Åsa Kettis Lindblad

To follow or not to follow dermatological treatment : A review of the literature

Creams, ointments and solutions applied to the skin surface by patients as part of a daily routine might be expected to provide a more variable dosage than do standard tablets. However, adherence to treatment in dermatology has been little studied. This article reviews recent publications in the field. These are dominated by questionnaire-based studies, which tend to over-estimate adherence. Reduced adherence to dermatological treatment is noted in 34-45% of patients. It is likely that the percentage of patients who practice truly optimal treatment in their daily life is even lower considering the variable practice of self-treatment. Self-reported psychiatric morbidity contributes to poor adherence to dermatological treatment, while a well-functioning doctor-patient interaction is a major determinant of good adherence, as is patient satisfaction. In conclusion, adherence to dermatological treatment is unsatisfactory and there is a need for intervention and change in clinical routines. The therapeutic and economic benefits may be considerable. The immediate challenge is to stimulate a change in patient behaviour and improve self-treatment at home.

Adherence to treatment in Swedish HIV-infected patients

Objectives:  The objectives were to assess the prevalence of adherence to antiretroviral treatment in Swedish human immunodeficiency virus (HIV)‐infected patients and to evaluate factors associated with adherence.

Patient-physician communication during oncology consultations.

Objective: The aim of this study was to characterize the content of patient‐physician communication in standard oncology care.

Focus on the individual--quality of life assessments in oncology.

In this review we investigate how assessments of quality of life (QoL) can be used in daily clinical practice. The focus is on individualized QoL assessments, but computerized-adaptive testing and interpretation of QoL scores are also considered. Quality of life (QoL) measurements have been used relatively infrequently in clinical practice, although individualized care planning and follow-up based on QoL information may lead to better outcomes of treatment and informed and autonomous decision-making by patients. A recent approach in assessing QoL is by individualized measures, which tap QoL as defined by the individual patient. Individualized QoL instruments, such as the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and the Patient-Generated Index (PGI), have obvious appeal for use in clinical practice, since they incorporate topics of greatest concern to the individual patient, while also capturing their ratings and weightings. However, before general use in daily clinical practice can be recommended, some aspects of these instruments require further research, particularly issues concerning reliability, feasibility, interpretation and effectiveness.

The use of prescription medicines and self-medication among children--a population-based study in Finland.

The aim of this study was to investigate the prevalence and concomitant use of prescription medicines and self‐medication, including over‐the‐counter (OTC) medicines, vitamins, and complementary and alternative medicines (CAMs) among Finnish children aged under 12 years.

Pharmacy users’ expectations of pharmacy encounters: a Q-methodological study

Background  Pharmacy practice is evolving according to general health‐care trends such as increased patient involvement and public health initiatives. In addition, pharmacists strive to find new professional roles. Clients’ expectations of service encounters at pharmacies is an under‐explored topic but crucial to understanding how pharmacy practice can evolve efficiently.

Counselling behaviour and content in a pharmaceutical care service in Swedish community pharmacies

Objective To characterise the counselling behaviour of practitioners providing a pharmaceutical care (PC) service in community pharmacy, and to describe the content of the consultations. Setting Community pharmacies in Sweden. Methods Non-participant observations, including audio recording, of five practitioners in five different pharmacies counselling 16 patients, were analysed qualitatively using an iterative, stepwise, interpretivist approach. Main outcome measure Descriptions of counselling behaviour and content of consultations. Results The counselling behaviour was characterised by attempts to understand the patients’ narratives by listening and asking questions and a willingness to help. The computer often had an important role in consultations, being used for documentation and as a supportive tool for identification of drug–drug interactions. The practitioners often took command in the initial phase of the consultation, and omitted to determine the patients’ most urgent drug-related needs. However, counselling behaviour that identified and focused on the patient’s needs, giving the computer little attention during the consultation was also observed. Practitioners provided vague descriptions of the purpose and outline of the service. Consultations included a wide variety of issues, which potentially could help patients’ achieve optimal outcomes of medical treatment. Conclusion The practitioners provided important advice and different forms of support to patients. Focus on the computer screen limited their abilities to practise patient centred care.

Exploring the relationship between safety culture and reported dispensing errors in a large sample of Swedish community pharmacies.

BackgroundThe potential for unsafe acts to result in harm to patients is constant risks to be managed in any health care delivery system including pharmacies. The number of reported errors is influenced by a various elements including safety culture. The aim of this study is to investigate a possible relationship between reported dispensing errors and safety culture, taking into account demographic and pharmacy variables, in Swedish community pharmacies.MethodsA cross-sectional study was performed, encompassing 546 (62.8%) of the 870 Swedish community pharmacies. All staff in the pharmacies on December 1st, 2007 were included in the study. To assess safety culture domains in the pharmacies, the Safety Attitudes Questionnaire (SAQ) was used. Numbers of dispensed prescription items as well as dispensing errors for each pharmacy across the first half year of 2008 were summarised. Intercorrelations among a number of variables including SAQ survey domains, general properties of the pharmacy, demographic characteristics, and dispensing errors were calculated. A negative binomial regression model was used to further examine the relationship between the variables and dispensing errors.ResultsThe first analysis demonstrated a number of significant correlations between reported dispensing errors and the variables examined. Negative correlations were found with SAQ domains Teamwork Climate, Safety Climate, Job Satisfaction as well as mean age and response rates. Positive relationships were demonstrated with Stress Recognition (SAQ), number of employees, educational diversity, birth country diversity, education country diversity and number of dispensed prescription items. Variables displaying a significant relationship to errors in this analysis were included in the regression analysis. When controlling for demographic variables, only Stress Recognition, mean age, educational diversity and number of dispensed prescription items and employees, were still associated with dispensing errors.ConclusionThis study replicated previous work linking safety to errors, but went one step further and controlled for a variety of variables. Controlling rendered the relationship between Safety Climate and dispensing insignificant, while the relationship to Stress Recognition remained significant. Variables such as age and education country diversity were found also to correlate with reporting behaviour. Further studies on the demographic variables might generate interesting results.

Comparing two versions of the Schedule for Evaluation of Individual Quality of Life in patients with advanced cancer

Abstract Background. The aim was to compare two individualized patient reported outcomes or the Schedule for the Evaluation of Individual Quality of Life – Direct Weighting (SEIQoL-DW) measuring quality of life in general, and the disease-related version (SEIQoL-DR) measuring quality of life related to disease. Both instruments have been used in clinical practice settings within oncology. The instruments were compared with regard to feasibility, the areas nominated by patients as important and patients’ ratings of how they were doing in these areas (Index scores). Material and methods. The study included 40 patients with gastrointestinal cancer. All patients completed both versions of the instrument on a touch screen computer in relation to a medical consultation. Firstly, the participants were invited to nominate the five domains she/he currently considered to be most important in life. Secondly, they were asked to rate how they were doing in each of these domains. Finally, they were asked to quantify the relative importance of each area. Cohens effect sizes were calculated to illuminate the clinical importance of mean value differences. Results. Both instruments took less than ten minutes to complete and the procedure was considered feasible by both patients and interviewers. The proportion of patients nominating the same areas in the two versions did not differ, however, the SEIQoL-DW Index score was significantly higher than the corresponding score for the SEIQoL-DR. The detected difference in the mean score measured by effect size was medium. Conclusion. The magnitude of the effect size of the difference in Index score imply that the two versions tap into different constructs, i.e. quality of life (QoL) versus health-related QoL (HRQL), supporting the construct validity of the two versions of the instrument. The SEIQoL-DW and the SEIQoL-DR should be considered as complementary rather than interchangeable when used in patients with cancer.

Swedish Students' and Preceptors' Perceptions of What Students Learn in a Six-Month Advanced Pharmacy Practice Experience

Objective. To identify what pharmacy students learn during the 6-month advanced pharmacy practice experience (APPE) in Sweden. Methods. Semi-structured interviews were conducted with 18 pharmacy APPE students and 17 pharmacist preceptors and analyzed in a qualitative directed content analysis using a defined workplace learning typology for categories. Results. The Swedish APPE provides students with task performance skills for work at pharmacies and social and professional knowledge, such as teamwork, how to learn while in a work setting, self-evaluation, understanding of the pharmacist role, and decision making and problem solving skills. Many of these skills and knowledge are not accounted for in the curricula in Sweden. Using a workplace learning typology to identify learning outcomes, as in this study, could be useful for curricula development. Conclusions. Exploring the learning that takes place during the APPE in a pharmacy revealed a broad range of skills and knowledge that students acquire.