| 1. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Antidepressants and suicidal behaviour in late life: a prospective population-based study of use patterns in new users aged 75 and above.
- 2018
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Ingår i: European journal of clinical pharmacology. - : Springer Science and Business Media LLC. - 1432-1041 .- 0031-6970. ; 74, s. 201-208
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Tidskriftsartikel (refereegranskat)abstract
- To investigate associations between antidepressant use patterns and risk of fatal and non-fatal suicidal behaviours in older adults who initiated antidepressant therapy.A national population-based cohort study conducted among Swedish residents aged ≥75years who initiated antidepressant treatment. Patients who filled antidepressant prescriptions between January 1, 2007 and December 31, 2013 (N=185,225) were followed until December 31, 2014. Sub-hazard ratios of suicides and suicide attempts associated with use patterns of antidepressants, adjusting for potential confounders such as serious depression were calculated using the Fine and Gray regression models.During follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) were increased for both outcomes in those who switched to another antidepressant (aSHR for suicide 2.42, 95% confidence interval 1.65 to 3.55, and for attempt 1.76, 1.32 to 2.34). Elevated suicide risks were also observed in those who concomitantly filled anxiolytics (1.54, 1.20 to 1.96) and hypnotics (2.20, 1.69 to 2.85). Similar patterns were observed for the outcome suicide attempt. Decreased risk of attempt was observed among those with concomitant use of anti-dementia drugs (0.40, 0.27 to 0.59).Switching antidepressants, as well as concomitant use of anxiolytics or hypnotics, may constitute markers of increased risk of suicidal behaviours in those who initiate antidepressant treatment in very late life. Future research should consider indication biases and the clinical characteristics of patients initiating antidepressant therapy.
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| 2. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Late-life suicidal behaviours among new users of antidepressants: A prospective population-based study of sociodemographic and gender factors in those aged 75 and above
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:10
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Tidskriftsartikel (refereegranskat)abstract
- To investigate sociodemographic and gender factors associated with suicide and suicide attempts among new users of antidepressants aged 75 and above.DesignRegister-based cohort study.SettingNational population-based cohort of Swedish residents aged ≥75 years.Participants185 225 patients who initiated antidepressant medication between 1 January 2007 and 31 December 2013 were followed until 31 December 2014.Main outcome measuresSuicide and suicide attempts. Fine and Gray regression models were used to analyse the sociodemographic factors (age, country of birth, marital status, education level, last occupation, income and social allowance) associated with suicidal behaviours in the entire cohort and by gender.ResultsDuring follow-up, 295 suicides and 654 suicide attempts occurred. Adjusted sub-hazard ratios (aSHRs) for suicide were lower among older age groups (aSHR 0.73, 95% CI 0.53 to 0.99 for those 85–89 years; and aSHR 0.53, 95% CI 0.33 to 0.86 for those ≥90 years). A similar pattern was observed for suicide attempts. Suicide attempts were more common among those born in foreign countries (aSHR 1.58, 95% CI 1.16 to 2.15 for those born in another Nordic country; and aSHR 1.43, 95% CI 1.06 to 1.93 for those born in non-Nordic countries). In the gender-stratified analyses, being single or divorced, and born in another Nordic country was associated with a higher risk of suicide among men. Educational and occupational history and being born in a non-Nordic country influenced risk of suicidal behaviours in women.ConclusionSuicidal behaviours occurred more commonly among new users who were ‘younger’ old adults and those with foreign background, suggesting that those groups might require greater support when initiating antidepressant therapy. Our findings suggest the need for gender-specific, multifaceted approaches to the prevention of suicidal behaviours in late life.
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| 3. |
- Hedna, Khedidja, 1978, et al.
(författare)
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Refill adherence and self-reported adverse drug reactions and sub-therapeutic effects: a population-based study.
- 2013
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Ingår i: Pharmacoepidemiology and drug safety. - : Wiley. - 1099-1557 .- 1053-8569. ; 22:12, s. 1317-1325
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Tidskriftsartikel (refereegranskat)abstract
- To assess refill adherence to dispensed oral long-term medications among the adult population and to investigate whether the percentages of self-reported adverse drug reactions (ADRs) and sub-therapeutic effects (STEs) differed for medications with adequate refill adherence, oversupply, and undersupply.
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| 4. |
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| 5. |
- Andersson Sundell, Karolina, 1978, et al.
(författare)
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Beliefs about medicines are strongly associated with medicine-use patterns among the general population
- 2016
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Ingår i: International Journal of Clinical Practice. - : Hindawi Limited. - 1368-5031 .- 1742-1241. ; 70:3, s. 277-285
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Tidskriftsartikel (refereegranskat)abstract
- AimsTo investigate self-reported beliefs and perceived sensitivity to medicines and their effects in relation to self-reported use of medicines and herbal remedies. MethodsA survey sent to 13,931 randomly selected Swedish adults included the Beliefs about Medicines Questionnaire-General (BMQ-General) Questionnaire and the Perceived Sensitivity to Medicines Scale (PSM). The survey also asked about individuals' use of prescribed and over-the-counter (OTC) medicines and herbal remedies in the past month. We examined all associations between scores on the BMQ-General subscales and PSM in relation to the use of medicines and herbal remedies, using analysis of covariance adjusted for potential confounders. ResultsAmong 7099 respondents, those using herbal remedies exclusively believed strongly that prescription and OTC medicines are harmful and overprescribed. Respondents using prescription and OTC medicines reported more positive beliefs [coefficient 0.67 (95% CI 0.47-0.87) and 0.70 (95% CI 0.51-0.90)] on the benefits of medicines compared with those using herbal remedies [-0.18 (95% CI -0.57-0.20)]. Perceived sensitivity to medicines was higher among those using herbal remedies only [1.25 (95% CI 0.46-2.03)] compared with those using no medicines (reference 0) or prescription [-0.44 (95% CI -0.84 to -0.05)] or OTC [-0.27 (95% CI -0.66-0.12)] medicines alone. ConclusionRespondents using prescription and/or OTC medicines reported stronger positive beliefs about the benefits of medicines in general, supporting the hypothesis that beliefs influence medicine use. Therefore, addressing beliefs and concerns about medicines during patient counselling may influence medicine use, particularly regarding unintentional non-adherence.
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| 6. |
- Andersson Sundell, Karolina, 1978, et al.
(författare)
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Factors associated with switching and combination use of antidepressants in young Swedish adults.
- 2013
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Ingår i: International journal of clinical practice. - : Hindawi Limited. - 1742-1241 .- 1368-5031. ; 67:12, s. 1302-10
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Tidskriftsartikel (refereegranskat)abstract
- Little is known on factors associated with switching and combination use of antidepressants. Our aim was to describe such use and to analyse the association with socioeconomic factors and level of care in Swedish adults aged 20-34years.
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| 7. |
- Andersson Sundell, Karolina, 1978, et al.
(författare)
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Socio-economic determinants of early discontinuation of anti-depressant treatment in young adults.
- 2013
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Ingår i: European journal of public health. - : Oxford University Press (OUP). - 1464-360X .- 1101-1262. ; 23:3, s. 433-440
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Early discontinuation of anti-depressant treatment is common. This study analysed whether socio-economic factors influence early discontinuation among new anti-depressant users aged 20-34 years. METHODS: Our study population included all Swedes aged 20-34 years who purchased anti-depressants in 2006 and had not purchased such drugs in the preceding 6 months (n=25003). We obtained prescription data from the Swedish Prescribed Drug Register. Information about demographic and socio-economic factors (country of birth, marital status, household size, education level, occupation, income and social assistance) was collected from Statistics Sweden by record linkage. We defined early discontinuation as filling only one anti-depressant prescription within a 6-month period. We used multiple logistic regression analysis to analyse the socio-economic factors associated with early discontinuation. RESULTS: We identified 6536 individuals (26.1%) as early discontinuers. Early discontinuation was less common among women [odds ratio (OR)=0.82; 95% confidence intervals (CI) 0.75-0.87] and in those with at least two years of higher education (OR=0.71; 95% CI 0.61-0.83), whereas it was more common among those born outside Sweden (OR=1.76; 95% CI 1.48-2.10) and those who received social assistance (OR=1.26; 95% CI 1.11-1.44). Compared with selective serotonin re-uptake inhibitors, SSRI, early discontinuation was more common among individuals who started treatment with a tri-cyclic anti-depressant, TCA, (OR=2.58; 95% CI 2.24-2.98) or an anti-depressant other than SSRIs, TCAs or selective serotonin-norepinephrine re-uptake inhibitors/norepinephrine (noradrenaline) re-uptake inhibitors (OR=2.90; 95% CI 2.05-4.10). CONCLUSION: Early discontinuation occurred more commonly among social assistance recipients and those with immigrant background, suggesting that those groups might require greater support when initiating anti-depressant therapy.
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| 8. |
- Bjerkeli, Pernilla J., et al.
(författare)
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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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Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 11:5
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Tidskriftsartikel (refereegranskat)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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| 9. |
- Bäck, Annika, et al.
(författare)
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The Medication Adherence Report Scale (MARS-5) in a Swedish sample with bipolar disorder - a pilot study
- 2012
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Ingår i: The International Journal of Person Centered Medicine. - 2043-7730 .- 2043-7749. ; 2:2, s. 263-270
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To test the acceptability and reliability of the Swedish translation of the Medication Adherence Report Scale-5 (MARS-5) in a sample of patients who use mood stabilising medicines for bipolar disorder. A further aim was to compare the Swedish translation of the MARS-5 with the Swedish translation of the four-item scale Morisky Medication Adherence Scale (MMAS-4). Method: The study population (n=47, 70% women) was recruited through patient education sessions, at a Patient Association meeting, in Gothenburg, Sweden, as well as through advertisements on the home pages and newsletters of the Swedish patient associations. Participants received the Swedish translations of the MARS-5 and the MMAS-4, and questions on age, education, and country of birth. Reliability was examined for internal consistency (Cronbach’s α) and test-retest (intraclass correlation (ICC), MARS-5: Pearson’s correlation coefficient (r), MMAS-4: Spearman’s rho (ρ)). The acceptability of the MARS-5 was examined with a correlation analysis between the MARS-5 and the MMAS-4 and for face validity. Results: In the study population 53.3% were categorised as adherent with the MARS-5 and 82.6% using the MMAS-4. The value of Cronbach’s α was 0.66 for the MARS-5 and 0.37 for the MMAS-4. The test-retest of the MARS-5 resulted in r=0.90 and ICC=0.91. Corresponding values for the MMAS-4 were ρ=0.84 and ICC=0.85. The correlation between the MARS-5 and the MMAS-4 was 0.55. The face validity resulted in four comments regarding difficulties in answering the MARS-5. Conclusion: The Swedish translation of the MARS-5 ought to be used instead of the MMAS-4 to measure self-reported adherence in a Swedish sample with bipolar disorder. The MARS-5 showed good psychometric properties.
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| 10. |
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| 11. |
- Ekström, Nils, et al.
(författare)
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Glucose-lowering treatment and clinical results in 163 121 patients with type 2 diabetes: an observational study from the Swedish national diabetes register
- 2012
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Ingår i: Diabetes Obesity & Metabolism. - : Wiley. - 1462-8902 .- 1463-1326. ; 14:8, s. 717-726
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To analyse clinical characteristics and treatment results in unselected type 2 diabetes mellitus (T2DM) patients, with non-pharmacological treatment as well as the most commonly used pharmacological glucose-lowering treatment regimens, in everyday clinical practice. Methods: In this population-based cross-sectional study, information was linked from the Swedish National Diabetes Register, Prescribed Drug Register and Patient Register. T2DM patients with non-pharmacological treatment and T2DM patients continuously using the 12 most common pharmacological treatment regimens were included in the study (n = 163121). Results: There were statistically significant differences in clinical characteristics between the groups. Patients with insulin-based treatment regimens had the longest duration of diabetes and more cardiovascular risk factors than the T2DM-population in general. The proportion of patients reaching HbA1c =7% varied between 70.1% (metformin) and 25.0% [premixed insulin (PMI) + SU) in patients with pharmacological treatment. 84.8% of the patients with non-pharmacological treatment reached target. Compared to patients on metformin, patients on other pharmacological treatments had a lower likelihood, with hazard ratios ranging from 0.58; 95% confidence interval (CI), 0.540.63 to 0.97;0.940.99, of having HbA1c =7% (adjusted for covariates). Patients on insulin-based treatments had the lowest likelihood, while non-pharmacological treatment was associated with an increased likelihood of having HbA1c =7%. Conclusion: This nation-wide study shows insufficiently reached treatment goals for haemoglobin A1c (HbA1c) in all treatment groups. Patients on insulin-based treatment regimens had the longest duration of diabetes, more cardiovascular risk factors and the highest proportions of patients not reaching HbA1c target.
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| 12. |
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| 13. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Cost of illness of patient-reported adverse drug events: a population-based cross-sectional survey.
- 2013
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 3:6
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Tidskriftsartikel (refereegranskat)abstract
- To estimate the cost of illness (COI) of individuals with self-reported adverse drug events (ADEs) from a societal perspective and to compare these estimates with the COI for individuals without ADE. Furthermore, to estimate the direct costs resulting from two ADE categories, adverse drug reactions (ADRs) and subtherapeutic effects of medication therapy (STE).
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| 14. |
- Hakkarainen, Katja M, et al.
(författare)
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Prevalence and perceived preventability of self-reported adverse drug events--a population-based survey of 7099 adults.
- 2013
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Ingår i: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 8:9
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Tidskriftsartikel (refereegranskat)abstract
- Adverse drug events (ADEs) are common and often preventable among inpatients, but self-reported ADEs have not been investigated in a representative sample of the general public. The objectives of this study were to estimate the 1-month prevalence of self-reported ADEs among the adult general public, and the perceived preventability of 2 ADE categories: adverse drug reactions (ADRs) and sub-therapeutic effects (STEs).
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| 15. |
- Hakkarainen, K M, et al.
(författare)
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Prevalence, nature and potential preventability of adverse drug events - A population-based medical record study of 4970 adults
- 2014
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Ingår i: British Journal of Clinical Pharmacology. - : Wiley-Blackwell. - 0306-5251 .- 1365-2125. ; 78:1, s. 170-183
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To estimate the 3-month prevalence of adverse drug events (ADEs), categories of ADEs, and preventable ADEs, and the preventability of ADEs among adults in Sweden. Further, to identify drug classes and organ systems associated with ADEs and estimate their seriousness.METHODS: A random sample of 5025 adults in Swedish county council in 2008 was drawn from the Total Population Register. All their medical records in 29 inpatient care departments in three hospitals, 110 specialised outpatient clinics, and 51 primary care units were reviewed retrospectively in a stepwise manner, and complemented with register data on dispensed drugs. ADEs, including adverse drug reactions (ADRs), sub-therapeutic effects of drug therapy (STEs), drug dependence and abuse, drug intoxications from overdose, and morbidities due to drug-related untreated indication, were detected during a 3-month study period, and assessed for preventability.RESULTS: Among included 4970 individuals, the prevalence of ADEs was 12.0% (95% confidence interval 11.1-12.9%), and preventable ADEs 5.6% (5.0-6.2%). ADRs (6.9%; 6.2-7.6%) and STEs (6.4%; 5.8-7.1%) were more prevalent than the other ADEs. Of the ADEs, 38.8% (35.8-41.9%) was preventable, varying by ADE category and seriousness. ADEs were frequently associated with nervous system and cardiovascular drugs, but the associated drugs and affected organs varied by ADE category.CONCLUSIONS: The considerable burden of ADEs and preventable ADEs from commonly used drugs across care settings warrants large-scale efforts to redesign safer, higher quality healthcare systems. The heterogeneous nature of the ADE categories should be considered in research and clinical practice for preventing, detecting and mitigating ADEs.
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| 16. |
- Hedenrud, Tove, 1967, et al.
(författare)
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Attitudes towards sales and use of over-the-counter drugs in Sweden in a reregulated pharmacy market: A population-based study
- 2019
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Ingår i: International Journal of Pharmacy Practice. - : Oxford University Press (OUP). - 0961-7671 .- 2042-7174. ; 27:1, s. 17-24
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Tidskriftsartikel (refereegranskat)abstract
- © 2018 Royal Pharmaceutical Society. Objectives: To analyse attitudes towards sales and use of over-the-counter (OTC) drugs in the Swedish adult population. Methods: Data were collected through the web-based Citizen Panel comprising 21 000 Swedes. A stratified sample of 4058 participants was emailed a survey invitation. Questions concerned use of OTC drugs, and attitudes towards sales and use of OTC drugs. Correlations between the attitudinal statements were assessed using Spearman's rank correlation. Associations between attitudes and participant characteristics were analysed using multinomial logistic regression. Key findings: Participation rate was 64%. Altogether 87% reported use of OTC drugs in the last 6 months. Approximately 10% of participants stated that they used OTC drugs at the first sign of illness, and 9% stated that they used more OTC drugs compared with previously, due to increased availability. The statement on use of OTC drugs at first sign of illness correlated with the statement about using more OTC drugs with increased availability. Socio-demographic factors (age, sex and education) and frequent use of OTC drugs were associated with attitudes to sales and use of OTC drugs. Conclusions: Increased use due to greater availability, in combination with OTC drug use at first sign of illness illustrates the need for continuous education of the population about self-care with OTC drugs. Increased awareness of the incautious views on OTC drugs in part of the population is important. Swedish policy-makers may use such knowledge in their continuous evaluation of the 2009 pharmacy reform to review the impact of sales of OTC drugs in retail outlets on patient safety and public health. Pharmacy and healthcare staff could be more proactive in asking customers and patients about their use of OTC drugs and offering them advice.
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| 17. |
- Hero, Christel, et al.
(författare)
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Adherence to lipid-lowering therapy and risk for cardiovascular disease and death in type 1 diabetes mellitus: A population-based study from the Swedish National Diabetes Register
- 2020
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Ingår i: BMJ Open Diabetes Research and Care. - : BMJ. - 2052-4897. ; 8:1
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis Dyslipidemia is an important modifiable risk factor and lipid-lowering treatment (LLT) is essential to reduce the risk of cardiovascular disease (CVD). Studies in type 2 diabetes indicate that low adherence to statin therapy is a barrier to reach full protective potential, and less is known in type 1 diabetes (T1D). The aim was to assessrisk of CVD by adherence and nonpersistence to LLT in T1D. Method A population-based study with a retrospective longitudinal design was conducted between 2006 and 2010, with follow-up until December 2013. In total, 6192 adult individuals withT1D, initiatingLLTbetween 2006 and 2010, were included.Information on LLT, socioeconomic characteristics, comorbidities and cardiovascular eventswere collected. After 18 months, refill adherence was estimated by calculating medication possession ratio (MPR). Nonpersistence was defined as being without medicines on hand for at least 180 days. Individuals were thereafterfollowed untilCVD, deathorend of follow-up in December 2013. Cox regression analyses were performed to assess adherence level and nonpersistence of LLT as predictor ofCVD. Analyses wereadjusted for cardiovascular risk factors andsocioeconomic status. Results Mean MPRwas 72%, 52% of the participants had an MPR above 80% and 27% discontinued LLT. There were 637nonfataland58 fatal CVDevents, mean follow-up 3.6 and 3.9 years, respectively. MPR above 80% was associated with reduced risk for nonfatal CVD compared with lower MPR, HR 0.78 (95% CI 0.65 to 0.93)). For fatal CVD, results indicated a negative effect of high adherence but the association did not reach statistical significance, HR 1.96 (0.96 to 4.01). Individuals discontinuing LLT had higher risk of nonfatal CVD, HR 1.43 (95% CI 1.18 to 1.73). Conclusions/Interpretation In T1D, the risk for nonfatal CVD was lower among individuals with high adherence and higher among those discontinuing LLT within 18 months. It is important to evaluate andemphasize adherence toprescribedLLTat clinical visits to achieve treatment goals and reduce the risk of CVD. © Author(s) (or their employer(s)) 2020.
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| 18. |
- Hero, Christel, et al.
(författare)
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Impact of Socioeconomic Factors and Gender on Refill Adherence and Persistence to Lipid-Lowering Therapy in Type 1 Diabetes
- 2021
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Ingår i: Diabetes Therapy. - : Springer Science and Business Media LLC. - 1869-6953 .- 1869-6961. ; 12:9, s. 2371-2386
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Lipid-lowering therapy (LLT) reduces the risk of cardiovascular disease (CVD) in patients with type 1 diabetes (T1D). However, socioeconomic factors and gender may have an impact on the adherence to and non-persistence with LLT. Methods This was a nationwide register-based cohort study that included 6192 individuals with T1D aged >= 18 years who were registered in the Swedish National Diabetes Register and had initiated novel use of LLT. Information on socioeconomic parameters (source: Statistics Sweden) and comorbidity (source: National Patient Register) was collected. The individuals were followed for 36 months, and adherence to LLT was analyzed according to age, socioeconomics and gender. The medication possession ratio (MPR; categorized into <= 80% and > 80%) and non-persistence (discontinuation) with medication was calculated after 18 and 36 months. Results Individuals older than 53 years were more adherent to LLT (MPR > 80%) than those younger than 36 years (odds ratio [(OR] 1.30, p < 0.0001) at 36 months. Women were more adherent and less prone to discontinue LLT at 18 months (OR 1.05, p = 0.0005 and OR 0.95, p = 0.0004, respectively), but not at 36 months. Divorced individuals were less adherent than married ones (OR 0.93, p = 0.0005) and discontinued LLT more often than the latter (OR 1.06, p = 0.003). Education had no impact on adherence, but individuals with higher incomes discontinued LLT less frequently than those with lower incomes. Individuals with a country of origin other than Sweden discontinued LLT more often. Conclusion Lower adherence to LLT in individuals with T1D was associated with male gender, younger age, marital status and country of birth. These factors should be considered when evaluating adherence to LLT in clinical practice, with the aim to help patients achieve full cardioprotective treatment.
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| 19. |
- Håkonsen, Helle, 1980, et al.
(författare)
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Consumer preferences for over-the-counter drug retailers in the reregulated Swedish pharmacy market
- 2016
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Ingår i: Health Policy. - : Elsevier BV. - 0168-8510. ; 120:3, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Following a large regulatory reform in 2009, which ended the state's pharmacy monopoly, non-pharmacy retailers in Sweden today sell certain over-the-counter (OTC) drugs. The aim of this study was to investigate consumer preferences regarding OTC drug retailers and the reasons for choosing a pharmacy versus non-pharmacy retailer. We conducted a web survey aimed at Swedish adults. Out of a stratified sample of 4058 persons, 2594 agreed to take part (48% women; mean age: 50.3 years). Questions related to OTC drug use, retailer choice and factors affecting the participants' preferences for OTC drug retailers. Logistic regression was conducted to analyse OTC drug use and reasons for retailer choice in relation to sex, age and education. Nine in ten participants reported OTC drug use in the 6 months prior to the study. For their last OTC purchase, 76% had gone to a pharmacy, 20% to a grocery shop and 4% to a convenience store, gas station or online. Geographic proximity, opening hours and product range were reported as the most important factors in retailer choice. Counselling by trained staff was important to 57% of participants. The end of the state's pharmacy monopoly and the increase in number of pharmacies seem to have impacted more on Swedish consumers' purchase behaviours compared with the deregulation of OTC drug sales.
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| 20. |
- Håkonsen, Helle, 1980, et al.
(författare)
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Pharmaceutical Pricing Policies in Norway and Sweden
- 2015
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Ingår i: Pharmaceutical Prices in the 21st Century. - Switzerland : Springer International Publishing. - 9783319121680 ; , s. 209-227
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 21. |
- Imai, Shinobu, et al.
(författare)
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Comparison of pharmaceutical policies to stimulate use of generics in Japan and Sweden
- 2016
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Ingår i: Health Policy and Technology. - : Elsevier BV. - 2211-8837. ; 5:2, s. 189-195
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Among OECD countries, the proportion of total expenditure on health spent on pharmaceuticals is highest in Japan, 20%. In Sweden, the corresponding proportion is 13%. Swedish pharmaceutical expenditures increased dramatically in the 1990s and policy changes were introduced to curb this. Both countries have introduced policy changes to increase cost containment. This study aims to compare the pharmaceutical policies regarding generic medicines in Japan and Sweden. Methods: Information on pharmaceutical policies was collected. We compared pharmaceutical policies according to the 4E (Education, Engineering, Economics, and Enforcement) component framework developed to describe the differences in policies. Results and conclusions: In Sweden, there were several organizational and managerial interventions within the Engineering class. Japan had several positive incentives for health care actors in the Economics category. The Enforcement category had a stronger legal component in Sweden compared to Japan. The Swedish policies were mainly directed towards prescribing and dispensing whereas the Japanese addressed several stakeholders to promote use of generic drugs. The countries were similar with respect to the Education category. Within the Enforcement component the Swedish policies were legally enforced whereas the Japanese to large extent were recommendations. (C) 2016 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.
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| 22. |
- Jönsson, Anna K, et al.
(författare)
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Influence of refill adherence method when comparing level of adherence for different dosing regimens
- 2014
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Ingår i: European Journal of Clinical Pharmacology. - : Springer Science and Business Media LLC. - 0031-6970 .- 1432-1041. ; 70:5, s. 589-597
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Tidskriftsartikel (refereegranskat)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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| 23. |
- Karlsson, Sofia A., et al.
(författare)
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Association between refill adherence to lipid-lowering medications and the risk of cardiovascular disease and mortality in Swedish patients with type 2 diabetes mellitus: a nationwide cohort study.
- 2018
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 8:3
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Tidskriftsartikel (refereegranskat)abstract
- To analyse the association between refill adherence to lipid-lowering medications, and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes mellitus.Cohort study.National population-based cohort of Swedish patients with type 2 diabetes mellitus.86568 patients aged ≥18 years, registered with type 2 diabetes mellitus in the Swedish National Diabetes Register, who filled at least one prescription for lipid-lowering medication use during 2007-2010, 87% for primary prevention.Refill adherence of implementation was assessed using the medication possession ratio (MPR), representing the proportion of days with medications on hand during an 18-month exposure period. MPR was categorised by five levels (≤20%, 21%-40%, 41%-60%, 61%-80% and >80%). Patients without medications on hand for ≥180 days were defined as non-persistent. Risk of CVD (myocardial infarction, ischaemic heart disease, stroke and unstable angina) and mortality by level of MPR and persistence was analysed after the exposure period using Cox proportional hazards regression and Kaplan-Meier, adjusted for demographics, socioeconomic status, concurrent medications and clinical characteristics.The hazard ratios for CVD ranged 1.33-2.36 in primary prevention patients and 1.19-1.58 in secondary prevention patients, for those with MPR ≤80% (p<0.0001). The mortality risk was similar regardless of MPR level. The CVD risk was 74% higher in primary prevention patients and 33% higher in secondary prevention patients, for those who were non-persistent (p<0.0001). The mortality risk was 6% higher in primary prevention patients and 18% higher in secondary prevention patients, for non-persistent patients (p<0.0001).Higher refill adherence to lipid-lowering medications was associated with lower risk of CVD in primary and secondary prevention patients with type 2 diabetes mellitus.
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| 24. |
- Karlsson, Sofia A., et al.
(författare)
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Prescription of lipid-lowering medications for patients with type 2 diabetes mellitus and risk-associated LDL cholesterol: a nationwide study of guideline adherence from the Swedish National Diabetes Register.
- 2018
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Management of type 2 diabetes mellitus (T2DM) encompasses intensive glycaemic control, along with treatment of comorbidities and complications to handle the increased risk of cardiovascular disease (CVD). Improved control of LDL-cholesterol (LDL-C) with lipid-lowering medications is associated with reduced CVD risk in T2DM patients. Thus, treatment guidelines recommend lipid-lowering medications for T2DM patients with LDL-C above risk-associated thresholds. This study aimed to assess healthcare provider adherence to guidelines regarding lipid-lowering medication prescription among T2DM patients and to analyse factors associated with lipid-lowering medication prescription.Observations in 2007-2014 for T2DM patients age≥18 were collected from the Swedish National Diabetes Register. Observations were excluded if they lacked information about LDL-C, lipid-lowering medication prescription or CVD. Observations with established CVD were attributed to secondary prevention; remaining observations were attributed to primary prevention. The analyses included primary and secondary prevention observations with LDL-C above risk-associated thresholds (LDL-C≥2.5mmol/l and LDL-C≥1.8mmol/l respectively). Guideline adherence was analysed as the probability of prescribing lipid-lowering medications using mixed-effect model regression adjusted for potential confounders. Factors associated with prescribing lipid-lowering medications were analysed for patient and healthcare provider characteristics using mixed-effect model regression and odds ratio.A total of 1,204,376 observations from 322,046 patients reported by 1352 healthcare providers were included. Primary prevention accounted for 63%; 52% were men, mean age was 64 and mean LDL-C was 3.4mmol/l. For secondary prevention, 60% were men, mean age was 72 and mean LDL-C was 2.7mmol/l. During 2007-2014, guideline adherence ranged from 36 to 47% for primary prevention and 59 to 69% for secondary prevention. In general, concomitant prescription of diabetes medications, antiplatelets and antihypertensives along with smoking and specialised care were associated with higher prescription of lipid-lowering medications. Patients age≥80 were associated with lower prescription of lipid-lowering medications. Higher prescription was associated with longer diabetes duration in primary prevention and men in secondary prevention.Adherence to treatment guidelines levelled off after an initial increase in both prevention groups. Lipid-lowering medication prescription was based on individualised CVD risk.
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| 25. |
- Karlsson, Sofia A., et al.
(författare)
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Refill adherence and persistence to lipid-lowering medicines in patients with type 2 diabetes: A nation-wide register-based study.
- 2017
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Ingår i: Pharmacoepidemiology and drug safety. - : Wiley. - 1099-1557 .- 1053-8569. ; 26:10, s. 1220-1232
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to describe and compare refill adherence and persistence to lipid-lowering medicines in patients with type 2 diabetes by previous cardiovascular disease (CVD).We followed 97595 patients (58% men; 23% with previous CVD) who were 18years of age or older when initiating lipid-lowering medicines in 2007-2010 until first fill of multi-dose dispensed medicines, death, or 3years. Using personal identity numbers, we linked individuals' data from the Swedish Prescribed Drug Register, the Swedish National Diabetes Register, the National Patient Register, the Cause of Death Register, and the Longitudinal Integration Database for Health Insurance and Labour Market Studies. We assessed refill adherence using the medication possession ratio (MPR) and the maximum gap method, and measured persistence from initiation to discontinuation of treatment or until 3years after initiation. We analyzed differences in refill adherence and persistence by previous CVD in multiple regression models, adjusted for socioeconomic status, concurrent medicines, and clinical characteristics.The mean age of the study population was 64years, 80% were born in Sweden, and 56% filled prescriptions for diabetes medicines. Mean MPR was 71%, 39% were adherent according to the maximum gap method, and mean persistence was 758days. Patients with previous CVD showed higher MPR (3%) and lower risk for discontinuing treatment (12%) compared with patients without previous CVD (P<0.0001).Patients with previous CVD were more likely to be adherent to treatment and had lower risk for discontinuation compared with patients without previous CVD.
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