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Adherence to national diabetes guidelines through monitoring quality indicators--A comparison of three types of care for the elderly with special emphasis on HbA1c.

https://arctichealth.org/en/permalink/ahliterature271560
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Publication Type
Article
Date
Aug-2015
Author
Ann-Sofie Nilsson Neumark
Lars Brudin
Thomas Neumark
Source
Prim Care Diabetes. 2015 Aug;9(4):253-60
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Aged, 80 and over
Biomarkers - blood
Blood Glucose - drug effects - metabolism
Cross-Sectional Studies
Diabetes Mellitus, Type 1 - blood - diagnosis - drug therapy - epidemiology
Diabetes Mellitus, Type 2 - blood - diagnosis - drug therapy - epidemiology
Female
Guideline Adherence - standards
Health Services for the Aged - standards
Hemoglobin A, Glycosylated - metabolism
Home Care Services
Homes for the Aged
Humans
Hypoglycemic Agents - adverse effects - therapeutic use
Independent living
Male
Nursing Homes
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Prevalence
Process Assessment (Health Care) - standards
Quality Indicators, Health Care - standards
Sweden - epidemiology
Treatment Outcome
Abstract
To compare adherence to Swedish guidelines for diabetes care between elderly people living at home with or without home health care, and residents of nursing homes.
Medical records of 277 elderly people aged 80 and older, with known diabetes in a Swedish municipality, were monitored using quality indicators to evaluate processes and outcomes.
Monitoring, in accordance to diabetes guidelines, of HbA1c, lipids, blood pressure and foot examinations was lower among residents of nursing homes (p
PubMed ID
25865853 View in PubMed
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An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU(7)-PIM list.

https://arctichealth.org/en/permalink/ahliterature288291
Source
Eur J Clin Pharmacol. 2017 Jun;73(6):735-742
Publication Type
Article
Date
Jun-2017
Author
Eva Sönnerstam
Maria Sjölander
Maria Gustafsson
Source
Eur J Clin Pharmacol. 2017 Jun;73(6):735-742
Date
Jun-2017
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cognitive Dysfunction - epidemiology
Cross-Sectional Studies
Dementia - epidemiology
Drug-Related Side Effects and Adverse Reactions - epidemiology
Female
Hospitalization
Humans
Inappropriate Prescribing - statistics & numerical data
Male
Potentially Inappropriate Medication List
Practice Patterns, Physicians' - standards - statistics & numerical data
Prevalence
Randomized Controlled Trials as Topic
Risk factors
Sweden - epidemiology
Abstract
As people get older, their sensitivity to drugs and adverse drug reactions can increase due to pharmacokinetic and pharmacodynamic changes. Older people with dementia are a particularly vulnerable group of people. They are at an increased risk of being prescribed potentially inappropriate medications, which may lead to harmful consequences. The aim of this study was to investigate the prevalence of potentially inappropriate medications among older patients with cognitive impairment.
Medical records for patients aged =65 years admitted to two hospitals in Northern Sweden were reviewed. Potentially inappropriate medications were identified using the EU(7)-PIM list as an identification tool.
Of 428 patients included in the study, 40.9% had one or more potentially inappropriate medication prescribed. The most commonly represented potentially inappropriate medication classes were hypnotics and sedatives, cardiovascular drugs and laxatives. The most commonly involved potentially inappropriate medications were zopiclone, digoxin and sodium picosulfate. There was an association seen between having a higher number of medications prescribed and having one or more potentially inappropriate medication.
Potentially inappropriate medications are prevalent among older people with cognitive impairment living in Northern Sweden. It is important to continuously evaluate the need for potentially inappropriate medications in this patient group, in order to prevent adverse drug reactions, especially among those who have a higher number of medications prescribed.
Notes
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Cites: Int J Clin Pharm. 2015 Oct;37(5):815-2125986290
Cites: Can J Diabetes. 2016 Feb;40(1):73-626778684
PubMed ID
28246889 View in PubMed
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Antibiotic prescribing in primary care by international medical graduates and graduates from Swedish medical schools.

https://arctichealth.org/en/permalink/ahliterature270259
Source
Fam Pract. 2015 Jun;32(3):343-7
Publication Type
Article
Date
Jun-2015
Author
Thomas Neumark
Lars Brudin
Sigvard Mölstad
Source
Fam Pract. 2015 Jun;32(3):343-7
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - therapeutic use
Drug Utilization - standards - statistics & numerical data
Education, Medical - statistics & numerical data
Electronic Health Records
Female
Foreign Medical Graduates - standards - statistics & numerical data
Geography
Guideline Adherence - statistics & numerical data
Humans
Male
Middle Aged
Practice Patterns, Physicians' - standards - statistics & numerical data
Primary Health Care - methods - standards - statistics & numerical data
Retrospective Studies
Schools, Medical - statistics & numerical data
Sweden
Abstract
Studies of antibiotic prescribing related to diagnosis comparing prescribers trained abroad with those trained in Sweden are lacking.
To determine whether general practices (GPs) and GP residents trained abroad had different prescribing patterns for antibiotics for common infections than those trained in Sweden using retrospective data from electronic patient records from primary health care in Kalmar County, Sweden.
Consultations with an infection diagnosis, both with and without the prescription of antibiotics to 67 GPs and residents trained in Western Europe outside Sweden and other countries, were compared with a matched control group trained in Sweden.
For 1 year, 44101 consultations of patients with an infection diagnosis and 16276 prescriptions of antibiotics were registered. Foreign-trained physicians had 20% more visits compared with physicians trained in Sweden. The prescription of antibiotics per visit and physician in the respective groups, and independent of diagnosis, did not significantly differ between groups, when scaled down from number of consultations to number of prescribing physicians.
There were minor and non-significant differences in antibiotic prescribing comparing GPs and residents trained abroad and in Sweden, most likely the result of an adaptation to Swedish conditions. Nevertheless, no group prescribed antibiotics in accordance to national guidelines. The results suggest that interventions are needed to reduce irrational antibiotic prescribing patterns, targeting all physicians working in Swedish primary health care.
PubMed ID
25715961 View in PubMed
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Appropriateness of antibiotic prescribing for upper respiratory tract infections in general practice: Comparison between Denmark and Iceland.

https://arctichealth.org/en/permalink/ahliterature276312
Source
Scand J Prim Health Care. 2015;33(4):269-74
Publication Type
Article
Date
2015
Author
Nanna Rún Sigurðardóttir
Anni Brit Sternhagen Nielsen
Anders Munck
Lars Bjerrum
Source
Scand J Prim Health Care. 2015;33(4):269-74
Date
2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anti-Bacterial Agents
Bacterial Infections - drug therapy - epidemiology
Child
Clinical Audit
Cross-Sectional Studies
Denmark - epidemiology
Drug Resistance, Bacterial
Family Practice - statistics & numerical data
Female
Humans
Iceland - epidemiology
Inappropriate Prescribing - statistics & numerical data
Male
Middle Aged
Practice Patterns, Physicians' - standards - statistics & numerical data
Respiratory Tract Infections - drug therapy - epidemiology
Young Adult
Abstract
To compare the appropriateness of antibiotic prescribing for upper respiratory tract infections (URTIs) in two countries with different prevalence of antimicrobial resistance: Denmark and Iceland.
A cross-sectional study.
General practitioners (GPs) in Denmark (n = 78) and Iceland (n = 21) registered all patients with URTI according to the Audit Project Odense (APO) method during a three-week period in the winter months of 2008 and 2009.
Appropriateness of antibiotic prescribing in patients with URTI in Denmark and Iceland.
A total of 1428 patients were registered (Denmark: n = 1208; Iceland: n = 220). A majority of patients in both countries were prescribed antibiotics, and only a minority of the prescriptions could be classified as appropriate prescribing. In general, Icelandic GPs more often prescribed antibiotics (Iceland = 75.8% vs. Denmark = 59.3%), but Danish GPs had a higher percentage of inappropriate antibiotic prescribing for sinusitis, and Icelandic GPs for pharyngotonsillitis. No differences were found for acute otitis media (AOM). The different antibiotic prescribing patterns between Denmark and Iceland could not fully be explained by different symptoms and signs among patients.
Icelandic GPs have a higher antibiotic prescribing rate compared with Danish GPs, but the percentage of inappropriate antibiotic prescribing is highest in Denmark for sinusitis, and in Iceland for pharyngotonsillitis. Key points Within the Nordic countries there are marked differences in antimicrobial resistance and antibiotic use. Iceland differs from Denmark by a higher antibiotic prescribing rate and a higher prevalence of antimicrobial resistance. The majority of antibiotics are prescribed in primary care and most often for upper respiratory infections (URTIs). Only a minor amount of antibiotic prescriptions for URTIs can be classified as appropriate; inappropriate antibiotic prescribing is higher in Denmark than in Iceland for sinusitis and the opposite for pharyngotonsillitis. The different antibiotic prescribing patterns between Denmark and Iceland cannot be fully explained by different clinical criteria among patients.
Notes
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Cites: Tidsskr Nor Laegeforen. 1991 Sep 30;111(23):2830-11948877
Cites: Scand J Prim Health Care. 1998 Mar;16(1):2-69612871
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Cites: BMJ. 2010;340:c209620483949
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Cites: Lancet Infect Dis. 2002 Jul;2(7):404-1512127352
Cites: Scand J Infect Dis. 2002;34(12):880-612587619
PubMed ID
26683287 View in PubMed
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Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs' and radiologists' perspectives.

https://arctichealth.org/en/permalink/ahliterature298054
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Publication Type
Journal Article
Date
07-16-2018
Author
Ann Mari Gransjøen
Siri Wiig
Kristin Bakke Lysdahl
Bjørn Morten Hofmann
Author Affiliation
Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway. ann.gransjoen@ntnu.no.
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Date
07-16-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Diagnostic Imaging - standards
Female
General Practitioners - standards
Guideline Adherence - standards
Humans
Male
Middle Aged
Norway
Perception
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Radiologists - standards
Abstract
Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.
Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.
Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.
There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.
PubMed ID
30012130 View in PubMed
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Source
Tidsskr Nor Laegeforen. 2015 Sep 22;135(17):1527
Publication Type
Article
Date
Sep-22-2015
Author
Sigurd Høye
Source
Tidsskr Nor Laegeforen. 2015 Sep 22;135(17):1527
Date
Sep-22-2015
Language
English
Norwegian
Publication Type
Article
Keywords
Certification
General Practice - standards
Humans
Norway
Practice Patterns, Physicians' - standards
Quality of Health Care
PubMed ID
26394561 View in PubMed
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The benzodiazepine nation of Croatia: an observational, comparative study of psychotropic drug utilization between Croatia and Sweden 2014-2015.

https://arctichealth.org/en/permalink/ahliterature295468
Source
Expert Rev Pharmacoecon Outcomes Res. 2018 Dec; 18(6):641-646
Publication Type
Comparative Study
Journal Article
Date
Dec-2018
Author
Ines Potocnjak
Robert Likic
Vesna Degoricija
Eric Nham
Björn Wettermark
Author Affiliation
a Department of Medicine , University Hospital Centre Sisters of Charity , Zagreb , Croatia.
Source
Expert Rev Pharmacoecon Outcomes Res. 2018 Dec; 18(6):641-646
Date
Dec-2018
Language
English
Publication Type
Comparative Study
Journal Article
Keywords
Adult
Benzodiazepines - therapeutic use
Croatia
Cross-Sectional Studies
Databases, Factual
Drug Utilization - statistics & numerical data - trends
Female
Humans
Inappropriate Prescribing - statistics & numerical data
Male
Practice Patterns, Physicians' - standards - statistics & numerical data - trends
Psychotropic Drugs - therapeutic use
Retrospective Studies
Sweden
Abstract
The consumption of psychotropic drugs (PD) is increasing worldwide with a significant variation between countries. Croatia and Sweden have similar health and pharmaceutical systems; however, Sweden is a high-income country with developed medical care, registries, and prescribing guidelines. We sought to compare the utilization of PD between Croatia and Sweden to identify areas for improvement in rational use of drugs.
This was a cross-sectional study using national databases to assess utilization of PD (ATC N05, N06) in Croatia and Sweden in 2014 and 2015.
Prescribing of PD in Croatia increased from 127 DDD/TID (defined daily dose/1000 inhabitants) in 2014 to 131 DDD/TID in 2015. In Sweden, the total utilization was higher with an increase from 183 DDD/TID in 2014 to 188 DDD/TID in 2015. There were substantial differences. In Croatia, the utilization of benzodiazepine derivatives (N05BA) was 72.5 DDD/TID in 2014 and increased to 74.4 DDD/TID, in 2015. In Sweden, the utilization was only 11.2 DDD/TID for benzodiazepine derivatives in both years.
There were substantial differences in utilization of PD between Croatia and Sweden. Highlighting the problem of inappropriate benzodiazepine utilization in Croatia can help to introduce measures to change prescribing habits and improve prescribing quality.
PubMed ID
30073882 View in PubMed
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Case-specific colleague guidance for general practitioners' management of sickness absence.

https://arctichealth.org/en/permalink/ahliterature294916
Source
Occup Med (Lond). 2017 Dec 02; 67(8):644-647
Publication Type
Journal Article
Date
Dec-02-2017
Author
H P Nordhagen
S B Harvey
E O Rosvold
D Bruusgaard
R Blonk
A Mykletun
Author Affiliation
Norwegian Labor and Welfare Administration, Bergen, Norway.
Source
Occup Med (Lond). 2017 Dec 02; 67(8):644-647
Date
Dec-02-2017
Language
English
Publication Type
Journal Article
Keywords
Adult
Female
General Practitioners - utilization
Humans
Male
Middle Aged
Norway
Organizational Policy
Practice Patterns, Physicians' - standards - statistics & numerical data
Sick Leave
Surveys and Questionnaires
Work Capacity Evaluation
Abstract
General practitioners (GPs) report sickness absence certification as challenging. They express need for support with functional assessment beyond guidelines and reforms. Case-specific collegial one-to-one guidance for other clinical topics has proved popular with GPs and may be an acceptable and effective way to improve GPs skills and competence in sickness absence certification.
To present a new model of case-specific colleague guidance focusing on the management of long-term sickness absence and to describe its feasibility in terms of application and reception among GPs, and also GPs' self-reports of effects on their practice.
Randomly selected GPs received case-specific collegial guidance over a 12-month period, in two Norwegian trials, delivered by former GPs employed by the social security administration. We measured reception and perceived effects by GPs' self-report and registered participation and withdrawal rates.
The participation rate (n = 165) was 94%, and no GPs withdrew during training. Among the 116 GPs responding to the survey (70%), 112 (97%; 95% CI 92-99) stated they would recommend it to their colleagues. Considerable benefit from the guidance was reported by 68 (59%; 95% CI 50-68). The GPs self-reported other effects on their sickness absence certification, specifically an increased use of part-time sickness absence (Fit-Note equivalent).
This model of case-specific colleague guidance to aid GPs' management of long-term sickness absence is feasible and was popular. This type of guidance was perceived by GPs to be somewhat beneficial and to alter their sickness absence certification behaviour, though the true impact requires further testing in controlled trials.
PubMed ID
29016957 View in PubMed
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Co-Prescribing of Potentially Interacting Drugs during Warfarin Therapy - A Population-Based Register Study.

https://arctichealth.org/en/permalink/ahliterature271591
Source
Basic Clin Pharmacol Toxicol. 2015 Aug;117(2):126-32
Publication Type
Article
Date
Aug-2015
Author
Maria Rikala
Milka Hauta-Aho
Arja Helin-Salmivaara
Riitta Lassila
Maarit Jaana Korhonen
Risto Huupponen
Source
Basic Clin Pharmacol Toxicol. 2015 Aug;117(2):126-32
Date
Aug-2015
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - administration & dosage - adverse effects
Databases, Factual
Drug Interactions
Drug Monitoring - methods
Female
Finland
Humans
Male
Middle Aged
Practice Patterns, Physicians' - standards - statistics & numerical data
Prescription Drugs - administration & dosage - adverse effects
Registries
Warfarin - administration & dosage - adverse effects
Abstract
We analysed the occurrence of co-prescribing of potentially interacting drugs during warfarin therapy in the community-dwelling population of Finland. We identified drugs having interaction potential with warfarin using the Swedish Finnish INteraction X-referencing drug-drug interaction database (SFINX) and obtained data on drug purchases from the nationwide Prescription Register. We defined warfarin users as persons purchasing warfarin in 2010 (n = 148,536) and followed them from their first prescription in 2010 until the end of the calendar year. Co-prescribing was defined as at least 1-day overlap between warfarin and interacting drug episodes. In addition, we identified persons who initiated warfarin therapy between 1 January 2007 and 30 September 2010 (n = 110,299) and followed these incident users for a 3-month period since warfarin initiation. Overall, 74.4% of warfarin users were co-prescribed interacting drugs. Co-prescribing covered 46.4% of the total person-years of warfarin exposure. Interacting drugs that should be avoided with warfarin were co-prescribed for 13.4% of warfarin users. The majority of the co-prescriptions were for drugs that are not contraindicated during warfarin therapy but require special consideration. Among incident users, 57.1% purchased potentially interacting drugs during the 3-month period after initiation, while 9.0% purchased interacting drugs that should be avoided with warfarin. To conclude, the occurrence of co-prescribing of potentially interacting drugs was high during warfarin therapy. Our findings highlight the importance of close monitoring of warfarin therapy and the need for further studies on the clinical consequences of co-prescribing of interacting drugs with warfarin.
PubMed ID
25537751 View in PubMed
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[Evaluation of Rational Use of Antibacterial Drugs].

https://arctichealth.org/en/permalink/ahliterature272623
Source
Vestn Ross Akad Med Nauk. 2015;(6):734-40
Publication Type
Article
Date
2015
Author
I. Gaynullina
Source
Vestn Ross Akad Med Nauk. 2015;(6):734-40
Date
2015
Language
Russian
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - pharmacology - therapeutic use
Antibiotic Prophylaxis - methods - statistics & numerical data
Child
Cholecystectomy - methods
Drug Resistance, Bacterial
Female
Humans
Male
Perioperative Care - methods
Practice Patterns, Physicians' - standards
Program Evaluation
Quality Improvement
Russia
Safety Management - methods - organization & administration
Staff Development - methods
Abstract
WHO considers the problem of antimicrobial resistance to be the serious threat to humanity. One approach to solve it is to restrict the use ofantimicrobials. This approach implies the implementation of educational programs. Such programmes take much time and money. However, the effectiveness of educational programs is not clear.
determine the effectiveness of educational activities in the field of rationalization of the use of antibacterial drugs.
Two-stage multicenter research on the practice of antibacterial drugs application and the effectiveness of educational programs designed to rationalize antibiotic therapy in Primorsky Territory.
It wasfound that programs aimed only at the training of doctors are ineffective. The frequency of unjustified use of antimicrobials remains high--72.7% (2002-2003) and 70.4% (2011-2012).
To improve the rationality of medical prescriptions (antibacterial drugs) it is necessary to combine educational programs with management measures.
PubMed ID
27093802 View in PubMed
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20 records – page 1 of 2.