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Article ; Online: Exploring pharmacists' perspectives about substandard and falsified medical products through interviews.

Persson, A / Troein, M / Lundin, S / Midlöv, P / Lenander, C

Exploratory research in clinical and social pharmacy

2024 Volume 13, Page(s) 100421

Abstract: Background: The problem with substandard and falsified (SF) medical products may grow in high-income countries when e-commerce of medicines increases. Unauthorized websites offer medicines of insufficient quality. This underscores the importance of ... ...

Abstract	Background: The problem with substandard and falsified (SF) medical products may grow in high-income countries when e-commerce of medicines increases. Unauthorized websites offer medicines of insufficient quality. This underscores the importance of evaluating how the problem with SF medical products can be prevented from escalating. However, little is known about what knowledge and experience professionals working primarily with medicines have about the phenomenon. Objective: This study was conducted to explore purposively selected pharmacists' experience and knowledge about SF medical products. Methods: Twelve individual interviews were conducted with purposively selected pharmacists between May 2021 and September 2021. An interview guide was used with specific questions about e-commerce, which focused on exploring pharmacists' experience and knowledge about SF medical products. The interviews lasted, on average, 49 min and were analyzed using inductive qualitative content analysis. Results: A main theme 'Pharmacists as guardians of safe medicines' emerged. This theme consisted of three categories pinpointing 'risk factors', 'protective factors', and 'opportunities for improvement' regarding SF medical products. Findings suggest that pharmacists can play a role in preventing the problem with SF medical products from escalating. Participants emphasized they were in this line of work to help patients and increase patient safety. Conclusions: Pharmacists have the opportunity to empower the public with knowledge about SF medical products since they discuss medicines with many people every day. Awareness of risk factors for SF medical products enables pharmacists to guide patients to avoid risky purchases from unauthorized websites. To do this, better communication, and cooperation with patients and other healthcare professionals are needed.
Language	English
Publishing date	2024-02-14
Publishing country	United States
Document type	Journal Article
ISSN	2667-2766
ISSN (online)	2667-2766
DOI	10.1016/j.rcsop.2024.100421
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Swedish community pharmacy employees' knowledge and experience of substandard and falsified medical products: a cross-sectional descriptive survey.

Persson, A / Troein, M / Lundin, S / Midlöv, P / Lenander, C

The International journal of pharmacy practice

2022 Volume 30, Issue 5, Page(s) 414–419

Abstract: Objectives: Substandard and falsified medical products are, according to the World Health Organization, a global threat to public health. To evaluate if community pharmacy employees can guide the public to safer medication purchases, their knowledge and ...

Abstract	Objectives: Substandard and falsified medical products are, according to the World Health Organization, a global threat to public health. To evaluate if community pharmacy employees can guide the public to safer medication purchases, their knowledge and experience about SF medical products was examined. Methods: A digital questionnaire was distributed to the five dominating pharmacy companies in Sweden, representing 97% of the community pharmacies (1391/1433), giving the theoretical possibility of reaching 6200 employees. Three companies published a link to the questionnaire on their intranets, one distributed the link via e-mail to the responsible pharmacist for quality and knowledge, respectively. The fifth company did not pass on, due to technical problems. Employees aged 18 years or older with customer contact were invited to participate. Key findings: The questionnaire was available for 74% of all community pharmacies (1067/1433), having approximately 4900 employees with customer contact. The response rate was 5% (228/4900). Of the respondents, 89% were pharmacists (203/228), 84% were women (191/228) and 43% were 35-49 years (98/228). The respondents worked in pharmacies of different size, located both in rural and urban areas. The definition of substandard and falsified medical products was known by 182 of the 228 respondents (80%) and the main source of knowledge was media (61%, 111/228). The common European logo for authorized online pharmacies was not recognized by 74% (169/228). Conclusions: For pharmacy employees to guide the public to safer medication purchases, knowledge about substandard and falsified medical products needs to be enhanced specially about legal international e-commerce.
MeSH term(s)	Female ; Humans ; Male ; Pharmacies ; Sweden ; Cross-Sectional Studies ; Pharmacy ; Pharmaceutical Services ; Pharmacists ; Community Pharmacy Services
Language	English
Publishing date	2022-07-18
Publishing country	England
Document type	Journal Article
ZDB-ID	1087040-4
ISSN	2042-7174 ; 0961-7671
ISSN (online)	2042-7174
ISSN	0961-7671
DOI	10.1093/ijpp/riac059
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Article: The Impact of Medication Reviews Conducted in Primary Care on Hospital Admissions and Mortality: An Observational Follow-Up of a Randomized Controlled Trial.

Milos Nymberg, Veronica / Lenander, Cecilia / Borgström Bolmsjö, Beata

Drug, healthcare and patient safety

2021 Volume 13, Page(s) 1–9

Abstract: 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 ... ...

Abstract	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.
Language	English
Publishing date	2021-01-27
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2520700-3
ISSN	1179-1365
ISSN	1179-1365
DOI	10.2147/DHPS.S283708
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Article ; Online: Clinical impact of medication reviews for community-dwelling patients in primary healthcare.

Dobszai, Annika / Lenander, Cecilia / Borgström Bolmsjö, Beata / Wickman, Katarina / Modig, Sara

BMC primary care

2023 Volume 24, Issue 1, Page(s) 259

Abstract: Background: A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent ... ...

Abstract	Background: A high number of drug-related problems has previously been shown among community-dwelling patients in primary healthcare in Skåne County, Sweden. Medication reviews are one way to solve these problems, but their impact is largely dependent on the process. We aimed to evaluate medication reviews for community-dwelling patients regarding the clinical relevance of the pharmacists' recommendations, and their implementation by general practitioners. We also wanted to investigate if the general practitioners' tendency to act on drug-related problems was correlated to different factors of the process. Methods: This was a cohort study, where patients in primary healthcare considered in need of a medication review were selected. Pharmacists identified drug-related problems and gave written recommendations on how to solve the problems to the general practitioner, via the medical record, and in addition in some cases via verbal communication. The clinical relevance of the recommendations was graded according to the Hatoum scale, ranging from one (adverse significance) to six (extremely significant). Descriptive statistics were used regarding the clinical relevance and the general practitioners´ tendency to act on drug-related problems. Multiple logistic regression analysis was used to examine the association between the tendency to act and different factors of the process. Results: A total of 96.1% of the 384 assessed recommendations from the pharmacists were graded as significant or more for the patient (Hatoum grade 3 or higher). The general practitioners acted on 63.8% of the drug-related problems. Fewer recommendations per patient, as well as verbal communication in addition to written contact, significantly increased the general practitioners' tendency to act on a drug-related problem. No significant association was seen between the tendency to act and the clinical relevance of the recommendation. Conclusions: The high proportion of clinically relevant recommendations from the pharmacists in this study strengthens medication reviews as an important tool for reducing drug-related problems. Verbal communication between the pharmacist and the general practitioner is important for measures to be taken. Multiple recommendations for the same patient reduced their likelihood to of being addressed by the general practitioner.
MeSH term(s)	Humans ; Medication Review ; Cohort Studies ; Independent Living ; General Practitioners ; Primary Health Care
Language	English
Publishing date	2023-12-02
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-023-02216-0
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Article ; Online: Pharmacist-led medication reviews in primary healthcare for adult community-dwelling patients - a descriptive study charting a new target group.

Wickman, Katarina / Dobszai, Annika / Modig, Sara / Bolmsjö, Beata Borgström / Caleres, Gabriella / Lenander, Cecilia

BMC primary care

2022 Volume 23, Issue 1, Page(s) 237

Abstract: Background: Medication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne ... ...

Abstract	Background: Medication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne county, Sweden, a well-established multi-professional model for MRs in nursing homes is practiced. However, a demand for MRs regarding community-dwelling patients has emerged. These patients may be extra vulnerable since they have less supervision from healthcare personnel. Aim: To describe the community-dwelling patients in primary healthcare considered in need of an MR, as well as the outcomes of these pharmacist-led MRs. Methods: Personnel from 14 primary healthcare centers selected patients for the MRs. Based on electronic medical records, the symptom assessment tool PHASE-20 (PHArmacotherapeutical Symptom Evaluation 20 questions) and medication lists, pharmacists conducted MRs and communicated adjustment suggestions via the medical record to the general practitioners (GPs). Results: A total of 109 patients were included in the study and 90.8% (n = 99) of the patients were exposed to at least one DRP, with an average of 3.9 DRPs per patient. Patients with impaired renal function (glomerular filtration rate, GFR < 45 ml/min) or ≥ 10 medications were exposed to a significantly higher number of DRPs per patient, 5.1 DRP and 5.3 respectively. The most frequent DRP-categories were Unnecessary drug therapy and Adverse drug reaction, which represented 23.0% respectively 22.9% of the total amount of DRPs. Conclusions: Our results indicate a prioritized need for MRs for community-dwelling patients, specifically with impaired renal function or polypharmacy.
MeSH term(s)	Adult ; General Practitioners ; Humans ; Independent Living ; Medication Review ; Pharmacists ; Primary Health Care
Language	English
Publishing date	2022-09-16
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-022-01849-x
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Article ; Online: The Impact of Medication Reviews Conducted in Primary Care on Hospital Admissions and Mortality

Milos Nymberg V / Lenander C / Borgström Bolmsjö B

Drug, Healthcare and Patient Safety, Vol Volume 13, Pp 1-

An Observational Follow-Up of a Randomized Controlled Trial

2021 Volume 9

Abstract: Veronica Milos Nymberg,1,2 Cecilia Lenander,1,2 Beata Borgström Bolmsjö1,2 1Department of Clinical ...

Abstract	Veronica Milos Nymberg,1,2 Cecilia Lenander,1,2 Beata Borgström Bolmsjö1,2 1Department of Clinical Sciences, Lund University, Malmö, Sweden; 2CPF, Center for Primary Healthcare Research, Malmö, SwedenCorrespondence: Beata Borgström BolmsjöCPF, Center for Primary Health Care Research, Clinical Research Centre (CRC), Building 28, Floor 11, Jan Waldenström Street 35, Malmö SE-205 02, SwedenEmail beata.borgstrom_bolmsjo@med.lu.seBackground: 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– ...
Keywords	medication reviews ; primary care ; elderly ; randomized controlled study ; hospital admissions ; mortality ; Medicine (General) ; R5-920
Subject code	360
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	Dove Medical Press
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: An intervention model with self-assessment and subsequent multi-professional review might be effective and feasible to improve drug safety in primary healthcare. A survey-based evaluation of SÄKLÄK2.

Skoog, Jessica / Lenander, Cecilia / Modig, Sara

Journal of evaluation in clinical practice

2019 Volume 26, Issue 1, Page(s) 125–133

Abstract: Rationale, aims, and objectives: Drug-related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi-professional intervention model aiming at improving drug safety in primary health care. The ... ...

Abstract	Rationale, aims, and objectives: Drug-related morbidity is common, which results in suffering for the patients and a high cost to society. SÄKLÄK2 is a multi-professional intervention model aiming at improving drug safety in primary health care. The objective of this study was to elucidate the perceptions of the participants' regarding the efficiency of the intervention and the feasibility to introduce this model widely. Method: SÄKLÄK2 is a multi-professional intervention model in primary health care in Sweden that consisted of self-assessment, peer-review, written feedback, and agreements for change. Web-based surveys were sent to both the management of participating primary health care centres (PHC) and to reviewers. The participating PHCs were fairly well-staffed and had a high interest in improvement work. Descriptive analysis and content analysis was used. Results: For the PHC management, the following categories were formed: Comprehensive project, Time-consuming, Multi-professional character, Relevant action agreements, and Feasible to implement. For the reviewers, the following categories were formed: Multi-professional character, Relevant action agreements, Feasible to implement, Useful self-assessment questionnaire, and Valuable visit at the PHC. There was a high degree of consistency between the PHC management and the reviewers' answers, especially regarding the efficiency of the model to improve drug safety and the feasibility to implement it on a broad front. Conclusion: SÄKLÄK2, a model with self-assessment, peer review, written feedback, and the formation of action agreements was considered by both the participating heads of the PHC centres and the reviewers to be effective to improve drug safety in primary health care. Though time-consuming, this multi-professional model was considered to be feasible to implement on a broad front and might thereby be one way of working with quality improvement regarding drug safety.
MeSH term(s)	Humans ; Pharmaceutical Preparations ; Primary Health Care ; Self-Assessment ; Surveys and Questionnaires ; Sweden
Chemical Substances	Pharmaceutical Preparations
Language	English
Publishing date	2019-06-14
Publishing country	England
Document type	Journal Article
ZDB-ID	1327355-3
ISSN	1365-2753 ; 1356-1294
ISSN (online)	1365-2753
ISSN	1356-1294
DOI	10.1111/jep.13195
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Article ; Online: Life's Essential 8 in relation to self-rated health and health-related quality of life in a large population-based sample: the SCAPIS project.

Herraiz-Adillo, Ángel / Ahlqvist, Viktor H / Daka, Bledar / Wångdahl, Josefin / Wennberg, Patrik / Carlsson, Jakob / Higueras-Fresnillo, Sara / Lenander, Cecilia / Östgren, Carl Johan / Berglind, Daniel / Rådholm, Karin / Henriksson, Pontus

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation

2024 Volume 33, Issue 4, Page(s) 1003–1014

Abstract: Purpose: To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and ... ...

Abstract	Purpose: To monitor cardiovascular health, in 2022, the American Heart Association (AHA) updated the construct "Life's Simple 7" (LS7) to "Life's Essential 8" (LE8). This study aims to analyze the associations and capacity of discrimination of LE8 and LS7 in relation to self-rated health (SRH) and health-related quality of life (HRQoL). Methods: This study from the Swedish CArdioPulmonary bioImage Study (SCAPIS) included 28 731 Swedish participants, aged 50-64 years. Three different scores were derived from the SF-12 questionnaire: 1-item question SRH ("In general, would you say your health is …?"), mental-HRQoL and physical-HRQoL. Logistic regression, restricted cubic splines, and ROC analysis were used to study the associations between the AHA scores in relation to SRH and HRQoL. Results: Compared to those with a LE8 score of 80, participants with a LE8 score of 40 were 14.8 times more likely to report poor SRH (OR: 14.8, 95% CI: 13.0-17.0), after adjustments. Moreover, they were more likely to report a poor mental-HRQoL (OR: 4.9, 95% CI: 4.2-5.6) and a poor physical-HRQoL (OR: 8.0, 95% CI: 7.0-9.3). Area under curves for discriminating poor SRH were 0.696 (95% CI: 0.687-0.704), 0.666 (95% CI: 0.657-0.674), and 0.643 (95% CI: 0.634-0.651) for LE8, LS7 (0-14), and LS7 (0-7), respectively, all p values < 0.001 in the DeLong's tests. Conclusion: LE8 and LS7 had strong and inverse associations with SRH, mental-HRQoL, and physical-HRQoL, though LE8 had a somewhat higher capacity of discrimination than LS7. The novel LE8, a construct initially conceived to monitor cardiovascular health, also conveys SRH and HRQoL.
MeSH term(s)	United States ; Humans ; Risk Factors ; Quality of Life/psychology ; Surveys and Questionnaires ; American Heart Association ; Cardiovascular Diseases
Language	English
Publishing date	2024-01-25
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1161148-0
ISSN	1573-2649 ; 0962-9343
ISSN (online)	1573-2649
ISSN	0962-9343
DOI	10.1007/s11136-023-03580-1
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Article ; Online: Physical fitness in male adolescents and atherosclerosis in middle age: a population-based cohort study.

Herraiz-Adillo, Ángel / Ahlqvist, Viktor H / Higueras-Fresnillo, Sara / Hedman, Kristofer / Hagström, Emil / Fortuin-de Smidt, Melony / Daka, Bledar / Lenander, Cecilia / Berglind, Daniel / Östgren, Carl Johan / Rådholm, Karin / Ortega, Francisco B / Henriksson, Pontus

British journal of sports medicine

2024

Abstract: Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age.: Methods: This population-based cohort study linked physical fitness data from the Swedish Military ... ...

Abstract	Objectives: To examine the associations between physical fitness in male adolescents and coronary and carotid atherosclerosis in middle age. Methods: This population-based cohort study linked physical fitness data from the Swedish Military Conscription Register during adolescence to atherosclerosis data from the Swedish CArdioPulmonary bioImage Study in middle age. Cardiorespiratory fitness was assessed using a maximal cycle-ergometer test, and knee extension muscular strength was evaluated through an isometric dynamometer. Coronary atherosclerosis was evaluated via Coronary Computed Tomography Angiography (CCTA) stenosis and Coronary Artery Calcium (CAC) scores, while carotid plaques were evaluated by ultrasound. The associations were analysed using multinomial logistic regression, adjusted (marginal) prevalences and restricted cubic splines. Results: The analysis included 8986 male adolescents (mean age 18.3 years) with a mean follow-up of 38.2 years. Physical fitness showed a reversed J-shaped association with CCTA stenosis and CAC, but no consistent association was observed for carotid plaques. After adjustments, compared with adolescents in the lowest tertile of cardiorespiratory fitness and muscular strength, those in the highest tertile had 22% (OR 0.78; 95% CI 0.61 to 0.99) and 26% (OR 0.74; 95% CI 0.58 to 0.93) lower ORs for severe (≥50%) coronary stenosis, respectively. The highest physical fitness group (high cardiorespiratory fitness and muscular strength) had 33% (OR 0.67; 95% CI 0.52 to 0.87) lower OR for severe coronary stenosis compared with those with the lowest physical fitness. Conclusion: This study supports that a combination of high cardiorespiratory fitness and high muscular strength in adolescence is associated with lower coronary atherosclerosis, particularly severe coronary stenosis, almost 40 years later.
Language	English
Publishing date	2024-02-14
Publishing country	England
Document type	Journal Article
ZDB-ID	600592-5
ISSN	1473-0480 ; 0306-3674
ISSN (online)	1473-0480
ISSN	0306-3674
DOI	10.1136/bjsports-2023-107663
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Article ; Online: Socio-economic disparities in the dispensation of antibiotics in Sweden 2016-2017: An intersectional analysis of individual heterogeneity and discriminatory accuracy.

Wemrell, Maria / Lenander, Cecilia / Hansson, Kristofer / Perez, Raquel Vicente / Hedin, Katarina / Merlo, Juan

Scandinavian journal of public health

2021 Volume 50, Issue 3, Page(s) 347–354

Abstract: Aims: ...

Abstract	Aims:
MeSH term(s)	Anti-Bacterial Agents/therapeutic use ; Female ; Humans ; Income ; Public Health ; Socioeconomic Factors ; Sweden/epidemiology
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-01-18
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/1403494820981496
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