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Johnsson L, Nordgren L. The voice of the self: a typology of general practitioners' emotional responses to situational and contextual stressors. Scand J Prim Health Care 2022; 40:289-304. [PMID: 35822622 PMCID: PMC9397474 DOI: 10.1080/02813432.2022.2097616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To develop a comprehensive typology of emotional reactions associated with stress among general practitioners (GPs), grounded in their own experiences. DESIGN Data was generated using observations and unstructured interviews, using Straussian grounded theory as the overarching methodology. The typology was built using multidimensional property supplementation. SETTING Eleven health care centres in urban and rural communities in four Swedish regions. SUBJECTS Sixteen GPs and GP residents. MAIN OUTCOME MEASURES Characteristics of GPs' emotional reactions in everyday work situations. RESULTS Accounts of negative emotions connected to stress revealed four principal personal needs of the GP: trust, efficacy, understanding, and knowledge. Simultaneous threats to more than one of these needs invariably increased the level of tension. From these more complex accounts, six second-order needs could be identified: integrity, judgment, pursuit, authority, autonomy, and competence. The most extreme encounters, in which all four principal needs were threatened, were characterised by the experience of being reduced into an assistant. CONCLUSION The considerable resilience of GPs may belie some of the pressures that they are facing while being far from a fail-safe defence against being diverted from purposeful and morally responsible action. Our typology distinguishes between different forms of stress that may affect how GPs carry out their work, and connects to the vast literature on GP wellness. The results of this study could be used to develop tools for self-reflection with the aim of countering the effects of stress, and are potentially relevant to future research into its causes and consequences.Key pointsWhat is known•Stress among GPs may have severe consequences for themselves and their patients, and levels of stress appear to be increasing.What this article adds•Stressful situations threaten at least one of four principal needs of the GP: trust, efficacy, understanding, and knowledge.•More complex threats increase the level of tension and bring out second-order needs: integrity, judgment, pursuit, authority, autonomy, and competence.•The wealth of literature on GP stress can be clearly understood through the lens of our four-dimensional typology.
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Affiliation(s)
- Linus Johnsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- CONTACT Linus Johnsson Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Lena Nordgren
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Clinical Research Sörmland/Uppsala University, Eskilstuna, Sweden
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Lau S, Lun P, Ang W, Tan KT, Ding YY. Barriers to effective prescribing in older adults: applying the theoretical domains framework in the ambulatory setting - a scoping review. BMC Geriatr 2020; 20:459. [PMID: 33167898 PMCID: PMC7650160 DOI: 10.1186/s12877-020-01766-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND As the population ages, potentially inappropriate prescribing (PIP) in the older adults may become increasingly prevalent. This undermines patient safety and creates a potential source of major morbidity and mortality. Understanding the factors that influence prescribing behaviour may allow development of interventions to reduce PIP. The aim of this study is to apply the Theoretical Domains Framework (TDF) to explore barriers to effective prescribing for older adults in the ambulatory setting. METHODS A scoping review was performed based on the five-stage methodological framework developed by Arksey and O'Malley. From 30 Aug 2018 to 5 Sep 2018, we conducted our search on PubMed, CINAHL, EMBASE, the Cochrane Database of Systematic Reviews, and Web of Science. We also searched five electronic journals, Google and Google Scholar to identify additional sources and grey literature. Two reviewers applied eligibility criteria to the title and abstract screening, followed by full text screening, before systematically charting the data. RESULTS A total of 5731 articles were screened. Twenty-nine studies met the selection criteria for qualitative analysis. We mapped our results using the 14-domain TDF, eventually identifying 10 domains of interest for barriers to effective prescribing. Of these, significant domains include physician-related factors such as "Knowledge", "Skills", and "Social/Professional Role and Identity"; issues with "Environmental Context and Resources"; and the impact of "Social Influences" and "Emotion" on prescribing behaviour. CONCLUSION The TDF elicited multiple domains which both independently and collectively lead to barriers to effective prescribing for older adults in the ambulatory setting. Changing the prescribing climate will thus require interventions targeting multiple stakeholders, including physicians, patients and hospital/clinic systems. Further work is needed to explore individual domains and guide development of frameworks to aid guide prescribing for older adults in the ambulatory setting.
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Affiliation(s)
- Sabrina Lau
- Department of Geriatric Medicine, Tan Tock Seng Hospital, TTSH Annex 2, Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Penny Lun
- Geriatric Education & Research Institute, Singapore, Singapore
| | - Wendy Ang
- Pharmacy, Changi General Hospital, Singapore, Singapore
| | - Keng Teng Tan
- Pharmacy, Tan Tock Seng Hospital, Singapore, Singapore
| | - Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, TTSH Annex 2, Level 3, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
- Geriatric Education & Research Institute, Singapore, Singapore
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Roulet C, Rozsnyai Z, Jungo KT, A. van der Ploeg M, Floriani C, Kurpas D, Vinker S, Kreitmayer Pestic S, Petrazzuoli F, Hoffmann K, Viegas RPA, Mallen C, Tatsioni A, Maisonneuve H, Collins C, Lingner H, Tsopra R, Mueller Y, Poortvliet RKE, Gussekloo J, Streit S. Managing hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries. PLoS One 2020; 15:e0236064. [PMID: 32649727 PMCID: PMC7351187 DOI: 10.1371/journal.pone.0236064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 06/26/2020] [Indexed: 01/10/2023] Open
Abstract
Background The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old. Design/Setting Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey. Methods GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs’ sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries. Results Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used. Conclusion Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
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Affiliation(s)
- Céline Roulet
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Zsofia Rozsnyai
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | | | - Milly A. van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Carmen Floriani
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Donata Kurpas
- Family Medicine Department, Wroclaw Medical University, Wroclaw, Poland
| | - Shlomo Vinker
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ferdinando Petrazzuoli
- Department of Clinical Sciences, Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kathryn Hoffmann
- Department of General Practice and Family Medicine, Medical University of Vienna, Vienna, Austria
| | - Rita P. A. Viegas
- Department of Family Medicine, NOVA Medical School, Lisbon, Portugal
| | - Christian Mallen
- Primary Care and Health Sciences, Keele University, Newcastle, United Kingdom
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, University of Ioannina, Ioannina, Greece
| | | | | | - Heidrun Lingner
- Center for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
| | - Rosy Tsopra
- INSERM, Research center in Information Science to Support Personalized Medicine, University Paris Descartes and University Sorbonne Paris Cité, Paris, France
- INSERM, LTSI Team Health Big Data, University of Rennes, Rennes, France
| | - Yolanda Mueller
- Department of Family Medicine, Center for primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | | | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Gerontology and Geriatrics, Leiden University, Leiden, The Netherlands
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- * E-mail:
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The interplay of context factors in hypnotic and sedative prescription in primary and secondary care-a qualitative study. Eur J Clin Pharmacol 2018; 75:87-97. [PMID: 30215101 PMCID: PMC6326988 DOI: 10.1007/s00228-018-2555-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Abstract
Purpose Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the prescription of hypnotics and sedatives and to compare their role in primary and secondary care. Methods Understanding medical practices as games with specific rules and strategies and performed in a largely habitual, not fully conscious manner, we asked a maximum variation sample of 12 hospital doctors and 12 general practitioners (GPs) about their use of hypnotics and sedatives. The interviews were analyzed by qualitative content analysis. Results Hospital doctors’ and GPs’ use of hypnotics and sedatives was influenced by a variety of contextual factors, such as the demand of different patient groups, aims of management, time resources, or the role of nurses and peers. Negotiating patient demands, complying with administrative regulations, and finding acceptable solutions for patients were the main challenges, which characterized the game of drug use in primary care. Maintaining the workflow in the hospital and finding a way to satisfy both nurses and patients were the main challenges in secondary care. Conclusions Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices. Electronic supplementary material The online version of this article (10.1007/s00228-018-2555-9) contains supplementary material, which is available to authorized users.
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Raguz Lucic N, Jakab J, Smolic M, Milas AM, Omanovic Kolaric T, Nincevic V, Bojanic K, Kralik K, Miskulin M, Wu GY, Smolic R. Primary Care Provider Counseling Practices about Adverse Drug Reactions and Interactions in Croatia. J Clin Med 2018; 7:jcm7090231. [PMID: 30135390 PMCID: PMC6162839 DOI: 10.3390/jcm7090231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Prescribing medications is one of the most common medical decisions that is made by primary care providers (PCPs). In the Republic of Croatia, PCPs hold a key position in prescribing and evaluating the medications that are provided for patients. Accordingly, providing advice for patients regarding the potential adverse drug reactions (ADRs) and drug-drug interactions (DDIs) is frequently the responsibility of the PCPs. The aim of the current study was to assess the knowledge, attitudes, and counseling practices of PCPs regarding drug interactions and adverse effects. METHODS After enrolling 195 PCPs that were selected at random, a survey was conducted while using an anonymous questionnaire that was created based on previously published studies, adjusted in a way that includes the most commonly prescribed medications in Croatia. RESULTS Of the 10 questions on knowledge about DDIs and ADRs, the median number of correct responses by PCPs was 5 (interquartile range 4 to 7). More than half of respondents (56%) agreed with the claim that knowledge of drug side effects facilitated their work in family medicine. Almost all of the respondents (92.8%) explained side effects and drug interactions to special groups of patients (pregnant women, elderly patients etc.). CONCLUSION The results show a need for additional education in the field of drug prescribing. However, PCPs were aware of the importance of counseling practices about adverse drug reactions and interactions and counseling practices among special patients populations are satisfactory.
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Affiliation(s)
- Nikola Raguz Lucic
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Jelena Jakab
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Martina Smolic
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Ana-Maria Milas
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
| | - Tea Omanovic Kolaric
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Vjera Nincevic
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Kristina Bojanic
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Faculty of Dental Medicine and Health, University of Osijek, Crkvena 21, HR-31000 Osijek, Croatia.
| | - Kristina Kralik
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
| | - Maja Miskulin
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
| | - George Y Wu
- Division of Gastroenterology-Hepatology, Department of Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06032, USA.
| | - Robert Smolic
- Faculty of Medicine, University of Osijek, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
- Division of Gastroenterology-Hepatology, Department of Medicine, Osijek University Hospital, Josipa Huttlera 4, HR-31000 Osijek, Croatia.
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Ekelin E, Hansson A. The dilemma of repeat weak opioid prescriptions - experiences from swedish GPs. Scand J Prim Health Care 2018; 36:180-188. [PMID: 29693484 PMCID: PMC6066274 DOI: 10.1080/02813432.2018.1459241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/12/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore general practitioners' (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions. DESIGN Qualitative focus group interviews. Systematic text condensation analysis. SETTING AND SUBJECTS 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden. MAIN OUTCOME MEASURES Strategies for handling the dilemma of prescribing weak opioids without seeing the patient. RESULTS After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP's inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct. CONCLUSION Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue. Key points Opioid prescription for chronic non-cancer pain is known to cause discomfort, feelings of guilt and conflicts for the prescribing doctor. From focus group interviews with GPs we found that to deal with this: • Doctors can use active strategies, such as confronting the patient or creating common routines together with their colleagues, or… • They can use passive coping strategies such as accepting the situation, handing over the responsibility to the patient or choosing not to see that there is a problem. • Opportunities for doctors to discuss prescription routines may be the best way to influence prescription habits.
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Affiliation(s)
- Elsa Ekelin
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anders Hansson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Bastholm-Rahmner P, Gustafsson LL, Aggefors K, Ateva K, Elfving S, Eriksen J, Jirlow M, Juhasz-Haverinen M, Malmström RE, Nikpour-Ardaly M, Röjvall M, Vallin M, Andersén-Karlsson E, Ovesjö ML. Patients' knowledge and attitudes to the Wise List - a drug formulary from the Stockholm Drug and Therapeutic committee. BMC Health Serv Res 2018. [PMID: 29530028 PMCID: PMC5848508 DOI: 10.1186/s12913-018-2968-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Involving patients in decisions about their pharmacotherapy is crucial for a satisfactory treatment outcome. Information and opinions about medicines are available from a variety of sources. The Wise List is the drug formulary of recommended essential medicines for the Stockholm healthcare region and is issued by the Drug and Therapeutics Committee (DTC). To inform the public about treatment for common diseases and the concept of recommended medicines, a patient edition of the Wise List was developed. The aim of this study was to explore patients’ knowledge, needs and attitudes to the Wise List, DTC and information about medicines in general. Methods To examine patient knowledge about recommended medicines a survey (n = 312) was carried out at four large primary healthcare centres in Stockholm, Sweden. To further elucidate the patients’ needs of the information on recommended medicines and medicines in general, three focus group discussions (FGDs) were performed. Results Of the respondents 57% did not recognise the Wise List, 26% recognised but did not use it and 17% used it. A total of 63% reported that they search for information about medicines. The most common information source was “asking their doctor” (36%) followed by searching the internet (31%). The FGDs revealed that the patients were not interested in medicines in general, only in the medicines they use themselves. They did not understand the aim of the Wise List or how they could benefit from information about recommended medicines. The patients expressed a wish to access all information they need about their own care as well as public healthcare information at one location. Conclusion The intended aim of the DTC with providing information to the public was not achieved as the patients have difficulties to understand the information and how they should use it. The patients were not interested in medicines in general, they wanted information tailored to their specific needs. The findings highlight the importance of creating tools for patients in collaboration with them and evaluate the concept continuously.
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Affiliation(s)
- Pia Bastholm-Rahmner
- Medical Management Centre, LIME, Karolinska Institutet, Tomtebodavägen 18 A, 171 77, Stockholm, Sweden.
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Kristina Aggefors
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Kristina Ateva
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Susanne Elfving
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
| | - Malena Jirlow
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | | | - Rickard E Malmström
- Clinical Pharmacology, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, 171 76, Stockholm, Solna, Sweden
| | | | - Magnus Röjvall
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Martina Vallin
- Karolinska Institutet, Department of Public Health Sciences, Tomtebodavägen 18A, Stockholm, Sweden
| | - Eva Andersén-Karlsson
- Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, 118 83, Stockholm, Sweden
| | - Marie-Louise Ovesjö
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, 141 86, Stockholm, Sweden
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The changing multiple sclerosis treatment landscape: impact of new drugs and treatment recommendations. Eur J Clin Pharmacol 2018; 74:663-670. [PMID: 29429031 PMCID: PMC5893684 DOI: 10.1007/s00228-018-2429-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 02/01/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study is to describe the utilization of disease-modifying treatments (DMTs) in relapsing-remitting multiple sclerosis (MS) and assess the impact of both the introduction of new drugs and treatment recommendations (local recommendation on rituximab use issued at the largest MS clinic in Stockholm and regional Drug and Therapeutics Committee (DTC) recommendation on how dimethyl fumarate should be used). METHODS Interrupted time series analyses using monthly data on all MS patients treated with DMTs in the Stockholm County, Sweden, from January 2011 to December 2017. RESULTS There were 4765 individuals diagnosed with MS residing in the Stockholm County from 2011 to 2017. Of these, 2934 (62%) were treated with an MS DMT. Since 2011, fingolimod, alemtuzumab, teriflunomide, dimethyl fumarate, peginterferon beta-1a, and daclizumab were introduced. Only fingolimod and dimethyl fumarate significantly impacted MS DMT utilization. In parallel, the use of rituximab off-label increased steadily, reaching 58% of all DMT-treated MS patients by the end of the study period. The local recommendation on rituximab was associated with an increase in rituximab use. The regional DTC recommendation on dimethyl fumarate was associated with a decrease in dimethyl fumarate use. CONCLUSIONS Three MS DMTs-fingolimod, dimethyl fumarate, and rituximab off-label-impacted MS DMT utilization in the Stockholm County. The associations between the treatment recommendations and the subsequent changes in MS DMT utilization indicate that such interventions can influence the uptake and utilization of new drugs used in the specialized care setting.
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Eriksen J, Ovesjö ML, Vallin M, Juhasz-Haverinen M, Andersén-Karlsson E, Ateva K, Gustafsson LL, Jirlow M, Bastholm-Rahmner P. Primary care physicians report high trust in and usefulness of the Stockholm drug and therapeutic committee's list of recommended essential medicines (the 'Wise List'). Eur J Clin Pharmacol 2017; 74:131-138. [PMID: 29063149 PMCID: PMC5748393 DOI: 10.1007/s00228-017-2354-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/11/2017] [Indexed: 11/29/2022]
Abstract
Purpose Inappropriate use of medicines causes increased morbidity, mortality, adverse drug reactions, therapeutic failures and drug resistance as well as wastes valuable resources. Evidence-based cost-effective treatment recommendations of essential medicines are a way of avoiding these. We assessed primary care prescribers’ knowledge about and perceptions of an essential medicines formulary, as well as the reasons for adhering to the recommendations. Methods We conducted a web based questionnaire survey targeting all physicians working in the primary healthcare of the Stockholm healthcare region (2.3 million inhabitants), regarding the knowledge of, attitudes to and usefulness of the essential medicines formulary of the Stockholm Drug and Therapeutics Committee, the so-called Wise List. Results Of the 1862 physicians reached by our e-mail invitations, 526 (28%) participated in the survey. All but one respondent knew of the formulary, and 72% used it at least once a week when prescribing. The main reason for using the formulary was evidence-based prescribing; 97% trusted the guidelines, and almost all (98%) found the content easy to understand. At the same time, many prescribers thought that the annual changes of some recommendations were too frequent, and some felt that a national formulary would increase its trustworthiness. Conclusions We found that the essential medicines formulary was widely used and trusted by the prescribers. The high uptake of the treatment recommendations could be due to the Stockholm Drug and Therapeutics Committee’s transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interest, feedback to prescribers, continuous medical education and minor financial incentives. Electronic supplementary material The online version of this article (10.1007/s00228-017-2354-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jaran Eriksen
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden. .,Department of Clinical Pharmacology, Karolinska University Hospital, 141 86, Stockholm, Sweden.
| | - Marie-Louise Ovesjö
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Quality and Development, Södersjukhuset, 118 83, Stockholm, Sweden
| | - Martina Vallin
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | | | - Eva Andersén-Karlsson
- Department of Clinical Science and Education, Södersjukhuset, 118 83, Stockholm, Sweden.,Internal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Ateva
- Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Lars L Gustafsson
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Pharmacology, Karolinska University Hospital, 141 86, Stockholm, Sweden
| | - Malena Jirlow
- Public Healthcare Services Committee, Box 17533, 118 91, Stockholm, Sweden
| | - Pia Bastholm-Rahmner
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, 171 77, Stockholm, Sweden
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Mazińska B, Hryniewicz W. Polish Physicians’ Attitudes Towards Antibiotic Prescription and Antimicrobial Resistance. Pol J Microbiol 2017; 66:309-319. [PMID: 29319521 DOI: 10.5604/01.3001.0010.4856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial resistance has been one of the biggest global current issues in medicine and public health. Overuse and imprudent use of antimicrobial agents are recognized as one of the leading causes of antibiotic resistance. The aim of this study was to analyze the attitudes of Polish physicians practicing at the community level towards antibiotics and antimicrobial resistance. The majority of physicians taking part in the survey believed that Polish people overuse antibiotics (98%). Most physicians (91%) considered that antimicrobial resistance is a major problem at present. The majority of physicians indicated the reasons for prescribing the antibiotic are related to health factors, such as optimal recovery (best effectiveness, least side effects) (80%), latest therapeutic guidelines (70%) and microbiological/epidemiological factors (63%). Knowledge of the National Recommendations for the management of Community-Acquired Respiratory Tract Infections 2010 (NR-CA-RTI) developed within National Programme for Protection of Antibiotics was declared by 84% of respondents. Among those who are aware of the NR-CA-RTI, the majority follow them in their daily practice (91%). Among physicians, 62% are not familiar with the Centor/McIsaac scores used to differentiate bacterial and viral infections in patients presenting with a sore throat. Among physicians familiar with the scores, 90% use them in their daily practice. Rapid microbiological detection methods for Group A beta-hemolytic streptococcal pharyngitis are used only by 20% of respondents. Almost all of physicians declared readiness to use these tests. Main sources of information on antibiotics prescribing originate from Polish medical journals, scientific conferences organized by medical societies, pharmaceutical companies.
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Affiliation(s)
- Beata Mazińska
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, The National Reference Centre for Susceptibility Testing, National Medicines Institute, Warsaw, Poland
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Gené-Badia J, Gallo P, Caïs J, Sánchez E, Carrion C, Arroyo L, Aymerich M. The use of clinical practice guidelines in primary care: professional mindlines and control mechanisms. GACETA SANITARIA 2016; 30:345-51. [DOI: 10.1016/j.gaceta.2016.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
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Yohana JM, Enoch S, Vincent S, Mpho C, Maureen B, Amos YM. Availability of guidelines and policy documents for enhancing performance of practitioners at the Primary Health Care (PHC) facilities in Gaborone, Tlokweng and Mogoditshane, Republic of Botswana. ACTA ACUST UNITED AC 2016. [DOI: 10.5897/jphe2016.0812] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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