J. Lars G. Nilsson

Large Differences between Prescribed and Dispensed Medicines Could Indicate Undertreatment

The difference between prescribed and dispensed medicines in Sweden has been determined for the 20 most common diagnoses for all outpatients. For all diagnoses together, the value of dispensed medicines was 14% lower than for those prescribed. For some diagnoses a considerable number of the prescriptions never appeared at the pharmacies, for example, climactic symtoms—48%, allergic rhinitis—42%, glaucoma— 41%, and diabetes—39%. If the doctors intended that the medicines prescribed should also be consumed by the patients in order to obtain appropriate treatment, these data indicate that considerable undertreatment occurs for patients with certain diagnoses.

Patient information leaflets - patients' comprehension of information about interactions and contraindications

ObjectiveTo determine how well patients could correctly recognize and comprehend the various information items on patient information leaflets, and to explore the reasons underlying poor comprehensibility.MethodsLeaflets from 30 randomly selected, commonly prescribed medicines were examined by experts using protocols to evaluate leaflet layout, language and content. The same leaflets were also evaluated by patients who had their medicines dispensed at 24 randomly selected Swedish pharmacies. A questionnaire was used for the patients’ examination.ResultsThe results showed that most information on the leaflets is sound and is well comprehended by the patients. For two information items regarding ’risks of interactions’ and ’contraindications’ the patient scores were low, indicating poor comprehensibility.ConclusionLeaflets with low scores on warnings of interactions and contraindications were found to deliver more complex messages to older patients as compared to leaflets with high scores for these items.

Interaction Between Participants in Focus Groups With Older Patients and General Practitioners

Group interaction is put forward as the principal advantage for focus group research, although rarely reported on. The aim of the article is to contribute to the methodological knowledge regarding focus group research by providing an empirical example of the application of the Lehoux, Poland, and Daudelin template suggested for analysis of the interaction in focus groups. The data source was 18 focus groups’ performance in Sweden: 12 with older patients and 6 with general practitioners (GPs). GPs found common ground in belonging to the same profession, whereas the older patients, instead of constituting a group in the word’s real sense, started just sharing a common focus. We found the template easy to understand and use, except for identifying participants’ explicit and implicit purposes for participating. Furthermore, adding an interaction analysis to the content analysis helped us appreciate and clarify the contexts from which these data were created.

Surveys of drug‐related therapy problems of patients using medicines for allergy, asthma and pain

Objective — To determine the incidence of drug‐related therapy problems (DRTPs) among patients obtaining medicines for allergy, asthma or pain.

Diabetes Mass Education for Patients, Their Educators, and the General Public by the Pharmacies of Sweden

The Swedish National Pharmacies organized a nationwide diabetes campaign during 1991 in order to improve services for patients with diabetes and to enhance public awareness of the disease. The rationale behind this activity was new medical findings indicating that the burden of late complications due to diabetes mellitus could be diminished if current knowledge was used. Several ways of educating patients, and health care and pharmacy staffs, as well as the general public, were used. More than 6,000 patients were asked to point out problems with diabetes services for the local staffs, new educational material was developed, and the staff of the National Pharmacy Organisation was educated. The follow-up of the campaign showed a broad involvement by pharmacies in Sweden and media visibility. A large proportion of the population (26%) was aware of the campaign and 10% had obtained some printed material from the local pharmacy. The sale of home blood glucose tests increased, especially in the age group below 45, as total sales increased. The number of patients reporting that they had diabetes in the National Health survey showed a small tendency to increase. The cost of the campaign amounted to 0.5% of the total yearly pharmacy sales to patients with diabetes in Sweden.

Increased introduction, advertising, and sales of preventive drugs during 1986-2002 in sweden.

The objective of this study was to survey how introduction of new drugs and promotional activities influence drug sales in Sweden. All drugs on the Swedish market were categorized as curative, symptom-alleviating, substitutive, or preventive. The number of new drugs introduced, drug sales in volume and value, and the number of drug advertisements appearing in the major Swedish medical journal during 1986–2002 were determined for each of the 4 drug categories. Between 1986 and 1998, the relative shares of the 4 drug categories were relatively constant. From 1998 to 2002, the share of new preventive drugs increased from 24% to 30%, their share of advertisements increased from 20% to 35%, and their sales value increased from 25% to 30%. During the same period, the shares of other drugs decreased correspondingly. Pharmaceutical companies have shifted their attention to the introduction, advertising, and sales of preventive drugs in an attempt to exploit preventive medicine. This might lead to waste of resources when expensive preventive drugs are used by numerous patients over many years, as the benefit of preventive drugs for the individual patient cannot be judged easily.

A Method to Evaluate Patient Information Leaflets

The aim of this study was to develop a useful method for evaluating patient information leaflets by comparing the result of expert and patient evaluations. The hypothesis was that if there was a correlation between the results of these evaluations it would be acceptable to only do expert review for patient information leaflets currently in use. Experts and patients examined patient information leaflets from 30 common medicines, following European Union Directive 92/27 EEC, which outlined the legal requirements for patient information leaflets. The scoring system allowed a direct comparison between the outcomes of expert and patient examinations. We found a significant correlation between the expert and patient examinations of the content of the patient information leaflets. We conclude that patient information leaflets that score above average on the expert examination of content (ie, adherence to the directive) will also score above the average on the patient examination.

Asthma/COPD drugs reflecting disease prevalence, patient adherence and persistence

The aim of this review is to discuss the methodological issues involved in using pharmacy-record databases of drug sales in pharmacoepidemiology and to illustrate the usefulness of such data in estimating disease prevalence, patient adherence and persistence to therapy. Recent studies show that asthma/chronic obstructive pulmonary disease (COPD) prevalence increases with age. The volume of acquired asthma/COPD drugs per patient also increases with age and was approximately 2.5-times higher for patients aged 60–69 years compared with patients aged 20–29 years. Despite this, there is a comparatively low interest in asthma/COPD research involving elderly individuals. Published asthma/COPD-prevalence data and drug-treatment-prevalence data correspond reasonably well. Short- as well as long-term studies on drug acquisition indicate that approximately a third of patients have drugs available to cover at least 80% of the prescribed treatment time. Only approximately a tenth of the patients acquired steroids or steroid combinations, corresponding to one daily defined dose per day over a 5-year treatment period. It is probable that asthma/COPD is undertreated in all age groups.

Use of Generic Drugs and Effects of the Reference Price System in Sweden

A survey of the use of generic drugs in Sweden was performed. About 30% of the pharmaceuticals used in Sweden are generics. The market share for generics in 1996 was 70% in volume and 38% in value. It is difficult to introduce new generic drugs in Sweden. Within five years of introduction, almost 50% of all generic drugs were taken off the market. The effect of the reference price system introduced in 1993 was studied. In this system, prescribed drugs were reimbursed to a maximum price of 10% above the price of the least expensive equivalent drug, which usually is a generic equivalent. An immediate effect of the introduction of the system was that most original pharmaceuticals out of patent and high priced branded generics reduced their prices to the reference price level. It was concluded that from 1993 to 1996 the system led to a total cost reduction of

Electronically transferred prescriptions: picked up faster than paper prescriptions

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