Bo Hovstadius

Factors Leading to Excessive Polypharmacy

There are numerous risk factors for patients to develop excessive polypharmacy. The most prominent risk factors are associated with sociodemographics and the patients’ conditions. Risk factors associated with patient behavior, such as patient’s self medication with all types of medications, have not been observed to the same extent but might be at the same level of importance for patients developing excessive polypharmacy. Risk factors related to physicians, and the interaction between patient and physician, are studied to a much lesser extent. The few studies conducted regarding the large variation in physicians’ individual prescribing practices, in terms of polypharmacy, add another perspective to the complexity of the area. Interventions aiming to improve communication between GP and hospital specialist, to create support systems for medical reviews that include all patients’ medications, and to improve the knowledge of multiple prescribing might have the largest potential to better manage excessive polypharmacy.

Dispensed drugs and multiple medications in the Swedish population: an individual-based register study.

BackgroundMultiple medications is a well-known potential risk factor in terms of patients health. The aim of the present study was to estimate the prevalence of dispensed drugs and multiple medications in an entire national population, by using individual based data on dispensed drugs.MethodsAnalyses of all dispensed out-patient prescriptions in 2006 from the Swedish prescribed drug register. As a cut-off for multiple medications, we applied five or more different drugs dispensed (DP ≥ 5) at Swedish pharmacies for a single individual during a 3-month, a 6-month, and a 12-month study period. For comparison, results were also calculated with certain drug groups excluded.Results6.2 million individuals received at least one dispensed drug (DP ≥ 1) during 12 months in 2006 corresponding to a prevalence of 67.4%; 75.6% for females and 59.3% for males. Individuals received on average 4.7 dispensed drugs per individual (median 3, Q1–Q3 2–6); females 5.0 (median 3, Q1–Q3 2–7), males 4.3 (median 3, Q1–Q3 1–6).The prevalence of multiple medications (DP ≥ 5) was 24.4% for the entire population. The prevalence increased with age. For elderly 70–79, 80–89, and 90-years, the prevalence of DP ≥ 5 was 62.4, 75.1, and 77.7% in the respective age groups. 82.8% of all individuals with DP ≥ 1 and 64.9% of all individuals with DP ≥ 5 were < 70 years.Multiple medications was more frequent for females (29.6%) than for males (19.2%). For individuals 10 to 39 years, DP ≥ 5 was twice as common among females compared to males. Sex hormones and modulators of the genital system excluded, reduced the relative risk (RR) for females vs. males for DP ≥ 5 from 1.5 to 1.4.The prevalence of DP ≥ 1 increased from 45.1 to 56.2 and 67.4%, respectively, when the study period was 3, 6, and 12 respectively months and the corresponding prevalence of DP ≥ 5 was 11.3, 17.2, and 24.4% respectively.ConclusionThe prevalence of dispensed drugs and multiple medications were extensive in all age groups and were higher for females than for males. Multiple medications should be regarded as a risk in terms of potential drug-drug interactions and adverse drug reactions in all age groups.

Individuals appreciate having their medication record on the web: a survey of attitudes to a national pharmacy register.

Background Many patients receive health care in different settings. Thus, a limitation of clinical care may be inaccurate medication lists, since data exchange between settings is often lacking and patients do not regularly self-report on changes in their medication. Health care professionals and patients are both interested in utilizing electronic health information. However, opinion is divided as to who should take responsibility for maintaining personal health records. In Sweden, the government has passed a law to enforce and fund a national register of dispensed medications. The register comprises all individuals with dispensed medications (6.4 million individuals, September 2006) and can be accessed by the individual online via “My dispensed medications”. The individual has the right to restrict the accessibility of the information in health care settings. Objective The aim of the present study was to evaluate the users’ attitudes towards their access to “My dispensed medications” as part of a new interactive Internet service on prescribed medications. Method A password-protected Web survey was conducted among a first group of users of “My dispensed medications”. Data was anonymously collected and analyzed with regard to the usefulness and design of the Web site, the respondents’ willingness to discuss their “My dispensed medications” with others, their reasons for access, and their source of information about the service. Results During the study period (January-March, 2007), all 7860 unique site visitors were invited to answer the survey. Invitations were accepted by 2663 individuals, and 1716 responded to the online survey yielding a view rate of 21.8% (1716/7860) and a completion rate of 64.4% (1716/2663). The completeness rate for each question was in the range of 94.9% (1629/1716) to 99.5% (1707/1716). In general, the respondents’ expectations of the usefulness of “My dispensed medications” were high (total median grade 5; Inter Quartile Range [IQR] 3, on a scale 1-6). They were also positive about the design of the Web site (total median grade 5; IQR 1, on a scale 1-6). The high grades were not dependent on age or number of drugs. A majority of the respondents, 60.4% (1037/1716), had learned about “My dispensed medications” from pharmacies. 70.4% (1208/1716) of all respondents said they visited “My dispensed medications” to get control or an overview of their drugs. Getting control was a more common (P < .001) answer for the elderly (age 75 or above), whereas curiosity was more common (P < .001) for the younger age group (18-44 years). Conclusion We found that users of the provider-based personal medication record “My dispensed medications” appreciated the access to their record. Since we found that the respondents liked the design of the Web site and perceived that the information was easy to understand, the study provided no reason for system changes. However, a need for more information about the register, and to extend its use, was recognized.

Assessment of regional variation in polypharmacy

To assess polypharmacy in a population with emphasis on regions.

Acquisition cost of dispensed drugs in individuals with multiple medications--A register-based study in Sweden

OBJECTIVES To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population. METHODS We collected and analysed individual based data regarding the acquisition cost of dispensed prescription drugs for all individuals with five or more dispensed drugs (DP≥5) in Sweden 2006 (2.2 million). RESULTS Individuals with DP≥5 (24.5% of the population) accounted for 78.8% of the total acquisition cost, and individuals with DP≥10 (8.6% of the population) and DP≥15 (3.0% of the population) accounted for 46.3% and 23.2%, respectively. The average acquisition cost per defined daily doses (DDD) generally decreased with increasing age. The highest average cost per DDD was observed for individuals with DP≥10. The acquisition cost for women with DP≥5 represented 56.0% of the total acquisition cost. Men with DP≥5 represented 44.0% of the total acquisition cost. CONCLUSIONS In an entire national population, individuals with multiple medication accounted for four fifths of the total acquisition cost of dispensed drugs. Actions to reduce the number of prescription drugs for the group of patients with a number of different drugs may also result in a substantial reduction of the total acquisition cost.

Prevalence and therapeutic intensity of dispensed drug groups for individuals with multiple medications : a register-based study of 2.2 million individuals

Objectives  To assess the prevalence and the therapeutic intensity of dispensed drug groups for individuals receiving multiple medications.

Adherence, therapeutic intensity, and the number of dispensed drugs.

To estimate non‐adherence in relation to the therapeutic intensity (TI) and the number of dispensed drugs per individual and study whether the TI can be used as an estimator of non‐adherence with an increasing number of drugs.

Patients’ views on electronic patient information leaflets

Background: Information in society and in health care is currently undergoing a transition from paper to digital formats, and the main source of information will probably be electronic in the future. Objective: To explore patients’ use and perceptions of the patient information leaflet included in the medication package, and their attitude towards a transition to an electronic version. Methods: The data was collected during October to November 2014 among individuals in South-Eastern Sweden, using a questionnaire (n=406, response rate 78%) and interviews (n=15). Results: The questionnaire showed that the majority of the respondents (52%) occasionally read the patient information leaflet, 37% always read it, and 11% never read it. Almost half of the patients (41%) were positive towards reading the patient information leaflet electronically while 32% were hesitant and 26% neutral. A majority of the patients would request to get the patient information leaflet printed at the pharmacy if it was not included in the package. There were differences in attitude related to age and gender. The interviews showed that patients had mixed views on a transition to an electronic patient information leaflet. The patients perceived several positive aspects with an electronic patient information leaflet but were concerned about elderly patients. Conclusion: Although many were positive towards reading the patient information leaflet electronically, the majority prefer the patient information leaflet in paper form. Providing appropriate and useful eHealth services for patients to access the patient information leaflet electronically, along with education, could prepare patients for a transition to electronic patient information leaflet.

e-Learning for the elderly on drug utilization: A pilot study:

This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.