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  1. Article ; Online: "Returning to the core tasks": a qualitative interview study about how general practitioners in home health care solved problems during the COVID-19 pandemic.

    Wachtler, Caroline / Bergqvist, Monica / Holmgren, Katarina / Mannheimer, Stina / Bastholm-Rahmner, Pia / Schmidt-Mende, Katharina

    Scandinavian journal of primary health care

    2024  Volume 42, Issue 1, Page(s) 91–100

    Abstract: Objective: Optimizing care at home, or home health care (HHC), is necessary as the population of care-dependent older people receiving care at home steadily increases. The COVID-19 pandemic tested Swedish primary care professionals as they provided HHC ... ...

    Abstract Objective: Optimizing care at home, or home health care (HHC), is necessary as the population of care-dependent older people receiving care at home steadily increases. The COVID-19 pandemic tested Swedish primary care professionals as they provided HHC for a population of very frail older homebound people, but a better understanding of what healthcare workers did to manage the crisis may be useful for the further development of HHC. In this study, we aimed to understand how HHC physicians solved the problems of providing home healthcare during the pandemic to learn lessons on how to improve future HHC.
    Methods: This is a qualitative study of individual interviews with 11 primary care physicians working in HHC (8 women) from 7 primary care practices in Region Stockholm, Sweden. Interviews were conducted between 1 December 2020, and 11 March 2021. The data were analyzed using inductive thematic analysis.
    Results: We generated an overarching theme in our analysis: Physicians focus on core tasks and professional values in response to crisis. This theme incorporated three underlying subthemes describing this response: physicians prioritize and resolve ethically challenging situations in new ways, cultivate the patient perspective, and build on existing teams.
    Conclusion: This study indicates that a healthcare system that gives HHC physicians agency to focus on core tasks and professional values could promote person-centered care.
    MeSH term(s) Humans ; Female ; Aged ; Pandemics ; General Practitioners ; COVID-19 ; Home Care Services ; Qualitative Research
    Language English
    Publishing date 2024-02-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 605763-9
    ISSN 1502-7724 ; 0281-3432 ; 0284-6020
    ISSN (online) 1502-7724
    ISSN 0281-3432 ; 0284-6020
    DOI 10.1080/02813432.2023.2291676
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  2. Article ; Online: Homecare workers - an untapped resource in preventing emergency department visits among older individuals? A qualitative interview study from Sweden.

    Bastholm-Rahmner, Pia / Bergqvist, Monica / Modig, Karin / Gustafsson, Lars L / Schmidt-Mende, Katharina

    BMC geriatrics

    2024  Volume 24, Issue 1, Page(s) 350

    Abstract: Background: Older individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study ... ...

    Abstract Background: Older individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study explores if and how HCWs perceive they may contribute to the prevention of ED visits among their clients.
    Methods: In this qualitative study, 12 semi-structured interviews were conducted with HCWs from Sweden between July and November 2022. Inductive thematic analysis was used to identify barriers and facilitators to prevent ED visits in older home-dwelling individuals.
    Results: HCWs want to actively contribute to the prevention of ED visits among clients but observe many barriers that hinder them from doing so. Barriers refer to care organisation such as availability to primary care staff and information transfer; perceived attitudes towards HCWs as co-workers; and client-related factors. Participants suggest that improved communication and collaboration with primary care and discharge information from the ED to homecare services could overcome barriers. Furthermore, they ask for support and geriatric education from primary care nurses which may result in increased respect towards them as competent staff members.
    Conclusions: HCWs feel that they have an important role in the health management of older individuals living at home. Still, they feel as an untapped resource in the prevention of ED visits. They deem that improved coordination and communication between primary care, ED, and homecare organisations as well as proactive care would enable them to add significantly to the prevention of ED visits.
    MeSH term(s) Humans ; Aged ; Sweden/epidemiology ; Emergency Room Visits ; Emergency Service, Hospital ; Qualitative Research ; Palliative Care
    Language English
    Publishing date 2024-04-18
    Publishing country England
    Document type Journal Article
    ZDB-ID 2059865-8
    ISSN 1471-2318 ; 1471-2318
    ISSN (online) 1471-2318
    ISSN 1471-2318
    DOI 10.1186/s12877-024-04906-5
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  3. Article ; Online: Experiences of patients receiving Home Care and living with polypharmacy: a qualitative interview study.

    Mannheimer, Stina / Bergqvist, Monica / Bastholm-Rahmner, Pia / Gustafsson, Lars L / Vég, Anikó / Schmidt-Mende, Katharina

    BJGP open

    2022  Volume 6, Issue 2

    Abstract: Background: In Sweden, patients receiving Home Care (HC) are older people with frailty and multimorbidity, and are often treated with many medicines. Their perspectives on polypharmacy have been sparsely explored.: Aim: To investigate HC patients' ... ...

    Abstract Background: In Sweden, patients receiving Home Care (HC) are older people with frailty and multimorbidity, and are often treated with many medicines. Their perspectives on polypharmacy have been sparsely explored.
    Aim: To investigate HC patients' experiences and perceptions regarding polypharmacy.
    Design & setting: Semi-structured interviews with 17 patients with HC in Stockholm, Sweden.
    Method: The interview questions were open and aimed to encourage participants to speak freely about their personal experiences of living with polypharmacy. Data were analysed using an inductive thematic analysis.
    Results: The participants' median age was 83.5 years (range 74-97 years) and the median number of prescribed medicines was 11 (range 5-30). The following two themes were identified: (1) experiences from daily life with polypharmacy; and (2) dependency on the relationship to healthcare professionals. The first theme contains the main finding, which was the diversity in how older people experienced polypharmacy and how they coped with polypharmacy in everyday life. While some were satisfied despite having multiple medicines, others experienced such psychological unease owing to polypharmacy that it led to reduced quality of life. The second theme reflects the importance of the relationship between the older person and healthcare professionals for medicine-related ideas and attitudes.
    Conclusion: The individual variation in experiences regarding polypharmacy points to the value of interprofessional teamwork with the patient as an active partner. Therefore, healthcare professionals need to adapt a more person-centred approach where the patient's perspectives are respected and considered in medicine-related decisionmaking.
    Language English
    Publishing date 2022-08-30
    Publishing country England
    Document type Journal Article
    ISSN 2398-3795
    ISSN (online) 2398-3795
    DOI 10.3399/BJGPO.2021.0181
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  4. Article ; Online: How much are we worth? Experiences of nursing assistants in Swedish nursing homes during the first wave of COVID-19.

    Bergqvist, Monica / Bastholm-Rahmner, Pia / Gustafsson, Lars L / Holmgren, Katarina / Veg, Anikó / Wachtler, Caroline / Schmidt-Mende, Katharina

    International journal of older people nursing

    2022  , Page(s) e12498

    Abstract: Background: NHs have been severely exposed during the COVID-19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing ... ...

    Abstract Background: NHs have been severely exposed during the COVID-19 pandemic. Little is known about how staff who provide practical daily care of older residents experienced work during the pandemic. The aim of this study was to understand how nursing assistants (NAs) experienced their work at nursing homes (NHs) for older people during the first wave of the COVID-19 pandemic.
    Methods: We conducted a qualitative study of focus group discussions with in total 20 participants from four NHs in Stockholm, Sweden. Discussions were held in November 2020. Transcripts were analyzed using inductive thematic analysis.
    Results: We identified three major themes: 1) We felt abandoned, scared and disrespected, 2) We made sure we made it through, and 3) We can do good work with appropriate resources. NAs felt disregarded as they were often left alone without adequate support from managers, registered nurses and the municipalities. NAs felt distressed and guilty and developed their own strategies to cope and manage their work.
    Conclusion and implication for practice: During the first wave of the COVID-19 pandemic NAs felt abandoned and burdened due to lack of leadership. Organizational improvements are required to protect the wellbeing of NAs and to ensure sustainability of patient safety. NAs are crucial in the care for vulnerable older people and their experiences should constitute a keystone for development of future policy and practice in NHs.
    Language English
    Publishing date 2022-08-17
    Publishing country England
    Document type Journal Article
    ZDB-ID 2250661-5
    ISSN 1748-3743 ; 1748-3735
    ISSN (online) 1748-3743
    ISSN 1748-3735
    DOI 10.1111/opn.12498
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  5. Article ; Online: Medication errors as malpractice-a qualitative content analysis of 585 medication errors by nurses in Sweden.

    Björkstén, Karin Sparring / Bergqvist, Monica / Andersén-Karlsson, Eva / Benson, Lina / Ulfvarson, Johanna

    BMC health services research

    2016  Volume 16, Issue 1, Page(s) 431

    Abstract: Background: Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. ...

    Abstract Background: Many studies address the prevalence of medication errors but few address medication errors serious enough to be regarded as malpractice. Other studies have analyzed the individual and system contributory factor leading to a medication error. Nurses have a key role in medication administration, and there are contradictory reports on the nurses' work experience in relation to the risk and type for medication errors.
    Methods: All medication errors where a nurse was held responsible for malpractice (n = 585) during 11 years in Sweden were included. A qualitative content analysis and classification according to the type and the individual and system contributory factors was made. In order to test for possible differences between nurses' work experience and associations within and between the errors and contributory factors, Fisher's exact test was used, and Cohen's kappa (k) was performed to estimate the magnitude and direction of the associations.
    Results: There were a total of 613 medication errors in the 585 cases, the most common being "Wrong dose" (41 %), "Wrong patient" (13 %) and "Omission of drug" (12 %). In 95 % of the cases, an average of 1.4 individual contributory factors was found; the most common being "Negligence, forgetfulness or lack of attentiveness" (68 %), "Proper protocol not followed" (25 %), "Lack of knowledge" (13 %) and "Practice beyond scope" (12 %). In 78 % of the cases, an average of 1.7 system contributory factors was found; the most common being "Role overload" (36 %), "Unclear communication or orders" (30 %) and "Lack of adequate access to guidelines or unclear organisational routines" (30 %). The errors "Wrong patient due to mix-up of patients" and "Wrong route" and the contributory factors "Lack of knowledge" and "Negligence, forgetfulness or lack of attentiveness" were more common in less experienced nurses. The experienced nurses were more prone to "Practice beyond scope of practice" and to make errors in spite of "Lack of adequate access to guidelines or unclear organisational routines".
    Conclusions: Medication errors regarded as malpractice in Sweden were of the same character as medication errors worldwide. A complex interplay between individual and system factors often contributed to the errors.
    MeSH term(s) Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Communication ; Female ; Humans ; Infant ; Male ; Malpractice/legislation & jurisprudence ; Malpractice/statistics & numerical data ; Medication Errors/legislation & jurisprudence ; Medication Errors/nursing ; Medication Errors/statistics & numerical data ; Middle Aged ; Nurses/legislation & jurisprudence ; Nurses/statistics & numerical data ; Risk Factors ; Sweden ; Young Adult
    Language English
    Publishing date 2016-08-24
    Publishing country England
    Document type Journal Article
    ISSN 1472-6963
    ISSN (online) 1472-6963
    DOI 10.1186/s12913-016-1695-9
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  6. Article: Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients

    Bergqvist, Monica / Ulfvarson, Johanna / Andersén Karlsson, Eva

    European journal of clinical pharmacology. 2009 Nov., v. 65, no. 11

    2009  

    Abstract: Purpose To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients. Methods Nurses were given a 1-day training in clinical pharmacology to identify drug-related ... ...

    Abstract Purpose To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients. Methods Nurses were given a 1-day training in clinical pharmacology to identify drug-related problems (DRPs). All patients admitted to the ward aged 65 or more were studied. Patients at the same ward before the intervention were considered as control group. Outcome variables were re-hospitalized 3 months from discharge, drug-related re-admissions, the proportion of inappropriate drug use (IDU), and DRPs found by the nurses. Results Of 460 patients (250 intervention group and 210 in the control group) 38 and 36%, respectively, had at least one re-admission to hospital (p = 0.86) and 24% of the patients died. Eighteen and 17% (43/37), respectively, used one or more inappropriate drug (p 0.90). The nurses found 86 clinically significant DRPs not detected by the usual care. A substantial part of the DRPs detected by the nurses were revealed with assistance of Symptoms Assessment Form (SYM). There were no statistical difference in the number of drug-related re-admissions between the groups, 14/16, respectively, (p = 0.40). Conclusions Nurses are able to detect a high proportion of clinically relevant DRPs not detected by the usual care and thereby increase the quality of the drug treatment in elderly hospitalized patients. Our study showed no effect on re-hospitalization or IDU. By using a SYM nurses can find DRPs that computer-based decision support systems miss.
    Language English
    Dates of publication 2009-11
    Size p. 1089-1096.
    Publisher Springer-Verlag
    Publishing place Berlin/Heidelberg
    Document type Article
    ZDB-ID 121960-1
    ISSN 1432-1041 ; 0031-6970
    ISSN (online) 1432-1041
    ISSN 0031-6970
    DOI 10.1007/s00228-009-0728-2
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  7. Article ; Online: Nurse-led medication reviews and the quality of drug treatment of elderly hospitalized patients.

    Bergqvist, Monica / Ulfvarson, Johanna / Karlsson, Eva Andersén

    European journal of clinical pharmacology

    2009  Volume 65, Issue 11, Page(s) 1089–1096

    Abstract: Purpose: To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients.: Methods: Nurses were given a 1-day training in clinical pharmacology to identify drug- ... ...

    Abstract Purpose: To evaluate if nurses after receiving training in clinical pharmacology can improve the quality of the drug therapy in elderly hospitalized patients.
    Methods: Nurses were given a 1-day training in clinical pharmacology to identify drug-related problems (DRPs).All patients admitted to the ward aged 65 or more were studied. Patients at the same ward before the intervention were considered as control group. Outcome variables were re-hospitalized 3 months from discharge, drug-related readmissions, the proportion of inappropriate drug use (IDU), and DRPs found by the nurses.
    Results: Of 460 patients (250 intervention group and 210 in the control group) 38 and 36%, respectively, had at least one re-admission to hospital (p=0.86) and 24% of the patients died. Eighteen and 17% (43/37), respectively, used one or more inappropriate drug (p 0.90). The nurses found 86 clinically significant DRPs not detected by the usual care. A substantial part of the DRPs detected by the nurses were revealed with assistance of Symptoms Assessment Form (SYM). There were no statistical difference in the number of drug-related re-admissions between the groups, 14/16, respectively, (p=0.40).
    Conclusions: Nurses are able to detect a high proportion of clinically relevant DRPs not detected by the usual care and thereby increase the quality of the drug treatment in elderly hospitalized patients. Our study showed no effect on re-hospitalization or IDU. By using a SYM nurses can find DRPs that computer-based decision support systems miss.
    MeSH term(s) Aged ; Aged, 80 and over ; Drug Therapy/standards ; Drug Utilization Review/methods ; Education, Nursing ; Female ; Hospitalization ; Humans ; Male ; Medication Errors/prevention & control ; Nurse's Role ; Nurses ; Patient Discharge ; Patient Readmission ; Pharmacology/education
    Language English
    Publishing date 2009-10-02
    Publishing country Germany
    Document type Clinical Trial ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 121960-1
    ISSN 1432-1041 ; 0031-6970
    ISSN (online) 1432-1041
    ISSN 0031-6970
    DOI 10.1007/s00228-009-0728-2
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  8. Article ; Online: A nurse-led intervention for identification of drug-related problems.

    Bergqvist, Monica / Ulfvarson, Johanna / Andersen Karlsson, Eva / von Bahr, Christer

    European journal of clinical pharmacology

    2008  Volume 64, Issue 5, Page(s) 451–456

    MeSH term(s) Adult ; Adverse Drug Reaction Reporting Systems/organization & administration ; Aged ; Aged, 80 and over ; Creatinine/metabolism ; Drug Interactions ; Drug-Related Side Effects and Adverse Reactions ; Feasibility Studies ; Female ; Humans ; Male ; Middle Aged ; Nursing Staff, Hospital/organization & administration ; Process Assessment, Health Care
    Chemical Substances Creatinine (AYI8EX34EU)
    Language English
    Publishing date 2008-01-19
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 121960-1
    ISSN 1432-1041 ; 0031-6970
    ISSN (online) 1432-1041
    ISSN 0031-6970
    DOI 10.1007/s00228-007-0449-3
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  9. Article: A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions

    Mannheimer, Buster / Ulfvarson, Johanna / Eklöf, Sara / Bergqvist, Monica / von Bahr, Christer

    European journal of clinical pharmacology. 2008 Dec., v. 64, no. 12

    2008  

    Abstract: Purpose To evaluate the clinical relevance of the Janus Web Application (JWA) in screening for potential drug-drug interactions (DDIs). Methods One hundred and fifty patients taking two drugs or more were studied. Potential DDIs were identified by the ... ...

    Abstract Purpose To evaluate the clinical relevance of the Janus Web Application (JWA) in screening for potential drug-drug interactions (DDIs). Methods One hundred and fifty patients taking two drugs or more were studied. Potential DDIs were identified by the JWA. Interviewing the patient and looking into his/her medical records provided complementing information. A clinical pharmacologist judged which potential DDIs were clinically relevant. Potentially relevant DDIs identified by the JWA were then correlated with clinically relevant DDIs. Results A total of 150 significant potential DDIs were found. Sixteen percent (24/150) were judged to be clinically relevant. Conclusions A very small proportion of DDIs was considered clinically relevant in the specific clinical context. To optimise the software's user-friendliness, the following points need to be considered: the possibility of eliminating trivial potential DDIs, individualising drug alerts, and providing written information, accessible via a hyperlink.
    Keywords drug interactions
    Language English
    Dates of publication 2008-12
    Size p. 1209-1214.
    Publisher Springer-Verlag
    Publishing place Berlin/Heidelberg
    Document type Article
    ZDB-ID 121960-1
    ISSN 1432-1041 ; 0031-6970
    ISSN (online) 1432-1041
    ISSN 0031-6970
    DOI 10.1007/s00228-008-0547-x
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  10. Article ; Online: A clinical evaluation of the Janus Web Application, a software screening tool for drug-drug interactions.

    Mannheimer, Buster / Ulfvarson, Johanna / Eklöf, Sara / Bergqvist, Monica / von Bahr, Christer

    European journal of clinical pharmacology

    2008  Volume 64, Issue 12, Page(s) 1209–1214

    Abstract: Purpose: To evaluate the clinical relevance of the Janus Web Application (JWA) in screening for potential drug-drug interactions (DDIs).: Methods: One hundred and fifty patients taking two drugs or more were studied. Potential DDIs were identified by ...

    Abstract Purpose: To evaluate the clinical relevance of the Janus Web Application (JWA) in screening for potential drug-drug interactions (DDIs).
    Methods: One hundred and fifty patients taking two drugs or more were studied. Potential DDIs were identified by the JWA. Interviewing the patient and looking into his/her medical records provided complementing information. A clinical pharmacologist judged which potential DDIs were clinically relevant. Potentially relevant DDIs identified by the JWA were then correlated with clinically relevant DDIs.
    Results: A total of 150 significant potential DDIs were found. Sixteen percent (24/150) were judged to be clinically relevant.
    Conclusions: A very small proportion of DDIs was considered clinically relevant in the specific clinical context. To optimise the software's user-friendliness, the following points need to be considered: the possibility of eliminating trivial potential DDIs, individualising drug alerts, and providing written information, accessible via a hyperlink.
    MeSH term(s) Aged ; Decision Support Systems, Clinical ; Drug Interactions ; Drug Utilization Review/methods ; Drug Utilization Review/statistics & numerical data ; Drug-Related Side Effects and Adverse Reactions ; Female ; Humans ; Male ; Medical Records ; Pharmaceutical Preparations/administration & dosage ; Software ; Surveys and Questionnaires ; Sweden
    Chemical Substances Pharmaceutical Preparations
    Language English
    Publishing date 2008-08-10
    Publishing country Germany
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 121960-1
    ISSN 1432-1041 ; 0031-6970
    ISSN (online) 1432-1041
    ISSN 0031-6970
    DOI 10.1007/s00228-008-0547-x
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