Older people admitted to hospital are at high risk of rehospitalization and medication errors. We have demonstrated, in a randomized controlled trial, that a clinical pharmacist intervention reduces the incidence of revisits to hospital for patients aged 80 years or older admitted to an acute internal medicine ward. The aims of this thesis were to further study the effects of the intervention and to investigate possibilities of targeting the intervention by identifying predictors of treatment response or adverse health outcomes. The effect of the pharmacist intervention on the appropriateness of prescribing was assessed, by using three validated tools. This study showed that the quality of prescribing was improved for the patients in the intervention group but not for those in the control group. However, no association between the appropriateness of prescribing at discharge and revisits to hospital was observed. Subgroup analyses explored whether the clinical pharmacist intervention was equally effective in preventing emergency department visits in patients with few or many prescribed drugs and in those with different levels of inappropriate prescribing on admission. The intervention appeared to be most effective in patients taking fewer drugs, but the treatment effect was not altered by appropriateness of prescribing. The most relevant risk factors for rehospitalization and mortality were identified for the same study population, and a score for risk-estimation was constructed and internally validated (the 80+ score). Seven variables were selected. Impaired renal function, pulmonary disease, malignant disease, living in a nursing home, being prescribed an opioid and being prescribed a drug for peptic ulcer or gastroesophageal reflux disease were associated with an increased risk, while being prescribed an antidepressant drug (tricyclic antidepressants not included) was linked with a lower risk. These variables made up the components of the 80+ score. Pending external validation, this score has potential to aid identification of high-risk patients. The last study investigated the occurrence of prescription errors when patients with multi-dose dispensed (MDD) drugs were discharged from hospital. Twenty-five percent of the MDD orders contained at least one medication prescription error. Almost half of the errors were of moderate or major severity, with potential to cause increased health-care utilization.

The thesis investigates team talk and team collaboration from a dialogical perspec­tive, and is based on video recordings of 15 multi­professional team conferences involving a pain rehabilitation team. The analyses also draw upon a vast material of interviews, field notes and documents collected during almost a year of fieldwork at the clinic. The main purpose of the thesis is to shed light on some of the distinguish­ing linguistic features of such team confe­ren­ces and on the pragmatic strategies deployed by the team members in order to bring into play the variety of professional perspectives represented in the team. Ana­lyses of their lexical choices and interaction show three areas of responsibility: professional, overlapping and shared. Analyses of phases, activities and participant structures show how the team conferences can be understood as a specific type of institutional interaction, a communicative activity type that makes it possible both to share information and to reach a shared understanding of the patients’ problems. A deeper interactional analysis reveals pragmatic strategies enhancing the team’s multiprofessional com­munication: the identification and sorting of information, in-depth discussions of specific problems and decision-making procedures. The results illustrate central aspects of what is often called interprofessional competence within the field of health care, i.e. the ability to make the most of multiprofessional collabo­ration. The thesis adds to our understanding of team conferences as a communi­ca­tive activity type and increases our understanding of how participants can offer their perspec­tive through conversation, thereby making it possible for the others to adopt this perspective – in short, to achieve what is often referred to as a democratic dialogue. / Med utgångspunkt i ett dialogiskt perspektiv analyseras samtalen under teamkon­ferenserna i ett smärtrehabiliteringsteam för att beskriva språkliga strategier som stödjer samarbetet mellan företrädare för olika professioner. Analyserna baseras på videoinspelningar av 15 teamkonferenser (motsv. c:a 40 tim) samt fältanteck­ningar, intervjuer och dokument insamlade under ett knappt års fäl­tarbete. Analys­erna av ordförråd och interaktion visar att teammedlemmarnas ansvars­områden består av tre typer: professionsspecifika, delade och gemen­samma ansvarsom­råden. Analyser av faser, delaktiviteter och deltagarstruktur visar hur samtalen kan beskrivas som en form av inominstitutionella arbetsmöten, en verksamhetstyp som både ger möjlighet för teammedlemmarna att dela med sig av information till varandra och att nå en delad förståelse av patienternas situation och möjliga lös­ningar. Vidare har en mer omfattande interaktionsanalys resulterat i en beskriv­ning av språkliga strategier som stödjer samarbetet i teamet: inventering och sortering av information, fördjupande diskussioner av specifika problem samt för­handling och förankring av beslut. Analyserna visar också hur teammedlemmarna tillsammans definierar vilket förklaringsdjup som krävs i dis­kussionen av en viss aspekt av ett problem för att en delad förståelse av prob­lem och potentiella lös­ningar ska kunna uppnås. Tillsammans tydliggör resultaten några centrala aspek­ter av det som brukar kallas interprofessionell kompetens – förmågan att på ett socialt smidigt och interaktionellt effektivt sätt förhålla sig till och överskrida gränserna mellan olika professioners kompetens- och ansvarsområden. Avhandlingen bidrar till för­ståelsen av team­konferenser som verksamhetstyp och fördjupar förståelsen av hur samtalsdel­tagare kan göra sina respektive perspektiv tillgängliga för varandra – en grundläggande förutsättning för att uppnå det vi brukar kalla det goda samtalet.