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Article ; Online: Is anticholinergic and sedative drug burden associated with postdischarge institutionalization in community-dwelling older patients acutely admitted to hospital? A Norwegian registry-based study.

Havnes, Kjerstin / Svendsen, Kristian / Johansen, Jeanette Schultz / Granas, Anne Gerd / Garcia, Beate Hennie / Halvorsen, Kjell H

Pharmacoepidemiology and drug safety

2023 Volume 32, Issue 6, Page(s) 607–616

Abstract: Purpose: Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and postdischarge institutionalization (PDI) in community-dwelling older patients acutely admitted to hospital.: Methods: A cross- ... ...

Abstract	Purpose: Investigate the association between anticholinergic (AC) and sedative (SED) drug burden before hospitalization and postdischarge institutionalization (PDI) in community-dwelling older patients acutely admitted to hospital. Methods: A cross-sectional study using data from the Norwegian Patient Registry and the Norwegian Prescription Database. We studied acutely hospitalized community-dwelling patients ≥70 years during 2013 (N = 86 509). Patients acutely admitted to geriatric wards underwent subgroup analyses (n = 1715). We calculated drug burden by the Drug Burden Index (DBI), use of AC/SED drugs, and the number of AC/SED drugs. Piecewise linearity of DBI versus PDI and a knot point (DBI = 2.45) was identified. Statistical analyses included an adjusted multivariable logistic regression model. Results: In the total population, 45.4% were exposed to at least one AC/SED drug, compared to 52.5% in the geriatric subgroup. AC/SED drugs were significantly associated with PDI. The DBI with odds ratios (ORs) of 1.11 (95% CI 1.07-1.15) for DBI < 2.45 and 1.08 (95% CI 1.04-1.13) for DBI ≥ 2.45. The number of AC/SED drugs with OR of 1.07 (95% CI 1.05-1.09). The AC component of DBI with OR 1.23 and the number of AC drugs with OR 1.13. In the subgroup, ORs were closer to 1 for AC drugs. Conclusions: The use of AC/SED drugs was highly prevalent in older patients before acute hospital admissions, and significantly associated with PDI. The number, or just using AC/SED drugs, gave similar associations with PDI compared to applying the DBI. Using AC drugs showed higher sensitivity, indicating that to reduce the risk of PDI, a clinical approach could be to reduce the number of AC drugs.
MeSH term(s)	Humans ; Aged ; Independent Living ; Hypnotics and Sedatives ; Cholinergic Antagonists ; Cross-Sectional Studies ; Aftercare ; Patient Discharge ; Hospitalization ; Tranquilizing Agents ; Hospitals ; Institutionalization ; Registries
Chemical Substances	Hypnotics and Sedatives ; Cholinergic Antagonists ; Tranquilizing Agents
Language	English
Publishing date	2023-01-10
Publishing country	England
Document type	Journal Article
ZDB-ID	1099748-9
ISSN	1099-1557 ; 1053-8569
ISSN (online)	1099-1557
ISSN	1053-8569
DOI	10.1002/pds.5590
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Zs.A 3395: Show issues

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Article ; Online: Emergency department physicians' experiences and perceptions with medication-related work tasks and the potential role of clinical pharmacists.

Johnsgård, Tine / Elenjord, Renate / Lehnbom, Elin C / Risør, Torsten / Zahl-Holmstad, Birgitte / Vesela Holis, Renata / Hugaas Ofstad, Eirik / Garcia, Beate Hennie

International journal of qualitative studies on health and well-being

2023 Volume 18, Issue 1, Page(s) 2226941

Abstract: Purpose: Medication-related problems are frequent among emergency department patients. Clinical pharmacists play an important role in identifying, solving, and preventing these problems, but are not present in emergency departments worldwide. We aimed ... ...

Abstract	Purpose: Medication-related problems are frequent among emergency department patients. Clinical pharmacists play an important role in identifying, solving, and preventing these problems, but are not present in emergency departments worldwide. We aimed to explore how Norwegian physicians experience medication-related work tasks in emergency departments without pharmacists present, and how they perceive future introduction of a clinical pharmacist in the interprofessional team. Methods: We interviewed 27 physicians in three emergency departments in Norway. Interviews were audio-recorded, transcribed, and analysed using qualitative content analysis. Results: Our informants' experience with medication-related work tasks mainly concerned medication reconciliation, and few other tasks were systematically performed to ensure medication safety. The informants were welcoming of clinical pharmacists and expressed a need and wish for assistance with compiling patient's medication lists. Simultaneously they expressed concerns regarding e.g., responsibility sharing, priorities in the emergency department and logistics. These concerns need to be addressed before implementing the clinical pharmacist in the interprofessional team in the emergency department. Conclusions: Physicians in Norwegian emergency departments welcome assistance from clinical pharmacists, but the identified professional, structural, and legislative barriers for this collaboration need to be addressed before implementation.
MeSH term(s)	Humans ; Pharmacists ; Physicians ; Emergency Service, Hospital ; Norway ; Attitude of Health Personnel
Language	English
Publishing date	2023-06-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2232726-5
ISSN	1748-2631 ; 1748-2623
ISSN (online)	1748-2631
ISSN	1748-2623
DOI	10.1080/17482631.2023.2226941
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Article ; Online: How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study.

Johnsgård, Tine / Elenjord, Renate / Holis, Renata Vesela / Waaseth, Marit / Zahl-Holmstad, Birgitte / Fagerli, Marie / Svendsen, Kristian / Lehnbom, Elin Christina / Ofstad, Eirik Hugaas / Risør, Torsten / Garcia, Beate Hennie

BMC emergency medicine

2024 Volume 24, Issue 1, Page(s) 56

Abstract: Background: Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and ... ...

Abstract	Background: Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. Methods: An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. Results: In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. Conclusion: In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.
MeSH term(s)	Humans ; Physicians ; Medication Errors/prevention & control ; Patient Safety ; Time and Motion Studies ; Emergency Service, Hospital
Language	English
Publishing date	2024-04-09
Publishing country	England
Document type	Observational Study ; Journal Article
ZDB-ID	2050431-7
ISSN	1471-227X ; 1471-227X
ISSN (online)	1471-227X
ISSN	1471-227X
DOI	10.1186/s12873-024-00974-3
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Article ; Online: Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7.

Pedersen, Elisabeth / Garcia, Beate Hennie / Halvorsen, Kjell H / Eggen, Anne Elise / Schirmer, Henrik / Waaseth, Marit

BMC cardiovascular disorders

2021 Volume 21, Issue 1, Page(s) 44

Abstract: Background: Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its ... ...

Abstract	Background: Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement. Method: We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015-2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol. Results: The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6-54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7-2.7). Conclusion: Treatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Antihypertensive Agents/therapeutic use ; Biomarkers/blood ; Blood Pressure/drug effects ; Cholesterol, LDL/metabolism ; Coronary Disease/diagnosis ; Coronary Disease/prevention & control ; Female ; Glycated Hemoglobin/metabolism ; Guideline Adherence/trends ; Heart Disease Risk Factors ; Humans ; Hyperlipidemias/blood ; Hyperlipidemias/diagnosis ; Hyperlipidemias/drug therapy ; Hypertension/diagnosis ; Hypertension/drug therapy ; Hypertension/physiopathology ; Hypolipidemic Agents/therapeutic use ; Male ; Middle Aged ; Norway ; Practice Guidelines as Topic ; Practice Patterns, Physicians'/trends ; Risk Assessment ; Secondary Prevention/trends ; Time Factors ; Treatment Outcome
Chemical Substances	Antihypertensive Agents ; Biomarkers ; Cholesterol, LDL ; Glycated Hemoglobin A ; Hypolipidemic Agents ; hemoglobin A1c protein, human
Language	English
Publishing date	2021-01-21
Publishing country	England
Document type	Journal Article
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/s12872-021-01866-1
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Article ; Online: Correction to: Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7.

Pedersen, Elisabeth / Garcia, Beate Hennie / Halvorsen, Kjell H / Eggen, Anne Elise / Schirmer, Henrik / Waaseth, Marit

BMC cardiovascular disorders

2021 Volume 21, Issue 1, Page(s) 406

Language	English
Publishing date	2021-08-24
Publishing country	England
Document type	Published Erratum
ZDB-ID	2059859-2
ISSN	1471-2261 ; 1471-2261
ISSN (online)	1471-2261
ISSN	1471-2261
DOI	10.1186/s12872-021-02214-z
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Article ; Online: Intervention fidelity and process outcomes of the IMMENSE study, a pharmacist-led interdisciplinary intervention to improve medication safety in older hospitalized patients.

Johansen, Jeanette Schultz / Halvorsen, Kjell H / Havnes, Kjerstin / Wetting, Hilde Ljones / Svendsen, Kristian / Garcia, Beate Hennie

Journal of clinical pharmacy and therapeutics

2021 Volume 47, Issue 5, Page(s) 619–627

Abstract: What is known and objective: The majority of hospitalized older patients experience medication-related problems (MRPs), and there is a call for interventions to solve MRPs and improve clinical outcomes like medical visits. The IMMENSE study is a ... ...

Abstract	What is known and objective: The majority of hospitalized older patients experience medication-related problems (MRPs), and there is a call for interventions to solve MRPs and improve clinical outcomes like medical visits. The IMMENSE study is a randomized controlled trial investigating the impact of a pharmacist-led interdisciplinary intervention on emergency medical visits. Its multistep intervention is based on the integrated medicines management methodology and includes a follow-up step with primary care. This study aims to describe how the intervention in the IMMENSE study was delivered and its process outcomes. Methods: The study includes the 221 intervention patients in the per-protocol group of the IMMENSE study. Both intervention delivery, reasons for not performing interventions and process outcomes were registered daily by the study pharmacists in a Microsoft Access Results and discussion: A total of 121 (54.8%) patients received all intervention steps if appropriate. All patients received medication reconciliation (MedRec) and medication Review (MedRev) (step 1 and 2), while between 10% and 20% of patients were missed for medication list in discharge summary (step 3), patient counselling (step 4), or communication with general practitioner and nurse (step 5). A total of 437 discrepancies were identified in 159 (71.9%) patients during MedRec, and 1042 MRPs were identified in 209 (94.6%) patients during MedRev. Of these, 292 (66.8%) and 700 (67.2%), respectively, were communicated to and solved by the interdisciplinary team during the hospital stay. What is new and conclusion: The fidelity of the single steps of the intervention was high even though only about half of the patients received all intervention steps. The impact of the intervention may be influenced by not implementing all steps in all patients, but the many discrepancies and MRPs identified and solved for the patients could explain a potential effect of the IMMENSE study.
MeSH term(s)	Aged ; General Practitioners ; Humans ; Medication Reconciliation ; Patient Discharge ; Pharmacists
Language	English
Publishing date	2021-12-21
Publishing country	England
Document type	Journal Article ; Randomized Controlled Trial
ZDB-ID	639006-7
ISSN	1365-2710 ; 0269-4727
ISSN (online)	1365-2710
ISSN	0269-4727
DOI	10.1111/jcpt.13581
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Zs.A 1313: Show issues

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Article ; Online: Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol.

Pedersen, Elisabeth / Primicerio, Raul / Halvorsen, Kjell H / Eggen, Anne Elise / Garcia, Beate Hennie / Schirmer, Henrik / Waaseth, Marit

European journal of clinical pharmacology

2022 Volume 78, Issue 5, Page(s) 857–867

Abstract: Purpose: To describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, ... ...

Abstract	Purpose: To describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, and systolic and diastolic blood pressure. Methods: Based on record linkage between the seventh wave of the Tromsø Study and the Norwegian Prescription Database, medication adherence was calculated as the proportion of days covered (PDC) for persistent prevalent users in the period of 365 days before the attendance date. Multivariable linear regression models were used to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes. Results: Mean PDC was 0.94 for LLDs and antihypertensive drugs and 0.97 for ASA. Among persons with PDC ≥ 0.80 for LLDs, 12.0% had an LDL-cholesterol < 1.8 mmol/L. Blood pressure < 140/90 mmHg (< 140/80 mmHg if diabetes patient) was reached by 55.1% of those with a PDC ≥ 0.80 for antihypertensive drugs. Adherence to LLDs was associated with lower LDL-cholesterol, while neither systolic nor diastolic blood pressure was associated with adherence to antihypertensive drugs. Conclusion: Adherence to antihypertensive drugs, LLDs, and ASA among persons with CHD were high despite low achievement of treatment goals for blood pressure and LDL-cholesterol. There was a statistically significant association between adherence to LLDs and LDL-cholesterol, but not between adherence to antihypertensive drugs and blood pressure.
MeSH term(s)	Antihypertensive Agents/pharmacology ; Antihypertensive Agents/therapeutic use ; Blood Pressure ; Cholesterol ; Cholesterol, LDL ; Coronary Disease/drug therapy ; Humans ; Hypolipidemic Agents/pharmacology ; Hypolipidemic Agents/therapeutic use ; Medication Adherence
Chemical Substances	Antihypertensive Agents ; Cholesterol, LDL ; Hypolipidemic Agents ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2022-01-21
Publishing country	Germany
Document type	Journal Article
ZDB-ID	121960-1
ISSN	1432-1041 ; 0031-6970
ISSN (online)	1432-1041
ISSN	0031-6970
DOI	10.1007/s00228-022-03276-4
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Zs.A 672: Show issues

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Article ; Online: Empirical prescribing of penicillin G/V reduces risk of readmission of hospitalized patients with community-acquired pneumonia in Norway: a retrospective observational study.

Høgli, June Utnes / Garcia, Beate Hennie / Svendsen, Kristian / Skogen, Vegard / Småbrekke, Lars

BMC pulmonary medicine

2020 Volume 20, Issue 1, Page(s) 169

Abstract: Background: Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or ... ...

Abstract	Background: Norwegian guideline recommendations on first-line empirical antibiotic prescribing in hospitalised patients with community-acquired pneumonia (CAP) are penicillin G/V in monotherapy, or penicillin G in combination with gentamicin (or cefotaxime) in severely ill patients. The aim of this study was to explore how different empirical antibiotic treatments impact on length of hospital stay (LOS) and 30-day hospital readmission. A secondary aim was to describe median intravenous- and total treatment duration. Methods: We included CAP patients (≥18 years age) hospitalised in North Norway during 2010 and 2012 in a retrospective study. Patients with negative chest x-ray, malignancies or immunosuppression or frequent readmissions were excluded. We collected data on patient characteristics, empirical antibiotic prescribing, treatment duration and clinical outcomes from electronic patient records and the hospital administrative system. We used directed acyclic graphs for statistical model selection, and analysed data with mulitvariable logistic and linear regression. Results: We included 651 patients. Median age was 77 years [IQR; 64-84] and 46.5% were female. Median LOS was 4 days [IQR; 3-6], 30-day readmission rate was 14.4% and 30-day mortality rate was 6.9%. Penicillin G/V were empirically prescribed in monotherapy in 51.5% of patients, penicillin G and gentamicin in combination in 22.9% and other antibiotics in 25.6% of patients. Prescribing other antibiotics than penicillin G/V monotherapy was associated with increased risk of readmission [OR 1.9, 95% CI; 1.08-3.42]. Empirical antibiotic prescribing was not associated with LOS. Median intravenous- and total treatment duration was 3.0 [IQR; 2-5] and 11.0 [IQR; 9.8-13] days. Conclusions: Our findings show that empirical prescribing with penicillin G/V in monotherapy in hospitalised non-severe CAP-patients, without complicating factors such as malignancy, immunosuppression and frequent readmission, is associated with lower risk of 30-day readmission compared to other antibiotic treatments. Median total treatment duration exceeds treatment recommendations.
MeSH term(s)	Aged ; Aged, 80 and over ; Anti-Bacterial Agents/therapeutic use ; Community-Acquired Infections/drug therapy ; Community-Acquired Infections/mortality ; Female ; Guideline Adherence ; Humans ; Length of Stay/statistics & numerical data ; Linear Models ; Male ; Middle Aged ; Multivariate Analysis ; Norway/epidemiology ; Patient Readmission/statistics & numerical data ; Penicillin G/therapeutic use ; Penicillin V/therapeutic use ; Pneumonia/drug therapy ; Pneumonia/mortality ; Retrospective Studies ; Time Factors
Chemical Substances	Anti-Bacterial Agents ; Penicillin G (Q42T66VG0C) ; Penicillin V (Z61I075U2W)
Language	English
Publishing date	2020-06-15
Publishing country	England
Document type	Journal Article ; Observational Study
ZDB-ID	2059871-3
ISSN	1471-2466 ; 1471-2466
ISSN (online)	1471-2466
ISSN	1471-2466
DOI	10.1186/s12890-020-01188-6
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Article ; Online: Patient perceptions and experiences with medication-related activities in the emergency department: a qualitative study.

Zahl-Holmstad, Birgitte / Garcia, Beate Hennie / Johnsgård, Tine / Ofstad, Eirik Hugaas / Lehnbom, Elin Christina / Svendsen, Kristian / Risør, Torsten / Holis, Renata Vesela / Elenjord, Renate

BMJ open quality

2023 Volume 12, Issue 2

Abstract: Background: Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients' perceptions ... ...

Abstract	Background: Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients' perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present. Methods: We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis. Results: From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed. Conclusion: Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients' individual needs.
MeSH term(s)	Humans ; Professional Role ; Medication Errors/prevention & control ; Health Personnel ; Pharmacists ; Emergency Service, Hospital
Language	English
Publishing date	2023-05-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2399-6641
ISSN (online)	2399-6641
DOI	10.1136/bmjoq-2022-002239
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Article ; Online: A Trial-Based Cost-Utility Analysis of a Medication Optimization Intervention Versus Standard Care in Older Adults.

Robinson, Eirin Guldsten / Gyllensten, Hanna / Johansen, Jeanette Schultz / Havnes, Kjerstin / Granas, Anne Gerd / Bergmo, Trine Strand / Småbrekke, Lars / Garcia, Beate Hennie / Halvorsen, Kjell H

Drugs & aging

2023 Volume 40, Issue 12, Page(s) 1143–1155

Abstract: Background: Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes.: Objective: We ... ...

Abstract	Background: Older adults are at greater risk of medication-related harm than younger adults. The Integrated Medication Management model is an interdisciplinary method aiming to optimize medication therapy and improve patient outcomes. Objective: We aimed to investigate the cost effectiveness of a medication optimization intervention compared to standard care in acutely hospitalized older adults. Methods: A cost-utility analysis including 285 adults aged ≥ 70 years was carried out alongside the IMMENSE study. Quality-adjusted life years (QALYs) were derived using the EuroQol 5-Dimension 3-Level Health State Questionnaire (EQ-5D-3L). Patient-level data for healthcare use and costs were obtained from administrative registers, taking a healthcare perspective. The incremental cost-effectiveness ratio was estimated for a 12-month follow-up and compared to a societal willingness-to-pay range of €/QALY 27,067-81,200 (NOK 275,000-825,000). Because of a capacity issue in a primary care resulting in extended hospital stays, a subgroup analysis was carried out for non-long and long stayers with hospitalizations < 14 days or ≥ 14 days. Results: Mean QALYs were 0.023 [95% confidence interval [CI] 0.022-0.025] higher and mean healthcare costs were €4429 [95% CI - 1101 to 11,926] higher for the intervention group in a full population analysis. This produced an incremental cost-effectiveness ratio of €192,565/QALY. For the subgroup analysis, mean QALYs were 0.067 [95% CI 0.066-0.070, n = 222] and - 0.101 [95% CI - 0.035 to 0.048, n = 63] for the intervention group in the non-long stayers and long stayers, respectively. Corresponding mean costs were €- 824 [95% CI - 3869 to 2066] and €1992 [95% CI - 17,964 to 18,811], respectively. The intervention dominated standard care for the non-long stayers with a probability of cost effectiveness of 93.1-99.2% for the whole willingness-to-pay range and 67.8% at a zero willingness to pay. Hospitalizations were the main cost driver, and readmissions contributed the most to the cost difference between the groups. Conclusions: According to societal willingness-to-pay thresholds, the medication optimization intervention was not cost effective compared to standard care for the full population. The intervention dominated standard care for the non-long stayers, with a high probability of cost effectiveness. Clinical trial registration: The IMMENSE trial was registered in ClinicalTrials.gov on 28 June, 2016 before enrolment started (NCT02816086).
MeSH term(s)	Humans ; Aged ; Cost-Benefit Analysis ; Hospitalization ; Surveys and Questionnaires ; Cost-Effectiveness Analysis ; Quality-Adjusted Life Years ; Quality of Life
Language	English
Publishing date	2023-11-22
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	1075770-3
ISSN	1179-1969 ; 1170-229X
ISSN (online)	1179-1969
ISSN	1170-229X
DOI	10.1007/s40266-023-01077-7
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