{"id":6374,"date":"2026-10-19T09:48:50","date_gmt":"2026-10-19T09:48:50","guid":{"rendered":"https:\/\/phd.hi.is\/doktorsvorn\/doktorsvorn-i-lyfjafraedi-freyja-jonsdottir\/"},"modified":"2026-10-19T09:48:50","modified_gmt":"2026-10-19T09:48:50","slug":"doktorsvorn-i-lyfjafraedi-freyja-jonsdottir","status":"publish","type":"phd_defence","link":"https:\/\/phd.hi.is\/en\/doktorsvorn\/doktorsvorn-i-lyfjafraedi-freyja-jonsdottir\/","title":{"rendered":"Doktorsv\u00f6rn \u00ed lyfjafr\u00e6\u00f0i – Freyja J\u00f3nsd\u00f3ttir"},"content":{"rendered":"
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Fimmtudaginn 14. n\u00f3vember 2024 ver Freyja J\u00f3nsd\u00f3ttir doktorsritger\u00f0 s\u00edna \u00ed lyfjafr\u00e6\u00f0i vi\u00f0 Lyfjafr\u00e6\u00f0ideild H\u00e1sk\u00f3la \u00cdslands. Ritger\u00f0in ber heiti\u00f0:\u00a0Faraldsfr\u00e6\u00f0i lyfjanotkunar me\u00f0al sj\u00faklinga fyrir og eftir innl\u00f6gn \u00e1 sj\u00fakrah\u00fas. Afturs\u00fdn, l\u00fdsandi gagnaranns\u00f3kn.\u00a0<\/strong>Epidemiology of medication use among patients prior to and following hospital admission \u2013 A Retrospective, population-based cohort study.<\/strong><\/p>\n

Andm\u00e6lendur eru Dr. Bryony Franklin, pr\u00f3fessor vi\u00f0 University College London og Dr. Helga Gar\u00f0arsd\u00f3ttir, pr\u00f3fessor vi\u00f0 Utrecht-h\u00e1sk\u00f3lann \u00ed Hollandi.<\/p>\n

Umsj\u00f3narkennari var Anna Brynd\u00eds Bl\u00f6ndal, d\u00f3sent og lei\u00f0beinandi var Martin Ingi Sigur\u00f0sson pr\u00f3fessor. Auk \u00feeirra s\u00e1tu \u00ed doktorsnefnd El\u00edn Soff\u00eda \u00d3lafsd\u00f3ttir, pr\u00f3fessor, A\u00f0alsteinn Gu\u00f0mundsson, kl\u00edn\u00edskur d\u00f3sent, Jennifer M. Stevenson, kl\u00edn\u00edskur akadem\u00edskur lyfjafr\u00e6\u00f0ingur og Ian Bates, pr\u00f3fessor.<\/p>\n

Berglind Eva Benediktsd\u00f3ttir, pr\u00f3fessor og deildarforseti Lyfjafr\u00e6\u00f0ideildar, stj\u00f3rnar ath\u00f6fninni sem fer fram \u00ed H\u00e1t\u00ed\u00f0asal H\u00e1sk\u00f3la \u00cdslands og hefst kl. 13.00.<\/p>\n

<\/a><\/a><\/a>\u00c1grip<\/strong><\/p>\n

Hugtaki\u00f0 fj\u00f6llyfjame\u00f0fer\u00f0 er \u00feekkt innan heilbrig\u00f0iskerfisins og v\u00edsar til samt\u00edmis notkun margra lyfjaflokka og tengist neikv\u00e6\u00f0um \u00e1hrifum \u00e1 heilsufar. Ranns\u00f3knir hafa s\u00fdnt a\u00f0 sl\u00edk \u00e1hrif geta falist \u00ed skertum l\u00edfsg\u00e6\u00f0um, skertri me\u00f0fer\u00f0arheldni, auknum hrumleika og auknum l\u00edkum \u00e1 sp\u00edtalainnl\u00f6gn. \u00cd lj\u00f3s hefur komi\u00f0 a\u00f0 fj\u00f6llyfjame\u00f0fer\u00f0 er einnig helsti \u00e1h\u00e6ttu\u00fe\u00e1ttur \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0ar.<\/p>\n

Markmi\u00f0i\u00f0 verkefnisins var a\u00f0 meta algengi og n\u00fdgengi fj\u00f6llyfjame\u00f0fer\u00f0ar me\u00f0al sj\u00faklinga \u00ed tengslum vi\u00f0 innlagnir \u00e1 skur\u00f0deildir og lyfl\u00e6kningadeildir Landsp\u00edtala, fyrir og eftir sp\u00edtalainnl\u00f6gn og lagt var mat \u00e1 m\u00f6gulega \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0 hj\u00e1 \u00fe\u00fd\u00f0i eldri sj\u00faklinga (\u226565) sj\u00faklinga. Ritger\u00f0in byggir \u00e1 fj\u00f3rum greinum. \u00cd fyrstu greininni var markmi\u00f0i\u00f0 a\u00f0 nota \u00edslenska skur\u00f0gagnagrunninn til a\u00f0 meta algengi, n\u00fdgengi og breytingar \u00e1 fj\u00f6llyfjanotkun og tengda \u00e1h\u00e6ttu\u00fe\u00e6tti og kl\u00edn\u00edskar \u00fatkomur sj\u00faklinganna. \u00cd annarri greininni var \u00edslenski lyfl\u00e6kningagagnagrunninn n\u00fdttur til a\u00f0 meta algengi, n\u00fdgengi og breytingar \u00ed fj\u00f6llyfjanotkun, tengda \u00e1h\u00e6ttu\u00fe\u00e6tti og kl\u00edn\u00edskar \u00fatkomur allra fullor\u00f0inna sj\u00faklinga \u00ed tengslum vi\u00f0 innl\u00f6gn. \u00cd \u00feri\u00f0ju greininni var algengi, n\u00fdgengi og breytingar \u00e1 algengi m\u00f6gulega \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0ar samkv\u00e6md Beers skilmerkjum \u00e1 me\u00f0al sj\u00faklinga \u226565 \u00e1ra sem l\u00f6g\u00f0ust inn \u00e1 lyfl\u00e6kningadeild. Loks var \u00ed fj\u00f3r\u00f0u greininni var \u00edslenski skur\u00f0gagnagrunnurinn n\u00fdttur til a\u00f0 meta algengi og n\u00fdgengi og m\u00f6gulega \u00f3vi\u00f0eigandi lyfjanotkunar \u00e1 me\u00f0al skur\u00f0sj\u00faklinga (\u226565). B\u00e1\u00f0ir ranns\u00f3knargagnagrunnum veri\u00f0 haldi\u00f0 vi\u00f0 eftir doktorsv\u00f6rn til frekari ranns\u00f3kna.<\/p>\n

\u00cd lj\u00f3s kom a\u00f0 fj\u00f6llyfjame\u00f0fer\u00f0 og m\u00f6guleg \u00f3vi\u00f0eigandi lyfjanotkun eru algeng \u00e1 me\u00f0al sj\u00faklinga sem leggjast inn \u00e1 sp\u00edtala, b\u00e6\u00f0i vegna skur\u00f0a\u00f0ger\u00f0a og til lyfl\u00e6knisme\u00f0fer\u00f0ar. N\u00fd lyfjame\u00f0fer\u00f0, eftir \u00fatskrift af sp\u00edtala, er algeng og a\u00f0 auki er n\u00fd m\u00f6gulega \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0 algeng \u00e1 me\u00f0al eldri sj\u00faklinga (>65) eftir innl\u00f6gn \u00e1 sj\u00fakrah\u00fas. \u00deessi doktorsritger\u00f0 s\u00fdnir fram \u00e1 a\u00f0 fj\u00f6llyfjanotkun \u00e1 me\u00f0al skur\u00f0sj\u00faklinga tengist skertum l\u00edfsl\u00edkum, lengdri sp\u00edtalainnl\u00f6gn og endurinnl\u00f6gnum. Jafnframt s\u00fdnir \u00feessi doktorsritger\u00f0 fram \u00e1 a\u00f0 m\u00f6gulega \u00f3vi\u00f0eigandi lyfjanotkun er algeng \u00e1 me\u00f0al sj\u00faklinga sem lag\u00f0ir hafa veri\u00f0 inn \u00e1 lyfl\u00e6kningadeild og skur\u00f0deild og tengdir \u00e1h\u00e6ttu\u00fe\u00e6ttir eru me\u00f0al annars h\u00e6kkandi aldur, kvenkyn, taka fleiri lyf og n\u00fdta lyfjask\u00f6mmtun.<\/p>\n

Samf\u00e9lagi\u00f0 er st\u00f6\u00f0ugt a\u00f0 eldast me\u00f0 tilsvarandi \u00e1skorunum \u00fear sem aukin fj\u00f6lveikindi og tengd fj\u00f6llyfjanotkun ver\u00f0ur s\u00edfellt meira \u00e1hyggjuefni. \u00dea\u00f0 eru engar algildar lausnir til a\u00f0 takast \u00e1 vi\u00f0 fj\u00f6llyfjanotkun og \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0. Markmi\u00f0 heilbrig\u00f0isstarfsf\u00f3lks \u00e6tti a\u00f0 vera a\u00f0 hefja einungis lyfjame\u00f0fer\u00f0 \u00feegar \u00feess reynist \u00fe\u00f6rf og \u00e1vinningur umfram \u00e1h\u00e6ttu. Jafnv\u00e6gi\u00f0 \u00fearna \u00e1 milli ver\u00f0ur enn vi\u00f0kv\u00e6mara eftir \u00fev\u00ed sem hrumleiki sj\u00faklinga eykst. \u00deess vegna er nau\u00f0synlegt a\u00f0 beita fj\u00f6lda \u00farr\u00e6\u00f0a, allt fr\u00e1 \u00fev\u00ed a\u00f0 auka kennslu, valdefla sj\u00faklinga og me\u00f0fer\u00f0ara\u00f0ila \u00feeirra, taka upp \u00feverfagleg inngrip, sem b\u00e6\u00f0i eru almenn og s\u00e9rmi\u00f0u\u00f0 a\u00f0 tilteknum lyfjaflokkum og sj\u00faklingah\u00f3pum, auk \u00feess a\u00f0 n\u00fdta rafr\u00e6nar lausnir til a\u00f0 sty\u00f0ja vi\u00f0 lyfja\u00e1v\u00edsanir. Heilbrig\u00f0isstarfsf\u00f3lk og sj\u00faklingar \u00feurfa aukinn stu\u00f0ning sem stu\u00f0lar a\u00f0 \u00f6ruggri og skilvirkri lyfjanotkun. Fj\u00f6lga \u00fearf verkf\u00e6rum \u00ed verkf\u00e6rakassa \u00edslenskra heilbrig\u00f0isstarfsmanna og sj\u00faklinga. Auki\u00f0 samstarf milli heilbrig\u00f0isst\u00e9tta og aukin tilf\u00e6rsla \u00e1 f\u00e6rni \u00feeirra \u00e1 milli, myndi \u00fej\u00f3na \u00feessu markmi\u00f0i. A\u00f0 lokum, er mikilv\u00e6gt a\u00f0 heilbrig\u00f0isstarfsf\u00f3lk s\u00fdni varf\u00e6rna fyrirhyggju \u00feegar n\u00fd lyfjame\u00f0fer\u00f0 er hafin og markviss endursko\u00f0un \u00e1 \u00e1vinningi og \u00e1h\u00e6ttu me\u00f0fer\u00f0ar fari reglulega fram.<\/p>\n

<\/a><\/a><\/a><\/a>Abstract<\/strong><\/p>\n

Polypharmacy is a well-known term within the healthcare setting. It describes the usage of multiple medicines and is associated with adverse health consequences. Research has shown that such consequences can be decreased quality of life, decreased medication adherence, increased frailty, and increased likelihood of hospitalisation. Polypharmacy has been identified as the leading risk for potentially inappropriate medication use.<\/p>\n

This thesis aimed to estimate the prevalence and incidence of polypharmacy among adult surgical and internal medicine patients and assess potential inappropriate medication use among older (\u226565) patients. The thesis is based on four studies presented in four manuscripts. Manuscript I used the Icelandic perioperative database to estimate the prevalence, incidence, and changes of polypharmacy and associated patient factors and clinical outcomes of patients. Manuscript II used the newly established Icelandic internal medicine database to estimate the prevalence, incidence, and changes of polypharmacy-associated risk factors and clinical outcomes of patients. In manuscript III the prevalence, incidence, and changes of the prevalence of potentially inappropriate medication use was assessed amongst internal medicine patients \u226565 years by applying Beers 2019 prescribing criteria. Finally, manuscript IV aimed to use the Icelandic perioperative database to estimate the prevalence and incidence and changes in the prevalence of potentially inappropriate medication use amongst surgical patients \u226565 years. Both research databases will be maintained for future research projects.<\/p>\n

Polypharmacy and potentially inappropriate medication use are common among patients admitted to hospitals both for surgical and internal medicine care. New medications post-discharge are frequent, as well as new, potentially inappropriate medication among older (>65) patients post-hospital admission. This thesis demonstrates that polypharmacy among surgical patients was associated with decreased survival, extended hospital stays, and readmissions. This thesis also demonstrated that potentially inappropriate medication use is prevalent among patients admitted by internal medicine specialty and due to surgical admission and associated risk factors among increased ages, female gender, use of higher number of medications, and use of multidose dispensing service.<\/p>\n

The population is continuously ageing. This presents certain challenges, with multimorbidity and associated polypharmacy becoming an increasingly alarming factor concerning public health. There is no one-size-fits-all solution for addressing polypharmacy and inappropriate prescribing. Healthcare providers should aim to initiate medication treatment only when the benefit outweighs the harm. This balance becomes more delicate as the patient becomes more frail. Therefore, multiple measures are required, ranging from upscaling educational activities, empowering patients and their carers, and implementing multidisciplinary interventions that are both general and targeted at specific medication classes and patient groups, in addition to using computerised prescribing aids when possible. Healthcare providers, especially prescribers and patients, need further support with strategies to facilitate safe and effective use of medications. Tools need to be added to the toolbox of Icelandic healthcare professionals and patients. Increased collaboration between healthcare professionals, as well as an increased skill shift between them, would serve this purpose. Finally, healthcare professionals must apply cautious foresight when initiating new medication and planning appropriate revisions.<\/p>\n

Um doktorsefni\u00f0<\/strong><\/p>\n

Freyja J\u00f3nsd\u00f3ttir er f\u00e6dd \u00e1ri\u00f0 1980 \u00ed Reykjav\u00edk. H\u00fan \u00fatskrifa\u00f0ist af n\u00e1tt\u00farufr\u00e6\u00f0ibraut Menntask\u00f3lanum \u00ed Hamrahl\u00ed\u00f0 \u00e1ri\u00f0 2000 og lauk kand\u00eddatspr\u00f3fi fr\u00e1 lyfjafr\u00e6\u00f0ideild fr\u00e1 H\u00e1sk\u00f3la \u00cdslands \u00e1ri\u00f0 2006. Eftir \u00fatskrift h\u00f3f Freyja st\u00f6rf \u00e1 Landsp\u00edtala. \u00c1ri\u00f0 2012 h\u00e9lt Freyja \u00e1samt fj\u00f6lskyldu til Bretlands \u00fear sem h\u00fan lag\u00f0i stund \u00e1 s\u00e9rn\u00e1m \u00ed kl\u00edn\u00edskri lyfjafr\u00e6\u00f0i vi\u00f0 University College London. Eftir s\u00e9rn\u00e1mi\u00f0 h\u00f3f Freyja st\u00f6rf \u00e1 Landsp\u00edtala sem kl\u00edn\u00edskur lyfjafr\u00e6\u00f0ingur. \u00c1ri\u00f0 2016 h\u00f3f a\u00f0 starfa vi\u00f0 Lyfjafr\u00e6\u00f0ideild sem akadem\u00edskur starfsma\u00f0ur og hefur leitt uppbyggingu \u00e1 s\u00e9rn\u00e1mi \u00ed kl\u00edn\u00edskri lyfjafr\u00e6\u00f0i undanfarin \u00e1r. \u00d6ryggi og g\u00e6\u00f0i \u00ed lyfjam\u00e1lum einstaklingar hefur veri\u00f0 Freyju hugleiki\u00f0 auk \u00feess a\u00f0 efla ranns\u00f3knir \u00e1 fr\u00e6\u00f0isvi\u00f0inu. \u00c1ri\u00f0 2020 h\u00f3f Freyja doktorsn\u00e1m me\u00f0 \u00e1herslu \u00e1 a\u00f0 auka \u00feekkingu \u00e1 fj\u00f6llyfjame\u00f0fer\u00f0, \u00f3vi\u00f0eigandi lyfjame\u00f0fer\u00f0, fylgni vi\u00f0 \u00e1h\u00e6ttu\u00fe\u00e6tti og afdrif eldri sj\u00faklinga \u00e1 \u00cdslandi. Foreldrar Freyja eru Magg\u00fd Magn\u00fasd\u00f3ttir og J\u00f3n J\u00f3el Einarsson. Eiginma\u00f0ur Freyja er H\u00f6skuldur Eir\u00edksson og eiga \u00feau saman fimm b\u00f6rn, Ragnhei\u00f0i V\u00f6lu, Hildi Evu, J\u00f3el, Reg\u00ednu og Dan\u00edel.<\/p>\n<\/div><\/div>","protected":false},"featured_media":5706,"template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"_phd_date_start":"2024-11-14T13:00:00+00:00","_phd_date_end":"2024-11-14T16:00:00+00:00","_phd_location":"A\u00f0albygging H\u00e1t\u00ed\u00f0asalur","_phd_admission":"A\u00f0gangur \u00f3keypis","_phd_thesis_title":"Faraldsfr\u00e6\u00f0i lyfjanotkunar me\u00f0al sj\u00faklinga fyrir og eftir innl\u00f6gn \u00e1 sj\u00fakrah\u00fas. 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