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Bernsten, Cecilia
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Publications (10 of 33) Show all publications
Holmström, I. K., Bastholm-Rahmner, P., Bernsten, C., Röing, M. & Björkman, I. (2014). Swedish teenagers and over-the-counter analgesics: Responsible, casual or careless use. Research in Social and Administrative Pharmacy, 10(2), 408-418
Open this publication in new window or tab >>Swedish teenagers and over-the-counter analgesics: Responsible, casual or careless use
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2014 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, E-ISSN 1934-8150, Vol. 10, no 2, p. 408-418Article in journal (Refereed) Published
Abstract [en]

Background

Teenagers in Sweden were given greater access as consumers of OTC drugs in 2009 after the reregulation of the pharmacy market, which allowed for the establishment of private pharmacies and sale of specific over-the-counter (OTC) drugs in retail stores and gas stations. Increased access to OTC drugs could provide new opportunities for self-care but attenuates the opportunity for the traditional expert surveillance of pharmacists, thus increasing the possibility of inappropriate OTC drug use.

Objectives

Views of 16–19 year old Swedish teenagers on OTC drugs, with special regard to analgesic drugs were explored and described, based on the following questions: How and where did they acquire their knowledge and attitudes regarding OTC drugs? What perceptions did they have about the use of OTC drugs?

Methods

A qualitative approach with a descriptive design was chosen. Data were collected in 2011 with 10 focus group discussions with high school students aged 16–19 years from different parts of Sweden. A total of 77 teenagers participated, 33 males and 44 females. A manifest qualitative content analysis was performed.

Results

While most teenagers appeared to have responsible attitudes toward OTC drugs and their use, some teenagers had attitudes that ranged from casual to careless. The focus group discussions also revealed knowledge gaps among teenagers regarding OTC drugs, and the significant influence of parents and peers on their OTC drug use.

Conclusions

This study provides insight into how vulnerable some teenagers could be as new consumers of OTC drugs and suggested that educational efforts could be geared toward parents as well as teenagers.

Keywords
Teenagers, OTC drugs, Analgesics, Sweden, Qualitative content analysis
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-220734 (URN)10.1016/j.sapharm.2013.06.004 (DOI)000332532000012 ()
Available from: 2014-03-20 Created: 2014-03-20 Last updated: 2017-12-05Bibliographically approved
Bardage, C., Westerlund, T., Barzi, S. & Bernsten, C. (2013). Non-prescription medicines for pain and fever: A comparison of recommendations and counseling from staff in pharmacy and general sales stores. Health Policy, 110(1), 76-83
Open this publication in new window or tab >>Non-prescription medicines for pain and fever: A comparison of recommendations and counseling from staff in pharmacy and general sales stores
2013 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 110, no 1, p. 76-83Article in journal (Refereed) Published
Abstract [en]

Objectives: The purpose of this study is to map and analyze the content and quality of theencounter when customers buy non-prescription medicines for pain and fever.

Methods: 297 pharmacies and 801 general sales stores (GSS) in Sweden were selected. A"Mystery shopper" exercise was conducted. Three scenarios were used and a total of 366units were selected for each scenario. There were in total 625 observers: 208 in the childwith fever scenario, 225 in the Reliv scenario, and 192 in the painkiller during pregnancyscenario. Data collection: 21st September to 20th November 2011.

Results: In two out of three visits to GSS, the staff proposed a medicine for a heavily pregnantwoman. The staff suggested in 9% of the visits a medicine that is inappropriate in latepregnancy. The corresponding percentage in pharmacies was 1%.Both pharmacies and GSS proposed, in 6% a medicine that is inappropriate for babies toa feverish child. Only 16% of the pharmacists and 14% of the staff in GSS asked for the ageof the child.General sales staff recommended in 10% ibuprofen and in 4% an acetylsalicylic acid productwhen an acetaminophen preparation was requested. The corresponding percentage inthe pharmacy were 4% ibuprofen, 2% diclofenac, and 1% an acetylsalicylic acid product.

Conclusions: The staff in GSS and pharmacies do not pay sufficient attention to the heterogeneityof painkillers, which lead to inappropriate recommendations.

Keywords
Analgesics, General sales stores’ counseling, Non-prescription medicines, Over-the-counter drugs, Pharmacists’ recommendations and counseling, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-192340 (URN)10.1016/j.healthpol.2012.12.006 (DOI)000317372200010 ()
Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2017-12-06Bibliographically approved
Tully, M. P., Beckman-Gyllenstrand, A. & Bernsten, C. B. (2011). Factors predicting poor counselling about prescription medicines in Swedish community pharmacies. Patient Education and Counseling, 83(1), 3-6
Open this publication in new window or tab >>Factors predicting poor counselling about prescription medicines in Swedish community pharmacies
2011 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 83, no 1, p. 3-6Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate predictors of 'no counselling', 'no questioning' and 'provision of no information' for three prescribed medicines in community pharmacies in Sweden. Methods: One hundred pharmacies were randomly selected, stratified by size and location. Three simulated patients visited each with a prescription for fluoxetine, naproxen or metformin. Counselling details and information about the pharmacy and its staff were recorded immediately after the visit. Data were weighted by strata size for analysis. Results: Data were available for 292 prescriptions. No questioning occurred for 108 (37%), no information for 75 (26%) and no counselling (no questioning and no information) occurred with 53 (18%) prescriptions. Staff ignored negative responses about previous usage and rarely asked further questions or provided information. Predictors of no counselling included when the staff member was over 50 years old (OR = 2.10, CI = 1.18-3.43), during lunchtime (OR = 1.69, CI = 1.00-2.86) and when the prescription was for metformin (OR = 2.49, CI = 1.34-4.63). Conclusion: The findings suggest the importance of therapeutic class and busy times as predictors of no counselling about prescription medicines in Swedish pharmacies. Practice Implications: Although pharmacy staff should counsel patients, in many cases they did not. Why this happens and what hinders them from doing so needs to be further investigated.

Keywords
Community pharmacy, Information provision, Prescription medicines, Questioning, Sweden
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-126082 (URN)10.1016/j.pec.2010.04.029 (DOI)000289026000002 ()20605395 (PubMedID)
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2018-01-12Bibliographically approved
Bernsten, C., Andersson, K., Gariepy, Y. & Simoens, S. (2010). A comparative analysis of remuneration models for pharmaceutical professional services. Health Policy, 95(1), 1-9
Open this publication in new window or tab >>A comparative analysis of remuneration models for pharmaceutical professional services
2010 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 95, no 1, p. 1-9Article, review/survey (Refereed) Published
Abstract [en]

Objectives: Pharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services. Methods: Information about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts. Results: Remuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services. budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients. Conclusions: Professional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality. (C) 2009 Elsevier Ireland Ltd. All rights reserved.

Keywords
Remuneration, Pharmaceutical professional services, Community pharmacy, Comparative analysis
Identifiers
urn:nbn:se:uu:diva-152249 (URN)10.1016/j.healthpol.2009.11.008 (DOI)000276594600001 ()19945762 (PubMedID)
Available from: 2011-04-27 Created: 2011-04-27 Last updated: 2017-12-11Bibliographically approved
Hughes, C. M., Hawwa, A. F., Scullin, C., Anderson, C., Bernsten, C. B., Björnsdóttir, I., . . . McElnay, J. C. (2010). Provision of pharmaceutical care by community pharmacists: a comparison across Europe. Pharmacy World & Science, 32(4), 472-487
Open this publication in new window or tab >>Provision of pharmaceutical care by community pharmacists: a comparison across Europe
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2010 (English)In: Pharmacy World & Science, ISSN 0928-1231, E-ISSN 1573-739X, Vol. 32, no 4, p. 472-487Article in journal (Refereed) Published
Abstract [en]

Objective To investigate the provision of pharmaceutical care by community pharmacists across Europe and to examine the various factors that could affect its implementation. Methods A questionnaire-based survey of community pharmacies was conducted within 13 European countries. The questionnaire consisted of two sections. The first section focussed on demographic data and services provided in the pharmacy. The second section was a slightly adapted version of the Behavioral Pharmaceutical Care Scale (BPCS) which consists of three main dimensions (direct patient care activities, referral and consultation activities and instrumental activities). Results Response rates ranged from 10–71% between countries. The mean total score achieved by community pharmacists, expressed as a percentage of the total score achievable, ranged from 31.6 (Denmark) to 52.2% (Ireland). Even though different aspects of pharmaceutical care were implemented to different extents across Europe, it was noted that the lowest scores were consistently achieved in the direct patient care dimension (particularly those related to documentation, patient assessment and implementation of therapeutic objectives and monitoring plans) followed by performance evaluation and evaluation of patient satisfaction. Pharmacists who dispensed higher daily numbers of prescriptions in Ireland, Germany and Switzerland had significantly higher total BPCS scores. In addition, pharmacists in England and Ireland who were supported in their place of work by other pharmacists scored significantly higher on referral and consultation and had a higher overall provision of pharmaceutical care. Conclusion The present findings suggest that the provision of pharmaceutical care in community pharmacy is still limited within Europe. Pharmacists were routinely engaged in general activities such as patient record screening but were infrequently involved in patient centred professional activities such as the implementation of therapeutic objectives and monitoring plans, or in self-evaluation of performance.

Keywords
Community pharmacy, Europe, Pharmaceutical care, Pharmacists
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-126078 (URN)10.1007/s11096-010-9393-x (DOI)000280802200010 ()
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2018-01-12Bibliographically approved
Olsson, J., Bergman, Å., Carlsten, A., Thimothy, O., Bernsten, C., Schmidt, I. K. & Fastbom, J. (2010). Quality of Drug Prescribing in Elderly People in Nursing Homes and Special Care Units for Dementia: A Cross-Sectional Computerized Pharmacy Register Analysis. Clinical drug investigation, 30(5), 289-300
Open this publication in new window or tab >>Quality of Drug Prescribing in Elderly People in Nursing Homes and Special Care Units for Dementia: A Cross-Sectional Computerized Pharmacy Register Analysis
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2010 (English)In: Clinical drug investigation, ISSN 1173-2563, E-ISSN 1179-1918, Vol. 30, no 5, p. 289-300Article in journal (Refereed) Published
Abstract [en]

Background: Drug prescribing to the elderly is extensive and often inappropriate. Furthermore, the number of drugs used is the most important risk factor for adverse drug reactions. Despite this, drug prescribing in the elderly in Sweden is high and increasing. In 2003 the Swedish National Board of Health and Welfare launched a set of indicators to evaluate the quality of drug therapy in the elderly. Use of this tool in combination with the Swedish computerized national register covering all persons receiving multi-dose drug dispensing (drugs dispensed in one dose unit bag for each dose occasion) would enable detection of inappropriate drug prescribing and could help reduce the risk of drug-related problems among the elderly.

Objectives: To assess the extent and quality of drug prescribing in younger and older elderly residents receiving multi-dose drug dispensing in ordinary nursing homes (NHs) and special care units for dementia (NHDs), and to evaluate the relationship between the quality of prescribing and the number of prescribers per resident, in a Swedish county.

Methods: The computerized national pharmacy drug register provided the database and a cross-sectional design was used. Selected drug-specific quality indicators proposed by the Swedish National Board of Health and Welfare in 2003 were used to assess the quality of drug prescribing.

Results: This study included 3705 residents. Their mean age was 85 years and 72% were women. The mean number of prescribed drugs was 10.3 per resident. The proportion of residents with prescriptions for psychotropic drugs was 80% in NHs and 85% in NHDs. The prevalence of each drug-specific quality indicator was as follows: long-acting benzodiazepines 16.4% (NHs) versus 11.7% (NHDs), anticholinergic drugs 20.7% versus 18.5%, drug duplication 14.6% versus 13.6%, three or more psychotropic drugs 25.6% versus 35.3%, class C interactions (drug combinations that may require dose adjustment) 41.9% versus 38.7% and class D interactions (drug combinations that should be avoided) 8.1% versus 5.6%. Younger elderly residents (age 65-79 years) had a lower quality of drug prescribing. An increasing number of prescribers per resident was associated with a lower quality of drug therapy.

Conclusions: We found a lower quality of drug prescribing, e.g. anticholinergic drugs prescribed to approximately 20% of residents of NHs and NHDs, and a higher rate of psychotropic drug use (>=80%) compared with previous studies in NHs. Our results also demonstrated a negative correlation between quality of prescribing and number of prescribers per resident.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-126081 (URN)10.2165/11534320-000000000-00000 (DOI)000277371300002 ()
Available from: 2010-06-02 Created: 2010-06-02 Last updated: 2017-12-12Bibliographically approved
Björkman, I., Bernsten, C. & Sanner, M. (2009). Author reply [Letter to the editor]. Research in Social and Administrative Pharmacy : RSAP, 5(1), 3-3
Open this publication in new window or tab >>Author reply
2009 (English)In: Research in Social and Administrative Pharmacy : RSAP, ISSN 1551-7411, Vol. 5, no 1, p. 3-3Article in journal, Letter (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-103885 (URN)10.1016/j.sapharm.2009.02.003 (DOI)000264066100002 ()19285284 (PubMedID)
Available from: 2009-05-25 Created: 2009-05-25 Last updated: 2011-04-27Bibliographically approved
Björkman, I., Bernsten, C. & Sanner, M. (2008). Care ideologies reflected in 4 conceptions of pharmaceutical care. Research in Social and Administrative Pharmacy, 4(4), 332-342
Open this publication in new window or tab >>Care ideologies reflected in 4 conceptions of pharmaceutical care
2008 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-741, Vol. 4, no 4, p. 332-342Article in journal (Refereed) Published
Abstract [en]

Background: Different ways to practice pharmaceutical care have been developed. One expression of this fact is the existence of many different classification systems to document drug-related problems (DRPs). Evidence suggests that classification systems have different characteristics and that these characteristics reflect different conceptions of pharmaceutical care. To increase the understanding of conceptions of pharmaceutical care, underlying values and beliefs (ideologies) can be explored. Objective: To explore various conceptions of pharmaceutical care to identify the care ideologies on which these conceptions are based. Methods: Representatives of 4 selected conceptions of pharmaceutical care were interviewed in face-to-face meetings. During the interviews, 4 basic questions were asked. Three were focused on pharmaceutical care and 1 on DRPs. Interview transcripts were analyzed by an inductive method inspired by grounded theory. The conceptions studied were Strand, Granada-II, PCNE v5.0, and Apoteket. Results: In Strand, patients are given a more active role in the pharmaceutical care process, as compared to Granada-II, PCNE v5.0, and Apoteket. Pharmacists in all the conceptions of pharmaceutical care assume they have special knowledge that patients benefit from. However, they use their knowledge in different ways in the various pharmaceutical care conceptions. In Strand, individual goals of drug therapy are established together with the patient, whereas in Granada-II, PCNE, and Apoteket goals are not explicitly discussed. The identified differences correspond to different care ideologies. Conclusions: The pharmaceutical care conceptions are based on different care ideologies. The ideology is expressed in how therapy goals are set and patient needs defined. Strand is based on a patient-centered ideology; patient therapy goals and needs are defined by the patient together with the practitioners. Granada-II, PCNE, and Apoteket are based on an evidence-based medicine approach; patient therapy goals and needs are defined by the practitioners, based on available scientific knowledge.

Keywords
Pharmaceutical care, Care ideology
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-95183 (URN)10.1016/j.sapharm.2008.01.001 (DOI)000262301800003 ()19064240 (PubMedID)
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2018-01-13Bibliographically approved
Björkman, I., Sanner, M. & Bernsten, C. (2008). Comparing 4 classification systems for drug-related problems: Processes and functions. Research in Social and Administrative Pharmacy, 4(4), 320-31
Open this publication in new window or tab >>Comparing 4 classification systems for drug-related problems: Processes and functions
2008 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-7411, Vol. 4, no 4, p. 320-31Article in journal (Refereed) Published
Abstract [en]

Background

Counseling patients on drug-related problems (DRPs) is a new enterprise for pharmacists. Accordingly, a variety of classification systems have been created to document DRPs. This aroused our interest in finding out how classification systems differ.

Objective

The objective is to explore and describe the characteristics of 4 classification systems for DRPs to understand their similarities and differences with regard to processes and functions.

Methods

Four established classification systems were selected; they were Strand, Granada-II, Pharmaceutical Care Network Europe v5.0, and Apoteket. To gain experience of the use of the systems, an existing database containing documented problems that were identified during patient counseling at community pharmacies was used. The entries in the database were classified using the 4 selected classification systems, one at a time. In the following analysis, focus was set on what issues were classified and how they were classified in each system. Based on similarities and differences, 8 themes were identified and characteristics of the 4 systems were listed according to these themes. Characteristics of each system were thoroughly scrutinized and interpreted.

Results

The processes of selecting classification categories were different in all 4 systems, and as a result the contents of categories in systems were different. The systems had different characteristics and a decisive characteristic was whether the patients were involved in the classification of problems or not. Because of the different characteristics the systems had different functions.

Conclusions

To understand the usefulness of a classification system, both structure of categories and work process must be considered. The studied systems had different functions that revealed different aims embedded in the systems. To develop the counseling role of pharmacists, a limited number of classification systems would be beneficial. To get there, common aims and common systems must be developed.

Keywords: Pharmaceutical care; Drug-related problems; Classification systems

Identifiers
urn:nbn:se:uu:diva-95182 (URN)10.1016/j.sapharm.2007.10.006 (DOI)
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2010-05-26Bibliographically approved
Björkman, I., Schmidt, I., Holmström, I. & Bernsten, C. (2007). Developing the role of the drug and therapeutics committees: Perceptions of chairs. International Journal of Health Care Quality Assurance, 20(2), 161-178
Open this publication in new window or tab >>Developing the role of the drug and therapeutics committees: Perceptions of chairs
2007 (English)In: International Journal of Health Care Quality Assurance, ISSN 0952-6862, Vol. 20, no 2, p. 161-178Article in journal (Refereed) Published
Abstract [en]

Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.

Keywords
Health services, Patients, Public interest, Sweden
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-95181 (URN)10.1108/09526860710731843 (DOI)17585614 (PubMedID)
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2010-05-26Bibliographically approved
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