oru.sePublikationer
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rational drug treatment in the elderly: "To treat or not to treat"
Örebro University, School of Health and Medical Sciences.
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The general aim of this thesis was to examine the effect of interventions on the usage of inappropriate and hazardous multi-medication in the elderly ≥75 years with ≥5 drugs.

Methods: Paper I describes a cluster randomization of nursing homes, the outcomes were; number of drugs, health status and evaluations. A randomized controlled trial concerning elderly in ordinary homes was performed in paper II and the outcomes were; EQ-5D index, EQ VAS and prescription quality. In paper III a cohort study was carried out and the outcomes were; medication appropriateness index, EQ-5D index and EQ VAS. In paper IV, registered nurses from the nursing homes study were interviewed in a descriptive study with a qualitative approach.

Results:There was a significant reduction of number of drugs used per patient at the intervention nursing homes (p<0.05). Monitoring and evaluation of medications were significantly more frequent at the intervention homes (p<0.01). The registered nurses at the nursing homes described a self-made role in their profession and the leadership was not at sight. Drug treatment seems to be a passive process without own reflection. Extreme polypharmacy was persistent in all three groups of elderly living in ordinary homes and there was an unchanged frequency of drug-risk indicators. In the cohort study a lower medication quality was shown to be associated with a lower quality of life. EQ-5D index was statistically significantly different among the groups as was EQ VAS.

Conclusion: The nursing home study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. More attention must be focused on the complexity of the nursing process; medication management must be promoted in teamwork with the physician. The resistance to change prescriptions in accordance with the intervention underlines the need of new strategies for improving prescription quality. Since medication quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment in shared decision with the patient.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2012. , 84 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 64
Keyword [en]
Elderly, polypharmacy, drug evaluation, nursing process, monitoring, inappropriate prescribing, quality of life, patient participation
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-20618ISBN: 978-91-7668-843-4 (print)OAI: oai:DiVA.org:oru-20618DiVA: diva2:468916
Public defence
2012-02-03, Wilandersalen, Universitetssjukhuset, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2011-12-22 Created: 2011-12-22 Last updated: 2016-04-20Bibliographically approved
List of papers
1. Patient focused drug surveillance of elderly patients in nursing homes
Open this publication in new window or tab >>Patient focused drug surveillance of elderly patients in nursing homes
2010 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 19, no 2, 150-157 p.Article in journal (Refereed) Published
Abstract [en]

Purpose To examine whether patient focused drug surveillance was associated with a higher quality of drug treatment at nursing homes.

Methods An intervention study in four nursing homes in Sweden and four other nursing homes served as controls. At the intervention nursing homes physicians focused on patients' health status as a baseline for further ongoing medication. The outcomes were mortality, health care consumption, and number of drugs, health status and evaluations as parameters for "quality of drug treatment".

Results There were no significant differences in mortality rates. Healthcare consumption and polypharmacy were extensive in both groups. There was a significant reduction of number of drugs used per patient at the intervention homes during the study (p < 0.05). Monitoring and evaluation of the effects of medications were significantly more frequent at the intervention homes (p < 0.01).

Conclusions The intervention resulted in significant positive results in relation to "quality of drug treatment", a shift in health care utilization with concomitant use of fewer drugs. The study showed an extreme shortage of monitoring of health status and surveillance of the effects of drugs in the elderly. Copyright (C) 2009 John Wiley & Sons, Ltd.

Keyword
elderly, polypharmacy, drug evaluation, monitoring
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-13003 (URN)10.1002/pds.1891 (DOI)000274957000006 ()
Available from: 2011-01-03 Created: 2011-01-03 Last updated: 2017-02-15Bibliographically approved
2. Drug treatment in the elderly: an intervention in primary care to enhance prescription quality and quality of life
Open this publication in new window or tab >>Drug treatment in the elderly: an intervention in primary care to enhance prescription quality and quality of life
2012 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 1, 3-9 p.Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of the study was to assess the effect on prescription quality and quality of life after intervention with prescription reviews and promotion of patient participation in primary care. Design. A randomized controlled study with three groups: (A) controls, (B) prescription review sent to physician, and (C) as in B and with a current comprehensive medication record sent to the patient. Setting. The municipality of Ö rebro, Sweden (130 000 inhabitants). Intervention. The study focused on the easiest possible intervention to increase prescription quality and thereby increase quality of life. The intervention should be cost-effi cient, focus on colleague-to-colleague advice, and be possible to perform in the primary health care centre without additional resources such as a pharmacist.

Subjects: 150 patients recently discharged from hospital. Inclusion criteria were: 75 years, fi ve drugs and living in ordinary homes. Main outcome measures. Quality of life (EQ-5D index, EQ VAS) and quality of prescriptions.

Results: Extreme polypharmacy was common and persistent in all three groups and this was accompanied by an unchanged frequency of drug-risk indicators. There was a low EQ-5D index and EQ VAS in all three groups throughout the study. No statistically signifi cant differences were found anywhere between the groups.

Conclusion: The intervention seems to have had no effect on quality of prescriptions or quality of life. This underlines the major challenge of fi nding new strategies for improving prescription quality to improve patient outcome measures such as quality of life and reduce the known risks of polypharmacy for the elderly.

Place, publisher, year, edition, pages
London, United Kingdom: Informa Healthcare, 2012
Keyword
Frail elderly, inappropriate prescribing, patient participation, polypharmacy, quality of life
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20722 (URN)10.3109/02813432.2011.629149 (DOI)000300452700002 ()22175269 (PubMedID)2-s2.0-84857244458 (Scopus ID)
Note

Rebecka Runnamo is also affiliated to Faculty of Health Sciences, Linköping University, Sweden; This article is an Informa Healthcare "Early Online", 1–7

Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2016-04-20Bibliographically approved
3. Medication quality and quality of life in the elderly, a cohort study
Open this publication in new window or tab >>Medication quality and quality of life in the elderly, a cohort study
2011 (English)In: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 9, 95Article in journal (Refereed) Published
Abstract [en]

Background: Modern drugs have made large contributions to better health and quality of life. Increasing proportions of negative side effects due to extensive pharmacological treatment are however observed especially among elderly patients who have multiple health problems. The aim of our study was to see if there is an association between medication quality and quality of life.

Methods: 150 patients discharged from hospital. Inclusion criteria were: living in ordinary homes, ≥ 75 years and ≥ 5 drugs. Home visits were performed to all, including prescription reviews and calculation of medication appropriateness index. The patients were divided into three groups depending on index score and followed for 12 months. The validated and recognized EQ-5D and EQ VAS instruments were used to assess quality of life.

Results: A lower medication quality was associated with a lower quality of life. EQ-5D index was statistically significantly different (declining for each group) among the groups (p = 0.001 at study start, p = 0.001 at 6 months and p = 0.013 at 12 months) as was EQ VAS (p = 0.026 at study start, p = 0.003 at 6 months and p = 0.007 at 12 months).

Conclusions: This study has shown the validity of the basic principle in prescribing: the more appropriate medication the better quality of life. Since drug quality is related to the patients’ quality of life, there is immense reason to continuously evaluate every prescription and treatment. The evaluation and if possible deprescribing should be done as a process where both the patient and physician are involved.

Place, publisher, year, edition, pages
BioMed Central, 2011
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20724 (URN)10.1186/1477-7525-9-95 (DOI)000297062800001 ()22054205 (PubMedID)2-s2.0-80155201276 (Scopus ID)
Note

Inger Nordin Olsson is also affiliated to The National Board of Health and Welfare Regional Supervisory Unit Central P.O. Box 423,SE-701 48 Örebro, Sweden; Rebecka Runnamo is also affiliated to Faculty of Health Sciences, Linköping University, SE- 581 83 Linköping, Sweden;

Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2017-02-08Bibliographically approved
4. Registered nurses’ perceptions of their professional role in medication in elderly care
Open this publication in new window or tab >>Registered nurses’ perceptions of their professional role in medication in elderly care
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The role of the municipal registered nurse (RN) is rarely discussed with regard to multimedication. The aim of this study was to describe RNs’ perceptions of their professional role especially regarding medication management in elderly care. The study is descriptive with a qualitative approach. Interviews with 16 RNs at nursing homes for the elderly were analysed. The RNs described an undefined profession lacking leadership. The findings can be categorized into seven roles showing different aspects of their work: controller, executer, messenger, supervisor, initiator, visionary and solitary worker. Health assessment and medication management should be promoted in elderly care. There must be sufficient and adequate reporting based on the RNs’ nursing and medical skills to monitor and evaluate the drug treatment in teamwork with the physician. This requires leadership with understanding of the integration process in care of the elderly, of the medical processes and nursing skills involved.

Keyword
collaboration, elderly, medication management and quality, multi-medication, nursing process
National Category
Medical and Health Sciences Nursing
Research subject
Nursing Science
Identifiers
urn:nbn:se:oru:diva-20728 (URN)
Available from: 2012-01-09 Created: 2012-01-09 Last updated: 2016-12-12Bibliographically approved

Open Access in DiVA

fulltext(2512 kB)1084 downloads
File information
File name FULLTEXT02.pdfFile size 2512 kBChecksum SHA-512
b4b64ed5584bfb086e13572267c7c54cdc3f8db1a958f699b69e2163fe427ad473333d164e0c762a3978d77f8cc7b446dffb1d2428885a5cdf31fdeef3da5d6a
Type fulltextMimetype application/pdf
omslag(1624 kB)150 downloads
File information
File name COVER01.pdfFile size 1624 kBChecksum SHA-512
70a3bfe2a51a7e7dc0e4521551b9bbb254120c87fa2f578d57f0582ced8a675306d0742a80827013df7e76be7341f98f96e17642cf609c90584c56585168d245
Type coverMimetype application/pdf
spikblad(130 kB)17 downloads
File information
File name SPIKBLAD01.pdfFile size 130 kBChecksum SHA-512
716c4834bcd084bdb3b235c98a097099cc063e524a31b027d2de01891e2931c058050795a4aa0c914cda7d10b3604376de3d9f0e4326a8bf17544f9f6a6707ff
Type spikbladMimetype application/pdf

Search in DiVA

By author/editor
Nordin Olsson, Inger
By organisation
School of Health and Medical Sciences
Medical and Health SciencesNursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 1084 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

Total: 1442 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf