Objective:To describe the organization and delivery of community pharmacy and medical care, as well as pharmaceutical care practice and research, in Sweden.Findings:The Swedish retail pharmacy system of 800 community pharmacies and nearly 80 hospital pharmacies is unique in that it is organized into one single, government-owned chain, known as Apoteket AB. The pharmacy staff consists of pharmacists, prescriptionists, and pharmacy technicians. Some activities related to pharmaceutical care have been directed toward specific patient groups during annual theme campaigns. In the past few years, there has been a growing emphasis on the identification, resolution, and documentation of drug-related problems (DRPs) in Swedish pharmacy practice. A classification system for documenting DRPs and pharmacy interventions was developed in 1995 and incorporated into the software of all community pharmacies in 2001. A national DRP database (SWE-DRP) was established in 2004 to collect and analyze DRPs and interventions on ...

Pharmaceutical Care in Community Pharmacies: Practice and Research in Sweden

The objective of the overall study was to create a foundation for improving the quality of counselling practice in pharmacies. The research question addressed in this sub-study was to describe drug-related problems (DRPs) in terms of frequency as well as type in people with angina pectoris, type 2 diabetes and asthma, as the problems were identified through medication reviews and home interviews. During their pharmacy internships, fourth-year pharmacy students collected data for the study in 1999, 2000 and 2001 by carrying out medication reviews, conducting home interviews and registering DRPs for 414 patients. Data were collected from the following patient groups in the years indicated: in 1999, 123 angina pectoris patients; in 2000, 192 type 2 diabetes patients, and in 2001, 99 asthma patients. The interviews dealt with the patient’s drug-related experiences, knowledge, perceptions, problems and actions. The DRPs were registered according to the so-called PI-Doc system. A medication review was supplemented by qualitative interviews with the three patient groups, which revealed a relatively high number of DRPs compared to other studies. An average of 2.8 DRPs were identified per angina pectoris patient; 4.1 DRPs per type 2 diabetes patient and 4.0 DRPs per asthma patient. “Inappropriate use of medicines by the patient” and “Other problems” (such as limited knowledge of the illness, inappropriate lifestyle, fear of medication, lack of information, etc.) were the two most common DRP sub-categories identified in all three patient groups. The study provided a profile of a pharmacy-based population of 414 patients visiting the pharmacy, all of whom are at high risk of experiencing drug-related problems. Pharmacy staff needs to take this high rate of DRPs in people with angina pectoris, asthma and type 2 diabetes into account when dispensing medicines to and advising patients from the three groups, especially when explaining how to use medicines appropriately.

Drug-related problems in patients with angina pectoris, type 2 diabetes and asthma--interviewing patients at home.

The role of pharmacy has changed dramatically during the last decades, which has led to new demands on pharmacy personnel. Objective: This study aims at exploring the attitudes of Swedish pharmacy personnel on their role as public health promoters and to look at the opportunities and obstacles they identify in the efforts to widen the pharmacy remit to include a wider health approach. Method Eight focus group discussions were conducted with a strategic sample of pharmacy personnel working in two counties in Sweden. The discussions were transcribed verbatim and analysed by qualitative inductive analysis. Results Five themes were identified, “Pharmacy activities impact on public health”, “The employer, Apoteket AB”, “The new role welcomed”, “Obstacles in the new role”, and “Need of change and support”. Conclusion The concept of pharmacy personnel as public health promoters was not initially in the mindset of the participants. In the process of discussion, the impact of traditional pharmacy practice as well as new pharmacy based initiatives on public health gradually became more obvious to them. The findings show a pharmacy staff involved in a process of change. The participants have not yet landed in their new role as public health promoters and the study shows that practical as well as conceptual support is needed in order for pharmacy personnel to play a more important role in public health.

http://scielo.isciii.es/pdf/pharmacin/v6n4/211-218.pdf

Health promotion at Swedish pharmacies - views of the staff.

Folate is a dietary micronutrient essential to one-carbon metabolism. The World Health Organisation recommends folic acid (FA) supplementation pre-conception and in early pregnancy to reduce the risk of fetal neural tube defects (NTDs). Subsequently, many countries (~92) have mandatory FA fortification policies, as well as recommendations for periconceptional FA supplementation. Mandatory fortification initiatives have been largely successful in reducing the incidence of NTDs. However, humans have limited capacity to incorporate FA into the one-carbon metabolic pathway, resulting in the increasingly ubiquitous presence of circulating unmetabolised folic acid (uFA). Excess FA intake has emerged as a risk factor in gestational diabetes mellitus (GDM). Several other one-carbon metabolism components (vitamin B12, homocysteine and choline-derived betaine) are also closely entwined with GDM risk, suggesting a role for one-carbon metabolism in GDM pathogenesis. There is growing evidence from in vitro and animal studies suggesting a role for excess FA in dysregulation of one-carbon metabolism. Specifically, high levels of FA reduce methylenetetrahydrofolate reductase (MTHFR) activity, dysregulate the balance of thymidylate synthase (TS) and methionine synthase (MTR) activity, and elevate homocysteine. High homocysteine is associated with increased oxidative stress and trophoblast apoptosis and reduced human chorionic gonadotrophin (hCG) secretion and pancreatic β-cell function. While the relationship between high FA, perturbed one-carbon metabolism and GDM pathogenesis is not yet fully understood, here we summarise the current state of knowledge. Given rising rates of GDM, now estimated to be 14% globally, and widespread FA food fortification, further research is urgently needed to elucidate the mechanisms which underpin GDM pathogenesis.

/pdf/high-folate-perturbed-one-carbon-metabolism-and-gestational-3ix5vgyu.pdf

High Folate, Perturbed One-Carbon Metabolism and Gestational Diabetes Mellitus

Relatively little is known about the use of medicines and its predictors in adolescents and young adults However, individuals of this age frequently use medicines, in particular over-the-counter ones In addition, their knowledge of medicine use is often poor and their health behavior often comprises risky characteristics that increase a risk for medication related problems Stress caused by the military service, for example, is suggested to increase the use of medicines and other health care services Of Finnish young men, 80% perform compulsory military service for 6–12 months The aim of this study was to investigate the prevalence and predictors of the use of medicines among the Finnish conscripts performing common military service as well as to describe a drug information campaign to the conscripts and to evaluate the conscripts' attitudes towards it The data for this cross-sectional questionnaire study were drawn from three samples: overall prescribed and nonprescribed medicine use and their predictors among the male conscripts were examined in February 1999 (Sample 1, studies I and V, N = 3725, from 8 brigades, response rate 97%) and among the female conscripts in April 1999 (Sample 3, study IV, N = 177, 68% of all the women on duty) Self-medication patterns among the male conscripts were investigated in July 1999 (Sample 2, studies II and III, N = 857, from 8 brigades, 95%) In the self-medications studies II and III, Andersen's et al (1968 and 1995) theoretical health care utilization model was employed Univariate, bivariate and multivariate analyses were done Study I was carried out as part of a nationwide "Drug Information for Conscripts" -campaign Of the male conscripts, 71% had used medicines in 2 weeks in February 1999 (I), and 61 % of the female conscripts in April 1999 (IV) Of the men, 60% (44% of women) used prescribed and 42% (31%) nonprescribed medicines Solely nonprescribed medicines were used by 15% of the men In July 1999 (II), 65% of the men reported self-medication at least for one indication in the last 2 weeks Most of the self-medication was for pains or common cold symptoms (54% of all respondents) or for cough Of the men (I), 63% had used nonprescribed analgesics at least few times a week (15% daily or almost daily) In April 1999, 79% of the female conscripts reported self-medication Nonprescribed analgesics were used at least few times a week by 71% Vitamins were taken by 20% of the men in February 1999 (III) and by 36% of the women in April (IV) Use of caffeine tablets or other stimulants was reported by approximately 9% of individuals of both genders Overall use of prescribed medicines was associated with the male and female conscripts' sociodemographic, health and health behavior variables (I,IV) Among the men (II,III), overall self-medication and vitamin use was associated with predisposing and health behavior variables, but not with need ones Instead, along with predisposing and health behavior variables, need variables predicted self-medication for pain or common cold symptoms or use of caffeine tablets or other stimulants Potentially risky health behaviors with overall use of prescribed medicines and self-medication were detected In general, the conscripts had a positive attitude to the drug information campaign, received new information from it, and found this information useful The study showed that Finnish male and female conscripts commonly use prescribed medicines and self-medication In particular among the male conscripts, the prevalence of the use of medicines seemed to be at the same or a little higher level than reported among adolescents and young adults under civilian circumstances The prevalence of the use of prescribed and nonprescribed medicines among the conscripts can be seen high, because it is reported by probably the healthiest individuals of the age group The results underline the importance of appropriate medical and pharmaceutical services and drug information provided to the conscripts

/pdf/a-pharmacoepidemiological-study-of-medicine-use-among-15a5k1ra4p.pdf

A Pharmacoepidemiological Study of Medicine Use among Finnish Conscripts

Objective — To determine the incidence of drug-related therapy problems (DRTPs) among patients obtaining medicines for allergy, asthma or pain.



Method — Problem detection interventions at the pharmacies were carried out as project-like activities. Pharmacy staff members used open-ended questions to detect all DRTPs in patients presenting prescriptions for medicine for allergy, asthma and pain and in people buying over-the-counter (OTC) medicines for allergy. The data were collected under regular health care conditions and the study can therefore be considered as a survey of the epidemiology of DRTPs among the selected groups of patients.



Setting — Swedish community pharmacies during two one-year nationwide disease management programmes on allergy and pain.



Key findings — Of the 44,504 patients with prescriptions registered in the study, 13,895 (31 per cent) with DRTPs were detected. Of 1,135 people buying OTC medicines for hay fever/pollen allergy, 144 (13 per cent) with DRTPs were detected.



Conclusion — The study indicates that about one-third of patients with prescriptions have DRTPs. Only a fraction of all DRTPs are apparently discovered in the regular dispensing process at the pharmacies. Pharmacy staff need to use more active interventions, such as dialogue with open-ended questions, to efficiently identify and help patients with DRTPs.

Surveys of drug‐related therapy problems of patients using medicines for allergy, asthma and pain

https://academic.oup.com/ajcn/article-pdf/115/5/1432/43549103/nqab436.pdf

Plasma unmetabolized folic acid in pregnancy and risk of autistic traits and language impairment in antiseizure medication–exposed children of women with epilepsy

Forbattrad lakemedelsanvandning genom battre foljsamhet till lakemedelsordinationen : forslag till gemensamma mal for lakare, sjukskoterskor och farmaceuter

Förbättrad läkemedelsanvändning genom bättre följsamhet till läkemedelsordinationen : förslag till gemensamma mål för läkare, sjuksköterskor och farmaceuter

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Surveys of drug‐related therapy problems of patients using medicines for allergy, asthma and pain

Plasma unmetabolized folic acid in pregnancy and risk of autistic traits and language impairment in antiseizure medication–exposed children of women with epilepsy

Förbättrad läkemedelsanvändning genom bättre följsamhet till läkemedelsordinationen : förslag till gemensamma mål för läkare, sjuksköterskor och farmaceuter