Healthcare system intervention for safer use of medicines in elderly patients in primary care-a qualitative study of the participants' perceptions of self-assessment, peer review, feedback and agreement for change.
BACKGROUND
The elderly population is increasing and with advanced age comes a higher risk for contracting diseases and excessive medicine use. Polypharmacy can lead to drug-related problems and an increased need of health care. More needs to be done to help overcome these problems. In order for new models to be successful and possible to implement in health care they have to be accepted by caregivers. The aim of this study was to evaluate participants' perceptions of the SÄKLÄK project, which aims to enhance medication safety, especially for elderly patients, in primary care.


METHODS
This is a qualitative study within the SÄKLÄK project. The SÄKLÄK project is a multi-professional intervention in primary care consisting of self-assessment, peer review, feedback and written agreements for change. A total of 17 participants from the intervention's primary care units were interviewed. Most of the interviews were done on a one-to-one basis. The interviews were recorded and transcribed verbatim. A survey was also sent to the primary care unit heads. Qualitative content analysis was used to explore the participants' perceptions.


RESULTS
The analysis of the interviews yielded six categories: multi-professional co-operation, a focus on areas of improvement, the joy of sharing knowledge, disappointment with the focus of the feedback, spend time to save time and impact on work. From these categories a theme developed: "Medication safety is a large area. In order to make improvements time needs to be invested and different professions must contribute."


CONCLUSIONS
This study shows that our studied intervention method is feasible to use in primary care and that the multi-professional approach was perceived as being very positive by the participants. Multi-professional co-operation was time consuming, but was also deemed as an investment and an opportunity to share knowledge. Some points of improvement of the method were identified such as simplification of the self-assessment form and clearer instructions for reviewers. In addition, to have an impact on work the focus must lie in areas within the primary care units' scope.
Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden. cecilia.lenander@med.lu.se.
Cecilia
C
Lenander
Department of Medicines Management and Informatics, Region Skåne, Sweden. Asa.c.bondesson@skane.se.
Åsa
Å
Bondesson
Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden. patrik.midlov@med.lu.se.
Patrik
P
Midlöv
Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden. nina.viberg@vardanalys.se.|Department for Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. nina.viberg@vardanalys.se.
Nina
N
Viberg
D000368:Aged; D004358:Drug Therapy / Q000379:methods* / Q000592:standards; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005246:Feedback; D006801:Humans; D007407:Interviews as Topic; D061214:Patient Safety; D010380:Peer Review; D019338:Polypharmacy; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D036301:Qualitative Research; D058996:Quality Improvement; D013548:Sweden