Liv Mathiesen

• Phan, Tuan Anh; Palm, Pia; Stiphout, Anita van Haaren-van; Graav, Gretchen de; Lea, Marianne & Wøien, Hilde [Show all 12 contributors for this article] (2026). Serious gaming as a platform for interprofessional education about the medication process: A curricular resource for students of medicine, pharmacy, and nursing. Journal of Interprofessional Education & Practice. 45, p. 1–6. doi: 10.1016/j.xjep.2026.100846. Full text in Research Archive
• Glatkauskas, Mikas; Syversen, Malin Olsen; Mathiesen, Liv; Scott, Michael; Svensberg, Karin & Denstad, Berit Gallefoss [Show all 7 contributors for this article] (2026). Perspectives on shared decision making related to medications from patients with multiple long-term conditions transitioning from hospital to home: a qualitative study. International Journal of Clinical Pharmacy. ISSN 2210-7703. doi: 10.1007/s11096-026-02143-x. Full text in Research Archive Show summary

  Introduction Shared decision making is particularly important for patients with multiple long-term conditions due to the nature of long-term treatments and frequent changes in medication regimens. However, the complexity of the medication regimens could exclude these vulnerable patients from shared decision making. There is little knowledge about how patients with multiple long-term conditions experience and perceive shared decision making. Aim The aim was to explore the perspectives and experiences of patients with multiple long-term conditions regarding shared decision making related to medications before, during and after a hospital stay. Method Semi-structured interviews with 21 patients and three next of kin were conducted. Patients ≥ 18 years, usually living at home, on at least four medications for at least two separate conditions were included. These patients were purposively sampled from two geriatric wards and one internal medicine ward at a university hospital in Norway and interviewed approximately 14 days post hospital discharge. The inclusion and interviews lasted from December 2022 to February 2024. A semi-structured interview guide was used, and the qualitative data were analyzed using directed content analysis guided by the three-talk model developed by Elwyn et al. from 2017. Results Patients reported not being invited to be part of the shared decision-making process and perceived their limited medical knowledge as a barrier to being invited to participate. They reflected on themselves being primarily focused on single details regarding one medication option they had received. Furthermore, they were not encouraged by the healthcare professionals to discuss and compare different medication options. Both patients and next of kin described an expectation that decisions being made by healthcare professionals would be accepted although the patient did not necessarily understand the treatment plan adequately. Several patients reported that healthcare professional led decisions left little to no room for further discussion and that medication decisions and patient health goals were almost solely in the hands of the healthcare professional. Although most patients trusted the healthcare professional to act in their best interests, this reliance resulted in further disengagement from their own treatment. Conclusion Patients with multiple long-term conditions were in general unfamiliar with and uninvolved in shared decision making related to medications. Additionally, the patients reflected on a lack of invitation to team talk which resulted in limited patient involvement both in option and decision talk.

• Syversen, Malin Olsen; Glatkauskas, Mikas; Mathiesen, Liv; Lea, Marianne; Denstad, Berit Gallefoss & Svensberg, Karin (2025). Facilitators and barriers to medication self-management for patients with multiple long-term conditions transitioning from hospital to home. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 18. doi: 10.1016/j.rcsop.2025.100598. Full text in Research Archive
• Glatkauskas, Mikas; Syversen, Malin Olsen; Lea, Marianne; Scott, Michael; Svensberg, Karin & Denstad, Berit G. [Show all 8 contributors for this article] (2025). Application of a human factors approach to investigate the hospital to home transition for patients with multiple long-term conditions. Human Factors in Healthcare (HFH). 7. doi: 10.1016/j.hfh.2025.100100. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Sedeniussen, Sandra Johanne; Hauge, Monica; Benny, Steffi & Horgen, Kristine [Show all 12 contributors for this article] (2025). Discrepancies in medication lists after hospital discharge in patients with multiple long-term conditions. Research in Social and Administrative Pharmacy. ISSN 1551-7411. 21(8), p. 580–588. doi: 10.1016/j.sapharm.2025.03.062. Full text in Research Archive Show summary

  Background Inadequate information flow in the transition from hospital to home poses a challenge to medication safety, especially for patients with multiple long-term conditions (MLTCs). Purpose To investigate the frequency, categories, underlying reasons, and potential clinical relevance of medication discrepancies (MDs) by comparing medication lists in hospital discharge summaries with actual medication use after discharge in patients with MLTCs. Methods Home-dwelling adult patients with MLTCs, using minimum four medications were included near the time of their planned discharge, from one internal medicine and two geriatric wards in Oslo, to this cross-sectional observational study. Medication reconciliation was performed 1–2 weeks post-discharge. Discrepancies between the medication list in the discharge summary and the patient's medication use were classified into six categories. A panel assessed the potential clinical relevance of the MDs in a short-term and long-term perspective. Results 150 patients, median age 75 years (range 22–94), were included. 132 (88 %) had at least one MD, with a median of 3 per patient (range 0–10). The most common MDs involved medications in use although not listed in the discharge summary. Apparent lack of or insufficient medication reconciliation during the hospital stay was the most frequent reason for MDs. Of the MDs, 5.5 % and 28 % were assessed to be of potential clinical relevance in the short-term and long-term perspective, respectively. Conclusion Almost all patients had MDs following hospital discharge. The potential clinical relevance increases over time if MDs are not corrected. Our findings highlight the need for more effective interventions to ensure medication safety in care transitions for this vulnerable population.

• Mathiesen, Liv; Blix, Hege Salvesen; Molden, Espen; Kersten, Hege; Trapnes, Elin & Bergan, Stein [Show all 7 contributors for this article] (2024). Erfaringsbasert master i klinisk farmasi – en kartleggingsstudie. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. p. 32–36. Full text in Research Archive Show summary

  Hensikt Kartlegge bakgrunn for farmasøyter som har gjennomført minst halve det erfaringsbaserte masterprogrammet i klinisk farmasi ved Farmasøytisk institutt, Universitetet i Oslo. Kartlegge i hvilken grad arbeidsoppgavene har endret seg for de som har fullført utdanningen. Materiale og metode Deskriptiv nettbasert spørreskjemaundersøkelse med spørsmål knyttet til demografi, grunnutdanningen i farmasi, det erfaringsbaserte masterprogrammet og arbeidsoppgaver. Farmasøyter som hadde fullført minst tre av seks emner i masterprogrammet, kunne inkluderes, og 92 farmasøyter ble invitert til å delta. Resultater 82 farmasøyter (88 %) besvarte undersøkelsen, hvorav 53 hadde gjennomført hele utdanningen, og 29 farmasøyter hadde gjennomført minst halve utdanningen. Blant respondentene som hadde fullført masterprogrammet, hadde en signifikant høyere andel 5-årig farmasiutdanning (master i farmasi eller cand.pharm.) (p < 0,01) og jobbet i sykehus med klinisk farmasøytiske oppgaver før de startet på masterprogrammet (p = 0,04), sammenliknet med de som var underveis i utdanningen. Blant de som hadde fullført masterprogrammet, svarte 93 % at de hadde jobbet med klinisk farmasøytiske oppgaver etter utdanningen. Det var 70 % som for tiden utførte klinisk farmasøytiske arbeidsoppgaver, sammenliknet med 62 % før oppstart. 43 % hadde vært involvert i kliniske forskningsprosjekter etter endt utdanning. Konklusjon Blant de som var i ferd med å gjennomføre videreutdanningen var det flere med bachelorgrad og færre med erfaring som klinisk farmasøyt enn i gruppen som hadde fullført. Ni av ti farmasøyter som hadde gjennomført hele videreutdanningen, har hatt klinisk arbeidsoppgaver etterpå, mens seks av ti hadde slike oppgaver før utdanningen. Nesten halvparten hadde vært involvert i kliniske forskningsprosjekter.

• Mikaelsen, Helena Zaitzow; Ulla, Ingeborg Hjalland; Karimi, David; Mathiesen, Liv; Viktil, Kirsten Kilvik & Syversen, Malin Olsen [Show all 14 contributors for this article] (2024). Medication Discrepancies in Hospitalised Medical Patients – Status After a Decade With Targeted Medication Reconciliation Measures, a Cross-sectional Multicenter Study. Health Services Insights (HSI Journal). 17, p. 1–8. doi: 10.1177/11786329241254202. Full text in Research Archive Show summary

  Several targeted medication reconciliation (MR) initiatives have been introduced to reduce the number of medication discrepancies (MDs). The real-life quality of medication lists at hospital admission has however not been comprehensively investigated in the last decade. We aimed to examine the frequency and potential clinical relevance of MDs at hospital admission and investigate whether certain characteristics are associated with MDs. Patients ⩾18 years old admitted to medical wards at 4 hospitals in Norway were included. MR was performed, and discrepancies between the reconciled medication list and the medication chart were identified. The potential clinical relevance was assessed in a short-term and long-term perspective. We included 250 patients and 201 (80%) had 1 or more MDs, mean 3.2 (SD 2.9) per patient. Out of 824 identified MDs, 171 (20.8%) and 362 (43.9%) were of moderate, major, or extreme potential clinical relevance in short- and long-term perspective, respectively. The risk of MDs increased with increasing age, increasing number of medications, and the use of multidose drug dispensing. Although several targeted MR initiatives have been launched, the frequency of MDs upon hospital admission is still high. However, the potential clinical relevance of the MDs seems less severe, which indicates an improvement.

• Mathiesen, Liv; Nguyen, Tram Bich Michelle; Dæhlen, Ingrid; Mowe, Morten & Lea, Marianne (2024). Effect of integrated medicines management on quality of discharge medication information—a secondary endpoint in a randomized controlled trial. International Journal for Quality in Health Care. ISSN 1353-4505. 36(4), p. 1–8. doi: 10.1093/intqhc/mzae100. Full text in Research Archive Show summary

  Background High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information. Methods Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a prespecified secondary endpoint analysis of the randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information. Results The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 [mean difference 2.7, 95% confidence interval (CI) 2.3–3.2, P < .001]. In total, 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), P < .001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6–4.4, P < .001). Conclusion Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.

• Rognan, Stine; Mathiesen, Liv; Lea, Marianne; Mowe, Morten; Molden, Espen & Skovlund, Eva (2024). Development and external validation of a prognostic model for time to readmission or death in multimorbid patients. Research in Social and Administrative Pharmacy. ISSN 1551-7411. 20(9), p. 926–933. doi: 10.1016/j.sapharm.2024.06.007. Full text in Research Archive Show summary

  Objective To develop and externally validate a prognostic model built on important factors predisposing multimorbid patients to all-cause readmission and/or death. In addition to identify patients who may benefit most from a comprehensive clinical pharmacist intervention. Methods A multivariable prognostic model was developed based on data from a randomised controlled trial investigating the effect of pharmacist-led medicines management on readmission rate in multimorbid, hospitalised patients. The derivation set comprised 386 patients randomised in a 1:1 manner to the intervention group, i.e. with a pharmacist included in their multidisciplinary treatment team, or the control group receiving standard care at the ward. External validation of the model was performed using data from an independent cohort, in which 100 patients were randomised to the same intervention, or standard care. The setting was an internal medicines ward at a university hospital in Norway. Results The number of patients who were readmitted or had died within 18 months after discharge was 297 (76.9 %) in the derivation set, i.e. the randomized controlled trial, and 69 (71.1 %) in the validation set, i.e. the independent cohort. Charlson comorbidity index (CCI; low, moderate or high), previous hospital admissions within the previous six months and heart failure were the strongest prognostic factors and were included in the final model. The efficacy of the pharmaceutical intervention did not prove significant in the model. A prognostic index (PI) was constructed to estimate the hazard of readmission or death (low, intermediate or high-risk groups). Overall, the external validation replicated the result. We were unable to identify a subgroup of the multimorbid patients with better efficacy of the intervention. Conclusions A prognostic model including CCI, previous admissions and heart failure can be used to obtain valid estimates of risk of readmission and death in patients with multimorbidity.

• Hjemås, Bodil Jahren; Bøvre, Katrine; Bjerknes, Kathrin; Mathiesen, Liv; Mellingsæter, Marte & Molden, Espen (2023). Implementation of pharmacogenetic testing in medication reviews in a hospital setting. British Journal of Clinical Pharmacology. ISSN 0306-5251. 89(10), p. 3116–3125. doi: 10.1111/bcp.15815. Full text in Research Archive Show summary

  Abstract Aim To investigate whether it is feasible to perform pharmacogenetic testing and implement the test results as part of medication reviews during hospitalization of multimorbid patients. Methods Patients with ≥2 chronic conditions and ≥5 regular drugs with at least one potential gene‐drug interaction (GDI) were included from one geriatric and one cardiology ward for pharmacogenetic testing. After inclusion by the study pharmacist, blood samples were collected and shipped to the laboratory for analysis. For patients still hospitalized at the time when the pharmacogenetic test results were available, the information was used in medication reviews. Recommendations from the pharmacist on actionable GDIs were communicated to the hospital physicians, who subsequently decided on potential immediate changes or forwarded suggestions in referrals to general practitioners. Results The pharmacogenetic test results were available for medication review in 18 of the 46 patients (39.1%), where median length of hospital stay was 4.7 days (1.6‐18.3). The pharmacist recommended medication changes for 21 of 49 detected GDIs (42.9%). The hospital physicians accepted 19 (90.5%) of the recommendations. The most commonly detected GDIs involved metoprolol ( CYP2D6 genotype), clopidogrel ( CYP2C19 genotype) and atorvastatin ( CYP3A4/5 and SLCOB1B1 genotype). Conclusions The study shows that implementation of pharmacogenetic testing for medication review of hospitalized patients has the potential to improve drug treatment before being transferred to primary care. However, the logistics workflow needs to be further optimized, as test results were available during hospitalization for less than half of the patients included in the study.

• Henriksen, Ben Tore; Krogseth, Maria; Andersen, Randi D.; Nordsveen, Maren; Nguyen, Caroline Thy & Mathiesen, Liv [Show all 7 contributors for this article] (2023). Clinical pharmacist intervention to improve medication safety for hip fracture patients through secondary and primary care settings: a nonrandomised controlled trial. Journal of Orthopaedic Surgery and Research. 18(1). doi: 10.1186/s13018-023-03906-2. Full text in Research Archive Show summary

  Background: Hip fracture patients face a patient safety threat due to medication discrepancies and adverse drug reactions when they have a combination of high age, polypharmacy and several care transitions. Consequently, optimised pharmacotherapy through medication reviews and seamless communication of medication information between care settings is necessary. The primary aim of this study was to investigate the impact on medication management and pharmacotherapy. The secondary aim was to evaluate implementation of the novel Patient Pathway Pharmacist intervention for hip fracture patients. Methods: Hip fracture patients were included in this nonrandomised controlled trial, comparing a prospective intervention group (n = 58) with pre-intervention controls who received standard care (n = 50). The Patient Pathway Pharmacist intervention consisted of the steps: (A) medication reconciliation at admission to hospital, (B) medication review during hospitalisation, (C) recommendation for the medication information in the hospital discharge summary, (D) medication reconciliation at admission to rehabilitation, and (E) medication reconciliation and (F) review after hospital discharge. The primary outcome measure was quality score of the medication information in the discharge summary (range 0-14). Secondary outcomes were potentially inappropriate medications (PIMs) at discharge, proportion receiving pharmacotherapy according to guidelines (e.g. prophylactic laxatives and osteoporosis pharmacotherapy), and all-cause readmission and mortality. Results: The quality score of the discharge summaries was significantly higher for the intervention patients (12.3 vs. 7.2, p < 0.001). The intervention group had significantly less PIMs at discharge (- 0.44 (95% confidence interval - 0.72, - 0.15), p = 0.003), and a higher proportion received prophylactic laxative (72 vs. 35%, p < 0.001) and osteoporosis pharmacotherapy (96 vs. 16%, p < 0.001). There were no differences in readmission or mortality 30 and 90 days post-discharge. The intervention steps were delivered to all patients (step A, B, E, F = 100% of patients), except step (C) medication information at discharge (86% of patients) and step (D) medication reconciliation at admission to rehabilitation (98% of patients). Conclusion: The intervention steps were successfully implemented for hip fracture patients and contributed to patient safety through a higher quality medication information in the discharge summary, fewer PIMs and optimised pharmacotherapy.

• Mathiesen, Liv & Skovlund, Eva (2023). Avbrutte tidsserieanalyser. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(14). doi: 10.4045/tidsskr.23.0559. Full text in Research Archive Show summary

  Når man skal teste effekten av helsetjenesteintervensjoner, er det ikke alltid mulig å gjennomføre randomiserte kontrollerte studier. Avbrutte tidsserieanalyser regnes som et godt alternativ. Randomiserte kontrollerte studier er gullstandarden for å vurdere effekten av en intervensjon, men det er ikke alltid mulig å gjøre slike studier. Dette vil særlig gjelde for intervensjoner på et populasjons- eller systemnivå. Avbrutte tidsserieanalyser (engelsk: interrupted time series) har vært brukt til å analysere effekt av tiltak for å oppnå endret forskrivning fra leger, som opplæringsprogram på sykehus (1) eller endringer i refusjonsvilkår (2). Metoden kan også brukes i epidemiologiske studier, for eksempel for å studere hvorvidt graviditet gjør at kvinner avslutter behandling med legemidler (3). En tidsserie er en serie av gjentatte observasjoner over tid, gjerne med faste intervaller mellom observasjonene. Prinsippet for en avbrutt tidsserieanalyse er at man gjør observasjoner både før og etter at en intervensjon introduseres. Serien «avbrytes» av intervensjonen. Dette kan illustreres ved et eksempel hvor observasjonene var andelen forskrivninger av antibiotika i tråd med gjeldende retningslinjer før og etter en intervensjon på en sykehusavdeling basert på revisjon med tilbakemelding (audit and feedback intervention study) (figur 1) (1). Hver av de to periodene, før og etter intervensjonen, defineres av to parametere, trenden og nivået. Begge vil kunne påvirkes av intervensjonen.

• Rognan, Stine; Jørgensen, Mie Jedig; Mathiesen, Liv; Druedahl, Louise Christine; Lie, Helene Berg & Bengtsson, Kajsa Rebecka [Show all 8 contributors for this article] (2023). ‘The way you talk, do I have a choice?’ Patient narratives of medication decision-making during hospitalization. International Journal of Qualitative Studies on Health and Well-being. ISSN 1748-2623. 18(1). doi: 10.1080/17482631.2023.2250084. Full text in Research Archive Show summary

  Objective Based on the principle of the autonomy of the patient, shared decision-making (SDM) is the ideal approach in clinical encounters. In SDM, patients and healthcare professionals (HCPs) share knowledge and power when faced with the task of making decisions. However, patients are often not involved in the decision-making process. In this study, we explore medication decision-making during hospitalization and how power in the specific patient—HCP relationship is articulated, as analysed by Foucauldian theory. Methods A qualitative case study, comprising observations of patient-HCP encounters at an internal medicines ward at a university hospital in Norway, followed by semi-structured interviews. The narratives (n = 4 patients) were selected from a larger study (n = 15 patients). The rationale behind the choice of these patients was to include diverse and rich accounts. The four patients in their 40s–70s were included close to the day of presumed discharge. Results The narratives provide an insight into the patients as persons, their perspectives, including what mattered to them during their hospitalization, especially in relation to medications. Overall, SDM was not observed in this study. Even though all the participants actively tried to keep their autonomous capacity and to resist the HCPs’ use of power, they were not able to change the established dynamics. Moreover, they were not allowed an equal voice to those of HCPs and thus not to escape the system’s objectification and subjectification of them. Conclusion There is a need for HCPs to get more familiarized with SDM. The healthcare system and the individual HCP need to make more room for dialogue with the patients about their preferences. A part of this is also how health care systems are structured and scheduled, thus, it is important to empower patients and HCPs alike.

• Syversen, Malin Olsen; Shah, Sarah Farhin; Mathiesen, Liv; Mowe, Morten & Lea, Marianne (2023). Effect of integrated medicines management on the quality of drug treatment in hospitalised multimorbid patients - a secondary endpoint analysis of a randomised controlled trial. International Journal of Pharmacy Practice (IJPP). ISSN 0961-7671. 31(3), p. 314–320. doi: 10.1093/ijpp/riad007. Full text in Research Archive Show summary

  Abstract Objectives To investigate the effect of integrated medicines management provided to hospitalised multimorbid patients on the quality of drug treatment at discharge measured as the mean number of potential prescribing omissions and potentially inappropriate medicines. Methods Multimorbid patients ≥18 years, using a minimum of four regular drugs from a minimum of two therapeutic drug classes, were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a pre-specified secondary endpoint analysis of a randomised controlled trial; the difference between the intervention and control group at discharge in the mean number of potential prescribing omissions and potentially inappropriate medicines, measured with START-2 and STOPP-2 criteria, respectively. The difference between the groups was calculated using rank analysis. Key findings In total, 386 patients were analysed. Integrated medicines management reduced the mean number of potential prescribing omissions at discharge, compared to the control group, 1.34 versus 1.57, respectively (mean difference 0.23, 95% CI 0.07–0.38, P = 0.005, adjusted for values at admission). There was no difference in the mean number of potentially inappropriate medicines at discharge (1.84 versus 1.88, respectively; mean difference 0.03, 95% CI −0.18 to 0.25, P = 0.762, adjusted for values at admission). Conclusions Integrated medicines management delivered to multimorbid patients during a hospital stay led to an improvement in undertreatment. No effect on deprescribing of inappropriate treatment was seen.

• Kållberg, Cecilia Birgit Maria; Mathiesen, Liv; Gopinathan, Unni & Blix, Hege Salvesen (2023). The role of drug regulatory authorities and health technology assessment agencies in shaping incentives for antibiotic R&D: a qualitative study. Journal of Pharmaceutical Policy and Practice. 16. doi: 10.1186/s40545-023-00556-x. Full text in Research Archive Show summary

  Background Few antibiotics have entered the market in recent years despite the need for new treatment options. Some of the challenges of bringing new antibiotics to market are linked to the marketing authorization and health technology assessment (HTA) processes. Research shows great variation in geographic availability of new antibiotics, suggesting that market introduction of new antibiotics is unpredictable. We aimed to investigate regulatory authorities’ and HTA agencies’ role in developing non-financial incentives to stimulate antibiotic research and development (R&D). Methods We conducted individual, semi-structured, stakeholder interviews. Participants were recruited from regulatory authorities (EMA and FDA) and HTA agencies in Europe. Participants had to be experienced with assessment of antibiotics. The data were analyzed using a deductive and inductive approach to develop codes and identify key themes. Data were analyzed using thematic analysis including the constant comparison method to define concepts, and rival thinking to identify alternative explanations. Results We found that (1) interpretation of key concepts guiding the understanding of what type of antibiotics are needed vary (2) lack of a shared approach on how to deal with limited clinical data in the marketing authorization and HTA processes is causing barriers to getting new antibiotics to market (3) necessary adaptations to the marketing authorization process causes uncertainties that transmit to other key stakeholders involved in delivering antibiotics to patients. Conclusions A shared understanding of limited clinical data and how to deal with this issue is needed amongst stakeholders involved in antibiotic R&D, marketing authorization, and market introduction to ensure antibiotics reach the market before resistance levels are out of control. Regulatory authorities and HTA agencies could play an active role in aligning the view of what constitutes an unmet medical need, and direct new economic models towards stimulating greater diversity in the antibiotic armamentarium.

• Kebede, Adyam Tesfamariam; Trapnes, Elin; Lea, Marianne; Abrahamsen, Bjørg & Mathiesen, Liv (2022). Effect of pharmacist-led inhaler technique assessment service on readmissions in hospitalized COPD patients: a randomized, controlled pilot study. BMC Pulmonary Medicine. 22(1). doi: 10.1186/s12890-022-02004-z. Full text in Research Archive Show summary

  Objective To investigate the effect of pharmacist-led inhaler technique assessment service on readmissions and CAT-score in hospitalized COPD patients. Furthermore, to provide an effect estimate for sample size calculations for future studies and to gain experience on the feasibility of such studies. Methods A randomized controlled pilot study. Patients were randomized 1:1 to intervention or standard care. The primary endpoint was the difference in time to first readmission after hospital discharge between the treatment groups. Results There was no statistically significant effect on the time to readmission (median 41 days in the intervention group (19 patients) and 95 days in the control group (20 patients), HR 1.74, 95% CI 0.81–3.75, p = 0.16). There was no statistically significant difference between the groups in CAT-score 2 months after discharge, median scores being 25.5 and 24 in the intervention and the control group, respectively (p = 0.29). There was, however, a reduction of 3.5 units in CAT-score from baseline to 2 months after discharge in the intervention group, compared to no change in the control group. Conclusion Pharmacist-led inhaler technique training had no effect on time to readmission or CAT-score. Future studies in larger populations should consider focusing on patients with less severe COPD, exploring CAT-score as a primary endpoint, consider stratifying for important baseline variables and evaluate the acceptability of the intervention. Trial registration Date of registration 01/10/2018. ClinicalTrials.gov identifier: NCT03691324.

• Henriksen, Ben Tore; Krogseth, Maria; Nguyen, Caroline Thy; Mathiesen, Liv; Andersen, Randi Dovland & Andersson, Yvonne [Show all 7 contributors for this article] (2022). Medication management for patients with hip fracture at a regional hospital and associated primary care units in Norway: a descriptive study based on a survey of clinicians' experience and a review of patient records. BMJ Open. 12(11), p. 1–10. doi: 10.1136/bmjopen-2022-064868. Full text in Research Archive Show summary

  Objective: Patients with hip fracture are at high risk of medication errors due to a combination of high age, comorbidities, polypharmacy and several care transitions after fracture. The aim was to study medication management tasks concerning patient safety: medication reconciliation, medication review and communication of key medication information in care transitions. Design: Descriptive study comprising a self-administered clinician survey (MedHipPro-Q) and a retrospective review of hospital medical records of patients with hip fracture. Setting: Regional hospital and the associated primary care units (South-Eastern Norway). Participants: The survey received responses from 253 clinicians, 61 medical doctors and 192 nurses, involved in the medication management of patients with hip fracture, from acute admittance to the regional hospital, through an in-hospital fast track, primary care rehabilitation and back to permanent residence. Respondents' representativeness was unknown, introducing a risk of selection and non-response bias, and extrapolating findings should be done with caution. The patient records review included a random sample of records of patients with hip fracture (n=50). Outcome measures: Medication reconciliation, medication review and communication of medication information from two perspectives: the clinicians' (ie, experiences with medication management) and the practice (ie, documentation of completed medication management). Results: In the survey, most clinicians stated they performed medication reconciliation (79%) and experienced that patients often arrived without a medication list after care transition (37%). Doctors agreed that more patients would benefit from medication reviews (86%). In the hospital patient records, completed medication reconciliation was documented in most patients (76%). Medication review was documented in 2 of 50 patients (4%). Discharge summary guidelines were followed fully for 3 of 50 patients (6%). Conclusion: Our study revealed a need for improved medication management for patients with hip fracture. Patients were at risk of medication information not being transferred correctly between care settings, and medication reviews seemed to be underused in clinical practice.

• Bengtsson, Kajsa Rebecka; Rognan, Stine; Sporrong, Sofia Kälvemark; Lie, Helene Berg; Andersson, Yvonne & Mowe, Morten [Show all 7 contributors for this article] (2022). Health literacy in medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway. BMJ Open. 12(6), p. 1–8. doi: 10.1136/bmjopen-2021-058473. Full text in Research Archive Show summary

  Objective When discharged from hospital patients are often assumed to have sufficient health literacy (HL) to participate in their medical treatment and manage medical self-care after discharge. However, limited HL is a widespread concern and patient participation during discharge is lacking. In this study, we explore how HL influences medication communication during hospital discharge. Design A qualitative case study, comprising unstructured observations of patient–healthcare personnel (HCP) encounters followed by semistructured interviews. Data were analysed using content analysis. Setting An internal medicines ward at a university hospital in Norway. Participant Fifteen patients aged 40–89 years were included close to the day of discharge. Results The following themes describing dimensions of HL emerged: (1) access, (2) understand, (3) appraise and (4) apply. Most patients sought access to medication information from HCP, while some felt dependent on HCP to provide it. However, their abilities to understand, evaluate and make informed decisions were challenged, partly because HCPs’ ability to adapt their communication to the patient’s knowledgebase varied. Conclusion The results give a broader understanding of how HL influences medication communication during hospital discharge. To consider central dimensions of HL is important to achieve optimal medication communication, as the communication only can be exercised within the frames of the patient’s HL. The findings in this study support that HL should be described as a shared responsibility between the patients and HCP. Attention should be focused to the HCP’s responsibility to adapt the communication to the patient’s knowledgebase.

• Mulac, Alma; Mathiesen, Liv; Taxis, Katja & Granås, Anne Gerd (2021). Barcode medication administration technology use in hospital practice: a mixed-methods observational study of policy deviations. BMJ Quality and Safety. ISSN 2044-5415. 30(12), p. 1021–1030. doi: 10.1136/bmjqs-2021-013223. Full text in Research Archive Show summary

  Introduction Barcode medication administration (BCMA) can, if poorly implemented, cause disrupted workflow, increased workload and cause medication errors. Further exploration is needed of the causes of BCMA policy deviations. Objective To gain an insight into nurses’ use of barcode technology during medication dispensing and administration; to record the number and type of BCMA policy deviations, and to investigate their causes. Methods We conducted a prospective, mixed-methods study. Medication administration rounds on two hospital wards were observed using a digital tool and field notes. The SEIPS (Systems Engineering Initiative for Patient Safety) model was used to analyse the data. Results We observed 44 nurses administering 884 medications to 213 patients. We identified BCMA policy deviations for more than half of the observations; these related to the level of tasks, organisation, technology, environment and nurses. Task-related policy deviations occurred with 140 patients (66%) during dispensing and 152 patients (71%) during administration. Organisational deviations included failure to scan 29% of medications and 20% of patient’s wristbands. Policy deviations also arose due to technological factors (eg, low laptop battery, system freezing), as well as environmental factors (eg, medication room location, patient drawer size). Most deviations were caused by policies that interfere with proper and safe BCMA use and suboptimal technology design. Conclusion Our findings indicate that adaptations of the work system are needed, particularly in relation to policies and technology, to optimise the use of BCMA by nurses during medication dispensing and administration. These adaptations should lead to enhanced patient safety, as the absolute goal with BCMA implementation.

• Rognan, Stine Eidhammer; Sporrong, Sofia Kälvemark; Bengtsson, Kajsa Rebecka; Lie, Helene Berg; Andersson, Yvonne & Mowe, Morten [Show all 7 contributors for this article] (2021). Empowering the patient? Medication communication during hospital discharge: a qualitative study at an internal medicines ward in Norway. BMJ Open. doi: 10.1136/bmjopen-2020-044850. Full text in Research Archive Show summary

  Objective Effective communication and patient empowerment before hospital discharge are important steps to ensure medication safety. Patients discharged from hospitals are often expected to assume self-management, frequently without healthcare personnel (HCP) having ensured patients’ knowledge, motivation and/or skills. In this substudy of a larger study, we explore how patients experience medication communication during encounters with HCPs and how they are empowered at hospital discharge. Design This is a qualitative case study. Data collection was done through qualitative observations of patient–HCP encounters, semistructured interviews with patients and drug reconciliation. Data were analysed using content analysis. Setting An internal medicines ward at a university hospital in Norway. Participants Nine patients aged 49–90 years were included close to the day of discharge. Results The analysis revealed the following themes: (1) patient-centred care (PCC), which included ‘understanding and involvement in the patient-as-person’, ‘establishment of a therapeutic alliance’, and ‘sharing power and responsibility’; and (2) biomedical (conventional) care, including the subthemes ‘HCPs in power and control’ and ‘optimising medical outcomes, following guidelines’. Even though the elements of PCC were observed in several encounters, overall communication was not sufficiently fostering patient empowerment. Spending time with patients and building relations based on mutual trust seemed undervalued. Conclusions The results provide a broader understanding of how patients experience medication communication at hospital discharge. Both the patients and the HCPs appear to be inculcated with biomedical traditions and are uncertain about the roles and opportunities associated with PCC. Attention should be paid to patient preferences and to the core elements of the PCC model from admission to discharge to empower patients in medication self-management.

• Svensberg, Karin; Kalleberg, Birgitte Grøstad; Mathiesen, Liv; Andersson, Yvonne; Rognan, Stine Eidhammer & Sporrong, Sofia Kälvemark (2021). The observer effect in a hospital setting - Experiences from the observed and the observers. Research in Social and Administrative Pharmacy. ISSN 1551-7411. 17(12), p. 2136–2144. doi: 10.1016/j.sapharm.2021.07.011. Full text in Research Archive Show summary

  Background Observation studies are used in health care research, e.g. to explore behaviors of patients or health care professionals in hospitals. A methodological challenge in observation studies is the observer effect, as it can jeopardize the quality of a study. Objectives To capture different dimensions of the observer effect through health care professionals' and patients' experiences, and their reactions to being observed in a hospital setting, and in addition, observers' experiences from performing an observation study. Method Four focus group interviews (health care professionals and observers) and 10 individual interviews (patients) were conducted with participants from a Norwegian observation study focusing on medication communication at a hospital ward. In all 26 persons were interviewed, whereof 3 were observers (pharmacist, pharmacy students). Data were collected between September 2019 and January 2020 and analyzed by an inductive, thematic analysis approach. Results Five main themes were identified; Experiencing being observed; Temporarily adapting medication communication behavior; Consequences for the patients; To interact or not - reflections on the relations and Observing the observers. Respondents reported some observer effects, but also that these diminished with time. Even though minimal interaction was used as a strategy, observers and the observed still built rapport. Conclusions The observer effect in relation to medication communication seemed to be small and temporary in this specific hospital setting, among other things as staff and patients were used to extra persons (e.g. students) being around. Medication communication in hospital settings is a complex behavior, and appears to not be strongly impacted by the presence of observers, especially with a long observation time. It is important for researchers to monitor and record the observer effect in the specific setting of the study. This can be done by interviews with the observed and the observers by someone not connected to the observation study.

• Vallet, Thibault; Bensouda, Yahya; Saito, Jumpei; Mathiesen, Liv; Pokharkar, Varsha & Klingmann, Viviane [Show all 17 contributors for this article] (2021). Exploring Acceptability Drivers of Oral Antibiotics in Children: Findings from an International Observational Study. Pharmaceutics. 13(10). doi: 10.3390/pharmaceutics13101721. Full text in Research Archive Show summary

  Antibiotics are among the most commonly prescribed drugs in children. Adherence to the treatment with these drugs is of the utmost importance to prevent the emergence of resistant bacteria, a global health threat. In children, medicine acceptability is likely to have a significant impact on compliance. Herein we used a multivariate approach, considering simultaneously the many aspects of acceptability to explore the drivers of oral antibiotic acceptability in children under twelve, especially in toddlers and in preschoolers. Based on 628 real-life observer reports of the intake of 133 distinct medicines, the acceptability reference framework highlighted the influence of many factors such as age and sex of patients, previous exposure to treatment, place of administration, administration device, flavor agent in excipients and active pharmaceutical ingredient. These findings from an international observational study emphasize the multidimensional nature of acceptability. Therefore, it is crucial to consider all these different aspects for assessing this multi-faceted concept and designing or prescribing a medicine in order to reach adequate acceptability in the target population.

• Rognan, Stine Eidhammer; Sporrong, Sofia Kälvemark; Lie, Helene Berg; Bengtsson, Kajsa Rebecka; Andersson, Yvonne & Mowe, Morten [Show all 7 contributors for this article] (2021). Discharge processes and medicines communication from the patient perspective: A qualitative study at an internal medicines ward in Norway. Health Expectations. ISSN 1369-6513. doi: 10.1111/hex.13232. Full text in Research Archive Show summary

  Background Patients are expected to participate in the hospital discharge process, assume self‐management after discharge and communicate relevant information to their general practitioner; however, patients report that they are not being sufficiently empowered to take on these responsibilities. The aim of this study was to explore and understand the discharge process with a focus on medicines communication, from the patient perspective. Methods Patients were included at a hospital ward, observed during health‐care personnel encounters on the day of discharge and interviewed 1‐2 weeks after discharge. A process analysis was performed, and a content analysis combined data from observations and data from patient interviews focusing on medicines communication in the discharge process. Results A total of 9 patients were observed on the day of discharge, equalling 67.5 hours of observations. The analysis resulted in the following themes: (a) the observed discharge process; (b) patient initiatives; and (c) the patient role. The medicines communication in the discharge process appeared unstructured. Various patient preferences and needs were revealed. The elements of the best practice structured discharge conversation were observed; however, some patients did not have a discharge conversation at all. Conclusions The study contributes to a broader understanding of the discharge process, how patients experience it, including their role. It is evident that the discharge process is not always tailored to meet the patients’ needs. More focus on early patient involvement and communication, in order to better prepare patients for self‐management of their medications, is important for their health outcomes.

• Svensberg, K.; Kalleberg, Birgitte Grøstad; Rosvold, E.O.; Mathiesen, Liv; Wøien, H. & Hove, L.H. [Show all 11 contributors for this article] (2021). Interprofessional education on complex patients in nursing homes: a focus group study. BMC Medical Education. 21(1). doi: 10.1186/s12909-021-02867-6. Full text in Research Archive Show summary

  Background An ageing population leads up to increasing multi-morbidity and polypharmacy. This demands a comprehensive and interprofessional approach in meeting patients’ complex needs. This study describes graduate students’ experiences of working practice based in interprofessional teams with complex patients’ care needs in nursing homes. Method Students from advanced geriatric nursing, clinical nutrition, dentistry, medicine and pharmacy at the University of Oslo in Norway were assigned to groups to examine and develop a care plan for a nursing home patient during a course. Focus groups were used, 21 graduate students participating in four groups. Data were collected during spring 2018, were inductively analysed according to a thematic analysis method (Systematic Text Condensation). An analytical framework of co-ordination practices was applied to get an in-depth understanding of the data. Results Three themes were identified: 1) Complex patients as learning opportunities- an eye-opener for future interprofessional collaboration 2) A cobweb of relations, and 3) Structural facilitators for new collective knowledge. Graduate university students experienced interprofessional education (IPE) on complex patients in nursing homes as a comprehensive learning arena. Overall, different co-ordination practices for work organization among the students were identified. Conclusions IPE in nursing homes facilitated the students’ scope from a fragmented approach of the patients towards a relational and collaborative practice that can improve patient care and strengthen understanding of IPE. The study also demonstrated the need for preparatory teamwork training to gain maximum benefit from the experience. Something that can be organized by the education institutions in the form of a stepwise learning module and as an online pre-training course in interprofessional teamwork. Further, focusing on the need for well thought through processes of the activity by the institutions and the timing the practice component in students’ curricula. This could ensure that IPE is experienced more efficient by the students.

• Svensberg, Karin; Trapnes, Elin; Nguyen, Diana; Hasan, R.A.; Sund, Janne Kutschera & Mathiesen, Liv (2020). Patients’ perceptions of medicines information received at hospital discharge in Norway: a qualitative interview study. International Journal of Clinical Pharmacy. ISSN 2210-7703. p. 1–10. doi: 10.1007/s11096-020-01122-0. Full text in Research Archive
• Lea, Marianne; Mowe, Morten; Molden, Espen; Kvernrød, Kristin; Skovlund, Eva & Mathiesen, Liv (2020). Effect of medicines management versus standard care on readmissions in multimorbid patients: a randomised controlled trial. BMJ Open. 10(12). doi: 10.1136/bmjopen-2020-041558. Full text in Research Archive Show summary

  Objective To investigate the effect of pharmacist-led medicines management in multimorbid, hospitalised patients on long-term hospital readmissions and survival. Design Parallel-group, randomised controlled trial. Setting Recruitment from an internal medicine hospital ward in Oslo, Norway. Patients were enrolled consecutively from August 2014 to the predetermined target number of 400 patients. The last participant was enrolled March 2016. Follow-up until 31 December 2017, that is, 21–40 months. Participants Acutely admitted multimorbid patients ≥18 years, using minimum four regular drugs from minimum two therapeutic classes. 399 patients were randomly assigned, 1:1, to the intervention or control group. After excluding 11 patients dying in-hospital and 2 erroneously included, the primary analysis comprised 386 patients (193 in each group) with median age 79 years (range 23–96) and number of diseases 7 (range 2–17). Intervention Intervention patients received pharmacist-led medicines management comprising medicines reconciliation at admission, repeated medicines reviews throughout the stay and medicines reconciliation and tailored information at discharge, according to the integrated medicines management model. Control patients received standard care. Primary and secondary outcome measures The primary endpoint was difference in time to readmission or death within 12 months. Overall survival was a priori the clinically most important secondary endpoint. Results Pharmacist-led medicines management had no significant effect on the primary endpoint time to readmission or death within 12 months (median 116 vs 184 days, HR 0.82, 95% CI 0.64 to 1.04, p=0.106). A statistically significantly increased overall survival was observed during 21–40 months follow-up (HR 0.66, 95% CI 0.48 to 0.90, p=0.008). Conclusions Pharmacist-led medicines management had no statistically significant effect on time until readmission or death. A statistically significant increased overall survival was seen. Further studies should be conducted to investigate the effect of such an intervention on a larger scale.

• Hjemås, Bodil Jahren; Bøvre, Katrine; Mathiesen, Liv; Lindstrøm, Jonas Christoffer & Bjerknes, Kathrin (2019). Interventional study to improve adherence to phosphate binder treatment in dialysis patients. BMC Nephrology. 20(178). doi: 10.1186/s12882-019-1334-x. Full text in Research Archive Show summary

  Background Adherence to phosphate binder treatment is important to prevent high serum phosphate level in chronic dialysis patients. We therefore wanted to investigate patient knowledge, beliefs about and adherence to phosphate binders among these patients and assess whether one-to-one pharmacist-led education and counselling enhance adherence and lead to changes in serum phosphate levels. Methods A descriptive, interventional, single arm, pre-post study was performed at a hospital in Norway, including chronic dialysis patients aged 18 years or more using phosphate binders. The primary end-point was change in the proportion of patients with serum phosphate below 1.80 mmol/L and the secondary end-points included change in the patient’s knowledge, beliefs and adherence after the intervention measured by completion of questionnaires ‘Patient Knowledge’, Medication Adherence Report Scale (MARS− 5) and Beliefs about Medicines Questionnaire (BMQ). Data was collected both prior to and after one-to-one pharmacist-led education and counselling about their phosphate binders. Other medicines used by the patient was also registered. Results A total of 69 patients were enrolled in the study. After intervention, the probability of serum phosphate being below the target threshold 1.80 mmol/L (5.58 mg/dL) increased, although no significant change in mean serum phosphate levels was seen. On the other hand, the knowledge regarding phosphate binder treatment and the patients’ beliefs about the necessity of the treatment increased, while the concerns decreased (BMQ). This effect did not lead to increase in self-reported adherence measured by MARS-5. However the scores were high before the intervention. Conclusions Short term one-to-one individualized pharmacist-led education and counselling about phosphate binders increased the probability of serum phosphate concentrations being below the target threshold level 1.80 mmol/L (5.58 mg/dL), although not statistically significant. However, it did not decrease the mean serum phosphate level or increase the patients’ self-reported adherence. The patients increased their knowledge about the phosphate binder and their understanding of adherence, and were less concerned about the side effects of the medication. Trial registration ISRCTN52852596 , registered 11 April 2019. The trial was registered retrospectively.

• Lea, Marianne; Mowe, Morten; Mathiesen, Liv; Kvernrød, Kristin; Skovlund, Eva & Molden, Espen (2019). Prevalence and risk factors of drug-related hospitalizations in multimorbid patients admitted to an internal medicine ward. PLOS ONE. 14(7). doi: 10.1371/journal.pone.0220071. Full text in Research Archive Show summary

  Background Knowledge of risk factors for drug-related hospitalizations (DRHs) is limited. Aim To examine the prevalence of DRHs and the relationships between DRHs and various variables in multimorbid patients admitted to an internal medicine ward. Methods Multimorbid patients ≥ 18 years, using minimum of four regular drugs from minimum two therapeutic classes, were included from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016. Clinical pharmacists prospectively conducted medicines reconciliations and reviews to reveal drug-related problems (DRPs). Blinded for identified DRPs, an interdisciplinary group retrospectively made comprehensive, clinical assessments of each patient case to classify hospitalizations as drug-related (DRH) or non-drug-related (non-DRH). Age, sex distribution, Charlson Comorbidity Index (CCI), renal function, aberrant genotype frequencies, body-mass index, number of drugs, proportion of patients which received assistance for drug administration from the home care service, and/or through multidose-dispensed drugs, and occurrence of specific DRP subgroups, were compared separately between patients with DRHs versus non-DRHs, followed by multiple logistic regression analysis. Results Hospitalizations were classified as drug-related in 155 of the 404 included patients (38%). Factors significantly associated with DRHs were occurrence of adverse effect DRPs (adjusted odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–8.0), adherence issues (OR 2.9, 1.1–7.2), home care (OR 1.9, 1.1–3.5), drug monitoring DRPs (OR 1.9, 1.2–3.0), and CCI score ≥6 (OR 0.33, 0.14–0.77). Frequencies of aberrant genotypes did not differ between the patient groups, but in 41 patients with DRHs (26.5%), gene-drug interactions influenced the assessments of DRHs. Conclusion DRHs are prevalent in multimorbid patients with adverse effect DRPs and adherence issues as the most important risk factors.

• Høgholen, Anna Helene; Storhaug, Anette; Kvernrød, Kristin; Kostovski, Emil; Viktil, Kirsten Kilvik & Mathiesen, Liv (2018). Use of medicines, adherence and attitudes to medicines among persons with chronic spinal cord injury. Spinal Cord. ISSN 1362-4393. 56, p. 35–40. doi: 10.1038/sc.2017.95. Full text in Research Archive Show summary

  Objectives: To describe the use of medicines and adherence among persons with spinal cord injury (SCI). Further, to examine the influence of pain, spasms and beliefs about medicines on adherence. Methods: Persons (18 years) with chronic SCI (more than 1-year post injury), using at least one drug regularly, and admitted for a follow-up stay at Sunnaas Rehabilitation Hospital were included. Participants were interviewed about their drug regimen and filled out validated self-report questionnaires: Morisky Medication Adherence Scale (MMAS-8), beliefs about medicines questionnaire (BMQ), visual analogue scale (VAS) for pain and modified Penn spasm frequency scale (mPSFS). Results: The 105 participants used in average 4.2 drugs regularly (range, 1–15), and 70% reported high or moderate adherence to their treatment. Of the 39 participants using oral spasmolytics, 74% reported high or moderate adherence to these drugs. A total of 97% of the participants reported high perceptions of necessity to their treatment and 54% reported a high level of concern. Conclusion: The persons with SCI included in this study used in average the same number of regular drugs compared to persons with other chronic conditions. Regardless of high overall adherence, the participants were more concerned about their medicines compared to other patient groups. Further studies are required for understanding adherence and attitudes toward medicines in this population, especially to help the persons with chronic SCI feel safe about their drug regimen.

• Holdhus, Hanne; Bøvre, Katrine; Mathiesen, Liv; Bjelke, Erik Börje & Bjerknes, Kathrin (2018). Limited effect of structured medication report as the only intervention at discharge from hospital. European Journal of Hospital Pharmacy (EJHP). ISSN 2047-9956. doi: 10.1136/ejhpharm-2017-001371. Full text in Research Archive
• Johansen, Jeanette Schultz; Havnes, Kjerstin; Halvorsen, Kjell H.; Haustreis, Stine-Mari; Skaue, Lillann Wilsgård & Kamycheva, Elena [Show all 10 contributors for this article] (2018). Interdisciplinary collaboration across secondary and primary care to improve medication safety in the elderly (IMMENSE study): study protocol for a randomised controlled trial. BMJ Open. 8:e020106, p. 1–8. doi: 10.1136/bmjopen-2017-020106. Full text in Research Archive Show summary

  <p><i>Introduction:</i> Drug-related problems (DRPs) are common in the elderly, leading to suboptimal therapy, hospitalisations and increased mortality. The integrated medicines management (IMM) model is a multifactorial interdisciplinary methodology aiming to optimise individual medication therapy throughout the hospital stay. IMM has been shown to reduce readmissions and drug-related hospital readmissions. Using the IMM model as a template, we have designed an intervention aiming both to improve medication safety in hospitals, and communication across the secondary and primary care interface. This paper presents the study protocol to explore the effects of the intervention with regard to healthcare use, health-related quality of life (HRQoL) and medication appropriateness in elderly patients. <p><i>Methods and analysis:</i> A total of 500 patients aged ≥70 years will be included and randomised to control (standard care) or intervention group (1:1). The intervention comprises five steps mainly performed by pharmacists: (1) medication reconciliation at admission, (2) medication review during hospital stay, (3) patient counselling about the use of medicines, (4) a comprehensible and patientfriendly medication list with explanations in discharge summary and (5) postdischarge phone calls to the primary care level. The primary outcome is the difference between intervention and control patients in the rate of emergency medical visits (acute readmissions and visits to emergency department) 12 months after discharge. Secondary outcomes include length of index hospital stay, time to first readmission, mortality, hip fractures, strokes, medication changes, HRQoL and medication appropriateness. Patient inclusion started in September 2016. <p><i>Ethics and dissemination:</i> The trial was approved by the Norwegian Centre for Research Data and the Norwegian Data Protection Authority. We aim to publish the results in international peer-reviewed open access journals, at national and international conferences, and as part of two PhD theses.

• Lea, Marianne; Barstad, Ingeborg; Mathiesen, Liv; Mowe, Morten & Molden, Espen (2016). Effect of teaching and checklist implementation on accuracy of medication history recording at hospital admission. International Journal of Clinical Pharmacy. ISSN 2210-7703. 38(1), p. 20–24. doi: 10.1007/s11096-015-0218-9. Full text in Research Archive
• Holm, Hilde; Bjerke, Kirsti; Holst, Lone & Mathiesen, Liv (2015). Use of renal risk drugs in patients with renal impairment. International Journal of Clinical Pharmacy. ISSN 2210-7703. 37(6), p. 1136–1142. doi: 10.1007/s11096-015-0175-3. Full text in Research Archive
• Christensen, Hege Staaland; Hestad, Anette Leirvik; Molden, Espen & Mathiesen, Liv (2011). CYP3A5-mediated metabolism of midazolam in recombinant systems is highly sensitive to NADPH-cytochrome P450 reductase activity. Xenobiotica. ISSN 0049-8254. 41(1), p. 1–5. doi: 10.3109/00498254.2010.523734. Full text in Research Archive
• Christensen, Hege Staaland; Mathiesen, Liv; Postvoll, Lillian Wåge; Winther, Bjørn & Molden, Espen (2009). Different Enzyme Kinetics of Midazolam in Recombinant CYP3A4 Microsomes from Human and Insect Sources. Drug Metabolism and Pharmacokinetics (DMPK). ISSN 1347-4367. 24(3), p. 261–268. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1997). Hydrogen bond formation as a fundament for radical scavenging activity: A structure-activity study of C-methylated dihydrochalcones from Myrica gale and structurally related acetophenones. Free Radical Biology & Medicine. ISSN 0891-5849. 22, p. 307–311. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1996). Uncoupling of respiration and inhibition of ATP synthesis by C-methylated dihydrochalcones from Myrica gale L. European Journal of Pharmaceutical Sciences. ISSN 0928-0987. 4, p. 373–379. Full text in Research Archive
• Mathiesen, Liv; Wang, Siri; Halvorsen, Bente; Malterud, Karl Egil & Sund, Reidar Bredo (1996). Inhibition of lipid peroxidation in low density lipoprotein by the flavonoid myrigalone B and ascorbic acid. Biochemical Pharmacology. ISSN 0006-2952. 51, p. 1719–1725. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil; Nenseter, Marit Sofie & Sund, Reidar Bredo (1996). Inhibition of low density lipoprotein oxidation by myrigalone B, a naturally occurring flavonoid. Pharmacology and Toxicology. ISSN 0901-9928. 78, p. 143–146. Full text in Research Archive Show summary

  Abstract: The influence of myrigalone B, a flavonoid from the fruit exudate of Myrica gale L. on Cu2+ -induced oxidation of low density lipoprotein from cholesterol fed rabbits was investigated. Myrigalone B was an effective antioxidant, as shown by its ability to dose-dependently prolong the lag time for the formation of conjugated dienes. A 100 % increase in lag time corresponds to a myrigalone B concentration of 1.4+ 1.1 µM. For a-tocopherol, used as a reference, this effect corresponds to a concentration of 1.9+ 1.2 µM. Myrogalone B also dose-dependently reduced the maximum rate of formation of conjugated dienes, 1.4 µM causing a 15+ 5 % reduction, but it had no influence on the maximum amount of conjugated dienes formed.

• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1995). Antioxidant activity of fruit exudate and C-methylated dihydrochalcones from Myrica gale L. Planta Medica. ISSN 0032-0943. 61, p. 515–518. Full text in Research Archive

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• Lea, Marianne & Mathiesen, Liv (2025). Økt pasientsikkerhet gjennom bedre informasjonsflyt om legemidler. Full text in Research Archive Show summary

  Vi ønsker å øke pasientsikkerheten gjennom å bedre informasjonsflyten om legemidler når pasienter overflyttes mellom helsetjenestenivåer. Det siste tiåret har vi gjennomført flere forskningsprosjekter som omhandler overganger i helsevesenet og optimalisering av legemiddelbehandling.

• Glatkauskas, Mikas; Lea, Marianne & Mathiesen, Liv (2025). How to meet the patients needs? Employing design thinking into pharmaceutical care innovation projects. Full text in Research Archive
• Mathiesen, Liv; Wøien, Hilde & Reinås, Karl Henrik Storhaug (2025). Fasilitatorutdanning - et pedagogisk tilbud for å styrke studentenes læringsutbytte for tverrprofesjonell samarbeidslæring i praksis. Full text in Research Archive Show summary

  Innledning: SamPraks, UiOs modell for tverrprofesjonell samarbeidslæring (TPS), oppskaleres kraftig for å møte RETHOS’ føringer. For å sikre kvaliteten på studentenes læringsutbytte må flere kompetente fasilitatorer utdannes. Studentene har i flere år verdsatt fasilitering av praksisen i sine evalueringer. Faglærerne har på sin side etterstrebet å øke egen fasilitatorkompetanse og etablere et pedagogisk grunnlag for fasilitering av SamPraks. Betydningen av en solid og konsistent pedagogikk for TPS er forankret gjennom mange år i en rekke forskningsstudier. I 2023 bestemte vi oss derfor for å etablere et pedagogisk tilbud for å gi nye og eksisterende fasilitatorer i SamPraks en omfattende opplæring til denne funksjonen. Metode: Gjennom samarbeid med pedagoger ved Det utdanningsvitenskapelige fakultet ved UiO utviklet vi et fasilitatorkurs for vitenskapelige ansatte, som gir en uttelling på 15 timers universitetspedagogisk basiskompetanse. Som forberedelse før kursstart må deltakerne gjennomføre SamPraks’ digitale introduksjonskurs, og skrive et refleksjonsnotat. Deretter kommer to samlinger med teori om gruppedynamikk og TPS. Avslutningsvis får deltakerne praktisk opplæring i å fasilitere tverrprofesjonelle grupper; først som observatører av en erfaren fasilitator, og dernest som aktive fasiliatatorer med en erfaren pedagog som støtte. Det er utviklet en manual som bidrar til å gi retning og veiledning i hvordan man kan skape god fasilitering og gi studentene et godt læringsutbytte. Resultater: Vi har nå gjennomført to fasilitatorkurs og utdannet tilsammen 17 nye SamPraksfasilitatorer. Etter gjennomført fasilitatorkurs er deltagerne selvstendige, og de utgjør allerede en avgjørende ressurs for gjennomføringen av SamPraks og kvaliteten på den TPS-en. Oppsummering: Fasilitatorene er avgjørende i å sikre kvaliteten på læringsutbyttet for studentene i TPS. Gjennom aktiv støtte til å fremme læringsprosesser bidrar fasilitatorene til at studentene i større grad kan utnytte læringspotensialet som ligger i å lære av, med og om hverandre i praksis. 'Stiftelsen til fremme for norsk apotekfarmasi' har bidratt til finansiering av kursene.

• Glatkauskas, Mikas; Syversen, Malin Olsen; Scott, Michael; Svensberg, Karin; Denstad, Berit Gallefoss & Wibe, Torunn [Show all 7 contributors for this article] (2024). Application of a Human Factors and Systems Engineering Approach to Explore the Hospital to Home transition for patients with multiple long-term conditions. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Benny, Steffi; Horgen, Kristine; Sedeniussen, Sandra Johanne & Hauge, Monica [Show all 12 contributors for this article] (2024). Medication discrepancies revealed by medication reconciliation after hospital discharge in patients with multiple long-term conditions. Full text in Research Archive
• Glatkauskas, Mikas; Syversen, Malin Olsen; Denstad, Berit Gallefoss; Wibe, Torunn; Svensberg, Karin & Scott, Michael [Show all 8 contributors for this article] (2024). Exploring hospital-to-home transition for patients with MLTC's: Human Factors & System Engineering Approach. Full text in Research Archive
• Viktil, Kirsten Kilvik; Kinnear, Moira; Lea, Marianne; Blix, Hege Salvesen & Mathiesen, Liv (2023). Teach the Teachers - Workplace based training in clinical pharmacy using patients as a learning resource. Full text in Research Archive
• Syversen, Malin Olsen; Glatkauskas, Mikas; Lea, Marianne; Benny, Steffi; Horgen, Kristine & Svensberg, Karin [Show all 7 contributors for this article] (2023). Medication discrepancies after a hospital stay in patients with multiple long term conditions. Full text in Research Archive
• Henriksen, Ben Tore; Andersen, Randi D.; Krogseth, Maria; Mathiesen, Liv; Davies, Maren Nordsveen & Andersson, Yvonne (2022). 5PSQ-003 Development and applicability of the MedHipPro-Q: a questionnaire assessing medical doctors’ experience with medication management in the hip fracture patient pathway. Full text in Research Archive
• Viktil, Kirsten Kilvik; Mathiesen, Liv; Lea, Marianne & Blix, Hege Salvesen (2022). Styrking av ¬kliniske farmasøyters veiledningskompetanse. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. Full text in Research Archive
• Sporrong, Sofia Kälvemark; Kalleberg, Birgitte Grøstad; Mathiesen, Liv; Andersson, Yvonne; Rognan, Stine & Svensberg, Karin (2022). Understanding and addressing the observer effect in observation studies. In Desselle, Shane; Cardenas, Victoria Garcia; Anderson, Claire; Aslani, Parisa; Chen, Aleda & Chen, Timothy F. (Ed.), Contemporary Research Methods in Pharmacy and Health Services. Academic Press. ISSN 9780323918886. p. 261–270. Full text in Research Archive
• Rosvold, Elin Olaug; Svensberg, Karin; Kalleberg, Birgitte; Mathiesen, Liv; Hellesø, Ragnhild & Hove, Lene Hystad (2018). SamPraks Research Project at UiO. Full text in Research Archive
• Lea, Marianne; Mathiesen, Liv; Mowe, Morten & Molden, Espen (2017). Baseline characteristics of multimorbid patients included in an RCT. Full text in Research Archive
• Lea, Marianne; Trapnes, Elin; Davidsson, Malin & Mathiesen, Liv (2017). Experiences from a pharmacist-led RCT in a hospital setting in Norway. Full text in Research Archive
• Holdhus, Hanne; Bøvre, Katrine; Mathiesen, Liv; Bjelke, Börje & Bjerknes, Kathrin (2016). Medication lists – Challenges in the communication between hospital and primary care service. Full text in Research Archive
• Lea, Marianne; Engnes, Anette; Mathiesen, Liv; Mowe, Morten & Molden, Espen (2016). Drug-related problems at hospital admission in multimorbid internal medical patients. Full text in Research Archive
• Høgholen, Anna Helene; Storhaug, Anette; Kvernrød, Kristin; Kostovski, Emil; Viktil, Kirsten Kilvik & Mathiesen, Liv (2016). Adherence and attitudes to medicines among patients with chronic spinal cord injury. Full text in Research Archive
• Hestad, Kristin; Lea, Marianne; Steen, Hanne; Njaastad, Anne Mette; Thomassen, Kristin & Mathiesen, Liv (2013). Legemiddelsamstemming. Full text in Research Archive
• Trapnes, Elin; Berge, Foss Jorunn; Lea, Marianne; Steen, Hanne; Davidsson, Malin & Mathiesen, Liv (2013). Implementing a Clinical Pharmacy Service in South East Norway. Full text in Research Archive
• Lea, Marianne; Njaastad, Anne Mette; Thomassen, Kristin; Mathiesen, Liv; Ørnes, Silje Engdal & Flage, Marianne [Show all 7 contributors for this article] (2012). LegemiddelsamstemmingGenerell indremedisinsk sengepost, Medisinsk klinikk, Oslo Universitetssykehus HF. Full text in Research Archive
• Christensen, Hege Staaland; Hestad, Anette L; Molden, Espen & Mathiesen, Liv (2009). Effect of NADPH-cytochrome P450 oxidoreductase on CYP3A5-mediated metabolism of midazolam. Full text in Research Archive
• Christensen, Hege Staaland; Postvoll, Lillian W; Mathiesen, Liv; Johannesen, Siri & Molden, Espen (2007). Different microsomal preparations exhibit different CYP3A4 enzyme kinetics of midazolam. Full text in Research Archive
• Christensen, Hege Staaland; Postvoll, Lillian W; Mathiesen, Liv; Johannesen, Siri & Molden, Espen (2007). Different CYP3A4 enzyme kinetics of midazolam in different microsomal preparations. Full text in Research Archive
• Mathiesen, Liv; Midtvedt, Tore & Solberg, Claus Ola (2006). Daptomycin – et nytt antibiotikum mot hud- og bløtdelsinfeksjoner. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 126(18), p. 2383–2384. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1996). Hydrogen bond formation as basis for radical scavenging activity. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1996). Hydrogenbinding som basis for radikalfangende aktivitet. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1995). Uncoupling of mitochondrial respiration by flavonoids from Myrica gale L. Full text in Research Archive
• Wang, Siri; Mathiesen, Liv; Halvorsen, Bente; Malterud, Karl Egil & Sund, Reidar Bredo (1995). Inhibition of lipid peroxidation in human LDL by the flavonoid myrigalone B and ascorbic acid. Full text in Research Archive
• Wang, Siri; Mathiesen, Liv; Halvorsen, Bente; Malterud, Karl Egil & Sund, Reidar Bredo (1995). Inhibition of lipid peroxidation in human LDL by the flavonoid myrigalone B and ascorbic acid. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1995). Uncoupling of mitochondrial respiration by flavonoids from Myrica gale L. Full text in Research Archive
• Mathiesen, Liv; Wang, Siri; Halvorsen, Bente; Malterud, Karl Egil & Sund, Reidar Bredo (1994). Inhibition of lipid peroxidation in LDL by the flavonoid MyB and vitamin C. Full text in Research Archive
• Mathiesen, Liv; Wang, Siri; Nenseter, Marit Sofie; Malterud, Karl Egil & Sund, Reidar Bredo (1994). Inhibition of lipid peroxidation in low density lipoprotein by myrigalon B, a naturally occurring flavonoid. Full text in Research Archive
• Malterud, Karl Egil; Sund, Reidar Bredo; Lyckander, Inge M.; Mathiesen, Liv; Wang, Siri & Diep, Oanh Hong [Show all 8 contributors for this article] (1994). Bioactive naturally occurring phenols. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil; Sund, Reidar Bredo & Nenseter, Marit Sofie (1993). Myrigalon B inhibits peroxidation of low density lipoprotein. Full text in Research Archive
• Malterud, Karl Egil; Sund, Reidar Bredo; Mathiesen, Liv & Nenseter, Marit Sofie (1993). Inhibition of lipid peroxidation in low density lipoprotein by myrigalon B, a naturally occurring flavonoid. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1992). Inhibition of lipid peroxidation in mitochondria by myrigalon B, a naturally occurring flavonoid. Full text in Research Archive
• Malterud, Karl Egil; Sund, Reidar Bredo; Mathiesen, Liv & Nenseter, Marit Sofie (1992). Hemming av lipidperoksydering i LDL (low density lipoprotein) av myrigalon B, et flavonoid fra pors. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil & Sund, Reidar Bredo (1992). Hemming av lipidperoksydering i mitokondrier av myrigalon B, et flavonoid fra pors. Full text in Research Archive
• Mathiesen, Liv; Malterud, Karl Egil; Sund, Reidar Bredo & Osmundsen, Harald (1992). Antioxidant activity of Myrica gale fruit extract and of Myrigalon B. Full text in Research Archive
• Syversen, Malin Olsen; Mathiesen, Liv; Lea, Marianne & Svensberg, Karin (2025). Optimising medication use in patients with multiple longterm conditions - During and after a hospital stay. Universitetet i Oslo. Full text in Research Archive Show summary

  Increased life expectancy, a broad range of healthcare services, and the growing availability of treatment options have contributed to a higher prevalence of patients living with multiple long-term conditions (MLTCs). However, healthcare systems and treatment guidelines remain largely structured around single conditions, with limited consideration of coexisting conditions or concurrent medication use. Patients with MLTCs often use numerous medications, experience several care transitions due to their complex care needs and are at higher risk of hospitalisations. Altogether, this creates a significant challenge in delivering safe, optimal, and evidence-based healthcare to this vulnerable population. This thesis was designed in response to this emerging and urgent need. The overall aim of this thesis was to obtain knowledge and understanding of how to optimise medication use in patients with MLTCs during and after a hospital stay. This was done by various approaches and through three studies: • First, the frequency of potential prescribing omissions (PPOs) and potentially inappropriate medications (PIMs) at hospital admission and discharge were investigated to estimate the effect of a pharmacist-led intervention on the quality of drug treatment. • Then, the focus was turned to detect the frequency, categories, underlying reasons and potential clinical relevance of medication discrepancies (MDs) between the medication list in discharge summaries and actual medication use after hospital discharge. • Finally, facilitators and barriers to medication self-management in the transition from hospital to home were explored. The first study, described in Paper I, showed that the pharmacist-led intervention had an effect on the mean number of PPOs, but not on the mean number of PIMs at discharge. PPOs and PIMs were frequent in patients with MLTCs, both at hospital admission and discharge. A minimum of 69% of the patients had either a PPO or PIM at any time point. For both the control and intervention group, the number of PIMs decreased from admission to discharge, while the number of PPOs only decreased in the intervention group. It seems essential that a systematic approach and professionals trained in identifying PPOs and PIMs are Incorporated to optimise medication use in this patient group during a hospital stay. However, the hospital may not be the most suitable setting in reducing PIMs. In the second study, presented in Paper II, almost 90% of the patients had at least one MD between the medication list in the discharge summary and actual medication use after hospital discharge. The most frequent category was that a medication was in use, although it was not listed in the discharge summary. The underlying reason was for a majority of the MDs an apparent lack of or insufficient medication reconciliation during the hospital stay. Most MDs were classified as potential minor clinically relevant, however, there was over a five-fold increase in potential clinically relevant MDs, i.e. extreme, major or moderate, in the long-term perspective compared to the short-term perspective. This highlights that the potential clinical relevance increases over time if MDs are not revealed and corrected. Our results indicates that the majority of MDs could be prevented by sufficient actions to obtain accurate medication information during the hospital stay. This may help optimise medication use during and after a hospital stay. The third study, presented in Paper III, was a qualitative study with patients and next of kin. Facilitators and barriers to medication self-management were numerous and complex. For some, the transition from hospital to home was experienced as a sudden handover of responsibility for managing medications. The patients considered support to medication self-management as important. The results suggest that healthcare professionals should adapt an overall holistic approach tailored to the individual patient’s needs to support patients in medication self-management and thereby optimising medication use after hospital discharge. Increased care coordination and patient empowerment seems like crucial components to improve patients’ medication self-management potential in the transition from hospital to home. Altogether, the findings from these studies illustrate the great potential for improvement in how to optimise medication use in patients with MLTCs during and after a hospital stay. As PPOs, PIMs and MDs are preventable, targeted actions to reduce and avoid them, such as giving healthcare professionals sufficient training to identify these, could be a step towards optimising medication use in these vulnerable patients. Patients with MLTCs have various facilitators and barriers to medication self-management, suggesting that an overall holistic and patient-centred approach is needed to improve medication self-management and hence optimise medication use.

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