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  • 1.
    Abdul Rahim, Ranya
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kommunikationsproblem på svenska apotek: Förekomst och orsak2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication.

    The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions.

    Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication.

    The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors?

    Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

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  • 2.
    Ax, Fredrik
    et al.
    Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Electronic transmitted prescriptions not picked up at pharmacies in Sweden2010In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 6, no 1, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Background: Electronic transmitted prescriptions (ETPs) became common after 1995 in Sweden; however, it is accompanied by a substantial increase in the number of prescriptions not picked up at pharmacies.

    Objective: To investigate the ‘‘no pick-up’’ rates of ETPs at pharmacies across type of drug and patient age and gender and the reasons patients’ report for no pick-up.

    Methods: A cross-sectional study examining no pick-up of ETPs transmitted during 3 months in 2002, and a mail survey of patients to determine the reasons for failure to pick-up in the county of Sormland, Sweden, with a population of 261,000, and 21 pharmacies. Chi-square tests were used for calculations of frequency differences among groups.

    Results: The overall no pick-up rate of ETPs was 2.5%; men had consistently higher rates than women. The highest rates were seen for adolescents and young adults. Rates were higher than average for antibiotics. About 60% of the answers indicated that prescriptions not picked up were duplicate prescriptions or not needed. ‘‘Unintentional nonadherence’’ was reported by one-fifth of patients.

    Conclusions: No pick-up rate in general was low (2.5%), but there were differences across patient age and sex, the rates being higher among adolescents and young adults. Duplicate prescriptions may explain a significant share of the abandoned prescriptions.

  • 3.
    Bardage, Carola
    et al.
    Uppsala University, Sweden.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ring, Lena
    Uppsala University, Sweden.
    Health care professionals’ perspectives on automated multi-dose drug dispensing2014In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 12, no 4, article id 470Article in journal (Refereed)
    Abstract [en]

    Background: During the 1980s, manual repackaging of multi-dose medications from pharmacies in Sweden was successively substituted with automated multi-dose drug dispensing (MDD). There are few studies evaluating the consequences of automated MDD with regard to patient safety, and those that investigate this issue are not very extensive.

    Objectives: To investigate Swedish health care professionals’ perceived experience of automated MDD and its effects on patient adherence and patient safety.

    Methods: Three questionnaire forms, one for physicians, nurses, and assistant nurses/nursing assistants, were developed based on reviews of the literature and pilot testing of the questions in the intended target groups. The target groups were health professionals prescribing or administrating MDD to patients. A sample (every sixth municipality) was drawn from the sampling frame of Swedish municipalities, resulting in 40 municipalities, about 14% of all municipalities in Sweden. Email addresses of general practitioners were obtained from county councils, while the municipalities assisted in getting contact details for nurses, assistant nurses and nursing assistants. A total of 915 questionnaires were distributed electronically to physicians, 515 to nurses, and 4,118 to assistant nurses/nursing assistants. The data were collected in September and October 2012.

    Results: The response rate among physicians, nurses and assistant nurses/nursing assistants was 31%, 43% and 23%, respectively. The professionals reported that automated MDD reduces duplication of medication, contributes to correct dosages, helps patients take their medication at the right time, and reduces confusion among patients. Fifteen per cent of the physicians and about onethird of the nurses and assistant nurses/nursing assistants reported that generic substitution makes it more difficult for the patient to identify the various medicines available in the sachets. The physicians did, however, note that prescribing medicine to patients with automated MDD is complicated and can be a risk for patient safety. Both physicians and nurses requested more information on and training in automated MDD. They also asked for more medication reviews.

    Conclusions: The professionals generally had a positive attitude to automated MDD with regard to improved medication adherence, but said they believed that the electronic prescribing system posed a safety risk for patients.

  • 4.
    Bardage, Carola
    et al.
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Med Prod Agcy, Uppsala.
    Ring, Lena
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Health-Care Professionals' Perspectives on Multi-Dose Dispensed Medicines2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, p. 251-251Article in journal (Other academic)
  • 5.
    Berg, Christer
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Dosages involving split tablets - common but unnecessary?2010In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 3, p. 137-141Article in journal (Refereed)
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  • 6.
    Berg, Christer
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Haupt, Dan
    Department of Health Sciences, Lulea University of Technology, Lulea.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Prescriptions on split tablets: a common drug related problem - but unnecessary?2007In: ESCP 7th Spring Conference on Clinical Pharmacy 16-19 May 2007, Edinburgh: Tackling Inequalities in the Delivery of Pharmaceutical Care, 2007, p. 1-16Conference paper (Refereed)
  • 7.
    Bladh, Emil
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Säkerhet vid val av apotek: Enkätundersökning om kunskap och uppfattningar om symboler för godkänt apotek2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Aim: The aim of the degree project is to examine individual’s knowledge about symbols for approved pharmacy and how such a marking and other factors affect their choice of pharmacy from a safety perspective.

    Introduction: In a survey made by the Swedish Medical Products Agency (MPA) from 2008, 51 illegal websites targeting Swedish pharmacy customers were found. These websites illegally sold prescription pharmaceuticals without the requirement of a prescription from their customers. Shopping on illegal internet pharmacies can have great risks like contaminated drugs, lack of information about the drugs or that the drugs never gets delivered. To lower the risk that pharmacy customers accidently buys medications from the illegal online pharmacies, two symbols have been created for Swedish pharmacy customers, one by the MPA (figure 1) and one by the European Commission (figure 2). The idea is that the customer is supposed to click on one of the symbols on an online pharmacy’s website which is linked to a list for approved online pharmacies at the website of the MPA. If the customer finds the name and web address of the pharmacy on that list, the customer will know that the pharmacy is approved. But if the name and address isn’t found on the list, the pharmacy can be illegal, and the customer should avoid from shopping from the pharmacy.

    Material and methods: An electronic questionnaire with 10 question (Appendix A) was created in regard of the aim and sent out via the social platform “Facebook” through the students Facebook account. The survey included questions about which factors, from a security perspective, that influence the respondents to choose an online pharmacy and the respondents’ knowledge about the two symbols for controlling if an online pharmacy is approved. The results were analysed at a group level so that no individuals could be identified.

    Results and Discussion: The survey showed that a majority of the respondents had seen the Swedish symbol for approved pharmacy (figure 1) from the MPA (n=44, 59 %). However, a majority did not know what it means (n=57 or 77 %). Regarding the EU-symbol for approved pharmacy (figure 2), it turned out that most of the respondents had not seen it (n=58, 78 %) and even more didn’t know what it means (n=62, 84 %). The respondents in the study controlled pharmacies in different ways, for example making their own assessment if an online pharmacy seems safe (n=21, 51 %) or that they choose an online pharmacy that they have seen on some sort of commercial (n=17, 41 %) (Table II). For some it wasn’t something they thought about (n=10, 24 %) (Table II).

    Conclusions: The conclusion is that most of the respondents had seen the Swedish symbol for approved pharmacy but did not know what it means. Few respondents had seen the EU-symbol for approved pharmacy and even fewer knew what it means. The most common factors influencing the respondents’ choice of a pharmacy, from a security perspective, was by making their own assessment if the online pharmacy seems safe or choose a pharmacy which they have seen from a commercial. For some of the respondents, it wasn’t something they considered when choosing pharmacy.

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    Säkerhet vid val av apotek
  • 8.
    Bondesson, Åsa
    et al.
    Lunds Universitet.
    Hellström, Lina
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Eriksson, Tommy
    Lunds Universitet.
    Höglund, Peter
    Lunds Universitet.
    A structured questionnaire to assess patient compliance and beliefs about medicines taking into account the ordered categorical structure of data2009In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 15, no 4, p. 713-723Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVE: The objectives were to describe and evaluate the structured medication questionnaire and to improve data handling of results from the Morisky four-item scale for patient compliance and Beliefs about Medicines Questionnaire-specific (BMQ-specific). METHODS: A questionnaire was developed with the purpose of being used when identifying medication errors and assessing patient compliance to and beliefs about medicines. RESULTS: A majority of the respondents (62%; CI 45-77%) had at least one medication error. Assuming that all items are equally important in the Morisky four-item scale we presented four alternative ways to create a unidimensional global scale. A two-dimensional global scale was also constructed. The results from the BMQ-specific were presented in different ways, all taking into account that the scale has ordered verbal categories: at the level addressing each specific question, at the sub-scales 'concern' and 'necessity' level and at the global level. CONCLUSIONS: The structured medication questionnaire can be used in daily practice as a tool to identify drug-related problems. The choice of how to use and present data from those scales in research depends on patient characteristics and how discriminating one would like the scales to be.

  • 9.
    Castensson, Staffan
    et al.
    Forskning och Utveckling, Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Pharmaceutical Waste: The Patient Role2010In: Green and Sustainable Pharmacy / [ed] Kümmerer, Klaus; Hempel, Maximilian, Heidelberg Dordrecht London New York: Springer, 2010, 1, p. 179-200Chapter in book (Other academic)
  • 10.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Occurrence of prescriptions for noncurrent - changed or terminated -treatment and prescription duplicates in electronic medical records and the Swedish national prescription repository2010In: The 14th European Symposium on Patient Adherence, COMpliance and Persistence, LODZ, POLAND 17-18.09.2010, Lodz.Polen, 2010Conference paper (Refereed)
    Abstract [en]

    Patient adherence to prescribed treatment for chronic conditions has been estimated to be on average about 50% [1] and drug related problems may cause as much as 30% of acute admittances to hospital care [2]. Discrepancies between medical records and patients’ actual current medication are common [3-5].

     

    The objective of the present study was to compare current prescribed treatment stated by patients with the printouts from the electronic medical record (EMR) and the Swedish national prescription repository (NPR) with regard to (1) prescriptions for noncurrent (previously changed or terminated) treatment, (2) prescription duplicates and (3) missing prescriptions.

     

    Design: Cross-sectional study. Patients over 18 years of age with 5 or more prescriptions stored in the NPR or the EMR, with follow-up visit at a health care centre or visiting a pharmacy, were invited to the study. Patients giving written informed consent to participate were interviewed. The stated prescribed current, ongoing treatment was compared with printouts of prescribed medication from the EMR and of the stored prescriptions in the NPR.

     

    Main Outcome Measures: Proportions of prescriptions for (a) noncurrent treatment (changed or terminated), (b) prescription duplicates and (c) missing prescriptions in the EMR and the NPR.

     

    Results: 216 patients with altogether 2515 prescriptions were included. In total, 71% were unique prescriptions for current ongoing treatment, 17% were prescriptions for noncurrent treatment (changed or terminated therapy) and 11% were prescription duplicates. Of 2195 prescriptions in the EMR, 75% were unique prescriptions for current treatment, 13% were noncurrent, 11% were prescription duplicates and 8% of the current prescriptions were missing. Of 1904 prescriptions in the NPR, 75% were unique prescriptions for current ongoing medication, 13% were noncurrent prescriptions, 11% were prescription duplicates and 20% of the current prescriptions were missing. The EMR and the NPR contained ≥1 noncurrent prescription or duplicate for 76% and 69% of patients.

     

    Conclusion: Prescriptions for noncurrent treatment and prescription duplicates as well as missing prescriptions are common in both EMR and the Swedish NPR. Consequently, claims data based on data of prescribed medicines in the EMR or the stored prescriptions in NPR contain many errors. Adherence estimates measured as “claims data” for prescriptions in the EMR and NPR may deviate significantly from true figures.

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  • 11.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Medical Products Agency / Läkemedelsverket.
    Patients' "self-reconciliation" of the medication list compared with medication verification with pharmacist2013In: International Journal of Clinical Pharmacy, ISSN 2210-7703, Vol. 35, no 3, p. 505-505Article in journal (Other academic)
  • 12.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Reasons why medicines are returned to Swedish pharmacies unused.2006In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 28, no 6, p. 352-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused. SETTING: A random sample of the pharmacies in Sweden. METHOD: Interviews using a semi-structured interview form with pharmacy customers returning unused medicines to the pharmacy. MAIN OUTCOME MEASURE: Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy. RESULTS: The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons. CONCLUSION: Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines.

  • 13.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Al-Fakhri, Marwa
    Institutionen för farmaceutisk biovetenskap, Uppsala universitet.
    Andersson, Clara
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Babic, Dina
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Lubarsky, Nadja
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Ly, Helen
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Comparison of prescription data in the electronic medical record, stored prescriptions in the Swedish national prescription repository and the current prescribed treatment stated by patients2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, p. 678-679Article in journal (Other academic)
    Abstract [en]

    Thirty percent of the prescriptions in the EMR and one fourth of all prescriptions in the NPR were either non-current treatment or prescription duplicates. The present data show that printouts of the prescriptions in both the EMR and the NPR contain many errors. Printouts may be confusing and if patients are not fully aware of their prescribed present treatment, medical errors may occur. The problem may be aggravated by generic substitution

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  • 14.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Brosius, Helen
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Jönsson, Julia
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Karlsson, Hanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Yngvesson, M
    Differences between the data in the electronic medical record, the prescriptions stored in the Swedish national prescription repository and and the patient’s knowledge of the present treatment2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, p. 679-Article in journal (Other academic)
    Abstract [en]

    Background and objective Patient adherence to prescribed treatmentfor chronic conditions has been estimated to be on average about 50%(1), drug related problems may cause as much as 30% of acuteadmittances to hospital care (2), and the costs have been estimated tobe of the same magnitude as the direct costs for pharmaceutical drugs.A reason for lack of adherence to the treatment and medication errorsmay be that patients with many drugs, especially when changes in thetreatment have occurred, may have knowledge gaps on the drugsrepresenting the actual prescribed treatment.

    E-prescribing, from the physicians’ electronic medical record(EMR) directly to the pharmacies, constitute[75% of all prescriptionsin Sweden and [70% of patients in Sweden store theirprescriptions electronically at the national prescription repository(NPR), accessible from any pharmacy in Sweden. Any new e-prescriptionwill automatically be stored in the NPR.However, the NPR may contain both prescriptions for the present,actual treatment, prescription duplicates, and prescriptions for previous,terminated or changed treatment. For patients with manymedications and/or many changes in the treatment it is obvious thatthe risk for medication errors is increased.The objective of the present study was to compare the prescribedtreatment in the EMR, the prescriptions in the NPR, and patient’sknowledge of her/his present prescribed treatment.Design Compare prescribed treatment in the EMR with the prescriptionsin the NPR, and patients knowledge of her/his presentprescribed treatment with regard to prescriptions; prescribed drug,strength; formula and dosing.Setting Ten HCCs in four cities in Sweden, February 2010.Main outcome measures Differences between the computerisedpatients health care journal record and the prescriptions in the NPR,and patients view of her/his actual present prescribed treatment withregard to prescriptions; prescribed drug, strength; formula and dosing.Results The results are available in March 2010.Conclusions Conclusion.

    References1. Adherence to long-term therapies: evidence for action. WHO,2003.2. Fryckstedt J, Asker-Hagelberg C. Drug-related problems commonat the medical acute care clinic—the cause of admission foralmost one-third of patients. [Läkemedelsrelaterade problemvanliga på medicinakuten - Orsak till inläggning hos nästan vartredje patient, enligt kvalitetsuppföljning] Läkartidningen 2008;105(12–13): 894–898.

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  • 15.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Brosius, Helen
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Jönsson, Julia
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Karlsson, Hanna
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Yngvesson, Maria
    Discrepancies between the electronic medical record, the prescriptions in the Swedish national prescription repository and the current medication reported by patients.2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 11, p. 1177-1183Article in journal (Refereed)
    Abstract [en]

    Purpose To study discrepancies between (i) the prescribed current treatment stated by patients with congestive heart failure (CHF) compared with patients with other chronic diseases, (ii) the data in the medication list (ML) in the electronic medical record and (iii) the data in the prescription list (PL) on the prescriptions stored in the national prescription repository in Sweden, to determine current, noncurrent, duplicate and missing prescriptions.

    Methods At one healthcare centre, a random sample of patients 18 years and older with a diagnosis of CHF, diabetes mellitus (DM) or osteoarthritis (OA) provided written informed consent to participate. Participants were interviewed by telephone on the prescribed current treatment.

    Results Of 161 invited patients (61 CHF, 50 DM and 50 OA), 66 patients were included. More than 80% of the patients had at least one discrepancy, a noncurrent, a duplicate or a missing prescription, in the ML and PL. The overall congruence for unique prescriptions on current treatment between the ML and the PL was only 55%. Patients with CHF had overall more discrepancies and patients with DM fewer discrepancies in the ML.

    Conclusions Prescriptions for noncurrent treatment, duplicates and missing prescriptions are common in both the ML in the electronic medical record and the list on prescriptions stored in the Swedish National Prescription Repository. Patients with CHF had more discrepancies in the ML. The risk for medication errors in primary care due to incorrect information on prescribed treatment may be substantial.

  • 16.
    Ekedahl, Anders
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Mattsson, Johanna
    Institutionen för farmaceutisk biovetenskap, Uppsala Universitet.
    Patients’ knowledge of prescriptions stored in the Swedishnational prescription repository—prescription duplicates,double medications and changed treatment2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, p. 688-689Article in journal (Other academic)
    Abstract [en]

    Prescriptions for non-current treatment that previously has been changed or terminated and prescription duplicates are common in the Swedish NPR. The risk for medication errors in the open care setting may be substantial.

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  • 17.
    Ekedahl, Anders
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Oskarsson, Vivianne
    Sundberg, Barbro
    Gustafsson, Veronica
    Lundberg, Therese
    Impact of postal and telephone reminders to patients not claiming their e-prescriptions”2006In: 35th European Symposium on Clinical Pharmacy: The Role of Communication in Patient Safety and Pharmacotherapy Effectiveness 18 – 21 October 2006, Vienna, Austria, 2006Conference paper (Refereed)
  • 18.
    Ekedahl, Anders
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Oskarsson, Vivianne
    Luleå University of Technology, Lulea, Sweden.
    Sundberg, Barbro
    Luleå University of Technology, Lulea, Sweden.
    Gustafsson, Veronica
    Luleå University of Technology, Lulea, Sweden.
    Lundberg, Therese
    Luleå University of Technology, Lulea, Sweden.
    Gullberg, Bo
    Department of Clinical Sciences, Lund University, Malmo.
    Impact of postal and telephone reminders on pick-up rates of unclaimed e-prescriptions.2008In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 30, no 5, p. 503-508Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the impact of a reminder (i.e., a mailed letter or short telephone call) from the pharmacy to patients, compared with no reminder in a control group, on the pick-up rates of unclaimed e-prescriptions. METHOD: Patients, with e-prescriptions transmitted to four large community pharmacies in two counties in northern Sweden and remaining unclaimed after 4 weekdays, were randomised to one of two intervention groups (a mailed reminder or a short telephonic reminder) or a control group. MAIN OUTCOME MEASURES: Rates of patients' pick-up of their e-prescriptions at follow-up after about 1, 2 and 3 weeks. RESULTS: Altogether, 320 patients with e-prescriptions, transmitted from March 21 through April 6 and not picked-up or dispensed, were identified and randomised to the study. There were no statistically significant differences in overall pick-up rates between the groups or with respect to gender. However, pick-up rates increased with increasing age. Higher pick-up rates were observed for two subgroups (but only in the mailed reminder group compared with controls)--for cardiovascular drugs to men and for respiratory drugs to adolescents and young adults. CONCLUSION: A reminder (i.e., a mailed letter or short telephone call) from the pharmacy to the patient had no statistically significant effect on overall pick-up rates of unclaimed e-prescriptions compared with no reminders.

  • 19.
    Emilsson, Maria
    et al.
    University West, Sweden.
    Gustafsson, Per
    Linköping University, Sweden;Region Östergötland 3, Sweden.
    Öhnström, Gisela
    Linköping University, Sweden;Region Östergötland 3, Sweden.
    Marteinsdottir, Ina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Impact of personality on adherence to and beliefs about ADHD medication, and perceptions of ADHD in adolescents2020In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 20, no 1, p. 1-10, article id 139Article in journal (Refereed)
    Abstract [en]

    Background Adherence to attention deficit hyperactivity disorder (ADHD) medication can prevent serious consequences, possibly with lifelong effects. Numerous factors have been observed that influence adherent behaviour, but the impact of personality traits has been inadequately explored. The purpose of this study was to explore the associations between personality traits and adherence to ADHD medication, beliefs about the medication, and perceptions of ADHD. Method Adolescents (n = 99) on ADHD medication were administered: Health-Relevant Personality Traits Five-Factor Inventory, Medication Adherence Report Scale, Beliefs about Medicines Specific and Brief Illness Perceptions Questionnaires. Results The personality trait Antagonism correlated with adherence behaviour (r = - 0.198, p = 0.005) and perceived personal control of ADHD (r = - 0.269, p = 0.007). Negative Affectivity correlated with beliefs regarding necessity (r = 0.319, p = 0.001), concerns (r = 0.344, p = 0.001), and experienced side effects of medication (r = 0.495, p = 0.001), alongside perceptions regarding duration (r = 0.272, p = 0.007), identity (r = 0.388, p < 0.001), being emotionally affected (r = 0.374, p < 0.01), personal control (r = - 0.287, p = 0.004) and concerns about ADHD (r = 0.465, p < 0.001). Impulsivity correlated with perceived consequences (r = - 0.226, p = 0.0255) and personal control of ADHD (r = - 0.379, p < 0.001). Hedonic Capacity correlated with concerns about medication (r = - 0.218, p = 0.0316) and perceived identification with ADHD (r = - 0.203, p = 0.045). Conclusion Personality traits are related to adherence, beliefs about ADHD medicines and perceptions of ADHD. Antagonism is associated with adherence, especially intentional non-adherence, while Negative Affectivity correlates with numerous perceptions of ADHD and beliefs about medications. Personality assessments could be useful in the care and treatment of adolescents with ADHD.

  • 20.
    Frisk, Pia
    et al.
    Hälsa och Farmaci, Apoteket AB.
    Carlsten, Anders
    Forskning och Utveckling, Apoteket AB.
    Rydberg, Tony
    Hälsa och Farmaci, Apoteket AB.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Patients' experiences with generic substitution-a Swedish pharmacy survey2010In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 5, p. 681-Article in journal (Other academic)
    Abstract [en]

    Background and objective Generic substitution for reimbursed drugs was introduced in Sweden 1 of October 2002. Concerns have been expressed that generic substitution may compromise patient safety. This study aimed to evaluate how Swedish drug consumers experience generic substitution, more than 5 year after implementation. 

    Design Survey study with an electronic questionnaire, offered to 1551 pharmacy customers/patients presenting with a prescription on one of the 2688 drugs included. The selected drugs constituted 75% of the total volume of dispensed drugs subjected to generic substitution in August 2007.

    Setting Fifty-eight Swedish community pharmacies. 

    Main outcome measures Positive experiences with generic substitution; problems and their degree of seriousness; and the reported incidence of medication errors. Consumers’ suggestions of improvements to the generic substitution system were also captured.

     Results Of 1551 respondents (602 male, 949 female), 35% (n = 536) reported one or more positive experiences, the most common being the lower drug price. Sixty percent (n= 932) claimed they had not experienced any problems. Forty percent reported at least one problem related to substitution. Seven percent (n=109) reported medication errors attributed to generic substitution. Twenty-two percent (n=342) of the respondents offered suggestions for improvement. The most common suggestions were to revise the criteria for assessing interchangeability between brand-name and generic alternatives and to abolish substitution.

    Conclusions A majority of respondents do not experience any problems related to generic substitution. A sizeable minority experience problems, partly resulting in medication errors. Over- and undermedication, lack of compliance, and intake of wrong drug or of both the original and the generic were the problems most often reported. Future system changes should consider the importance of revised criteria for generic and brand name interchangeability.

  • 21.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Implementation of a shared medication list: physicians’ views on availability, accuracy and confidentiality2014In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 36, no 5, p. 933-942Article in journal (Refereed)
    Abstract [en]

    Background Physicians, patients and others involved need to have accurate information on patients’ current drug prescriptions available, and have that information protected from unauthorized access. During the past decade, many counties in Sweden have implemented regionally shared medication lists within health care. Objective The aim of this study was to describe physicians’ views on changes in accuracy, availability and confidentiality in the transition from local medication lists to a regionally shared medication list. Setting Health care units in four different counties of Sweden after the transition from local medication lists to a regionally shared medication list. The shared medication list was an integrated part of the electronic health record system in the respective counties, but the system and implementation process varied. Methods Physicians (n = 7) with experience of transition from local medication lists to a regionally shared medication list were interviewed in a semi-structured manner. Main outcome measure: Physicians’ views on changes in information risks, focusing on accuracy, availability and confidentiality. Results The transition from local medication lists to a shared medication list increased the availability of information: from being time consuming or not possible to access from other care givers to most information being available in one place. A regionally shared medication list was perceived as having the potential to provide a greater accuracy of information, but not always: the shared medication list was perceived as more complete but with more non-current drugs. On the other hand, a shared medication list implied an increased risk of violating patient privacy, placing greater demands on IT security in order to protect the confidentiality of information. Conclusion Physicians perceived a regionally shared medication list to increase the availability of information about current prescriptions and potentially the accuracy but may decrease the confidentiality of information. To implement a shared medication list, we recommend providing clear description of responsibilities and routines for normal activities as well as back-up routines, consider IT-security and data protection early, involve patients to improve the accuracy of the list as well as to monitor and evaluate the implementation.

  • 22.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Lidström, Bodil
    Swedish EHlth Agcy, Stockholm, Sweden.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eiermann, Birgit
    Karolinska Inst ; Swedish EHlth Agcy, Stockholm, Sweden.
    Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing.2014In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 36, no 5, p. 943-952Article in journal (Refereed)
    Abstract [en]

    Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients’ prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug–drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5–June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients’ age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (±17.5, range 1–110) and had 10.0 different medications (±4.7, range 1–53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (±2.4, range 0–27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug–drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.

  • 23.
    Hellström, Lina
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Clinical pharmacy services within a multiprofessional healthcare team2012Doctoral 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.

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  • 24.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Bondesson, Åsa
    Hoglund, Peter
    Eriksson, Peter
    Errors in medication history at hospital admission: prevalence and predicting factors2012In: BMC Clinical Pharmacology, ISSN 1472-6904, Vol. 12, p. Article ID: 9-Article in journal (Refereed)
    Abstract [en]

    Background: An accurate medication list at hospital admission is essential for the evaluation and further treatment of patients. The objective of this study was to describe the frequency, type and predictors of errors in medication history, and to evaluate the extent to which standard care corrects these errors.

    Methods:A descriptive study was carried out in two medical wards in a Swedish hospital using Lund Integrated Medicines Management (LIMM)-based medication reconciliation. A clinical pharmacist identified each patient's most accurate pre-admission medication list by conducting a medication reconciliation process shortly after admission. This list was then compared with the patient's medication list in the hospital medical records. Addition or withdrawal of a drug or changes to the dose or dosage form in the hospital medication list were considered medication discrepancies. Medication discrepancies for which no clinical reason could be identified (unintentional changes) were considered medication history errors.

    Results: The final study population comprised 670 of 818 eligible patients. At least one medication history error was identified by pharmacists conducting medication reconciliations for 313 of these patients (47%; 95% CI 43-51%). The most common medication error was an omitted drug, followed by a wrong dose. Multivariate logistic regression analysis showed that a higher number of drugs at admission (odds ratio [OR] per 1 drug increase = 1.10; 95% CI 1.06 - 1.14; p<0.0001) and the patient living in their own home without any care services (OR1.58; 95% CI 1.02 - 2.45; p = 0.042) were predictors for medication history errors at admission. The results further indicated that standard care by non-pharmacist ward staff had partly corrected the errors in affected patients by four days after admission, but a considerable proportion of the errors made in the initial medication history at admission remained undetected by standard care (OR for medication errors detected by pharmacists' medication reconciliation carried out on days 4 - 11 compared to days 0 - 1 = 0.52; 95% CI 0.30 - 0.91; p = 0.021).

    Conclusions: Clinical pharmacists conducting LIMM-based medication reconciliations have a high potential for correcting errors in medication history for all patients. In an older Swedish population, those prescribed many drugs seem to benefit most from admission medication reconciliation.

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  • 25.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Bondesson, Åsa
    Lund University, Sweden.
    Höglund, Peter
    Lund University, Lund.
    Eriksson, Tommy
    Lund University, Sweden.
    Impact of the Lund Integrated Medicines Management model on medication appropriateness2011In: 39th ESCP European symposium on clinical pharmacy & 13th SFPC congress: clinical pharmacy at the front line of innovations. 21–23 October 2010, Lyon, France, Springer, 2011Conference paper (Refereed)
    Abstract [en]

    Introduction Inappropriate prescribing among elderly patients may increase the risk for drug-related problems. The objective of this study was to examine the impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness in hospitalised patients. Materials & Methods A prospective controlled study of 210 elderly patients, from three internal medicine wards in a Swedish hospital. We compared patients receiving Medication Reviews, including Admission Medication Reconciliation, according to the LIMM-model, with patients receiving standard care. The LIMMmodel was implemented at one ward at a time between January 2007 and March 2008. We chose four dates for inclusion of patients during this period, one date before implementation and three dates about one month after implementation on the first, second and third ward, respectively. All patients who were staying at any of the wards on  these dates were eligible for inclusion. The main outcome measure was the change, from admission to discharge, in the number of drugs with at least one inappropriate rating, according to the Medication Appropriateness Index (MAI). The MAI consists of 10 criteria: indication, effectiveness, dosage, correct directions, practical directions, drug-drug interactions, drug-disease interactions, duplication, duration and expense. For intervention patients, the MAI assessment at discharge was performed in two steps. Step 1, which was a blinded assessment based on information in the patient’s medical record, was used in the main analysis. In step 2, the drugs were reassessed (unblinded), by adding information from the pharmacists’ Medication Review Forms that had not been documented in the medical records. Results The control and intervention group were similar regarding baseline demographic data. The mean number of drugs with at least one inappropriate rating decreased from 3.0 at admission to 1.5 at discharge in the intervention group, and from 2.8 to 1.7 in the control group. This represented a 51% (95% CI, 43-58%) decrease in the intervention group (step 1 assessment), compared to a 39% (95% CI, 30-48%) decrease in the control group (p = 0.0446, Poisson regression). In the assessment step 2, the MAI rating was changed from ‘inappropriate’ to ‘appropriate’ in 23% of the drugs (27/117). The mean decrease per patient between step 1 and 2 in number of drugs with at least one inappropriate rating was 0.38 (95% CI 0.22–0.54). In both control and intervention patients the most common MAI problems involved ‘expense’, ‘indication’ and ‘duration’. Discussion & Conclusion This study showed that medication appropriateness at discharge from hospital improved in patients receiving Medication Reviews and Reconciliation, according to the LIMM-model. In order to take full advantage of the work done by the clinical pharmacists, the information documented in the Medication Review Forms should also be documented in the medical records.

  • 26.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Bondesson, Åsa
    Höglund, Peter
    Eriksson, Tommy
    Predictors for medication history errors at admission2011Conference paper (Refereed)
  • 27.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Esporlas, Lily
    Deierborg, Eva
    Holmdahl, Lydia
    Midlöv, Patrik
    Höglund, Peter
    Eriksson, Tommy
    The impact of an integrated clinical pharmacy service on drug-related hospital contacts.2010In: ESCP–GSASA 38th symposium on clinical pharmacy 30 years of clinical pharmacy; a bright future ahead, 3rd–6th November 2009, Geneva, Switzerland, 2010Conference paper (Refereed)
  • 28.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Höglund, P
    Bondesson, Å
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Eriksson, T
    Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all cause emergency department revisits2012In: Journal of Clinical Pharmacy and Therapeutics, ISSN 0269-4727, E-ISSN 1365-2710, Vol. 37, no 6, p. 686-692Article in journal (Refereed)
    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.  

  • 29.
    Hellström, Lina
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Council.
    Throfast, Victoria
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    General beliefs about medicines among independent elderly adults in Sweden: data from an RCT2017In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 39, no 1, p. 223-224, article id PH009Article in journal (Refereed)
  • 30.
    Hermansson, Michael
    et al.
    Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Ekedahl, Anders
    Department of Community Health Sciences, Lund University, Malmö, Sweden.
    Ranstam, Jonas
    NKO, Lund University Hospital, Lund.
    Zilling, Thomas
    Department of Surgery, Varberg Hospital, Sweden.
    Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002.2009In: BMC Gastroenterology, ISSN 1471-230X, E-ISSN 1471-230X, Vol. 9, no April, p. Article number: 25-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA).

    METHODS: All cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey. RESULTS: When comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p < 0.001). Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 2002. The number of prescribed sales to women was higher than to males. Sales of low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the counter sale and sold on prescription, increased by 28% during the same period.

    CONCLUSION: When comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.

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  • 31.
    Johansson Östbring, Malin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Council.
    Eriksson, Tommy
    Malmö University;Norwegian University of Sciences and Technology, Norway.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Kalmar County Council.
    Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC): Intervention Development and Protocol for the Process Evaluation2018In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, no 1, p. 1-12, article id e21Article in journal (Refereed)
    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.

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  • 32.
    Johansson Östbring, Malin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Council.
    Eriksson, Tommy
    Malmö University;Norweigan University of Sciences and Technology, Norway.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Kalmar County Council.
    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 Life2018In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 7, no 2, p. 1-15, article id e57Article in journal (Refereed)
    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).

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  • 33.
    Johansson Östbring, Malin
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kalmar county, Sweden.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Region Kalmar county, Sweden.
    Mårtensson, Jan
    Jönköping University, Sweden.
    Trivial or Troublesome: Experience with Coronary Heart Disease Medication from the Patient's Perspective2020In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 14, p. 411-424Article in journal (Refereed)
    Abstract [en]

    Background: Living with coronary heart disease (CHD) usually means being prescribed several medications to help prevent new cardiac events. Using medicines for long-term conditions impacts on day-to-day life, and coping with medicines can be burdensome and can affect the quality of life. To enable better support of these patients, we need to understand their collective medicine-related experience. Purpose: The purpose of this study was to describe patients' medicine-related experience 1 year after the diagnosis of CHD. Patients and Methods: A qualitative, descriptive study using semi-structured interviews was conducted in 19 patients in their homes or at Linnaeus University, Sweden. Interviews were recorded and transcribed verbatim. Qualitative content analysis with an inductive approach was used. Results: Patients' experiences with using their medicines after diagnosis of CHD differed considerably. Some patients found handling the medicines and administering their treatment very easy, natural and straightforward, while others found that it was distressing or trouble-some, and influenced their lives extensively. There was a varied sense of personal responsibility about the treatment and use of medicines. The patients' experiences were classified into one of seven categories: a sense of security, unproblematic, learning to live with it, taking responsibility for it, somewhat uncertain, troublesome, or distressing. Participants in the study who expressed an unproblematic view of medicine taking also often revealed that they had dilemmas or uncertainties. Conclusion: Patients' medicine-related experiences after CHD vary greatly. The findings of this study highlight a need for more individualized support for patients using medicines for secondary prevention. The patients often needed better dialogue with healthcare providers to optimally manage their medicines. Medicine-related support for these patients should encompass various aspects of medicine-taking.

  • 34.
    Juhlin, Madeleine
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Elektroniskt expertstöd ur kundens perspektiv: En enkätstudie om kundens kännedom och inställning till EES2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Abstract

    Medicines are substances used to prevent, alleviate or cure diseases which is an important part of health care. The role of the pharmacist in the healthcare chain is important because they are the patients last contact with healthcare professionals. After this contact they must assume responsibility over their own treatment. The pharmacist's responsibility is to make sure that the patient has received essential information about their drugs and to check that the prescribed dose is correct.

    The increased digitalization of society brings an opportunity for the patients to increase participation and understanding of their drug treatment.

    Decision support systems are different methods used to obtain a basis for decision making. Pharmacists use these systems to check if prescriptions are correct, for example by ensuring that the right medication, in the correct dose, has been prescribed to the right patient at the right time.

    In Sweden there is a decision support system called elektroniskt expertstöd (EES). This system offers pharmacy customers further drug control in addition to other controls that are available through the pharmacy's other systems. The benefit of this system is that the pharmacist has better support in detecting incorrect doses, interactions, duplicate medications and if the drug is inappropriate for the patient's gender or age. When the system alerts, the pharmacist makes an assessment which may be discussed with the patient or the physician if needed.

    Purpose

    The purpose of this survey study was to investigate what the pharmacy customers knows about EES and the pharmacists use of the system.

    Method

    Before the study started, approval from the southeast ethic committee was obtained which said that there were no ethical barriers for the performance of the study. The surveys were handed out to anyone who would receive prescriptions at different pharmacies in Luleå, Grängesberg, Värnamo, Kalmar and Torsås. The common goal was to spend 20 hours of handing out surveys per student. The results were put together and analyzed in IBM SPSS Statistics with descriptive statistics. 

    Results and discussion

    The results show that most of the respondents did not know about EES and did not know if the pharmacists are using this support system. The results also show that most of the respondents had not given their consent to EES and did not know if EES could support the pharmacists work. More than half of the survey population answered “do not know” on a question asking if they wanted the pharmacist to use EES when dispensing drugs. Almost a quarter of the total population wanted the pharmacist to use EES and close to three quarters of the total population had no knowledge of the system. This could mean that the customers who have knowledge wants the system to be used. A reason for wanting the system to be used without having knowledge of it could be that customers trust it is beneficial for themselves and for the pharmacists. Building trust and showing care in each customer meeting is important to make the customer susceptible to information. Sufficient information can lead to better compliance in drug treatments. Before the pharmacist can use EES for the first time the customer must consent. Although it was a few years since the introduction of EES into pharmacies, some pharmacists find it difficult to connect customers to the system. It is a relatively new way of working with drug analysis at the pharmacies in Sweden. More practice in the system could provide increased use of it and help the pharmacists decision making.  

    Conclusion

    Only a small proportion of the pharmacy customers have knowledge of EES. But even so, one fourth of them wanted the system to be used to analyze their medication which is considered positive.

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  • 35.
    Karia, Ajay Mahendrarai
    et al.
    Curtin Univ, Australia.
    Balane, Christine
    UNSW, Australia.
    Norman, Richard
    Curtin Univ, Australia.
    Robinson, Suzanne
    Curtin Univ, Australia.
    Lehnbom, Elin C.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. UiT Arctic Univ Norway, Norway.
    Durakovic, Iva
    UNSW, Australia.
    Laba, Tracey-Lea
    UNSW, Australia;Univ Technol Sydney, Australia.
    Joshi, Rohina
    UNSW Sydney, Australia;George Inst Global Hlth India, India.
    Webster, Ruth
    UNSW, Australia.
    Community pharmacist workflow: Space for Pharmacy-based Interventions and Consultation TimE study protocol2020In: International Journal of Pharmacy Practice, ISSN 0961-7671, E-ISSN 2042-7174, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Background Pharmacists' roles are expanding to delivering a wider set of professional services including medication management optimisation, vaccinations and screening services. Robust research determining whether pharmacists have the capacity to offer such services in the Australian community pharmacy setting is lacking. This protocol details a mixed methods study that investigates the variation in pharmacists' daily tasks and the workspace they work in as a measure of their workload capacity for expanding pharmacy services. Methods An observational time and motion study will be conducted in up to twenty community pharmacies in metropolitan and rural regions of Australia. A trained observer will follow a pharmacist and record the type, location and duration of tasks undertaken over the course of their working day. Data will be collected and analysed using the electronic Work Observation Method By Activity Timing (WOMBAT) tool. Pharmacists' work patterns will be described as time for each task, and by proportionating multitasking and interruptions. This information will be combined with workspace data collected using floor plans, photographs and a qualitative assessment of the working environment completed by the observer. Analysis will include heat-mapped floor plans visually highlighting pharmacist movements. Discussion Pharmacists may provide solutions to the strained health workforce and system. There is limited quantitative evidence on whether pharmacists have the time or work setting to support such needs. The use of time and motion methodology is novel to Australian community pharmacy research, and the findings will provide a better understanding of pharmacists' capacity and work environment.

  • 36.
    Karlsson, Anette
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Farmaceutiska interventioner som kräver förskrivarkontakt.En studie på två öppenvårdsapotek i mellersta Kalmar län2006Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
  • 37.
    Krigsman, Kristin
    et al.
    NEPI Foundation, Stockholm, Sweden.
    Melander, Arne
    Department of Community Medicine, Malmö University Hospital, Malmö, Sweden.
    Carlsten, Anders
    National Corporation of Swedish Pharmacies.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Nilsson, J Lars
    NEPI Foundation, Stockholm, Sweden.
    Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs.2007In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 29, no 1, p. 19-24Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine the nature and extent of undersupply and the economic consequences of oversupply of medication among non-adherent patients. METHODS: This study used copies of repeat prescriptions (= multiple dispensations), collected during 1 week in 2002 at 16 Swedish community pharmacies. For patients with a refill adherence below 80%, treatment gaps were defined as the number of days they had no drug available. The cost of drug oversupply (i.e., refill adherence > 120%) was calculated from the prices of the drug packages dispensed. RESULTS: The number of collected repeat prescriptions was 3,636. The median of treatment gaps among patients with a refill adherence below 80% was 53 days per 90-100 days treatment period and the corresponding median for oversupply was 40 days. The cost of oversupply for exempt patients (i.e., patients who have paid 1,800 SEK (Euro 196; US$ 243) per year for medicines) was 32,000 SEK (Euro 3,500; US$ 4,300) higher than for non-exempt patients. An extrapolation to all Sweden indicates that exemption from charges leads to an additional oversupply of about 142 million SEK (Euro 15 million; US$ 19 million) per year above that of non-exempt patients. CONCLUSION: Both undersupply and oversupply of prescribed medicines are common in Sweden. Patients with a refill adherence below 80% seem to have less than half of the prescribed treatment available. Oversupply or drug stockpiling occurs more frequently among exempt than among non-exempt patients, and this oversupply leads to high unnecessary costs.

  • 38.
    Lindh, Åsa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Patienternas informationsunderlag för receptordinerade läkemedel samt avvikelser i receptlista2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    För att uppnå en optimal läkemedelsbehandling krävs uppdaterade och korrekta ordinationsunderlag inom hela vårdkedjan. Studiens syfte var att kartlägga vad patienten använder som underlag för sin läkemedelsbehandling samt hur många som kände till läkemedelslistan, receptlistan och läkemedelsförteckningen. Vidare syftade studien till att kartlägga hur vanligt förekommande avvikelser är mellan receptlistan och vad patienten uppger vara inaktuella recept, inaktuella/aktuella dubbletter eller saknade recept, samt att jämföra resultatet med motsvarande studie gjord 2012.

    Datainsamlingen gjordes med hjälp av patientintervjuer på åtta olika apotek under fyra veckor mellan februari och mars 2018. Studiens resultat visade att nästan alla patienter kände till receptlistan och att mer än varannan patient använde den som underlag för sin läkemedelsbehandling. Fyra av tio patienter använde förpackningsetiketterna, drygt sex av tio patienter kände till läkemedelslistan, varav endast var åttonde patient använde den som underlag. Var sjätte patient kände till läkemedelsförteckningen men endast ett fåtal använde den som underlag. Ungefär 8 av 10 patienter hade en eller flera avvikelser i receptlistan. Varannan patient hade aktiva dubbletter vilket var den mest frekventa avvikelsen bland deltagarna.

    Jämförelse av avvikelser i aktuell studie med studien 2012 visade att ingen större förändring har skett mellan åren 2012 och 2018 med avseende på avvikelser mellan receptlistan och vad kunden uppgav vara inaktuella recept, aktuella dubbletter eller saknade recept i receptlistan.

    Studien visar dels att en stor andel patienter inte känner till nödvändiga informationsunderlag som behövs för en säker läkemedelsbehandling, samt att receptlistan ofta innehåller avvikelser, något som kan öka risken för felmedicinering.

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  • 39. Lindström, Kjell
    et al.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Carlsten, Anders
    Mårtensson, Jan
    Department of Nursing Science, School of Health Sciences, Jönköping,.
    Mölstad, Sigvard
    Department of Health and Society, Linköping University, Linköping,.
    Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. DESIGN: Open, prospective, interventional study. SETTING: Four counties in Sweden. SUBJECTS: Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. MAIN OUTCOME MEASURES: Clinical evaluation, registration of drugs used and rating with Montgomery-Asberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. RESULTS: About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. CONCLUSIONS: Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

  • 40.
    Mandt, Ingunn
    et al.
    Institute for Pharmacy Practice Research, Box 5070 Majorstuen, NO-0301 Oslo, Norway.
    Horn, Anne Marie
    Institute for Pharmacy Practice Research, Box 5070 Majorstuen, NO-0301 Oslo, Norway.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Granas, Anne Gerd
    Institute for Pharmacy Practice Research, Box 5070 Majorstuen, NO-0301 Oslo, Norway.
    Community pharmacists' prescription intervention practices: exploring variations in practice inNorwegian pharmacies2010In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 6, no 1, p. 6-17Article in journal (Refereed)
    Abstract [en]

    Background

    Evidence suggests that prescription intervention frequencies have been found to vary as much as 10-fold among Norwegian pharmacies and among pharmacists within the same pharmacy.

    Objective

    To explore community pharmacists' perceptions of how their prescription intervention practices were influenced by their working environment, their technological resources, the physical and social structures of the pharmacies, their relations with colleagues, and to the individual pharmacist's professional skills.

    Methods

    Two focus groups consisting of 14 community pharmacists in total, from urban and rural areas in Norway, discussed their working procedures and professional judgments related to prescription interventions. Organizational theories were used as theoretical and analytical frameworks in the study. A framework based on Leavitt's organizational model was to structure our interview guide. The study units were the statements of the individual pharmacists. Recurrent themes were identified and condensed.

    Results

    Two processes describing variations in the dispensing workflow including prescription interventions were derived—an active dispensing process extracting information about the patient's medication from several sources and a fast dispensing process focusing mainly on the information available on the prescription. Both workflow processes were used in the same pharmacies and by the same pharmacist but on different occasions. A pharmacy layout allowing interactions between pharmacist and patients and a convenient organization of technology, layout, pharmacist-patient and pharmacist-coworker transactions at the workplace was essential for detecting and solving prescription problems. Pharmacists limited their contact with general practitioners when they considered the problem a formality and/or when they knew the answers themselves. The combined use of dispensing software and the Internet was a driving force toward more independent and cognitively advanced prescription interventions.

    Conclusion

    Implementation of a general organizational model made it easier to analyze and interpret the pharmacists' intervention practices. Working environment, technology, management and professional skills may all contribute to variations in pharmacists' prescription intervention practices in and between community pharmacies.

     

  • 41.
    Muthanna, Ban
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kunderna med arabisk bakgrund och deras attityd till generiskt utbyte på apotek: En enkätundersökning2020Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Generikareformen genomfördes i Sverige år 2002. Den ledde till ekonomiska besparingar för både samhället och allmänheten, på cirka 8 miljarder kronor per år. Enligt reformen och den svenska lagen (2002:160) är apoteken skyldiga att erbjuda generiskt utbyte d.v.s. byta ut originalläkemedel till billigare men likvärdigt generiskt läkemedel som omfattas av läkemedelsförmånen. Både originalläkemedel och generika ska vara godkända som läkemedel, ha samma beredningsform och vara bioekvivalenta. De kan dock ha olika produktnamn, hjälpämnen, bipacksedel, utseende och har en annan leverantör. Studier visar att generiskt utbyte kan bidra till oro och leda en till negativ inställning hos kunder. För att minska risker med dubbelmedicinering, dålig följsamhet och biverkningar är det viktigt med anpassad information från farmaceuten angående generiskt utbyte. Den här studien lyfter fram kunder av arabiskt ursprung, en målgrupp som tidigare inte har studerats, för att undersöka deras åsikter och attityder om generiskt utbyte.

    Syfte: Syftet med studien var att undersöka hur kunderna med arabisk bakgrund i Sverige upplever generiskt utbyte på apotek. Målet var att identifiera vilka eventuella problem som kan förekomma och att kartlägga vilka faktorer som påverkar deras syn på̊ generiskt utbyte. 

    Metod: En enkätstudie som utfördes på två olika orter i Sverige under perioden 4–17 november 2019. Inklusionskriterier: Personer över 18 års ålder med arabisk bakgrund som hade förskrivna läkemedel vilka ingår i generiskt utbytbara grupper. 

    Resultat: Av de 63 deltagarna som svarade på enkäten uppgav 89% att de accepterade att byta ut sina mediciner mot generiskt alternativ. Majoriteten av dem som accepterade utbytet uppgav att det fanns en arabisktalande farmaceut eller tolk på plats som förklarade innebörden av utbytet. Ingen deltagare fick information angående generiskt utbyte från läkaren, däremot uppgav hälften (49%) av deltagarna att de fick informationen från farmaceuten. Cirka hälften (49%) av deltagarna ansåg att de fick mycket bra information från farmaceuten medan 40% av deltagarna ansåg att de fått varken bra eller dålig information. Två personer (11%) nekade till generiskt utbyte på grund av en annorlunda förpackning, skillnad i effekt eller kommunikationssvårigheter. Ingen deltagare visste att det fanns en gratis broschyr på arabiska angående genetiskt utbyte. Majoriteten (99%) ville gärna få en broschyr. I resultatet framkom det att 89% av deltagarna var nöjda med den totala upplevelsen kring generiskt utbyte. 

    Slutsats: Studien visar att majoriteten (89%) var nöjda med generiskt utbyte. Det var på apotek som de flesta deltagarna fick information om generiskt utbyte och de accepterade utbytet efter de fick informationen på arabiska. 

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    Examensarbete Ban Muthanna
  • 42.
    Relli, Matilda
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Kunders attityd till generiskt utbyte på apoteket2018Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Generikareformen trädde i kraft i Sverige 1 oktober 2002 med avsikt att sänka kostnader för läkemedel dels för den enskilde individen men även för samhället. Detta innebar att receptförskrivna läkemedel började bytas ut mot billigare generiska preparat, om varken behandlande läkare, expedierande farmaceut eller kund motsatte sig utbytet. Reformen har minskat läkemedelskostnaderna, men har för kunderna i vissa fall lett till förvirring, osäkerhet och medicinska problem.

    Syfte: Syftet med denna studie är att undersöka vilken attityd kunder på apoteket har till generiskt utbyte 16 år efter att reformen trädde i kraft, vilka problem som eventuellt kan uppstå i samband med detta, samt att identifiera eventuella skillnader mellan kvinnor och män i deras inställning till generiskt utbyte.

    Material & Metod: För att besvara syftet med studien utfördes en enkätstudie på fem olika orter i Sverige, där kunden genom 11 flervalsfrågor fick ge sin syn på generisk substitution. Inkluderades i studien gjorde personer över 18 år som besökte apoteket för att hämta ut receptförskrivet läkemedel åt sig själv och i samband med detta gavs möjlighet att byta till generika. Svaren sammanställdes i databas (Excel). Kvalitetssäkring och korstabulering utfördes. Chi2-test användes för att testa om skillnader mellan könen är statistiskt signifikanta eller ej.

    Resultat: Övervägande del av kunderna som deltog i studien hade en positiv inställning till generisk substitution, ingen skillnad mellan könen. Dock uppgav en del av kunderna sig ha fått problem i samband med att deras läkemedel byts ut mot generika. Vanliga problem var att kunden ej kände igen namn på läkemedlet eller utseendet av beredningen respektive förpackningen. Större andel kvinnor än män angav sig ha problem med nya biverkningar efter utbytet samt skillnad i effekt.

    Slutsats: På grund av flera tänkbara biaser bör generella slutsatser utifrån denna studie dras med viss försiktighet. Men resultatet pekar till viss del i samma riktning som tidigare utförda studier och visar att övervägande del av kunderna på apoteket är både villiga att byta ut sina receptförskrivna läkemedel mot generiska preparat och är överlag nöjda med sitt utbyte. Ingen skillnad mellan könen. De problem som oftast uppstår i samband med generisk substitution är att kunden ej känner igen sitt läkemedel efter utbytet, därför finns det ett behov av att se över om det går att göra förbättringar som tydligare förpackningar och likartade tabletter. Kvinnor verkar stöta på problem i samband med generiskt utbyte i större utsträckning än män, detta samt eventuella orsaken bör dock studeras vidare.

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  • 43.
    Ring, Lena
    et al.
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Bardage, Carola
    Med Prod Agcy, Uppsala / Uppsala Univ.
    Ekedahl, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences. Med Prod Agcy, Uppsala.
    Patient's Views on Multi-Dose Dispensed Medicines2013In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, p. 463-464Article in journal (Other academic)
  • 44.
    Semark, Birgitta
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Engström, Sven
    Arvidsson, Eva
    Nilsson, Gunilla
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Participation in decision making when starting long-term medication: patients´ experiences2014In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 2, no 3, p. 282-289Article in journal (Refereed)
    Abstract [en]

    Rationale, aim and objective

    To achieve the beneficial effect of drug treatment and reduce unnecessary health care costs, patients must be involved in shared decision making. The aim of this study was to describe patient experiences of participation in decision making when starting long-term medication.

    Method

    Nine patients at two health care centers were semi-structured interviewed about their experiences, beliefs and feelings about their participation in the decision to start long-term medication. Data was analyzed by a qualitative content method.

    Results

    Respondents stated that participating in decision making in drug treatment requires knowledge of the relevant area and requiring trusting the physician. The respondent’s responsibility and motivation facilitate adherence to drug treatment. 

    Conclusion

    Patients sought participation in the decision making of long-term medication and wished for adequate time needed for this dialogue. If they lacked sufficient knowledge, they wanted relevant and useful information from the physician. To experience trust in the physician through a good encounter increases the possibility for participation and enhancement of medication adherence. In order to participate in decision making, the patient needs the physician’s encouragement.

     

  • 45.
    Singer, Andrew C.
    et al.
    NERC – Centre for Ecology and Hydrology, United Kingdom.
    Jarhult, Josef D.
    Uppsala University.
    Grabic, Roman
    Umeå University ; University of South Bohemia in České Budějovice, Czech Republic.
    Khan, Ghazanfar A.
    Umeå University.
    Fedorova, Ganna
    Umeå University ; University of South Bohemia in České Budějovice, Czech Republic.
    Fick, Jerker
    Umeå University.
    Lindberg, Richard H.
    Umeå University.
    Bowes, Michael J.
    NERC – Centre for Ecology and Hydrology, United Kingdom.
    Olsen, Björn
    Linnaeus University, Faculty of Health and Life Sciences, Department of Biology and Environmental Science. Uppsala University.
    Söderström, Hanna
    Umeå University.
    Compliance to Oseltamivir among Two Populations in Oxfordshire, United Kingdom Affected by Influenza A(H1N1)pdm09, November 2009: A Waste Water Epidemiology Study2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 4, article id e60221Article in journal (Refereed)
    Abstract [en]

    Antiviral provision remains the focus of many pandemic preparedness plans, however, there is considerable uncertainty regarding antiviral compliance rates. Here we employ a waste water epidemiology approach to estimate oseltamivir (Tamiflu (R)) compliance. Oseltamivir carboxylate (oseltamivir's active metabolite) was recovered from two waste water treatment plant (WWTP) catchments within the United Kingdom at the peak of the autumnal wave of the 2009 Influenza A (H1N1)pdm09 pandemic. Predictions of oseltamivir consumption from detected levels were compared with two sources of national government statistics to derive compliance rates. Scenario and sensitivity analysis indicated between 3-4 and 120-154 people were using oseltamivir during the study period in the two WWTP catchments and a compliance rate between 45-60%. With approximately half the collected antivirals going unused, there is a clear need to alter public health messages to improve compliance. We argue that a near real-time understanding of drug compliance at the scale of the waste water treatment plant (hundreds to millions of people) can potentially help public health messages become more timely, targeted, and demographically sensitive, while potentially leading to less mis- and un-used antiviral, less wastage and ultimately a more robust and efficacious pandemic preparedness plan.

  • 46.
    Stöger, Ulrika
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Kommunala sjuksköterskors kontakt med apoteken: en tids- och enkätstudie bland Kalmar kommuns sjuksköterskor2009Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Syftet med denna studie är dels att undersöka hur stor andel av arbetstiden som sjuksköterskor, inom kommunala hälso- och sjukvården i Kalmar kommun, använder för kontakt med apoteken, dels att belysa hur sjuksköterskorna ser på kontakten med apoteken med avseende på dess omfattning och innehåll.

    Kalmars kommunala sjuksköterskor förde under en vecka i februari 2009 tidsdagbok över sin apotekskontakt. I anslutning till detta utfördes även en enkätundersökning bland dessa sjuksköterskor.

    Svarsfrekvensen var låg; 43 % av sjuksköterskorna deltog i enkätstudien och endast 19 % deltog i tidsstudien. Den genomsnittliga andelen arbetstid som ägnades åt apotekskontakt fastställdes till 4,6 ± 3,9 %. Enkätstudien visade på en del önskemål om förändring i såväl kontakten med apoteken som i de kommunala rutinerna. Förslag som lades fram av sjuksköterskorna för en minskning av kontakttiden med apoteken var bland annat att annan personal inom hälso- och sjukvården eller anhöriga till patienten gör apoteksärenden i stället för sjuksköterskorna, samt att apoteken ska införa en särskild kö för vårdpersonal och därmed minska kötiden.

    Den låga svarsfrekvensen gör att inga statistiskt signifikanta slutsatser kan dras av studien och då i synnerhet inte av tidsstudien. Studien visar dock på stora variationer sjuksköterskorna emellan, i andel arbetstid som ägnas åt apotekskontakt. Validiteten och precisionen för denna variation är ej hög, delvis på grund av det låga deltagandet. Enkätundersökningen visade på problem som kan härröras till brist i kommunikationen mellan såväl sjuksköterskor och övrig hälso- och sjukvårdspersonal, som mellan sjuksköterskor och apotekspersonal. En förbättrad interprofessionell kommunikation skulle eventuellt kunna lösa denna problematik.

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  • 47.
    Svensson, Frida
    Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
    Imepitoin - framtidens förstahandsval vid epilepsi hos hund?2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: In Sweden, approximately 1-2 % of all dogs suffer from epilepsy. The first seizures often occur when the dog is between one and six years old. In Sweden the first-line drug is phenobarbital, a substance which increases the threshold of electrical stimulation in the motor cortex. It also decreases synaptic transmission which leads to decreased neuronal excitability. In February 2013 a new antiepileptic drug was regis­tered with imepitoin as active substance. Imepitoin is a partial agonist which binds to the benzodiazepine binding site at the GABAA receptor and amplifies the effects medi­ated by GABAA receptors at the neurons. Additionally, imepitoin has a weak calcium channel blocking effect.

    Objective: The main aim of the study was to examine if imepitoin should be the first-line drug instead of phenobarbital when treating dogs diagnosed with idiopathic epi­lepsy. A further aim was to look into which effect imepitoin had in controlling the epilepsy and which adverse effects were experienced when dogs are treated with imepitoin.

    Results: Treatment with imepitoin resulted in a decrease in monthly seizure frequency (MSF), similar to the decrease seen upon treatment with phenobarbital. Imepitoin was decreasing MSF both when used as monotherapy and in combination with phenobarbital or potassium bromide. The adverse effects were in general less severe with imepitoin than with phenobarbital. Treatment with phenobarbital affected the liver while treatment with imepitoin affected the cholesterol levels.

    Conclusion: Imepitoin has a good antiepileptic effect, similar to that of phenobarbital. Treatment with imepitoin can be used both as monotherapy and in combination with other antiepileptic drugs. Less severe adverse effects makes imepitoin a possible choice for treating idiopathic epilepsy in dogs. On the other hand, phenobarbital has been used during a long period of time and adverse effects of long term use are therefore better known than for imepitoin.

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  • 48.
    Volmer, Daisy
    et al.
    TÜ farmaatsia, Tartu, Estland.
    Haavik, Svein
    Universitetet i Bergen, Norge.
    Ekedahl, Anders
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Veski, Peep
    TÜ farmaatsia, Tartu, Estland.
    Probleemsed retseptid, mille alusel  ravimi valjastamine apteegist nouab konsultatsiooni ravimi ordineerijaga Eesti, Norra ja Rootsi vordlusuuringu [Problem prescriptions in communitypharmacies necessitating contact with the prescriber before dispensing in Estonia, Norway and Sweden]2010In: Pohjal Eesti Arst, Vol. 89, no 1, p. 5-12Article in journal (Refereed)
    Abstract [en]

    AIM. 

    To compare the frequency and nature of prescr ipt ion problems detected in´community pharmacies in Estonia, Norway and Sweden where pharmacists considered it necessary to contact the prescribers for clarifi cation, completion or correction of prescriptions before dispensing. 

    METHOD.

     

     

    RESULTS.

     

     

    Pharmacists in Estonia considered it necessary to contact the prescriber for 1.5% of problem prescriptions, which is about 3 times higher rate than in Norway (0.5%) and Sweden (0.4%). Formal problems were identifi ed more frequently in Estonia (52.1%); problems related to wrong dose, and strength and form of the medication occurred in Estonia (21.9%) and Sweden (18.7%). In Sweden 28.6% and in Norway 25.1% of the problems were connected with missing or insuf f icient information concerning administration and instructions for use.

     

     

    CONCLUSION.

     

    Pharmacists reveal and solve prescript ion problems that otherwise would compromise patient safety. The f requency of problem prescr ipt ions was higher in Estonia mainly because of the high f requency of handwr itten prescr ipt ions . Computer generated prescriptions may reduce formal errors as well as errors of clinical importance but may also introduce new clinical ly important errors.

  • 49.
    Åstrand, Bengt
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Montelius, Emelie
    University of Kalmar, School of Human Sciences.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Assessment of ePrescription quality: an observational study at three mail-order pharmacies2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 1, p. Article number: 8-Article in journal (Refereed)
    Abstract [en]

    Background: The introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.

    Methods: A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.

    Results: Of the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.

    Conclusion: The increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.

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