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Drug-drug interactions in the elderly
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
2002 (English)In: The Annals of Pharmacotherapy, ISSN 1060-0280, Vol. 36, no 11, 1675-81 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To detect the frequency of potential drug-drug interactions (DDIs) in an outpatient group of elderly people in 6 European countries, as well as to describe differences among countries. DATA SOURCES AND METHODS: Drug use data were collected from 1601 elderly persons living in 6 European countries. The study population participated in a controlled intervention study over 18 months investigating the impact of pharmaceutical care. Potential DDIs were studied using a computerized detection program. RESULTS: The elderly population used on average 7.0 drugs per person; 46% had at least 1 drug combination possibly leading to a DDI. On average, there were 0.83 potential DDIs per person. Almost 10% of the potential DDIs were classified to be avoided according to the Swedish interaction classification system, but nearly one-third of them were to be avoided only for predisposed patients. The risk of subtherapeutic effect as a result of a potential DDI was as common as the risk of adverse reactions. Furthermore, we found differences in the frequency and type of potential DDIs among the countries. CONCLUSIONS: Potential DDIs are common in elderly people using many drugs and are part of a normal drug regimen. Some combinations are likely to have negative effects; more attention must be focused on detecting and monitoring patients using such combinations. As differences in potential DDIs among countries were found, the reasons for this variability need to be explored in further studies.

Place, publisher, year, edition, pages
2002. Vol. 36, no 11, 1675-81 p.
URN: urn:nbn:se:uu:diva-95179DOI: 10.1345/aph.1A484OAI: oai:DiVA.org:uu-95179DiVA: diva2:169296
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2010-05-26Bibliographically approved
In thesis
1. Towards Improved Medication Use: Increasing Understanding of Professional Efforts
Open this publication in new window or tab >>Towards Improved Medication Use: Increasing Understanding of Professional Efforts
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Professionals and researchers have developed a number of strategies aimed at improving the quality and safety of medication use. However, studies continue to demonstrate persistent problems. For instance, the first paper in this thesis reveals the prevalence of potentially harmful drug combinations among elderly people in Europe. The following four papers focus on two professional groups and how they have approached safety and quality issues related to medication use: 1) the Swedish drug and therapeutics committees (DTCs) and 2) pharmacist involved in pharmaceutical care, an international movement. Qualitative research approaches were applied.

Papers II and III focus on the DTCs: analyses indicate a development of the perception of the DTC role over time. The focus of the activities was broadened – from targeting prescribing physicians to incorporating decision-makers and patients. However, a clear patient-centered perspective was generally lacking. Moreover, the findings indicate a shift in focus from cost aspects of medication use to an increased focus on quality and safety aspects.

In the studies addressing pharmaceutical care (Papers IV and V), the findings propose that different classification systems for drug-related problems had different characteristics which reflected differences in goals in the pharmaceutical care process. It was also found that the concept of pharmaceutical care was understood in different ways and that the perceptions were based on at least two different understandings of health and illness. First, a patient-centered perspective characterized by a holistic understanding of health and illness, and, second, an “EBM perspective” primarily based on a biomedical understanding of health and illness.

This thesis has disclosed new aspects of how two groups of professionals perceive their work towards improved quality and safety of medication use. A patient-centered perspective among healthcare collectives is not obvious; therefore, efforts and comprehensive strategies supporting change are necessary. Strategies should focus on challenging the traditional thought patterns and care approaches among professionals and students.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2006. 85 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 206
Health services research, drug quality problems, drug and therapeutics committees, pharmaceutical care, perceptions, patient centeredness, Hälso- och sjukvårdsforskning
urn:nbn:se:uu:diva-7343 (URN)91-554-6731-8 (ISBN)
Public defence
2006-12-12, Robergsalen, Akademiska sjukhuset ing 40, 4 tr, Uppsala, 13:15
Available from: 2006-11-21 Created: 2006-11-21Bibliographically approved

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Björkman, IngeborgBernsten, Cecilia
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