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Table 1 Description of the different parts of the tested intervention model (SÄKLÄK)

From: Healthcare system intervention for safer use of medicines in elderly patients in primary care—a qualitative study of the participants’ perceptions of self-assessment, peer review, feedback and agreement for change

1. Introductory meeting Representatives from the steering committeea visited the primary care units, gave a structured introduction and presented the intervention model for unit managers and staff representatives, including nurses working in home care and pharmacists. The involvement of all professional categories was presented as a prerequisite for the self-assessment process.
2. Structured self-assessment The self-assessment was developed by an expert group, appointed by the steering committeea. It contained 12 questions covering areas of importance for safe use of medications in primary care, with focus on elderly patients with multiple diseases. The areas covered were: prescribing of drugs, follow-up, medication reviews, environmental aspects, co-operation with specialized care, pharmacies and communal home care. For each of the 12 questions, five follow-up questions were asked:
 1. What methods/routines/guidelines do you have?
 2. How do you provide conditions to ensure compliance?
 3. How do you measure compliance?
 4. How do you give feedback on the results to the staff?
 5. What ideas do you have for improvement?
3. Peer review A group of doctors, nurses and pharmacists selected by the professional organisationsb served as reviewers. For each primary care unit, a peer-review team consisting of five to six reviewers with different professions was formed at a seminar 4 months after the project was initiated. At this meeting the teams discussed the answered self-assessments and how to conduct the site visits. The primary care units were visited by a peer-review team 5 months after the project was initiated. A document based on the questions used in the self-assessment procedure served as support for the peer review. New or updated information arising during the visit or in dialogue with the primary care unit was noted in this document.
4. Written feedback and agreement for change The peer-review team presented a written feedback report regarding their view on strengths and weaknesses, priority areas for improvement and proposed measures to be taken. Eventually, a written contract consisting of a detailed action plan was jointly produced by the primary care unit and the peer-review team.
5. Follow-up seminar A seminar for the steering committee, the reviewers and all managers at the intervention primary care units.
6. Follow up on accomplishment of agreements The agreements for change were to be followed up on 6 months after they were signed.
  1. aThe steering committee comprised representatives from the Swedish Association of Local Authorities and Regions (SALAR) and The Patient Insurance LÖF and one delegate each from the six professional organisations listed below
  2. bThe Swedish College of General Practice, The Swedish Pharmaceutical Society, Geriatric Medicine in Sweden, Riksföreningen för Medicinskt Ansvariga Sjuksköterskor (a Swedish association of authorized nurses), Sweden’s National Organisation of District Nurses and The Swedish Society of Clinical Pharmacology and Therapeutics