Åsa Kettis

Not just another evaluation: a comparative study of four educational quality projects at Swedish universities

In this study, four recent self-initiated educational quality projects at Swedish universities are compared and analyzed. The article focuses on how the universities have handled the tension between external demands and internal norms. The aim is to contribute to an improved understanding of quality management in contemporary universities. On the one hand, the projects are found to be built on similar rationales associated with accountability, reputation building and strategic management. This is interpreted as a response to the shared external policy context. They are also found to mirror similar ambitions regarding raising the status of education. On the other hand, the projects are found to differ considerably in their actual design, methodology, implementation, stakeholders and outcomes. This is interpreted as an active adaptation to the unique internal academic norms and cultures that exist in each university.

Reducing dispensing errors in Swedish pharmacies: the impact of a barrier in the computer system

Background Since 2004, a web-based reporting system enables monitoring of dispensing errors in all Swedish pharmacies. The adoption of this system was followed by an overall increase in reports, mainly explained by the dispensing of medicines of improper strength. In 2006 an intervention was implemented, aimed at reducing these errors. The objective of this study was to assess the impact of the intervention on the number of errors. Methods Monthly data on the reported number of dispensing errors from July 2004 until December 2007 were used. These were analysed in total and subdivided by type and cause of error. A time-series design was applied, and linear segmented regression analysis used to analyse whether changes in slope or level occurred; shifts in intercept or slope where p<0.01 were considered as statistically significant. Results The intervention coincided with a distinct decrease in error reports and a statistically significant change in slope that switched from a slight increase, 0.09, to a decrease, −0.26 (p=0.0035). Medicines dispensed with wrong strength also displayed a significant change in slope, from 0.08 to −0.27 (p<0.0001), as well as dispensing errors caused by registration failure, that is, failure of the registration of a prescription in pharmacy computers, which changed from 0.05 to −0.29 (p<0.0001). Conclusion The intervention was associated with a decrease in the number of reports on drugs dispensed with the wrong strength, but also had a decreasing effect on errors caused by registration failure and on the dispensing errors in total as well.

Comparison of two instruments for measurement of quality of life in clinical practice - a qualitative study

BackgroundThe study aimed to investigate the meaning patients assign to two measures of quality of life: the Schedule for Evaluation of Individual Quality of Life Direct Weighting (SEIQoL-DW) and the SEIQoL-DW Disease Related (DR) version, in a clinical oncology setting. Even though the use of quality of life assessments has increased during the past decades, uncertainty regarding how to choose the most suitable measure remains. SEIQoL-DW versions assesses the individual’s perception of his or her present quality of life by allowing the individual to nominate the domains to be evaluated followed by a weighting procedure resulting in qualitative (domains) as well as quantitative outcomes (index score).MethodsThe study applied a cross-sectional design with a qualitative approach and collected data from a purposeful sample of 40 patients with gastrointestinal cancer. Patients were asked to complete two measures, SEIQoL-DW and the SEIQoL-DR, to assess quality of life. This included nomination of the areas in life considered most important and rating of these areas; after completion patients participated in cognitive interviews around their selections of areas. Interviews were audiotaped and transcribed verbatim which was followed by analysis using a phenomenographic approach.ResultsThe analyses of nominated areas of the two measures resulted in 11 domains reflecting what patients perceived had greatest impact on their quality of life. Analysis of the cognitive interviews resulted in 16 thematic categories explaining the nominated domains. How patients reflected around their quality of life appeared to differ by version (DW vs. DR). The DW version more often related to positive aspects in life while the DR version more often related to negative changes in life due to having cancer.ConclusionsThe two SEIQoL versions tap into different concepts; health-related quality of life, addressing losses and problems related to having cancer and, quality of life, more associated with aspects perceived as positive in life. The SEIQoL-DR and the SEIQoL-DW are recommended in clinical practice to take both negative and positive aspects into account and acting on the problems of greatest importance to the patient.

The Degree of Readiness among a Population of HIV Infected Patients in Sweden

Objective: The objectives were to assess the degree of readiness for HIV infected patients currently on treatment and to evaluate factors potentially influencing readiness. Methods: All HIV-treated patients, who attended a HIV clinic in Sweden, during 7 months, were asked to complete a questionnaire containing Willey´s 2-item readiness assessment and questions about other factors potentially affecting readiness. The Willey´s 2-item readiness assessment categorises patients into either of five stages of change. Patients categorized as in the action or maintenance stage were classified as ‘ready to adhere to medicines’. Results: In total 327 patients participated (response rate 87.4%). The proportion categorised as in the action and maintenance stage was 97%. Factors associated with readiness were lower mean CD4 count at start of treatment and lack of resistance. The proportion with viral loads below detection limit was very high (91%). Conclusion: Although the initiation of ART is extremely important, to ensure good treatment results, follow-up and motivation throughout the treatment are also important. Continuous measurement of the patients´ readiness to maintain treatment adherence needs to be further explored.

Doctors' perspectives of responsibility for patient's drugs

Background and objective Patient adherence to prescribed treatmentfor chronic conditions has been estimated to be on average about 50%(1), drug related problems may cause as much as 30% of acuteadmittances to hospital care (2), and the costs have been estimated tobe of the same magnitude as the direct costs for pharmaceutical drugs.A reason for lack of adherence to the treatment and medication errorsmay be that patients with many drugs, especially when changes in thetreatment have occurred, may have knowledge gaps on the drugsrepresenting the actual prescribed treatment.E-prescribing, from the physicians’ electronic medical record(EMR) directly to the pharmacies, constitute[75% of all prescriptionsin Sweden and [70% of patients in Sweden store theirprescriptions electronically at the national prescription repository(NPR), accessible from any pharmacy in Sweden. Any new e-prescriptionwill automatically be stored in the NPR.However, the NPR may contain both prescriptions for the present,actual treatment, prescription duplicates, and prescriptions for previous,terminated or changed treatment. For patients with manymedications and/or many changes in the treatment it is obvious thatthe risk for medication errors is increased.The objective of the present study was to compare the prescribedtreatment in the EMR, the prescriptions in the NPR, and patient’sknowledge of her/his present prescribed treatment.Design Compare prescribed treatment in the EMR with the prescriptionsin the NPR, and patients knowledge of her/his presentprescribed treatment with regard to prescriptions; prescribed drug,strength; formula and dosing.Setting Ten HCCs in four cities in Sweden, February 2010.Main outcome measures Differences between the computerisedpatients health care journal record and the prescriptions in the NPR,and patients view of her/his actual present prescribed treatment withregard to prescriptions; prescribed drug, strength; formula and dosing.Results The results are available in March 2010.Conclusions Conclusion.References1. Adherence to long-term therapies: evidence for action. WHO,2003.2. Fryckstedt J, Asker-Hagelberg C. Drug-related problems commonat the medical acute care clinic—the cause of admission foralmost one-third of patients. [Lakemedelsrelaterade problemvanliga pa medicinakuten - Orsak till inlaggning hos nastan vartredje patient, enligt kvalitetsuppfoljning] Lakartidningen 2008;105(12–13): 894–898.European Society of Clinical Pharmacy international workshop on patient safety and pharmacy 10–11 May 2010, Uppsala, Sweden