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  • 1.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Nyström, Sofie
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Apoteket AB (National Corporation of Swedish Pharmacies), Stockholm.
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Rydberg, Tony
    Åstrand, Bengt
    Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Swedish pharmacists value ePrescribing: a survey of a nation-wide implementation2010In: Journal of Pharmaceutical Health Services Research, ISSN 1759-8885, Vol. 1, no 1, p. 23-32Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate Swedish pharmacists’ attitudes towards ePrescribing, including thetransfer of ePrescriptions, electronic storing of prescriptions and mail-order prescriptions.

    Method

    This study was conducted as a web-based survey among 500 randomly selectedSwedish community pharmacists. The questionnaire included open-ended questions,multiple-choice questions and statements to which respondents gave their degree ofagreement on a six-point Likert-type rating scale. Free-text answers were categorized intothe most commonly mentioned opinions. Differences in respondents’ general characteristicsand their level of satisfaction with ePrescribing were tested for significance using χ2test. The survey had a response rate of 52% (259/500). 96% (248/259) of the respondentswere female, and 76% (196/259) were aged 40–64 years.

    Key findings

    Swedish community pharmacists were generally satisfied with ePrescribing(98%, 253/259). No significant (P > 0.05) difference in the general satisfaction could beexplained by the respondents’ age, gender or years in practice. A majority of the respondentsregarded ePrescriptions and electronic storing of prescriptions as being safe for patients (95 and93% respectively), providing patient benefits (96 and 95% respectively), being cost-effectivefor the pharmacy (92 and 91% respectively) and contributing to better communication andrelationships with both patients and prescribers (62–88%). The positive aspects of ePrescribingmost frequently mentioned in free-text answers were being safe (72%, 187/259) and timesaving(55%, 143/259). However, several weaknesses with ePrescribing were also describedby the respondents, as well as suggestions for improvement.

    Conclusion

    Our nationwide survey of Swedish community pharmacists’ attitudestowards ePrescribing shows that pharmacists are generally satisfied with it, including thetransfer of ePrescriptions, electronic storing of prescriptions and to a lower degree mailorderprescriptions.

  • 2.
    Hammar, Tora
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
    Nyström, Sofie
    Apoteket AB (National Corporation of Swedish Pharmacies), SE-118 81 Stockholm, Sweden..
    Petersson, Göran
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Åstrand, Bengt
    Apoteket AB (National Corporation of Swedish Pharmacies), SE-118 81 Stockholm, Sweden..
    Rydberg, Tony
    Apoteket AB (National Corporation of Swedish Pharmacies), SE-118 81 Stockholm, Sweden..
    Patients satisfied with e-prescribing in Sweden: a survey of a nationwide implementation2011In: Journal of pharmaceutical health services research, ISSN 1759-8885, Vol. 2, no 2, p. 97-105Article in journal (Refereed)
    Abstract [en]

    Objective

    To evaluate Swedish patients’ attitudes towards e-prescribing, including the transfer of e-prescriptions, electronic storing of prescriptions and mail-order prescriptions.

    Methods

    This study was a nationwide survey of attitudes among Swedish patients and was conducted as a postal questionnaire. The questionnaire was developed for the purpose of thisstudy and aimed to evaluate respondents’ views concerning e-prescribing, electronic storingof e-prescriptions and mail-order prescriptions from aspects including safety, personal benefits and effectiveness. A study population of 1500 individuals meeting the inclusioncriteria was randomly selected from a database of individuals in Sweden storing prescriptions electronically (n = 5 840 599).The response rate was 52% (739/1429).

    Key findings

    The vast majority of the respondents had a positive attitude towards e-prescriptions (85%, 628/739) and electronic storing of prescriptions (86%, 633/739), andregarded e-prescriptions to be safe (79%, 584/739), creating benefits for them (78%, 576/739) and promoting faster dispensing (69%, 512/739). Significant differences in attitudes towards e-prescriptions and electronic storing of prescriptions were detected between age groups. Patients storing all their prescriptions electronically had a more positive attitudetowards both e-prescriptions and electronic storing of prescriptions compared to patientswho stated they had paper prescriptions. The most common suggestion (n = 27) for improvement was to extend the information given about the services.

    Conclusion

    Our nationwide survey showed that a vast majority of Swedish patients had positive attitudes towards e-prescriptions and electronic storing of prescriptions. However, a need for extended information regarding e-prescribing was identified.

  • 3.
    Hellström, Lina
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Waern, Karolina
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Montelius, Emelie
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Rydberg, Tony
    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,.
    Physicians' attitudes towards ePrescribing: evaluation of a Swedish full-scale implementation2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no August, p. Article number: 37-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The penetration rate of Electronic Health Record (EHR) systems in health care is increasing. However, many different EHR-systems are used with varying ePrescription designs and functionalities. The aim of the present study was to evaluate experienced ePrescribers' attitudes towards ePrescribing for suggesting improvements. METHODS: Physicians (n = 431) from seven out of the 21 Swedish health care regions, using one of the six most widely implemented EHR-systems with integrated electronic prescribing modules, were recruited from primary care centers and hospital clinics of internal medicine, orthopaedics and surgery. The physicians received a web survey that comprised eight questions on background data and 19 items covering attitudes towards ePrescribing. Forty-two percent (n = 199) of the physicians answered the questionnaire; 90% (n = 180) of the respondents met the inclusion criteria and were included in the final analysis. RESULTS: A majority of the respondents regarded their EHR-system easy to use in general (81%), and for the prescribing of drugs (88%). Most respondents believed they were able to provide the patients better service by ePrescribing (92%), and regarded ePrescriptions to be time saving (91%) and to be safer (83%), compared to handwritten prescriptions. Some of the most frequently reported weaknesses were: not clearly displayed price of drugs (43%), complicated drug choice (21%), and the perception that it was possible to handle more than one patient at a time when ePrescribing (13%). Moreover, 62% reported a lack of receipt from the pharmacy after successful transmission of an ePrescription. Although a majority (73%) of the physicians reported that they were always or often checking the ePrescription a last time before transmitting, 25% declared that they were seldom or never doing a last check. The respondents suggested a number of improvements, among others, to simplify the drug choice and the cancellation of ePrescriptions. CONCLUSION: The Swedish physicians in the group studied were generally satisfied with their specific EHR-system and with ePrescribing as such. However, identified weaknesses warrant improvements of the EHR-systems as well as of their implementation in the individual health care organisation.

  • 4.
    Holmgren, Christina M.
    et al.
    University of Gothenburg, Sweden;County Hospital Ryhov, Sweden.
    Abdon, Nils J.
    Hudiksvall Hospital, Sweden.
    Bergfeldt, Lennart B.
    University of Gothenburg, Sweden.
    Edvardsson, Nils G.
    University of Gothenburg, Sweden.
    Herlitz, Johan D.
    University of Borås, Sweden;Sahlgrenska University Hospital, Sweden.
    Karlsson, Thomas
    University of Gothenburg, Sweden.
    Svensson, Leif G.
    Karolinska Institutet, Sweden.
    Åstrand, Bengt
    Linnaeus University, Faculty of Health and Life Sciences, Department of Medicine and Optometry.
    Changes in Medication Preceding Out-of-hospital Cardiac Arrest Where Resuscitation Was Attempted2014In: Journal of Cardiovascular Pharmacology, ISSN 0160-2446, E-ISSN 1533-4023, Vol. 63, no 6, p. 497-503Article in journal (Refereed)
    Abstract [en]

    Objective: To describe recent changes in medication preceding out-of-hospital cardiac arrest (OHCA) where resuscitation was attempted. Methods: OHCA victims were identified by the Swedish Cardiac Arrest Register and linked by means of their unique 10-digit personal identification numbers to the Prescribed Drug Register. We identified new claimed prescriptions during a 6-month period before the OHCA compared with those claimed in the period 12 to 18 months before. The 7-digit Anatomical Therapeutical Chemical codes of individual drugs were used. The study period was November 2007-January 2011. Results: OHCA victims with drugs were (1) older than those who did not claim any drugs in any period (70 +/- 16 years vs. 54 +/- 22 years, P < 0.001), (2) more often women (34% vs. 20%, P < 0.001), and (3) had more often a presumed cardiac etiology (67% vs. 54%, P < 0.001). The OHCA victims were less likely to have ventricular tachycardia/ventricular fibrillation as the first recorded ;rhythm (26% vs. 33%, P < 0.001) or to survive 1 month (9% vs. 17%, P < 0.0001). New prescriptions were claimed by 5122 (71%) of 7243 OHCA victims. The most frequently claimed new drugs were paracetamol (acetaminophen) 10.3%, furosemide 7.8%, and omeprazole 7.6%. Of drugs known or supposed to cause QT prolongation, ciprofloxacin was the most frequent (3.4%) altogether; 16% had a new claimed prescription of a drug included in the "qtdrugs.org" lists. Conclusions: Most OHCA victims had new drugs prescribed within 6 months before the event but most often intended for diseases other than cardiac. No claims can be made as to the causality.

  • 5.
    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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9.
    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.

  • 10.
    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.

  • 11.
    Semark, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Fredlund, K
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Brudin, L
    Linköpings universitet.
    Reimbursement for drugs: a register study comparing economic outcome for five healthcare centres in areas with different socioeconomic conditions2009In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 37, no 6, p. 647-653Article in journal (Refereed)
    Abstract [en]

    AIMS

    Previous studies have indicated the negative effects of socioeconomic deprivation on health status and morbidity. Nevertheless, the economic assignment systems for pharmaceutical benefits in Sweden do not take socioeconomic status (SES) into account. The aim of the study was, therefore, to compare reimbursement for subsidized drugs at primary healthcare centres (HCCs) with differing socioeconomic conditions in relation to real costs. The word reimbursement is used to denote economic compensation to the HCCs from the county council for drug benefit costs.

    METHODS

    The numbers of individuals dispensed drugs, total costs and reimbursement at five HCCs with different socioeconomic conditions were compared. A socioeconomic index was calculated for each HCC on the basis of information from the municipality registries on income (with negative sign), assistance allowance, education, foreign background, and unemployment. Register data on drug benefit costs were retrieved from the National Corporation of Pharmacies (Apoteket AB) and the Swedish Prescribed Drug Register at the National Board of Health and Welfare. Data on listed and unlisted citizens at the Kalmar County Council and on public statistics from registers at the HCC municipalities where the HCCs were situated were retrieved.

    RESULTS

    There was an almost inverse linear relationship between total cost compensation and the socioeconomic index (n = 5; r =-0.99; p = 0.001). The HCCs with the lowest SES received lower cost compensation.

    CONCLUSIONS

    HCCs responsible for citizens with lower SES appeared to be disadvantaged by the prevalent reimbursement system in Sweden, thereby increasing differences in the state of health of the citizens. This, in turn, hampers health preventing programmes and lifestyle interventions. An HCC-specific standardized summary of socioeconomic burden is presented.

  • 12.
    Steinschaden, Thomas
    et al.
    University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Physicians’ attitudes towards ePrescribing: A comparative web survey in Austria and Sweden2009In: Informatics in Primary Care, ISSN 1476-0320, E-ISSN 1475-9985, Vol. 17, no 4, p. 241-248Article in journal (Refereed)
    Abstract [en]

    Background: The eHealth Action Plan required the member states of the European Union (EU) to provide online services such as eprescribing of pharmaceuticals by the end of 2008. So far, implementation activities and efforts of the member states have been uneven. While in Austria pilot projects and feasibility studies have been conducted, Sweden has always been one of the leading countries in the field of eprescribing.Objective: To identify potential success factors for the implementation of eprescribing in Sweden, by comparing the attitudes of Austrian and Swedish physicians.Method: In a web survey, we asked 1824 Austrian and 427 Swedish physicians within primary care and other disciplines to declare to what extent they agreed with ten statements regarding their attitudes towards eprescribing. We deployed the chi-square test for testing the relationship between the country of residence of physicians and their attitudes towards eprescribing.Results: We demonstrated a relationship between the country of residence of physicians and their attitudes towards eprescribing (P<0.001) for all the responses. Of the Swedish physicians, 92% regarded eprescribing as time-saving, 88.1% as being safer and 96.0% as providing a better service for patients. Although less strongly supportive, the attitudes of the Austrian physicians were mainly positive.Conclusion: We found that the major potential success factors for the implementation of eprescribing in Sweden were saving of time for the physician, improved safety and better service for patients. The mainly positive attitudes of the Austrian physicians may enable implementation of eprescribing in due course.

  • 13.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Avoiding drug-drug interactions.2009In: Chemotherapy, ISSN 1421-9794, Vol. 55, no 4, p. 215-20Article in journal (Refereed)
    Abstract [en]

    BACKGROUND

    Drugs may be prescribed in combinations causing drug-drug interactions (DDI) and adverse drug reactions (ADR), resulting in hospital care.

    METHODS

    To provide prescribers of drug therapy with a better knowledge of individuals' current drug therapy, governments have started to collect prescribing data.

    RESULTS

    The data on individuals' dispensed drugs is available for prescribers, pharmacists, and the registered individuals in Sweden and Denmark. The information has not yet come to an extensive use in healthcare. Pilot projects have been reported positively, but accessibility has to be improved.

    CONCLUSIONS

    To avoid DDIs, reliable information on all drugs used by each single individual needs to be available at the point of care. Knowledge databases about clinically relevant DDIs must be updated and accurate. To tailor the magic bullet for the individual, new genomic- and proteomic-based knowledge about the individual has to be considered in the future.

  • 14.
    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)
  • 15.
    Åstrand, Bengt
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Montelius, Emelie
    University of Kalmar, School of Human Sciences.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Ekedahl, Anders
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Assessment of ePrescription quality: an observational study at three mail-order pharmacies2009In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 9, no 1, p. Article number: 8-Article in journal (Refereed)
    Abstract [en]

    Background: The introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.

    Methods: A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.

    Results: Of the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.

    Conclusion: The increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.

  • 16.
    Åstrand, Bengt
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Åstrand, Emelie
    Uppsala universitet.
    Antonov, Karolina
    Apoteket AB, Stockholm.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Detection of potential drug interactions: a model for a national pharmacy register2006In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 62, no 9, p. 749-756Article in journal (Refereed)
    Abstract [en]

    Objective  The widespread use of pharmaceuticals prescribed by different physicians has caused the Swedish government to propose a new legislation with registration of all prescriptions dispensed at the Swedish pharmacies. In the present study, we wanted to examine the frequency, distribution and determinants of potential drug interactions.Methods  The prescriptions from all individuals (n=8,214) with two or more prescriptions during October 2003 to December 2004 were collected from the ongoing Jämtland cohort study of a total of about 11,000 individuals. Potential drug–drug interactions were detected with a computerized interaction detection system and classified according to clinical relevance (types A–D).Results  On average each individual filled 14.6 (men 14.3, women 14.8) prescriptions during the study period. 3.6% of the individuals used more than 15 different drugs. The number of detected potential drug interactions type A–D was 4,941 (men 1,949, women 2,992). The risk of receiving a potential interaction type A–D was estimated as the cumulative incidence 0.26 (2,116/8,214) overall, 0.22 (748/3,467) for men and 0.29 (1,368/4,747) for women during the 15-month study period. The age adjusted risk, RRadj, for women was estimated as 1.30. Excluding sex hormones and modulators of the genital system, the RRadj was 0.96, with no elevated risk for women. For potential interactions type D, that might have serious clinical consequences, 167 (cumulative incidence 0.0203) individuals (72 men, cumulative incidence 0.0208, 95 women cumulative incidence 0.0200) were detected. The risk of receiving a combination of potentially interacting drugs was positively correlated to age and polypharmacy. The cumulative incidence for elderly was estimated as 0.36 (65–84 years) and 0.39 (85 years and above). The relative risk for individuals with 15 drugs or more was estimated as 3.67 (95% CI 3.46–3.90).Conclusion  In a general population there were relatively few severe potential drug interactions. The new Swedish national pharmacy register will provide health care professionals with a powerful tool to systematically review all prescriptions. An alert system should focus on the more potential drug interactions, type C–D, with close monitoring of elderly and patients with polypharmacy.

  • 17.
    Åstrand, Emelie
    et al.
    University of Kalmar.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences.
    Antonov, Karolina
    The Association of Pharmaceutical Industry, Stockholm.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Erratum: Potential drug interactions during a three-decade study2007In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 63, no 11, p. 1095-Article in journal (Refereed)
  • 18.
    Åstrand, Emelie
    et al.
    University of Kalmar, School of Pure and Applied Natural Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Åstrand, Bengt
    University of Kalmar, School of Pure and Applied Natural Sciences. Apoteket AB.
    Antonov, Karolina
    The Association of Pharmaceutical IndustryStockholm.
    Petersson, Göran
    University of Kalmar, School of Human Sciences. University of Kalmar, eHealth Institute, School of Human Sciences, University of Kalmar,.
    Potential drug interactions during a three-decade study period: a cross-sectional study of a prescription register2007In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 63, no 9, p. 851-859Article in journal (Refereed)
    Abstract [en]

    Objectives  The increased risk of adverse events in patients receiving potentially interacting drugs has long been recognized. The purpose of the present study was to evaluate the change in the risk of receiving potentially interacting drugs during a period covering three decades and to examine the relative risk of actual drug combinations. Methods  The prescriptions from all individuals (about 8,000) with two or more prescriptions during three periods of 15 months, October to December 1983–1984, 1993–1994 and 2003–2004, were collected from an ongoing cohort study in the county of Jämtland, Sweden. The potential interactions were detected by a computerized system. Results  The relative risk (RR) of receiving potentially interacting drugs increased for type C interactions [RR: 1.177, 95% confidence interval (CI): 1.104–1.256] and decreased for type D interactions (RR: 0.714, 95% CI: 0.587–0.868) from the period 1983–1984 to 2003–2004. Polypharmacy for the participants increased by 61%, from 9.05 filled prescriptions per subject in 1983–1984 to 10.6 in 1993–1994 and 14.6 in 2003–2004. The RR was positively correlated to the pronounced increase in polypharmacy; in addition, an exponential relationship was found for the more severe type D interactions. Few interacting drug combinations were responsible for a large proportion of the risk. Conclusion  We conclude that the risk of receiving potentially interacting drugs was strongly correlated to the concomitant use of multiple drugs. The pronounced increase in polypharmacy over time implies a growing reason for prescribers and pharmacists to be aware of drug interactions. Recently established national prescription registers should be evaluated for drug interaction vigilance, both clinically and epidemiologically.

  • 19.
    Öhlund, Sten-Erik
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences. Linköping University, Sweden ; Logica Sverige AB, Sweden.
    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.
    Improving interoperability in ePrescribing2012In: Interactive Journal of Medical Research, E-ISSN 1929-073X, Vol. 1, no 2, article id e17Article in journal (Refereed)
    Abstract [en]

    Background: The increased application of eServices in health care, in general, and ePrescribing (electronic prescribing) in particular, have brought quality and interoperability to the forefront. The application of standards has been put forward as one important factor in improving interoperability. However, less focus has been placed on other factors, such as stakeholders’ involvement and the measurement of interoperability. An information system (IS) can be regarded to comprise an instrument for technology-mediated work communication. In this study, interoperability refers to the interoperation in the ePrescribing process, involving people, systems, procedures and organizations. We have focused on the quality of the ePrescription message as one component of the interoperation in the ePrescribing process.

    Objective: The objective was to analyze how combined efforts in improving interoperability with the introduction of the new national ePrescription format (NEF) have impacted interoperability in the ePrescribing process in Sweden, with the focus on the quality of the ePrescription message.

    Methods: Consecutive sampling of electronic prescriptions in Sweden before and after the introduction of NEF was undertaken in April 2008 (pre-NEF) and April 2009 (post-NEF). Interoperability problems were identified and classified based on message format specifications and prescription rules.

    Results: The introduction of NEF improved the interoperability of ePrescriptions substantially. In the pre-NEF sample, a total of 98.6% of the prescriptions had errors. In the post-NEF sample, only 0.9% of the prescriptions had errors. The mean number of errors was fewer for the erroneous prescriptions: 4.8 in pre-NEF compared to 1.0 in post-NEF.

    Conclusions: We conclude that a systematic comprehensive work on interoperability, covering technical, semantical, professional, judicial and process aspects, involving the stakeholders, resulted in an improved interoperability of ePrescriptions.

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