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| 2. |
- Moen, Janne, et al.
(författare)
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Factors associated with multiple medication use in different age groups
- 2009
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 43:12, s. 1978-1985
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long period of time. By learning more about how multiple medication use develops, the quality of prescribing may be improved across the adult lifespan. OBJECTIVE: To describe patterns of multiple medicine use in the general Swedish population and its association with sociodemographic, lifestyle, and health status factors. METHODS: Data from a cross-sectional population health survey collected during 2001-2005 from 2816 randomly selected Swedish residents (age 30-75 y; response rate 76%) were analyzed. Multiple medicine use was restricted to prescription drugs and defined as the 75th percentile; that is, the 25% of the study group using the highest number of drugs per individual. RESULTS: Seventy-one percent of the respondents used some kind of drug, 51.5% used one or more prescription drug, 38.4% used one or more over-the-counter (OTC) medication, and 8.3% used one or more herbal preparation. The cutoff amounts defining multiple medicine use were: 2 or more medications for 30- to 49-year-olds, 3 or more for 50- to 64-year-olds, and 5 or more for 65- to 75-year-olds. No association between use of multiple medicines and use of OTC drugs or herbal preparations was found. When drugs were classified into therapeutic subgroups, 76.3% of those aged 30-49 years, 97.9% of those aged 50-64 years, and 100% of those aged 65-75 years were taking a unique combination of drugs. Multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female sex and hypertension were associated with multiple medicine use among those aged 30-49 and 50-64 years, current smoking among those aged 50-64 years, and obesity among those aged 65-75 years. CONCLUSIONS: Multiple medicine use was associated with morbidity and poor self-rated health across all age groups. The vast majority of users of multiple drugs are taking a unique combination of medications.
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| 3. |
- Moen, Janne, 1980-, et al.
(författare)
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GPs' perceptions of multiple-medicine use in older patients
- 2010
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Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley. - 1356-1294 .- 1365-2753. ; 16:1, s. 69-75
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Tidskriftsartikel (refereegranskat)abstract
- Rationale, aim and objective: Multiple-medicine use (polypharmacy) is a growing problem for older patients, prescribers and health policy makers. The general practitioner (GP) is most often the main professional care provider; hence, improvements of treatment can only be carried out in concordance with GPs. The aim of this study was, therefore, to explore using a qualitative approach GPs' perspectives of treating older users of multiple medicines. Method: Six focus groups, with four private GPs and 27 county-employed GPs, were analysed by using the framework method. Results: In contrast to definitions in most epidemiologic studies, the GPs gave a spontaneous definition of polypharmacy as 'the administration of more medicines than are clinically indicated'. They had problems stating both a cut-off number and which medicines should be included. Clinical practice guidelines were thought of as 'medicine generators', having an ambiguous effect on the GPs, who both trust them and find them difficult to apply. There was a perceived lack of communication between GPs and hospital specialists concerning their patients' medicines, which was further perceived to reduce treatment quality. The influence of patient pressure was acknowledged by the GPs as a factor contributing to the development of multiple-medicine use. Conclusions: The GPs felt insecure although surrounded by clinical practice guidelines. There is a need for policy makers to appreciate this paradox, as the problem is likely to grow in size and proportion. GPs must be empowered to handle the increasing proportion of older users of multiple medicines with individual agendas, receiving care from multiple specialists.
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| 4. |
- Moen, Janne, 1980-, et al.
(författare)
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"I don't know how many of these [medicines] are necessary.." - a focus group study among elderly users of multiple medicines
- 2009
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Ingår i: Patient Education and Counseling. - : Elsevier BV. - 0738-3991 .- 1873-5134. ; 74:2, s. 135-141
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The growing prevalence of multiple medicine use among elderly challenges health care. The aim was to conduct an exploratory study describing multiple medicine use from the elderly patient's perspective. METHODS: Twelve focus groups of 29 men and 30 women 65 years of age or older, using five or more medicines were analysed qualitatively. RESULTS: Initially the participants reported no problems with using multiple medicines; they felt fortunate that medicines existed and kept them alive. However, negative attitudes were also revealed, both similar to those presented in studies on lay experience of medicine-taking and some that appear more specific to users of multiple medicines. The foremost of these was that acceptance of medicines depends on not experiencing adverse effects and worrying whether multiple medicine use is 'good' for the body. Furthermore, participants' perception of their medicines depended on interaction with doctors, i.e. trusting 'good' doctors. CONCLUSION: The participants revealed co-existing accounts of both immediate gratitude and problems with using multiple medicines. Furthermore, the patient-doctor relationship coloured their attitudes towards their medicines. PRACTICE IMPLICATIONS: Importance of the patient-doctor relationship for treatment success is highlighted. Moreover, to be able to capture both accounts of the elderly in this study an appropriate consultation length is needed.
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| 5. |
- Moen, Janne, 1980-, et al.
(författare)
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Interaction Between Participants in Focus Groups With Older Patients and General Practitioners
- 2010
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Ingår i: Qualitative Health Research. - : SAGE Publications. - 1049-7323 .- 1552-7557. ; 20:5, s. 607-616
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Tidskriftsartikel (refereegranskat)abstract
- Group interaction is put forward as the principal advantage for focus group research although rarely reported on. The aim of this paper is to contribute to the methodological knowledge regarding focus group research by providing an empirical example of the application of the Lehoux, Poland and Daudelin template suggested for analysis of the interaction in focus groups. The data source was 18 focus groups' performance in Sweden; 12 with older participants and 6 with general practitioners (GPs). GPs found a common ground in belonging to the same profession, while older participants instead of constituting a group in the words real sense started just sharing a common focus. We found the template easy to understand and use, except for identifying participants' explicit and implicit purposes for participating. Further, adding an interaction analysis to the content analysis helped us appreciate and clarify the contexts from which these data were created.
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| 6. |
- Moen, Janne, 1980-
(författare)
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Multiple Medicine Use : Patients’ and general practitioners’ perceptions and patterns of use in relation to age and other patient characteristics
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- There are widespread concerns about the increasing use of multiple medicines. The aims of this thesis were to identify older patients' and general practitioners' (GPs) attitudes to and experiences of multiple medicine use, as well as to describe patterns of multiple medicine use in different age groups in association with patient-related factors. An additional aim was to contribute to scientific methodological development by providing an empirical example of the application of the Lehoux, Poland, & Daudelin template for the analysis of interaction in focus groups. Data were collected via qualitative focus group discussions and from a cross-sectional community-based population survey conducted during 2001-2005. The patients revealed co-existing accounts of both immediate gratitude that medicines exist and problems with using multiple medicines such as worrying whether multiple medicine use is 'good' for the body. The patient-doctor relationship coloured their attitudes towards their treatment and care. The GPs at times felt insecure, though surrounded by treatment guidelines. Lack of communication with hospital specialists was perceived to reduce treatment quality, while influence of patient pressure was thought to contribute to the development of multiple medicine use. An interaction analysis helped in appreciating and clarifying the contexts in which results from the content analysis were created. Further discussion is needed on how to best report these results. Different cut-offs are useful in defining multiple medicine use in different age groups. Vast majorities of users of multiple medicines were found to have unique medicine combinations. Multiple medicine use was found to be associated with morbidity and poor self-rated health across all age groups.
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| 7. |
- Moen, Janne, 1980-, et al.
(författare)
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Multiple medicine use: factors of importance in different age groups
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Multiple medicine use among elderly persons is likely to be the result of treatment regimens developed over a long time. By learning more about this development, it might be possible to increase quality in management of multiple medicine use across the adult lifespan. OBJECTIVE: To describe patterns of multiple medicine use in a general population in association with sociodemographic factors, lifestyle, and health status. METHODS: Data from a cross-sectional population health survey collected during 2001-2005 in 2,816 randomly selected Swedish residents (age 30-75 years; response rate 76%). Multiple medicine use was defined as the upper quartile in each age cohort. RESULTS: The cut-offs defining multiple medicine use were: ≥2 for 30-49 year olds, ≥3 for 50-64 year olds, and ≥5 for 65-75 year olds. When drugs were classified into the second level of the ATC code, 76.3% of the 30-49 year olds, 97.9% of the 50-64 year olds, and 100% of the 65-75 year olds used a unique combination of drugs. The multivariate analyses showed that diabetes and poor self-rated health were associated with multiple medicine use in all age cohorts. Female gender and hypertension were associated with multiple medicine use among 30-49 and 50-64 year olds, ex-smoking among 50-64 year olds, and obesity among 65-75 year olds. CONCLUSIONS: Different cut-offs should be used in defining multiple medicine use in different age groups. A vast majority of users of multiple medicines have a unique drug combination. Multiple medicine use is associated with morbidity and poor self-rated health across all age groups, suggesting that multiple medicine use is not due to drug over-consumption.
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| 9. |
- Thurin, Anders, et al.
(författare)
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Shallow linguistic analysis of a large corpus of drug prescriptions.
- 2002
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Ingår i: Health data in the information society. - Amsterdam : IOS Press. - 1586032798 ; 90, s. 411-5
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Konferensbidrag (refereegranskat)abstract
- We report on first experiences from linguistic analyses of patient instructions from 19,8404 actual drug prescriptions regarding seven pharmaceutical products frequently prescribed in Sweden. The analysis includes expressions for amount, dose unit, dose interval, mode of administration, purpose and a few further details. Even simple processing seems useful to extract information from these short, rather formal text strings. We estimate the potential for calculation of prescribed dose from this material, and collected material gives a good starting point for more advanced linguistic analyses.
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| 10. |
- Åstrand, Bengt, et al.
(författare)
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Detection of potential drug interactions : a model for a national pharmacy register
- 2006
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 62:9, s. 749-756
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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