‘Illuminating determinants of implementation of non-dispensing pharmacist services in home care: a qualitative interview study’

Objectives - Medication errors are leading causes of hospitalization and death in western countries and WHO encourages health care providers to implement non-dispensing pharmacist services in primary care to improve medication work. However, these services struggle to provide any impact on clinical outcomes. We wanted to explore health care professionals’ views on medication work to illuminate determinants of the implementation success. The research was designed to inform and adapt implementation strategies for non-dispensing pharmacist services. Design - Semi-structured interview study with nine healthcare professionals. Setting - Four Norwegian home care wards. Subjects - Nine healthcare professionals working at different wards within one home care unit. Main outcome measures - Determinants of implementation outcomes. Results - Contextual determinants of the implementation process were mainly related to characteristics of the setting such as poorly designed information systems, work overload, and chaotic work environments. The identified barriers question the innovation’s appropriateness related to the setting’s needs but also provide possibilities for tailoring pharmacist services to local medication work issues. The observable positive effects and the perceived advantage of the pharmacist services are likely to facilitate the implementation process. Conclusion - Our study provided information on contextual elements that influence the implementation process of non-dispensing pharmacist services. Awareness of these factors can help develop strategies to help the organization succeed in in achieving program outcomes

At spise – ikke kun et spørgsmål om mad

Forholdet mellem kost og sundhed er emne for debat, forskning og praksis i og udenfor sundhedsvæsenet. Men det at spise – ikke blot kostens indhold, men den faktiske praksis hvor mad indtages som en integreret del af vores daglige liv – diskuteres mindre. Ikke desto mindre udgør denne aktivitet på forskellige måder en kontaktflade mellem menneskers sociale liv og deres helbred. Det er denne kontaktflade vi ønsker at sætte fokus på med dette temanummer

Church theft, insecurity, and community justice: the reality of source-end regulation of the market for illicit bolivian cultural objects

In 2012 two men were lynched in Bolivia, first because there is an illicit market for Bolivian cultural objects, and second because a small, poor community turned to desperate measures to protect themselves from that illicit market due to the failings of national and international regulation. This paper is a case study of the reality of source-end regulation of an international criminal market in a developing country. I will discuss what is known about thefts from Bolivian churches, the international market for items stolen from these churches, and how such thefts are meant to be prevented on-the ground. Following this, I will present lynching in Bolivia as the most severe community response to the issues created by local politics, ineffectual policing, unenforceable laws, and a history of oppressive racism. I will conclude with a discussion of what we can reasonably hope to accomplish with source-end regulation

How do general practitioners implement decision-making regarding COPD patients with exacerbations? An international focus group study

Johanna Laue,1 Hasse Melbye,1 Peder A Halvorsen,1 Elena A Andreeva,2 Maciek Godycki-Cwirko,3 Anja Wollny,4 Nick A Francis,5 Mark Spigt,6 Kenny Kung,7 Mette Bech Risør1 1Department of Community Medicine, General Practice Research Unit, University of Tromsø – The Arctic University of Norway, Tromsø, Norway; 2Department of Family Medicine, Northern State Medical University, Arkhangelsk, Russia; 3Department of Family and Community Medicine, Medical University of Lodz, Lodz, Poland; 4Institute of General Practice, University Medical Center Rostock, Rostock, Germany; 5Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK; 6CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands; 7The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Purpose: To explore the decision-making of general practitioners (GPs) concerning treatment with antibiotics and/or oral corticosteroids and hospitalization for COPD patients with exacerbations.Methods: Thematic analysis of seven focus groups with 53 GPs from urban and rural areas in Norway, Germany, Wales, Poland, Russia, the Netherlands, and Hong Kong.Results: Four main themes were identified. 1) Dealing with medical uncertainty: the GPs aimed to make clear medical decisions and avoid unnecessary prescriptions and hospitalizations, yet this was challenged by uncertainty regarding the severity of the exacerbations and concerns about overlooking comorbidities. 2) Knowing the patient: contextual knowledge about the individual patient provided a supplementary framework to biomedical knowledge, allowing for more differentiated decision-making. 3) Balancing the patients’ perspective: the GPs considered patients’ experiential knowledge about their own body and illness as valuable in assisting their decision-making, yet felt that dealing with disagreements between their own and their patients’ perceptions concerning the need for treatment or hospitalization could be difficult. 4) Outpatient support and collaboration: both formal and informal caregivers and organizational aspects of the health systems influenced the decision-making, particularly in terms of mitigating potentially severe consequences of “wrong decisions” and concerning the negotiation of responsibilities.Conclusion: Fear of overlooking severe comorbidity and of further deteriorating symptoms emerged as a main driver of GPs’ management decisions. GPs consider a holistic understanding of illness and the patients’ own judgment crucial to making reasonable decisions under medical uncertainty. Moreover, GPs’ decisions depend on the availability and reliability of other formal and informal carers, and the health care systems’ organizational and cultural code of conduct. Strengthening the collaboration between GPs, other outpatient care facilities and the patients’ social network can ensure ongoing monitoring and prompt intervention if necessary and may help to improve primary care for COPD patients with exacerbations. Keywords: COPD exacerbation, antibiotics, oral corticosteroids, hospitalization, primary care, decision-makin