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Care ideologies reflected in 4 conceptions of pharmaceutical care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. (Health Services Research)
2008 (English)In: Research in Social and Administrative Pharmacy, ISSN 1551-741, Vol. 4, no 4, 332-342 p.Article 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.

Place, publisher, year, edition, pages
2008. Vol. 4, no 4, 332-342 p.
Keyword [en]
Pharmaceutical care, Care ideology
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-95183DOI: 10.1016/j.sapharm.2008.01.001ISI: 000262301800003PubMedID: 19064240OAI: oai:DiVA.org:uu-95183DiVA: diva2:169300
Available from: 2006-11-21 Created: 2006-11-21 Last updated: 2010-12-30Bibliographically 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.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 206
Keyword
Health services research, drug quality problems, drug and therapeutics committees, pharmaceutical care, perceptions, patient centeredness, Hälso- och sjukvårdsforskning
Identifiers
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
Opponent
Supervisors
Available from: 2006-11-21 Created: 2006-11-21Bibliographically approved

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Björkman, IngeborgBernsten, CeciliaSanner, Margareta

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