Analysis of factors of importance for drug use

Background: There are differences in drug use depending on non-medical factors such as age, gender and socioeconomic status. The combined effect of these factors, with adjustment for multimorbidity, is highly relevant to study to ensure equality in drug use. Objectives: 1. To examine drug use related to age, gender, income and education after adjustment for multimorbidity, in an entire adult population and in a population where prescription drugs were issued only by general practitioners. 2. To analyse if gender-related morbidity explains the differences in drug use. 3. To examine to what extent the elderly may lack indication for treatment. Methods: Register-based methods were applied in all papers, using data from Östergötland County. To estimate multimorbidity the ACG-Case Mix was used in all papers. Drug use depending on age, gender, income- and educational level, after adjustment for multimorbidity, was analysed in the entire adult population in Paper I, and in the primary healthcare population in Paper III. In Paper II diseases tending to afflict females more frequently were identified, together with the prescription drugs used to treat these diseases. Drug use was analysed before and after exclusion of these identified prescription drugs. In Paper IV the proportion of patients 65 years or older having indication for a number of their prescription drugs, identified as inappropriate for elderly, was examined, with further analysis of what may affect the result. Results: Significant differences in drug use were identified depending on age, gender, income and education, despite adjustment for multimorbidity. The elderly, females and individuals with the lowest levels of income and education had higher drug use. The differences persisted when drug use in primary healthcare was examined. The gender difference in drug use decreased when prescription drugs used to treat diseases afflicting females more often were excluded from the analyses. Less than half of the patients’ prescription drugs (45.1%), studied in Paper IV had indication for treatment. The oldest patients had to the lowest extent indication for treatment. Conclusion: The patients’ age, gender, income and education affect the drug use, despite adjustment for multimorbidity. Gender-related morbidity seems to explain some of the gender difference in drug use, and lack of indication for treatment among the elderly explains some of the age difference

Indication for pharmacological treatment is often lacking: a cross-sectional study on the quality of drug therapy among the elderly.

Although the elderly have a substantially higher drug use than younger patients, even after adjustment for multimorbidity, there is limited knowledge about the elderly's indication for treatment. It is essential for elderly patients to have a well-planned drug therapy. The first step towards a correct and safe drug therapy is to ensure that the patient's drugs have an indication, i.e. correct diagnoses are linked to all of the prescription drugs. The aim of this study was to examine to what extent elderly patients have indication for a number of their prescribed drugs and, furthermore, if there are any differences in indication for treatment depending on gender, age, level of multimorbidity and income

Regionala riktlinjer vid förskrivning av beroendeframkallande läkemedel i Region Skåne

Sammanfattande kommentarer och rekommendation • Opioider och bensodiazepiner är kraftfulla läkemedel med god patientnytta i utvalda fall och under begränsade behandlingstider.• Läkare/vårdenhet som initierat förskrivning har ansvar för denna tills den upphört eller tills annaninstans accepterat övertag – Behandlingsansvar• Basbehandling – överväg alltid först alternativa behandlingsstrategier, såväl icke-farmakologiska som farmakologiska• Fortsätt med den basbehandling som fungerar även om beroendeframkallande läkemedel förskrivs• Gör Riskbedömning av beroende/överdosering före nyinsättning och vid varje förskrivningstillfälle. • Samtidig behandling med opioid och bensodiazepin innebär ökad risk för letal intoxikation. • Planera för korttidsbehandling – och var tydlig med det.• Kontinuerligt långtidsbruk medför ofta negativa effekter och har kända risker.• Vid all långtidsbehandling – överväg indikation och säkerhet regelbundet och diskutera med patienten om biverkningar och effekt.• Intermittent behandling vid recidiverande/kroniska besvär kan vara ett alternativ.• God Kontroll över förskrivningen innebäro tillgång till patientens uppgifter i Nationella läkemedelslistan utan spärrar, dvs patienten har inte dolt recept- och uttagsinformation via till exempel Läkemedelskolleno förskrivarkontinuiteto ställningstagande till behov av provtagning för alkohol/drogscreening och till korta uthämtningsintervall/dosdispensering/utdelning av mediciner • Patientinformation med nedtrappningsschema hittas i slutet av dokumentet

The Gothenburg H70 Birth cohort study 2014-16 : design, methods and study population.

To improve health care for older persons, we need to learn more about ageing, e.g. identify protective factors and early markers for diseases. The Gothenburg H70 Birth Cohort Studies (the H70 studies) are multidisciplinary epidemiological studies examining representative birth cohorts of older populations in Gothenburg, Sweden. So far, six birth cohorts of 70-year-olds have been examined over time, and examinations have been virtually identical between studies. This paper describes the study procedures for the baseline examination of the Birth cohort 1944, conducted in 2014-16. In this study, all men and women born 1944 on specific dates, and registered as residents in Gothenburg, were eligible for participation (n = 1839). A total of 1203 (response rate 72.2%; 559 men and 644 women; mean age 70.5 years) agreed to participate in the study. The study comprised sampling of blood and cerebrospinal fluid, psychiatric, cognitive, and physical health examinations, examinations of genetics and family history, use of medications, social factors, functional ability and disability, physical fitness and activity, body composition, lung function, audiological and ophthalmological examinations, diet, brain imaging, as well as a close informant interview, and qualitative studies. As in previous examinations, data collection serves as a basis for future longitudinal follow-up examinations. The research gained from the H70 studies has clinical relevance in relation to prevention, early diagnosis, clinical course, experience of illness, understanding pathogenesis and prognosis. Results will increase our understanding of ageing and inform service development, which may lead to enhanced quality of care for older persons