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Factors influencing the prescription of drugs of different price levels
Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.ORCID iD: 0000-0002-4064-3815
Linköpings universitet.
Linnaeus University, Faculty of Health and Life Sciences, Department of Chemistry and Biomedical Sciences.
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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.

Place, publisher, year, edition, pages
2013. Vol. 22, no 3, 286-293 p.
Keyword [en]
drug prescriptions, socioeconomic, education, income, caregivers, cost-effectiveness, pharmacoepidemiology
National Category
Pharmaceutical Sciences
Research subject
Natural Science, Biomedical Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-25221DOI: 10.1002/pds.3402ISI: 000315651200009OAI: oai:DiVA.org:lnu-25221DiVA: diva2:615485
Available from: 2013-04-10 Created: 2013-04-05 Last updated: 2017-01-19Bibliographically approved
In thesis
1. Patient characteristic, perceived health and drug prescription in primary care
Open this publication in new window or tab >>Patient characteristic, perceived health and drug prescription in primary care
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Individuella faktorer, skattad hälsa och läkemedelsförskrivning inom primärvård
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:nbn:se:lnu:diva-25640 (URN)978-91-87427-29-9 (ISBN)
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

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Semark, BirgittaTågerud, SvenPetersson, Göran
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