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Mikkelsen TH, Søndergaard J, Kjær NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Designing a tool ensuring older patients the right medication at the right time after discharge from hospital- the first step in a participatory design process. BMC Health Serv Res 2024; 24:511. [PMID: 38658997 PMCID: PMC11040918 DOI: 10.1186/s12913-024-10992-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily, increasing the risk of adverse drug reactions, interactions, or medication errors. Healthcare sector transitions increase the risk of information loss, misunderstandings, unclear treatment responsibilities, and medication errors. Therefore, it is crucial to identify possible solutions to decrease these risks. Patients, relatives, and healthcare professionals were asked to design the solution they need. METHODS We conducted a participatory design approach to collect information from patients, relatives, and healthcare professionals. The informants were asked to design their take on a tool ensuring that patients received the correct medication after discharge from the hospital. We included two patients using five or more medications daily, one relative, three general practitioners, four nurses from different healthcare sectors, two hospital physicians, and three pharmacists. RESULTS The patients' solution was a physical location providing a medication overview, including side effects and interactions. Healthcare professionals suggested different solutions, including targeted and timely information that provided an overview of the patient's diagnoses, treatment and medication. The common themes identified across all sub-groups were: (1) Overview of medications, side effects, and diagnoses, (2) Sharing knowledge among healthcare professionals, (3) Timely discharge letters, (4) Does the shared medication record and existing communication platforms provide relevant information to the patient or healthcare professional? CONCLUSION All study participants describe the need for a more concise, relevant overview of information. This study describes elements for further elaboration in future participatory design processes aimed at creating a tool to ensure older patients receive the correct medication at the correct time.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjær
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- The hospital pharmacy research unit, Hospital Sønderjylland, Aabenraa, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Hamzaei Z, Houlind MB, Kjeldsen LJ, Christensen LWS, Walls AB, Aharaz A, Olesen C, Coric F, Revell JHP, Ravn-Nielsen LV, Andersen TRH, Hedegaard U. Inappropriate prescribing in patients with kidney disease: A rapid review of prevalence, associated clinical outcomes and impact of interventions. Basic Clin Pharmacol Toxicol 2024; 134:439-459. [PMID: 38348501 DOI: 10.1111/bcpt.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 03/16/2024]
Abstract
BACKGROUND The prevalence of patients with chronic kidney disease (CKD) and polypharmacy is increasing and has amplified the importance of examining inappropriate prescribing (IP) in CKD. This review focuses on the latest research regarding the prevalence of IP in CKD and the related adverse clinical effects and explores new interventions against IP. METHOD A literature search was performed using PubMed, EMBASE and the Cochrane Library searching articles published between June 2016 and March 2022. RESULTS Twenty-seven studies were included. An IP prevalence of 12.6% to 96% and 0.3% to 66% was reported in hospital and outpatient settings, respectively. In nonhospital settings, the prevalence of IP varied between 3.9% and 60%. IP was associated with higher risk of hospitalisation (HR 1.46, 95% CI 1.17-1.81), higher bleeding rate (HR 2.34, 95% CI 1.32 to 3.37) and higher risk of all-cause mortality (OR 1.07, 95% CI 1.02 to 1.13). Three studies reported the impact of interventions on IP. CONCLUSION This review highlights widespread IP in CKD patients across healthcare settings, with varying prevalence rates. IP is substantially linked to adverse outcomes in patients. While limited interventions show promise, urgent research is needed to develop effective strategies addressing IP and improving CKD patient care.
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Affiliation(s)
- Zohra Hamzaei
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Morten Baltzer Houlind
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Louise Westberg Strejby Christensen
- The Capital Region Pharmacy, Herlev, Denmark
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | - Anne Byriel Walls
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Capital Region Hospital Pharmacy, Copenhagen, Denmark
| | - Anissa Aharaz
- Department of Clinical Research, Copenhagen University Hospital-Amager and Hvidovre, Hvidovre, Denmark
| | | | - Faruk Coric
- Hospital Pharmacy Funen, Odense University Hospital, Odense, Denmark
| | | | | | | | - Ulla Hedegaard
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Mikkelsen TH, Søndergaard J, Kjaer NK, Nielsen JB, Ryg J, Kjeldsen LJ, Mogensen CB. Handling polypharmacy -a qualitative study using focus group interviews with older patients, their relatives, and healthcare professionals. BMC Geriatr 2023; 23:477. [PMID: 37553585 PMCID: PMC10410867 DOI: 10.1186/s12877-023-04131-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/24/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND On average, older patients use five or more medications daily. A consequence is an increased risk of adverse drug reactions, interactions, or medication errors. Therefore, it is important to understand the challenges experienced by the patients, relatives, and healthcare professionals pertinent to the concomitant use of many drugs. METHODS We conducted a qualitative study using focus group interviews to collect information from patients, relatives, and healthcare professionals regarding older patients' management of prescribed medicine. We interviewed seven patients using five or more medications daily, three relatives, three general practitioners, nine nurses from different healthcare sectors, one home care assistant, two hospital physicians, and four pharmacists. RESULTS The following themes were identified: (1) Unintentional non-adherence, (2) Intentional non-adherence, (3) Generic substitution, (4) Medication lists, (5) Timing and medication schedule, (6) Medication reviews and (7) Dose dispensing/pill organizers. CONCLUSION Medication is the subject of concern among patients and relatives. They become confused and insecure about information from different actors and the package leaflets. Therefore, patients often request a thorough medication review to provide an overview, knowledge of possible side effects and interactions, and a clarification of the medication's timing. In addition, patients, relatives and nurses all request an indication of when medicine should be taken, including allowable deviations from this timing. Therefore, prescribing physicians should prioritize communicating information regarding these matters when prescribing.
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Affiliation(s)
- Thorbjørn Hougaard Mikkelsen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark.
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark.
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Kristian Kjaer
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Bo Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, 6 The, Odense, Denmark
| | - Lene Juel Kjeldsen
- Hospital Sønderjylland, Kresten Philipsens vej 15, indgang F, Aabenraa, 6200, Denmark
| | - Christian Backer Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
- Research Unit of Emergency Medicine, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Christensen KM, Skjøt-Arkil H, Kjeldsen LJ, Kampmann JD. The lack of transparency regarding the phosphate content of drugs. Int J Clin Pharm 2023; 45:1019-1021. [PMID: 37219676 DOI: 10.1007/s11096-023-01594-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/20/2023] [Indexed: 05/24/2023]
Affiliation(s)
- Kenneth Maersk Christensen
- Department of Internal Medicine, University Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark
| | - Helene Skjøt-Arkil
- Department of Emergency Medicine, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Lene Juel Kjeldsen
- Hospital Pharmacy Research Unit, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Jan Dominik Kampmann
- Department of Internal Medicine, University Hospital of Southern Jutland, Sydvang 1, 6400, Sønderborg, Denmark.
- Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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Kjeldsen LJ, Schlünsen M, Meijers A, Hansen S, Christensen C, Bender T, Ratajczyk B. Medication Dispensing by Pharmacy Technicians Improves Efficiency and Patient Safety at a Geriatric Ward at a Danish Hospital: A Pilot Study. Pharmacy (Basel) 2023; 11:pharmacy11030082. [PMID: 37218964 DOI: 10.3390/pharmacy11030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND This study aims to evaluate medication dispensing by pharmacy technicians at a geriatric inpatient ward at a Danish hospital. METHODS Four pharmacy technicians were trained in delivering a dispensing service at a geriatric ward. At baseline, the ward nurses recorded the time spent dispensing the medication and the number of interruptions. Similar recordings were completed twice during the period in which the pharmacy technicians delivered the dispensing service. Satisfaction among the ward staff with the dispensing service was assessed by a questionnaire. Reported medication errors were collected during the dispensing service period and compared to a similar time period during the previous two years. RESULTS The time spent on dispensing medications was on average reduced with 1.4 h per day ranging from 4.7 to 3.3 h per day when the pharmacy technicians performed the service. Interruptions during the dispensing process decreased from a daily average of more than 19 times to an average of 2-3 per day. The nursing staff reported positive feedback on the medication dispensing service provided, especially about easing their workload. There was a tendency toward decreased reporting of medication errors. CONCLUSION The medication dispensing service performed by the pharmacy technicians reduced time spent on dispensing medication and increased patient safety by reducing interruptions during the process and decreasing the number of medication errors reported.
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Affiliation(s)
- Lene Juel Kjeldsen
- The Hospital Pharmacy, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
- Institute for Regional Health Research, The University of Southern Denmark, 5000 Odense, Denmark
| | - Maja Schlünsen
- The Hospital Pharmacy, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
- Institute for Regional Health Research, The University of Southern Denmark, 5000 Odense, Denmark
| | - Annette Meijers
- The Hospital Pharmacy, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
| | - Steffan Hansen
- The Hospital Pharmacy, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
| | | | - Tanja Bender
- Brain and Nerve Diseases, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
| | - Barbara Ratajczyk
- Medical Diseases, University Hospital Sønderjylland, 6200 Aabenraa, Denmark
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Skjøt-Arkil H, Lundby C, Kjeldsen LJ, Skovgårds DM, Almarsdóttir AB, Kjølhede T, Duedahl TH, Pottegård A, Graabaek T. Multifaceted Pharmacist-led Interventions in the Hospital Setting: A Systematic Review. Basic Clin Pharmacol Toxicol 2018; 123:363-379. [PMID: 29723934 DOI: 10.1111/bcpt.13030] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 04/19/2018] [Indexed: 11/30/2022]
Abstract
Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.
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Affiliation(s)
- Helene Skjøt-Arkil
- Emergency Department, Hospital of Southern Jutland, Aabenraa, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Carina Lundby
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
| | | | | | | | - Tue Kjølhede
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Tina Hoff Duedahl
- Telepsychiatric Centre, The Mental Health Services, Region of Southern Denmark, Odense, Denmark
| | - Anton Pottegård
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Trine Graabaek
- Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
- Department of Quality, Hospital of South West Jutland, Esbjerg, Denmark
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Rishoej RM, Almarsdóttir AB, Thybo Christesen H, Hallas J, Juel Kjeldsen L. Identifying and assessing potential harm of medication errors and potentially unsafe medication practices in paediatric hospital settings: a field study. Ther Adv Drug Saf 2018; 9:509-522. [PMID: 30181859 PMCID: PMC6116774 DOI: 10.1177/2042098618781521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hospitalized children are prone to experience harm from medication errors (MEs). Strategies to prevent MEs can be developed from identified malfunctioning practices and conditions in the medication use process. In this study, we aimed to identify MEs and potentially unsafe medication practices (PUMPs) in hospitalized children, and to assess the potential harm of these, using raters of different professions. METHODS A 1-week observation using an undisguised technique was conducted on four paediatric hospital wards. One observer followed ward staff during medication prescribing, preparation and administration. MEs and PUMPs were documented using field notes. Three raters including a physician, a nurse and a clinical pharmacist assessed the potential harm of each ME and PUMP using a six-point Likert scale. Agreement was analysed using Fleiss' Kappa. RESULTS A total of 16 MEs and 809 PUMPs were identified involving a preparation and administration error rate of 8%. No actual harm to patients was observed during the study. Raters assessed the potential harm of 318 unique MEs and PUMPs. Only slight agreement was found (Kappa = 0.26-0.33). A 4-hour delay in the administration of intravenous cefuroxime received the highest harm score. Observations involving no information during prescribing and variations in medication preparation were considered potentially fatal for medications such as digoxin, morphine, enoxaparin and insulin. CONCLUSIONS MEs and potentially unsafe practices and conditions may affect medication safety of hospitalized children. However, observed MEs did not result in any harm. The agreement among raters assessing the potential harm of observations was low. Alternative methods to determine the clinical relevance of errors are needed.
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Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy, Department
of Public Health, University of Southern Denmark, JB Winsløws Vej 19, 2,
Odense C, Funen 5000, Denmark
| | | | - Henrik Thybo Christesen
- Hans Christian Andersen Children’s Hospital,
Odense University Hospital, Odense, Denmark; Department of Clinical
Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Department of Public Health, University of
Southern Denmark, Odense, Denmark
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Rishoej RM, Lai Nielsen H, Strzelec SM, Fritsdal Refer J, Allermann Beck S, Gramstrup HM, Thybo Christesen H, Juel Kjeldsen L, Hallas J, Almarsdóttir AB. Qualitative exploration of practices to prevent medication errors in neonatal intensive care units: a focus group study. Ther Adv Drug Saf 2018; 9:343-353. [PMID: 30034776 DOI: 10.1177/2042098618771541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/23/2018] [Indexed: 11/16/2022] Open
Abstract
Background Medication errors (MEs) in neonates are frequent and associated with increased potential for harm compared with adults. The effect of learning from reported MEs is potentially lacking due to underreporting, lack of feedback and missing actions to improve medication safety. A new approach involving positive recognition of current and future strategies may facilitate greater exploration of how to improve medication safety in neonates. We aimed to explore current and potential future practices to prevent MEs in neonatal intensive care units (NICUs). Methods Focus group interviews of physicians and nurses were conducted at three Danish NICUs. Participants were included if they had at least 1 month of working experience and provided direct patient care. A semistructured interview guide involving three questions was used: (a) how do you feel about discussing prevention of MEs? (b) how do you currently prevent MEs from occurring? and (c) how can we become better at preventing MEs in the future? Content analysis was used to identify themes in the interviews. Results Participants commented that MEs still occur and that action must be taken to improve medication safety. Current practices to prevent MEs involved technology, procedures, education, skills and hospital pharmacy services. Potential future practices to prevent MEs included customizing the computerized physician order entry systems to support optimal prescribing, standardizing the double-check process, training of calculation skills and teamwork and increased use of hospital pharmacy services. Conclusions Several current and potential future practices to reduce MEs in NICUs were identified, highlighting the complexity of MEs. Our findings support an interdisciplinary multifaceted intervention involving both technical and nontechnical elements to improve medication safety in NICUs.
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Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 19, 2. 5000 Odense C, Denmark
| | | | | | - Jane Fritsdal Refer
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | | | - Hanne Marie Gramstrup
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | - Jesper Hallas
- Department of Public Health, University of Southern Denmark, Odense, Denmark
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Houlind MB, McNulty HBØ, Treldal C, Andersen SL, Huneck Haupt T, Petersen J, Andersen O, Kjeldsen LJ. One-Stop Dispensing: Hospital Costs and Patient Perspectives on Self-Management of Medication. Pharmacy (Basel) 2018; 6:pharmacy6020046. [PMID: 29843357 PMCID: PMC6025360 DOI: 10.3390/pharmacy6020046] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 05/12/2018] [Accepted: 05/18/2018] [Indexed: 11/30/2022] Open
Abstract
(1) Objective: To assess hospital medication costs and staff time between One-Stop Dispensing (OSD) and the Traditional Medication System (TMS), and to evaluate patient perspectives on OSD. (2) Methods: The study was conducted at Hvidovre Hospital, University of Copenhagen, Denmark in an elective gastric surgery and acute orthopedic surgery department. This study consists of three sub-studies including adult patients able to self-manage medication. In Sub-study 1, staff time used to dispense and administer medication in TMS was assessed. Medication cost and OSD staff time were collected in Sub-study 2, while patient perspectives were assessed in Sub-study 3. Medication costs with two days of discharge medication were compared between measured OSD cost and simulated TMS cost for the same patients. Measured staff time in OSD was compared to simulated staff time in TMS for the same patients. Patient satisfaction related to OSD was evaluated by a questionnaire based on a five-point Likert scale (‘very poor’ (1) to ‘very good’ (5)). (3) Results: In total, 78 elective and 70 acute OSD patients were included. Overall, there was no significant difference between OSD and TMS in medication cost per patient ($2.03 [95% CI −0.57–4.63]) (p = 0.131). Compared with TMS, OSD significantly reduced staff time by an average of 12 min (p ≤ 0.001) per patient per hospitalization. The patients’ satisfaction for OSD was high with an average score of 4.5 ± 0.7. (4) Conclusion: There were no differences in medication costs, but staff time was significantly lower in OSD and patients were overall satisfied with OSD.
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Affiliation(s)
- Morten Baltzer Houlind
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | | | - Charlotte Treldal
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- The Capital Region Pharmacy, Marielundvej 25, 2730 Herlev, Denmark.
| | - Signe Lindgaard Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Thomas Huneck Haupt
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
| | - Janne Petersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Section of Biostatistics, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark.
| | - Ove Andersen
- Optimed, Clinical Research Centre, Copenhagen University Hospital Hvidovre, Kettegård Alle 30, Department 056, 2650 Hvidovre, Denmark.
- Emergency Department, Copenhagen University Hospital, 2650 Hvidovre, Denmark.
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Rishoej RM, Thybo Christesen H, Juel Kjeldsen L, Almarsdóttir AB, Hallas J. Disproportionality Analysis Used to Identify Patterns in Medication Error Reports Involving Hospitalized Children. Basic Clin Pharmacol Toxicol 2018; 122:531-533. [DOI: 10.1111/bcpt.12947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/06/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital; Odense University Hospital; Odense Denmark
- Department of Clinical Research; University of Southern Denmark; Odense Denmark
| | | | - Anna Birna Almarsdóttir
- Social and Clinical Pharmacy; Department of Pharmacy; University of Copenhagen; Copenhagen Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy; Department of Public Health; University of Southern Denmark; Odense Denmark
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Rishoej RM, Hallas J, Juel Kjeldsen L, Thybo Christesen H, Almarsdóttir AB. Likelihood of reporting medication errors in hospitalized children: a survey of nurses and physicians. Ther Adv Drug Saf 2017; 9:179-192. [PMID: 29492247 DOI: 10.1177/2042098617746053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background Hospitalized children are at risk of medication errors (MEs) due to complex dosage calculations and preparations. Incident reporting systems may facilitate prevention of MEs but underreporting potentially undermines this system. We aimed to examine whether scenarios involving medications should be reported to a national mandatory incident reporting system and the likelihood of self- and peer-reporting these scenarios among paediatric nurses and physicians. Methods Participants' reporting of MEs was explored through a questionnaire involving 20 medication scenarios. The scenarios represented different steps in the medication process, types of error, patient outcomes and medications. Reporting rates and odds ratios with 95% confidence interval [OR, (95% CI)] were calculated. Barriers to and enablers of reporting were identified through content analysis of participants' comments. Results The response rate was 42% (291/689). Overall, 61% of participants reported that scenarios should be reported. The likelihood of reporting was 60% for self-reporting and 37% for peer-reporting. Nurses versus physicians, and healthcare professionals with versus without patient safety responsibilities assessed to a larger extent that the scenarios should be reported [OR = 1.34 (1.05-1.70) and OR = 1.41 (1.12-1.78), respectively]; were more likely to self-report, [OR = 2.81 (1.71-4.62) and OR = 2.93 (1.47-5.84), respectively]; and were more likely to peer-report [OR = 1.89 (1.36-2.63) and OR = 3.61 (2.57-5.06), respectively].Healthcare professionals with versus without management responsibilities were more likely to peer-report [OR = 5.16 (3.44-7.72)]. Participants reported that scenarios resulting in actual injury or incidents considered to have a learning potential should be reported. Conclusion The likelihood of underreporting scenarios was high among paediatric nurses and physicians. Nurses and staff with patient safety responsibilities were more likely to assess that scenarios should be reported and to report. Incidents with actual injury or learning potential were more likely to be reported. The potential for improving reporting rates involving MEs seems high.
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Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 19, 2., 5000 Odense C, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna Birna Almarsdóttir
- Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
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Bech CF, Frederiksen T, Villesen CT, Højsted J, Nielsen PR, Kjeldsen LJ, Nørgaard LS, Christrup LL. Healthcare professionals’ agreement on clinical relevance of drug-related problems among elderly patients. Int J Clin Pharm 2017; 40:119-125. [PMID: 29248987 DOI: 10.1007/s11096-017-0572-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/28/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Christine Flagstad Bech
- Department of Drug Design and Pharmacology, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark
| | - Tine Frederiksen
- Department of Drug Design and Pharmacology, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark
| | - Christine Tilsted Villesen
- Department of Drug Design and Pharmacology, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark
- Multidisciplinary Pain Centre, Copenhagen University Hospital, 9. Blegdamsvej, Copenhagen, Denmark
| | - Jette Højsted
- Multidisciplinary Pain Centre, Copenhagen University Hospital, 9. Blegdamsvej, Copenhagen, Denmark
| | - Per Rotbøll Nielsen
- Multidisciplinary Pain Centre, Copenhagen University Hospital, 9. Blegdamsvej, Copenhagen, Denmark
| | | | - Lotte Stig Nørgaard
- Department of Pharmacy, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark
| | - Lona Louring Christrup
- Department of Drug Design and Pharmacology, University of Copenhagen, 2 Universitetsparken, Copenhagen, Denmark.
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13
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Rishoej RM, Almarsdóttir AB, Christesen HT, Hallas J, Kjeldsen LJ. Medication errors in pediatric inpatients: a study based on a national mandatory reporting system. Eur J Pediatr 2017; 176:1697-1705. [PMID: 28965285 DOI: 10.1007/s00431-017-3023-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED The aim was to describe medication errors (MEs) in hospitalized children reported to the national mandatory reporting and learning system, the Danish Patient Safety Database (DPSD). MEs were extracted from DPSD from the 5-year period of 2010-2014. We included reports from public hospitals on patients aged 0-17 years and categorized by reporters as medication-related. Reports from psychiatric wards and outpatient clinics were excluded. A ME was defined as any medication-related error occurring in the medication process whether harmful or not. MEs were categorized as harmful if they resulted in actual harm or interventions to prevent harm. MEs were further categorized according to occurrence in the medication process, type of error, and the medicines involved. A total of 2071 MEs including 487 harmful MEs were identified. Most MEs occurred during prescribing (40.8%), followed by dispensing (38.7%). Harmful MEs occurred mainly during dispensing (40.3%). Dosing errors were the most reported type of error, 47.7% of all MEs and 45.4% of harmful MEs. Antibiotics and analgesics were the most frequently reported medication classes. Common medicines associated with MEs included morphine, paracetamol, and gentamicin. MEs caused no harm (74.9%), mild (11.7%), moderate (10.5%), or severe harm (1.3%), but none were lethal. CONCLUSION MEs in hospitalized children occur in all medication processes and mainly involve dosing errors. Strategies should be developed to prevent MEs as these still threaten medication safety in pediatric inpatients. What is known: • Hospitalized children are more likely to experience medication errors than adults. • Voluntary national and local reporting and learning systems have previously been used to describe the nature and types of medication errors. What is new: • Medication errors in hospitalized children occur in all steps of the medication process, most frequently involving dosing errors and most commonly involving morphine, paracetamol, and gentamicin. • Of the medication errors, 1.3% cause severe harm, but no fatal errors were reported.
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Affiliation(s)
- Rikke Mie Rishoej
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 19.2, 5000, Odense, Denmark.
| | - Anna Birna Almarsdóttir
- Section of Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Thybo Christesen
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, J. B. Winsløws Vej 19.2, 5000, Odense, Denmark
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14
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Duedahl TH, Hansen WB, Kjeldsen LJ, Graabæk T. Pharmacist-led interventions improve quality of medicine-related healthcare service at hospital discharge. Eur J Hosp Pharm 2017; 25:e40-e45. [PMID: 31157065 DOI: 10.1136/ejhpharm-2016-001166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 04/29/2017] [Accepted: 05/05/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives This study aims to investigate the effects on quality of the medicine-related healthcare service provided at hospital discharge after implementing a pharmacist-led patient-centred discharge service. Methods Medical in-patients ready for discharge and prescribed at least six medicines were eligible for inclusion in this descriptive intervention study. A ward-based clinical pharmacist provided a patient-centred discharge service which comprised medication review (including reconciliation if appropriate), medication counselling and verification of the medication discharge summary plans. Satisfaction with the pharmacist-led interventions was collected by questionnaires and follow-up telephone interviews. A quality audit on the medical information stated in the discharge summary plans was conducted. Results A total of 313 medical records were prospectively reviewed by the clinical pharmacist, and 745 medicine-related problems each leading to a clinical recommendation were identified. The total rate of acceptance by the physicians was found to be 84%. The quality audit revealed a significantly higher quality of the medication discharge summary plans sent to primary care regarding content of updated lists of medication after the pharmacist's intervention. The involved physicians stated that contributions from the pharmacist had eased their workload and helped them to obtain a more rational prescribing practice. The interviewed patients felt secure and well-informed about their medicines. Conclusions Contributions from clinical pharmacists can improve both the quality of and satisfaction with the medicine-related healthcare service provided at hospital discharge and secure continuity of medical care at transitions.
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Affiliation(s)
| | | | | | - Trine Graabæk
- Department of Quality, Hospital of South West Jutland, Esbjerg, Denmark
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Kjeldsen LJ, Nielsen TRH, Olesen C. Investigating the Relative Significance of Drug-Related Problem Categories. Pharmacy (Basel) 2017; 5:E31. [PMID: 28970443 PMCID: PMC5597156 DOI: 10.3390/pharmacy5020031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 04/24/2017] [Accepted: 06/06/2017] [Indexed: 11/17/2022] Open
Abstract
The aim of the review was to investigate whether an assessment of clinical significance can be related to specific drug-related problems (DRPs) and hence may assist in prioritizing individual categories of DRP categorization systems. The literature search using Google Scholar was performed for the period 1990 to 2013 and comprised primary research studies of clinical pharmacy interventions including DRP and clinical significance assessments. Two reviewers assessed the titles, abstracts, and full-text papers individually, and inclusion was determined by consensus. A total of 27 unique publications were included in the review. They had been conducted in 14 different countries and reported a large range of DRPs (71-5948). Five existing DRP categorisation systems were frequently used, and two methods employed to assess clinical significance were frequently reported. The present review could not establish a consistent relation between the DRP categories and the level of clinical significance. However, the categories "ADR" and possibly "Drug interaction" were often associated with an assessed high clinical significance, albeit they were infrequently identified in the studies. Hence, clinical significance assessments do not seem to be useful in prioritizing individual DRPs in the DRP categorization systems. Consequently, it may be necessary to reconsider our current approach for evaluating DRPs.
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Affiliation(s)
- Lene Juel Kjeldsen
- The Danish Research Unit for Hospital Pharmacy, Amgros I/S, 2100 Copenhagen, Denmark.
| | | | - Charlotte Olesen
- The Hospital Pharmacy, Central Denmark Region, 8000 Aarhus, Denmark.
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Hedegaard U, Hallas J, Ravn-Nielsen LV, Kjeldsen LJ. Process- and patient-reported outcomes of a multifaceted medication adherence intervention for hypertensive patients in secondary care. Res Social Adm Pharm 2016; 12:302-18. [DOI: 10.1016/j.sapharm.2015.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/12/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022]
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Hedegaard U, Kjeldsen LJ, Pottegård A, Henriksen JE, Lambrechtsen J, Hangaard J, Hallas J. Improving Medication Adherence in Patients with Hypertension: A Randomized Trial. Am J Med 2015; 128:1351-61. [PMID: 26302142 DOI: 10.1016/j.amjmed.2015.08.011] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention. METHODS Patients (n = 532) were recruited from 3 hospital outpatient clinics and randomized to usual care or a 6-month pharmacist intervention comprising collaborative care, medication review, and tailored adherence counseling including motivational interviewing and telephone follow-ups. The primary outcome was composite medication possession ratio (MPR) to antihypertensive and lipid-lowering agents, at 1-year follow-up, assessed by analyzing pharmacy records. Secondary outcomes at 12 months included persistence to medications, blood pressure, hospital admission, and a combined clinical endpoint of cardiovascular death, stroke, or acute myocardial infarction. RESULTS At 12 months, 20.3% of the patients in the intervention group (n = 231) were nonadherent (MPR <0.80), compared with 30.2% in the control group (n = 285) (risk difference -9.8; 95% confidence interval [CI], -17.3, -2.4) and median MPR (interquartile range) was 0.93 (0.82-0.99) and 0.91 (0.76-0.98), respectively, P = .02. The combined clinical endpoint was reached by 1.3% in the intervention group and 3.1% in the control group (relative risk 0.41; 95% CI, 0.11-1.50). No significant differences were found for persistence, blood pressure, or hospital admission. CONCLUSIONS A multifaceted pharmacist intervention in a hospital setting led to a sustained improvement in medication adherence for patients with hypertension. The intervention had no significant impact on blood pressure and secondary clinical outcomes.
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Affiliation(s)
- Ulla Hedegaard
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark; Clinical Pharmacy Department, Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark.
| | | | - Anton Pottegård
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jan Erik Henriksen
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Jess Lambrechtsen
- Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jørgen Hangaard
- Department of Internal Medicine, Odense University Hospital - Svendborg, Svendborg, Denmark
| | - Jesper Hallas
- Clinical Pharmacology, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Graabæk T, Bonnerup DK, Kjeldsen LJ, Rossing C, Pottegård A. Pharmacist-led medication review in an acute admissions unit: a systematic procedure description. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000507] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Kjeldsen LJ, Bjerrum L, Dam P, Larsen BO, Rossing C, Søndergaard B, Herborg H. Safe and effective use of medicines for patients with type 2 diabetes – A randomized controlled trial of two interventions delivered by local pharmacies. Res Social Adm Pharm 2015; 11:47-62. [DOI: 10.1016/j.sapharm.2014.03.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 03/26/2014] [Accepted: 03/27/2014] [Indexed: 12/01/2022]
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20
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Hedegaard U, Kjeldsen LJ, Pottegård A, Bak S, Hallas J. Multifaceted intervention including motivational interviewing to support medication adherence after stroke/transient ischemic attack: a randomized trial. Cerebrovasc Dis Extra 2014; 4:221-34. [PMID: 25598772 PMCID: PMC4296247 DOI: 10.1159/000369380] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 10/24/2014] [Indexed: 01/11/2023] Open
Abstract
Background and Purpose Adherence to medication is often suboptimal after stroke and transient ischemic attack (TIA), which increases the risk of recurrent stroke and death. Complex interventions and motivational interviewing (MI) have been proven effective in other areas of medicine. The objective of this study was to investigate the effectiveness of a multifaceted intervention including MI in improving medication adherence for secondary stroke prevention. Methods In this randomized controlled trial, TIA and stroke patients receiving a pharmacist intervention in a hospital setting were compared with patients receiving usual care. The intervention consisted of a focused medication review, an MI-approached consultation and 3 follow-up telephone calls and lasted for 6 months. The primary outcome was a composite medication possession ratio (MPR) for antiplatelets, anticoagulants and statins in the year after hospitalization, assessed by analyzing pharmacy records and reported as both a continuous rate and a binary outcome. Secondary outcomes included composite MPRs at 3, 6 and 9 months as well as adherence and persistence to specific thrombopreventive medications at 12 months. Clinical outcomes included a combined end point of cardiovascular death, stroke or acute myocardial infarction. Patient satisfaction with the service was assessed for the intervention patients. Results The analyses included 102 intervention patients and 101 controls. At 12 months, the median MPRs (IQR) were 0.95 (0.77-1) in the intervention group and 0.91 (0.83-0.99) in the control group, and 28 and 21% of the patients, respectively, were nonadherent (MPR <0.80; risk difference: 7%; 95% CI: −5 to 19%). In both groups, the median MPR decreased over time. From 3 to 12 months, the MPR fell by 5% (p < 0.05) in the intervention group and by 9% (p < 0.05) in the control group, but between the groups, comparisons showed no statistically significant difference. No significant differences were found for adherence and persistence to specific thrombopreventive agents or for the clinical outcome. The intervention patients were satisfied with the service; about half of them reported increased knowledge about medication, and one third reported increased confidence with medication use. Pharmacists identified drug-related problems in one third of the patients. Conclusions A multifaceted pharmacist intervention including MI did not improve adherence or persistence to secondary stroke prevention therapy and had no impact on clinical outcomes. However, due to the high adherence rates, only little room for improvement existed. Future studies should focus on patients at high risk of nonadherence and include outcomes more sensitive to the impact of behavioral interventions.
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Affiliation(s)
- Ulla Hedegaard
- Clinical Pharmacology and Pharmacy, Institute of Public Health, University of Southern Denmark, and ; Hospital Pharmacy of Funen, Odense University Hospital, Odense, Denmark
| | - Lene Juel Kjeldsen
- Danish Research Unit for Hospital Pharmacy, Amgros I/S, Copenhagen, Denmark
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Institute of Public Health, University of Southern Denmark, and
| | - Søren Bak
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Jesper Hallas
- Clinical Pharmacology and Pharmacy, Institute of Public Health, University of Southern Denmark, and
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Kjeldsen LJ, Axelsen TB, Grønkjær LS, Nielsen TRH, Tomsen DV, Væver TJ. [Development of patient-specific issues in relation to medicines is a challenge to all health-care professionals]. Ugeskr Laeger 2014; 176:V11130639. [PMID: 25352199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
As a consequence of implementing clinical pharmacy at hospitals in Denmark, the need of defining some of the services delivered appeared: medication anamnesis, medication reconciliation, medication review and prescription review. Consensus was reached on the definitions with qualification by 20 colleagues from hospital pharmacies throughout the country as well as from external stakeholders. As an additional benefit, the definitions could cover the pharmacy services performed in primary care as well, which may help improve communication in the interface management of medication treatment.
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Plet HT, Kjeldsen LJ, Christensen RD, Nielsen GS, Hallas J. CP-120 Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomised controlled trial. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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23
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Kjeldsen LJ, Hansen PS, Kristensen AMF, Christensen A, Sørensen CH, Nielsen B. Outreach visits by clinical pharmacists improve screening for the metabolic syndrome among mentally ill patients. Nord J Psychiatry 2013; 67:249-57. [PMID: 23126478 DOI: 10.3109/08039488.2012.732115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients suffering from schizophrenia and affective disorder have an increased risk of the metabolic syndrome (MeS); hence identification of patients developing MeS may help preventing morbidity and mortality. AIMS The aim of the study was to evaluate the effect of outreach visit by clinical pharmacists to support the implementation of screening of MeS at a psychiatric ward. METHODS The study was conducted at the psychiatric ward, Odense University Hospital. In 2008, clinical guidelines for systematic screening and prevention of metabolic risk were developed and implemented by passive dissemination (PD) followed by a period of active implementation (AI). AI contained outreach visits by clinical pharmacists on a weekly basis. Patients with affective disorder or schizophrenia were included. The study was designed as a before-and-after study, and electronic patient charts were used for assessment of adherence to the clinical guidelines. RESULTS In total, 205 patients were included in the study (93 patients in the PD group, 112 patients in the AI group). A significant improvement of the use of the screening sheet from 36% in the PD group to 81% in the AI group was found (p < 0.001). Consequently, the quality of the screening increased significantly resulting in 45% in the AI group being identified with MeS compared with 10% in the PD group (p < 0.001). CONCLUSION The outreach visits by clinical pharmacists significantly improved the use of the screening sheet and resulted in a significant increase in the proportion of patients identified with MeS (p < 0.001). CLINICAL IMPLICATIONS The increase in the use of a screening sheet for MeS among patients admitted to a psychiatric ward as a result of outreach visits by clinical pharmacist improve assessment for MeS. This may lead to better identification of patients suffering from MeS and hence increase the possibility of treating MeS and preventing morbidity and mortaligy.
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Bendixen HK, Kjeldsen LJ. Treatment of pneumonia: adherence to a hospital policy. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2012-000049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Graabaek T, Kjeldsen LJ. Medication reviews by clinical pharmacists at hospitals lead to improved patient outcomes: a systematic review. Basic Clin Pharmacol Toxicol 2013; 112:359-73. [PMID: 23506448 DOI: 10.1111/bcpt.12062] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/14/2013] [Indexed: 11/29/2022]
Abstract
Suboptimal medication use may lead to morbidity, mortality and increased costs. To reduce unnecessary patient harm, medicines management including medication reviews can be provided by clinical pharmacists. Some recent studies have indicated a positive effect of this service, but the quality and outcomes vary among studies. Hence, there is a need for compiling the evidence within this area. The aim of this systematic MiniReview was to identify, assess and summarize the literature investigating the effect of pharmacist-led medication reviews in hospitalized patients. Five databases (MEDLINE, EMBASE, CINAHL, Web of Science and the Cochrane Library) were searched from their inception to 2011 in addition to citation tracking and hand search. Only original research papers published in English describing pharmacist-led medication reviews in a hospital setting including minimum 100 patients or 100 interventions were included in the final assessment. A total of 836 research papers were identified, and 31 publications were included in the study: 21 descriptive studies and 10 controlled studies, of which 6 were randomized controlled trials. The pharmacist interventions were well implemented with acceptance rates from 39% to 100%. The 10 controlled studies generally show a positive effect on medication use and costs, satisfaction with the service and positive as well as insignificant effects on health service use. Several outcomes were statistically insignificant, but these were predominantly associated with low sample sizes or low acceptance rates. Therefore, future research within this area should be designed using rigorous design, large sample sizes and includes comparable outcome measures for patient health outcomes.
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Affiliation(s)
- Trine Graabaek
- Department of Quality, Hospital South West Jutland, Esbjerg, Denmark.
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Graabæk T, Kjeldsen LJ. CPC-084 Medication Reviews by Clinical Pharmacists at Hospitals Lead to Improved Patient Outcomes: A Systematic Review. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hedegaard U, Kjeldsen LJ, Hallas J. CPC-007 Adherence Problems Identified by Motivational Interviewing and medicines Review in Stroke Patients. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kjeldsen LJ, Nielsen GS. Implementation of clinical pharmacy in Danish hospital pharmacies: winning the championship or the wooden spoon? Eur J Hosp Pharm 2012. [DOI: 10.1136/ejhpharm-2012-000230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vand S, Kjeldsen LJ, Kart T. Clinical pharmacy services are performed at several emergency wards in Denmark. Scand J Trauma Resusc Emerg Med 2012. [DOI: 10.1186/1757-7241-19-s2-p9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Kjeldsen LJ, Jensen TB, Jensen JJ. Physicians' evaluation of clinical pharmacy revealed increased focus on quality improvement and cost savings. Dan Med Bull 2011; 58:A4261. [PMID: 21535981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
INTRODUCTION The aims of the present study were to evaluate physicians' satisfaction with medication services delivered by a clinical pharmacist (CP); to investigate and document to which extent a CP could improve the medication quality and reduce medication costs at an intensive care unit (ICU); and to explore which types of tasks the CP was asked to perform. MATERIAL AND METHODS The project was conducted at an ICU from 1 February to 31 August 2008. The intervention consisted of certain tasks being performed by a CP. The intervention was evaluated on the basis of documentation of the intervention performed and on a questionnaire filled in by physicians at the end of the study. RESULTS The majority of the physicians reported that the CP's intervention had raised their attention to medication costs (70%) and medication quality (76%). This physician-reported impression correlated with the CP's intervention which improved medication quality and catalysed an annual estimated cost saving of at least DKK 330,000, which was achieved by targeting particular medication areas. The CP was asked to perform various medication-related tasks during the project period. Indeed, the physicians reported that they found the CP qualified to perform several medication-related tasks--and many physicians reported that they had benefitted from input regarding those tasks. CONCLUSION The intervention occasioned positive physician feedback on clinical pharmacy services and the study shows that the CP was perceived by the physicians as a valuable professional collaborator.
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Andersen LS, Kjeldsen LJ, Haugbølle LS. [Suitability of the Personal Electronic Medication profile for estimation of medication compliance]. Ugeskr Laeger 2009; 171:899-903. [PMID: 19278614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Denmark operates a so-called personal electronic medication record (PEM) containing information about prescription medicine purchased by patients. This study examined the PEM compliance module in order to determine its suitability for evaluating patient compliance. MATERIAL AND METHODS We collected data from 256 patients who participated in an intervention project conducted on Funen among users of antihypertensive medication. Data were collected from patient information in PEM. The data were used to compare three types of compliance which were all based on information in PEM: 1) calculating compliance, 2) compliance chart, 3) DDD (defined daily doses) chart. RESULTS The 256 patients used a total of 1,062 medications (1-13 medications per person). It was not possible to calculate compliance for 240 (23%) medications distributed on 141 patients (55%). Compliance was highest for method 1 and lowest for method 3; conversely, non-compliance was lowest for method 1 and highest for method 3. Combining the three revealed a considerable discrepancy (44-66%) in the assessment of patient compliance. CONCLUSION The PEMs lacked information for approx. 1/5 of the medications; consequently it was not possible to calculate compliance for these persons. The results indicate that for compliance assessment, PEM quality is less than optimal.
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Affiliation(s)
- Lena Skov Andersen
- Københavns Universitet, Det Farmaceutiske Fakultet, Institut for Farmakologi og Farmakoterapi & Pharmakon A/S
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