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Public Health Aspects of Pharmaceutical Prescription Patterns: Exemplified by treatments for prevention of cardiovascular disease
Nordic Council of Ministers, Nordic School of Public Health NHV.
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Public health aspects of pharmaceutical prescription patterns: Exemplified by treatments for prevention of cardiovascular disease. Louise Silwer. ISBN: 978-91-85721-18-4 ISSN: 0283-1961Main aim:To study patterns and trends of dispensed prescriptions, to explore what proportion of the population is exposed to some of the more prevalently prescribed pharmaceuticals, and to find possible ways of measuring drug-induced adverse symptoms in the population. Further, to illuminate conditions surrounding prescribing in primary prevention of cardiovascular disease. Methods: In three descriptive studies of prescription patterns, prescription data at aggregate level from a Swedish county were analysed retrospectively, and proportions were calculated. Data from the first ten years of the studies were obtained from a local prescription study, and data from another five years were local data from a national prescription survey. Data from a Danish database (OPED), with data at the individual level, were used for a prescription sequence symmetry analysis, and when Swedish national prescription data at the individual level became accessible, they were used for calculations of drug prevalence in the entire Swedish population. In a qualitative analysis of interview data, a phenomenographic approach was used. Main results: The purchase of pharmaceuticals on prescription almost doubled in the studied county in the period 1988-2002. Some common pharmaceuticals that increased to a great extent among the older part of the population were cardiovascular preventive drugs, such as antihypertensive and lipid modifying agents, and also hormone replacement therapy for women. In 2005, over half of all Swedish citizens, aged 60 or over, purchased antihypertensive or lipid modifying preparations during a six-month period. The different views that were found among GPs, regarding beliefs and practical management of primary prevention of CVD, could be interpreted as a reflection of the complexity of patient counselling in primary prevention in practice. Conclusion: The increase in dispensed prescriptions over the 15 years and the magnitude of the prevalence of the studied pharmaceuticals, such as antihypertensive, lipid modifying and hormonal treatments, which to a great extent are used by ‘healthy’ people, point to the need of following-up both beneficial and harmful consequences on public health. The prevalence of preventive treatments together with the variation in views of administration of primary prevention of cardiovascular disease, also point to the need of clarification of guidelines regarding pharmaceutical primary prevention and encouragement of therapy discussions among GPs.

Place, publisher, year, edition, pages
Göteborg: Nordic School of Public Health NHV Göteborg, Sweden , 2007. , 61 p.
Series
NHV Reports and Doctor of Public Health-Theses, ISSN 0283-1961 ; NHV Rapport 2007:4
Keyword [en]
pharmacoepidemiology, prevalence, drug use, adverse effects, primary care, primary prevention, cardiovascular, antihypertensives, lipid modifying agents, public health, Sweden
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3425ISBN: 978-91-85721-18-4 (print)OAI: oai:DiVA.org:norden-3425DiVA: diva2:749295
Public defence
2007-09-25, Nordic School of Public Health NHV, Göteborg, Sweden, 13:00 (English)
Opponent
Supervisors
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2014-09-23Bibliographically approved
List of papers
1. Drug prescribing in public primary care centres. Results from prescription studies 1988-1997 in the county of Halland, Sweden.
Open this publication in new window or tab >>Drug prescribing in public primary care centres. Results from prescription studies 1988-1997 in the county of Halland, Sweden.
2002 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 20, no 4, 236-41 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To present the prescribing patterns of general practitioners (GPs) at public primary care centres (PPCCs) in Halland, a county in the south-west of Sweden. GP share of the total prescribing of different drug groups 1988-1997 is presented, as well as changes in patterns.

DESIGN: A descriptive prescription study performed 3 months each year in 10 consecutive years.

SETTING: Medical service and pharmacies in Halland.

SUBJECTS: Prescriptions from about 100 GPs of PPCCs and 550 physicians of various other specialties.

MAIN OUTCOME MEASURES: Percentages and absolute numbers of GPs prescribing.

RESULTS: GPs prescribed 45% and 51% of the prescriptions from physicians in 1988 and 1997, respectively, while the cost shares were 40% and 42%. An increase in prescriptions was seen both in relative and in absolute numbers (from 117414 in 3 months in 1988 to 161012 in 1995). The increase in cost per DDD (defined daily dose) during the study period was 47% for GPs and 72% for other doctors.

CONCLUSIONS: GP prescribing increased in both absolute and relative numbers, while the cost increase per DDD was moderate compared to other physicians.

Keyword
Drug prescription, Prescribing, Drug Therapy, General Practice, Primary Care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3418 (URN)12564576 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
2. Statins and nonsteroidal anti-inflammatory drugs-an analysis of prescription symmetry.
Open this publication in new window or tab >>Statins and nonsteroidal anti-inflammatory drugs-an analysis of prescription symmetry.
2006 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 15, no 7, 510-1 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3421 (URN)10.1002/pds.1250 (DOI)16819761 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
3. Patterns of drug use during a 15 year period: data from a Swedish county, 1988--2002.
Open this publication in new window or tab >>Patterns of drug use during a 15 year period: data from a Swedish county, 1988--2002.
2005 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 14, no 11, 813-20 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To present and interpret drug prescription patterns, related to various groups of the population in a Swedish county, in order to estimate the prevalence of drug use in different age groups.

METHODS: Data on prescriptions, dispensed March-May 1988-2002, were combined with population statistics of Halland, a county in the south of Sweden, and analysed. Number of defined daily doses (DDD) per 100 inhabitants and day and prescriptions per 100 inhabitants and 3 months were used as indicators of drug prevalence.

RESULTS: The total drug exposure in the population of Halland nearly doubled during the 15-year period. The most frequently used drugs overall, in 2002, were psycholeptics (N05), analgesics (N02), antibacterials (J01) and sex hormones (G03). Nearly 30% of the women of 15-69 years were exposed to sex hormones. Multiplied drug prevalence among people above 60 was found for antithrombotic drugs (B01), agents acting on the renin-angiotensin system (C09), sex hormones (G03), serum lipid reducing agents (C10), antidepressants (N06) and drugs for peptic ulcer and GORD (A02B).

CONCLUSIONS: The increase in drug prescribing over the 15 years concerned both symptom-related treatments, like hormone replacement therapy, analgesics, antidepressants and drugs for acid-related disorders, as well as preventive treatments, like antithrombotics, lipid-lowering drugs and antihypertensives. The unit DDD/100 inhabitants and day gives a fairly correct measure of the percentage treated for chronic disorders. However, for short-term treatment courses and especially for drug use in children, number of prescriptions/100 inhabitants and adequate period of time, is easier to interpret.

Keyword
Drug Use, Drug Utilisation, Drug prescription, Drug Prevalence, DDD, Age, Population-based
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3420 (URN)10.1002/pds.1124 (DOI)15954078 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
4. Drug prescribing in primary care related to patient age.
Open this publication in new window or tab >>Drug prescribing in primary care related to patient age.
2005 (English)In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 11, no 1, 23-4, 28 p.Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3419 (URN)15841060 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
5. Prevalence of purchase of antihypertensive and serum lipid-reducing drugs in Sweden--individual data from national registers.
Open this publication in new window or tab >>Prevalence of purchase of antihypertensive and serum lipid-reducing drugs in Sweden--individual data from national registers.
2008 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 17, no 1, 37-42 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To determine the prevalence of purchase of prescribed antihypertensive and/or serum lipid-reducing pharmaceutical preparations among different age groups, from the age of 45, in the Swedish population. Further, to calculate the percentage of the population, from the age of 60, who purchased these pharmaceuticals without having had a circulatory diagnosis in the Hospital Discharge Register the last 7 years, or having purchased nitrate vasodilators, as an attempt to estimate the proportion of primary preventive treatments.

METHODS: A cross-sectional study, of individual data on prescriptions for antihypertensives (C02-C03, C07-C09) and serum lipid-reducing agents (C10), dispensed from July to December 2005 for the Swedish population. Data were obtained from the new Swedish Prescribed Drugs Register. The data were related to population statistics, and linked to data on diagnoses of cardiovascular disease (I00-I99), from the Swedish Hospital Discharge Register 1998-2004. Data on individuals with purchase of antihypertensive or serum lipid-reducing agents, but without a diagnosis of cardiovascular disease, were also linked to purchase of nitrate vasodilators (C01D).

RESULTS: Among Swedes of 60 years and above, 53% purchased antihypertensive or serum lipid-reducing pharmaceuticals, and 30% purchased the pharmaceuticals without having been hospitalized for a coronary or cerebrovascular event during the previous 7 years, or having purchased prescribed nitrate vasodilators during 6 months.

CONCLUSION: Over half of the Swedish senior population purchased prescribed antihypertensive or serum lipid-reducing drugs during 6 months in 2005. The magnitude of the prevalence points to the importance of intensified follow-up of both adverse effects and of effectiveness of these drugs.

Keyword
Drug Prevalence, Caridovascular disease, primary Prevention, Antihypertesive, Serum Lipid-Reducing, Sweden, Drug Use, Elderly
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3423 (URN)10.1002/pds.1515 (DOI)17987590 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2017-12-05Bibliographically approved
6. Views on primary prevention of cardiovascular disease--an interview study with Swedish GPs.
Open this publication in new window or tab >>Views on primary prevention of cardiovascular disease--an interview study with Swedish GPs.
2010 (English)In: BMC family practice, ISSN 1471-2296, Vol. 11, 44- p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs.

METHODS: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography.

RESULTS: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures.

CONCLUSIONS: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment.

Keyword
Preventive Therapy, Cardiovascular Disease, General Practitioner, Qualitative Research, Primary Prevention, Lifestyle
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:norden:org:diva-3424 (URN)10.1186/1471-2296-11-44 (DOI)20525174 (PubMedID)
Available from: 2014-09-23 Created: 2014-09-23 Last updated: 2014-09-23Bibliographically approved

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