Marianne Lea

• 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.

• Lea, Marianne; Trapnes, Elin; Steen, Hanne & Ødegaard, Nina Bjerketveit (2025). Design and evaluation of a comprehensive training program for hospital-based clinical pharmacists - various, active, and work-integrated learning. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 20. doi: 10.1016/j.rcsop.2025.100677. Full text in Research Archive
• 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.

• 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.

• 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.

• 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.

• Hofmann, Bjørn Morten & Lea, Marianne (2022). On the Ethics of Withholding and Withdrawing Unwarranted Diagnoses. Cambridge Quarterly of Healthcare Ethics. ISSN 0963-1801. 32(3), p. 425–433. doi: 10.1017/S0963180122000172. Full text in Research Archive Show summary

  The number of diagnoses and the number of persons having diagnoses have increased substantially, and studies indicate that diagnoses are given or upheld even if they are unwarranted, that is, that they do not satisfy professionally accepted diagnostic criteria. In this article, the authors investigate the ethics of withholding and withdrawing unwarranted diagnoses. First, they investigate ethical aspects that make it difficult to withhold and to withdraw such diagnoses. Second, they scrutinize whether there are psychological factors, both in persons/patients and healthcare professionals, making it difficult to withdraw and withhold unwarranted diagnoses. Lastly, they use recent elements of the withholding-versus-withdrawing treatment debate in medical ethics to investigate whether there are any differences between withholding and withdrawing treatment and withdrawing and withholding unwarranted diagnoses. The authors conclude that it is crucial to acknowledge and address all these issues to reduce and avoid unwarranted diagnoses.

• Lea, Marianne & Hofmann, Bjørn Morten (2021). Dediagnosing – a novel framework for making people less ill. European journal of internal medicine. ISSN 0953-6205. 95, p. 17–23. doi: 10.1016/j.ejim.2021.07.011. 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.

• 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.

• 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
• Nilsson, Niklas; Lea, Marianne; Lao, Yvonne; Wendelbo, Katherine; Gløersen, Gløer & Mowe, Morten [Show all 8 contributors for this article] (2015). Medication discrepancies revealed by medication reconciliation and their potential short-term and long-term effects: a Norwegian multicentre study carried out on internal medicine wards. European Journal of Hospital Pharmacy (EJHP). ISSN 2047-9956. 22(5), p. 298–303. doi: 10.1136/ejhpharm-2015-000686. Full text in Research Archive
• Lea, Marianne; Rognan, Stine Eidhammer; KORISTOVIC, RADOJKA; Wyller, Torgeir Bruun & Molden, Espen (2013). Severity and Management of Drug-Drug Interactions in Acute Geriatric Patients. Drugs & Aging. ISSN 1170-229X. 30(9), p. 721–727. doi: 10.1007/s40266-013-0091-y. Full text in Research Archive

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• Blystad, Julie Borge; Lea, Marianne & Hofmann, Bjørn Morten (2025). Å fjerne en diagnose kan i mange tilfeller være helsefremmende. [Journal]. Psykologisk.no. doi: https:/psykologisk.no/2025/11/a-fjerne-en-diagnose-kan-i-mange-tilfeller-vaere-helsefremmende/. Full text in Research Archive
• Lea, Marianne (2025). Legen kuttet medisiner for eldre: – Noen kunne dra på hytta igjen, gå på svaberg og gå turer. [Journal]. Fagbladet. Full text in Research Archive Show summary

  – Legemidler også omsorg Det trenger ikke være en motsetning mellom omsorg og legemidler, mener postdoktor Marianne Lea.

• Lea, Marianne (2025). (+) – Å fjerne en diagnose kan i mange tilfeller være helsefremmende. [Journal]. Psykologisk.no. Full text in Research Archive Show summary

  Stadig flere får en psykiatrisk diagnose. Postdoktor Marianne Lea mener det er på tide å snakke om det motsatte av diagnostisering – nemlig avdiagnostisering.

• 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.

• Frøiland, Hilde & Lea, Marianne (2025). Bokanmeldelse: Snevert og ensidig om avmedisinering - Farmatid. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. Full text in Research Archive Show summary

  Boken Mindre medisiner – mer omsorg. En håndbok i avmedisinering av eldre av sykehjemsoverlege Pernille Bruusgaard, tar opp et viktig og aktuelt tema: Avmedisinering og omsorg for eldre sykehjemspasienter. I boken utfordrer forfatteren etablerte praksiser og stimulerer til refleksjon rundt legemiddelbehandling, særlig på sykehjem. Det er et modig prosjekt – og et prosjekt som fortjener oppmerksomhet. Samtidig er det flere sider ved boken som gjør at den bør leses med et kritisk blikk og helst etterfulgt av diskusjon og samtale med andre fagpersoner.

• 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
• Lea, Marianne; Trapnes, Elin; Steen, Hanne & Ødegaard, Nina Bjerketveit (2024). A comprehensive training program on patient-centered tasks for hospital-based clinical pharmacists. 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
• Wastesson, Jonas W.; Lundby, Carina; Kamgang, Karl-Hermann Sielinou; Lea, Marianne & Denig, Petra (2024). Symposium: Deprescribing: a future strategy to optimize medication use in older adults? Full text in Research Archive
• Lea, Marianne; Trapnes, Elin; Steen, Hanne & Ødegaard, Nina Bjerketveit (2024). Evaluation of a comprehensive training program for hospital-based clinical pharmacists. 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
• Lea, Marianne (2023). Deprescribing and dediagnosing.The “Beito lecture”. Full text in Research Archive
• Lea, Marianne (2023). Nå skal de fjerne ADHD-diagnoser i Sverige. Bør vi følge etter? [Journal]. Morgenbladet. 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
• Lea, Marianne (2023). Marcus er som en af de første kommet af med sin adhd-diagnose. [Journal]. Kristeligt Dagblad. Full text in Research Archive
• Lea, Marianne (2023). Legemiddelsamstemming - hva er status? - resultater fra en multisenterstudie. Full text in Research Archive
• Lea, Marianne (2023). Avdiagnostisering. [Internet]. Medisinpodden, Diakonhjemmet Sykehusapotek. 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
• 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
• Lea, Marianne & Viktil, Kirsten Kilvik (2022). Avmedisinering – hva bør du vite? https://www.farmatid.no/vitenskap-og-fag/terapiomrader/avmedisinering-hva-bor-du-vite. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. Full text in Research Archive
• Lea, Marianne (2022). Tryggere legemiddelbehandling hos eldre og multisyke. https://www.farmatid.no/vitenskap-og-fag/doktor-master-bachelor/tryggere-legemiddelbehandling-hos-eldre-og-multisyke. Norsk Farmaceutisk Tidsskrift (NFT). ISSN 0029-1935. Full text in Research Archive
• Lea, Marianne & Hofmann, Bjørn Morten (2021). Gjør folk friskere – fjern diagnoser. Full text in Research Archive
• Lea, Marianne (2021). Intervju i Studio 2 P2 om avdiagnostisering. [Radio]. NRK P2. Full text in Research Archive
• Lea, Marianne (2021). Vil fjerne diagnoser som ikke gagner pasientene. [Journal]. Dagens Medisin. Full text in Research Archive
• Hofmann, Bjørn Morten & Lea, Marianne (2021). Dediagnosing- making people less ill with Prof. Bjørn Hofmann and Dr Marianne Lea. [Internet]. Words Matter. 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
• 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
• 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
• 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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