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Hellström, Lina
Publications (10 of 18) Show all publications
Throfast, V., Hellström, L., Hovstadius, B., Petersson, G. & Ericson, L. (2019). e-Learning for the elderly on drug utilization: a pilot study. Health Informatics Journal, 25(2), 227-239
Open this publication in new window or tab >>e-Learning for the elderly on drug utilization: a pilot study
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2019 (English)In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 25, no 2, p. 227-239Article in journal (Refereed) Published
Abstract [en]

This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
aged, computer-assisted instruction, drug utilization, e-learning, education
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Health and Caring Sciences, Health Informatics
Identifiers
urn:nbn:se:lnu:diva-74242 (URN)10.1177/1460458217704245 (DOI)000468931800001 ()28464726 (PubMedID)2-s2.0-85065640411 (Scopus ID)
Available from: 2018-05-09 Created: 2018-05-09 Last updated: 2019-08-29Bibliographically approved
Hellström, L. & Johansson Östbring, M. (2019). Patients with coronary heart disease who have negative beliefs about their medicines report lower adherence. International Journal of Clinical Pharmacy, 41(1), 343-343
Open this publication in new window or tab >>Patients with coronary heart disease who have negative beliefs about their medicines report lower adherence
2019 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 41, no 1, p. 343-343Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Springer, 2019
National Category
Pharmaceutical Sciences
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:lnu:diva-80951 (URN)000458652000176 ()
Available from: 2019-03-05 Created: 2019-03-05 Last updated: 2019-03-05Bibliographically approved
Johansson Östbring, M., Eriksson, T., Petersson, G. & Hellström, L. (2018). Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation. JMIR Research Protocols, 7(1), 1-12, Article ID e21.
Open this publication in new window or tab >>Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation
2018 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, no 1, p. 1-12, article id e21Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation.

OBJECTIVE: This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective.

METHODS: The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients' beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients' overall experience of care after coronary heart disease.

RESULTS: The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known.

CONCLUSIONS: This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.

Place, publisher, year, edition, pages
JMIR Publications, 2018
Keywords
coronary artery disease, quality of health care, medication adherence, medication therapy management, pharmacist
National Category
Social and Clinical Pharmacy
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:lnu:diva-71384 (URN)10.2196/resprot.8660 (DOI)000432915700019 ()29382630 (PubMedID)
Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2019-05-20Bibliographically approved
Johansson Östbring, M., Eriksson, T., Petersson, G. & Hellström, L. (2018). Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life. JMIR Research Protocols, 7(2), 1-15, Article ID e57.
Open this publication in new window or tab >>Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life
2018 (English)In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, no 2, p. 1-15, article id e57Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients' adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes.

OBJECTIVE: This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately.

METHODS: The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient's medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use.

RESULTS: The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019.

CONCLUSIONS: The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy).

Place, publisher, year, edition, pages
JMIR Publications, 2018
Keywords
coronary artery disease, medication adherence, medication therapy management, pharmacist, randomized controlled trial
National Category
Social and Clinical Pharmacy
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:lnu:diva-71385 (URN)10.2196/resprot.8659 (DOI)000432916000005 ()29463490 (PubMedID)
Funder
The Kamprad Family Foundation
Available from: 2018-03-06 Created: 2018-03-06 Last updated: 2019-05-20Bibliographically approved
Hellström, L. & Throfast, V. (2017). General beliefs about medicines among independent elderly adults in Sweden: data from an RCT. International Journal of Clinical Pharmacy, 39(1), 223-224, Article ID PH009.
Open this publication in new window or tab >>General beliefs about medicines among independent elderly adults in Sweden: data from an RCT
2017 (English)In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 39, no 1, p. 223-224, article id PH009Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Springer, 2017
National Category
Social and Clinical Pharmacy
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:lnu:diva-61682 (URN)000394437100064 ()
Available from: 2017-03-24 Created: 2017-03-24 Last updated: 2018-01-13Bibliographically approved
Johansson Östbring, M., Eriksson, T., Petersson, G. & Hellström, L. (2014). Medication beliefs and self-reported adherence - results of a pharmacist’s consultation: A pilot study. European Journal of Hospital Pharmacy: Science and Practice, 21(2), 102-107
Open this publication in new window or tab >>Medication beliefs and self-reported adherence - results of a pharmacist’s consultation: A pilot study
2014 (English)In: European Journal of Hospital Pharmacy: Science and Practice, ISSN 2047-9956, Vol. 21, no 2, p. 102-107Article in journal (Refereed) Published
Abstract [en]

ObjectivesClinical outcomes in the secondary prevention of cardiovascular disease depend on the patients’ adherence to prescribed medicines. Motivational interviewing (MI) is a patient-centered approach used to change different health behaviors. The objective of this pilot study was to explore the impact of a clinical pharmacist’s consultation on beliefs about medicines and self-reported medication adherence among patients with coronary heart disease (CHD).

MethodsCHD-patients participating in a prevention program at the Kalmar County Hospital were randomized to control or intervention. The intervention consisted of a medication review focused on cardiovascular drugs, and a semi-structured interview based on MI-approach, with a follow-up phone call two weeks later. The intervention was conducted by a clinical pharmacist at the cardiology unit three months post-discharge.

Primary outcome measures were the results from the Beliefs about medicines-Specific (BMQ-S) and the 8-Item Morisky Medication Adherence Scale (MMAS-8) two weeks after intervention.

Results21 enrolled patients (11 intervention) all completed to follow-up. MMAS-8 was very similar in the intervention and control groups. In BMQ-S the intervention group had a mean (SD) necessity score of 21 (4) and a concern score of 12 (6), corresponding results in the control group were 21 (3) and 10 (5). However, since there was a difference in BMQ-S at baseline, seven intervention patients shifted towards more positive beliefs compared to two control patients.

ConclusionNo difference was found in adherence and beliefs at follow-up. However, after consultation a larger proportion of patients changed towards more positive beliefs compared to control.

National Category
Pharmaceutical Sciences
Research subject
Biomedical Sciences, Pharmacology
Identifiers
urn:nbn:se:lnu:diva-31179 (URN)10.1136/ejhpharm-2013-000402 (DOI)000336518600010 ()2-s2.0-84895447658 (Scopus ID)
Available from: 2013-12-11 Created: 2013-12-11 Last updated: 2018-01-11Bibliographically approved
Johansson Östbring, M., Eriksson, T., Petersson, G. & Hellström, L. (2014). Patient-centered medication review in coronary heart disease: impact on beliefs about medicines. European Journal of Cardiovascular Nursing, 13, S15-S15
Open this publication in new window or tab >>Patient-centered medication review in coronary heart disease: impact on beliefs about medicines
2014 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 13, p. S15-S15Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-34074 (URN)000333672200028 ()
Available from: 2014-05-05 Created: 2014-05-05 Last updated: 2017-12-05Bibliographically approved
Hovstadius, B., Petersson, G., Hellström, L. & Ericson, L. (2014). Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators. Drugs & Aging, 31(5), 379-386
Open this publication in new window or tab >>Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators
2014 (English)In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 5, p. 379-386Article in journal (Refereed) Published
Abstract [en]

Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged >= 65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. Results For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged >= 75 years), all indicators except excessive polypharmacy showed improvement. Conclusion According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

National Category
Pharmaceutical Sciences Geriatrics
Research subject
Health and Caring Sciences
Identifiers
urn:nbn:se:lnu:diva-34475 (URN)10.1007/s40266-014-0165-5 (DOI)000335146000006 ()2-s2.0-84900829669 (Scopus ID)
Available from: 2014-05-28 Created: 2014-05-28 Last updated: 2018-01-11Bibliographically approved
Hellström, L., Höglund, P., Bondesson, Å., Petersson, G. & Eriksson, T. (2012). Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all cause emergency department revisits. Journal of Clinical Pharmacy and Therapeutics, 37(6), 686-692
Open this publication in new window or tab >>Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all cause emergency department revisits
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2012 (English)In: Journal of Clinical Pharmacy and Therapeutics, ISSN 0269-4727, E-ISSN 1365-2710, Vol. 37, no 6, p. 686-692Article in journal (Refereed) Published
Abstract [en]

What is known and objective: Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug-related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post-discharge hospital revisits or death.

Methods: This prospective, controlled study included all patients hospitalised in three internal medicine wards in a university hospital, between January 1 2006 and May 31 2008. Medication reconciliation on admission and inpatient medication review, conducted by clinical pharmacists in a multiprofessional team, were implemented in these wards at different times during 2007 and 2008 (intervention periods). A discharge medication reconciliation was undertaken in all the study wards, during both control and intervention periods. Patients were included in the intervention group (n=1216) if they attended a ward with medication reconciliation and review, whether they had received the intervention or not. Control patients (n=2758) attended the wards before implementation of the intervention. 

Results: No impact of medication reconciliation and reviews on ED revisits (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.86-1.04) or event-free survival (HR, 0.96; 95% CI, 0.88-1.04) was demonstrated. In the intervention group, 594 patients (48.8%) visited the ED, compared to 1416 (51.3%) control patients. In total, 716 intervention (58.9%) and 1688 (61.2%) control patients experienced any event (ED visit, hospitalisation or death). Because the time to a subsequent ED visit was longer for the control as well as the intervention groups in 2007 than in 2006 (p<0.05), we re-examined this cohort of patients; the proportion of patients revisiting the ED was similar in both groups in 2007 (p=0.608).

What is new and conclusion: Routine implementation of medication reconciliation and reviews on admission and during the hospital stay did not appear to have any impact on ED revisits, rehospitalisations or mortality over six months' follow-up.  

Keywords
Medications, hospital, medication review, medication reconciliation, pharmacist, clinical pharmacy, multiprofessional team, LIMM-model, readmission, Läkemedel, sjukhus, läkemedelsgenomgångar, läkemedelsavstämning, apotekare, klinisk farmaci, multiprofessionellt team, LIMM-modellen, återinläggning
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-21947 (URN)10.1111/jcpt.12001 (DOI)2-s2.0-84868369185 (Scopus ID)
Available from: 2012-10-08 Created: 2012-10-08 Last updated: 2018-01-12Bibliographically approved
Hellström, L. (2012). Clinical pharmacy services within a multiprofessional healthcare team. (Doctoral dissertation). Växjö, Kalmar: Linnaeus University Press
Open this publication in new window or tab >>Clinical pharmacy services within a multiprofessional healthcare team
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: The purpose of drug treatment is to reduce morbidity and mortality, and to improve health-related quality of life. However, there are frequent problems associated with drug treatment, especially among the elderly. The aim of this thesis was to investigate the impact of clinical pharmacy services within a multiprofessional healthcare team on quality and safety of patients’ drug therapy, and to study the frequency and nature of medication history errors on admission to hospital.

Methods: A model for clinical pharmacy services within a multiprofessional healthcare team (the Lund Integrated Medicines Management model, LIMM) was introduced in three hospital wards. On admission of patients to hospital, clinical pharmacists conducted medication reconciliation (i.e. identified the most accurate list of a patient’s current medications) to identify any errors in the hospital medication list. To identify, solve and prevent any other drug-related problems, the clinical pharmacists interviewed patients and performed medication reviews and monitoring of drug therapy. Drug-related problems were discussed within the multiprofessional team and the physicians adjusted the drug therapy as appropriate.

Results: On admission to hospital, drug-related problems, such as low adherence to drug therapy and concerns about treatment, were identified. Different statistical approaches to present results from ordinal data on adherence and beliefs about medicines were suggested. Approximately half of the patients were affected by errors in the medication history at admission to hospital; patients who had many prescription drugs had a higher risk for errors. Medication reconciliation and review reduced the number of inappropriate medications and reduced drug-related hospital revisits. No impact on all-cause hospital revisits was demonstrated.

Conclusion: Patients admitted to hospital are at high risk for being affected by medication history errors and there is a high potential to improve their drug therapy. By reducing medication history errors and improving medication appropriateness, clinical pharmacy services within a multiprofessional healthcare team improve the quality and safety of patients’ drug therapy. The impact of routine implementation of medication reconciliation and review on healthcare visits will need further evaluation; the results from this thesis suggest that drug-related hospital revisits could be reduced.

Place, publisher, year, edition, pages
Växjö, Kalmar: Linnaeus University Press, 2012. p. 63
Series
Linnaeus University Dissertations ; 84/2012
Keywords
Clinical pharmacy services, pharmacist, medication review, medication reconciliation, medication errors, drug-related problems, inappropriate prescribing, elderly, inpatients, patient readmissions, hospitalisation, multiprofessional, patient care team, continuity of patient care, Klinisk farmaci, farmaceut, läkemedelsgenomgång, läkemedelsavstämning, läkemedelsfel, läkemedelsrelaterade problem, olämpliga läkemedel, äldre, återinläggning, sjukhusinläggning, multiprofessionell, vårdteam, kontinuitet i vården
National Category
Social and Clinical Pharmacy
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-18293 (URN)978-91-86983-47-5 (ISBN)
Public defence
2012-05-16, N2007, Västergård, Smålandsgatan 26E, Kalmar, 13:00 (Swedish)
Opponent
Supervisors
Projects
Läkemedelsgenomgångar och läkemedelsavstämning - LIMM-modellen
Available from: 2012-04-12 Created: 2012-04-11 Last updated: 2018-01-12Bibliographically approved
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