Psychotropic drug use among Icelandic children: a nationwide population-based study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVE: The aim of this study was to investigate psychotropic drug use among children in Iceland between 2003 and 2007. METHODS: A nationwide population-based drug use study covering the total pediatric population (ages 0-17) in Iceland. Information was obtained from the National Medicines Registry to calculate prevalence of use by year and psychotropic drug group; incidence by year, psychotropic drug group, child's age and sex, and medical specialty of prescriber; the most commonly used psychotropic chemical substances, off-label and unlicensed use and concomitant psychotropic drug use. RESULTS: The overall prevalence of psychotropic drug use was 48.7 per 1000 Icelandic children in 2007. Stimulants and antidepressants increased in prevalence from 2003 to 2007 and were the two most prevalent psychotropic drug groups, respectively, 28.4 and 23.4 per 1000 children in 2007. A statistically significant trend of declining prevalence (p = 0.00013) and incidence (p = 0.0018) of antidepressant use occurred during the study period. Out of 21,986 psychotropic drugs dispensed in 2007, 25.4% were used off-label. CONCLUSIONS: With reference to reports from other European countries, the results indicate extensive psychotropic drug use among children in Iceland between 2003 and 2007. Further scrutiny is needed to assess the rationale behind this widespread use

SENATOR: a novel software approach to prescribing optimisation in older people with multimorbidity

Background: The challenges of prescribing optimisation in the growing population of multi-morbid older people with complex polypharmacy are considerable. Since most people who prescribe medication for multi-morbid older patients do not have specific training or expertise in medication optimisation or complex polypharmacy, there is a need for a novel, systematic and reliable solution to address this challenge. Methods: In 2012, the SENATOR consortium (www.senator-project.eu) was funded under the EU’s FP7 programme to design and test by clinical trial a software engine specifically designed for drug/nondrug treatment optimisation in older people with multi-morbidity and associated complex polypharmacy. In partnership with a healthcare software SME , the SENATOR consortium has developed a software engine for this purpose. The consortium has also embarked on a randomised clinical trial (RCT) comparing the effects of SENATOR softwareguided prescribing optimisation in older multi-morbid patients hospitalised with acute illness with standard pharmaceutical care in 6 European centres, randomised into two groups of approximately 900 patients each. Outcome measures: The primary outcome measure is the proportion of patients experiencing one or more non-trivial ADR’s during their index hospitalisation. Other outcome measures include medication appropriateness, all-cause in-patient mortality, cost of composite healthcare utilization and quality of life at 12 weeks follow-up. The SENATOR RCT will be completed in 2017. Conclusions: The SENATOR software tool is designed to curtail polypharmacy, inappropriate prescribing and prevent non-trivial adverse drug reactions/events. The SENATOR RCT will determine its efficacy in acutely ill older multi-morbid patients cared for by clinicians other than geriatricians

A Qualitative Analysis of the Culture of Antibiotic Use for Upper Respiratory Tract Infections Among Patients in Northwest Russia

Introduction: Due to the globally persistent threat of Antimicrobial Resistance (AMR), the purpose of this study was to gain an in-depth understanding of the antibiotic (AB) practices, knowledge and attitudes among patients residing in five regions in the northwest part of Russia. Given the high prevalence, this study focused on ABs for Upper Respiratory Tract Infections (URTI).Methods: The qualitative, semi-structured interviews followed a guide organized by major themes such as common symptoms, consultations with doctors and external influences in decision-making. Patient participants were recruited via convenience sampling. Fifty-five interviews were conducted among patients using ABs for URTIs purchased with or without prescription. Data was analyzed using a direct content analysis and validation rounds were conducted between interviewers and data analyzers.Results: Self-medication with ABs seemed a common practice across all five Russian regions; in some cases, patients tried to persuade pharmacists into selling them ABs without prescription. Factors, such as time spent going to the doctor, need of a sick leave or self-persuasion, influenced the decisions of whether or not to seek the doctor for symptoms of URTIs. Knowledge of ABs and AMR was generally low; however, some patients with seemingly good knowledge practiced self-medication from time to time. Family members and friends were often involved in decisions about how to handle symptoms of URTIs, especially among those patients using ABs without prescription. Few patients had noticed ABs awareness campaigns, and very few reported having learned something important from them.Conclusion: Despite enforced regulation of AB use in Russia, self-medication still exists. Knowledge is not always linked to appropriate use of AB, and the few campaigns conducted were not always noticed