The Author(s) 2014. This article is published with open access at Springerlink.com Background Med... more The Author(s) 2014. This article is published with open access at Springerlink.com Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the doc-ument ‘‘Indicators of appropriate drug therapy in the elderly’ ’ as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indi-cators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged C65 years
Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medfor direkta och indirek... more Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medfor direkta och indirekta kostnader for samhallet pa kort och lang sikt. Denna halsoekonomiska studie ar en berakning av sa ...
Oversikten ar en sammanfattning av atta rapporter om barn som anhoriga i Sverige. Rapporterna har... more Oversikten ar en sammanfattning av atta rapporter om barn som anhoriga i Sverige. Rapporterna har gjorts inom ramen for ett regeringsuppdrag om ett brett nationellt utvecklingsarbete dar Socialstyr ...
Socialstyrelsen har under 2014 tagit fram en webbutbildning for att forbattra AT-lakares kompeten... more Socialstyrelsen har under 2014 tagit fram en webbutbildning for att forbattra AT-lakares kompetens inom omradet lakemedelsbehandling av aldre. I juni 2014 uppdrog Socialstyrelsen at eHalsoinstitute ...
A web site including e-learning modules with informative films was used to distribute information... more A web site including e-learning modules with informative films was used to distribute information in the field of drug utilization. The modules were adapted for the use of the elderly. Data were collected using questionnaires; the General Beliefs about Medicines Questionnaire (BMQ) were used as well as a questionnaire concerning the content in the e-learning modules (knowledge questions). The participants were asked to fill in and return the questionnaires within two weeks after agreeing to participate in the study.
This study explores the attitudes of elderly people to the use of electronic educational technolo... more This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.
Journal of Pharmaceutical Health Services Research, 2010
ABSTRACT Objectives To assess the prevalence and the therapeutic intensity of dispensed drug grou... more ABSTRACT Objectives To assess the prevalence and the therapeutic intensity of dispensed drug groups for individuals receiving multiple medications.Methods The individual-based data of all dispensed outpatient prescriptions in Sweden in 2006 were analysed. Five or more dispensed drugs (DP ≥ 5) during a 12-month period were applied as an indicator of multiple medications. The drugs were categorized according to the second level of the World Health Organization's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the therapeutic intensity.Key findings For the 2.2 million individuals with DP ≥ 5, the drug groups with the highest prevalences were antibacterials (48.2%), analgesics (40.3%), psycholeptics (35.9%), antithrombotic agents (33.4%) and beta-blocking agents (31.7%). As examples, the level of prevalence increased with age for analgesics, psycholeptics, antithrombotic agents and diuretics, and decreased with age for antibacterials, drugs for obstructive airway diseases and antihistamines for systemic use. Substantial differences in the level of prevalence between women and men were observed for several drug groups; for example, thyroid therapy (13.3 vs 3.6%), psychoanaleptics (26.3 vs 18.2%), drugs used in diabetes (9.1 vs 15.7%) and lipid-modifying agents (18.1 vs 30.7%). Generally, the therapeutic intensity increased with the increasing number of dispensed drugs. For a third of the most common drug groups, the therapeutic intensity increased with an increasing age above the 60–69-year age group.Conclusion The number of drugs taken not only increases the potential risks associated with multiple drug use, but also increases the potential burden of an increased therapeutic intensity, especially for older people. The reported findings may enlighten physicians and healthcare stakeholders concerning the complex patterns of multiple drug use in the entire population and the associated expenses. The findings may also be used as a base for interventions aiming to bring about the most appropriate and balanced prescription of medicines to individuals with multiple diseases.
To estimate non-adherence in relation to the therapeutic intensity (TI) and the number of dispens... more To estimate non-adherence in relation to the therapeutic intensity (TI) and the number of dispensed drugs per individual and study whether the TI can be used as an estimator of non-adherence with an increasing number of drugs. The study comprised an individual-based register of all dispensed outpatient prescriptions in Sweden in 2006, including 6.2 million individuals. The applied definition of drug was the chemical entity or substance comprising the fifth level in the World Health Organisation's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the TI. We found a positive linear relation between the TI and the increasing number of dispensed drugs per individual, both for men and women. We found a slightly diminishing TI with an increasing number of drugs only for the age groups above 70 years, at a level above 13 drugs per individual. The linear relationship between the TI and the increasing number of dispensed drugs per individual provides poor support for using decreasing TI as an estimator of non-adherence. The low rate of cost-related non-adherence in Sweden might contribute to explaining the linear relationship.
To assess polypharmacy in a population with emphasis on regions. We studied the individual-based ... more To assess polypharmacy in a population with emphasis on regions. We studied the individual-based data of all dispensed prescription drugs (DP) during a 3-month study period in Sweden 2006. As an indicator of polypharmacy, five or more (DP > or = 5) different drugs (substances) dispensed were applied. For analysis, we used comparisons of prevalence, correlation of prevalence of polypharmacy with different socioeconomic variables, and a novel weighted polypharmacy index. The national prevalence of polypharmacy, DP > or = 5, was 10.5% (inter-regional variation 9.1-12.1%). The regional variation in the prevalence of polypharmacy was largest for the age groups > or =90 (45.6-59.1%), 80-89 (46.1-53.4%) and 70-79 years (33.1-38.0%). The national prevalence of excessive polypharmacy, DP > or = 10, was 2.2% (inter-regional variation 1.9-2.6%). The regional variation in prevalence of excessive polypharmacy was largest for the age groups > or =90 (9.8-22.3%), 80-89 (11.4-17.1%) and 70-79 years (7.0-9.4%). We found a fairly strong positive correlation between polypharmacy and the age group > or =70 years (r = 0.84 for men and 0.71 for women). The novel weighted polypharmacy index indicated regional differences in the internal distribution of the prevalence of dispensed drugs for individuals with polypharmacy. Our findings indicate that the observed regional differences in the prevalence of polypharmacy partly can be explained by the regional age distribution in Sweden. The use of the novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy.
World military expenditure is currently believed to exceed $500 billion annually. Tens of million... more World military expenditure is currently believed to exceed $500 billion annually. Tens of millions of people — according to some estimates 50-60 million — around the world are directly or indirectly dependent on the military sector. What would, in this situation, the economic consequences of global disarmament be? And how could less developed countries become the main beneficiaries of possible savings? These are the key quesions in a research project under the auspices of the United Nations which this article seeks to illuminate. A number of contributions to the project conclude that it is not economic conversion problems which block disarmament. How large an addition disarmament might contribute to international economic aid depends on how sizable the military expenditure reduction would be and what proportion of the savings were allocated to economic aid. In some of the reviewed alternatives, the addition would be highly marginal, while in other hypothetical scenarios it would gro...
The Author(s) 2014. This article is published with open access at Springerlink.com Background Med... more The Author(s) 2014. This article is published with open access at Springerlink.com Background Medication for elderly patients is often complex and problematic. Several criteria for classifying inappropriate prescribing exist. In 2010, the Swedish National Board of Health and Welfare published the doc-ument ‘‘Indicators of appropriate drug therapy in the elderly’ ’ as a guideline for improving prescribing for the elderly. Objective The aim of this study was to assess trends in the prescription of inappropriate drug therapy in the elderly in Sweden from 2006 to 2013 using national quality indi-cators for drug treatment. Methods Individual-based data on dispensed prescription drugs for the entire Swedish population aged C65 years
Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medfor direkta och indirek... more Att barn och unga lever i hem med missbruk och/eller allvarlig sjukdom medfor direkta och indirekta kostnader for samhallet pa kort och lang sikt. Denna halsoekonomiska studie ar en berakning av sa ...
Oversikten ar en sammanfattning av atta rapporter om barn som anhoriga i Sverige. Rapporterna har... more Oversikten ar en sammanfattning av atta rapporter om barn som anhoriga i Sverige. Rapporterna har gjorts inom ramen for ett regeringsuppdrag om ett brett nationellt utvecklingsarbete dar Socialstyr ...
Socialstyrelsen har under 2014 tagit fram en webbutbildning for att forbattra AT-lakares kompeten... more Socialstyrelsen har under 2014 tagit fram en webbutbildning for att forbattra AT-lakares kompetens inom omradet lakemedelsbehandling av aldre. I juni 2014 uppdrog Socialstyrelsen at eHalsoinstitute ...
A web site including e-learning modules with informative films was used to distribute information... more A web site including e-learning modules with informative films was used to distribute information in the field of drug utilization. The modules were adapted for the use of the elderly. Data were collected using questionnaires; the General Beliefs about Medicines Questionnaire (BMQ) were used as well as a questionnaire concerning the content in the e-learning modules (knowledge questions). The participants were asked to fill in and return the questionnaires within two weeks after agreeing to participate in the study.
This study explores the attitudes of elderly people to the use of electronic educational technolo... more This study explores the attitudes of elderly people to the use of electronic educational technology (e-learning) on drug utilization, with particular emphasis on the layout, usability, content, and level of knowledge in the tool. e-Learning modules were evaluated by a group of elderly people (aged ⩾65 years, n = 16) via a questionnaire comprising closed and open-ended questions. Both qualitative and quantitative analyses of the responses showed mostly positive reviews. The results indicate that the e-learning modules are a suitable tool for distributing information and education and that they can be managed by elderly individuals who are familiar with computers, allowing them to learn more about medication use.
Journal of Pharmaceutical Health Services Research, 2010
ABSTRACT Objectives To assess the prevalence and the therapeutic intensity of dispensed drug grou... more ABSTRACT Objectives To assess the prevalence and the therapeutic intensity of dispensed drug groups for individuals receiving multiple medications.Methods The individual-based data of all dispensed outpatient prescriptions in Sweden in 2006 were analysed. Five or more dispensed drugs (DP ≥ 5) during a 12-month period were applied as an indicator of multiple medications. The drugs were categorized according to the second level of the World Health Organization's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the therapeutic intensity.Key findings For the 2.2 million individuals with DP ≥ 5, the drug groups with the highest prevalences were antibacterials (48.2%), analgesics (40.3%), psycholeptics (35.9%), antithrombotic agents (33.4%) and beta-blocking agents (31.7%). As examples, the level of prevalence increased with age for analgesics, psycholeptics, antithrombotic agents and diuretics, and decreased with age for antibacterials, drugs for obstructive airway diseases and antihistamines for systemic use. Substantial differences in the level of prevalence between women and men were observed for several drug groups; for example, thyroid therapy (13.3 vs 3.6%), psychoanaleptics (26.3 vs 18.2%), drugs used in diabetes (9.1 vs 15.7%) and lipid-modifying agents (18.1 vs 30.7%). Generally, the therapeutic intensity increased with the increasing number of dispensed drugs. For a third of the most common drug groups, the therapeutic intensity increased with an increasing age above the 60–69-year age group.Conclusion The number of drugs taken not only increases the potential risks associated with multiple drug use, but also increases the potential burden of an increased therapeutic intensity, especially for older people. The reported findings may enlighten physicians and healthcare stakeholders concerning the complex patterns of multiple drug use in the entire population and the associated expenses. The findings may also be used as a base for interventions aiming to bring about the most appropriate and balanced prescription of medicines to individuals with multiple diseases.
To estimate non-adherence in relation to the therapeutic intensity (TI) and the number of dispens... more To estimate non-adherence in relation to the therapeutic intensity (TI) and the number of dispensed drugs per individual and study whether the TI can be used as an estimator of non-adherence with an increasing number of drugs. The study comprised an individual-based register of all dispensed outpatient prescriptions in Sweden in 2006, including 6.2 million individuals. The applied definition of drug was the chemical entity or substance comprising the fifth level in the World Health Organisation's Anatomic, Therapeutic, Chemical classification. The defined daily dosage per individual during 12 months was applied as an indicator of the TI. We found a positive linear relation between the TI and the increasing number of dispensed drugs per individual, both for men and women. We found a slightly diminishing TI with an increasing number of drugs only for the age groups above 70 years, at a level above 13 drugs per individual. The linear relationship between the TI and the increasing number of dispensed drugs per individual provides poor support for using decreasing TI as an estimator of non-adherence. The low rate of cost-related non-adherence in Sweden might contribute to explaining the linear relationship.
To assess polypharmacy in a population with emphasis on regions. We studied the individual-based ... more To assess polypharmacy in a population with emphasis on regions. We studied the individual-based data of all dispensed prescription drugs (DP) during a 3-month study period in Sweden 2006. As an indicator of polypharmacy, five or more (DP > or = 5) different drugs (substances) dispensed were applied. For analysis, we used comparisons of prevalence, correlation of prevalence of polypharmacy with different socioeconomic variables, and a novel weighted polypharmacy index. The national prevalence of polypharmacy, DP > or = 5, was 10.5% (inter-regional variation 9.1-12.1%). The regional variation in the prevalence of polypharmacy was largest for the age groups > or =90 (45.6-59.1%), 80-89 (46.1-53.4%) and 70-79 years (33.1-38.0%). The national prevalence of excessive polypharmacy, DP > or = 10, was 2.2% (inter-regional variation 1.9-2.6%). The regional variation in prevalence of excessive polypharmacy was largest for the age groups > or =90 (9.8-22.3%), 80-89 (11.4-17.1%) and 70-79 years (7.0-9.4%). We found a fairly strong positive correlation between polypharmacy and the age group > or =70 years (r = 0.84 for men and 0.71 for women). The novel weighted polypharmacy index indicated regional differences in the internal distribution of the prevalence of dispensed drugs for individuals with polypharmacy. Our findings indicate that the observed regional differences in the prevalence of polypharmacy partly can be explained by the regional age distribution in Sweden. The use of the novel weighted polypharmacy index indicated regional differences in drug therapy for individuals with polypharmacy.
World military expenditure is currently believed to exceed $500 billion annually. Tens of million... more World military expenditure is currently believed to exceed $500 billion annually. Tens of millions of people — according to some estimates 50-60 million — around the world are directly or indirectly dependent on the military sector. What would, in this situation, the economic consequences of global disarmament be? And how could less developed countries become the main beneficiaries of possible savings? These are the key quesions in a research project under the auspices of the United Nations which this article seeks to illuminate. A number of contributions to the project conclude that it is not economic conversion problems which block disarmament. How large an addition disarmament might contribute to international economic aid depends on how sizable the military expenditure reduction would be and what proportion of the savings were allocated to economic aid. In some of the reviewed alternatives, the addition would be highly marginal, while in other hypothetical scenarios it would gro...
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