Nurses' and pharmacists' learning experiences from participating in interprofessional medication reviews for elderly in primary health care - a qualitative study.

BACKGROUND: Traditionally, drug prescription and follow up have been the sole responsibility of physicians. However, interprofessional medication reviews (IMRs) have been developed to prevent drug discrepancies and patient harm especially for elderly patients with polypharmacy and multimorbidity. What participating nurses and pharmacists learn from each other during IMR is poorly studied. The aim of this study was to investigate nurses' and pharmacists' perceived learning experience after participating in IMRs in primary health care for up to two years. METHODS: A qualitative study with semi-structured focus group interviews and telephone interviews with nurses and pharmacists with experience from IMRs in nursing homes and home based services. The data was analysed thematically by using systematic text condensation. RESULTS: Thirteen nurses and four pharmacists were interviewed. They described some challenges concerning how to ensure participation of all three professions and how to get thorough information about the patient. As expected, both professions talked of an increased awareness with time of the benefit of working as a team and the perception of contributing to better and more individual care. The nurses' perception of the pharmacist changed from being a controller of drug management routines towards being a source of pharmacotherapy knowledge and a discussant partner of appropriate drug therapy in the elderly. The pharmacists became more aware of the nurses' crucial role of providing clinical information about the patient to enable individual advice. Increasingly the nurses learned to link the patient's symptoms of effect and side effect to the drugs prescribed. CONCLUSIONS: Although experiencing challenges in conducting IMRs, the nurses and pharmacists had learning experiences they said improved both their own practice and the quality of drug management. There are some challenges concerning how to ensure participation of all three professions and how to get thorough information about the patient.

Discrepancies between physicians' prescriptions and patients' use of antiepileptic drugs.

OBJECTIVES: The purpose of this study was to investigate whether prescribed antiepileptic drugs (AEDs) were consistent with what patients actually used, and to explore challenges in treatment and reasons for possible discrepancies according to patients' view of their medication. MATERIAL AND METHODS: Anonymized data were collected from a questionnaire distributed to in- and outpatients and their physicians at the National Center for Epilepsy, Norway. They were asked to report AEDs and dosages currently used. Additionally, 20 patients were interviewed regarding AED treatment. This information was analyzed qualitatively. RESULTS: Answers from 174 patients and their physicians were analyzed. The patients' mean age was 43 years (21-83 years), 85 (49%) were women, and 56% used AED polytherapy (2-5 AEDs). For 56 patients (32%), there was a discrepancy regarding either dosage (n = 70) or prescribed drug (n = 32) (12%). There were discrepancies for all top 10 used drugs, with a similar distribution of patients stating lower or higher doses. Based upon interviews of 20 patients, concerns and challenges in AED treatment were addressed. Polytherapy and adverse effects which reduced the patients' quality of life were the most important obstacles for adherence to the treatment. CONCLUSIONS: This study revealed that 32% of the patients had one or more discrepancies between what the physician had prescribed and what the patients actually used, in either the type or the dosages of AEDs. Polytherapy, adverse effects, and poor adherence were common challenges. Improved communication and information about AEDs may improve adherence and thus treatment outcome.