[Control center team in interdisciplinary multimodal pain therapy]. / Schaltzentrale Team in der interdisziplinären multimodalen Schmerztherapie.

The topic of this article is the team in interdisciplinary multimodal pain therapy (IMPT) in the context of the development of the team concept. The starting points are historical developments, both social and scientific. After World War II numerous war victims continued to suffer from persistent pain. On the part of medicine, the consequences were the failure of the usual procedures for acute pain and the resulting helplessness. Both the concept of pain as a symptom of physical injury and also the previous treatment options were no longer adequate. Very early on an interdisciplinary approach to pain management was organized. This involved the communication of experts from various disciplines with very different competencies and opinions. Various medical disciplines and psychotherapy were the core subjects. Crucial for functioning teams is an effective cooperation and interaction. Related organizational issues, conflicts, peculiarities, and possibilities for solutions are presented. In the meantime, IMPT as a procedure has become a regular service provided in health care.

Facilitators and barriers for performing comprehensive medication reviews and follow-up by multiprofessional teams in older hospitalised patients.

PURPOSE: There is a lack of knowledge about factors that influence the performance of comprehensive medication reviews (CMRs) by multiprofessional teams in hospital practice. This study aimed to explore the facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients from the healthcare professional perspective. METHODS: Physicians and ward-based pharmacists were recruited from an ongoing trial at four hospitals in Sweden. Semi-structured interviews were conducted with 16 physicians and 7 pharmacists. Interview topics were working processes, resources, competences, medication-related problems, intervention effects and collaboration. The interviews were audio-recorded, transcribed verbatim and thematically analysed using the Consolidated Framework for Implementation Research (CFIR). Identified subthemes were categorised as facilitators or barriers and grouped into overarching main themes. RESULTS: In total, 21 facilitators and 25 barriers were identified across all CFIR domains and grouped in 6 main themes: (a) CMRs and follow-up are needed, but not in all patients; (b) there is a general belief in positive effects; (c) lack of resources is an issue, although the performance of CMRs may save time; (d) pharmacists' knowledge and skills are valuable, but they need more clinical competence; (e) compatibility with hospital practice is challenging, and roles and responsibilities are unclear and (f) personal contact at the ward is essential for physician-pharmacist collaboration. CONCLUSION: Multiple facilitators and barriers for performing CMRs and post-discharge follow-up in older hospitalised patients exist. These factors should be addressed in future initiatives with similar interventions by multiprofessional teams to ensure successful implementation and performance in hospital practice.

[Multiprofessional Approach for Chronic Kidney Disease (CKD) Risk Reduction and Prophylaxis in the Kushiro Medical Area].

Chronic kidney disease (CKD) is closely related to disorders of various organs of the body and is also a factor in increasing social security costs such as medical costs for dialysis. Multiprofessional public health associations in Kushiro City jointly manage CKD-targeted action as "Kushiro CKD network" composed of medical/dental physicians, nurses, nutritionists and pharmacists. Pharmacists have played a central role in affixing a CKD sticker to a patient's medicine notebook when the patient's estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2, in order to highlight the risk of CKD for those patients and related medical staff. There are many drugs that require dose reduction considering for renal function, but we had found cases where renal function was not monitored and pharmaceutical dispensation adjusted before the CKD network started. Therefore, we took this opportunity to investigate the impact of CKD stickers on pharmacists' work. During the period from August 2018 to August 2021, about 3200 CKD stickers were affixed by pharmacists, and about 4500 cases of decreased renal function were detected at pharmacies. In addition, there were 334 cases in which renal function deterioration was identified by the CKD stickers and led to further inquiries, of which 265 cases, or about 80%, resulted in prescription changes. Based on these results, it is considered that CKD stickers are effective method for pharmacies understand renal function deterioration and conduct appropriate prescription reviews. Finally, and perhaps most importantly, the use of CKD stickers can help assure that patients with renal impairment care treated with appropriate medication doses.

Effects of Using a Video-Sharing Application on Multidisciplinary Staff During Pre-discharge Home Assessment Visits for Elderly Hospitalized Patients.

Background: Pre-discharge home assessment visits for elderly hospitalized patients are conducted by the hospital staff to ensure a smooth transition to home care and are effective in preventing falls and reducing the rehospitalization rates. However, the effect of an application that enables the viewing of videos of the patient's home activities during the pre-discharge visit on the multidisciplinary professionals who provide services to the patient has not yet been fully clarified. Methods: Multidisciplinary professionals at 23 facilities located in western Tottori Prefecture who used a video-sharing application (Patto-Mie Net) were invited to be interview participants. Those who agreed were interviewed about the usefulness of the application in their work and its effect on multidisciplinary collaboration. A verbatim transcript was made, and thematic analysis was conducted using the qualitative analysis software NVivo. Results: Twenty-eight people participated in the interviews, including nurses, care managers, rehabilitation specialists, care workers, and other social care professions. Fourteen themes and five categories were generated from the analysis: comprehensive information visualization and transferability, identification of changes over time and prognostic prediction, promoting multidisciplinary collaboration, patient and family reality, and disadvantages and concerns. Conclusion: The use of an application that allows video-sharing of a patient's home movement status during a pre-discharge visit has revealed a variety of benefits for multiple professionals in hospitals and other facilities. In particular, the results were characterized by the psychological closeness between multiple professionals, promotion of interprofessional communication, and sharing of reality, including the psychosocial background of the patient and family.

The perceived development needs for medicines information services in university hospital pharmacies: A mixed methods study.

Background: Reliable and evidence-based medicines information (MI) is critical for patient care. To guarantee this, in many countries, there are medicines information centers (MICs) which offer medicines information services (MISs). While there are no MICs in Finland, pharmacists in all five university hospital pharmacies provide MISs. A proposal for establishing five MICs has been made by the National Medicines Information Network. Objectives: The aim was to explore the current MISs and the perceptions of current and potential MI service providers of the need for the proposed national MICs. Barriers and facilitators for potential transition from the current MISs provided by the university hospital pharmacies to establishing national MICs, were examined. Methods: This sequential explanatory mixed methods study was conducted nationally during September 2019-April 2020 as an online survey and semi-structured individual, pair and group theme interviews with hospital representatives. The survey questionnaire was sent to chief pharmacists and MI pharmacists in all five Finnish university hospital pharmacies (n = 5, census). The interviews (n = 13) were carried out with chief pharmacists, MI pharmacists, medication safety officers (pharmacists), chairs of the Medicines Advisory Board (physicians) and clinical pharmacologists (physicians) (participants n = 19). The data was analyzed using descriptive quantitative analysis and qualitative content analysis. Results: All invited representatives participated in the study. Offered MISs are quite similar but the human resources vary among the organizations. Answering MI questions was one of the core MISs. Most representatives considered a proposal of establishing five MICs to Finland positively. The expected benefits were related to achieving an official status to enhance MI, establishing the MICs within the university hospitals and close to where the MISs are needed, and fostering multiprofessional collaboration and collaboration between the MICs. Limited financial and human resources were seen the most critical challenges. Conclusion: The existing expertise of the pharmacists and the similarities in MISs provided by the university hospital pharmacies seem to provide a good basis and preconditions for expanding MI operations and forming MICs at the national level. By pooling current limited resources, synergies could be achieved and MISs, and potentially MICs developed. The establishment of MICs may enhance utilization of networking and multiprofessional collaboration in producing MISs at the national level.