The Swedish pharmacies have gone through a period of many changes during the last decade, due to the deregulation of the pharmacy market in 2009. Beside the traditional mission to provide medicine and qualified advice to the citizens, a commercial mission with profitability demands has been added. The purpose of this study was to contribute to a new understanding of the leadership processes at pharmacies. The point of departure was a broadened perspective of leadership, where leadership is seen as the effects of social processes in organizing and understanding of the goals and aims of the work. The theoretical framework included theories of organizing, sensemaking and professionalism. The design of the study consisted of a case study based on participant observations and semi-structed interviews at two pharmacies. The findings showed that there were four institutional logics that explained and guided the employees’ behaviours; efficiency, sales, quality and customer satisfaction. Each logic was connected to certain characteristics of the leadership processes; the sensemaking of the direction of work and the organizing in action nets. The direction of work was understood either from the employees’ organizational or professional identity and the organizing consisted either of dense or sparse action nets. It was also apparent that the leadership processes for the different institutional logics were opposing to one another in several situations, which challenged the identities and hindered the collective understanding of the work. These institutional logics were also reflected in the pharmacies’ dual missions, where the aim for efficiency and sales formed the prerequisites for the business and the aim for quality and customer satisfaction represented the legitimacy of the profession and the organization.

Abstract Mål: Syftet med denna studie var att kartlägga farmaceuters upplevelser kring huruvida en frågelista (Question Prompt List, QPL) är ett användbart verktyg för att öka kommunikationen och patientaktiveringen på svenska öppenvårdsapotek. Kommunikationen på öppenvårdsapotek bör förbättras så patienter får optimal läkemedelsanvändning. Metod: Kvalitativa semistrukturerade intervjuer genomfördes med 27 farmaceuter och två apotekarstudenter på sju olika öppenvårdsapotek i Stockholm, Uppsala och Göteborg under hösten 2020. Respondenterna bestod av 24 kvinnor och fem män som hade använt QPL:en i sitt arbete under 1-2 veckor. Intervjuerna varade mellan 6-47 minuter, median 15 minuter. Dessa transkriberades och analyserades via systematisk textkondensering (STC). Resultat: Efter STC identifierades fyra resultatkategorier; 1. Ett kommunikationsverktyg som får farmaceuterna att tänka till om sina kundmöten, 2. QPL:en var en tankeställare som kan bjuda in till samtal samt tända en och annan glödlampa hos kunderna, 3. En användbar inbjudande lista med förbättringspotential för att underlätta ytterligare för kunderna på apoteken, 4. Det är viktigt att möta och fånga upp kunden för att kunna ge den bästa servicen. Majoriteten av farmaceuterna (n=28) kan tänka sig använda QPL:en i framtiden. Tidsbrist gjorde att listan inte var användbar i alla kundmöten. QPL:en ansågs ha utvecklingspotential och farmaceuterna gav förslag på hur kommunikation på öppenvårdsapotek kan optimeras; genom exempelvis ökat engagemang från farmaceuternas sida. Slutsats: Farmaceuterna upplevde att QPL:en var användbar och fick kunderna att fråga mer, men inte vid alla kundmöten. QPL:en kan optimeras ytterligare och göras mer lättläslig. Kommunikationen på öppenvårdsapotek bör optimeras ytterligare.

The COVID-19 pandemic has led to a series of physical restrictions on society that have affected the elderly population the hardest. The elderly have been urged to stay in their homes which has led to a series of changes in how older people need to make their pharmaceutical purchases. This paper aims to investigate how older people perceive and what motivates them to make e-commerce purchases. By specifically examining the pharmacy market adaptation, perception and possible change, this study intends to contribute with an in-depth situational analysis. The empirical material of the study is taken from qualitative semi-structured interviews with three pharmacies and ten elderly (65+ years), and a non-participatory observation. The study is based on the theories Protection motivation theory (PMT) and Model of Digital Access, that is used in the analysis of the empirical data. The conclusion shows that the elderly who have high perceived self-efficacy, trust in recommendations and haven't experienced e-commerce as difficult have improved its relationship with e-commerce.

Bakgrund: Användning av läkemedel ökar och därmed ökar också läkemedelsrelaterade problem. För att patienter ska kunna ha en säker läkemedelsbehandling krävs bland annat korrekt och fullständig läkemedelsinformation. I dagsläget finns det olika informationskällor som patienter använder för att hålla koll på sin läkemedelsbehandling men i många av dem förekommer avvikelser som gör att risken för felmedicinering eller överdosering ökar. Syfte: Syftet med det här arbetet var att undersöka prevalensen av avvikelser i läkemedelslista ”Mina sparade recept på apotek” (MSR), samt att se om vissa läkemedelsgrupper skulle förekomma oftare än andra bland avvikelserna. Även andra variabler, såsom informationskällor som patienter använder för att hålla reda på sin läkemedelsbehandling, avsaknad av receptbelagda läkemedel i MSR och användning av receptfria läkemedel mättes. Metod: Data for studien samlades in genom speciellt utformade läkemedelsintervjuer med patienter på ett öppenvårdsapotek i Sverige under veckorna 3–5 i början av 2021. Patienterna som inkluderades var vuxna patienter som hade åtminstone tre receptbelagda läkemedel i sin MSR och som hämtade ut läkemedel åt sig själva. Innan läkemedelsintervjuerna påbörjade erhölls också ett skriftligt samtycke från alla deltagare. Resultat: Nästan 70 procent av 69 intervjuade patienter hade minst en typ av avvikelse i MSR, därav dubbla och inaktuella recept var vanligaste. Bland avvikelserna var de vanligaste läkemedel för behandling av sjukdomar som rör nervsystemet, hjärta och kretslopp samt matsmältningsorgan och ämnesomsättning. En del av patienterna (35 procent) saknade receptbelagda läkemedel i sin MSR, medan 30 procent av dem uppgav att de använde receptfria läkemedel. Informationskällan som användes av de flesta patienterna för att hålla koll på deras läkemedelsbehandling var just MSR.  Slutsats: Avvikelser i MSR förekommer hos nästan 7 av 10 patienter och de läkemedelsgrupperna som var vanligare bland avvikelser är också läkemedelsgrupper som orsakar mest läkemedelsrelaterade problem. Dessa avvikelser måste åtgärdas eftersom de påverkar patienternas säkerhet och förhoppningsvis kommer implementering av den nya nationella läkemedelslistan (NLL) kunna förbättra situationen för både patienten och hälso- och sjukvårdspersonalen. / Background: The use of medicines has increased in the past few years, which has also led to increased amount of drug-related problems (DRP), such as drug-drug interactions and serious adverse effects which lead to hospitalization. In order to decrease the amount of DRP, the medication lists of individual patients need to be accurate and updated. The most used medication list among those available is the one that is printed out at a pharmacy “My stored prescriptions at pharmacy”.  It is also called “Prescription List” (PL). Even though a lot of patients use the PL, there are a lot of discrepancies in it, such as noncurrent and missing prescriptions, but also prescription duplicates. Aim: The aim of this study was to study the prevalence of discrepancies in the PL, such as noncurrent or duplicate prescriptions, wrong dosage or other unclarities, but also to see if there are some particular drug groups which are more common among the discrepancies. Secondary outcomes that were measured included the amount of missing prescriptions in the PL, as well as the usage of over-the-counter (OTC) medicines and primary information sources that patients use to keep track of their prescriptions. Methods: Data needed for the study was collected by interviewing patients at a local pharmacy. The interview was specially designed to answer to all the outcomes and the patient’s individual PL was also used to identify the discrepancies. In order to be included in the study patients needed to be at least 18 years old, have three or more prescriptions in the national prescription repository (NPR) and pick up their own medication, as well as provide a written consent to participate. Pharmacists that were dispensing patient’s prescriptions were also in charge of the recruitment of patients. Result: Out of the 103 patients that were informed about the study, 69 patients were included. Almost 70 percent of them had at least one type of discrepancy in the PL. The most common discrepancy was prescription duplicates (46 percent), followed by noncurrent prescriptions (44 percent). Drug groups which were common among the discrepancies were the drugs used to treat diseases in the nervous system, cardiovascular system and digestive system (including metabolism). Secondary outcomes showed that 35 percent of the patients had at least one missing prescription in the PL, but also that 30 percent of the patients used OTC medicines, the most common being paracetamol (acetaminophen). The most used information source was the PL with 32 percent of patients using it as their primary information source for their medication therapy. Conclusions: Prescription duplicates and noncurrent prescriptions are frequent in the PL and are a major source of medication errors for patients and health-care workers. Drug groups which where the most common among the discrepancies are also the ones responsible for half of the hospitalizations in Sweden. This implies that they could probably be prevented by improving the PL. The number of the missing prescriptions was quite low. The usage of OTC medicines showed that most of patients used painkillers. These are the drugs that Swedes often overuse and therefore, for future safety, monitoring of OTC sales should be implemented. Although it had 21 percent of inaccuracies, the PL was the most used information source for the patients, which gives the conclusion that the improvement of it is needed as soon as possible in order to prevent and decrease the frequency of DRP.

Background: The increasing elderly population is challenging todays management in healthcare. Elderly have a higher risk of adverse effect and inappropriate use of medication. The Swedish healthcare today pays 12-19 billion kronor due to adverse effects and inappropriate use of medications. By optimizing elderlies use of medicine, the social cost can decrease and contribute to a better healthcare management.  Aim: Identify communication methods that can optimize counselling and communication to the elderly in pharmacies. In the sense of preventing inappropriate use of drugs and future side effects such as adverse effects or no effect. The questions that were answered are as follows: what methods are available to optimize counselling and communication? is it possible to use the methods in pharmacies? Methods: Systematic review, data search on pubmed and web of science.  Results: Identified interventions were Alice-app, Geriatic Resources for Assessment and Care of Elders Team Care (GRACE), empathetic communication, communication education, motivational interviewing, my medical passport (MMP), in depth patient-centered care communication, smartwatch, smartphone, ingestible sensor system (ISS) and SPACE-program. Conclusions: Communication education helped to strengthen the patient-/carer relationship and management of medication counselling. Electronic notification systems helped elder with memory- and movement impairment. The implementation depends on the pharmacy resources and propensity of the patient. The most applicable methods were ALICE-app, smartwatch, smartphone, ISS, SPACE-team, empathetic communication, communication education in geriatric care, MI, MMP and partly GRACE-team concerning home visits by pharmacists and teamwork management.

The purpose of this project was to examine the possibilities of automating pharmacies by developing a vendingmachine-like device. As a result, a prototype was designed, constructed and programmed. The main focus of this prototype is to inspect whether it is possible to minimize the need for staff in pharmacies. In order for the prototype to archive it’s purpose, a various amount of components were used. Those components were connected and controlled using the Arduino Mega. A screen and a keypad were used to facilitate the user interaction with the prototype. Furthermore, three different types of motors were needed to deliver medicine to the user. The final prototype was able to deliver medicine to the user from four different boxes. Various experiments were carried out to ensure that the machine could perform the required tasks and automate medicine delivery process in an effective way. / Syftet med detta projekt ör att studera möjligheten till apoteksautomation genom att utveckla en enhet som liknar en varuautomat. Genom att designa, konstruera och programmera uppförs en prototyp. Huvudfokus för denna prototyp är att kontrollera om det är möjligt att minimera personalbehovet på apoteket. För att prototypen ska uppnå sitt syfte används ett stort antal komponenter. En skärm och ett tangentbord används för att låta användare interagera med prototypen. Dessutom krävs tre olika typer av motorer för att tillhandahålla läkemedel till användarna. Den slutliga prototypen kan förse användare med läkemedel från fyra olika rutor. Olika experiment genomfördes för att säkerställa att maskinen kan utföra de önskade uppgifterna och att den kan effektivt automatisera leveransen av olika mediciner.

<p>En ofullständig eller inaktuell dokumentation av läkemedel i Receptregistret och läkemedelslistorna kan leda till en sämre vetskap om vilka läkemedel som är aktuella att administrera samt till felmedicinering.</p><p>Syftet med denna studie är att hos patienter med diagnosen artros undersöka förekomsten av avvikelser mellan recept i Receptregistret på apotek, vårdcentralens läkemedelslista från ordinationsjournalen samt patienternas egen uppfattning om aktuell läkemedelsbehandling.</p><p>Studien genomfördes dels som registerstudie genom avstämning av journaldata på aktuella läkemedelsordinationer från Stensö Hälsocentral mot sparade recept i Receptregistret och dels som telefonintervju med patienterna om vilka recept som utgör hans/hennes aktuella ordinationer.</p><p>Av artrospatienternas recept i Receptregistret var 89 % aktuella och av artrospatiernas ordinationer i läkemedelslistorna på hälsocentralen var 69 % aktuella. Av alla artrospatienters ordinationer var det 52 % som var aktuella och som förekom i både Receptregistret och läkemedelslistorna.</p><p>Trots att studien är begränsad i storlek och att patienterna bara rekryterades från en vårdcentral indikerar resultaten att det finns betydande skillnader mellan artrospatienternas aktuella medicinering, deras läkemedelslistor på vårdcentral samt Receptregister från apotek. Genom att förbättra och göra regelbundna läkemedelsavstämningar efter ändringar i patientens läkemedelsbehandling, såväl på apotek som inom sjukvården, kan antalet avvikelser reduceras, följsamheten hos patienterna kan ökas genom att det blir lättare för dem att veta vilka läkemedel som är aktuella att administrera och medicineringsfel kan reduceras.</p> / <p>Misuse of drugs is a growing problem and a major cause of both morbidity and mortality in today's society. This may be a result of an incomplete or outdated medication history of patients and it is therefore important that all medical records are updated with the current drugs for the patient to use to prevent medication errors.</p><p>The ultimate effect of any drug therapy depends on the patient's decision to take their medicines as the doctor has prescribed, to have so-called adherence to their prescription medicines, which in turn depends in particular on the patient's knowledge of the drugs at issue. To assist the patient there are two kinds of printing, a list with the doctor’s prescriptions from the electronic patient record (EMR) and also a list from the national prescription repository (NPR) of all the saved prescriptions at pharmacies by the patient. Discrepancies may exist between what is documented in the patient's EMR and that in the pharmacy record, which both also may differ from the drugs that the patient actually is using. These discrepancies between the documents, which can both include valid and outdated prescriptions so as prescription duplicates, can cause a worsening of compliance and medication errors especially in patients with multiple drugs that may have difficult to keep track of their current drug treatment.</p><p>The aim of the study was compare the national prescription repository (NPR), the electronic medical records (EMR) and patient’s knowledge of the prescribed treatment for people with a diagnosis of osteoarthritis.</p><p>The study was conducted both as registry study by reconciliation of journal data on current drug prescriptions from a health centre (HCC) with saved recipes in the Swedish national prescription repository (NPR) and partly by telephone interview with patients about the prescriptions that represent his / her current prescriptions. The participation rate was 58 %. Twenty-nine patients with osteoarthritis were included in the study.</p><p>Of the osteoarthritis patients 89 % the recipes in the NPR were found to be valid and 11 % were outdated. Duplicates of recipes were estimated to 5 %, and double-medication occurred in 1 % of the recipes.</p><p>Of the patients' prescriptions in the medical records at the health centre 69 % were found to be valid. The outdated prescriptions were estimated to 31 % while 4 % was duplicates.</p><p>For all of the osteoarthritis patients' 247 drugs, only 52 % was valid and occurred both in the NPR and in the EMR.</p><p>There were major discrepancies between the prescriptions in the EMR, the NPR and what the patients with osteoarthritis are seeing as their current prescriptions. Through regular medical reconciliations after changes in the patients' treatment, in both health care and pharmacies, the discrepancies can be reduced, the patient can be surer of what to administrate and therefore medication errors can be reduced.</p>

Titel: Recept på differentiering – En studie om differentiering och kundlojalitet på den svenska apoteksmarknaden Författare: Elin Enblom &amp; Anita Music Handledare: Richard Afriyie Owusu Examinator: Bertil Hultén Kurs: Examensarbete på magisternivå 30 hp. Civilekonomprogrammet inriktning marknadsföring, Linnéuniversitetet Kalmar, VT2017. Forskningsfrågor: Hur nyttjar svenska apotek differentieringsstrategier för att uppnå konkurrensfördelar gentemot marknadens aktörer? På vilket sätt påverkas kundlojalitet av differentiering på den svenska apoteksmarknaden? Syfte: Syftet med studien är att utreda och analysera hur differentieringsstrategier nyttjas av apotek och vilken påverkan förevarande har på lojalitet hos kunden. Syftet kommer att undersökas utifrån både konsumenternas och apotekens perspektiv för att ge en mer objektiv syn. Studien ämnar att tolka de båda perspektivens syn på apoteksbranschens nuvarande arbete gällande differentiering och kundlojalitet för bidra till ökad kunskap inom området. Genom det önskar vi att bidra med teoretiska implikationer till den befintliga teorin. Studien ämnar även att bidra med generella praktiska implikationer för apoteksmarknaden och dess framtida utveckling inom området för differentiering och lojalitet. Slutligen kommer studien att bidra med mer specifika implikationer till uppdragsgivaren Apoteksgruppen AB på hur de borde differentiera sig för att kunna påverka kundernas lojalitet positivt. Genom dessa förslag önskar vi uppvisa hur Apoteksgruppen AB kan stärka sin konkurrenskraft gentemot marknadens övriga aktörer. Metod: Studien har nyttjat en kvalitativ inriktad fallstudie med en abduktiv ansats. Datainsamlingen av primärdata har skett genom fokusgrupper och intervjuer utifrån både ett kund- och företagsperspektiv. Resultat &amp; slutsatser: Differentieringsstrategier som nyttjas av svenska apotek och som ger konkurrensfördelar är varumärke, erbjudande, plats och lojalitetsprogram. Differentiering har en positiv påverkan på såväl beteende- och attitydaspekter av lojalitet där främst plats, service och erbjudande påverkar. Teoretiska &amp; praktiska implikationer: De teoretiska implikationerna består av en reviderad undersökningsmodell där sambandet mellan differentiering och lojalitet på den svenska apoteksmarknaden förklaras. Studien ger både generella praktiska implikationer samt implikationer specifika för Apoteksgruppen AB där de utvecklingsmöjligheter som finns för marknaden presenteras. Nyckelord: Differentiering, differentieringsstrategier, lojalitet, beteendelojalitet, attitydlojalitet, apotek. / Title: Recipe for differentiation - A study in differentiation and customer loyalty in the Swedish pharmacy market Authors: Elin Enblom &amp; Anita Music Supervisor: Richard Afriyie Owusu Examiner: Bertil Hultén Course: Master Thesis 30 ECTS, Business Administration and Economics Programme, Linnaeus University Kalmar, Spring 2017. Research questions: How does Swedish pharmacies use differentiation strategies to achieve competitive advantages against the market actors? How is customer loyalty affected by differentiation in the Swedish pharmacy market? Purpose: The purpose of the study is to investigate and analyze how differentiation strategies are used by pharmacies and what impact this has on the loyalty of the customer. The aim will be examined from the perspective of both consumers and pharmacists to provide a more objective view. The study aims to interpret the views of the two perspectives on the pharmaceutical industry's current work regarding differentiation and customer loyalty to contribute to increased knowledge in the field. Through this we wish to contribute theoretical implications to existing theory. The study also aims to provide general practical implications for the pharmacy market and its future development in ​​differentiation and loyalty. Finally, the study will contribute more specific implications to the client Apoteksgruppen AB on how they should differentiate to positively influence customer loyalty. Through these proposals, we wish to display how Apoteksgruppen AB can strengthen its competitiveness against other actors in the market. Method: The study has used a qualitatively oriented case study with an abductive approach. The data collection of primary data has been conducted through focus groups and interviews based on both a customer and business perspective. Results &amp; conclusions: Differentiation strategies used by Swedish pharmacies and which provide competitive advantages are brand, offer, location and loyalty programs. Differentiation has a positive impact on both behavioral and attitudinal aspects of loyalty, primarily in terms of location, service and offerings. Theoretical &amp; practical implications: The theoretical implications consist of a revised survey model explaining the relationship between differentiation and loyalty in the Swedish pharmacy market. The study gives both general practical implications and implications specific to Apoteksgruppen AB, where the opportunities of development available to the market are presented. Keywords: Differentiation, differentiation strategies, loyalty, behavioral loyalty, attitude loyalty, pharmacy.

The word communication originates from the Latin word communicare that means to do something in common. When human beings communicate with each other, we share thoughts, emotions, values and actions. The foundation in communication is found within the interpersonal communication, which is the act of communication between two persons. All types of communications include of verbal and nonverbal acts of communication. The verbal communication consists of words either in speech or writing, the nonverbal act implies gestures, frequency of the tone and facial expressions. Within the pharmaceutical profession, good communication between the pharmacist and the customer is important and can affect the customer’s health and quality of life in both direct as well as indirect ways. In recent years, the pharmacist's role in the pharmacy has drastically changed. Nowadays the care of the customer has gained more significance than before. To improve customer health and quality of life it is important that the pharmacist acts to promote a good relationship with the customer and the foundation for this relationship should be built on good terms of communication. The purpose of this study was to study how common it is with communication errors between pharmacist and customer, and to demonstrate probable underlying causes. Secondary questions were, how is the drug advice the pharmacist provides affected by communication errors? Collection of data for the study was done with structured observation charts, where the customer and pharmacist were strictly observed. A total of 316 meetings were observed and the data collected referred to prescriptions. In more than one-third of the observed meetings, there were communication errors between the pharmacist and the customer. Communication errors that arose concerned lack of eye contact, language barriers, choice of questions, background noise from colleagues and customers and discussions from generic exchanges. To reduce future communication errors, the pharmacist's actions should be strengthened, such as eye contact, clear follow-up questions and improved feedback.

Denna studie syftar till att utveckla kunskap om utländskt utbildade farmaceuters lärande. Särskild uppmärksamhet riktas mot deras upplevelser av den svenska arbetsmarknaden. Detta är ett aktuellt ämne i dagens samhälle och en förutsättning för en resursstark arbetsmarknad är att alla kompetenser tillvaratas. Med hjälp av sociokulturella perspektiv riktas särskild uppmärksamhet mot lärande som en aspekt av farmaceuternas upplevelser. Materialet består av fyra kvalitativa intervjuer med yrkesverksamma apotekare som tidigare deltagit i Uppsala universitets kompletteringsutbildning för utländskt utbildade farmaceuter. Forskningsfrågorna som ställs är: I vilka avseenden skiljer sig den kunskap om apotekaryrket som behövs i Sverige från farmaceuternas hemländer? Vilka lärsituationer uppger farmaceuterna uppkommit i deras arbetsliv? samt vad i kompletteringsutbildningens utformande och innehåll anser farmaceuterna varit särskilt utmärkande? Några av de mer framträdande resultaten är att det som främst skiljer apotekaryrket i Sverige från informanternas hemländer är lagregleringen av yrket, att nya system och hjälpmedel upplevs som utmanande samt förekomsten av nedsättande kommentarer från både kunder och kollegor. Sammantaget kan sägas att informanternas lärande i huvudsak är relaterat till skillnader mellan å ena sidan svensk yrkes- och professionskultur och å andra sidan den kultur som varit bärande i deras ursprungsländer. / The purpose of this study is to expand knowledge about foreign educated pharmacists’ learning. More specifically, this study aims to look at their experiences of the Swedish labor market. To utilize all competences is essential in order to maintain a profitable labor market. Special attention is paid to the pharmacists’ experiences of learning, viewed from socio-cultural perspectives. The results of the study are based on four qualitative interviews with working pharmacists who have completed the complementary programme at Uppsala University for pharmacists with a foreign degree. This study focuses on the differences in the profession between Sweden and other cultures, what learning situations the pharmacists experience in their working life, and aspects of the complementary programme. The results show that the law regulation and working routines in Sweden are what mainly differs from the respondents home countries. Furthermore, they regularly meet customers who act offensive towards them. The essential aspect of the respondents learning seems to be to understanding the Swedish working culture, which differs from that of other cultures. Learning is context-dependent and, depending on how much this is understood, learning situations can become more or less adapted.