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Acceptance and importance of clinical pharmacists' LIMM-based recommendations.

https://arctichealth.org/en/permalink/ahliterature127887
Source
Int J Clin Pharm. 2012 Apr;34(2):272-6
Publication Type
Article
Date
Apr-2012
Author
Asa Bondesson
Lydia Holmdahl
Patrik Midlöv
Peter Höglund
Emmy Andersson
Tommy Eriksson
Author Affiliation
Department of Clinical Pharmacology, Lund University, Lund, Sweden. asa.c.bondesson@skane.se
Source
Int J Clin Pharm. 2012 Apr;34(2):272-6
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Attitude of Health Personnel
Drug-Related Side Effects and Adverse Reactions
Female
Health Knowledge, Attitudes, Practice
Humans
Interdisciplinary Communication
Male
Medication Errors - prevention & control
Medication Reconciliation - organization & administration
Medication Therapy Management - organization & administration - standards
Middle Aged
Models, organizational
Patient Care Team - organization & administration
Pharmacists - organization & administration - psychology
Pharmacy Service, Hospital - organization & administration - standards
Physicians - psychology
Quality of Health Care - organization & administration - standards
Retrospective Studies
Risk assessment
Sweden
Abstract
The objective of this study was to evaluate the quality of the clinical pharmacy service in a Swedish hospital according to the Lund Integrated Medicine Management (LIMM) model, in terms of the acceptance and clinical significance of the recommendations made by clinical pharmacists.
The clinical significance of the recommendations made by clinical pharmacists was assessed for a random sample of inpatients receiving the clinical pharmacy service in 2007. Two independent physicians retrospectively ranked the recommendations emerging from errors in the patients' current medication list and actual drug-related problems according to Hatoum, with rankings ranging between 1 (adverse significance) and 6 (extremely significant).
The random sample comprised 132 patients (out of 800 receiving the service). The clinical significance of 197 recommendations was assessed. The physicians accepted and implemented 178 (90%) of the clinical pharmacists' recommendations. Most of these recommendations, 170 (83%), were ranked 3 (somewhat significant) or higher.
This study provides further evidence of the quality of the LIMM model and confirms that the inclusion of clinical pharmacists in a multi-professional team can improve drug therapy for inpatients. The very high level of acceptance by the physicians of the pharmacists' recommendations further demonstrates the effectiveness of the process.
PubMed ID
22252773 View in PubMed
Less detail

Active listing and more consultations in primary care are associated with reduced hospitalisation in a Swedish population.

https://arctichealth.org/en/permalink/ahliterature294536
Source
BMC Health Serv Res. 2018 02 09; 18(1):101
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
02-09-2018
Author
Karin Ranstad
Patrik Midlöv
Anders Halling
Author Affiliation
Department of Clinical Sciences in Malmö, Centre for Primary Health Care Research, Clinical Research Centre (CRC), Lund University, Skåne University Hospital, Jan Waldenströms gata 35, 205 02, Malmö, Sweden. karin.ranstad@med.lu.se.
Source
BMC Health Serv Res. 2018 02 09; 18(1):101
Date
02-09-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Databases, Factual
Delivery of Health Care
Female
Hospitalization - trends
Humans
Income
Male
Middle Aged
Primary Health Care
Referral and Consultation - utilization
Social Class
Sweden
Young Adult
Abstract
Healthcare systems are complex networks where relationships affect outcomes. The importance of primary care increases while health care acknowledges multimorbidity, the impact of combinations of different diseases in one person. Active listing and consultations in primary care could be used as proxies of the relationships between patients and primary care. Our objective was to study hospitalisation as an outcome of primary care, exploring the associations with active listing, number of consultations in primary care and two groups of practices, while taking socioeconomic status and morbidity burden into account.
A cross-sectional study using zero-inflated negative binomial regression to estimate odds of any hospital admission and mean number of days hospitalised for the population over 15 years (N =?123,168) in the Swedish county of Blekinge during 2007. Explanatory factors were listed as active or passive in primary care, number of consultations in primary care and primary care practices grouped according to ownership. The models were adjusted for sex, age, disposable income, education level and multimorbidity level.
Mean days hospitalised was 0.94 (95%CI 0.90-0.99) for actively listed and 1.32 (95%CI 1.24-1.40) for passively listed. For patients with 0-1 consultation in primary care mean days hospitalised was 1.21 (95%CI 1.13-1.29) compared to 0.77 (95%CI 0.66-0.87) days for patients with 6-7 consultations. Mean days hospitalised was 1.22 (95%CI 1.16-1.28) for listed in private primary care and 0.98 (95%CI 0.94-1.01) for listed in public primary care, with odds for hospital admission 0.51 (95%CI 0.39-0.63) for public primary care compared to private primary care.
Active listing and more consultations in primary care are both associated with reduced mean days hospitalised, when adjusting for socioeconomic status and multimorbidity level. Different odds of any hospitalisation give a difference in mean days hospitalised associated with type of primary care practice. To promote well performing primary care to maintain good relationships with patients could reduce mean days hospitalised.
Notes
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PubMed ID
29426332 View in PubMed
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Being in a Bubble: the experience of loneliness among frail older people.

https://arctichealth.org/en/permalink/ahliterature277468
Source
J Adv Nurs. 2016 Mar;72(3):631-40
Publication Type
Article
Date
Mar-2016
Author
Elin Taube
Ulf Jakobsson
Patrik Midlöv
Jimmie Kristensson
Source
J Adv Nurs. 2016 Mar;72(3):631-40
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Activities of Daily Living - psychology
Aged
Aged, 80 and over
Female
Frail Elderly - psychology
Humans
Loneliness - psychology
Male
Social Isolation - psychology
Social Participation - psychology
Sweden
Abstract
The aim of this study was to explore the experience of loneliness among frail older people living at home.
Loneliness is a threat to the physical and psychological well-being with serious consequences if left unattended. There are associations between frailty and poor psychological well-being, implying that frail older people who experience loneliness are vulnerable.
Qualitative content analysis, focusing on both latent and manifest content.
Frail older people (65+ years), living at home and who have experienced various levels in intensity of loneliness, were purposively selected from a larger interventional study (N = 12). For this study, 'frail' means being dependent in activities of daily life and having repeated contacts with healthcare services. Data were collected between December 2009-August 2011. Semi-structured interviews were performed, audio recorded and transcribed verbatim.
The analysis resulted in the overall theme 'Being in a Bubble', which illustrates an experience of living in an ongoing world, but excluded because of the participants' social surroundings and the impossibility to regain losses. The theme 'Barriers' was interpreted as facing physical, psychological and social barriers for overcoming loneliness. The theme 'Hopelessness' reveals the experience when not succeeding in overcoming these barriers, including seeing loneliness as a constant state. A positive co-existing dimension of loneliness, offering independence, was reflected in the theme 'Freedom'.
The findings suggest that future strategies for intervening should target the frail older persons' individual barriers and promoting the positive co-existing dimension of loneliness. When caring, a person centred approach, encompassing knowledge regarding physical and psychological aspects, including loneliness, is recommended.
PubMed ID
26568280 View in PubMed
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Can gender difference in prescription drug use be explained by gender-related morbidity?: a study on a Swedish population during 2006.

https://arctichealth.org/en/permalink/ahliterature263883
Source
BMC Public Health. 2014;14:329
Publication Type
Article
Date
2014
Author
Jessica Skoog
Patrik Midlöv
Lars Borgquist
Jan Sundquist
Anders Halling
Source
BMC Public Health. 2014;14:329
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Contraceptive Agents
Diagnosis-Related Groups
Drug Prescriptions
Female
Health Services - utilization
Humans
Male
Men's health
Middle Aged
Morbidity
Population Groups
Prescription Drugs - therapeutic use
Research Design
Sex Factors
Sweden
Women's health
Young Adult
Abstract
It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity.
Data was collected on all individuals 20 years and older in the county of Östergötland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses.
The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females.
Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.
Notes
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PubMed ID
24713023 View in PubMed
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Case managers for frail older people: a randomised controlled pilot study.

https://arctichealth.org/en/permalink/ahliterature144071
Source
Scand J Caring Sci. 2010 Dec;24(4):755-63
Publication Type
Article
Date
Dec-2010
Author
Jimmie Kristensson
Anna K Ekwall
Ulf Jakobsson
Patrik Midlöv
Ingalill R Hallberg
Author Affiliation
Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden. Jimmie.Kristensson@med.lu.se
Source
Scand J Caring Sci. 2010 Dec;24(4):755-63
Date
Dec-2010
Language
English
Publication Type
Article
Keywords
Aged
Case Management
Frail Elderly
Humans
Pilot Projects
Sweden
Abstract
The aim was to test sampling and explore sample characteristics in a pilot study using a case management intervention for older people with functional dependency and repeated contact with the healthcare services as well as to investigate the effects of the intervention on perceived health and depressed mood after 3 months. The aim was also to explore internal consistency in the life satisfaction index Z, activities of daily living-staircase and Geriatric Depression Scale-20.
This pilot study was carried out in a randomised controlled design with repeated follow-ups. In all, 46 people were consecutively and randomly assigned to either an intervention (n = 23) or a control (n = 23) group. Two nurses worked as case managers and carried out the intervention, which consisted of four parts.
No differences were found between the groups at baseline. The results showed the participants had low life satisfaction (median 14 vs. 12), several health complaints (median 11) and a high score on the Geriatric Depression Scale (median 6) at baseline, indicating the risk of depression. No significant effects were observed regarding depressed mood or perceived health between or within groups at follow-up after 3 months. Cronbach's alpha showed satisfactory internal consistency for group comparisons.
The sampling procedure led to similar groups. The life satisfaction, functional dependency and symptoms of depression measures were reliable to use. No changes in perceived health and symptoms of depression were found after 3 months, indicating that it may be too early to expect effects. The low depression score is noteworthy and requires further research.
PubMed ID
20409057 View in PubMed
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Colonization with Staphylococcus aureus in Swedish nursing homes: a cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature131878
Source
Scand J Infect Dis. 2012 Jan;44(1):3-8
Publication Type
Article
Date
Jan-2012
Author
Magnus Olofsson
Per-Eric Lindgren
Carl Johan Ostgren
Patrik Midlöv
Sigvard Mölstad
Author Affiliation
Ödeshög Health Care Centre, Ödeshög, Sweden. magnus.olofsson@lio.se
Source
Scand J Infect Dis. 2012 Jan;44(1):3-8
Date
Jan-2012
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Carrier State - epidemiology
Cross Infection - epidemiology
Cross-Sectional Studies
Drug Resistance, Bacterial
Female
Humans
Institutionalization
Male
Mass Screening - methods
Middle Aged
Nursing Homes
Staphylococcal Infections - drug therapy - epidemiology
Staphylococcus aureus - drug effects - isolation & purification
Sweden
Abstract
Screening for bacterial colonization among risk populations could provide better estimates of the volume of the bacteria-related disease reservoir and the level of antimicrobial resistance, than do conventional laboratory reports.
Two hundred and one participants at 10 Swedish nursing homes were screened for colonization with Staphylococcus aureus between January and October 2009. Of the 201 participants, 61 (30%) were male. The median age was 86 y. All participants were systematically sampled from the nasal mucosa, the pharyngeal mucosa, the groin, and active skin lesions, if any.
Ninety-nine of 199 participants (50%) were colonized with S. aureus. The colonization rate was 34% for the nose, 35% for throat, 10% for groin, and 54% for active skin lesions. An antibiotic-resistant S. aureus isolate was identified in 8.5% of all participants regardless of colonization status. A total of 24 resistant isolates were detected, and 21 of these were resistant to fluoroquinolones. There was no case of colonization with methicillin-resistant S. aureus (MRSA).
The presence of resistant isolates was generally low, and the greater part of the resistance was fluoroquinolone-related. To achieve reasonable precision, screening programmes of this kind must include samples from both the nose and throat, and, although low, the prevalence of antimicrobial resistance in Swedish nursing homes still calls for reflection on how to use the fluoroquinolones wisely.
PubMed ID
21867472 View in PubMed
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Depression and use of antidepressants in Swedish nursing homes: a 12-month follow-up study.

https://arctichealth.org/en/permalink/ahliterature259522
Source
Int Psychogeriatr. 2014 Apr;26(4):669-75
Publication Type
Article
Date
Apr-2014
Author
Patrik Midlöv
Martin Andersson
Carl Johan Ostgren
Sigvard Mölstad
Source
Int Psychogeriatr. 2014 Apr;26(4):669-75
Date
Apr-2014
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Antidepressive Agents - therapeutic use
Dementia - drug therapy - epidemiology
Depression - drug therapy - epidemiology
Depressive Disorder - drug therapy - epidemiology
Drug Prescriptions - statistics & numerical data
Female
Follow-Up Studies
Frail Elderly
Homes for the Aged
Humans
Male
Middle Aged
Nursing Homes - statistics & numerical data
Polypharmacy
Prevalence
Sweden - epidemiology
Abstract
The prescription of antidepressants in nursing homes has increased markedly since the introduction of SSRIs, while at the same time depressive symptoms often go unrecognized and untreated. The aim of this study was to examine whether depression among residents in nursing homes is treated adequately.
A sample of 429 participants from 11 Swedish nursing homes was selected and was assessed with the Cornell Scale for Depression in Dementia (CSDD) and using medical records and drug prescription data. For 256 participants a follow-up assessment was performed after 12 months.
The prevalence of depression, according to medical records, was 9.1%, and the prevalence of CSDD score of =8 was 7.5%. Depression persisted in more than 50% of cases at the 12-month follow-up. Antidepressants were prescribed to 33% of the participants without a depression diagnosis or with a CSDD score of
PubMed ID
24331291 View in PubMed
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Descriptive study and pharmacotherapeutic intervention in patients with epilepsy or Parkinson's disease at nursing homes in southern Sweden.

https://arctichealth.org/en/permalink/ahliterature71698
Source
Eur J Clin Pharmacol. 2002 Feb;57(12):903-10
Publication Type
Article
Date
Feb-2002
Author
Patrik Midlöv
Asa Bondesson
Tommy Eriksson
Jesper Petersson
Lennart Minthon
Peter Höglund
Author Affiliation
Department of Clinical Pharmacology, Lund University Hospital, Sweden.
Source
Eur J Clin Pharmacol. 2002 Feb;57(12):903-10
Date
Feb-2002
Language
English
Publication Type
Article
Keywords
Activities of Daily Living
Adult
Aged
Aged, 80 and over
Epilepsy - drug therapy - psychology
Female
Humans
Male
Middle Aged
Nursing Homes
Parkinson Disease - drug therapy - psychology
Quality of Life
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVES: To describe the drug use in epilepsy and Parkinson's patients living in nursing homes and to evaluate the impact of multi-speciality team intervention on health-related quality of life, activities of daily living (ADL) and confusion state. METHODS: Nursing home residents with epilepsy or Parkinson's disease in the county of Skåne in Sweden were identified. From 119 nursing homes, 262 patients were identified. After obtaining informed consent, 157 patients from 48 nursing homes were included. Of these patients 74 were diagnosed with epilepsy and 84 with Parkinson's disease (one patient had both diagnoses). The average age of the epilepsy patients was 79 years and of the Parkinson's patients 81 years. Pharmacists documented the patients' drug use and any drug-related problems after communication with nursing-home residents, their contact persons at the nursing home and the residents' physicians. A multi-speciality group consisting of pharmacists, a primary care physician, a neurologist, a neuro-psychiatrist and a clinical pharmacologist evaluated the patients' medication and, when appropriate, suggested changes. Lists of each resident's medications were collected together with information about drug-related problems. The use of drugs deemed inappropriate for geriatric nursing-home residents according to Beer's criteria was documented. Health-related quality of life was evaluated using a generic health-related quality of life instrument, SF-36. Confusion state was measured using the Behaviour Pathology in Alzheimer's Disease Rating Scale (Behave-AD), and ability to perform ADL was assessed using the Schwab and England capacity for daily living scale. All measurements were repeated after approximately 6 months. During that period, for the group randomised to active intervention, the physicians involved in the care of the patients had received the recommendations for changes in drug treatment from the multi-speciality group. RESULTS: Epilepsy patients at nursing homes used on average 8.0 drugs for continuous use whereas Parkinson's patients used 8.6 drugs. According to Beer's criteria about 40% of both patient groups used drugs that are classified as inappropriate to geriatric nursing-home patients. Dopamine receptor-blocking psychotropic drugs were used by 29% of the Parkinson's patients. Indication for a patient's total drug treatment was not documented for 50% of epilepsy and 40% of Parkinson's patients. There were no significant differences between the active and control groups in changes in SF-36, Behave-AD or ADL for epilepsy patients. For Parkinson's patients there was a significant decrease in ADL for the active group, whereas there were no differences in SF-36 or Behave-AD. CONCLUSION: Nursing-home residents with epilepsy or Parkinson's disease use many drugs and often drugs that are classified as inappropriate. A simple problem-oriented questionnaire may be helpful in identifying specific drug-related problems in geriatric patients with common neurological diseases. Methods on how to improve the pharmacotherapy of these patients still have to be developed.
PubMed ID
11936711 View in PubMed
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Developing a Competency-based Curriculum in Basic and Clinical Pharmacology--A Delphi Study among Physicians.

https://arctichealth.org/en/permalink/ahliterature277518
Source
Basic Clin Pharmacol Toxicol. 2015 Dec;117(6):413-20
Publication Type
Article
Date
Dec-2015
Author
Patrik Midlöv
Peter Höglund
Tommy Eriksson
Annika Diehl
Gudrun Edgren
Source
Basic Clin Pharmacol Toxicol. 2015 Dec;117(6):413-20
Date
Dec-2015
Language
English
Publication Type
Article
Keywords
Clinical Competence
Consensus
Curriculum
Delphi Technique
Education, Medical, Undergraduate - methods
Humans
Pharmacology, Clinical - education
Program Development
Schools, Medical
Surveys and Questionnaires
Sweden
Teaching - methods
Abstract
A new curriculum is planned for the medical school at Lund University, Sweden. Pharmacology, in a broad sense, has been identified as a subject that needs to be strengthened based on needs in the healthcare system. The aim was to identify the competencies in basic and clinical pharmacology that a newly qualified physician needs. Using a modified three-round Delphi technique, 31 physicians were invited to list necessary competencies (round 1). After content analysis, these panel members classified the list by importance on two occasions (rounds 2 and 3) using a 4-point scale (4 = necessary, 3 = desirable, 2 = useful, 1 = not necessary). Competencies with the highest ranks based on necessity were retained. Thirty physicians accepted the invitation and 25 (83%) of them completed all three rounds. Round 1 resulted in 258 suggestions, which were subsequently reduced to 95 competencies. Of these 95 competencies, 40 were considered necessary by at least 75% of the panel members. The degree of consensus increased between round 2 and round 3. Using a modified Delphi technique, we identified 40 competencies that could be transferred to learning outcomes for a new curriculum in basic and clinical pharmacology at medical school.
PubMed ID
26123372 View in PubMed
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Drugs prescribed by general practitioners according to age, gender and socioeconomic status after adjustment for multimorbidity level.

https://arctichealth.org/en/permalink/ahliterature267411
Source
BMC Fam Pract. 2014;15:183
Publication Type
Article
Date
2014
Author
Jessica Skoog
Patrik Midlöv
Anders Beckman
Jan Sundquist
Anders Halling
Source
BMC Fam Pract. 2014;15:183
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Aged, 80 and over
Comorbidity
Educational Status
Female
General practice
Humans
Income - statistics & numerical data
Male
Middle Aged
Odds Ratio
Physician's Practice Patterns - statistics & numerical data
Prescription Drugs - therapeutic use
Sex Factors
Social Class
Socioeconomic Factors
Sweden
Young Adult
Abstract
Age, gender and socioeconomic status have been shown to be associated with the use of prescription drugs, even after adjustment for multimorbidity. General practitioners have a holistic and patient-centred perspective and our hypothesis is that this may reflect on the prescription of drugs. In Sweden the patient may seek secondary care without a letter of referral and the liability of the prescription of drugs accompanies the patient, which makes it suitable for this type of research. In this study we examine the odds of having prescription drug use in the population and the rates of prescription drugs among patients, issued in primary health care, according to age, gender and socioeconomic status after adjustment for multimorbidity level.
Data were collected on all individuals above 20 years of age in Östergötland county with about 400 000 inhabitants in year 2006. The John Hopkins ACG Case-mix was used as a proxy for multimorbidity level. Odds ratio (OR) of having prescription drugs issued in primary health care in the population and rates of prescription drug use among patients in primary health care, stated as incidence rate ratio (IRR), according to age, gender and socioeconomic status were calculated and adjusted for multimorbidity.
After adjustment for multimorbidity, individuals 80 years or older had higher odds ratio (OR 3.37 (CI 95% 3.22-3.52)) and incidence rate ratio (IRR 6.24 (CI 95% 5.79-6.72)) for prescription drug use. Male individuals had a lower odds ratio of having prescription drugs (OR 0.66 (CI 95% 0.64-0.69)), but among patients males had a slightly higher incidence rate of drug use (IRR 1.06 (CI 95% 1.04-1.09)). Individuals with the highest income had the lowest odds ratio of having prescription drugs and individuals with the second lowest income had the highest odds ratio of having prescription drugs (OR 1.10 (CI 95% 1.07-1.13)). Individuals with the highest education had the lowest odds ratio of having prescription drugs (OR 0.61 (CI 95% 0.54-0.67)).
Age, gender and socioeconomic status are associated with large differences in the use of prescribed drugs in primary health care, even after adjustment for multimorbidity level.
Notes
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PubMed ID
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