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Patient characteristic, perceived health and drug prescription in primary care
Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. (eHälsoinstitutet)ORCID iD: 0000-0002-4064-3815
2013 (English)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Individuella faktorer, skattad hälsa och läkemedelsförskrivning inom primärvård (Swedish)
Abstract [en]

Patients have increased demands for information and involvement in decision-making including drug selection.  At the same time, society needs to limit costs, e.g. for subsidized drugs, thus entailing a challenge to in particular primary care. The overall aim of this thesis was to describe different factors influencing drug prescription in primary care and perceived health.

In a register study, the actual costs of prescribed subsidized drugs at five health care centers (HCCs) in areas of varying socioeconomic status (SES) were compared to the assigned drug budget. It revealed that HCCs with many citizens in the catchment area with low SES showed a deficit at year’s end. HCCs in areas with citizens with a higher SES showed a surplus.

In another register study, the prescription of drugs at lower or higher price levels for the diagnoses of chronic obstructive bronchitis, depression, diabetes and osteoporosis was studied. Drug prescription was then compared with individual factors for age, sex, education, income and country of birth, and whether the care provider was private or public. It was found that certain individual and provider factors appear to influence the prescribing of drugs of different price levels.

To investigate patient involvement in the decision to start long-term drug treatment, respondents who had recently begun taking medication were interviewed. The study showed that patient participation was important, but that participation implied different things to different patients. One view was that participation could be achieved without sharing the decision-making process, whereas another view was that participation was more or less willingness to become involved in decision-making. Prerequisites for patient participation were knowledge in the relevant area and trust in the physician.

A fourth study examined how individuals aged 65-80 years rated their health. The study showed that health was assessed much lower in respondents with depressive symptoms compared to those without corresponding symptoms. Health was also assessed as worse for people with hypertension and in those treated with drugs for depression and hypertension. Health was perceived as better in the younger age groups, in individuals with higher educational levels, and for men. 

Drug prescription in primary care is controlled, in addition to medical necessity, by economic constraints, and that patients need an opportunity to influence decisions about their care and treatment. However, economic constraints make it difficult for physicians to support patients in their choice of medication. This may influence patient adherence to medication.

Place, publisher, year, edition, pages
Växjö: Linnaeus University Press, 2013. , 72 p.
Series
Linnaeus University Dissertations, 136/2012
National Category
Nursing
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-25640ISBN: 978-91-87427-29-9 (print)OAI: oai:DiVA.org:lnu-25640DiVA: diva2:621203
Public defence
2013-05-29, N2007 Västergård, Smålandsgatan 26a, Kalmar, 09:43 (Swedish)
Opponent
Supervisors
Available from: 2013-05-23 Created: 2013-05-14 Last updated: 2017-05-30Bibliographically approved
List of papers
1. Reimbursement for drugs: a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions
Open this publication in new window or tab >>Reimbursement for drugs: a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions
2009 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 6, 647-653 p.Article in journal (Refereed) Published
Abstract [en]

AIMS

Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs.

METHODS

The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved.

RESULTS

There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation.

CONCLUSIONS

HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

Keyword
Reimbursement, Primary healthcare, Drug benefit, Socioeconomic conditions
National Category
Medical and Health Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:hik:diva-2332 (URN)10.1177/1403494809106544 (DOI)19546143 (PubMedID)
Available from: 2009-11-02 Created: 2009-11-02 Last updated: 2017-12-12Bibliographically approved
2. Factors influencing the prescription of drugs of different price levels
Open this publication in new window or tab >>Factors influencing the prescription of drugs of different price levels
Show others...
2013 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 22, no 3, 286-293 p.Article in journal (Refereed) Published
Abstract [en]

Purpose Socioeconomic factors have been suggested to influence the prescribing of newer and more expensive drugs. In the present study, individual and health care provider factors were studied in relation to the prevalence of differently priced drugs. Methods Register data for dispensed drugs were retrieved for 18486 individuals in a county council in Sweden. The prevalence of dispensed drugs was combined with data for the individual's gender, age, education, income, foreign background, and type of caregiver. For each of the diagnostic groups (chronic obstructive pulmonary disease [COPD], depression, diabetes, and osteoporosis), selected drugs were dichotomized into cost categories, lower and higher price levels. Univariate and multivariate logistic regressions were performed using cost category as the dependent variable and the individual and provider factors as independent variables. Results In all four diagnostic groups, differences were observed in the prescription of drugs of lower and higher price levels with regard to the different factors studied. Age and gender affected the prescription of drugs of lower and higher price levels more generally, except for gender in the osteoporosis group. Income, education, foreign background, and type of caregiver affected prescribing patterns but in different ways for the different diagnostic groups. Conclusions Certain individual and provider factors appear to influence the prescribing of drugs of different price levels. Because the average price for the cheaper drugs versus more costly drugs in each diagnostic group was between 19% and 69%, there is a risk that factors other than medical needs are influencing the choice of drug. Copyright (c) 2013 John Wiley & Sons, Ltd.

Keyword
drug prescriptions, socioeconomic, education, income, caregivers, cost-effectiveness, pharmacoepidemiology
National Category
Pharmaceutical Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-25221 (URN)10.1002/pds.3402 (DOI)000315651200009 ()2-s2.0-84874531284 (Scopus ID)
Available from: 2013-04-10 Created: 2013-04-05 Last updated: 2017-12-06Bibliographically approved
3. Participation in decision making when starting long-term medication: patients´ experiences
Open this publication in new window or tab >>Participation in decision making when starting long-term medication: patients´ experiences
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2014 (English)In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 2, no 3, 282-289 p.Article in journal (Refereed) Published
Abstract [en]

Rationale, aim and objective

To achieve the beneficial effect of drug treatment and reduce unnecessary health care costs, patients must be involved in shared decision making. The aim of this study was to describe patient experiences of participation in decision making when starting long-term medication.

Method

Nine patients at two health care centers were semi-structured interviewed about their experiences, beliefs and feelings about their participation in the decision to start long-term medication. Data was analyzed by a qualitative content method.

Results

Respondents stated that participating in decision making in drug treatment requires knowledge of the relevant area and requiring trusting the physician. The respondent’s responsibility and motivation facilitate adherence to drug treatment. 

Conclusion

Patients sought participation in the decision making of long-term medication and wished for adequate time needed for this dialogue. If they lacked sufficient knowledge, they wanted relevant and useful information from the physician. To experience trust in the physician through a good encounter increases the possibility for participation and enhancement of medication adherence. In order to participate in decision making, the patient needs the physician’s encouragement.

 

Keyword
patient, participastion, decision-making, drug treatment, adherence
National Category
Social and Clinical Pharmacy
Research subject
Chemistry, Biochemistry
Identifiers
urn:nbn:se:lnu:diva-30337 (URN)
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-12-06Bibliographically approved
4. Self-rated health and educational level among elderly with depressive and physical disorders
Open this publication in new window or tab >>Self-rated health and educational level among elderly with depressive and physical disorders
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aim: Poor self-rated health (SRH) among elderly has been suggested to be more closely related to mental than to physical disorders. The aim was to investigate the association between SRH in elderly and depressive and physical disorders in relation to age, sex and educational level.

Methods: A cross-sectional study was conducted using a questionnaire sent to a randomised Swedish sample of individuals aged 65-80 years with a response rate of 67% (n= 6659). SRH in relation to age, sex, education, depressive symptoms, hypertension, diabetes and asthma was calculated by univariate and multivariate logistic regressions analyses.

Results: There was an association between good SRH and not feeling depressed (OR 9.4), to not having hypertension (OR 1.6), diabetes (OR 2.8), or asthma (OR 2.1). SRH was rated as less good with higher age. SRH was rated as better with higher educational levels and men rated their health as better than women did. The association to depressive symptoms, hypertension, diabetes and asthma were lower with higher educational level and varied with sex.

Conclusion: Poor SRH in elderly was associated with depressive symptoms, hypertension, diabetes and asthma with the strongest association to depressive symptoms. Thus, SRH might serve as a valuable complement to other diagnostic methods in the health care of the elderly, as it also can provide health information beyond classical risk factors or medical history.

Keyword
Asthma, Depression, Diabetes, Education, Elderly, Hypertension, Self-rated health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Natural Science, Biomedical Sciences
Identifiers
urn:nbn:se:lnu:diva-30339 (URN)
Available from: 2013-11-11 Created: 2013-11-11 Last updated: 2017-01-19Bibliographically approved

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