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Embedding Medication Review in Clinical Practice [Elektronisk resurs] Reconceptualising Implementation Using a Practice Theory Perspective / Ursula Reichenpfader.

Reichenpfader, Ursula, 1969- (författare)
Carlfjord, Siw, 1959- (preses)
Wickström, Anette, 1959- (preses)
Abrandt Dahlgren, Madeleine, 1956- (preses)
Alternativt namn: Dahlgren, Madeleine Abrandt, 1956-
Alternativt namn: Abrandt, Madeleine, 1956-
Buch, Anders (opponent)
Linköpings universitet. Institutionen för medicin och hälsa (utgivare)
Alternativt namn: Engelska: Linköping Universty. Department of Medical and Health Sciences
Alternativt namn: Linköping Universty. Department of Medicine and Health Sciences
Alternativt namn: IMH
Se även: Linköpings universitet. Institutionen för hälsa och samhälle
Se även: Linköpings universitet. Institutionen för medicin och vård
Linköpings universitet Medicinska fakulteten (utgivare)
Publicerad: Linköping : Linköping University Electronic Press, 2019
Engelska 1 onlineresurs (98 sidor)
Serie: Linköping University Medical Dissertations, 0345-0082 ; 1684
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  • E-bokAvhandling(Diss. (sammanfattning) Linköping : Linköpings universitet, 2019)
Sammanfattning Ämnesord
Stäng  
  • The hospital is a critical setting with respect to medication safety and quality of medication therapy. Medication review, the structured assessment of an individual patient’s medications with the aim of improving therapy, has been advocated as a strategy to reduce medication-related harm. Although programs of medication review have been widely introduced, its implementation has encountered difficulties. While seemingly a rather straightforward concept, processes to identify current medication use and reconcile different medication lists have been complicated by organizational, interprofessional, or technical factors. There is, thus, a need to better understand medication review implementation. However, it is also important to critically consider how the implementation of healthcare interventions is generally understood , and what theoretical or conceptual considerations inform implementation efforts. Studying organizational and social phenomena as they unfold in practice has the potential to shed light on how these everyday activities are generated, how they are adapted over time, and what consequences this has on social and organizational processes. The purpose of this thesis is to develop an alternative perspective on studying the implementation of a healthcare intervention in routine care. More specifically, this thesis aims to theorize the embedding and practicing of medication review in routine hospital work. Theorizing, here, refers to empirically and theoretically exploring phenomena based on cases of local medication review implementation. Drawing on empirical case examples of medication review implementation in southeast Sweden, an ethnographic approach is employed conducting participant observation, informal conversations and semi-structured interviews with different healthcare professionals in two hospital settings, as well as semi-structured interviews with patients from three different hospital settings. A so-called toolkit approach for practice theory is employed, using a range of different practice-theoretical concepts to empirically study practice. The empirical findings point to the centrality of dealing with medication-related problems when conducting and embedding medication review. Both practicing and embedding medication review were shaped by how medication-related problems and potential medication harms were constructed, contested, and negotiated in practice. Practitioners’ everyday actions and practices revealed different meanings attached to the concept of medication-related problem bringing to the fore the contested and conflictual nature of the practice. Also, insight was provided into how practices to embed medication review in routine hospital work unfolded, revealing material-discursive and reflective practices, but also silent modes of legitimizing the ‘non-practicing’ of medication review in a highly structured way. This thesis provides an alternative perspective on studying the implementation of a healthcare intervention and challenges various assumptions underpinning implementation research. Instead, a broadened perspective is suggested directing attention to the practical and situated knowing involved, the local processes of negotiating objectives in practice, as well as to the meaning-making required when practitioners engage with a practice. Finally, there are opportunities to learn from implementation processes, when frontline practitioners involved in embedding medication review are able to reflect on adapting medication review to make routines better fit the local context. 

Ämnesord

Medication Reconciliation  (MeSH)
Medical and Health Sciences  (ssif)
Medicin och hälsovetenskap  (ssif)
Medical and Health Sciences  (ssif)
Health Sciences  (ssif)
Other Health Sciences  (ssif)
Medicin och hälsovetenskap  (ssif)
Hälsovetenskap  (ssif)
Annan hälsovetenskap  (ssif)

Genre

government publication  (marcgt)

Indexterm och SAB-rubrik

implementation
professional practice
ethnography
medication safety
practice theory

Klassifikation

615.6 (DDC)
Vmf (kssb/8 (machine generated))
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