Statistics on local drug sales: A tool to identify problem areas and to follow effects of education on drug use

Aims: 1) To assess if drug sales data indicate differences in morbidity, mortality, socio-economic conditions and deviating prescribing habits among physicians; 2) to identify areas for educational interventions and to analyse changes in prescribing after educational activities. In addition, an effort was made to estimate differences between pharmacy sales and purchases by the population, and the amount and value of unused drugs returned to pharmacies. Method: Information on drug sales was gathered from three Swedish and one Nordic drug registers, namely, Sales Statistics on Drugs, Nordic Statistics on Medicines, The National Prescription Survey and The Diagnosis-Prescription Survey, as well as from local prescription studies, copies of prescriptions processed at pharmacies, copies of issued prescriptions and computerised patient records at a health care centre. Results: There was a significant correlation between sales of tranquillizers and hypnotics/sedatives, on the one hand, and mortality, suicides and UnderPrivileged Area score, on the other, in the 33 municipalities of Skåne County. Benzodiazepine sales in the city of Helsingborg were the highest in the country and higher than the national average to all age groups and both genders. A minority of the physicians, <5%, had issued about 10 times as many benzodiazepine prescriptions as the average physician in Helsingborg. High compliance rates among district physicians after information by pharmacists, to brands recommended by the Drugs and Therapeutics Committee, attributed to cost savings several times the costs of the information campaign. Repeated verbal producer-independent education produced significant changes in attitudes towards drugs, drug treatment and drug information. Both this programme and a local educational programme at a health care centre resulted in an overall and sustained reduction in antibiotic prescribing. There was a substantial difference between sales at the local pharmacy and the purchases on prescription by the local population. Less than 4% of the purchased drugs were returned unused to pharmacies for destruction. Conclusion: There are large differences in sales of drugs between municipalities within the same county. The results show that local drug sales covariates with, and hence may indicate, socio-economic conditions, morbidity and mortality. This information may be used to identify areas where there is a need of information and education activities to promote rational prescribing. Local sales data are reasonably well suited to follow effects of such information and educational activities. However, local sales of drugs do not fully correspond to purchases and drug use by the local population, neither to prescribing by the local physicians. In order to identify target groups for information and education, there is a need for additional information, as deviant prescribing habits among a minority of doctors may be influential. Nevertheless, successively improved quality and accessibility of local sales data may provide a useful and cost-effective means to analyse and improve prescribing and use of drugs

Use of a generic protocol in documentation of prescription errors in Estonia, Norway and Sweden

Beskriver en studie hvor hensikten var å evaluere egnethet av et generisk instrument for å dokumentere forskrivningsproblemer som krever kontakt med lege før utlevering.Pharmacists have an important role in detecting, preventing, and solving prescription problems, which if left unresolved, may pose a risk of harming the patient. Objective: the objectives of this study were to evaluate the feasibility of a generic study instrument for documentation of prescription problems requiring contact with prescriber before dispensing. The study was organized: 1) by countries: Estonia, Norway and Sweden; 2) by type of prescriptions: handwritten prescriptions, printouts of prescriptions in the electronic medical record and electronically transmitted prescriptions to pharmacies; and 3) by recording method - self-completion by pharmacists and independent observers. Methods: observational study with independent observers at community pharmacies in Estonia (n=4) and Sweden (n=7) and self-completed protocols in Norway (n=9). Results: pharmacists' in Estonia contacted the prescriber for 1.47% of the prescriptions, about 3 times as often as in Norway (0.45%) and Sweden (0.38%). Handwritten prescriptions dominated among the problem prescriptions in Estonia (73.2%), printouts of prescriptions in the electronic medical record (89.1%) in Norway and electronically transmitted prescriptions to pharmacies (55.9%) in Sweden. More administrative errors were identified on handwritten prescriptions and printouts of prescriptions in the electronic medical record in Estonia and in Norway compared with electronically transmitted prescriptions to pharmacies in Sweden (p<0.05 for prescription types and p<0.01 for countries). However, clinically important errors and delivery problems appeared equally often on the different types of prescriptions. In all three countries, only few cases of drug interactions and adverse drug reactions were identified. Conclusion: despite the different patterns of prescription problems in three countries, the instrument was feasible and can be regarded appropriate to document and classify prescription problems necessitating contact with prescriber before dispensing, irrespective of the type of prescription or recording method

Probleemsed retseptid, mille alusel ravimi väljastamine apteegist nõuab konsultatsiooni ravimi ordineerijaga Eesti, Norra ja Rootsi võrdlusuuringu põhjal

Uuringu eesmärgiks oli võrrelda probleemsete retseptide esinemissagedust ja sisu Eestis, Norras ning Rootsis. Retsept on probleemne, kui proviisor peab enne ravimi väljastamist apteegist pöörduma ravimi ordineerija poole, samas saab apteeker paljud formaalsed probleemid lahendada iseseisvalt või koostöös patsiendiga. Vaatlusuuring toimus 2006.–2007. a ja selles osales 4 apteeki Eestist, 9 apteeki Norrast ja 6 apteeki Rootsist. Probleemseid retsepte esines enim Eestis, järgnesid Norra ja Rootsi. Formaalsed probleemid olid enim levinud Eestis, ravimi annuse, tugevuse ja ravimivormiga eksiti enam Eestis ja Rootsis. Rootsis oli 28,6%-l ja Norras 25,1%-l juhtudest probleemiks puudulik info ravimi annustamise ning manustamise kohta. Probleemsete retseptide suurem esinemine Eestis oli peamiselt seotud käsitsi kirjutatud retseptide suure osakaaluga. Elektrooniliste retseptide kasutuselevõtu korral võivad ilmneda aga uut tüüpi sisulised vead. Eesti Arst 2010; 89(1):5−1

Assessment of ePrescription quality: an observational study at three mail-order pharmacies

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>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.</p> <p>Conclusion</p> <p>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.</p

Decreasing incidence of peptic ulcer complications after the introduction of the proton pump inhibitors, a study of the Swedish population from 1974–2002

<p>Abstract</p> <p>Background</p> <p>Despite a decreasing incidence of peptic ulcer disease, most previous studies report a stabile incidence of ulcer complications. We wanted to investigate the incidence of peptic ulcer complications in Sweden before and after the introduction of the proton pump inhibitors (PPI) in 1988 and compare these data to the sales of non-steroid anti-inflammatory drugs (NSAID) and acetylsalicylic acid (ASA).</p> <p>Methods</p> <p>All cases of gastric and duodenal ulcer complications diagnosed in Sweden from 1974 to 2002 were identified using the National hospital discharge register. Information on sales of ASA/NSAID was obtained from the National prescription survey.</p> <p>Results</p> <p>When comparing the time-periods before and after 1988 we found a significantly lower incidence of peptic ulcer complications during the later period for both sexes (p < 0.001). Incidence rates varied from 1.5 to 7.8/100000 inhabitants/year regarding perforated peptic ulcers and from 5.2 to 40.2 regarding peptic ulcer bleeding. The number of sold daily dosages of prescribed NSAID/ASA tripled from 1975 to 2002. The number of prescribed sales to women was higher than to males. Sales of low-dose ASA also increased. The total volume of NSAID and ASA, i.e. over the counter sale and sold on prescription, increased by 28% during the same period.</p> <p>Conclusion</p> <p>When comparing the periods before and after the introduction of the proton pump inhibitors we found a significant decrease in the incidence of peptic ulcer complications in the Swedish population after 1988 when PPI were introduced on the market. The cause of this decrease is most likely multifactorial, including smoking habits, NSAID consumption, prevalence of Helicobacter pylori and the introduction of PPI. Sales of prescribed NSAID/ASA increased, especially in middle-aged and elderly women. This fact seems to have had little effect on the incidence of peptic ulcer complications.</p

Reasons why medicines are returned to Swedish pharmacies unused.

Objective: To identify the reasons and their relative importance why medicines are returned to Swedish pharmacies unused. Setting: A random sample of the pharmacies in Sweden. Method: Interviews using a semi-structered interview form with pharmacy customers returning unused medicines to the pharmacy. Main outcome measure: Reasons given by patients/relatives/carers for returning unused medicines to the pharmacy. Results: The four main reasons for returning unused medicines to the pharmacy were: (1) the medicines were too old, (2) the user had died, (3) there was no need for the medicine anymore, and (4) therapy changes. These reasons made up 75% of all reported reasons. Conclusion: Hoarding or over-supply of prescribed medicines may explain a large part of the volume of medicines that remain unused. Actions aiming to reduce waste of prescribed medicines ought to focus on those patients who contribute to a substantial part of all unused medicines

Occurrence of prescriptions for noncurrent - changed or terminated -treatment and prescription duplicates in electronic medical records and the Swedish national prescription repository

Patient adherence to prescribed treatment for chronic conditions has been estimated to be on average about 50% [1] and drug related problems may cause as much as 30% of acute admittances to hospital care [2]. Discrepancies between medical records and patients’ actual current medication are common [3-5].   The objective of the present study was to compare current prescribed treatment stated by patients with the printouts from the electronic medical record (EMR) and the Swedish national prescription repository (NPR) with regard to (1) prescriptions for noncurrent (previously changed or terminated) treatment, (2) prescription duplicates and (3) missing prescriptions.   Design: Cross-sectional study. Patients over 18 years of age with 5 or more prescriptions stored in the NPR or the EMR, with follow-up visit at a health care centre or visiting a pharmacy, were invited to the study. Patients giving written informed consent to participate were interviewed. The stated prescribed current, ongoing treatment was compared with printouts of prescribed medication from the EMR and of the stored prescriptions in the NPR.   Main Outcome Measures: Proportions of prescriptions for (a) noncurrent treatment (changed or terminated), (b) prescription duplicates and (c) missing prescriptions in the EMR and the NPR.   Results: 216 patients with altogether 2515 prescriptions were included. In total, 71% were unique prescriptions for current ongoing treatment, 17% were prescriptions for noncurrent treatment (changed or terminated therapy) and 11% were prescription duplicates. Of 2195 prescriptions in the EMR, 75% were unique prescriptions for current treatment, 13% were noncurrent, 11% were prescription duplicates and 8% of the current prescriptions were missing. Of 1904 prescriptions in the NPR, 75% were unique prescriptions for current ongoing medication, 13% were noncurrent prescriptions, 11% were prescription duplicates and 20% of the current prescriptions were missing. The EMR and the NPR contained ≥1 noncurrent prescription or duplicate for 76% and 69% of patients.   Conclusion: Prescriptions for noncurrent treatment and prescription duplicates as well as missing prescriptions are common in both EMR and the Swedish NPR. Consequently, claims data based on data of prescribed medicines in the EMR or the stored prescriptions in NPR contain many errors. Adherence estimates measured as “claims data” for prescriptions in the EMR and NPR may deviate significantly from true figures