20 research outputs found
Knowledge Bases for Clinical Decision Support in Drug Prescribing – Development, Quality Assurance, Management, Integration, Implementation and Evaluation of Clinical Value
Doctors and Drugs : How Swedish Emergency and Family Physicians Understand Drug Prescribing
Background: Drug prescribing is increasing, making prescribing one of the
most common interventions in healthcare. The beneficial effects of drugs
are manifold, but drug use also involves risks of drug-drug interaction
(DDI), side effects and other drug-related problems. Despite research, a
gap remains in our knowledge about the variation in physicians
understanding of drug prescribing. Knowledge of how physicians think
about and understand drug prescribing might make it possible to influence
their behaviour, and thus improve drug treatment.
Aims: The overall aim of this thesis is to explore how physicians
understand drug prescribing. Two groups of physicians were studied:
emergency room physicians (ERs) and general practitioners (GPs). The
specific aims were to (I) identify ERs perception of possibilities and
obstacles in the implementation of a computerised prescribing support
system; (II) explore how ERs view their work with patient drug treatment;
(III) identify ways of understanding drug prescribing among GPs; and (IV)
explore GPs understandings of who bears responsibility for a patient s
drug list and how this responsibility is managed.
Methods: An inductive qualitative approach was used in order to gain
deeper knowledge about physicians experiences. Data were collected by
means of semi-structured face-toface interviews (Studies I, III-IV) and
focus group discussions (Study II). Thematic (Studies I-II) and
phenomenographic methods (Studies III-IV) were used in analysing data.
Findings: Variations were found between ERs and GPs in their views of
drug prescribing, as well as within the group of GPs. The ERs expressed a
need for more pharmacological training and support in working with
patients drug treatment. They wanted access to current patient drug
lists in order to make the diagnosis safely and quickly. A lack of
follow-up appointments forces ERs to refrain from making changes to a
patient s drug regime. ERs perform their work in the here and now . The
GPs demonstrated how they understood drug prescribing in five ways, each
of which had different foci: the biomedical aspects, the patient and
society. Each GP had access to more than one view, but none included all
five ways. The GPs also demonstrated a variation in understanding about
responsibility for patient drug lists, and in particular about how they
use different strategies to manage this responsibility. These strategies
were described in five ways: imposed responsibility; responsibility for
own prescriptions; responsibility for all drugs; different but shared
responsibility; and patient responsibility for transferring drug
information between healthcare providers.
Implications: The question of responsibility for current patient drug
lists and communication between settings is of utmost importance. In
Sweden, a new law was passed in 2008 allowing the sharing of
patient-specific information between databases. In this thesis, we see
how ERs and GPs understand the responsibility for current patient drug
lists in different ways. These different ways indicate that information
sharing between healthcare providers is insufficient to remove potential
hazards in prescribing. In order to support physicians in moving towards
a comprehensive approach to prescribing, there is a need for a parallel
development in: 1) physicians competence in drug prescribing; 2)
patients understandings of drug use; and 3) technological solutions to
facilitate a shared understanding between different physicians and
patients in drug prescribing/drug therapy
Competence, competition and collaboration:Perceived challenges among Swedish community pharmacists engaging in pharmaceutical services provision and research
Pediatricians’ Understanding and Experiences of an Electronic Clinical-Decision-Support-System
Objectives: Subsequent dosing errors after implementing an Electronic Medical Record (EMR) at a pediatric hospital in Sweden led to the development, in close collaboration with the clinical profession, of a Clinical Decision Support System (CDSS) with Dose Range Check and Weight Based Dose Calculation integrated directly in the EMR. The aim of this study was to explore the understanding and experiences of the CDSS among Swedish pediatricians after one year of practice.Methods: Semi-structured interviews with physicians at different levels of the health care system were performed with seventeen pediatricians working at three different pediatrics wards in Stockholm County Council. The interviews were analysed with a thematic analysis without pre-determined categories.Results: Six categories and fourteen subcategories emerged from the analysis. The categories included the use, the benefit, the confidence, the situations of disregards, the misgivings/risks and finally the development potential of the implemented CDSS with Weight Based Dose Calculation and Dose Range Check. Â Conclusions: Â A need for CDSS in the prescribing for children is evident but also the need for further development based on the practical knowledge of the clinical profession
Pediatricians’ Understanding and Experiences of an Electronic Clinical-Decision-Support-System
Objectives: Subsequent dosing errors after implementing an Electronic Medical Record (EMR) at a pediatric hospital in Sweden led to the development, in close collaboration with the clinical profession, of a Clinical Decision Support System (CDSS) with Dose Range Check and Weight Based Dose Calculation integrated directly in the EMR. The aim of this study was to explore the understanding and experiences of the CDSS among Swedish pediatricians after one year of practice.Methods: Semi-structured interviews with physicians at different levels of the health care system were performed with seventeen pediatricians working at three different pediatrics wards in Stockholm County Council. The interviews were analysed with a thematic analysis without pre-determined categories.Results: Six categories and fourteen subcategories emerged from the analysis. The categories included the use, the benefit, the confidence, the situations of disregards, the misgivings/risks and finally the development potential of the implemented CDSS with Weight Based Dose Calculation and Dose Range Check. Â Conclusions: Â A need for CDSS in the prescribing for children is evident but also the need for further development based on the practical knowledge of the clinical profession
Whose Job Is It Anyway? Swedish General Practitioners’ Perception of Their Responsibility for the Patient’s Drug List
PURPOSE Information about the patient’s current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners’ (GPs) understandings of who is responsible for the patient’s drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed
Evaluation of usage patterns and user perception of the drug-drug interaction database SFINX
Purpose: The aim of the present study was to investigate how prescribers and pharmacists use and perceive the drug-drug interaction database SFINX in their clinical work. Methods: A questionnaire was developed with questions aimed at the usage of SFINX, and the perceptions of the database. The questionnaire was sent out to all registered users of the web application of SFINX. The anonymous answers from the target users, prescribers and pharmacists were summarized using descriptive statistics. Statistical analysis was performed on age and gender differences for some questions regarding different usage patterns. Results: The questionnaire was sent to 11,763 registered SFINX users. The response rate was 23%, including 1871 answers from prescribers or pharmacists. SFINX was reported to be used at least weekly or more often by 45% of the prescribers and 51% of the pharmacists. Many prescribers reported using the database during the patient consultation (60%) or directly before or after (56%). Among the prescribers, 74% reported that the information received made them change their action at least sometimes. About 20% of the prescribers and 25% of the pharmacists considered the information as irrelevant sometimes or more often. Conclusion: Most prescribers and pharmacists reported using SFINX in direct association with a patient consultation. Information received by using SFINX makes prescribers and pharmacists change their handling of patients. DDI databases with relevant information about patient handling might improve drug treatment outcome. (C) 2015 Elsevier Ireland Ltd. All rights reserved