The patients' perspective on multimorbidity and polypharmacy and how do we accommodate it in the healthcare system.

Patients living with multimorbidity, and polypharmacy can have difficulties handling the treatment burden they face daily. They often experience disjointed treatment courses and demand a more holistic approach to their multimorbidity and to be involved in decisions about their treatments. In the healthcare system, there are examples of new initiatives that go beyond the classic diagnostic silo thinking. However, this review finds that further development of new structures, approaches, and collaboration models in the healthcare system, as well as research, is still necessary to meet the needs of these patients.

Multifaceted Pharmacist-led Interventions in the Hospital Setting: A Systematic Review.

Clinical pharmacy services often comprise complex interventions. In this MiniReview, we conducted a systematic review aiming to evaluate the impact of multifaceted pharmacist-led interventions in a hospital setting. We searched MEDLINE, Embase, Cochrane Library and CINAHL for peer-reviewed articles published from 2006 to 1 March 2018. Controlled trials concerning hospitalized patients in any setting receiving patient-related multifaceted pharmacist-led interventions were considered. All types of outcome were accepted. Inclusion and data extraction were performed. Study characteristics were collected, and risk of bias assessment was conducted utilizing the Cochrane Risk of Bias tools. All stages were conducted by at least two independent reviewers. The review was registered in PROSPERO (CRD42017075808). A total of 11,896 publications were identified, and 28 publications were included. Of these, 17 were conducted in Europe. Six of the included publications were multi-centre studies, and 16 were randomized trials. Usual care was the comparator. Significant results on quality of medication use were reported as positive in eleven studies (n = 18; 61%) and negative in one (n = 18, 6%). Hospital visits were reduced significantly in seven studies (n = 16; 44%). Four studies (n = 12; 33%) reported a positive significant effect on either length of stay or time to revisit, and one study reported a negative effect (n = 12; 6%). All studies investigating mortality (n = 6), patient-reported outcome (n = 7) and cost-effectiveness (n = 1) showed no significant results. This MiniReview indicates that multifaceted pharmacist-led interventions in a hospital setting may improve the quality of medication use and reduce hospital visits and length of stay, while no effect was seen on mortality, patient-reported outcome and cost-effectiveness.

The lay public's explicit and implicit definitions of drugs.

BACKGROUND: The research project: Public Beliefs about Medicine was initiated in 2001, aiming at exploring people's views, hopes, and fears with respect to drugs/medicines, now and in the future. OBJECTIVES: A part of the research project mapping public beliefs about medicines aimed at getting the public to discuss definitions of drugs/medicines to grasp their explicit and implicit definitions and understand their point of reference when using the term(s). METHODS: Eight focus groups were conducted in urban and rural Iceland, with 42 participants of both genders and varying age, a fifty-fifty mix of lay and educated groups. The interviews were transcribed verbatim and excerpts translated into English. RESULTS: The direct question about definition of drugs generally resulted in a consensus among the informants about drugs/medicines being used to combat diseases and/or symptoms. Some included only prescribed or physician-recommended drugs in their definitions, others also over-the-counter products. Inclusion/exclusion of vitamins, food supplements, herbal remedies, functional foods, and illicit drugs was discussed without consensus and defining drugs in chemical terms or as interfering with bodily functions also occurred. New nuances emerged spontaneously later in the discussions, like viewing drugs as profit-making products, preferably prudently marketed, wishing information about "new release" drugs for the informants' diseases, and being concerned about side effects, overuse, misuse, and abuse. Other implicit definitions included viewing drugs as a product-service package, or as a necessary evil and/or as products with increasing potency and associated future problems or considering drugs to exert unreliable minor influence. CONCLUSION: Professionals should be aware of the variety of lay people's drug definitions when discussing drugs/medicines with them to avoid misunderstandings caused by definition discrepancies.

[The use of herbal medicines, food supplements, and OTCs - design and testing of a questionnaire.].

BACKGROUND: Epidemiologic studies show that open-ended questionnaire items are unreliable measures of the use of drugs and related substances. It is also important to avoid questions regarding the distant past. These issues were kept in mind when designing a questionnaire on the use of herbal medicines, food supplements, and over-the-counter drugs (OTCs). The objectives of this study were to pre-test the questionnaire and measure the prevalence of use in the last two weeks. METHODS: A questionnaire was constructed almost entirely with closed-ended responses. A pre-test was carried out in two phases. Respondents were patrons of the Icelandic Heart Association's clinic. In the utilization study a sample was taken from all 18 079 participants of the MONICA Reykjavík research study and the Descendant Study of the Icelandic Heart Association. The random sample was stratified according to age and sex (N=350). A chi-squared test was used to compare rates. RESULTS: The questionnaire was changed little after pre-testing. The main changes related to wording of questions. In the utilization study, 220 individuals responded (62.9%). The prevalence of herbal use was 46.8%, 75.9% for vitamins, minerals, and micronutrients, and 69.5% for OTCs. Garlic was the most commonly used herbal and food-supplement (14.5%). Codliver oil held a superior position in the group of vitamins, minerals, and micronutrients (59.1%). Vitamin C was the most used single vitamin (20,9%). Calcium was by far the most used mineral (11,4%). Pain relievers were the most common OTCs (38.6%). CONCLUSIONS: The format of the questionnaire was satisfactory. The prevalence of use of all groups of substances was high compared to foreign studies. Response bias may make the use seem higher than is true. As the sample was very small, this study should be viewed as a test of a specific method for measuring the use of these substances.