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Background: Drug-related problems (DRPs) are common among elderly patients with dementia. STOPP/START is an explicit tool that has been used to detect DRPs among elderly patients.

Objectives: The objective of this study was to compare prevalence and type of DRPs identified by STOPP/START with DRPs identified by clinical pharmacists among the same population. Secondary objectives were to investigate factors associated with the use of DRPs using the two methods.

Method: Extracts from medical records were used to identify DRPs in 212 patients by using STOPP/START. The patients were ≥65 years of age with dementia or cognitive impairment. An earlier study was performed in the same study population in 2012–2014, where DRPs were identified by clinical pharmacists in order to decrease the number of rehospitalizations.

Results: STOPP/START identified DRPs in 72.2% of the patients compared with 66.0% identified by the clinical pharmacists. The numbers of DRPs identified by the different methods were 326 and 310, respectively. Different types of DRPs were identified with the different tools. STOPP/START mainly identified DRPs in the categories “ineffective/inappropriate drug” and “needs additional drug therapy”, whereas the clinical pharmacists identified DRPs in several categories.

Conclusion: Even though STOPP/START was able to identify a similar number of DRPs compared with DRPs identified by clinical pharmacists, STOPP/START failed to identify DRPs in several important categories. To cover all DRPs, STOPP/START might be used as a complement to implicit criteria.

Background: The level of job satisfaction among practicing pharmacists is important because it has been found to affect job performance and employee turnover. The Swedish pharmacy market has undergone major changes in recent years, and little is known about pharmacists' job satisfaction.

Objectives: The objective of this study was to investigate the level of job satisfaction and associated factors among graduates from the web-based pharmacy programs at Umea University.

Methods: Job satisfaction of pharmacists was measured as part of an alumni survey conducted with those who graduated from the pharmacy programmes between 2006 and 2014. Data analysis included descriptive statistics, and logistic regression was used to explore factors affecting job satisfaction.

Results: The total number of graduates who completed the survey was 222 (response rate 43%.) The majority of respondents were female (95%), and most were employed at a community pharmacy (85%). The mean age was 39.7 years. The majority of graduates (91%) were satisfied with their job "most of the time" or "all of the time", and 87% of the respondents would "definitely" or "maybe" choose the same career again. The multivariate analysis showed that increasing years in the current position (OR: 0.672 (0.519-0.871)) was associated with lower job satisfaction. Older age (OR: 1.123 (1.022-1.234)), the perception that the knowledge and skills acquired during university education is useful in the current job (OR: 4.643 (1.255-17.182)) and access to continuing professional development (OR: 9.472 (1.965 -45.662)) were associated with higher job satisfaction.

Conclusion: Most graduates from the web-based pharmacy programmes were satisfied with their current job. Access to continuing professional development seems to be important for the level of job satisfaction among pharmacists.

Introduction: Medication-related hospital admissions (MRAs) are common among older people. Persons with cognitive impairment are especially vulnerable to adverse drug effects. At the same time, increased home health care and social support could theoretically prevent medication-related problems. This study aims to estimate the proportion of MRAs and explore their relationship with cognitive impairment in a population of acutely admitted older people.

Methods: This cross-sectional study comprised 300 individuals aged 75 years or older admitted to an acute medical ward. Two assessors identified possibly MRAs using the Assessment Tool for Hospital Admissions Related to Medications 10 (AT-HARM10). Screening for cognitive impairment was performed during ward stay using a 4-item test related to time orientation. Prevalence odds ratios between cognitive test scores and MRAs were analysed through logistic regression.

Results: Using AT-HARM10, 108 out of 300 admissions (36%) were classified as possibly MRAs by both assessors. Moreover, MRAs were least common among patients with the lowest cognitive test scores. There was an association regarding MRAs when the lowest test score was treated as a cut-off and compared against a reference category comprising all other scores (OR, 0.31 [95% CI 0.10–0.93]; p = 0.037) in a logistic regression model adjusted for cohabitation and home health care.

Conclusion: Approximately one-third of the hospital admissions among acutely admitted older people were considered at least possibly medication-related. Hence, there is still a great need to manage medication-related problems and reduce MRAs in this vulnerable population. Using a 4-item instrument to screen for cognitive impairment, there was a negative association between MRA and lowest cognitive test score. Further exploration of the relationship between MRAs and cognitive impairment may indicate appropriate components and target populations for interventions that aims to reduce the risk of MRA.

This educational workshop is a reoccurring opportunity to address best practices, content, assessment methods and research projects from pharmacy internship courses in the Nordic countries, providing a collaboration platform for development. The content components will be described and discussed in terms of development, stimulation and assessment in the different settings. The objective of the workshop is to share experiences from the pharmacy internships and related courses in the Nordic countries. We also want to investigate the opportunity to develop a platform for multicenter pharmacy practice research within the Nordic countries, aiming to improve the internship in each country. A short presentation from the Nordic countries on internship experiences will be the foundation for the discussion between the workshop participants. A possible joint project about supervisors’ skills and competences will be discussed. Prior to the workshop participants are therefore kindly asked to consider how to answer (some of the questions below:

1. Have you introduced any new methods for stimulating learning activities and assessment methods at the pharmacy internship course in your country?

2. What are the three most successful aspects/components of the pharmacy internship run by your university e and what is the most problematic aspect/component)

3. How is the pharmacy internship evaluated in your university (and why so?) e do you have ideas for changing the evaluation? What other courses (elective/obligatory) are run in your university which builds upon the pharmacy internship (might be clinical pharmacy courses, PhD-courses etc) e and which courses do you plan to run?

4. What are the skills, experiences and competencies of the supervisors today e and what are the competencies needed in the future? Our discussions on this issue will take the starting point from a pre-developed questionnaire that the workshop leaders plan to distribute in all the Nordic countries. The learning outcomes for the workshop are the following:

• The participants will learn about pharmacy internships and related courses in the Nordic countries in terms of current and planned learning outcomes and formal and summative evaluation.
• The participants will discuss and potentially develop a platform for a multicenter pharmacy practice research studies within the Nordic countries (on supervisor skills and training)

Background and objectives: We evaluated whether a pictorial representation of asymptomatic atherosclerosis based on carotid ultrasound examinations given to the participants and their physicians had an impact on the proportion of participants receiving prescriptions for lipid-lowering drugs during the following 465 days. The overall aim of the study was to optimize cardiovascular disease (CVD) prevention.

Methods: This study was performed within a CVD screening and prevention program in Vasterbotten County, Sweden 2013-2016. 3532 par- € ticipants were randomly assigned 1:1 to receive or not receive a simplified picture of an ultrasound scan by mail plus a phone call including a health dialogue with a trained nurse. The picture indicated vascular age and the presence of plaques, and was also sent to participants’ physicians. The control group received no information about the ultrasound. Data on prescriptions was collected from the County Council database.

Results: During the first 465 days, prescriptions of lipid-lowering drugs were higher in the intervention group compared with the control group among men (34.2% vs 21.3%, p<0.001) and women (25.8% vs 15.2% p<0.001). Corresponding proportions for first prescriptions were 19.2% vs 6.0% (p<0.001) and 16.6% vs 5.7% (p<0.001), respectively. Similar patterns were observed for participants with and without plaque, but with a higher proportion among those with plaque. Cholesterol level, diabetes, prescription of antihypertensives and previous myocardial infarction were in a multivariable logistic regression model associated with first prescriptions. Although prescriptions increased over the study period, 56% of participants with known plaque were not prescribed any lipid-lowering drug.

Conclusion: Provision of pictorial information on vascular age and carotid plaque based on ultrasound examination increased physician prescriptions of lipid-lowering drugs within the following 465 days.

BACKGROUND: Clinical pharmacists play an increasing role in the pharmacological treatment of hospital-admitted older patients with dementia or cognitive impairment. In an earlier randomised controlled trial, clinical pharmacist involvement in the ward team could significantly reduce drug-related readmissions in patient subgroups. However, the economic impact of the intervention has not been addressed so far.

OBJECTIVES: To evaluate the economic impact of clinical pharmacist engagement in hospital ward teams for medication therapy management in older patients with dementia or cognitive impairments.

METHODS: Economic evaluation of a randomised controlled trial conducted in two hospitals in Northern Sweden between January 2012 and December 2014. Participants included 460 hospital-admitted older patients with dementia or cognitive impairments. Patients were randomly assigned to usual care, or usual care with pharmacist intervention; the intervention consisted of medication reconciliation, medication review, and participation in ward rounds. The outcomes were measured as drug-related readmissions to hospital as assessed by a group of external experts, 180 and 30 days after discharge. Costs included pharmacists' direct labour costs for the interventions, average costs for drug-related readmissions, and from this the total cost per person was calculated.

RESULTS: The effect of the intervention on drug-related readmissions within 180 days was significant in patients without heart failure (subgroup analysis), and the intervention resulted in cost savings of €950 per person in this subgroup. Drug-related readmissions within 30 days were reduced in the total sample (post-hoc analysis), and the cost-savings in this intervention group were €460 per person.

CONCLUSIONS: Post-hoc and subgroup analyses indicate that engagement of pharmacists in hospital ward teams reduced the number of drug-related readmissions, and that the cost per person was lower in the intervention group compared to the control group. Including clinical pharmacists created savings in the subgroups of older patients with dementia or cognitive impairments.

Background: The use of potentially inappropriate medications (PIMs) is a problem since it might contribute significantly to adverse drug reactions and hospital admissions among elderly with major neurocognitive disorder (NCD). To assess the appropriateness of drug treatment, different explicit criteria have been developed.

Objectives: To investigate and compare the prevalence of PIM users among elderly with major NCD on a nationwide basis using 3 different explicit criteria. Furthermore, the study aimed to investigate factors associated with the use of PIMs.

Methods: This nationwide register-based study included 35,212 people, 65 years or older, diagnosed with major NCD and registered in the Swedish registry for cognitive/dementia disorders up to June 30, 2017 and alive December 31, 2017. PIMs were identified using 3 different explicit criteria; the Swedish quality indicators, the EU(7)-PIM list and the AGS Beers Criteria. PIM use was defined as having collected a minimum of one PIM at least once between July 01 – December 31, 2017.

Results: The numbers of people using one or more PIMs were 7629 (21.7%) according to the Swedish quality indicators, 11,838 (33.6%) according to the EU(7)-PIM list, and 12,002 (34.1%) according to AGS Beers Criteria. Antipsychotics, antithrombotic agents and anxiolytics were the most frequently used PIM class according to the different assessment tools, respectively. The use of PIMs was positively associated with vascular dementia and Lewy body dementia/Parkinson's disease dementia, regardless of the assessment tool used. However, the association between using at least one PIM and age, sex, MMT-value and frontotemporal dementia, differed depending on the criteria used.

Conclusions: The different results and included PIMs indicate the different perspectives on PIMs between criteria, which make it difficult to compare the results. However, psychotropic drug use requires further highlighting, as well as the association between PIM use and different types of major NCD.

Introduction: This study aims to present an implementation of reflective professional development portfolios in pharmacy programs. The overall aim with the project is to stimulate pharmacy students’ professional development. Reflection can be a way to deal with new knowledge and increase professional confidence and competence. Since the process of learning professional values, attitudes and behaviours starts early, an emphasis on students’ development is crucial.

Methods: New written reflective assignments have been introduced in about 10 different courses in the pharmacy programs at Umeå University, Sweden. Students’ level of reflection was measured (on a 6-degree level of reflection scale) to establish students’ level without any further introduction to reflective thinking and learning in the current curricula.

Results: Preliminary results show low reflection in the first introduction course in the program (mean 3.08, 22% reflective, n¼49) and the level has only slightly increased at the 6th semester (mean 3,48, 48,8% reflective, n¼66) and on the 10th semester (mean 3,5, 50% reflective, n¼46). Interrater reliability was calculated by Cohens kappa k¼0,37-0,63. Results from more courses, feasibility, and interrater reliability are going to be evaluated and calculated this spring and presented at the conference.

Conclusions: Umeå University are introducing “Reflective professional development portfolios (RPDP)” as a learning activity integrated in all theoretical courses as writing assignments combined with mentor discussions (4 occasions) and summative portfolios (2 assignments) in the pharmacy curricula. Assessments and feedback on reflective writing of portfolios are planned to occur on several occasions and different levels including level of reflection, discussions on professionalism, and content. This baseline measurement can be used to assess the suggested curricula developments.