Monitoring of patients prescribed potassium supplements Zuzana Hovorkova Degree Project 30 hp, Pharmacotherapy Department of Pharmaceutical Biosciences/Division of Pharmacokinetics and Drug Therapy Supervisor: Linden Ashfield, Examiner: Margareta Hammarlund-Udenaes Introduction: In Northern Ireland, clinical technicians have been supporting pharmacist in their work in over five decades. From initially having mainly administrative tasks, the role of pharmacy technicians has progressed to more clinical activities. Following recent incidents caused by inadequate monitoring of potassium blood levels it was suggested pharmacy technicians could be utilized to improve patient care. Aim: Aim of this project was to ensure the appropriate monitoring and compliance with treatment guidelines for patients prescribed potassium supplements by extending the role of pharmacy technicians at Antrim Area Hospital. Methods: Training for extending the roles of clinical technicians was developed, following the structure of  a regional training programme. Literature search was made to find appropriate background about the subject of interest. Data about monitoring of potassium levels in the relevant patients was collected. Daily monitoring of these patients before and after the change was implemented were compared. Results: Clinical technicians contribution to monitoring of patients prescribed potassium replacement therapy improved guidelines compliance from 66.6 %  to 90 % (x2-test, p = 0.028). Percentage of successful treatment raised from 66 % to 89.7 % (x2-test, p = 0.028). Conclusion: By extending roles of the clinical technicians, better and appropriate monitoring of patients prescribed potassium supplements can be reached. In future, roles of the pharmacy technicians could be extended further, thus releasing  pharmacists time to expand their role, leading to a more cost- effective system and ensuring medicines optimization.

För att uppnå en optimal läkemedelsbehandling krävs uppdaterade och korrekta ordinationsunderlag inom hela vårdkedjan. Studiens syfte var att kartlägga vad patienten använder som underlag för sin läkemedelsbehandling samt hur många som kände till läkemedelslistan, receptlistan och läkemedelsförteckningen. Vidare syftade studien till att kartlägga hur vanligt förekommande avvikelser är mellan receptlistan och vad patienten uppger vara inaktuella recept, inaktuella/aktuella dubbletter eller saknade recept, samt att jämföra resultatet med motsvarande studie gjord 2012. Datainsamlingen gjordes med hjälp av patientintervjuer på åtta olika apotek under fyra veckor mellan februari och mars 2018. Studiens resultat visade att nästan alla patienter kände till receptlistan och att mer än varannan patient använde den som underlag för sin läkemedelsbehandling. Fyra av tio patienter använde förpackningsetiketterna, drygt sex av tio patienter kände till läkemedelslistan, varav endast var åttonde patient använde den som underlag. Var sjätte patient kände till läkemedelsförteckningen men endast ett fåtal använde den som underlag. Ungefär 8 av 10 patienter hade en eller flera avvikelser i receptlistan. Varannan patient hade aktiva dubbletter vilket var den mest frekventa avvikelsen bland deltagarna. Jämförelse av avvikelser i aktuell studie med studien 2012 visade att ingen större förändring har skett mellan åren 2012 och 2018 med avseende på avvikelser mellan receptlistan och vad kunden uppgav vara inaktuella recept, aktuella dubbletter eller saknade recept i receptlistan. Studien visar dels att en stor andel patienter inte känner till nödvändiga informationsunderlag som behövs för en säker läkemedelsbehandling, samt att receptlistan ofta innehåller avvikelser, något som kan öka risken för felmedicinering.

Bakgrund: Generikareformen trädde i kraft i Sverige 1 oktober 2002 med avsikt att sänka kostnader för läkemedel dels för den enskilde individen men även för samhället. Detta innebar att receptförskrivna läkemedel började bytas ut mot billigare generiska preparat, om varken behandlande läkare, expedierande farmaceut eller kund motsatte sig utbytet. Reformen har minskat läkemedelskostnaderna, men har för kunderna i vissa fall lett till förvirring, osäkerhet och medicinska problem. Syfte: Syftet med denna studie är att undersöka vilken attityd kunder på apoteket har till generiskt utbyte 16 år efter att reformen trädde i kraft, vilka problem som eventuellt kan uppstå i samband med detta, samt att identifiera eventuella skillnader mellan kvinnor och män i deras inställning till generiskt utbyte. Material & Metod: För att besvara syftet med studien utfördes en enkätstudie på fem olika orter i Sverige, där kunden genom 11 flervalsfrågor fick ge sin syn på generisk substitution. Inkluderades i studien gjorde personer över 18 år som besökte apoteket för att hämta ut receptförskrivet läkemedel åt sig själv och i samband med detta gavs möjlighet att byta till generika. Svaren sammanställdes i databas (Excel). Kvalitetssäkring och korstabulering utfördes. Chi2-test användes för att testa om skillnader mellan könen är statistiskt signifikanta eller ej. Resultat: Övervägande del av kunderna som deltog i studien hade en positiv inställning till generisk substitution, ingen skillnad mellan könen. Dock uppgav en del av kunderna sig ha fått problem i samband med att deras läkemedel byts ut mot generika. Vanliga problem var att kunden ej kände igen namn på läkemedlet eller utseendet av beredningen respektive förpackningen. Större andel kvinnor än män angav sig ha problem med nya biverkningar efter utbytet samt skillnad i effekt. Slutsats: På grund av flera tänkbara biaser bör generella slutsatser utifrån denna studie dras med viss försiktighet. Men resultatet pekar till viss del i samma riktning som tidigare utförda studier och visar att övervägande del av kunderna på apoteket är både villiga att byta ut sina receptförskrivna läkemedel mot generiska preparat och är överlag nöjda med sitt utbyte. Ingen skillnad mellan könen. De problem som oftast uppstår i samband med generisk substitution är att kunden ej känner igen sitt läkemedel efter utbytet, därför finns det ett behov av att se över om det går att göra förbättringar som tydligare förpackningar och likartade tabletter. Kvinnor verkar stöta på problem i samband med generiskt utbyte i större utsträckning än män, detta samt eventuella orsaken bör dock studeras vidare.

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Title Prehospital pain management of traumatically injured adult patients Authors Benström S Institute Uppsala University, Uppsala, Sweden Background and objective Traumatic injuries are a major cause behind moderate and severe pain in a prehospital setting. Therefore, the aim of this study is to evaluate prehospital use of analgesics among adult traumatically injured patients treated within Tartu Ambulance Foundation by analysing how ambulance personnel evaluates and treats pain. Secondary aim is to map prehospital factors influencing the process. Setting and Method A retrospective, single-centre service evaluation study with the primary selection of 7526 electronic patient records (EPR) with the main diagnosis of S00-T98 (ICD-10) was conducted and a polyvariant logistic regression model was created to map factors that influence pain management. Main outcome measures Primary outcome measures were prevalence of pain evaluation and the use of analgesics. Secondary outcome measures were significant changes in odds ratios for prehospital-related factors that affected primary outcome measures. Results Mean age of the study population was 54 years (SD 22) and 775 (58.9%) were male. Out of all the patients in this study 529 (40.3%) received analgesics. Pain assessment before administrating analgesics was documented on 15.9% of EPRs. Nurses assessed pain 3.3 times (95% CI 2.0-5.3; p<0.001) more likely than physicians. The odds for receiving analgesics were 2.3 (95% CI 1.68-3.08; p < 0,001) times smaller when patients had consumed alcohol. Brief assignment (0-10 min) and hospitalisation reduced the odds of using analgesics by 3.6 times (95% CI 1.9-6.8; p<0,001) and 1.59 times (95% CI 1.13-2.24; p<0.007) respectively while lengthy assignments (>50 min) increased the odds by 3.4 times (95% CI 1.9-6.5; p<0,001). Monotherapy was chosen for 73.2% of patients while 24.6% received a combination of 2 and 2.2% a combination of 3 analgesics.   Conclusions   Current study showed that although nurses as brigade leaders are more likely to assess pain the overall prevalence remains low. Alcohol consumption among patients, short assignment times, and hospitalization decreased the odds for pharmacological pain management. Longer assignment times on the contrary were associated with increased odds. Improvements in pain management can be made in choosing between specific therapeutic options.

Background: The world prevalence of diabetes mellitus in 2019 was 8.3%, out of which 85-90% have type 2 diabetes mellitus (T2DM). Numerous drugs for treating T2DM are approved, and one of the newer classes of drugs are GLP-1 receptor agonists (GLP-1 RAs). In Sweden during 2015 to 2019, the number of patients using GLP-1 RAs has increased by 280%. Despite this, few studies have explored the experiences of patients using these drugs.  Aim: The aim of this study was to gain knowledge about how patients diagnosed with T2DM experience and understand their treatment with GLP-1 RAs in Sweden.  Methods: Individual semi-structural interviews were conducted with seven patients and three persons from the healthcare staff during October and November 2020 in Region Uppsala, Sweden. The data was analyzed qualitatively with systematic text condensation. Results: The four main findings were: 1) Both patients with great effect and less effect were satisfied with treatment and preferred GLP-1 RAs compared to their other treatments, 2) GLP-1 RAs may have an impact on lifestyle by effect on appetite and hunger and through the stability in glucose level, more freedom, 3) The preferred administration frequency depended on how easy it was to remember taking the drug, 4) Patients mostly understood their treatment as well as they wanted to, but regular initiation follow-ups and more explanations of decisions could increase treatment motivation and reduce anxiety.The healthcare staff confirmed these experiences by patients but assumed patients preferred weekly administrations compared to daily administrations.  Conclusions: Patients’ experiences of using GLP-1 RAs were positive and they described GLP-1 RAs as the best T2DM treatment they had.

Background and objectives: Medication is a source for improved health and increased life quality when used right but also a risk for unnecessary suffering when used wrong. Health personnel have a responsibility obligated by law to give patients individual information in order to enable safe usage and encourage concordance. This project aimed to investigate patients’ satisfaction with the information given about their cardiovascular medication by health personnel and to identify patients’ main sources of information. Design: This was a cross-sectional study with a duration of 2,5 weeks. The objectives were investigated using a survey. Participants were asked to rate the information they had received about their cardiovascular medications by health personnel on a response scale. Data was analyzed using descriptive statistics. Settings: Patients were recruited from four internal medicine wards in Trelleborg’s hospital. Main outcome measures: Satisfaction with information was categorized using the response scale. A score was calculated based on the survey in order to estimate the overall satisfaction and to compare subpopulations. Different options for information sources were listed in the survey. Results: Of 83 eligible patients 60 were included (32 women, age range 50-91). Populations satisfaction score median was 7,5 (5-10) out of 13. No significant difference could be found between subgroups based on gender (p=0,28), age (p=0,42) or educational level (p=0,85). Lowest satisfaction was seen with information about side effects, interactions and required life style changes while highest satisfaction was seen with information about the expected effect of the medicine and how to use it. Patients’ main sources for information were primary care physician, community pharmacist followed by the medicine leaflet which seemed to be the main source for information about side effects and handling of a missed dose. Conclusion: This study indicates that patients wish for more information linked to potential problems of their medicine usage. No difference was found between subgroups; however, this study is likely underpowered to confirm such a correlation. Although patients’ main sources were primary care physician and community pharmacist the medicine leaflet seemed to be an important complement and in some aspects a substitute for health personnel.

Abstrakt   Inledning Övervätskning har under senare tid väckt ett stort intresse då de kan leda till ödem och organdysfunktion. Patienter som vårdas på intensivvårdsavdelningar (IVA) administreras ofta intravenöst med vätskor i form av läkemedel och näring. Genom att ge mer koncentrerad administrering av läkemedel kan problem med övervätskning hanteras. På begäran av IVA i Västmanlands sjukhus begränsades fem läkemedelssubstanser där syftet för arbetet skulle studeras och besvaras. Syftet med denna studie var att undersöka om man på ett säkert sätt kan administrera de intravenösa läkemedelssubstanserna trimetoprim/sulfametoxazol, remifentanil, dexmedetomidin, erytromycin samt aciclovir i högre koncentrationän gängse praxis på en intensivvårdsavdelning. Metod Studien utfördes under perioden januari – maj 2020 på enheten för sjukvårdsfarmaci på Västmanlands sjukhus i Västerås. Metoden som användes för detta arbete var en litteratursökning i databaserna Pubmed och Cinahl. För att komplettera sökningen användes databaserna Eped, Micromedex samt UKCPAs handbok Minimum infusion volumes for fluid restricted critically ill patients. Resultat Totalt erhölls elva artiklar som inkluderades i studien. Trimetoprim/sulfametoxazol, remifentanil, erytromycin samt aciclovir kunde administreras i högre koncentration på ett säkert sätt än gängse praxis på IVA i Västmanlands sjukhus. Ingen artikel visade att dexmedetomidin kan administreras intravenöst i högre koncentration medan en studie visade att den kan administreras subkutant i högre koncentration. Slutsats Det fanns sparsamt med information inom detta område i dagsläget. Stabilitetsstudier var av hög kvalité, men kliniska studier saknas. Fyra av fem läkemedel kan antas  administreras i högre koncentration än vad IVA i Västmanlands sjukhus använder sig av idag. Som vidare forskning kan man göra studier på dexmedetomidin intravenöst eftersom den går att administreras subkutant i en högre koncentration. I framtiden krävs mer forskning inom detta område för att komma fram till fler resultat samt styrka resultaten av de studier som finns idag.

INTRODUCTION: Gastrointestinal cancers are one of the most fatal malignancies worldwide in both genders and all ages while breast cancer is the leading cause of cancer deaths in women internationally. Angiogenesis inhibitors and epidermal growth factor inhibitors are mainly used in colorectal and gastric cancer, while cyclin-dependent kinase inhibitors are mainly used in the treatment of breast cancer. However, studies of cost-effectiveness are needed to assess whether the high prices for these drugs can be justified with better outcomes and to what extent the total expenditure is acceptable for the health care system. Regional comparisons are important for future advancement within the field.   PURPOSE: The aim with this study was to describe whether there were any differences regarding the use of selected cancer drugs in Sweden’s six healthcare regions from 2005 to 2020.   METHOD: This research was a descriptive-comparative study. The aggregate-level data used in this paper was provided by the Swedish eHealth Agency and included the measurement total sales cost per 100,000 inhabitants of cyclin-dependent kinase inhibitors for both outpatient care as well as inpatient care. The angiogenesis inhibitors and epidermal growth factor receptor inhibitors were solely used in inpatient care. All data included both genders and all ages.   RESULTS: The majority of the cancer drugs studied in this paper had an uneven use and major differences were noted between the regions as regards the consumption of specifically bevacizumab and palbociclib in all the healthcare regions. Notable was the uptake of bevacizumab with approximately a four-fold difference between the southeast healthcare region and the west healthcare region in the year 2020. Palbociclib demonstrated circa seven-fold difference in uptake in the year 2020 between the west healthcare region and the north healthcare region.    CONCLUSION: Broadly, we can conclude that there are regional differences in the use of angiogenesis inhibitors and epidermal growth factor inhibitors in the treatment of colorectal cancer and gastric cancer. Cyclin-dependent kinase inhibitors also demonstrate regional differences in the treatment of breast cancer in Sweden’s six healthcare regions. It is of interest to further study why the regional differences exist in Sweden.

No description available.