Inappropriate prescribing for the elderly—a modern epidemic?

Tverrsnittstudie hvor hensikten var å undersøke forekomst av uheldige forskrivninger til eldre som bor hjemme.PURPOSE: The elderly often use several drugs on a regular basis and are especially at risk for drug-related harm from side effects and interactions. The aim of this study was to explore the overall prevalence of and predictors for potentially inappropriate medication use among Norwegian elderly outpatients. METHODS: A pharmaco-epidemiological retrospective cross-sectional survey was undertaken based on data from the Norwegian Prescription Database. Prescriptions from all doctors in Norway, dispensed by pharmacies to home-dwelling elderly ≥ 70 years in 2008, were included for a total of 11,491,065 prescriptions from 24,540 prescribers to 445,900 individuals (88.3% of the Norwegian population in this age group, 58.9% females). We applied a list of criteria for pharmacological inappropriateness for elderly people (the NORGEP criteria) to determine the prevalence of potentially inappropriate medications (PIMs) and applied a multiple logistic regression model to identify predictors. RESULTS: According to our criteria, 34.8% of the study population (28.5% of the men, 39.3% of the women) was exposed to at least one PIM. Of these, 59.9% represented psychoactive substances. The odds of receiving potentially harmful prescriptions increased with the number of prescribers (OR 3.52, 99% CI 3.44-3.60 for those with ≥ 5 compared to those with 1 or 2 prescribers). Twenty percent were prescribed more than 10 medications; among these two-thirds had at least one PIM. Adjusted for differences in age distribution and the number of prescribers involved, women were more frequently exposed to PIMs than men, with an odds ratio of 1.60 (99% CI 1.58-1.64). CONCLUSIONS: About one-third of the elderly Norwegian population is exposed to potentially inappropriate medications, and elderly females are at particular risk

Antihypertensive and lipid lowering treatment in 70–74 year old individuals – predictors for treatment and blood-pressure control: a population based survey. The Hordaland Health Study (HUSK)

BACKGROUND: In an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control. METHODS: A health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4 338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded. RESULTS: One third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control. CONCLUSION: One third of 70–74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control

Vet fastlegen hvilke medisiner hjemmesykepleien gir pasientene?

Artikkelen presenterer resultater fra en studie som avdekket dårlig informasjonsutveksling mellom fastlege og hjemmesykepleie, samt manglende samsvar mellom legemiddellistene de hadde for felles pasienter.Bakgrunn. Hjemmeboende, pleietrengende eldre må ofte overlate til hjemmesykepleien å administrere legemidlene sine. Lite er kjent om hvordan hjemmesykepleien og fastlegene samordner og oppdaterer medisinlister for felles pasienter. Materiale og metode. For 90 tilfeldig utvalgte pasienter som mottok medisiner fra hjemmesykepleien, ble hjemmesykepleiens lister over faste medisiner sammenliknet med fastlegenes tilsvarende lister. Rutiner og samarbeidsformer i forbindelse med legemiddelbruk hos felles pasienter ble kartlagt ved hjelp av et spørreskjema. Resultater. For over 60 % av pasientene var det ikke samsvar mellom fastlegenes lister over pasientenes faste medisiner og det som var anført på hjemmesykepleiens lister (antall medikamenter, døgndoser og antall doseringer per døgn for hver enkelt medisin). Avvik gjaldt hyppigst for medisiner mot hjerte- og karsykdommer og psykofarmaka. Legene oppgav generelt mindre tiltro til at pasientene mottok riktige medisiner enn hjemmesykepleierne. Mindre enn halvparten av legene hadde klare rutiner for oppdatering av medisinlistene ved mottak av epikriser fra andre leger. Fortolkning. Manglende samsvar mellom medisinlistene kan representere et potensielt folkehelseproblem. Kommunikasjonen mellom hjemmesykepleien og fastlegene bør bedres

Riktigere medisinlister ved multidosepakking?

Beskriver en studie hvor hensikten var å undersøke samsvar mellom informasjon hos fastlege og hjemmetjeneste ved multidose kontra dosett.Bakgrunn: hjemmesykepleien i en bydel i Oslo ønsket å undersøke om kjøp av multidosepakkede legemidler til brukerne medførte en kvalitetsgevinst i forhold til manuell fylling av dosetter. Materiale og metode: vi inkluderte 20 brukere som fikk multidosepakkede legemidler, og henholdsvis 17 og 16 brukere fra to ulike distrikter hvor dosetter ble fylt manuelt. Vi registrerte uoverensstemmelser og mangler i legemiddelopplysninger for faste legemidler mellom medisinoversikt fra fastlege og hjemmesykepleien eller multidoseprodusenten. Resultat: de 53 pasientene fikk til sammen 324 faste medisiner. For totalt 23 % av alle legemidlene ble det funnet uoverensstemmelser, og dette omfattet 58 % av pasientene. I tillegg ble det funnet mangler for totalt 6 % av legemidlene. I distriktet hvor brukerne fikk utlevert multidosepakkede legemidler, ble det funnet uoverensstemmelser for 21 % av legemidlene, og i distriktene hvor dosettene ble fylt manuelt, ble det funnet uoverensstemmelser for henholdsvis 17 % og 33 % av legemidlene. Fortolkning: både ved multidosepakking av legemidler og manuell fylling av dosetter var det uakseptable avvik i legemiddelopplysninger for faste legemidler mellom medisinoversikt fra fastlege og hjemmetjenesten eller multidoseprodusenten. Det er viktig å avklare hvem som skal ha ansvaret for å ha en ajourført medisinliste for den enkelte pasient som hjemmesykepleien administrerer legemidler for

The Norwegian General Practice (NORGEP) criteria for assessing potentially inappropriate prescriptions to elderly patients

Beskriver utvikling av en klinisk relevant liste med eksplisitte kriterier for farmakologisk uhensiktsmessige medikamentforeskrivinger for eldre ≥ 70 år i allmennpraksis.Objective. To establish a clinically relevant list with explicit criteria for pharmacologically inappropriate prescriptions in general practice for elderly people ]70 years. Design. A three-round Delphi process for validating the clinical relevance of suggested criteria (n 37) for inappropriate prescriptions to elderly patients. Setting. A postal consensus process undertaken by a panel of specialists in general practice, clinical pharmacology, and geriatrics. Main outcome measures. The Norwegian General Practice (NORGEP) criteria, a relevance-validated list of drugs, drug dosages, and drug combinations to be avoided in the elderly (570 years) patients. Results. Of the 140 invited panellists, 57 accepted to participate and 47 completed all three rounds of the Delphi process. The panellists reached consensus that 36 of the 37 suggested criteria were clinically relevant for general practice. Relevance of three of the criteria was rated significantly higher in Round 3 than in Round 1. At the end of the Delphi process, a significant difference between the different specialist groups’ scores was seen for only one of the 36 criteria. Conclusion. The NORGEP criteria may serve as rules of thumb for general practitioners (GPs) related to their prescribing practice for elderly patients, and as a tool for evaluating the quality of GPs’ prescribing in settings where access to clinical information for individual patients is limited, e.g. in prescription databases and quality improvement interventions

Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey

Objective Dependent on clinical setting, geography and timing during the pandemic, variable symptoms of COVID-19 have been reported. Our aim was to describe self-reported symptom intensity and contact with primary health care among nonhospitalized COVID-19 patients. Design Web-based survey. Setting Norway between March 2020 and July 2021. Subjects Adults in home isolation. Main outcome measures Participants reported possible COVID-19 symptoms, duration of symptoms, score of symptom severity (Likert scale 0–3), risk factors, comorbidity, and questions regarding follow-up and information from primary health care. Results Of 477 participants, 379 (79%) had PCR-confirmed COVID-19, 324 (68%) were females, and 90% were younger than 60 years. Most common symptoms were “fatigue and/or muscle ache” (80%), nasal symptoms (79%), and headache (73%). The mean severity of symptoms was generally low. Symptoms with the highest mean scores were “fatigue and/or muscle ache” (1.51, SD 1.02) and headache (1.27 (SD 1.00). Mean scores for severity ranged from 0.28 (nausea) to 1.51 (fatigue and/or muscle ache). Women reported higher symptom scores than men. For “affected sense of smell and/or taste”, patients either reported a high symptom score (24%) or no affliction at all (49%). A third of the participants (32%) were followed-up by primary care health personnel, and almost 40% had sought or received information about COVID-19 from general practitioners. Conclusion The mean severity of symptoms among nonhospitalized adult COVID-19 patients was generally low. We found large variations in the occurrence and severity of symptoms between patients.publishedVersio

Quality of care for patients with type 2 diabetes in general practice according to patients' ethnic background: a cross-sectional study from Oslo, Norway

<p>Abstract</p> <p>Background</p> <p>In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM) patients from these ethnic minority groups compared with the care received by Norwegians.</p> <p>Methods</p> <p>In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients). 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used.</p> <p>Results</p> <p>Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA): mean age 44.9 years, Middle East/North Africa (MENA): 47.2 years, East Asians (EA): 52.0 years, others: 49.0 years) compared with Norwegians (59.7 years, p < 0.001). HbA1c, systolic blood pressure (SBP) and s-cholesterol were measured in >85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (≥79% vs. 72%, p < 0.001). After adjusting for age, gender, diabetes duration, practice and physician unit, HbA1c (geometric mean) for Norwegians was 6.9% compared to 7.3-7.5% in the minority groups (p < 0.05). The proportion with poor glycaemic control (HbA1c > 9%) was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p < 0.001. No significant ethnic differences were found in the proportions reaching the combined target: HbA1c ≤ 7.5%, SBP ≤ 140 mmHg, diastolic blood pressure (DBP) ≤ 85 mmHg and total s-cholesterol ≤5.0 mmol/L (Norwegians: 25.5%, SA: 24.9%, MENA: 26.9%, EA: 26.1%, others:17.5%).</p> <p>Conclusions</p> <p>Mean age at the time of diagnosis of T2DM was 8-15 years younger in minority groups compared with Norwegians. Recording of important processes of care measures is high in all groups. Only one in four of most patient groups achieved all four treatment targets and prescribing habits may be sub-optimal. Patients from minority groups have worse glycaemic control than Norwegians which implies that it might be necessary to improve the guidelines to meet the needs of specific ethnic groups.</p

Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study

Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response

Søvnforstyrrelser og forskrivning av hypnotika i allmennpraksis – en PraksisNett-studie

Source at https://helse-bergen.no/nasjonal-kompetansetjeneste-for-sovnsykdommer-sovno/tidsskriftet-sovn.Søvnforstyrrelser er svært utbredt i befolkningen. Insomni er den vanligste søvnforstyrrelsen med en forekomst på omkring 10-20 % [1, 2]. Forekomsten ser ut til å være økende i befolkningen [1]. Blant pasienter på venterommet hos norske fastleger er forekomsten så høy som rundt 50 % ifølge to tidligere studier [3, 4]. Insomni utgjør en risikofaktor for utvikling av psykiske lidelser [5] og er identifisert som en mulig kausal årsaksfaktor for en rekke negative helseutfall [6]. Selv om sovemedisiner kun er anbefalt ved akutte søvnplager [7], er forskrivning av sovemedisiner også for langvarige plager svært vanlig [8]. Medikamentgruppen hypnotika inkluderer benzodiazepiner, benzodiazepinlignende sovemidler (z preparater) og melatoninpreparater. I klinisk praksis benyttes av og til også andre preparater enn hypnotika mot søvnproblemer, inkludert antidepressiva, antihistaminer og antipsykotika [9]

The Norwegian PraksisNett: a nationwide practice-based research network with a novel IT infrastructure

Clinical research in primary care is relatively scarce. Practice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary care. In Norway, almost all 5.4 million inhabitants have access to a general practitioner (GP) through a patient-list system. This gives opportunity for a PBRN with reliable information about the general population. The aim of the current paper is to describe the establishment, organization and function of PraksisNett (the Norwegian Primary Care Research Network). Materials and Methods We describe the development, funding and logistics of PraksisNett as a nationwide PBRN. Results PraksisNett received funding from the Research Council of Norway for an establishment period of five years (2018–2022). It is comprised of two parts; a human infrastructure (employees, including academic GPs) organized as four regional nodes and a coordinating node and an IT infrastructure comprised by the Snow system in conjunction with the Medrave M4 system. The core of the infrastructure is the 92 general practices that are contractually linked to PraksisNett. These include 492 GPs, serving almost 520,000 patients. Practices were recruited during 2019–2020 and comprise a representative mix of rural and urban settings spread throughout all regions of Norway. Conclusion Norway has established a nationwide PBRN to reduce hurdles for conducting clinical studies in primary care. Improved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaboration. This will benefit both patients, GPs and society in terms of improved quality of care.publishedVersio