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  • 1.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Carlsson, Martin
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Kalmar County Hospital.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Wanby, Pär
    Kalmar County Hospital.
    A cost analysis of systematic vitamin D supplementation in the elderly versus supplementation based on assessed requirements2017In: Journal of Aging Research and Healthcare, ISSN 2474-7785, Vol. 2, no 2, p. 13-22Article in journal (Refereed)
    Abstract [en]

    Hypovitaminosis D is common among older people and treatment with vitamin D is associated with reduced risk of falls and fractures. This paper provides a cost analysis of assessing the vitamin D status of and providing the pharmaceuticals for elderly citizens in Kalmar County, Sweden (population approximately 230,000). Four hypothetical interventions were analyzed: (a) systematic vitamin D/calcium supplementation to all elderly (≥75 years), (b) assessment of vitamin D status in elderly and supplementation to those with insufficient levels, (c) systematic vitamin D/calcium supplementation to all nursing-home residents, and (d) assessment of vitamin D status in nursing-home residents and supplementation to those with insufficient levels. The calculations were based on an estimated reduction in overall costs due to the assessed number of hip fractures after vitamin D/calcium supplementation. The annual net economic benefit of vitamin D/calcium supplementation was estimated at (a) €304,000, (b) €860,000, (c) €755,000, and (d) €740,000. The provision of systematic vitamin D supplementation to nursing-home residents would provide a substantial net economic benefit to society and assessment of the vitamin D status before starting supplementation does not seem to be necessary. Although assessment of all elderly citizens would be more comprehensive, the true proportion with insufficient vitamin D levels in the general population is uncertain and to reaching consensus on the most advantageous daily vitamin D intake, vitamin D blood levels are necessary. Also, systematic supplementation to all elderly would result in other outcomes that could be worth the cost, but that remains to be evaluated.

  • 2.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Hälsoekonomisk studie av barn och vuxna med fetalt alkoholsyndrom2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

  • 3.
    Ericson, Lisa
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. The Swedish Family Care Competence Centre.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Societal costs of fetal alcohol syndrome in Sweden2017In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 18, no 5, p. 575-585Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To estimate the annual societal cost of fetal alcohol syndrome (FAS) in Sweden, focusing on the secondary disabilities thought feasible to limit via early interventions.

    METHODS: Prevalence-based cost-of-illness analysis of FAS in Sweden for 2014. Direct costs (societal support, special education, psychiatric disorders and alcohol/drug abuse) and indirect costs (reduced working capacity and informal caring), were included. The calculations were based on published Swedish studies, including a register-based follow-up study of adults with FAS, reports and databases, and experts.

    RESULTS: The annual total societal cost of FAS was estimated at €76,000 per child (0-17 years) and €110,000 per adult (18-74 years), corresponding to €1.6 billion per year in the Swedish population using a prevalence of FAS of 0.2 %. The annual additional cost of FAS (difference between the FAS group and a comparison group) was estimated at €1.4 billion using a prevalence of 0.2 %. The major cost driver was the cost of societal support.

    CONCLUSIONS: The cost burden of FAS on the society is extensive, but likely to be underestimated. A reduction in the societal costs of FAS, both preventive and targeted interventions to children with FAS, should be prioritized. That is, the cost of early interventions such as placement in family homes or other forms of housing, and special education, represent unavoidable costs. However, these types of interventions are highly relevant to improve the individual's quality of life and future prospects, and also, within a long-term perspective, to limit the societal costs and personal suffering.

  • 4.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Lidström, Bodil
    Swedish EHlth Agcy, Stockholm, Sweden.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Eiermann, Birgit
    Karolinska Inst ; Swedish EHlth Agcy, Stockholm, Sweden.
    Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing.2014In: International Journal of Clinical Pharmacy, ISSN 2210-7703, E-ISSN 2210-7711, Vol. 36, no 5, p. 943-952Article in journal (Refereed)
    Abstract [en]

    Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients’ prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug–drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5–June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients’ age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (±17.5, range 1–110) and had 10.0 different medications (±4.7, range 1–53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (±2.4, range 0–27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug–drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.

  • 5.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Nilsson, Anna-Lena
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Patients' views on electronic patient information leaflets2016In: Pharmacy Practice, ISSN 1885-642X, E-ISSN 1886-3655, Vol. 14, no 2, article id 702Article in journal (Refereed)
    Abstract [en]

    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. © 2016, Grupo de Investigacion en Atencion Farmaceutica. All rights reserved.

  • 6.
    Hovstadius, Bo
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    On drug use, multiple medication and polypharmacy in a national population2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The application of multiple medications has successively increased during a number of years and has thereby increased the potential risks of adverse drug reactions, interactions and non-adherence to drug therapy. This may result in unnecessary health expenditure, directly due to redundant drug sales, and indirectly due to the increased hospitalization caused by drug-related problems. The overall aim of this thesis was to investigate the occurrence and development of drug use, multiple medication, and polypharmacy in an entire national population by using individual-based data on dispensed drugs. The studies (I-V) in the thesis are based on data of dispensed prescription drugs for up to 6.2 million individuals obtained from the Swedish Prescribed Drug Register. The data in the studies cover different periods of time between July 2005-Sept 2008, and the data have been analyzed on the basis of epidemiological measures and statistical methods. The major conclusions of the studies are: the prevalence of dispensed drugs and multiple medications was extensive in all age groups and was 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 (I). Regional differences in the prevalence of polypharmacy were observed and partly explained by the regional age distribution in Sweden. The use of a novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy (II). The number of drugs used by an individual not only increased the potential risks associated with multiple drug use, but also the potential burden of an increased therapeutic intensity, especially for elderly (III). Individuals with ten or more drugs accounted for almost fifty percent of the total acquisition costs of dispensed drugs. Therefore, interventions with a focus on the reduction of the number of prescription drugs for the small group of patients with a large number of different drugs may also result in a substantial reduction in the total drug costs (IV). In spite of national and regional efforts to reduce polypharmacy, the prevalence of polypharmacy and excessive polypharmacy and the mean number of drugs per individual continued to increase in Sweden 2005-2008 (V). The observed year-by-year increase in polypharmacy underlines the importance of monitoring the development of drug use in all ages. Individual-based registers studies of dispensed drugs provide high quality data and could serve as the basis for further research and also in terms of training health care personnel. It can also be used as a base for interventions and the evaluation of drug use. To enable better comparisons on drug use and its consequences, there is a need for standards concerning measurements, classification and criteria which encompass all types of medications. For clinicians, there is a need for information concerning the patient’s actual use of all different types of medications.

  • 7.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Magnusson, Lennart
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Swedish Family Care Competence Centre (NKA).
    Barn som anhöriga: ekonomisk studie av samhällets långsiktiga kostnader2015Report (Other academic)
    Abstract [sv]

    Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medför direkta och indirekta kostnader för samhället på kort och lång sikt. Denna hälsoekonomiska studie är en beräkning av samhällets årliga kostnad för den andel av befolkningen som vuxit upp som barn som anhörig till förälder med psykisk sjukdom eller missbruk av alkohol eller narkotika.

  • 8.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Hovstadius, Karl
    Åstrand, Bengt
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Increasing polypharmacy: an individual-based study of the Swedish population 2005-2008.2010In: BMC Clinical Pharmacology, ISSN 1472-6904, Vol. 10, p. Article ID: 16-Article in journal (Refereed)
    Abstract [en]

    BackgroundAn increase in the use of drugs and polypharmacy have been displayed over time in spite of the fact that polypharmacy represents a well known risk factor as regards patients' health due to the adverse drug reactions, drug-drug interactions, and low adherence to drug therapy arising from polypharmacy. For policymakers, as well as for clinicians, it is important to follow the developing trends in drug use and polypharmacy over time. We wanted to study if the prevalence of polypharmacy in an entire national population has changed during a 4-year period.MethodsBy applying individual-based data on dispensed drugs, we have studied all dispensed prescribed drugs for the entire Swedish population during four 3-month periods 2005-2008. Five or more (DP ≥5) and ten or more (DP ≥10) dispensed drugs during the 3-month period was applied as the cut-offs indicating the existence of polypharmacy and excessive polypharmacy respectively.ResultsDuring the period 2005-2008, the prevalence of polypharmacy (DP≥5) increased by 8.2% (from 0.102 to 0.111), and the prevalence of excessive polypharmacy (DP≥10) increased by 15.7% (from 0.021 to 0.024).In terms of age groups, the prevalence of polypharmacy and excessive polypharmacy increased as regards all ages with the exception of the age group 0-9 years. However, the prevalence of excessive polypharmacy displayed a clear age trend, with the largest increase for the groups 70 years and above. Furthermore, the increase in the prevalence of polypharmacy was, generally, approximately twice as high for men as for women. Finally, the mean number of dispensed drugs per individual increased by 3.6% (from 3.3 to 3.4) during the study period.ConclusionsThe prevalence of polypharmacy and excessive polypharmacy, as well as the mean number of dispensed drugs per individual, increased year-by-year in Sweden 2005-2008.

  • 9.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Adherence, therapeutic intensity, and the number of dispensed drugs2011In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 20, no 12, p. 1255-1261Article in journal (Refereed)
    Abstract [en]

    Purpose

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

    Methods

    The study comprised an individual-based register of all dispensed outpatient prescriptions in Sweden in 2006, including6.2 million individuals. The applied definition of drug was the chemical entity or substance comprising the fifth level in the World HealthOrganisation’s Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied asan indicator of the TI.

    Results

    We found a positive linear relation between the TI and the increasing number of dispensed drugs per individual, both for men andwomen. We found a slightly diminishing TI with an increasing number of drugs only for the age groups above 70 years, at a level above 13drugs per individual.

    Conclusions

    The linear relationship between the TI and the increasing number of dispensed drugs per individual provides poor support forusing decreasing TI as an estimator of non-adherence. The low rate of cost-related non-adherence in Sweden might contribute to explainingthe linear relationship.

  • 10.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Factors leading to excessive polypharmacy.2012In: Clinics in Geriatric Medicine, ISSN 0749-0690, E-ISSN 1879-8853, Vol. 28, no 2, p. 159-172Article in journal (Refereed)
    Abstract [en]

    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.

  • 11.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Non-adherence to drug therapy and drug acquisition costs in a national population: a patient-based register study2011In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 11, article id 326Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Patients' non-adherence to drug therapy is a major problem for society as it is associated with reduced health outcomes. Generally, approximately only 50% of patients with chronic disease in developed countries adhere to prescribed therapy, and the most common non-adherence refers to chronic under-use, i.e. patients use less medication than prescribed or prematurely stop the therapy. Patients' non-adherence leads to high additional costs for society in terms of poor health. Non-adherence is also related to the unnecessary sale of drugs. The aim of the present study was to estimate the drug acquisition cost related to non-adherence to drug therapy in a national population.

    METHODS:

    We constructed a model of the drug acquisition cost related to non-adherence to drug therapy based on patient register data of dispensed out-patient prescriptions in the entire Swedish population during a 12-month period. In the model, the total drug acquisition cost was successively adjusted for the assumed different rates of primary non-adherence (prescriptions not being filled by the patient), and secondary non-adherence (medication not being taken as prescribed) according to the patient's age, therapies, and the number of dispensed drugs per patient.

    RESULTS:

    With an assumption of a general primary non-adherence rate of 3%, and a general secondary non-adherence rate of 50%, for all types of drugs, the acquisition cost related to non-adherence totalled SEK 11.2 billion (€ 1.2 billion), or 48.5% of total drug acquisition costs in Sweden 2006.With the assumption of varying primary non-adherence rates for different age groups and different secondary non-adherence rates for varying types of drug therapies, the acquisition cost related to non-adherence totalled SEK 9.3 billion (€ 1.0 billion), or 40.2% of the total drug acquisition costs.When the assumption of varying primary and secondary non-adherence rates for a different number of dispensed drugs per patient was added to the model, the acquisition cost related to non-adherence totalled SEK 9.9 billion (€ 1.1 billion), or 42.6% of the total drug acquisition costs.

    CONCLUSIONS:

    Our estimate indicates that drug acquisition costs related to non-adherence represent a substantial proportion of the economic resources in the health care sector. A low rate of primary non-adherence, combined with a high rate of secondary non-adherence, contributes to a large degree of unnecessary medical spending. Thus, efforts of different types of interventions are needed to improve secondary adherence.

  • 12.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    The impact of increasing polypharmacy on prescribed drug expenditure: A register-based study in Sweden 2005-2009.2013In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 109, no 2, p. 166-174Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To analyse the impact of the observed increase in the prevalence in polypharmacy on the development of prescribed drug expenditure (PDE) in a national population during five years.

    METHODS:

    A register-based study of all prescribed drugs and PDE for the entire Swedish population during a 3-month period in 2005 and 2009, respectively. The prevalence of "polypharmacy" and "excessive polypharmacy" was defined as the proportion of patients receiving five or more (PD≥5) and ten or more (PD≥10) prescribed drugs during a 3-month period, respectively.

    RESULTS:

    Between 2005 and 2009, the prevalence of polypharmacy increased by 8.3% (from 11.1% to 12.0%), and the prevalence of excessive polypharmacy by 9.9% (from 2.4% to 2.6%). Total PDE increased by 4.8% in real prices. For the group of patients with polypharmacy and excessive polypharmacy, PDE increased by 6.2%, and 7.3%, respectively. A simulation, in which the increase in polypharmacy was neutralised, resulted in no increase in total PDE.

    CONCLUSIONS:

    The increase in the prevalence of polypharmacy has a substantial impact on the increase in PDE and can explain the entire increase in PDE in Sweden during 2005 to 2009. For clinicians and healthcare stakeholders, it is important to monitor and guidance the further development in multiple medication therapy, so that the cost associated with increasing polypharmacy will not exceed its benefits.

  • 13.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Trends in Inappropriate Drug Therapy Prescription in the Elderly in Sweden from 2006 to 2013: Assessment Using National Indicators2014In: Drugs & Aging, ISSN 1170-229X, E-ISSN 1179-1969, Vol. 31, no 5, p. 379-386Article in journal (Refereed)
    Abstract [en]

    Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the document "Indicators of appropriate drug therapy in the elderly" as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indicators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged >= 65 years during eight 3-month periods from 2006 to 2013 were accumulated. The data were extracted from the Swedish Prescribed Drug Register. Eight drug-specific quality indicators were monitored. Results For the entire population studied (n = 1,828,283 in 2013), six of the eight indicators showed an improvement according to the guidelines; the remaining two indicators (drugs with anticholinergic effects and excessive polypharmacy) remained relatively unchanged. For the subgroup aged 65-74 years, three indicators showed an improvement, four indicators remained relatively unchanged (e.g. propiomazine, and oxazepam) and one showed an undesirable trend (anticholinergic drugs) according to guidelines. For the older group (aged >= 75 years), all indicators except excessive polypharmacy showed improvement. Conclusion According to the quality indicators used, the extent of inappropriate drug therapy in the elderly decreased from 2006 to 2013 in Sweden. Thus, prescribers appear to be more likely to change their prescribing patterns for the elderly than previously assumed.

  • 14.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Tågerud, Sven
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Åstrand, Bengt
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Prevalence and therapeutic intensity of dispensed drug groups for individuals with multiple medications: a register-based study of 2.2 million individuals2010In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 4, p. 145-155Article in journal (Refereed)
    Abstract [en]

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

    Methods  The individual-based data of all dispensed outpatient prescriptions in Sweden in 2006 were analysed. Five or more dispensed drugs (DP ≥ 5) during a 12-month period were applied as an indicator of multiple medications. The drugs were categorized according to the second level of the World Health Organization's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the therapeutic intensity.

    Key findings  For the 2.2 million individuals with DP ≥ 5, the drug groups with the highest prevalences were antibacterials (48.2%), analgesics (40.3%), psycholeptics (35.9%), antithrombotic agents (33.4%) and beta-blocking agents (31.7%). As examples, the level of prevalence increased with age for analgesics, psycholeptics, antithrombotic agents and diuretics, and decreased with age for antibacterials, drugs for obstructive airway diseases and antihistamines for systemic use. Substantial differences in the level of prevalence between women and men were observed for several drug groups; for example, thyroid therapy (13.3 vs 3.6%), psychoanaleptics (26.3 vs 18.2%), drugs used in diabetes (9.1 vs 15.7%) and lipid-modifying agents (18.1 vs 30.7%). Generally, the therapeutic intensity increased with the increasing number of dispensed drugs. For a third of the most common drug groups, the therapeutic intensity increased with an increasing age above the 60–69-year age group.

    Conclusion  The number of drugs taken not only increases the potential risks associated with multiple drug use, but also increases the potential burden of an increased therapeutic intensity, especially for older people. The reported findings may enlighten physicians and healthcare stakeholders concerning the complex patterns of multiple drug use in the entire population and the associated expenses. The findings may also be used as a base for interventions aiming to bring about the most appropriate and balanced prescription of medicines to individuals with multiple diseases.

  • 15.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Åstrand, Bengt
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Assessment of regional variation in polypharmacy2010In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 19, no 4, p. 375-383Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To assess polypharmacy in a population with emphasis on regions. METHODS: We studied the individual-based data of all dispensed prescription drugs (DP) during a 3-month study period in Sweden 2006. As an indicator of polypharmacy, five or more (DP > or = 5) different drugs (substances) dispensed were applied. For analysis, we used comparisons of prevalence, correlation of prevalence of polypharmacy with different socioeconomic variables, and a novel weighted polypharmacy index. RESULTS: The national prevalence of polypharmacy, DP > or = 5, was 10.5% (inter-regional variation 9.1-12.1%). The regional variation in the prevalence of polypharmacy was largest for the age groups > or =90 (45.6-59.1%), 80-89 (46.1-53.4%) and 70-79 years (33.1-38.0%). The national prevalence of excessive polypharmacy, DP > or = 10, was 2.2% (inter-regional variation 1.9-2.6%). The regional variation in prevalence of excessive polypharmacy was largest for the age groups > or =90 (9.8-22.3%), 80-89 (11.4-17.1%) and 70-79 years (7.0-9.4%). We found a fairly strong positive correlation between polypharmacy and the age group > or =70 years (r = 0.84 for men and 0.71 for women). The novel weighted polypharmacy index indicated regional differences in the internal distribution of the prevalence of dispensed drugs for individuals with polypharmacy. CONCLUSION: Our findings indicate that the observed regional differences in the prevalence of polypharmacy partly can be explained by the regional age distribution in Sweden. The use of the novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy.

  • 16.
    Hovstadius, Bo
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Petersson, Göran
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Dispensed drugs and multiple medications in the Swedish population: an individual-based register study2009In: BMC Clinical Pharmacology, ISSN 1472-6904, Vol. 9, no May, p. Article number: 11-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Multiple medications is a well-known potential risk factor in terms of patient's 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.

    METHODS

    Analyses 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 >or= 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.

    RESULTS

    6.2 million individuals received at least one dispensed drug (DP >or= 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 >or= 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 >or= 5 was 62.4, 75.1, and 77.7% in the respective age groups. 82.8% of all individuals with DP >or= 1 and 64.9% of all individuals with DP >or= 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 >or= 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 >or= 5 from 1.5 to 1.4. The prevalence of DP >or= 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 >or= 5 was 11.3, 17.2, and 24.4% respectively.

    CONCLUSION

    The 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.

  • 17.
    Hovstadius, Bo
    et al.
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Åstrand, Bengt
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Persson, Ulf
    Institute of Economic Research, School of Economics and Management, University of Lund.
    Acquisition cost of dispensed drugs for individuals with multiple medications – a register-based study2011In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 101, no 2, p. 153-161Article in journal (Refereed)
    Abstract [en]

    Background:

    The total drug sales has increased substantially during the last decades. The increase is assumed to be associated with the observed increase in the individual use of several different drugs, the so-called multiple medications.

     

    Objective:

    To analyse the acquisition cost of dispensed prescription drugs for individuals with multiple medications in a national population.

     

    Study design, setting and participants:

    An individual based register study of all dispensed prescription drugs (DP) in Sweden in 2006, including 6.2 million individuals. As an indicator of multiple medications, five or more dispensed prescription drugs (DP≥5) during a 12-month period was applied. For comparison, ten or more (DP≥10) and fifteen and more (DP≥15) dispensed drugs during a 12-month period were used.

     

    Results:

    The total acquisition cost of dispensed drugs in Sweden in 2006 was SEK 23.2 billion, (corresponding to EUR 2.5 billion 2006). Individuals with DP≥5 (24.5% of total population) accounted for 78.8% of the total drug cost, and individuals with DP≥10 (8.6% of population) and DP≥15 (3.0% of population) accounted for 46.3% and 23.2% respectively.

     

    Individuals with DP>5 younger than 70 years of age (corresponding to 64.9% all individuals with DP>5) accounted for 64.7% of the total acquisition cost for all with DP>5.The highest total drug cost for individuals with DP>5 was displayed in the age group 60-69 followed by 70-79 and 50-59 years, 21.5%, 19.8%, and 17.4%, respectively.

     

    The average acquisition cost per daily defined dosage (DDD) generally decreased with increasing age. For individuals with DP≥5, the average cost per DDD decreased from SEK 8.04 to SEK 2.27 (-72%) for the age group 10-19 to 90 years and above. The highest average cost per DDD was observed for individuals with DP≥10.

     

    The drug cost for women with DP≥5 (corresponding to 60.9% all individuals with DP>5) represented 56.0% of the total cost. Men with DP≥5 (corresponding to 39.1% all individuals with DP>5) represented 44.0% of the total cost.

     

    For individuals with DP≥5, the average cost per DDD was SEK 4.31 (corresponding to EUR 0.46 2006), for women 4.08, and for men 4.62.

     

    Conclusion:

    Individuals with ten or more drugs accounted for almost half of the acquisition costs of dispensed drugs. In order to reduce the risks for adverse drug reactions, interactions and inappropriate drug us, interventions with focus on reduction of the number of prescription drugs for the small group of patients with many different drugs, may therefore also give a substantial reduction of the total drug costs.

  • 18.
    Montelius, Emelie
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Hovstadius, Bo
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Petersson, Göran
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Individuals Appreciate Having Their Medication Record on the Web: A Survey of Attitudes to a National Pharmacy Register2008In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 10, no 4, p. e35-Article in journal (Refereed)
    Abstract [en]

    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.

  • 19.
    Nilsson, Anna-Lena
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Pilotstudie - webbutbildningen: Läkemedelsbehandling av äldre för AT-läkare2015Report (Other academic)
    Abstract [sv]

    Socialstyrelsen har under 2014 tagit fram en webbutbildning för att förbättra AT-läkares kompetens inom området läkemedelsbehandling av äldre. I juni 2014 uppdrog Socialstyrelsen åt eHälsoinstitutet att under hösten 2014 genomföra en utvärdering huruvida webbutbildningen stärker AT-läkarnas kompetens inom området.

    Utvärderingen genomfördes som en kontrollerad studie, där studiepopulationen (AT-läkare som tidigare inte hade genomgått webbutbildningen) delades in i två grupper; en interventionsgrupp och en kontrollgrupp. Båda grupperna besvarade en webbenkät som bestod av bakgrundsfrågor och 20 kunskapsfrågor som hämtats från webbutbildningens kunskapstest inom modulerna allmänmedicin och internmedicin. Kunskapsfrågorna var både flersvarsfrågor och ensvarsfrågor. För att få rätt på flervalsfrågorna krävdes att alla rätta alternativ var ifyllda.

    Totalt besvarade 90 AT-läkare enkäten, 67 i kontrollgruppen och 23 i interventionsgruppen (svarsfrekvens 16%). I genomsnitt fick svarande i interventionsgruppen 9,5 rätt svar och svarande i kontrollgruppen 7,7 rätt svar. Frågorna skiljer sig i svårighetsgrad utifrån antal rätta svar och sex frågor särskilde sig genom att visa på mer markanta skillnader i resultat mellan grupperna.

    Utvärderingen visar att den valda utvärderingsmetoden och genomförandet fungerar och ger trots en relativt låg svarsfrekvens resultatet att de AT-läkare som genomgått webbutbildningen får ett bättre resultat i kunskapstestet än de som inte genomgått utbildningen. En framtida utvärdering som görs efter det att webbutbildningen integrerats in i AT-läkarnas ordinarie utbildning, antas kunna säkra en hög svarsfrekvens och då ge statistiskt signifikanta resultat.

  • 20.
    Throfast, Victoria
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Hellström, Lina
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry. Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences. Kalmar County Hospital, Sweden.
    Hovstadius, Bo
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Petersson, Göran
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Ericson, Lisa
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    e-Learning for the elderly on drug utilization: a pilot study2019In: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 25, no 2, p. 227-239Article in journal (Refereed)
    Abstract [en]

    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.

  • 21.
    Åstrand, Bengt
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Hovstadius, Bo
    Antonov, Karolina
    Petersson, Göran
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    The Swedish National Pharmacy Register2007In: MEDINFO 2007: Proceedings of the 12th World Congress on Health (Medical) Informatics – Building Sustainable Health Systems, 2007, Vol. 12, no 1, p. 345-349Conference paper (Refereed)
1 - 21 of 21
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