| 1. |
- Bjerkeli, Pernilla J., et al.
(author)
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Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users
- 2016
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:5
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Journal article (peer-reviewed)abstract
- Objective Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden. New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance. The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis. The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.
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| 2. |
- Björklund, L., et al.
(author)
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Aspirin in cardiology - benefits and risks
- 2009
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In: INTERNATIONAL JOURNAL OF CLINICAL PRACTICE. - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 63:3, s. 468-477
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Research review (peer-reviewed)
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| 3. |
- Jönsson, Anna K, et al.
(author)
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Influence of refill adherence method when comparing level of adherence for different dosing regimens
- 2014
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In: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 70:5, s. 589-597
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Journal article (peer-reviewed)abstract
- To examine the impact of two methods when estimating refill adherence in patients using bisphosphonates with different dosing regimens. In the Swedish Prescribed Drug Register, 18,203 new users of bisphosphonates aged 18-85 years were identified between 1 July 2006 and 30 June 2007 and followed for a maximum of 2 years. The patients were categorised based on dosing regimen: one tablet daily, one tablet weekly, switching between these regimens, and other regimens. Refill adherence was estimated with Continuous measure of Medication Acquisition (CMA, adherent if CMA a parts per thousand yenaEuro parts per thousand 80 %) and the maximum gap method (adherent if gaps < 45 days). Differences in adherence between patients in the groups were assessed with logistic regression models controlling for confounding factors. The proportion of patients classified as adherent was higher using CMA compared with patients classified as adherent using the maximum gap method. Patients on one tablet weekly had significantly lower adherence compared with patients on one tablet daily in the main analyses of both methods (the maximum gap method: 73 % vs. 80 %; adjusted OR = 0.71; 95 % CI 0.57-0.89 and CMA: 84 % vs. 88 %, adjusted OR = 0.75; 95 % CI 0.57-0.99). Patients using the other two dosing regimens had significantly lower adherence compared with patients on one tablet daily using both methods. Choice of method has an impact on the estimates of refill adherence to bisphosphonates. Patients on one tablet weekly dosing had lower adherence compared with patients on one tablet daily dosing using both methods.
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| 4. |
- Lesén, Eva, 1982, et al.
(author)
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A comparison of two methods for estimating refill adherence to statins in Sweden: the RARE project
- 2011
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In: Pharmacoepidemiology and Drug Safety. - : John Wiley and Sons. - 1053-8569 .- 1099-1557. ; 20:10, s. 1073-1079
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Journal article (peer-reviewed)abstract
- Purpose To analyse and compare refill adherence to statins estimated with two different methods with a focus on sensitivity to definitions. less thanbrgreater than less thanbrgreater thanMethods Individuals aged 18-85 years who filled a statin prescription for the first time in 1.5 years during 1 January-30 June 2007 were followed until emigration or death or until 2 years after their first statin purchase. The data were collected via linkage between the Swedish Prescribed Drug Register, the National Patient Register and the Total Population Register. Days supply was estimated based on amount dispensed and prescribed dosage. Refill adherence was estimated with the continuous measure of medication acquisition (CMA) and the maximum gap method (cut-off 45days). The impact of altering definitions, for example, regarding hospitalisations, length of observation period and management of overlapping supply, was analysed. less thanbrgreater than less thanbrgreater thanResults The study included 36661 individuals (mean age 64 years, 47% women). The median proportion of days with statins was 95%, and 76% were classified as adherent with a cut-off at andgt;= 80% with CMA. With the maximum gap method, 65% were adherent. Disregarding hospitalisations did not alter the results. Emigration or death at least one year after statin initiation was associated with a lower adherence with both methods, and a shorter observation period and adding overlapping supply to the subsequent prescription increased the adherence estimates. less thanbrgreater than less thanbrgreater thanConclusions The choice of method and definitions, particularly regarding the management of overlapping supplies and the length of observation period, has a substantial impact on estimates of refill adherence to statins.
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| 5. |
- Lesén, Eva, 1982, et al.
(author)
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Dose Patterns among patients using low-dose buprenorphine patches
- 2013
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In: Pain medicine. - : Oxford University Press (OUP). - 1526-2375 .- 1526-4637. ; 14:9, s. 1374-1380
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Journal article (peer-reviewed)abstract
- Objective: The objective of this study was to investigate the dose pattern of low-dose buprenorphine patches among patients in Swedish clinical practice. The clinical experts among the coauthors interpreted the results in relation to possible indications of development of tolerance and/or dependence/addiction. Design and Setting: This was a nationwide, observational study using data from the Swedish Prescribed Drug Register. Subjects: Individuals who were dispensed the low-dose buprenorphine patches continuously for more than 24 weeks during July 1, 2005 to February 28, 2011 were included. Methods: The dose pattern was analyzed as the change in dose over time for each patient: 1) the dose at baseline compared with each of the following 8-week intervals, and 2) the dose at baseline compared with the dose during the patients' last treatment period. Results: The majority of the patients were female (74%), and most were 75 years and older (69%). The median treatment duration was 260 days, and 4% and 1% of patients remained on continuous treatment for 2 and 3 years, respectively. The mean dose was 11μg/h at baseline, and 15μg/h during the patients' last treatment period. The average dose increased by 4μg/h during the patients' entire treatment course. Conclusions: The average dose increased by 4μg/h during the patients' treatment course, which lasted on an average of 260 days. From a clinical perspective, the dose increase of 4μg/h is low and does not suggest dependence/addiction, as also supported by the low proportion of patients remaining on continuous treatment. © 2013 American Academy of Pain Medicine.
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| 6. |
- Lesén, Eva, 1982, et al.
(author)
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Is the level of patient co-payment for medicines associated with refill adherence in Sweden?
- 2014
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In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 24:1, s. 85-90
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Journal article (peer-reviewed)abstract
- In the Swedish reimbursement scheme, the co-payment is based on the price of the product and decreases in a stepwise manner as the total accumulated co-payment increases. The aim of this study was to analyse how refill adherence in Sweden varies according to patient's co-payment level for medicines, with antiepileptic drug (AED) use as an example.
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| 7. |
- Lesén, Eva, 1982, et al.
(author)
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Psychotropic drug use in relation to mental disorders and institutionalization among 95-year-olds: a population-based study.
- 2011
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In: International psychogeriatrics. - 1741-203X. ; 23:8, s. 1270-1277
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Journal article (peer-reviewed)abstract
- Background: The prevalence of psychotropic drug use is high among the elderly, but research on how psychotropic drugs are used among individuals aged 90 years and older is limited. An increased knowledge on this topic may contribute to improved prescribing patterns in this vulnerable population. The aim of this study was to assess the use of psychotropic drugs in relation to mental disorders and institutionalization among 95-year-olds and to identify use of potentially inappropriate psychotropic drugs. Methods: All 95-year-olds born in 1901–1903 living in nursing homes or community settings in Gothenburg, Sweden were invited to participate. The response rate was 65% and 338 95-year-olds were examined (263 women, 75 men). Psychotropic drug use in relation to mental disorders and institutionalization was assessed. Information on drug use was collected primarily from multi-dose drug dispensing lists. Participants were examined by trained psychiatrists using the Comprehensive Psychopathological Rating Scale and a battery of cognitive tests. Dementia, depression, anxiety and psychotic disorders were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, third edition, revised (DSM-III-R). Results: Sixty percent of the 95-year-old participants used psychotropic drugs; hypnotics were most common (44%). Potentially inappropriate psychotropics were observed in one third (33%). Antidepressants were used by 7% of the participants without dementia who fulfilled criteria for a depressive disorder, while 56% used hypnotics and 30% used anxiolytics. Conclusions: The high prevalence of psychotropic drug use and the nonspecific nature of these treatments among 95-year-olds indicate a need for improvement in prescribing patterns.
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