| 1. |
- Krigsman, Kristin, et al.
(författare)
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Refill non-adherence to repeat prescriptions leads to treatment gaps or to high extra costs.
- 2007
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Ingår i: Pharmacy World & Science. - : Springer Netherlands. - 0928-1231 .- 1573-739X. ; 29:1, s. 19-24
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To determine the nature and extent of undersupply and the economic consequences of oversupply of medication among non-adherent patients. METHODS: This study used copies of repeat prescriptions (= multiple dispensations), collected during 1 week in 2002 at 16 Swedish community pharmacies. For patients with a refill adherence below 80%, treatment gaps were defined as the number of days they had no drug available. The cost of drug oversupply (i.e., refill adherence > 120%) was calculated from the prices of the drug packages dispensed. RESULTS: The number of collected repeat prescriptions was 3,636. The median of treatment gaps among patients with a refill adherence below 80% was 53 days per 90-100 days treatment period and the corresponding median for oversupply was 40 days. The cost of oversupply for exempt patients (i.e., patients who have paid 1,800 SEK (Euro 196; US$ 243) per year for medicines) was 32,000 SEK (Euro 3,500; US$ 4,300) higher than for non-exempt patients. An extrapolation to all Sweden indicates that exemption from charges leads to an additional oversupply of about 142 million SEK (Euro 15 million; US$ 19 million) per year above that of non-exempt patients. CONCLUSION: Both undersupply and oversupply of prescribed medicines are common in Sweden. Patients with a refill adherence below 80% seem to have less than half of the prescribed treatment available. Oversupply or drug stockpiling occurs more frequently among exempt than among non-exempt patients, and this oversupply leads to high unnecessary costs.
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| 2. |
- Lindström, Kjell, 1946-, et al.
(författare)
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Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?
- 2007
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Ingår i: Scandinavian Journal of Primary Health Care. - London : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 25:1, s. 3-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review. DESIGN: Open, prospective, interventional study. SETTING: Four counties in Sweden. SUBJECTS: Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year. MAIN OUTCOME MEASURES: Clinical evaluation, registration of drugs used and rating with Montgomery-Asberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses. RESULTS: About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable. CONCLUSIONS: Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.
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| 3. |
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| 4. |
- Björner, Anders, et al.
(författare)
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On the shape of Bruhat intervals
- 2009
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Ingår i: Annals of Mathematics. - Princeton : Annals of Mathematics. - 0003-486X .- 1939-8980. ; 170:2, s. 799-817
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Tidskriftsartikel (refereegranskat)abstract
- Let (W, S) be a crystallographic Coxeter group (this includes all finite and affine Weyl groups), and let J subset of S. Let W-J denote the set of minimal coset representatives modulo the parabolic subgroup W-J. For w is an element of W-J, let f(i)(w,J) denote the number of elements of length i below w in Bruhat order on W-J (with notation simplified to f(i)(w) in the case when W-J = W). We show that 0 <= i < j <= l(w)-i implies f(i)(w,J) <= f(j)(w,J). Also, the case of equalities f(i)(w) = f(l(w)-i)(w) for i = 1,..., k is characterized in terms of vanishing of coefficients in the Kazhdan-Lusztig polynomial P-e,P-w (q). We show that if W is finite then the number sequence f(0)(w), f(1)(w),... f(l(w))(w) cannot grow too rapidly. Further, in the finite case, for any given k >= 1 and any w is an element of W of sufficiently great length (with respect to k), we show f(l(w)-k)(w) >= f(l(w)-k+1)(w) >= ... >= f(l(w))(w). The proofs rely mostly on properties of the cohomology of Kac-Moody Schubert varieties, such as the following result: if (X) over bar (w) is a Schubert variety of dimension d = l(w), and lambda = c(1) (L) is an element of H-2 ((X) over bar (w)) is the restriction to (X) over bar (w) of the Chem class of an ample line bundle, then (lambda(k)) . : Hd-k((X) over bar (w)) -> Hd+k((X) over bar (w)) is injective for all k >= 0.
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| 5. |
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| 6. |
- Ekedahl, Anders, et al.
(författare)
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Impact of postal and telephone reminders on pick-up rates of unclaimed e-prescriptions.
- 2008
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Ingår i: Pharmacy World & Science. - : Springer Netherlands. - 0928-1231 .- 1573-739X. ; 30:5, s. 503-508
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the impact of a reminder (i.e., a mailed letter or short telephone call) from the pharmacy to patients, compared with no reminder in a control group, on the pick-up rates of unclaimed e-prescriptions. METHOD: Patients, with e-prescriptions transmitted to four large community pharmacies in two counties in northern Sweden and remaining unclaimed after 4 weekdays, were randomised to one of two intervention groups (a mailed reminder or a short telephonic reminder) or a control group. MAIN OUTCOME MEASURES: Rates of patients' pick-up of their e-prescriptions at follow-up after about 1, 2 and 3 weeks. RESULTS: Altogether, 320 patients with e-prescriptions, transmitted from March 21 through April 6 and not picked-up or dispensed, were identified and randomised to the study. There were no statistically significant differences in overall pick-up rates between the groups or with respect to gender. However, pick-up rates increased with increasing age. Higher pick-up rates were observed for two subgroups (but only in the mailed reminder group compared with controls)--for cardiovascular drugs to men and for respiratory drugs to adolescents and young adults. CONCLUSION: A reminder (i.e., a mailed letter or short telephone call) from the pharmacy to the patient had no statistically significant effect on overall pick-up rates of unclaimed e-prescriptions compared with no reminders.
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| 7. |
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| 8. |
- Ekedahl, Anders
(författare)
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Reasons why medicines are returned to Swedish pharmacies unused.
- 2006
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Ingår i: Pharmacy World & Science. - : Springer Netherlands. - 0928-1231 .- 1573-739X. ; 28:6, s. 352-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused. SETTING: A random sample of the pharmacies in Sweden. METHOD: Interviews using a semi-structured interview form with pharmacy customers returning unused medicines to the pharmacy. MAIN OUTCOME MEASURE: Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy. RESULTS: The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons. CONCLUSION: Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines.
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| 9. |
- Hermansson, Michael, et al.
(författare)
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Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974-2002.
- 2009
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Ingår i: BMC Gastroenterology. - : BioMed Central. - 1471-230X. ; 9:April, s. Article number: 25-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA).METHODS: All cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey. RESULTS: When comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p < 0.001). Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 2002. The number of prescribed sales to women was higher than to males. Sales of low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the counter sale and sold on prescription, increased by 28% during the same period.CONCLUSION: When comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.
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