| 1. |
- 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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| 2. |
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| 3. |
- Åstrand, Emelie, et al.
(författare)
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Potential drug interactions during a three-decade study period : a cross-sectional study of a prescription register
- 2007
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 63:9, s. 851-859
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 4. |
- Aurell, Emelie, et al.
(författare)
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Mikroplaster : Redovisning av regeringsuppdrag om källor till mikroplaster och förslag på åtgärder för minskade utsläpp i Sverige
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I augusti 2015 fick Naturvårdsverket i uppdrag från regeringen att identifiera viktigare källor i Sverige till utsläpp av mikroplaster till havet och verka för att reducera utsläppen från dessa källor. I den här rapporten redovisar Naturvårdsverket uppdraget. Vi presenterar resultaten från den första, övergripande kartläggningen av källor till och spridning av mikroplaster i Sverige, en bedömning av vilka av de kartlagda källorna som primärt bör åtgärdas samt vilka steg som behöver tas för att förebygga utsläpp och minska spridning av mikroplaster till hav, sjöar och vattendrag från dessa källor.Förekomsten av mikroplast i den marina miljön har uppmärksammats allt mer under senare år, inte minst på global nivå. Mikroplast är ett samlingsnamn för små, små plastfragment (1 nm till 5 mm). De mikroplaster som hittats i världshaven, men även i sötvattensystem, har olika ursprung. Mikroplast kan bildas oavsiktligt när plastföremål slits och plastpartiklar frigörs, eller när vi inte återanvänder, återvinner eller slänger plastmaterial på rätt sätt utan plasten blir skräp som succesivt bryts ned till mindre och mindre bitar i naturen. Det finns också plast som från början tillverkas som små pellets eller korn.Utgångspunkten för arbetet har varit miljökvalitetsmålen Hav i balans samt levande kust och Levande sjöar och vattendrag samt målet om Giftfri miljö. Reduceradeutsläpp av mikroplaster till hav, sjöar och vattendrag bidrar till att nå dessa mål.Uppdraget har genomförts av Naturvårdsverket i samarbete med Havs- och vattenmyndigheten, andra berörda myndigheter, samt med deltagande av berörda organisationer och andra intressenter mellan augusti 2015 och maj 2017. Slutsatserna är Naturvårdsverkets egna.
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| 5. |
- Hellström, Lina, 1975-, et al.
(författare)
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Physicians' attitudes towards ePrescribing : evaluation of a Swedish full-scale implementation
- 2009
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 9:August, s. Article number: 37-
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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| 6. |
- Montelius, Emelie, 1984-, et al.
(författare)
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Individuals Appreciate Having Their Medication Record on the Web : A Survey of Attitudes to a National Pharmacy Register
- 2008
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Ingår i: Journal of Medical Internet Research. - Toronto : JMIR Publications Inc.. - 1438-8871. ; 10:4, s. e35-
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundMany 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. ObjectiveThe 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.MethodA 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. ResultsDuring 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).ConclusionWe 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.
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| 7. |
- Wolgast, Emelie, et al.
(författare)
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Womens perceptions of medication use during pregnancy and breastfeeding-A Swedish cross-sectional questionnaire study
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 98:7, s. 856-864
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Use of medication for different kinds of symptoms and diseases during pregnancy is common. When counseling the pregnant woman, an understanding of her perceptions concerning the use of medication as well as possible associated anxiety and obstacles is important to ensure high adherence to the treatment regimen. Material and methods A questionnaire was developed regarding the use of medication, perceptions on use of medication, as well as perceptions about pregnancy outcomes in association with medication use during pregnancy. In total, 850 pregnant women in gestational weeks 25-29 participated in the study. Results The response rate was 92.7% (n = 832/898). About 19.4% of the respondents (n = 160/824) were frequent users (medication use daily to several times a week) and 28.4% (n = 234/824) were non-frequent users (medication use once a week to once a month). The majority perceived medication use during early pregnancy (61.4%, n = 501/816), late pregnancy (55.6%, n = 455/819) and breastfeeding (57.7%, n = 474/821) as probably harmful or harmful. These findings were more common in non-users (medication used rarely or never) than frequent users (P-value amp;lt;0.001, amp;lt;0.001 and 0.007). The pregnant women had great confidence in advice from a physician (83.8%, n = 666/795) or a midwife (77.0%, n = 620/805) concerning medication during pregnancy. Conclusions The majority of pregnant women in Sweden consider the use of medication during pregnancy either probably harmful or harmful and this perception is associated with non-use of medication. The pregnant women in our study had high confidence in healthcare professionals when seeking advice; thus, actively asking about perceptions could lead to better counseling.
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| 8. |
- Åstrand, Bengt, et al.
(författare)
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Assessment of ePrescription quality : an observational study at three mail-order pharmacies
- 2009
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Ingår i: BMC Medical Informatics and Decision Making. - : Springer Science and Business Media LLC. - 1472-6947. ; 9:1, s. Article number: 8-
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Tidskriftsartikel (refereegranskat)abstract
- 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.
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