Lina Hellström

Clinical implementation of systematic medication reconciliation and review as part of the Lund Integrated Medicines Management model – impact on all‐cause emergency department revisits

What is known and objective:  Interventions involving medication reconciliation and review by clinical pharmacists can reduce drug‐related problems and improve therapeutic outcomes. The objective of this study was to examine the impact of routine admission medication reconciliation and inpatient medication review on emergency department (ED) revisits after discharge. Secondary outcomes included the combined rate of post‐discharge hospital revisits or death.

Medication beliefs and self-reported adherence–results of a pharmacist's consultation: a pilot study

Objectives Clinical outcomes in the secondary prevention of cardiovascular disease depend on the patients’ adherence to prescribed medicines. Motivational interviewing (MI) is a patient-centred approach used to change different health behaviours. The objective of this pilot study was to explore the impact of a clinical pharmacists consultation on beliefs about medicines and self-reported medication adherence among patients with coronary heart disease (CHD). Methods CHD-patients participating in a prevention programme at the Kalmar County Hospital were randomised to control or intervention. The intervention consisted of a medication review focused on cardiovascular drugs, and a semistructured interview based on MI-approach, with a follow-up phone call 2 weeks later. The intervention was conducted by a clinical pharmacist at the cardiology unit 3 months postdischarge. Primary outcome measures were the results from the Beliefs about Medicines-Specific (BMQ-S) and the 8-Item Morisky Medication Adherence Scale (MMAS-8) 2 weeks after intervention. Results 21 enrolled patients (11 intervention) all completed to follow-up. MMAS-8 was very similar in the intervention and control groups. In BMQ-S the intervention group had a mean (SD) necessity score of 21 (4) and a concern score of 12 (6), corresponding results in the control group were 21 (3) and 10 (5). However, since there was a difference in BMQ-S at baseline, seven intervention patients shifted towards more positive beliefs compared with two control patients. Conclusions No difference was found in adherence and beliefs at follow-up. However, after consultation, a larger proportion of patients changed towards more positive beliefs compared with control.

Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC) : Intervention Development and Protocol for the Process Evaluation.

Background Trials of complex interventions are often criticized for being difficult to interpret because the effects of apparently similar interventions vary across studies dependent on context, targeted groups, and the delivery of the intervention. The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a randomized controlled trial (RCT) of an intervention aimed at improving pharmacological secondary prevention. Guidelines for the development and evaluation of complex interventions have recently highlighted the need for better reporting of the development of interventions, including descriptions of how the intervention is assumed to work, how this theory informed the process evaluation, and how the process evaluation relates to the outcome evaluation. Objective This paper aims to describe how the intervention was designed and developed. The aim of the process evaluation is to better understand how and why the intervention in the MIMeRiC trial was effective or not effective. Methods The research questions for evaluating the process are based on the conceptual model of change processes assumed in the intervention and will be analyzed by qualitative and quantitative methods. Quantitative data are used to evaluate the medication review in terms of drug-related problems, to describe how patients’ beliefs about medicines are affected by the intervention, and to evaluate the quality of motivational interviewing. Qualitative data will be used to analyze whether patients experienced the intervention as intended, how cardiologists experienced the collaboration and intervention, and how the intervention affected patients’ overall experience of care after coronary heart disease. Results The development and piloting of the intervention are described in relation to the theoretical framework. Data for the process evaluation will be collected until March 2018. Some process evaluation questions will be analyzed before, and others will be analyzed after the outcomes of the MIMeRiC RCT are known. Conclusions This paper describes the framework for the design of the intervention tested in the MIMeRiC trial, development of the intervention from the pilot stage to the complete trial intervention, and the framework and methods for the process evaluation. Providing the protocol of the process evaluation allows prespecification of the processes that will be evaluated, because we hypothesize that they will determine the outcomes of the MIMeRiC trial. This protocol also constitutes a contribution to the new field of process evaluations as made explicit in health services research and clinical trials of complex interventions.

Motivational Interviewing and Medication Review in Coronary Heart Disease (MIMeRiC) : Protocol for a Randomized Controlled Trial Investigating Effects on Clinical Outcomes, Adherence, and Quality of Life.

Background Preventive treatment goals for blood pressure and cholesterol levels continue to be unmet for many coronary patients. The effect of drug treatment depends on both its appropriateness and the patients’ adherence to the treatment regimen. There is a need for adherence interventions that have a measurable effect on clinical outcomes. Objective This study aims to evaluate the effects on treatment goals of an intervention designed to improve patient adherence and treatment quality in secondary prevention of coronary heart disease. A protocol for the prespecified process evaluation of the trial is published separately. Methods The Motivational Interviewing and Medication Review in Coronary heart disease (MIMeRiC) trial is a prospective, randomized, outcomes-blinded trial designed to compare individualized follow-up by a clinical pharmacist using motivational interviewing (MI) and medication review with standard follow-up. Patients were randomized to 2 groups after stratification according to their beliefs about medicines. After standard follow-up at the cardiology clinic, patients in the intervention group are seen individually by a clinical pharmacist 2 to 5 times as required over 7 months, at the clinic. The pharmacist reviews each patient’s medication and uses MI to manage any problems with prescribing and adherence. The primary study outcome is the proportion of patients who have reached the treatment goal for low-density lipoprotein cholesterol by 12 months after discharge. Secondary outcomes are the effects on patient adherence, systolic blood pressure, disease-specific quality of life, and health care use. Results The protocol for this study was approved by the Regional Ethics Committee, Linköping, in 2013. Enrollment started in October 2013 and ended in December 2016 when 417 patients had been included. Follow-up data collection will conclude in March 2018. Publication of the primary and secondary outcome results from the MIMeRiC trial is anticipated in 2019. Conclusions The MIMeRiC trial will assess the effectiveness of an intervention involving medication reviews and individualized support. The results will inform the continued development of support for this large group of patients who use preventive medicines for lifelong treatment. The design of this adherence intervention is based on a theoretical framework and is the first trial of an intervention that uses beliefs about medicines to individualize the intervention protocol. Trial Registration ClinicalTrials.gov NCT02102503; https://clinicaltrials.gov/ct2/show/NCT02102503 (Archived by WebCite at http://www.webcitation.org/6x7iUDohy)

e-Learning for the elderly on drug utilization: A pilot study:

This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.

Impact of the Lund Integrated Medicines Management model on medication appropriateness

It is well documented that skin diseases can have a detrimental effect on an individual’s day to day life and can severely affect their Quality of life (QoL). More recently, new research has highlighted the effect that these skin conditions can also have on the family members QoL. The Family Dermatology Life Quality Index (FDLQI) was developed recently by Basra, M et al. in 2007. This is a 10 item questionnaire designed to measure the negative impact on QoL of family members and partners of patients with skin diseases. There has also been research done into how much patients would be willing to pay (WTP) and Time Trade Off (TTO) for a treatment to suppress all the symptoms of the disease, however there is no research into WTP and TTO for relatives of dermatology patients. The aim of this study is to further research the impact of inflammatory skin conditions on family members QoL and to investigate how much time and money relatives would be willing to spend on a hypothetical treatment to relieve the patient of all symptoms of their disease.39th ESCP European symposium on clinical pharmacy & 13th SFPC congress: clinical pharmacy at the front line of innovations. 21–23 October 2010, Lyon, FranceThe primary objective of the study was to determine the level of support of North Carolina pharmacists for opportunities of providing additional vaccine-related services. Secondary objective was to measure whether there were any differences to obtain information to establish pharmacists’ opinions regarding expansion of pharmacist provided immunization services.Introduction Inappropriate prescribing among elderly patients may increase the risk for drug-related problems. The objective of this study was to examine the impact of the Lund Integrated Medicines ...

The impact of an integrated clinical pharmacy service on drug-related hospital contacts.

The pharmaceutical industry has a global market size in excess of

Impact of the Lund Integrated Medicines Management (LIMM) model on medication appropriateness and drug-related hospital revisits

600 billion. The industry has in recent times been the centre of much focus as its productivity levels have declined whilst the research and development cost have continued to rise. As the figures for drug development continue to escalate, sustainability of the current development model is being questioned and pharmaceutical companies are re-evaluating their development strategy with focus on implementing a global development programme to enable them to submit simultaneously in a number of regulatory authorities. Regulatory authorities’ role is to safeguard public health and ensure that the drug approval process is carried out in a timely manner. However, pharmaceutical companies can also influence this through the dossier submission strategies used. The aim of this study was to review approvals of new active substances (NASs) by US FDA, EU EMEA, Australian TGA, Canadian TPD, Japanese PMDA and Swissmedic between 1997 and 2008, in order to determine whether the harmonisation of technical guidelines (ICH) has enabled simultaneous submissions and approvals in these markets.Background and objective In 2003, State of North Carolina enacted legislation requiring licensed nursing homes to report medication errors. Since 2004, roughly 400 nursing homes have reported nearly 70,000 medication errors to a web-based error reporting system. Medication errors are a major concern, leading to estimated 800,000 preventable medication related injuries every year in the US. For every dollar spent on drugs in nursing homes,

Errors in medication history at hospital admission: prevalence and predicting factors

1.33 is spent on treatment of drug related morbidity and mortality. This amounts to

Physicians' attitudes towards ePrescribing--evaluation of a Swedish full-scale implementation.

7.6 billion for the USA. The aims were firstly to determine proportion of repeat errors occurring per nursing home, to assess contributory factors relating to repeat errors, and association of repeat errors with subsequent patient harm.HRQoL instruments such as the DLQI are useful in assessing how different skin conditions affect patients’ lives, efficacy of patients’ treatment over time and as an additional measure of benefit-risk ratio for certain drugs. If however any decisions are to be made on the basis of a change in HRQoL score over time, then there needs to be a definition of what change in score is meaningful to the patient. The smallest change in score over time that would be meaningful to the patient is called the Minimal Important Difference, or MID. The aim was to determine the MID for the DLQI.Background and objective Accurate dosing of unfractionated heparin (UFH) is difficult to achieve due to inter-patient variability in anticoagulant response, high rate of medication errors with UFH and problems in monitoring heparin via activated partial thromboplastin time (aPTT) levels. Although weight-based nomograms have marked an improvement, they have by no means eliminated limitations associated with UFH therapy. Study aims were to assess whether current dosing nomogram at UNC Hospitals was being used accurately by healthcare staff, and whether doses within the nomogram were achieving therapeutic anticoagulation.