University affiliation
Lund University
Main supervisor
Sara Modig, Associate professor, General practitioner
PhD project participating in the National Research School in General Medicine.
Correct medications are important in the patient’s treatment. Clinical pharmacists are experts on medications and can support patients and physicians to optimize treatment. The aim with this project is to evaluate if a new procedure can contribute to safety in medication treatment.
Clinical pharmacists in Skåne region, in Sweden conduct comprehensive medication reviews for hospitalized patients. A comprehensive medication review is a structured method to identify and solve drug-related problems. A drug-related problem might for example be interactions, adverse reactions, wrong dose in relation to renal function. Since hospitalized patients are mainly treated for an acute illness, some identified drug-related problems are more appropriate to deal with post discharge. In these situations, information needs to be transferred to the physician in primary healthcare. However, information transfer is known as a patient safety risk. To overcome this, it is recommended to send a referral. Since 2020, clinical pharmacists in hospitals in Skåne region have the possibility to send referrals with information about drug-related problems to primary healthcare. There is a lack of Swedish studies evaluating the model. Physicians in primary healthcare also have the possibility to send referrals to a clinical pharmacist with request for a comprehensive medication review. The demand for medication reviews in the community-dwelling patient group has increased but less is studied scientifically. To enable wider implementation of the model, more knowledge is required.
The project will include data from three different collections. The first collection is completed, a retrospective study with data from medication reviews for community-dwelling patients. Descriptive and comparative analysis was used to process the information from the medication reviews including patient data. Number of drug-related problems per patient was assessed and recategorized according to a model used in previous research.
The second data collection is under process, a retrospective study, charting hospitalized patients for whom a referral has been sent regarding drug-related problems, identified by clinical pharmacists. Descriptive and comparative analysis will be performed, as well as categorization of identified drug-related problems and medications. By using the Hatoum scale, we will explore clinical relevance of recommendations in referrals from clinical pharmacists working in hospitals to primary care physicians. The relationship between clinical relevance of recommendations and implementation will be analyzed. To understand the physicians’ perceptions about referrals from clinical pharmacists, a survey will be conducted.
In the third data collection we aim to understand the clinical pharmacists’ perceptions and experiences of referrals. A qualitative study will be conducted with focus group interviews as a method. Content analysis will be used, according to Graneheim and Lundman.
To ensure correct information transfer in the discharge process regarding drug-related problems, referrals might be a model for clinical pharmacists to use. Since this is a new work model for this profession the model requires adequate evaluation.
Lund University
Sara Modig, Associate professor, General practitioner