| 1. |
- Beelen, Rob, et al.
(author)
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Effects of long-term exposure to air pollution on natural-cause mortality : an analysis of 22 European cohorts within the multicentre ESCAPE project
- 2014
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In: The Lancet. - : Elsevier. - 0140-6736 .- 1474-547X. ; 383:9919, s. 785-795
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Journal article (peer-reviewed)abstract
- Background Few studies on long-term exposure to air pollution and mortality have been reported from Europe. Within the multicentre European Study of Cohorts for Air Pollution Effects (ESCAPE), we aimed to investigate the association between natural-cause mortality and long-term exposure to several air pollutants. Methods We used data from 22 European cohort studies, which created a total study population of 367 251 participants. All cohorts were general population samples, although some were restricted to one sex only. With a strictly standardised protocol, we assessed residential exposure to air pollutants as annual average concentrations of particulate matter (PM) with diameters of less than 2.5 mu m (PM2.5), less than 10 mu m (PM10), and between 10 mu m and 2.5 mu m (PMcoarse), PM2.5 absorbance, and annual average concentrations of nitrogen oxides (NO2 and NOx), with land use regression models. We also investigated two traffic intensity variables-traffic intensity on the nearest road (vehicles per day) and total traffic load on all major roads within a 100 m buff er. We did cohort-specific statistical analyses using confounder models with increasing adjustment for confounder variables, and Cox proportional hazards models with a common protocol. We obtained pooled effect estimates through a random-effects meta-analysis. Findings The total study population consisted of 367 251 participants who contributed 5 118 039 person-years at risk (average follow-up 13.9 years), of whom 29 076 died from a natural cause during follow-up. A significantly increased hazard ratio (HR) for PM2.5 of 1.07 (95% CI 1.02-1.13) per 5 mu g/m(3) was recorded. No heterogeneity was noted between individual cohort effect estimates (I-2 p value=0.95). HRs for PM2.5 remained significantly raised even when we included only participants exposed to pollutant concentrations lower than the European annual mean limit value of 25 mu g/m(3) (HR 1.06, 95% CI 1.00-1.12) or below 20 mu g/m(3) (1.07, 1.01-1.13). Interpretation Long-term exposure to fine particulate air pollution was associated with natural-cause mortality, even within concentration ranges well below the present European annual mean limit value.
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| 2. |
- Berg Skoog, Jessica, et al.
(author)
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An intervention model with self-assessment and subsequent multi-professional review might be effective and feasible to improve drug safety in primary healthcare. A survey-based evaluation of SÄKLÄK2.
- 2020
-
In: Journal of Evaluation in Clinical Practice. - : Wiley. - 1365-2753 .- 1356-1294. ; 26:1, s. 125-133
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Journal article (peer-reviewed)abstract
- Rationale, aims, and objectivesDrug‐related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi‐professional intervention model aiming at improving drug safety in primary health care. The objective of this study was to elucidate the perceptions of the participants' regarding the efficiency of the intervention and the feasibility to introduce this model widely.MethodSÄKLÄK2 is a multi‐professional intervention model in primary health care in Sweden that consisted of self‐assessment, peer‐review, written feedback, and agreements for change. Web‐based surveys were sent to both the management of participating primary health care centres (PHC) and to reviewers. The participating PHCs were fairly well‐staffed and had a high interest in improvement work. Descriptive analysis and content analysis was used.ResultsFor the PHC management, the following categories were formed: Comprehensive project, Time‐consuming, Multi‐professional character, Relevant action agreements, and Feasible to implement. For the reviewers, the following categories were formed: Multi‐professional character, Relevant action agreements, Feasible to implement, Useful self‐assessment questionnaire, and Valuable visit at the PHC. There was a high degree of consistency between the PHC management and the reviewers' answers, especially regarding the efficiency of the model to improve drug safety and the feasibility to implement it on a broad front.ConclusionSÄKLÄK2, a model with self‐assessment, peer review, written feedback, and the formation of action agreements was considered by both the participating heads of the PHC centres and the reviewers to be effective to improve drug safety in primary health care. Though time‐consuming, this multi‐professional model was considered to be feasible to implement on a broad front and might thereby be one way of working with quality improvement regarding drug safety.
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| 3. |
- Björk Javanshiri, Amanda, et al.
(author)
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Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care
- 2023
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In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 98-103
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Journal article (peer-reviewed)abstract
- ObjectiveGestational diabetes mellitus (GDM) is an established risk factor for developing type 2 diabetes mellitus (T2DM) that is possible to prevent by systematic follow-up and preventive measures. The aim of this study was to examine whether women with previous GDM were offered follow-up in primary care, according to Swedish national guidelines.DesignRetrospective review of electronic medical records.SettingPrimary care in southern Sweden, Skåne county.SubjectsWomen who received a GDM diagnosis in 2018 at the Endocrinology department, Skåne University Hospital in Lund. The study population consisted of a total number of 161 patients, whereof 83 patients were included.Main outcome measuresWhether primary care offered follow-up for T2DM after GDM and if any communication took place between secondary and primary care. Furthermore, it was examined whether the quality of the follow-up was in accordance with the national guidelines.ResultsOf the study population, a total of 29% (n = 24) had been followed-up by primary care. In 55% (n = 46) of the cases, there was no communication between secondary and primary care. Plasma glucose was checked in all (n = 20) cases where follow-up could be evaluated. Conversations about lifestyle habits took place in 70% (n = 14) of the cases. Weight and risk factors for cardiovascular disease were controlled in less than half (n = 9) of the patients. Lifestyle advice was offered in two cases and in 24% (n = 20) of the cases an annual check-up was planned.ConclusionsThe follow-up of women with previous GDM in primary care in southern Sweden was lacking in seven out of 10 cases and showed great potential for improvement.Key PointsGestational diabetes is an established risk factor for developing type 2 diabetes.Earlier research has recognized that risk reduction is possible by systematic follow-up and preventive measures, but the extent of follow-up in primary care in southern Sweden remains unknown.This study demonstrates a lack of follow-up according to national guidelines for women with previous gestational diabetes in primary care in southern Sweden.There is great potential to improve the care of these patients with relatively simple means.
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| 4. |
- Caleres, Gabriella, et al.
(author)
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A descriptive study of pain treatment and its follow-up in primary care of elderly patients after orthopaedic care
- 2020
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In: Journal of pharmaceutical health care and sciences. - : Springer Science and Business Media LLC. - 2055-0294. ; 6
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Journal article (peer-reviewed)abstract
- Background: Pain treatment post orthopaedic care in the elderly is complicated and requires careful follow-up. Current guidelines state all patients prescribed opioids should have a plan for gradual reduction, with the treatment progressively reduced and ended if any pain remains after more than three months. How this works in primary care remains to be explored.The aim was to describe pain treatment and its follow-up in primary care of elderly patients after orthopaedic care.Methods: In this descriptive study, medical case histories were collected for patients ≥ 75 years, which were enrolled at two rural primary care units in southern Sweden, and were discharged from orthopaedic care. Pain medication follow-up plans were noted, as well as current pain medication at discharge as well as two, six and twelve weeks later.Results: We included a total of 49 community-dwelling patients with medication aid from nurses in municipality care and nursing home residents, ≥ 75 years, discharged from orthopaedic care. The proportion of patients prescribed paracetamol increased from 28/49 (57%) prior to admission, to 38/44 (82%) after 12 weeks. The proportion of patients prescribed opioids increased from 5/49 (10%) to 18/44 (41%). Primary care pain medication follow-up plans were noted for 16/49 patients (33%).Conclusions: Many patients still used pain medication 12 weeks after discharge, and follow-up plans were quite uncommon, which may reflect upon lacking follow-up of these patients in primary care.
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| 5. |
- Caleres, Gabriella, et al.
(author)
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Drugs, distrust and dialogue : - a focus group study with Swedish GPs on discharge summary use in primary care
- 2018
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In: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
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Journal article (peer-reviewed)abstract
- BACKGROUND: Discharge summary with medication report effectively counteracts drug-related problems due to insufficient information transfer in care transitions. The benefits of the discharge summary may be lost if it is not adequately used, and factors affecting optimal use by the GP are of interest. Since the views of Swedish GPs are unexplored, this study aimed to explore and understand GPs experiences, perceptions and feelings regarding the use of the discharge summary with medication report.METHOD: This qualitative study was based on four focus group discussion with 18 GPs and resident physicians in family medicine which were performed in 2016 and 2017. A semi-structured interview guide was used. The interviews were transcribed verbatim and analysed using qualitative content analysis.RESULTS: The analysis resulted in three final main themes: "Importance of the discharge summary", "Role of the GP" and "Create dialogue" with six categories; "Benefits for the GP and perceived benefits for the patient", "GP use of the information", "Significance of different documents", "Spider in the web", "Terminus/End station" and "Improved information transfer in care transitions". Overall, the participants described clear benefits with the discharge summary when accurate although perceived deficiencies were also quite rife.CONCLUSION: The GPs experiences and views of the discharge summary revealed clear benefits regarding mainly medication information, awareness of any plans as well as shared knowledge with the patient. However, perceived deficiencies of the discharge summary affected its use by the GP and enhanced communication was called for.
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| 6. |
- Caleres, Gabriella, et al.
(author)
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Elderly at risk in care transitions When discharge summaries are poorly transferred and used -a descriptive study
- 2018
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In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Discharge summary with medication report effectively counteracts drug-related problems among elderly patients due to insufficient information transfer in care transitions. However, this requires optimal transfer and use of the discharge summaries. This study aimed to examine information transfer with discharge summaries from hospital to primary care.METHODS: A descriptive study with data consisting of discharge summaries of 115 patients, 75 years or older, using five or more drugs, collected during one week from 28 different hospital wards in Skåne county, Sweden. Two weeks after discharge, information transfer was examined via review of primary care medical records. It was noted whether the discharge summary was received (i.e. scanned to the primary care medical records), if the medication list was updated with drug changes and if a patient chart entry regarding medication or its follow-up was made in the primary care medical records. An electronic survey, which was sent to 151 primary care units in Skåne county, was used to examine experiences of the information transfer.RESULTS: Out of 115 discharge summaries, 47 (41%) were found in the primary care medical records. Patient chart entries regarding medication or its follow-up were seen in 53 (46%) cases. Drug changes during hospitalisation were seen in 51 out of 76 patients without multidose drug dispensing. In 16 (31%) out of these cases, medication lists were updated in primary care medical records. In the electronic survey, 22 (21%) out of the 107 responding primary care units reported the discharge summary was often received on the day of discharge, while 71 (66%) respondents indicated the discharge summary was always/often received but later. Medication list updates and patient chart entries in the primary care medical records were always/often done upon receipt of the discharge summary according to 61 (57%) respondents.CONCLUSION: The transfer of information was often deficient and the discharge summaries were insufficiently used. Many discharge summaries were lost, an insufficient proportion of medication lists were updated and patient chart entries were often lacking. These findings may increase the risk of medication errors and drug-related problems for elderly in care transitions.
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| 7. |
- Caleres, Gabriella, et al.
(author)
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Medication Discrepancies in Discharge Summaries and Associated Risk Factors for Elderly Patients with Many Drugs
- 2020
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In: Drugs - Real World Outcomes. - : Springer Science and Business Media LLC. - 2199-1154 .- 2198-9788. ; 7:1, s. 53-62
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Journal article (peer-reviewed)abstract
- BACKGROUND AND OBJECTIVE: Elderly patients are at high risk for medication errors in care transitions. The discharge summary aims to counteract drug-related problems due to insufficient information transfer in care transitions, hence the accuracy of its medication information is of utmost importance. The purpose of this study was to describe the medication discrepancy rate and associated risk factors in discharge summaries for elderly patients.METHODS: Pharmacists collected random samples of discharge summaries from ten hospitals in southern Sweden. Medication discrepancies, organisational, and patient- and care-specific factors were noted. Patients aged ≥ 75 years with five or more drugs were further included. Descriptive and logistic regression analyses were performed.RESULTS: Discharge summaries for a total of 933 patients were included. Average age was 83.1 years, and 515 patients (55%) were women. Medication discrepancies were noted for 353 patients (38%) (mean 0.87 discrepancies per discharged patient, 95% confidence interval 0.76-0.98). Unintentional addition of a drug was the most common discrepancy type. Central nervous system drugs/analgesics were most commonly affected. Major risk factors for the presence of discrepancies were multi-dose drug dispensing (adjusted odds ratio 3.42, 95% confidence interval 2.48-4.74), an increasing number of drugs in the discharge summary (adjusted odds ratio 1.09, 95% confidence interval 1.05-1.13) and discharge from departments of surgery (adjusted odds ratio 2.96, 95% confidence interval 1.55-5.66). By contrast, an increasing number of drug changes reduced the odds of a discrepancy (adjusted odds ratio 0.93, 95% confidence interval 0.88-0.99).CONCLUSIONS: Medication discrepancies were common. In addition, we identified certain circumstances in which greater vigilance may be of considerable value for increased medication safety for elderly patients in care transitions.
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| 8. |
- Dobszai, Annika, et al.
(author)
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Clinical impact of medication reviews for community-dwelling patients in primary healthcare
- 2023
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In: BMC Primary Care. - 2731-4553. ; 24:1
-
Journal article (peer-reviewed)abstract
- Background: A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent on the process. We aimed to evaluate medication reviews for community-dwelling patients regarding the clinical relevance of the pharmacists’ recommendations, and their implementation by general practitioners. We also wanted to investigate if the general practitioners’ tendency to act on drug-related problems was correlated to different factors of the process. Methods: This was a cohort study, where patients in primary healthcare considered in need of a medication review were selected. Pharmacists identified drug-related problems and gave written recommendations on how to solve the problems to the general practitioner, via the medical record, and in addition in some cases via verbal communication. The clinical relevance of the recommendations was graded according to the Hatoum scale, ranging from one (adverse significance) to six (extremely significant). Descriptive statistics were used regarding the clinical relevance and the general practitioners´ tendency to act on drug-related problems. Multiple logistic regression analysis was used to examine the association between the tendency to act and different factors of the process. Results: A total of 96.1% of the 384 assessed recommendations from the pharmacists were graded as significant or more for the patient (Hatoum grade 3 or higher). The general practitioners acted on 63.8% of the drug-related problems. Fewer recommendations per patient, as well as verbal communication in addition to written contact, significantly increased the general practitioners’ tendency to act on a drug-related problem. No significant association was seen between the tendency to act and the clinical relevance of the recommendation. Conclusions: The high proportion of clinically relevant recommendations from the pharmacists in this study strengthens medication reviews as an important tool for reducing drug-related problems. Verbal communication between the pharmacist and the general practitioner is important for measures to be taken. Multiple recommendations for the same patient reduced their likelihood to of being addressed by the general practitioner.
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| 9. |
- Gagnemo Persson, Rebecca, et al.
(author)
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Läkemedel
- 2016. - 1
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In: Omvårdnad & medicin. - 9789144076645 ; , s. 125-138
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Book chapter (pop. science, debate, etc.)
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| 10. |
- Hansen Kristensson, Jenny, et al.
(author)
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Medications causing potential cognitive impairment are common in nursing home dementia units – A cross-sectional study
- 2021
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In: Exploratory Research in Clinical and Social Pharmacy. - : Elsevier BV. - 2667-2766. ; 3
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Journal article (peer-reviewed)abstract
- BackgroundWith advancing age the brain becomes more sensitive to centrally acting drugs thus increasing the risk of cognitive side-effects. The Swedish National Board of Health and Welfare developed indicators to measure and follow quality in older people's drug therapy, one being “Potentially Inappropriate Medications risking Cognitive impairment (PIMcogn)”. Associations between anticholinergics and cognitive impairment are described, especially in persons with Alzheimer's disease or Lewy Body Dementia/Parkinson's disease dementia, due to degenerated cholinergic pathways.ObjectivesTo examine the prevalence of PIMcogn and if it differed between nursing home residents with and without a dementia diagnosis and between residents with different dementia aetiologias.MethodsDescriptive cross-sectional study, based on residents ≥65 years in nursing home dementia units in Malmö, Sweden, in 2012–2013 (N = 574).ResultsThe study population consisted of 76% women, the mean age was 86 years and a dementia diagnosis was registered in 92%. A total of 74% were prescribed at least one PIMcogn. Benzodiazepines were prevalent in 59%, opioids in 27%, antipsychotics in 20% and anticholinergics in 13%. Opioids used regularly and antiepileptics were more common in residents without a dementia diagnosis. The lowest proportion of anticholinergics was seen in the oldest age group, 11.0%. There was no difference seen in anticholinergics between dementia types with considerable cholinergic deficit and other dementia diagnoses.ConclusionsTreatment with at least one PIMcogn was common. Usage of benzodiazepines and antipsychotics was, despite the knowledge of alarming side-effects, high.An awareness of the inappropriateness in prescribing anticholinergics to the oldest old seems to be apparent, but not to persons with cholinergic deficit.
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| 11. |
- Høj Jørgensen, Terese Sara, et al.
(author)
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The importance of close next of kin for independent living and readmissions among older Swedish hip fracture patients
- 2022
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In: Health & Social Care in the Community. - : Hindawi Limited. - 0966-0410 .- 1365-2524. ; 30:3, s. e727-e738
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Journal article (peer-reviewed)abstract
- We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients’ probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture.
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| 12. |
- Kristensson, Jimmie, et al.
(author)
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Healthcare utilisation and knowledge concerning prescribed drugs among older people.
- 2010
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In: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 66, s. 1047-1054
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of this study was to explore healthcare consumption in relation to more versus less knowledge concerning prescribed drugs among older people with functional dependency and repeated healthcare contacts, and to explore the determinants of more versus less knowledge METHODS: The sample comprised 63 persons (mean age 82.8 years). Data concerning use and knowledge about drugs, demographics, health complaints and self-reported diseases were collected from the baseline measure in an ongoing randomised controlled trial (RCT) and merged with data from two public registers about healthcare consumption 2 years prior to baseline measurement. Data were analysed descriptively and using regression analysis. RESULTS: Fifty-two percent of the sample (n = 33) had less knowledge (defined as not knowing the indications for 50% or less of their prescribed drugs) and these had more acute hospitals stays (median 2 vs 0), more total hospital stays (median 2 vs 1) and more bed days in hospital (median 18 vs 3) than those with more knowledge. Bed days and visits to other outpatient staff groups were associated with less knowledge; visits to physicians were associated with more knowledge. CONCLUSIONS: The healthcare consumption pattern of those with less knowledge differed from that of those with more knowledge in terms of more acute inpatient care. The results indicate that there is a need for the health system to create mechanisms to ensure that patients do not lose their knowledge about their drugs when admitted in an acute situation; there is also an apparent need for educational intervention with patients, starting at the time of admission.
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| 13. |
- Lundell, Sara, 1982-, et al.
(author)
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Perceptions of Home Telemonitoring Use Among Patients With Chronic Obstructive Pulmonary Disease : Qualitative Study
- 2020
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In: JMIR mhealth and uhealth. - : JMIR Publications. - 2291-5222. ; 8:6
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Journal article (peer-reviewed)abstract
- Background: Chronic obstructive pulmonary disease (COPD) is a major health problem and an economic burden globally. There is growing interest in how electronic health (eHealth) can be used to provide efficient health care. Telemonitoring, where the patient's health-related data is transmitted to a health care provider, can be used to detect early signs of exacerbations. A successful implementation of telemonitoring systems into clinical practice requires in-depth knowledge of the users' preferences.Objective: The aim of this study was to explore perceptions of the use of a home telemonitoring system among patients with COPD.Methods: Semistructured individual interviews were carried out with 8 women and 5 men who were participants in a project aimed at developing and evaluating a telemonitoring system. The web-based telemonitoring system measured pulmonary function, subjective symptoms, and oxygen saturation. Participants were interviewed after having used the system for 2-4 months. Interview transcripts were analyzed with qualitative content analysis.Results: The analysis resulted in the theme A transition toward increased control and security and four categories: using with (in)security, affecting technical concern or confidence, providing easy access to health care, and increasing control over the disease. The participants reported various perceptions of using the telemonitoring system. They expressed initial feelings of insecurity, both in terms of operating the system and in terms of their disease. However, the practical management of the telemonitoring system became easier with time; the participants gradually gained confidence and improved their self-management. New technology was perceived as an important complement to existing health care, but the importance of maintaining a human contact in real life or through the telemonitoring system was emphasized.Conclusions: This study captured a transition among the participants from being insecure and experiencing technical concerns to acquiring technical confidence and improving disease management. Telemonitoring can be a valuable complement to health care, leading to increased self-knowledge, a sense of security, and improved self-management. Suggestions to improve the further development and implementation of telemonitoring systems include better patient education and the involvement of end users in the technical development process. Additional research is needed, particularly in the design of user-friendly systems, as well as in developing tools to predict which patients are most likely to find the equipment useful, as this may result in increased empowerment, improved quality of life, reduced costs, and a contribution to equity in health.
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| 14. |
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| 15. |
- Modig, Erik, et al.
(author)
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Can advertising creativity affect product perceptions and retailer evaluations?
- 2014
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In: Journal of Product and Brand Management. - 1061-0421. ; 23:6, s. 452-461
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Journal article (peer-reviewed)abstract
- Practical implications This study introduces advertising creativity as a way for retailers to increase perceived product quality and value. The results show that advertising creativity increases perceived effort on behalf of the sender, which positively influences purchase intentions. Originality/value The current study shows that advertising creativity can work as a signal of product quality, which has positive effects for retailers.
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| 16. |
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| 17. |
- Modig, Erik, et al.
(author)
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More Than Price? Exploring the Effects of Creativity and Price in Advertising
- 2013
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In: Advances in Consumer Research. - : Association for Consumer Research. - 0098-9258. ; 41, s. 373-377
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Journal article (peer-reviewed)abstract
- Even though advertising creativity has shown to be of importance for advertising effectiveness little research has tested it in relation to other marketing strategies. This paper explores the effects of advertising creativity (high/low) at different price levels (high/ medium/low). The results suggest that creativity has greatest impact at low price levels.
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| 18. |
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| 19. |
- Modig, Sara, et al.
(author)
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Assessment of medication discrepancies with point prevalence measurement : how accurate are the medication lists for Swedish patients?
- 2022
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In: Drugs and Therapy Perspectives. - : Springer Science and Business Media LLC. - 1172-0360 .- 1179-1977. ; 38:4, s. 185-193
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Journal article (peer-reviewed)abstract
- Background: Medication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements. Methods: Participants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used. Results: In total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029). Conclusion: Medication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.
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| 20. |
- Modig, Sara, et al.
(author)
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Depressive symptoms among frail elderly in ordinary living: who is affected and who is treated?
- 2014
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In: Aging & Mental Health. - : Informa UK Limited. - 1364-6915 .- 1360-7863. ; 18:8, s. 1022-1028
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Journal article (peer-reviewed)abstract
- Objectives: Depression is common but not always recognized and often undertreated among elderly. Cardiovascular diagnoses have been reported to be associated with depression. The study examined if this association could be confirmed in a frail elderly population. It also assessed the association between high depressive scores and certain health complaints and the use of certain drugs, respectively.Method: A total of 153 frail elderly in ordinary living were included. The association between depressive symptoms, assessed by geriatric depression scale (GDS) 20, and an inpatient diagnose of cerebrovascular disease or heart failure was assessed. Depressive symptoms were also compared with health complaints and background data. Furthermore, the use of certain drugs, such as antidepressants and other psychotropics, was compared with depressive symptoms.Results: Risk of depression was seen in 52% of the patients. Those showing risk of depression more often received municipal care or help with medication distribution and were more often treated with sedatives. They also had significantly more health complaints. No differences were found between those who had or did not have a diagnosis of heart failure or transient ischemic attack (TIA)/stroke during hospital care the previous year regarding risk for depression or treatment with antidepressants, respectively. Sixteen per cent were treated with antidepressants and this group was significantly younger than those who were not treated.Conclusion: Those elderly with a GDS score indicating a risk for depression have poorer health, are more dependent on help and are more often treated with sedatives. The study could not confirm an association between heart failure or TIA/stroke and risk for depression.
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| 21. |
- Modig, Sara, et al.
(author)
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Frail elderly patients' experiences of information on medication. A qualitative study
- 2012
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In: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 12
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Journal article (peer-reviewed)abstract
- Background: Older patients generally have only poor knowledge about their medicines. Knowledge is important for good adherence and for participating in decisions about treatment. Patients are entitled to be informed on an individual and adequate level. The aim of the study was to explore frail elderly patients' experiences of receiving information about their medications and their views on how the information should best be given. Methods: The study was qualitative in design and was carried out in 2011. Twelve frail elderly (aged 68-88) participants taking cardiovascular medications participated in semi-structured interviews covering issues related to receiving information about prescribed medicines. The interviews were recorded, transcribed and subjected to content analysis, in which the text was analysed in five steps, inspired by Graneheim and Lundman. Results: The results revealed that the experiences which the elderly participants had regarding the receiving of medical information fell into two main categories: "Comfortable with information" or "Insecure with information". The elderly felt comfortable when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Conclusions: Factors that frequently caused insecurity about information and anxiety were too short consultations, lack of availability of someone to answer questions or of the opportunity to contact the physician if adverse effects are suspected. These factors could easily be dealt with and there must be improvements in the clinics if the patients' feelings of security are to be increased.
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| 22. |
- Modig, Sara, et al.
(author)
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Frail elderly patients in primary care-their medication knowledge and beliefs about prescribed medicines.
- 2009
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In: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 65, s. 151-155
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Journal article (peer-reviewed)abstract
- PURPOSE: The aim of this study was to describe elderly patients' knowledge about and attitudes towards their medicines in Swedish primary care. METHODS: Thirty-four patients aged 65 years and above with multiple illnesses were included. Medication knowledge was assessed with a questionnaire measuring knowledge about indication and possible adverse effects for each medicine. Attitudes were investigated with the Beliefs about Medicines Questionnaire. RESULTS: The indication of at least 75% of their medicines was known to 71% of the patients. Patients with polypharmacy and multi-dose drug distribution respectively had significantly less knowledge. Eighty-four percent had no knowledge about possible adverse effects. For 93% of the patients, the benefits of the medication outweighed the costs (concerns). No correlation was found between attitudes and knowledge. CONCLUSIONS: The knowledge about indication was higher than previously seen, but the knowledge about possible adverse effects was poor. The patients had strong beliefs in the benefits of their medication.
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| 23. |
- Modig, Sara, et al.
(author)
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GP's Adherence to Guidelines for Cardiovascular Disease among Elderly: A Quality Development Study.
- 2012
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In: The Scientific World Journal. - : Hindawi Limited. - 2356-6140 .- 1537-744X. ; 2012
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Journal article (peer-reviewed)abstract
- Background: Evidence-based guidelines should in most cases be followed also in the treatment of elderly. Older people are often suboptimally treated with the recommended drugs. Objectives: To describe how well general practitioners adhere to current guidelines in the treatment of elderly with cardiovascular disease and evaluate local education as a tool for improvement. Method: Data was collected from the medical records of patients aged ≥65, who visited a primary health care center in Sweden 2006 and had one or more of the following diagnoses: hypertension, ischemic heart disease, heart failure, chronic atrial fibrillation, or prior stroke. Local education was organized and included feed-back to the patient's doctor and discussion about regional guidelines. Repeated measurements were performed in 2008. Results and Conclusion:The adherence to guidelines was low. Approximately one-third of the patients with hypertension reached target blood pressure, stroke patients more often. More patients with heart failure were treated with angiotensin converting enzyme inhibitor than in other European countries, but still only 60%. Half of the patients with chronic atrial fibrillation were treated with Warfarin, although more than two-thirds had a CHADS(2) score indicating the need. Educational efforts appeared to increase the adherence and hence should be encouraged.
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| 24. |
- Modig, Sara, et al.
(author)
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Kidney function and use of nonsteroidal anti-inflammatory drugs among elderly people : a cross-sectional study on potential hazards for an at risk population
- 2018
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In: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 40:4, s. 870-877
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Journal article (peer-reviewed)abstract
- Background Renal elimination normally decreases with age. Nonsteroidal antiinflammatory drugs (NSAIDs) carry a risk of additional kidney damage. Objective The aims of this study were to assess the prevalence of NSAIDs in the elderly (aged ≥ 65) population in Sweden, explore reasons for any possible differences in the level of use and assess their kidney functions. Setting Data were obtained from the cohort study Good Aging in Skåne, Sweden. Patients aged 65 or more were included. Methods Medication lists were collected as well as variables such as cognition and education levels. Glomerular filtration rate was estimated from creatinine and cystatin C. Descriptive statistics and multiple linear regression analysis were used. Main outcome measure: NSAID use among the general elderly population. Results A total of 1798 patients were included. Approximately six percent (n = 105) of the people in the study group were using NSAIDs and of those 82 (78%) bought NSAIDs over the counter (OTC). 42% of those buying NSAIDs OTC showed an estimated glomerular filtration rate below 60 ml/min/1.73 m2. Education level did not affect the use of nonsteroidal anti-inflammatory drugs, nor did age. NSAIDs were more commonly used than other recommended analgesics. Conclusion Many people are unaware of the risks associated with the use of NSAIDs. The findings imply that the frailest elderly use NSAIDs to the same extent as the younger elderly do. It is important that information about safety of these drugs be communicated to both patients and healthcare professionals.
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| 25. |
- Modig, Sara
(author)
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MANAGING DRUG USE IN THE ELDERLY. General practitioners’ adherence to guidelines and patients’ conceptions of medication
- 2012
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Older patients’ knowledge about their medicines is generally poor. Patients are entitled to be informed on an individual and adequate level. Evidence-based guidelines should, in most cases, be followed also in the treatment of elderly to avoid suboptimal treatment, for example for cardiovascular conditions, or risky prescriptions in the case of renal impairment. Objectives: 1. To describe frail elderly patients’ knowledge about and attitudes towards their medicines and to explore their experiences of receiving information about their medications. 2. To describe how well general practitioners (GPs) adhere to guidelines when using renal risk drugs in frail elderly patients and when treating elderly with cardio¬¬vascular disease and to evaluate local education of GPs as a tool for improvement. Methods: (Paper I, IV) For each prescribed medicine, the patient was asked about the indication and possible adverse effects. Attitudes were investigated with the Beliefs about Medicines Questionnaire. Semi-structured interviews covering questions on information about medication were analysed qualitatively. (Paper II) Medications for elderly patients in nursing homes were registered and the use of renal risk drugs was compared to renal function, estimated from s-creatinine and s-cystatin C. (Paper III) Data about GPs adherence to guidelines was collected from the medical records of patients aged ≥ 65 with a cardiovascular diagnosis. Local education was organized, followed by repeated measurements. Results: The knowledge about indication was satisfying but the knowledge about possible adverse effects was poor. The patients believed strongly in the benefits of their medication. The elderly felt comfortable with information when they trusted their physician or their medication, when they received enough information from the prescriber or when they knew how to find out sufficient information by themselves. They felt insecure if they were anxious, if the availability of medical care was poor or if they did not receive enough information. Reduced renal function was common (53%) in nursing home patients but s-creatinine was often normal. Renal risk drugs were rarely prescribed. The adherence to guidelines about cardiovascular diseases was low among GPs, but educational efforts appeared to increase the adherence. Conclusions: To receive an adequate drug therapy in the elderly, GPs should pay attention to patients’ need for suitable information on their medication and follow evidence-based guidelines about when to initiate and when to avoid certain drugs.
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