چکیده (انگلیسی):

Background:There is an urgent need to improve patient safety in the area of medication treatment among the
elderly. The aim of this study was to explore which improvement needs and strengths, relating to medication
safety, arise from a multi-professional intervention in primary care and further to describe and follow up on the
agreements for change that were established within the intervention.
Methods:The SÄKLÄK project was a multi-professional intervention in primary care consisting of self-assessment,
peer-review, feedback and written agreements for change. Data were obtained from five primary care units randomised
to the intervention group. Reviewer feedback reports and agreements for change were analysed using content analysis.
Results:Strengths that were identified included a committed leadership, work methods to enhance medication safety
and access to consultants.Methods for securing an accurate medication list, knowledge and methods of working of the
prescriberandpatient’s ability to contribute to medication safetywere areas that gave rise to three predesigned categories
for improvement needs on a local level. Another category became apparent during the analysis; namely learning from
mistakes and from results. In all categories, apparent shortcomings were identified. These included inaccurate
medication lists, lack of medication reconciliation, lack of time for follow-up of elderly patients, need for further
education in geriatrics and pharmacotherapy and lackof information on indication and maximum dosage. An
increased number of medication reviews were among the most common agreements for change seen.
Conclusions:This study identified substantial shortcomings, like poorly updated medication lists, which affected
medication safety in the participating Swedish primary care units. Similar shortcomings are most likely present in
other primary care units in the country. Working together multi-professionally, including performing medication
reviews, could be one way of improving medication safety. On the other hand, the individual physician must
possess enough pharmaceutical knowledge and the working conditions must allow time for follow-up of prescriptions.
Strengths of the primary care unit, such as successful methods of working, must be taken advantage of. The culture in
primary care may affect the ability to successfully implement routines that improve patient safety and reduce risk of
medication errors.