Papers by Ingunn Bjornsdottir
European journal of public health, Sep 1, 2001
Background: In this era of increasing problems with resistance, rational prescribing of antibioti... more Background: In this era of increasing problems with resistance, rational prescribing of antibiotics is extremely important. Therefore, rationales for prescribing require analyses. The objective of this study was to explore general practitioners' (GPs') reasons for prescribing antibiotics by telephone. Methods: Qualitative analysis of semistructured interviews with and observations of GPs in Iceland enquiring about the rationale for prescribing antibiotics was used. Ten GPs were interviewed for 45 min to 2 h each including three who were observed between 3 and 10 h. Results: The GPs generally indicated a restrictive attitude to telephone prescribing, although they all gave examples of their prescribing by telephone. The prescribing was mostly but not always based on some kind of diagnosis. The factors influencing diagnosis and prescribing were largely non-clinical: knowledge of the patients as persons, including their complaint threshold, confidence in their descriptions, the GPs' communication strategies and the travelling distance between patients and GPs. The clinical factors were the patients' description of signs and symptoms and knowledge of their history. Prescriptions not based on diagnosis were 'therapeutic trial' or GP-approved self-medication. Sometimes, the GPs requested to see a patient even though the diagnosis was based on history, signs and symptoms. Conclusions: Multiple factors affected the decision-making process when antibiotics were prescribed by telephone, most of which were non-clinical. The diagnosis, if there was one, was generally presumptive. GPs' general attitudes correlated well with current knowledge but were contrasted by the reality of their daily work conditions.
International Journal of Pharmacy Practice, Aug 9, 2019
Objectives Simulated patient (SP) methodology (mystery shopping) is used increasingly to assess q... more Objectives Simulated patient (SP) methodology (mystery shopping) is used increasingly to assess quality of pharmacy services, and evaluate impact of interventions. Our objective was to review papers reporting on the use of SP methodology in pharmacy practice research 2006-2016 in community pharmacies worldwide. Methods We searched EMBASE and MEDLINE for papers reporting on the use of mystery shopping in pharmacy settings, using a wide range of terms for SPs, based on previous review. We removed irrelevant papers, duplicates, papers not written in English, and review papers and reviewed remaining papers. Two reviewers carried out data abstraction, using the same tool as the previous review and inserting data into Excel, focusing on how the SP methodology is used. Key findings A total of 148 papers from 52 countries from all regions of the world were included in the review. A wide range of terms described the method, and simulated patient was the most common (49 papers). Most studies were cross-sectional (124), and most investigated only community pharmacies (115). The most common aim was to evaluate some aspect of pharmacists' or other staff's advice and counselling (94). Number of visits is 2-7785. Many papers did not cover details, such as number of visits planned, and carried out, scenario used, training and background of SPs, and ethical approval for the study. Conclusions The use of SP methodology has increased substantially in the field of pharmacy over the past decade. This is a useful method in a wide range of countries and settings. Greater detail is required in reporting.
Research in Social & Administrative Pharmacy, Aug 1, 2019
Research in Social & Administrative Pharmacy, May 1, 2017
Value in Health, 2019
membership offers several opportunities, which can be applied in the fields of either prevention ... more membership offers several opportunities, which can be applied in the fields of either prevention or health care or healthy way of lifestyle. By contrast, it is absolutely not sure that the opportunities are known and taken advantage of as well; no direct relationship was detected on the basis of our samples (p=0.85). Conclusions: Health care expenditures are continually growing, which will not be able to be financed by the government, thus the role of the supplementary health insurance is greatly appreciated not only in Hungary but in the European Union also.
Research in Social and Administrative Pharmacy, 2014
Up to 80% of all women use medication during pregnancy (1). Pregnant women have often questions r... more Up to 80% of all women use medication during pregnancy (1). Pregnant women have often questions related to medicine use and they commonly state that the pharmacist is a trusted source of information (2, 3). Consequently, the pharmacist may have an important role in care for pregnant women. It is unclear which areas the pharmacy profession should prioritize when it comes to pregnant and breast feeding women and which role pharmacists have in care for pregnant patients. Aims of the workshop: To discuss the role and opportunities for clinical pharmacy in obstetrics. Learning Objectives: Enhance their own awareness about the role of pharmacists interacting with pregnant women. Learn about the practices in the other countries. Explore, through discussion, future possibilities for clinical pharmacy in obstetrics. The workshop discussion will lead to a joint statement to be published in an international journal about the potential role of pharmacists in clinical pharmacy in obstetrics. Description of Workshop Activities: Introduction: Background and aim (10 min). Group activity: Group discussion for the purpose of sharing experiences and ideas (40 min). Plenary: Report back from each group and discussion (30 min). Summation and evaluation of workshop (10 min). The following topics will be addressed: The role of the pharmacists in several scenarios including promoting folic acid use, adherence to prescribed medication, use of natural remedies, and correcting misconceptions. Additional information: Reading suggestions: Ragland D, Briggs GG, Wasik M, et al. Obstetrical opportunities: will pharmacy ever realize them? Ann Pharmacother. 2012; 46: 297-300. References
The American Journal of Pharmaceutical Education, Mar 1, 2018
Objective. To describe Nordic pharmacy students' opinions of their patient communication skills t... more Objective. To describe Nordic pharmacy students' opinions of their patient communication skills training (PCST), and the association between course leaders' reports of PCST qualities and students' perceptions of their training. Secondary objective was to determine what factors influence these associations. Methods. A cross-sectional questionnaire-based study was performed. The various curricula were categorized into three types (basic, intermediate and innovative training) and students were divided into three groups according to the type of training they had received. Multivariable logistic regression models were fitted with different opinions as outcomes and three types of training as exposure, using generalized estimation equations. Results. There were 370 students who responded (response rate: 77%). Students within the innovative group were significantly more likely to agree that they had received sufficient training, and to agree with the assertion that the pharmacy school had contributed to their level of skills compared to students in the basic group. Conclusion. There appears to be an association between larger and varied programs of training in patient communication skills and positive attitudes toward this training on the part of the students, with students reporting that they received sufficient training, which likely enhanced their skills.
The American Journal of Pharmaceutical Education, Nov 1, 2017
Objective. To assess communication skills training at Nordic pharmacy schools and explore ways fo... more Objective. To assess communication skills training at Nordic pharmacy schools and explore ways for improvement. Methods. E-mail questionnaires were developed and distributed with the aim to explore current practice and course leaders' opinions regarding teaching of patient communication skills at all the 11 master level Nordic (Denmark, Finland, Iceland, Norway and Sweden) pharmacy schools. The questionnaires contained both closed-and open-ended questions. Results. There was a variation of patient communication skills training among schools. In general, communication skills training was included in one to five courses (mode 1); varied in quantity (6-92 hours); had low use of experiential training methods; and had challenges regarding assessments and acquiring sufficient resources. However, some schools had more focus on such training. Conclusion. The results show room for improvement in patient communication skills training in most Nordic pharmacy schools and give insights into how to enhance communication skill building in pharmacy curricula. Suggestions for improving the training include: early training start, evidencebased frameworks, experiential training, and scaffolding.
Research in Social & Administrative Pharmacy, Mar 1, 2018
Introduction: Good communication skills are essential for pharmacy students to help patients with... more Introduction: Good communication skills are essential for pharmacy students to help patients with their medicines. Students' attitudes towards communication skills learning will influence their willingness to engage in communication training, and their skills when dealing with patients later on in their professional life. Objective: The aim of this study was to explore Nordic pharmacy students' attitudes to communication skills learning, and the associations between those attitudes and various student characteristics. Method and Materials: A cross-sectional questionnaire-based study was conducted in 11 Nordic pharmacy schools between April 2015 and January 2016. The overall response rate for the final study population was 77% (367 out of 479 students). Pharmacy students who had fulfilled all mandatory communication training and most of their pharmacy practical experience periods were included. The communication skills attitudes scale was the main outcome. Linear regression models were fitted with the outcome variable and various student characteristics as the predictors, using generalized estimating equations to account for clustering within pharmacy schools. Results: Nordic pharmacy students in general have moderately positive attitudes towards learning communication skills. Positive attitudes towards learning communication skills among pharmacy students were associated with being female (β adjusted 0.42, 95% CI 0.20 to 0.63, p<0.001), following a newer pharmacy training program (β adjusted 0.81, 95% CI 0.63 to 0.98, p<0.001), having higher self-rated need for communication skills improvement (β adjusted 0.50, 95% CI 0.30 to 0.71, p<0.001) and believing one's communication skills are not the result of personality (β adjusted-0.24, 95% CI-0.44 to-0.04, p=0.017). Conclusion: The study provides important information for faculty members responsible for curriculum improvements and teachers to refine their teaching of communication skills. From this, the teaching can be better tailored to suit different students. The students' chances of being able to effectively help patients in the future will be increased by that.
Research in Social & Administrative Pharmacy, Nov 1, 2015
Pharmacist-patient communication around prescription medications can optimize treatment outcomes.... more Pharmacist-patient communication around prescription medications can optimize treatment outcomes. Society&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expectations of pharmacist-patient communication around medications can be expressed in legislation, economic incentives, and authority control. In this study, the Nordic countries of Denmark, Finland, Iceland, Norway and Sweden provide the legislative examples and can be used as a platform to discuss how society&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expectations, professional visions, and practice are aligning. The overall aim of this study was to describe society&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s expectations of pharmacist-patient communication around medications as expressed by the state in Nordic legislation, economic incentives and authority control. Additionally, this study describes how the states govern Nordic pharmacists in different pharmacy systems. A legal review was performed using online legislative databases. Regulating authorities were contacted to gather supplementary information. Thereafter, a qualitative document analysis was conducted. The Nordic countries regulate staff-patient communication by using broad laws. The legislation&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s main focus during dispensing is information on the use of medications, but also generic substitution and pricing. Pharmacies should have internal routines for this in place. Pharmacists&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; obligation to keep a journal on advice given during dispensing is ambiguously regulated. The economic incentives for communication on prescription medication during dispensing are included in the general pharmacy mark-up. Today&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s authority control focuses on the pharmacy management and appears to primarily evaluate structure indicators of communication, for example, if there is a routine method of counseling available. Various countries throughout the world differ in their requirements for pharmacy staff to communicate on the use of medicines during dispensing. The Nordic countries all require such communication, which aligns with professional visions. Regardless of the pharmacy system, the states let the employer and pharmacy professions carry out it in practice with apparently little state involvement, thus showing trust in the profession and employers. However, since Nordic communication studies show deviation from the legislation, there are reasons to reevaluate and discuss the legislation, the economic incentives and the control system.
Research in Social & Administrative Pharmacy, Jul 1, 2015
European Journal of General Practice, 2002
Many interventions have been implemented in an attempt to correct physicians' seemingly nonpruden... more Many interventions have been implemented in an attempt to correct physicians' seemingly nonprudent prescribing habits, but in general without great success. The aim of this study was to explore physicians' perceived reasons for deciding to prescribe antibiotics. Methods: Qualitative, semi-structured in-depth interviews with ten.Icelandic general practitioners (GPs) were conducted, and three of them were observed at work. The interviews were tape recorded and transcribed in full, and field notes were taken during observations. Open, axial and selective coding was used in the analysis. Results: Several non-therapeutic aspects of prescribing emerged as important factors in the GPs' decisionmaking. The attitude of physicians towards prescribing of antibiotics in general, either restrictive or liberal, played a role, as uncertainty about prescribing, time pressure, individual patient characteristics (e.g., proneness to complain, job situation, compliance, prosperity) and relations with colleagues. Three decision-making routes leading to a prescription were identified: 1) The GP believes that the infection cadwill interfere with the patient's planned activities, knows or thinks that the infection is or might be bacterial, and believes that antibiotics might help and will not harm. 2) The patient does not accept refusal and the GP lacks resources to explain why antibiotics are not appropriate. 3) The GP values patient autonomy higher than patient welfare. The primary purpose of prescribing Ingunn Bjornsdottir, CEO. The Pharmaceutical Society of Iceland. Ebba Holme Hansen, professor. Department of Social Pharmacy, Royal Danish School of Pharmacy. Director. antibiotics was to help patients to carry on with their everyday activities. Conclusions: Non-clinical factors seem at least as important as clinical factors in decision-making regarding antibiotic prescribing. Intervention planners should acknowledge this.
Pharmacy World & Science, Oct 8, 2010
Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resu... more Objective Antibiotics may frequently be prescribed on the basis of vague diagnoses, possibly resulting in unnecessary antimicrobial resistance. Our aim is to map general practitioners' (GPs') decision-making for common infections, exploring their diagnostic basis for antibiotic prescriptions. Setting General practice in Iceland. Method Ten in-depth qualitative interviews with, and three observations of, GPs in 1995. Diagnostic issues extracted and analysed. In 2006, eight GPs commented on analysis and updated (email/telephone). Main outcome measure Diagnostic variability and reasons for prescribing antibiotics, consistency or changes over time. Results Wide variations were uncovered in diagnostic procedures, although each GP remained consistent through time. Some GPs had developed ''rules-of-thumb''. They often balanced risks against issues like money, time, need for the workforce (perceived importance of the patient's job), client's need for job/earnings (perceived ability to afford a sick day) and doctor-patient relationship (risk of refusal adversely affecting the relationship). Perceptions of risk varied from focusing on resistance development to focusing on possible harm from untreated infections, also ranging between considering both to worrying about neither. Changes over time were not prominent but included increased point-ofcare testing and the perception by GPs that patients were increasingly willing to ''wait and see''. Conclusions Large variability and individuality characterized the GPs' diagnostic procedures, contrasted by consistency through time. If modification of diagnostic routines is needed, provision of ''scientific facts'' and technological aids is insufficient. A prerequisite for changing practice is GPs' acceptance of accuracy of information and of reliability, applicability, and relevance of technology, for physician and/or patient. Keywords Anti-bacterial agents Á Diagnosis Á Evidencebased medicine Á Iceland Á Infection Á Physician's practice patterns Impact of findings on practice • GPs' diagnostic procedures vary between individuals and between infections. • GPs' diagnostic procedures are relatively resistant to changes over time. • GPs only change diagnostic procedures if they consider themselves to have adequate information, indicating that change is beneficial.
Research in Social and Administrative Pharmacy, 2014
Value in Health, 2008
decision-making, from the moment of first application until the final decision made by the Minist... more decision-making, from the moment of first application until the final decision made by the Ministry. Results: As a result of the workshops the detailed process of making reimbursement decisions has been specified and the criteria for reimbursement and pricing are being defined. Bill regulating the reimbursement system in Poland is being prepared and will be implemented into polish legal system in January 2009. The Bill regulates the tasks of HTA Agency, its Consultative Council, which makes recommendations, and MoH in the process. It names the health priorities taken into account while giving recommendations, lists all the documents and analyses required in the reimbursement application. A separate Regulation will be prepared with the template of the reimbursement application and description of properly write analyses based on polish HTA guideline. The process of including (or excluding) drug to the reimbursement list is divided on the steps taking place in different institutions. The separate tracks are set for innovative drugs and for generics. The specialized institutions are responsible for each step: clinical effectiveness, safety and cost effectiveness is assessed in AHTAPol, formal and legal requirements in MoH, price negotiations by special Negotiations Committee and final recommendations to Minister is made by Reimbursement Committee which advice the Minister of Health. The documents prepared in each step of the process will be transparent and available for all stakeholders except price negotiations which are confidential and results are known only to the Ministry and the company involved. The whole process described above will result in a clear and transparent system of drug reimbursement in Poland, which will be implemented into the Polish legal system in 2009. That was big and important project, which improved cooperation between policy makers and industry, between international HTA experts and between Poland, France, the EC and other Member States. Lessons Learned: For creating a new or improving existing reimbursement decision making process experience of other countries is indispensible. Changes in the process should be transparent, understandable for all stakeholders and if possible consulted with all parties involved; policy makers, EC, industry, health professionals and patients associations.
Background: This article presents the results of a study on quality of pharmacy services and perc... more Background: This article presents the results of a study on quality of pharmacy services and perceived risk of pharmaceuticals. The results presented here are part of a multi-study evaluation of major changes in drug distribution in Iceland. Objectives: This sub-study addressed the question: what is the lay user perspective on pharmaceuticals and pharmacy services, including their perception of risk? Methods: To answer this question, seven focus group discussions were conducted with pharmacy customers in different locations in Iceland following new drug distribution legislation in 1996. Results: The lay perspective emphasizes a definite split between lay and expert views on the value and quality of pharmaceuticals, drug therapy and pharmacy services, as well as in their assessment of risk. Participants voiced spontaneous criticism of the roles of both physicians and pharmacists in drug therapy; and expressed concern about the quality and safety of pharmaceuticals. Some scope for shared values was noted between the legislative goals and the lay user perspective, despite the fact that the public was in no way involved in the drafting of the new legislation. Conclusion: The results of this study raise questions about the nature and extent of the perceived gap between the medical and pharmacy professions on the one side and the lay public and health policy decision-makers on the other side in their views on the quality and safety of pharmaceuticals and pharmacy services.
Public Health Genomics, 2008
Objective: To explore lay perceptions about medicine and drug therapy (including gene-based thera... more Objective: To explore lay perceptions about medicine and drug therapy (including gene-based therapy) in the present and in the future. Background: Following almost a year of national debate, the Icelandic parliament passed the Health Sector Database (HSD) Act in 1998. No single issue has been as much debated in Iceland as this database. Despite the explosion of popular and scientific literature in the field of bioethics, there is still a paucity of research concerning ‘lay’ contributions to the debates. Methods: The study was designed as a qualitative study. Focus groups (FGs) were conducted followed by one-on-one interviews with the FG moderator. Participants were asked to comment on a future scenario consisting of predictions concerning the consequence of the Human Genome Project over the next 40 years. Participants: Forty-two persons participated in eight FGs in Iceland. The Icelandic moderator was interviewed in English after each group. Conclusions: The lay public was relatively optimistic with regard to the future of drugs and gene-based therapy. Reasons for this optimism can be found in a basic trust and belief in the welfare state and the health system. These results are not consistent with studies carried out in other countries where the public appears to be focused on the negative effects of genetic research and the threats to privacy. Most participants expressed concern about potential problems with regard to social and equity issues, whereas the HSD controversy, a discourse based on the rhetoric of bioethics, was at variance with the issues focused on by the lay public.
Qualitative Health Research, May 1, 2004
There has been an upsurge of academic interest in using focus groups (FGs) as a main or stand-alo... more There has been an upsurge of academic interest in using focus groups (FGs) as a main or stand-alone qualitative method. In this article, the authors introduce a recently developed ancillary method to FGs called interviewing the moderator. The method is employed immediately after an FG and consists of a one-on-one interview with the FG moderator by another member of the research team. The authors argue, with reference to a specific study, that interviewing the moderator adds a new and valuable dimension to group interviews used in research. They describe how this method came about and provide a concrete example of its use in a recently completed research project. They discuss several advantages of the interview, among them that it provides information about group interaction and participant behavior, and furnishes additional data on what is discussed when the tape recorder is turned off.
Health policy, Feb 1, 2005
This study explores the lay view of pharmaceutical research and development-specifically pharmaco... more This study explores the lay view of pharmaceutical research and development-specifically pharmacogenomics. Forty-two persons participated in eight focus groups in Iceland. Participants were asked to comment on a future scenario consisting of predictions made by researchers concerning the consequences of the Human Genome Project over the next 40 years, and asked to give advice to politicians and the pharmaceutical industry. A dominating theme in the focus groups was the expectation that drugs developed based on pharmacogenomics will be more expensive than conventional mass produced drugs and concerns were voiced that this new technology would lead to inequalities locally and globally.
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Papers by Ingunn Bjornsdottir