Anders Ekedahl

Unclaimed prescriptions after automated prescription transmittals to pharmacies

Objective: To assess the extent of and the reasons for unclaimed prescriptions, primary non-compliance, after automated transmittals to pharmacies.Methods: Cross-sectional study in 3 health care districts (population 240,000) in the southernmost of Sweden on unclaimed electronic prescriptions (e-prescriptions), transmitted to 21 pharmacies during the period of 3 months (2000) and semi-structured interview study with patients not claiming their e-prescriptions transmitted to 4 pharmacies during a period of 3 weeks (2001).Main outcome measure: Proportion of unclaimed e-prescriptions of total number of (dispensed and unclaimed) e-prescriptions and reasons for primary non-compliance.Results: In total, 2171 (2.4%) e-prescriptions remained unclaimed at the pharmacies. The peak non-redemption rate was observed for those 15–24 years old (5.5%). The lowest rate was observed for those 65–74 years old. Men had a higher non-redemption rate than women. The highest rate for men was observed 25–34 years old (6.6%). Drugs for the musculo-skeletal system (ATC group M) had higher non-redemption rates than expected (3.9%), and antibiotics (ATC-group J) lower (1.7%). Adolescents and young adults, 15–24 years old, had high non-compliance rates for drugs for the musculo-skeletal system (14%) and anti-asthmatic drugs (11%). Of 78 interviewed patients, not claiming their e-prescriptions, 61% reported no need to have the prescription dispensed. However, unintentional non-compliance was reported by 28%, most of them were not aware that a prescription had been transmitted to the pharmacy. Thirteen percent reported that non-redemption had given further medical problems or made obtaining a new prescription necessary.Conclusion: Primary non-compliance was generally low, but there were differences related to age, gender and type of drugs. The most common reason reported for non-redemption was that the prescription was not needed, but some patients were unaware that prescriptions were issued and transmitted to the pharmacy.

Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002

BackgroundDespite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA).MethodsAll cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey.ResultsWhen comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p < 0.001). Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 2002. The number of prescribed sales to women was higher than to males. Sales of low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the counter sale and sold on prescription, increased by 28% during the same period.ConclusionWhen comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.

Reasons why medicines are returned to Swedish pharmacies unused.

Objective:To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused.Setting:A random sample of the pharmacies in Sweden.Method:Interviews using a semi-structered interview form with pharmacy customers returning unused medicines to the pharmacy.Main outcome measure:Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy.Results:The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons.Conclusion:Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines.

Medicine self-poisoning and the sources of the drugs in Lund, Sweden

The purpose of this study was to investigate the prevalence of toxic agents in attempted and completed suicides. The purpose was also to explore the sources of the drugs taken by suicide attempters. Verbal information on drug intake was collected from 280 suicide attempters during 1987–1990 in the Lund‐Orup catchment area. Information on the sources of the drugs was collected from 143 of these attempters. The study also includes toxicological screening from 73 fatal poisonings in southern Sweden during 1989. According to verbal information, the most common drugs used by suicide attempters were benzodiazepines (51%), analgesics (29%) and antidepressants (20%). In suicide attempters, diazepam and levomepromazine were reported more than expected from prescription data. Toxicological screenings of fatal poisonings showed that benzodiazepines were most common (55%), followed by analgesics (38%), mainly propoxyphene (29%) and antidepressants (30%), mainly amitriptyline (22%). Amitriptyline and diazepam were more commonly detected in completed suicides than expected from prescription data. The most common sources of drugs to attempted suicides were physicians, and especially psychiatrists. We therefore conclude that continuous information to physicians on drug overdose is important, and it is also important to introduce alternative strategies to prevent suicidal behaviour.

Benzodiazepine prescribing patterns in a high-prescribing Scandinavian community

SummarySales statistics indicate large variations in benzodiazepine consumption between the Scandinavian countries; the current difference between Denmark (highest) and Sweden (lowest) is almost two-fold. There are also large within-country variations; e.g. benzodiazepine sales in the Swedish city of Helsingborg, which is close to Denmark, were at the average Danish level and were the highest in Sweden.Repeated prescription analyses were carried out in Helsingborg, and register data were used to compare the extent of psychiatric morbidity and psychosocial problems in this city with those in neighbouring cities.Benzodiazepine consumption was higher than the national average in all age groups. However, neither the choice of the predominant benzodiazepine agents nor the dose size or number of doses per prescription showed any major deviation. Hence, Helsingborg may have a larger proportion of benzodiazepine users or longer exposure periods among users. The latter is supported by the fact that about 40% of all benzodiazepine prescriptions were repeated. Psychiatric morbidity, suicide rate, alcohol-related diseases, unemployment and the proportion of socially isolated subjects were higher than the county average. On the other hand, within the county, there were cities that despite lower benzodiazepine sales had an equal or higher rate of suicide, unemployment and alcohol-related diseases. Of all benzodiazepine prescriptions processed in Helsingborg, >30% were issued by <5% of the prescribers (≥15 prescriptions per prescriber and per week).Thus, the higher usage of benzodiazepines in Helsingborg may partly be related to higher psychiatric morbidity and more psychosocial problems, but deviant prescribing habits among a minority of physicians are also important.

Drug prescription attitudes and behaviour of general practitioners

A producer-independent, problem-oriented, group-education programme with 2-day meetings on drug treatment in primary health care (PHC) was developed and evaluated. Initially, it was tested on a selected group of general practitioners (district physicians), using a non-exposed group as control. A comprehensive questionnaire was used to test changes in attitudes.There was a significant change in attitudes concerning both general opinions on drugs and drug use, on information about drug treatment, and on use of drugs in selected therapeutic areas. Also, the district physicians became more critical towards information from pharmaceutical companies. Prescribing patterns tended to change in accordance with the attitude changes. Subsequently, the programme was offered to all district physicians (about 550) in the southern Swedish health care region for a 10-year period, with 20–25 district physicians per 2-day meeting. The impact of the programme on the prescribing of a selected group of drugs (antibiotics) was assessed by voluntary registration of prescription by the participants, by regional prescription analyses and by analyses of drug sales data. There were significant, consistent, and sustained changes in the prescribing of antibiotics.The study supports the view that, if drug prescribing in general practice is to be improved, producer-independent, problem-oriented, face-to-face, small-group education on drug treatment is worthwhile.

Sales of tranquillizers, hypnotics/sedatives and antidepressants and their relationship with underprivileged area score and mortality and suicide rates

Objective: This study analyses the correlation between the Swedish underprivileged area score and sales of tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants, and the correlation between these sales and mortality and suicide rates, with the aim of using sales data to identify areas with poor socioeconomic conditions.Setting:Southern Sweden, 33 municipalities in Skåne, 1987 and 1994.Design:Ecological study. Determined and undetermined cases of suicide were taken from the local death register for the years 1987–1993. Suicide rates (determined and undetermined cases) were calculated as the ratio between observed and expected number of suicides. Mortality for people aged 20–64 years was calculated from life tables for the decade 1981–1990. The underprivileged area score was calculated for municipalities using the proportion of persons in the following groups: elderly living alone, under 5 years of age, one-parent families, unskilled, unemployed, living in crowded households, those moving house in the previous year, and ethnic groups. After transformation (√arc sine) and standardization, each of the eight variables was weighted by the British general practitioners average weighting and added to give the underprivileged area score. The selection of the eight variables was based on general practitioners´ perceptions of the effect of the social characteristics of the populations in their respective residential areas on their workload or pressure on services. The total drug sales figures for tranquillizers, hypnotics/sedatives, neuroleptics and antidepressants are expressed in Defined Daily Doses per 1000 inhabitants per day. The relationship between these variables was analysed using Pearson´s correlation coefficient.Results:There was a moderate correlation (0.41–0.68) between the sales expressed as in Defined Daily Doses per 1000 inhabitants per day of tranquillizers and hypnotics/sedatives and underprivileged area score. Furthermore, the sales of tranquillizers and hypnotics/ sedatives seemed to be moderately correlated with both mortality (0.44–0.67) and suicide (0.47–0.58).Conclusion:Sales of tranquillizers or hypnotics/sedatives could be used with caution as markers for socio-economic conditions on the basis of their moderate ecological correlation with a composite socioeconomic index such as the Swedish underprivileged area score and their moderate correlation with mortality and suicide.

Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced

Objective. To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. Design. Open, prospective, interventional study. Setting. Four counties in Sweden. Subjects. Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. Main outcome measures. Clinical evaluation, registration of drugs used and rating with Montgomery–Åsberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. Results. About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. Conclusions. Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

Self-poisonings with drugs by adolescents in the Lund catchment area

Our objective was to investigate which drugs young people who attempt suicide use in the Lund catchment area eight municipalities in Skåne, southern Sweden. All patients aged up to 18 years admitted to Lund University Hospital after deliberate or probably deliberate self-poisoning from 1 January 1991 until 31 December 1995 were included. Forty-nine (58%) had used a single drug; 20 (24%) had used 3 or more drugs. Fifty-two (61%) used analgesics paracetamol was used by 38 (45%) and propoxyphene by 17 (20%). Thirty-one (36%) had ingested psychotropics 13 used benzodiazepines, 10 antidepressants, and 8 antipsychotics. Eleven (15%) had used drugs in combination with alcohol. We conclude that it is important to follow changes in self-poisoning patterns, to monitor the effects of preventive work and discover new trends in drug use.

Use of antidepressants in deliberate self-poisoning: psychiatric diagnoses and drugs used between 1987 and 1997 in Lund, Sweden.

Abstract.Objective:Based on the increased prescription of antidepressants,nthe aim of this study was to analyse the changes innself-poisonings with antidepressants during the periodn1987–1997.Methods:A total of 909 patients who were admitted to hospitalnafter deliberate self-poisoning were investigated regardingnpsychiatric diagnoses and drugs ingested.Results:In the whole group, there was no significant change in thenrate of antidepressant overdoses between 1987 and 1990 (20%) andn1995 and 1997 (17 %), but among females with a mood disordernoverdoses decreased from 43% to 22% (p = 0.01). The proportionnof selective serotonin reuptake inhibitors (SSRIs) innself-poisonings was significantly lower than expected from salesnfigures.Conclusion:The increased antidepressant sales have not caused annincreased use of antidepressants in self-poisonings. It is,ntherefore, tempting to assume that an increased use ofnantidepressants for appropriate indications causes decreasednself-poisoning rates.