Healthcare system intervention for safer use of medicines in elderly patients in primary care—a qualitative study of the participants’ perceptions of self-assessment, peer review, feedback and agreement for change

The elderly population is increasing and with advanced age comes a higher risk for contracting diseases and excessive medicine use. Polypharmacy can lead to drug-related problems and an increased need of health care. More needs to be done to help overcome these problems. In order for new models to be successful and possible to implement in health care they have to be accepted by caregivers. The aim of this study was to evaluate participants' perceptions of the SÄKLÄK project, which aims to enhance medication safety, especially for elderly patients, in primary care

Att leva med bakterier : Möjligheter till ett levbart immunitärt liv

Det uppskattas att år 2050 kommer tio miljoner människor att dö av infektionersom inte kan behandlas på grund av att bakterier blivit resistenta ochdärmed gjort antibiotika ineffektiv. Denna typ av dystopier är en form avresor både bakåt och framåt i tiden, och där samhället beskrivs som någotannat än vad vi är vana vid. Tanken om en framtid utan antibiotika – enså kallad postantibiotisk era – går tillbaka till början av 1990-talet och denökade kunskapen om resistens i kombination med frånvaron av nya antibiotika.Detta är en förändring som skulle kunna omskapa den mänskligahistorien på lång sikt. Men är framtiden så dystopisk? Och kan vi hittaalternativa vägar mot en sådan framtid som är mer levbar?Under 2019 och 2020 samlades elva forskare under Temat Postantibiotiskaframtider vid Pufendorfinstitutet, Lunds universitet, för att tvärvetenskapligtundersöka dessa problem. Antologin du håller i handen – ellerläser på en skärm – är ett av våra många resultat av dessa sammankomster

Ett antibiotikums uppgång och fall : Historien om läkemedlet Chloromycetin

Att leva med bakterier: möjligheter till ett levbart immunitärt liv är en antologi som tvärvetenskapligt undersöker betydelsen av bakteriers växande antibiotikaresistens. Detta är en förändring som håller på att göra antibiotikan ineffektiv och därmed omskapa den mänskliga historien på lång sikt. Det uppskattas att tio miljoner människor år 2050 kommer att dö av infektioner som inte längre svarar på den i dag tillgängliga antibiotikan. Hur kan vi här och nu hitta alternativa vägar mot en mer levbar framtid – med eller utan verksam antibiotika? Antologin är ett resultat av det tvärvetenskapliga forskarsamarbete som under 2019-20 bedrevs vid Pufendorfinstitutet, Lunds universitetet under Temat Postantibiotiska framtider. I antologin utvecklar tio forskare sina tankar och idéer kring hur samhället idag och i morgon kan utformas för att hantera smittämnen som bakterier och virus i vår vardag. Smittämnen det i framtiden kanske inte finns något botemedel mot

"Jag tycker det går framåt med min framtid": om unga Romers självbild och framtidstro

The purpose of this paper was to get a picture of how young Roma/Gypsies look upon themselves, their culture and their future. We were also interested in knowing how they felt about the way society look upon them. The main questions of issue were in what ways are young Roma/Gypsies affected by the culture they were brought up in, if they had felt discriminated by the society and how they look upon their possibilities to get access to education and work. The methods we used to collect the data were interviews with young Roma/Gypsies and professionals as well as reading literature. The outcome of the study showed that all of the youngsters had experienced discrimination in one way or another. It also showed that despite of that they have faith in their own capability and look upon their future with a sense of hope

Introduktion: bakterier och virus i en ny tid

Det uppskattas att år 2050 kommer tio miljoner människor att dö av infektionersom inte kan behandlas på grund av att bakterier blivit resistenta ochdärmed gjort antibiotika ineffektiv. Denna typ av dystopier är en form avresor både bakåt och framåt i tiden, och där samhället beskrivs som någotannat än vad vi är vana vid. Tanken om en framtid utan antibiotika – enså kallad postantibiotisk era – går tillbaka till början av 1990-talet och denökade kunskapen om resistens i kombination med frånvaron av nya antibiotika.Detta är en förändring som skulle kunna omskapa den mänskligahistorien på lång sikt. Men är framtiden så dystopisk? Och kan vi hittaalternativa vägar mot en sådan framtid som är mer levbar?Under 2019 och 2020 samlades elva forskare under Temat Postantibiotiskaframtider vid Pufendorfinstitutet, Lunds universitet, för att tvärvetenskapligtundersöka dessa problem. Antologin du håller i handen – ellerläser på en skärm – är ett av våra många resultat av dessa sammankomster

The impact of medication reviews conducted in primary care on hospital admissions and mortality : An observational follow-up of a randomized controlled trial

Background: Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim: The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study. Methods: Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results: An observational follow-up was performed in a cohort of 369 patients, previously randomized to an intervention group (182) and a control group (187). Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37–0.92, p=0.021), but found no difference in mortality (HR = 1.12, 95% CI 0.78–1.61, p=0.551) between the groups. Conclusion: We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions. The study is registered at ClinicalTrials.gov, registration number NCT04040855, Unique Protocol ID 2018/8

Safer drug use in primary care - a pilot intervention study to identify improvement needs and make agreements for change in five Swedish primary care units

Background: There is an urgent need to improve patient safety in the area of medication treatment among the elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the agreements for change that were established within the intervention. Methods: The SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment, peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis. Results: Strengths that were identified included a committed leadership, work methods to enhance medication safety and access to consultants. Methods for securing an accurate medication list, knowledge and methods of working of the prescriber and patient's ability to contribute to medication safety were areas that gave rise to three predesigned categories for improvement needs on a local level. Another category became apparent during the analysis; namely learning from mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further education in geriatrics and pharmacotherapy and lack of information on indication and maximum dosage. An increased number of medication reviews were among the most common agreements for change seen. Conclusions: This study identified substantial shortcomings, like poorly updated medication lists, which affected medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in other primary care units in the country. Working together multi-professionally, including performing medication reviews, could be one way of improving medication safety. On the other hand, the individual physician must possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions. Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of medication errors