Aim: This study aimed to translate the Living with Medicines Questionnaire, version 3 (LMQ-3) into Swedish for validation in an outpatient cohort regularly using medicines.

Methods: Phase 1 translated the originator questionnaire into Swedish, and tested face and content validity through cognitive interviews. Phase 2 tested validation through a cross-sectional survey. Exploratory factor analysis (EFA) of the 41 items in the LMQ-3 was conducted.

Results: Phase 1 involved 25 cognitive interviews. In phase 2, 779 respondents completed the questionnaire online. The total mean LMQ-3 score was 90.6 (95% confidence interval (CI) 89.0-92.2; range 43-176), and the mean visual analogue scale score was 3.1 (95% CI 2.9-3.3; range 0-10). The median age was 72 years (range 21-96) with 80.9% retired. The mean number of prescribed medicines was 8.5 (SD 3.8) per respondent. EFA analyses revealed most items loaded in their original domains, except three items: 'My medicines allow me to live my life as I want to' (question (Q)32), 'I have to put a lot of planning and thought into taking medicines' (Q37) and 'I find getting prescriptions from the doctor difficult' (Q1).

Conclusions: The LMQ-3 was successfully translated into Swedish and validated in a Swedish outpatient cohort regularly using medicines. Construct validity of the Swedish translation was adequate, with minor differences from the originator instrument. Future test-retest reliability will help assess suitability of the instrument for stability of scores over time and usefulness in longitudinal studies. In conclusion, this questionnaire can provide a person-centred measure of medicines burden in persons who regularly take prescribed medicines.

Background and aim: Medication management in primary care faces challenges that affect patient outcomes. The inclusion of clinical pharmacists in care teams aims to address these issues. In Nordic countries, the role of clinical pharmacy services in primary care is still evolving with limited research. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework for evaluating healthcare systems by examining the system factors and processes that influence outcomes. This study aimed to identify factors influencing the integration and advancement of the role of pharmacists in primary care using the SEIPS model.

Methods: A focus group study was conducted with four groups (n = 17): managers, pharmacists, nurses, and general practitioners. Deductive thematic analysis guided by the SEIPS model was used to structure the data.

Results: Despite taking time to establish the pharmacist as a colleague, the participants expressed satisfaction with the collaboration and the pharmacist's role within the work system and processes at healthcare centres. Central factors for system and process development were identified, including a needs-based and structured approach to implementation, pharmacists with the right qualities and skills, teamwork, and physical presence. Perceived outcomes included increased pharmaceutical knowledge among coworkers and patients, reduced workload for staff, and improved patient safety regarding therapies. Conclusion: Participants emphasised the potential of integrating pharmacists into primary care to address medication-management challenges. The SEIPS model provides insights into work system dynamics and can help develop the role of pharmacists in healthcare.

BackgroundMedication discrepancies in care transitions and medication non-adherence are problematic. Few interventions consider the entire process, from the hospital to the patient's medication use at home.AimIn preparation for randomised controlled trials (RCTs), this study aimed (1) to investigate the feasibility of recruitment and retention of patients, and data collection to reduce medication discrepancies at discharge and improve medication adherence, and (2) to explore the outcomes of the interventions.MethodParticipants were recruited from a hospital and a residential area. Hospital patients participated in a pharmacist-led intervention to establish a correct medication list upon discharge and a follow-up interview two weeks post-discharge. All participants received a person-centred adherence intervention for three to six months. Discrepancies in the medication lists, the Beliefs about Medicines Questionnaire (BMQ-S), and the Medication Adherence Report Scale (MARS-5) were assessed.ResultsOf 87 asked to participate, 35 were included, and 12 completed the study. Identifying discrepancies, discussing discrepancies with physicians, and performing follow-up interviews were possible. Conducting the adherence intervention was also possible using individual health plans for medication use. Among the seven hospital patients, 24 discrepancies were found. Discharging physicians agreed that all discrepancies were errors, but only ten were corrected in the discharge information. Ten participants decreased their total BMQ-S concern scores, and seven increased their total MARS-5 scores.ConclusionBased on this study, conducting the two RCTs separately may increase the inclusion rate. Data collection was feasible. Both interventions were feasible in many aspects but need to be optimised in upcoming RCTs.

Background: In the treatment of coronary heart disease, secondary prevention goals are still often unmet and pooradherence to prescribed drugs has been suggested as one of the reasons. We aimed to investigate whether pharmaceutical care by a pharmacist at the cardiology clinic trained in motivational interviewing improves clinical outcomesand patient adherence.

Methods: This was a prospective, randomized, controlled, outcomes-blinded trial designed to compare pharmaceutical care follow-up with standard care. After standard follow-up at the cardiology clinic, patients in the interventiongroup were seen by a clinical pharmacist two to fve times as required over seven months. Pharmacists were trainedto use motivational interviewing in the consultations and they tailored their support to each patient’s clinical needsand beliefs about medicines. The primary study end-point was the proportion of patients who reached the treatmentgoal for low-density lipoprotein cholesterol by 12 months after discharge. The key secondary outcome was patientadherence to lipid-lowering therapy at 15 months after discharge, and other secondary outcomes were the efectson patient adherence to other preventive drugs, systolic blood pressure, disease-specifc quality of life, and healthcareuse.

Results: 316 patients were included. The proportion of patients who reached the target for low-density lipoproteincholesterol were 37.0% in the intervention group and 44.2% in the control group (P=.263). More intervention thancontrol patients were adherent to cholesterol-lowering drugs (88 vs 77%; P=.033) and aspirin (97 vs 91%; P=.036)but not to beta-blocking agents or renin–angiotensin–aldosterone system inhibitors.

Conclusions: Our intervention had no positive efects on risk factors for CHD, but it increased patient adherence.Further investigation of the intervention process is needed to explore the diference in results between patient adherence and medication efects. Longer follow-up of healthcare use and mortality will determine if the increased adherence per se eventually will have a meaningful efect on patient health

BACKGROUND: The Lund Integrated Medicines Management model offers a systematic approach for individualising and optimising patient drug treatment. Clinical, economical and humanistic outcomes have been shown as well as results from the medication reconciliation process. There is a need also to describe the medication review process.

OBJECTIVE: To describe the frequency and types of drug-related problems (DRPs) identified during medication reviews and to evaluate the actions of the pharmacists and the physicians regarding the identified DRPs.

METHOD: Structured medication reviews were conducted by a multi-professional team on top of standard care for 719 patients in two internal medicine wards in a Swedish University Hospital. The medication reviews were studied retrospectively to classify DRPs and actions taken.

RESULTS: A total of 573 (80%) of patients had at least one actual DRP; an average of three DRPs per patient and in total 2164. Wrong drug and adverse drug reaction were the most common types of DRPs. The most frequent medication groups involved in DRPs were drugs for the cardiovascular system and the nervous system and the most frequent substances were warfarin, digoxin, furosemide and paracetamol. The 10 most common medications accounted for 27% of the actual DRPs. Of the identified DRPs, a total of 1740 (80%) were acted on. The three most common types of adjustments made were withdrawal of drug therapy, change of drug therapy and initiation of drug therapy. When the pharmacist suggested an adjustment, the physician implemented 88% (1037/1174) of the recommendations.

CONCLUSION: DRPs are common among elderly patients who are admitted to hospital. Systematic identification of high-risk medications and common DRP types enables targeting of prioritised patients for medication reviews.

The aim of this study was to explore the effects of web-based education in the field of drug utilization on elderly individuals’ knowledge of, concerns about and self-assessed understanding of drug utilization. The 260 included participants were randomized to a control group or an intervention group. To assess drug utilization literacy, we used a questionnaire containing 20 multiple-choice questions on drug utilization and ten statements about drug utilization (to which participants graded their response using a Likert scale: two about common concerns and eight about their self-assessed understanding of drug utilization). The Beliefs about Medicines Questionnaire-General was also used. The intervention group scored higher on the knowledge questions (p < 0.001) and on six of the eight statements about self-assessed understanding of drug utilization at the first check after 2 weeks (p < 0.05). At a second check 6 months later, the difference remained for the knowledge questions, but there was no difference in self-assessed understanding of drug utilization between the groups. There were no differences in the concerns about drug utilization or beliefs about medication at any time. We conclude that a web-based education can improve drug utilization literacy in elderly individuals and might contribute to the safer use of medications.

In pharmacies in Sweden, a clinical decision support system called Electronic Expert Support (EES) is available to analyse patients’ prescriptions for potential drug-related problems. A nationwide intervention was performed in 2018 among all Swedish pharmacy chains to increase the use of EES among patients 75 years or older. The aim of this research was to study the use of EES in connection with the national intervention in order to describe any effects of the intervention, to understand how pharmacists use EES and to identify any barriers and facilitators for the use of EES by pharmacists for elderly patients. Data on the number and categories of EES analyses, alerts, resolved alerts and active pharmacies was provided by the Swedish eHealth Agency. The effects of the intervention were analysed using interrupted time series regression. A web-based questionnaire comprising 20 questions was sent to 1500 pharmacists randomly selected from all pharmacies in Sweden. The study shows that pharmacists use and appreciate EES and that the national intervention had a clear effect during the week of the intervention and seems to have contributed to a faster increase in pharmacists’ use of EES during the year to follow. The study also identified several issues or barriers for using EES.

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.

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