To the patients

[Pages:60]To the patients

Cover: Old Lady Water colour (19x16.5cm) Olle Christoffersson 2012

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List of Papers

This thesis is based on the following papers, which are referred to in the text by their Roman numerals.

I Gillespie, U.,Alassaad, A., Henrohn, D.,Garmo, H., Hammarlund-Udenaes, M., Toss, H., Kettis-Lindblad, ?., Melhus, H., M?rlin, C. (2009) A Comprehensive Pharmacist Intervention to Reduce Morbidity in Patients 80 Years or Older- A Randomized Controlled Trial. Arch Intern Med. 169(9):894-900

II Gillespie, U., Alassaad, A., Melhus, H., M?rlin, C., Henrohn, D., Bertilsson, M., Hammarlund-Udenaes, M. Effects of pharmacists' interventions on appropriateness of prescribing for elderly and exploration of a possible correlation between scores for appropriateness and clinical outcomes ? analyses from a randomized controlled trial. In manuscript.

III Gillespie, U., M?rlin, C., Hammarlund-Udenaes, M., Hedstr?m, M. (2012) Perceived value of ward-based pharmacists from the perspective of physicians and nurses. International Journal of Clinical Pharmacy. 34(1): 127-135. DOI: 10.1007/s11096-0119603-1

IV Alassaad, A., Gillespie, U., Melhus, H., Bertilsson, M., Hammarlund-Udenaes, M. (2011) Prescription and transcription errors in multidose-dispensed medications on discharge from hospital: an observational and interventional study. Journal of Evaluation in Clinical Practice. E-published ahead of print. DOI: 10.1111/j.1365-2753.2011.01798.x

Reprints were made with permission from the respective publishers.

Abbreviations

ADR DRP MAI STOPP START ADE MDD PCI MAR ESCP PCNE PIM PPO ICD-10

RCT OTC ED GP

Adverse drug reaction Drug related problem Medication appropriateness index Screening Tool of Older Persons' Prescriptions Screening Tool to Alert doctors to Right Treatment Adverse drug event Multidose dispensed drugs Pharmaceutical care issue Medication administration record European Society of Clinical Pharmacy Pharmaceutical Care Network Europe Potentially inappropriate medicines Potential prescription omissions International Classification of Diseases and Related Health Problems, 10th edition. Randomised controlled trial Over-the-counter Emergency department General practitioner

Contents

Introduction ..................................................................................................... 9 The elderly population ...............................................................................9 Demographics ........................................................................................9 Drug therapy in the very old.......................................................................9 Effects of ageing on drug treatment.......................................................9 Polypharmacy ......................................................................................10 Multidose Drug Dispensing (MDD) ....................................................10 MDD ? routines in hospital .................................................................11 Drug-related problems (DRPs).................................................................12 Clinical DRPs ......................................................................................12 Technical DRPs ...................................................................................13 Inappropriate prescribing.....................................................................14 Drug-related hospitalisation .....................................................................15 Clinical pharmacy and pharmaceutical care.............................................16 Clinical pharmacy................................................................................16 Pharmaceutical care .............................................................................17 Education and training.........................................................................18 Clinical pharmacy tools............................................................................19 Medication reconciliation ....................................................................19 Medication review ...............................................................................20 Tools that assess appropriateness of prescribing .................................20 Pharmacists in healthcare teams...............................................................21

Aims of the thesis..........................................................................................23

Materials and methods ..................................................................................24 Paper I ......................................................................................................24 Paper II .....................................................................................................25 Paper III....................................................................................................26 Paper IV ...................................................................................................27

Results and Discussion .................................................................................29 Paper I ......................................................................................................29 Paper II .....................................................................................................31 Paper III....................................................................................................36 Paper IV ...................................................................................................37

Conclusions ................................................................................................... 40 Future perspectives .......................................................................................41 Swedish summary (svensk sammanfattning)................................................43 Acknowledgements ....................................................................................... 46 References ..................................................................................................... 50

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