of pharmacy personnel as public health promoters was not initially in the mindset of the participants. In the process of discussion, the impact of traditional pharmacy practice as well as new pharmacy based initiatives on public health gradually became more obvious to them. The findings show a pharmacy staff involved in a process of change. The participants have not yet landed in their new role as public health promoters and the study shows that practical as well as conceptual support is needed in order for pharmacy personnel to play a more important role in public health.
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3. |
- Bond, Melissa, et al.
(author)
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The current state of using learning analytics to measure and support K-12 student engagement : A scoping review
- 2023
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In: LAK23. - New York, NY : Association for Computing Machinery (ACM). - 9781450398657 ; , s. 240-249, s. 240-249
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Conference paper (peer-reviewed)abstract
- Student engagement has been identified as a critical construct for understanding and predicting educational success. However, research has shown that it can be hard to align data-driven insights of engagement with observed and self-reported levels of engagement. Given the emergence and increasing application of learning analytics (LA) within K-12 education, further research is needed to understand how engagement is being conceptualized and measured within LA research. This scoping review identifies and synthesizes literature published between 2011-2022, focused on LA and student engagement in K-12 contexts, and indexed in five international databases. 27 articles and conference papers from 13 different countries were included for review. We found that most of the research was undertaken in middle school years within STEM subjects. The results show that there is a wide discrepancy in researchers’ understanding and operationalization of engagement and little evidence to suggest that LA improves learning outcomes and support. However, the potential to do so remains strong. Guidance is provided for future LA engagement research to better align with these goals. © 2023 ACM
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4. |
- Lenander, Cecilia, et al.
(author)
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Effects of an intervention (SäkläK) on prescription of potentially inappropriate medication in elderly patients
- 2017
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In: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 34:2, s. 213-218
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Journal article (peer-reviewed)abstract
- Background. Polypharmacy is known to increase the risk for drug-related problems, and some drugs, potentially inappropriate medications (PIMs), are especially troublesome. Objective. To analyse the effects on prescription of PIMs of the SäKLäK project, an intervention model created to improve medication safety for elderly patients in primary care. Method. The SäkläK project was a multiprofessional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. Five Swedish primary care centres participated in the intervention and five served as comparison group. Data were collected from the Swedish Prescribed Drug Register on PIMs (long-acting benzodiazepines, anticholinergics, tramadol, propiomazine, antipsychotics and non-steroidal anti-inflammatory drugs) prescribed to patients aged 65 years and older. Total number of patients and change in patients using PIMs before and after intervention with-in groups was analysed as well as differences between intervention and comparison group. Results. A total of 32 566 prescriptions of PIMs were dispensed before the intervention, 19 796 in the intervention group and 12 770 in the comparison group. After intervention a decrease was seen in both groups, intervention-22.2% and comparison-8.8%. All groups of PIMs decreased, except for antipsychotics in the comparison group. For the intervention group, a significant decrease in mean dose/patient was seen after the intervention but not in the comparison group. Conclusion. Our study shows this method has some effects on prescription of PIMs. The evaluation indicates this is a feasible method for improvement of medication use in primary care and the method should be tested on a larger scale.
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5. |
- Lenander, Cecilia, et al.
(author)
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Effects of medication reviews on use of potentially inappropriate medications in elderly patients; a cross-sectional study in Swedish primary care
- 2018
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18
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Journal article (peer-reviewed)abstract
- BACKGROUND: Drug use among the elderly population is generally extensive and the use of potentially inappropriate medications (PIMs) is common, which increases the risk for drug-related problems (DRP). Medication reviews are one method to improve drug therapy by identifying, preventing and solving DRPs. The aim of this study was to evaluate the effect of medication reviews on total drug use and potentially inappropriate drug use in elderly patients, as well as describe the occurrence and types of drug-related problems.METHOD: This was a cross-sectional analysis to study medication reviews conducted by trained clinical pharmacists followed by team-based discussions with general practitioners (GPs) and nurses, for elderly primary care patients in Skåne, Sweden. Included in the analysis were patients ≥75 years living in nursing homes or in their own homes with home care, who received a medication review during 2011-2012. Documented DRPs were described as both the type of DRPs and as pharmacists' recommendations to the GP. The usage of ≥3 psychotropics and PIMs (antipsychotics, anticholinergics, long-acting benzodiazepines, tramadol and propiomazine) at baseline and after medication review were also studied.RESULTS: The analysis included a total of 1720 patients. They were on average aged 87.5 years, used typically 11.3 drugs (range 1-35) and 61% of them used 10 drugs or more. Of the patients, 84% had at least one DRP with a mean of 2.2 DRPs/patient. Of the DRPs, 12% were attributable to PIMs. The proportion of patients with ≥ one PIM was reduced significantly (p < 0.001) as was the use of ≥3 psychotropics (p < 0.001). The most common DRP was unnecessary drug therapy (39%), followed by dose too high (21%) and wrong drug (20%). Drug withdrawal was the most common result.CONCLUSION: This study shows that medication reviews performed in everyday care are one way of improving drug use among elderly patients. The use of potentially inappropriate medications and use of three or more psychotropic drugs decreased after the medication review. Our study also shows that drug use is extensive in nursing home residents and elderly patients with homecare, and that unnecessary drug therapy is a common problem.
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7. |
- Lenander, Cecilia, et al.
(author)
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Use of Antipsychotic Drugs by Elderly Primary Care Patients and the Effects of Medication Reviews: A Cross-Sectional Study in Sweden
- 2017
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In: Drugs - Real World Outcomes. - : Springer Science and Business Media LLC. - 2199-1154 .- 2198-9788. ; 4:3, s. 159-165
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Journal article (peer-reviewed)abstract
- Background Antipsychotics form a class of drugs that should be used with caution among elderly people because of a high risk of adverse events. Despite the risks and modest effects, their use is estimated to be high, especially in nursing homes. Objective The aim was to explore the effects of medication reviews on antipsychotic drug use for elderly primary care patients and describe the extent of, and reasons for, the prescription of antipsychotics.Methods In this cross-sectional study in primary care in Skane, Sweden, patients aged >75 years living in nursing homes or in their own homes with home care were included. The effects of medication reviews were documented, as were the use of antipsychotics and the differences in characteristics between patients receiving or not receiving antipsychotics.Results A total of 1683 patients aged 87.6 (±5.7) years were included in the analysis. Medication reviews reduced the use of antipsychotics by 23% (p\0.001) in this study. Of the 206 patients using antipsychotics, 43% (n = 93) had an approved indication, while for 15% (n = 32) the indication was not given. Antipsychotic drug use was more common with increasing number of drugs (p = 0.001), and in nursing home residents (p\0.01). It was also morefrequent in patients with cognitive impairment, depressive symptoms or sleeping problems.Conclusion The use of antipsychotic drugs is high in elderly patients in nursing homes. They are often given for indications that are not officially approved or are poorly documented. Medication reviews appear to offer one usefulstrategy for reducing excessive use of these drugs.
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8. |
- Modig, Sara, et al.
(author)
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Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units
- 2016
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 17:1, s. 1-10
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Journal article (peer-reviewed)abstract
- Background: There is an urgent need to improve patient safety in the area of medication treatment among the elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the agreements for change that were established within the intervention. Methods: The SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment, peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis. Results: Strengths that were identified included a committed leadership, work methods to enhance medication safety and access to consultants. Methods for securing an accurate medication list, knowledge and methods of working of the prescriber and patient's ability to contribute to medication safety were areas that gave rise to three predesigned categories for improvement needs on a local level. Another category became apparent during the analysis; namely learning from mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further education in geriatrics and pharmacotherapy and lack of information on indication and maximum dosage. An increased number of medication reviews were among the most common agreements for change seen. Conclusions: This study identified substantial shortcomings, like poorly updated medication lists, which affected medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in other primary care units in the country. Working together multi-professionally, including performing medication reviews, could be one way of improving medication safety. On the other hand, the individual physician must possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions. Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of medication errors.
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9. |
- Muxamuud, Xabiibo, et al.
(author)
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A collaborative development initiative to strengthen Midwifery Education in Somalia
- 2024
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In: Somali Health Action Journal. - 2004-1985. ; 4:1
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Journal article (peer-reviewed)abstract
- Galkayo University, in an ongoing partnership with Benadir University and the Karolinska Institutet, reports on the co-creation of a mentorship program for midwifery educators at Galkayo University. This program was initiated in Spring 2023 with the aim of sharing experiences on midwifery education between educators from Sweden and Somalia—both countries with long traditions of midwifery care. By leveraging the expertise of Swedish and Somali midwifery educators, the mentorship program seeks to bridge gaps in knowledge and skills, ultimately contributing to better midwifery education and care in both Somalia and Sweden. This commentary describes the significance of the program and its potential for impact if scaled up after contextualization.
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10. |
- Viberg, Nina
(author)
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Selling drugs or providing health care? The role of private pharmacies and drugstores, examples from Zimbabwe and Tanzania
- 2009
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Doctoral thesis (other academic/artistic)abstract
- Background: In low-income countries many people do not have access to formal health care because of poverty and weak health systems. Instead people seek care at private pharmacies and drugstores. Infectious diseases such as sexually transmitted infections (STI) and diarrhoea are common and access to correct management is of big importance. Assessing the quality and finding the potential for improvement of private pharmacy and drugstore practice is therefore of uttermost importance for public health. Main objective: To explore and describe the role of private pharmacies and drugstores in resourcelimited settings with a focus on antibiotics in Zimbabwe and Tanzania. Methods: Semi-structured interviews with pharmacists from nine African countries were analysed with a phenomenographic approach (I). Structured facility and staff interviews and the simulated client method (SCM) were used in private pharmacies in four Zimbabwean towns. The simulated clients presented a male and a female STI case and a child-with-acute-diarrhoea case. Statistical analysis was applied and step models were developed (II). Drugsellers in private drugstores in eight Tanzanian districts were interviewed. The SCM was used presenting a male and a female STI case. Data were analysed statistically and QATI scores were developed (III). Exit-customers of private drugstores in eight Tanzanian districts were interviewed. Drugsellers from three Tanzanian districts filled in a questionnaire with closed and open-ended questions. Mixed qualitative and quantitative analysis (IV). Results: Four different ways of perceiving the role of the pharmacist were identified: the satisfied dispenser; the dissatisfied dispenser; the health care team member and the life saver (I). A majority (69%) of the staff in the Zimbabwean pharmacies stated they would never sell an antibiotic without prescription and few actually did so, in spite of a high customer demand. Not many provided acceptable information and advice: 8% STI male, 33% STI female and 22% for the diarrhoea case (II). Although 74% of the Tanzanian drugsellers claimed there were no STI-related drugs in the store, drugs were dispensed in a majority of the SCM visits. In 80% of the male SCM visits and in 90% of the female, the client was dispensed drugs that are recommended in the Tanzanian guidelines for syndromic management of urethral and vaginal discharge syndromes. Dosage regimens were however often incorrect and complete syndromic management rarely provided. In 76% of the male SCM visits and 35% of the female, antibiotics were dispensed (III). Antibiotics were bought by 24% of the exitcustomers. Dispensed drugs were assessed to be relevant for the symptoms/disease presented in 83% of all cases and in 51% for antibiotics specifically. Thirty percent had seen a health worker before coming and almost all of these had a prescription. Non-prescribed drugs were more relevant than prescribed drugs. Of the drugsellers, 79% stated that bacterial diseases can be treated with antibiotics, of these, 24% stated the same for viral disease. Most (72%) had heard of antibiotic resistance. They described antibiotic resistance and how it occurs quite rationally from a biomedical point of view but also presented less plausible descriptions of the topics (IV). Conclusion: There is a potential to use private pharmacies and drugstores in a more formal way for the benefit of health in the low-income settings studied. Drugsellers have considerable practicalknowledge of antibiotics and other drugs. Current regulations might impede them from playing a more important role as well as improving their practice.
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