Anne Gerd Granas

Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes

Abstract Objective. To describe an innovative team intervention to identify and resolve DRPs (drug-related problems) in Norwegian nursing homes. Design. Descriptive intervention study. Setting. Three nursing homes in Bergen, Norway. Subjects. A total of 142 long-term care patients (106 women, mean age 86.9 years). Results. Systematic medication reviews performed by pharmacists in 142 patients revealed altogether 719 DRPs, of which 504 were acknowledged by the patients’ physician and nurses, and 476 interventions were completed. “Unnecessary drug” and “Monitoring required” were the most frequently identified DRPs. Drugs for treating the nervous system and the alimentary tract and metabolism were most commonly questioned. Conclusions. The multidisciplinary team intervention was suitable to identify and resolve drug-related problems in nursing home settings. Systematic medication reviews and involvement of pharmacists in clinical teams should therefore be implemented on a regular basis to achieve and maintain high-quality drug therapy.

Prescribing quality for older people in Norwegian nursing homes and home nursing services using multidose dispensed drugs

To examine and compare the quality of drug prescribing for older patients in nursing homes and home nursing services.

Patients' understanding and management of their illnesses and prescribed medicines - a descriptive study

AbstractObjective: The objective of this study was to explore patients’ understanding and management of their illnesses and prescribed medicines. Method: Patients receiving three or more repeat prescription drugs were interviewed in their homes after their repeat prescriptions had drug-related problem (DRP) identified by a community pharmacist in a GP surgery. Results: In total, 58 patients were interviewed. Patients distinguished strongly between ‘forgetting’ and ‘taking less’ of their medicines, and some actively reduced the dose themselves. More than 25% of the patients involved their spouse in the administration of their medicines. Patients had more worries about their illness (48%) than their medicines (31%). Any changes made to their present medication, or introduction of new medicines, were thought to ‘upset the balance’. Conclusion: More information is needed on patients’ perspectives, both on side effects, compliance and how to deal with long-term medication. Health care professionals should seek to understand and respect patients’ choices to assure optimal care.

Minor ailments in out-of-hours primary care: an observational study.

Abstract Background. Many consultations are partly or totally spent on minor ailments. A minor ailment is defined as a health complaint which, by simple actions, patients could handle themselves. Objective. To investigate the prevalence, type of conditions, and time spent on minor ailments in consultations in out-of-hours care in Norway. Design and setting. An observational study of consultations at six out-of-hours primary care centres was carried out during evenings and weekends in November and December 2008. Main outcome measures were number and type of minor ailments, as well as consultation time. The minor ailments were predefined by a list of conditions. Conditions which, by certain pre-set criteria, still needed a doctors professional advice were reclassified as “no minor ailment”. Results. A total of 210 consultations were observed. The patients’ mean age was 28 years (range 0–94). Cough, fever, sore throat, upper respiratory tract infection, and earache contributed 76% of the 211 minor ailments registered. After reclassification, 58 (28%) of the 210 consultations registered were classified as partly or totally a minor ailment. These minor ailments represented 18% of the doctors’ total consultation time in the 210 observed consultations. Conclusion. More than a quarter of the observed consultations were partly or totally spent on addressing minor ailments. This shows a potential for empowering patients to rely on self-care also for minor ailments in out-of-hours primary care.

The Prevalence of Self-Monitoring of Blood Glucose and Costs of Glucometer Strips in a Nationwide Cohort

OBJECTIVE This study used nationwide data to determine the prevalence of self-monitoring of blood glucose (SMBG) among all non-institutionalized persons living in Norway and to estimate the prevalence of SMBG among diabetes patients, the frequency and cost of SMBG, and the use of different glucometers. METHODS This retrospective, descriptive study is based on data of sales of glucometer strips to non-institutionalized persons in Norway in 2008. The data included gender, age group, month of purchase, sales place, type of strips, number of packages dispensed, and cost of strips. Additionally, statistics on sales of insulin and oral antidiabetes medications were obtained from the Norwegian Prescription Database. RESULTS A total of 96,999 persons purchased strips, a prevalence of 2%. Approximately 70% of diabetes patients practiced SMBG. An average patient used 1.7 strips per day, and younger patients purchased more strips than older patients. Fewer than 50% of patients performed glucose measurements daily. One percent of patients used more than 10 strips daily and was accountable for 8% of total costs. Most patients used only one type of strips, but the number of strips purchased increased with the number of different strips. The average annual cost of strips was 446 euro per person. CONCLUSIONS Two percent of all non-institutionalized inhabitants and an estimated 70% of patients using diabetes medication purchased SMBG strips. A small percentage of the patients incurred a substantial proportion of the costs. This, along with the fact that over half of the patients monitor less than once per day, calls for tighter follow-up of diabetes patients.

Diabetes care in Norwegian pharmacies: a descriptive study

Objective To describe Norwegian pharmacies’ involvement in diabetes care, to investigate pharmacists’ views on future services and to investigate whether the recommendations in the Norwegian diabetes declaration for pharmacies have been implemented. Setting Hospital and community pharmacies in Norway. Method All 543 pharmacies in Norway, of which 511 were community pharmacies and 32 were hospital pharmacies, received a link to a web-based questionnaire. One pharmacist from each pharmacy was asked to complete the questionnaire. The questionnaire covered subjects ranging from the diabetes declaration and the pharmacists’ views on which services the pharmacy should offer in the future, to demographic characteristics. Results In total 358 (66%) questionnaires were completed. The diabetes declaration was read by 37% of the pharmacists. Almost all pharmacies complied with the declarations’ recommendations regarding glucose monitoring services. Twenty four percent of the pharmacies could offer medication reviews, and roughly 10% could offer screening for undiagnosed diabetes. Counseling on lifestyle issues was the least implemented recommendation. Eighty one percent of the pharmacists reported a wish to expand their services towards diabetes patients. Services in regard to glucose monitoring had the highest score, however the views on which services should be offered varied a great deal. Already performing a service increased the chance of the pharmacist being positive towards offering it. Conclusion Norwegian pharmacists report that they are involved in a wide range of diabetes related services, although only 37% report to have read the diabetes declaration. The pharmacists generally wish to actively support patients with diabetes, and further research should concentrate on identifying the areas where their involvement is most productive.

Factors influencing prescribing of fall-risk-increasing drugs to the elderly: A qualitative study

Abstract Objective. Explore the situations in which GPs associate drug use with falls among their elderly patients, and the factors influencing the prescribing and cessation of fall-risk-increasing drugs (FRIDs). Design. A qualitative study with 13 GPs who participated in two semi-structured focus groups in Central Norway. Participants were encouraged to share overall thoughts on the use of FRIDs among elderly patients and stories related to prescribing and cessation of FRIDs in their own practice. Results. The main finding was that GPs did not immediately perceive the use of FRIDs to be a prominent factor regarding falls in elderly patients, exceptions being when the patient presented with dizziness, reported a fall, or when prescribing FRIDs for the first time. It was reported as common to renew prescriptions without performing a drug review. Factors influencing the prescribing and cessation of FRIDs were categorized into GPs’ clinical work conditions, uncertainty about outcome of changing prescriptions, patients’ prescribing demands, and lack of patient information. Conclusions. The results from this study indicate that GPs need to be reminded that there is a connection between FRID use and falls among elderly patients of enough clinical relevance to remember to assess the patients drug list and perform regular drug reviews.

Self-efficacy in counseling in Norwegian chain pharmacies: A cross-sectional study

BACKGROUND After pharmacy reform in Norway in 2001, pharmacy chains have systematically trained their personnel in advising self-medication of some symptoms and diseases to increase their competence. It may be important to reveal factors at work that increase self-efficacy in counseling as part of enhancing good pharmacy practice. OBJECTIVES The aims of this study were to investigate (1) self-efficacy in counseling among pharmacy personnel in respect to a range of medical complaints, and (2) the relationship between self-efficacy in counseling and pharmacy staffs education, age, years of work in pharmacy and psychosocial factors. METHODS A web-based questionnaire about self-efficacy in counseling, psychosocial factors, and demographic variables was completed by 693 individuals from 299 randomly selected community chain pharmacies in Norway. Multiple regression analysis was used to assess the relationship between self-efficacy and gender, age, years of work in pharmacy, and psychosocial factors. RESULTS On a scale from 0 (very difficult) to 10 (no problem), the mean score for self-efficacy on all 21 symptoms or needs was 7.2 (SD=1.3). Allergy, flu, and headache received the highest self-efficacy scores and leg ulcer treatment, self-test kits, and tiredness received the lowest scores. Significant associations between self-efficacy in counseling and years of work in pharmacy (P=.017), role clarity (P<.001), positive challenges at work (P=.002), and role conflict (P<.001) were observed. CONCLUSIONS Self-efficacy in counseling among pharmacy personnel seems to be high for providing advice for symptoms where over-the-counter medicines are available. Role clarity, positive challenge, and years of work in pharmacy are associated positively with self-efficacy in counseling, whereas role conflict is associated negatively. Future research may examine implications for self-efficacy in actual behavior and patient outcomes.

Smoking cessation advice provided in 53 Norwegian pharmacies

Objective To investigate the quality of the smoking cessation advice on over‐the‐counter (OTC) nicotine replacement treatment (NRT) provided by community and hospital pharmacies in Norway and to assess any change in customer services and pharmaceutical smoking cessation advice after a change in legislation deregulating NRT from pharmacy‐only to general sale.

Quality assessment of patients' self-monitoring of blood glucose in community pharmacies.

Objective To evaluate diabetes patients’ self-monitoring of blood glucose using a community pharmacy-based quality assurance procedure, to investigate whether the procedure improved the quality of the patient performance of self monitoring of blood glucose, and to examine the opinions of the patients taking part in the study. Methods The results of patient blood glucose measurements were compared to the results obtained with HemoCue Glucose 201+ by pharmacy employees in 16 Norwegian community pharmacies. Patient performance was monitored using an eight item checklist. Patients whose blood glucose measurements differed from pharmacy measurements by more than 20% were instructed in the correct use of their glucometer. The patients then re-measured their blood glucose. If the results were still outside the set limits, the control procedure was repeated with a new lot of glucometer strips, and then with a new glucometer. The patients returned for a follow-up visit after three months. Results During the first visit, 5% of the 338 patients had measurements that deviated from pharmacy blood glucose values by more than 20% and user errors were observed for 50% of the patients. At the second visit, there was no significant change in the analytical quality of patient measurements, but the percentage of patients who made user errors had decreased to 29% (p < 0.001). Eighty-five percent of the patients reported that they used their blood glucose results to adjust medication, exercise or meals. Fifty-one percent of the patients reported a greater trust in their measurements after the second visit. Eighty percent of patients wished to have their measurements assessed yearly. Of these patients, 83% preferred to have the assessment done at the community pharmacy. Conclusion A community pharmacy-based quality assessment procedure of patients’ self monitoring of blood glucose significantly reduced the number of user errors. The analytical quality of the patients’ measurements was good and did not improve further during the study. The high analytical quality might be explained by a selection bias of participating patients. Patients also reported increased confidence in their blood glucose measurements after their measurements had been assessed at the pharmacy.