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'DQVN 6HOVNDE IRU )DUPDNRHSLGHPLRORJL¶V Q\KHGVEUHY NEPI - Netværk for lægemiddelepidemiologi af *XQQDU /LQGEHUJ .3 25,(17(5,1*Interessante farmakoepidemiologiske artikler.4 Syddansk Universitet - Odense Universitet, Winsløwparken 19, 3. sal, 5000 Odense C Tlf.: 6550 3788. Fax: 6591 6089. Giro: 091-2425 Farmakoepidemiologi er en relativt ny gren af epidemiologien. Som navnet antyder, drejer det sig om anvendelse af epidemiologiske problemstillinger. Deskriptive undersøgelser af Vi vil her benytte lejligheden til at efterlyse lægemiddelforbrug, kvalitative undersøgelser indlæg fra medlemmerne. Hidtil har alle indlæg i nyhedsbrevet været forfattet af farmakoøkonomiske vurderinger, og analytiske bestyrelsesmedlemmer eller personer med tæt relation hertil. Vi vil for eksempel gerne beslægtede interesser. Kritik og forslag udviklingen af denne disciplin i Danmark. Selskabet er åbent for alle, som interesserer sig for farmakoepidemiologi inden for sundhedssektoren, de akademiske institutioner og industrien. Selskabet videnskabeligt møde, udgiver desuden et nyhedsbrev og samarbejder med tilsvarende udenlandske og internationale organisationer. rekvireres ved henvendelse til selskabets sekretariat; adresse ses på forsiden af Nyhedsbrevet. Årskontingentet er 200 kr. Bestyrelsen består p.t. af cand.pharm., ph.d. Højskole (formand); adjunkt, cand.med., ph.d. 0RUWHQ $QGHUVHQ, Klinisk Farmakologi, Syddansk Universitet - Odense Universitet (sekretær); 1. reservelæge, dr.med. -HVSHU Først vil jeg takke alle jer der svarede på +DOODV, Medicinsk afd., Svendborg Sygehus; spørgeskemaet om DSFEs aktiviteter. Vi er i cand.pharm. %HQWH 2YHUJDDUG /DUVHQ, Fyns gang med at analysere jeres svar, og jeg vil )OHPPLQJ +DOG 6WHIIHQVHQ, Center for beretning. Det er allerede klart at den nye bestyrelse har noget at rette sig efter, når de cand.oecon. .MHOG &KULVWHQVHQ, Astra Danmark A/S og revisorsuppleant er reservelæge, ph.d. -HQV8OULN 5RVKROP, Afdeling KKA, Odense overskriften ”Nytter det noget?”, der er en temadag om interventionsstudier. Vi er så heldige at have besøg af Dr. Malcolm Maclure fra Canada. Han er en ekspert i metoder til evaluering af interventioner. Det har jeg håb om, at I er interesserede i at vide noget mere Materiale, som ønskes optaget i nyhedsbrevet om. Det er vigtigt at vi får taget hul på dette emne i selskabet. Det store spørgsmål er om interventioner som patient- og lægeuddannelse, diskette i Microsoft Word- eller WordPerfect- ordinationsprofiler, farmaceutisk omsorg, lovændringer m.fl. har en indvirkning på lægemiddelanvendelsen i den ”rigtige” Lægemiddelindustriforeningen Lif afholdt en konference den 26. oktober d.å. med overskriften ”Patientbehandling i dag og i fremtiden – rationel eller politisk”. Vi der er sundhedsuddannede synes vi kender rationelt lægemiddelforbrug når vi ser det. For andre der forsker i sundhed og sygelighed er det et mere indviklet videnskabsteoretisk spørgsmål. I lovene for DSFE står der i 1. paragraf: ”Selskabets formål er at fremme udviklingen af farmakoepidemiologi i Danmark for herved at bidrage til en KHQVLJWVP VVLJ anvendelse af NEPI etableredes i 1994 efter at en statslig farmakoepidemiologiinteresserede må tage betænkning havde fastslået behovet for et netværk af læger, sygeplejersker og apotekere ”hensigtsmæssig” og ”rationel” når vi omtaler til at drive lægemiddelepidemiologisk aktivitet. Stifterne af NEPI, Apoteksbolaget (nuværende Apoteket AB) og Apotekarsocieteten oprettede Jeg hæftede mig også ved de modsætninger der en fond, hvis afkast i det væsentlige finansierer omtales i Lifs overskrift: ”rationel eller politisk?” Jeg har altid troet at der eksisterede bestyrelse, og i 1995 rekrutteredes NEPIs chef, noget der var politisk rationelt. Jeg er også professor Arne Melander og derefter de øvrige kommet til at tro på at lægemiddelbrugerne har deres egen udgave af rationalitet. De af medlemmerne der beskæftiger sig direkte med politiske beslutninger ved også, at der NEPIs overordnede formål er at fremme en medicinsk og økonomisk effektiv anvendelse sundhedsprofessionerne forstår. De er mere af lægemidler, gennem en kombination af forskning, studier, analyser, uddannelse og lægemiddelbehandlingen. Derfor må vi som information. NEPIs tre hovedområder er derfor medlemmer af DSFE have en bred forståelse lægemiddelepidemiologi, lægemiddeløkonomi for at ordene er underkastet en vis relativisme, og at det er der ikke noget at gøre ved. effektiviteten af lægemiddelbehandling i interventioner og dertil hørende rationalitet i lægemiddelforbruget hidrører fra almen velkomne til det næste Årsmøde. Jeg glæder mig til at se jer til en sjov og udbytterig dag. primærsektoren og med landstingene (amterne, red.), som er ansvarlige for sundhedsvæsnet i lægemiddelafprøvninger i almen praksis. I øjeblikket (efterår 1999) består personalet i Malmö af lederen, professor Melander, som er epidemiolog, Gunnar Lindberg, docent i almen medicin og en sekretær, Regina Ringkvist. På konsulentbasis haves desuden statistikeren Jonas Ranstam fra Högskolan i Malmö. I Stockholm har NEPI en administrator (Kristina Lundh). For eksterne midler har vi ansat en Rundt om denne kerne befinder sig netværket. involveret i NEPIs projekter. Et af de første Universitetssjukhuset MAS, 205 02 Malmö, NEPI-studier blev således udført sammen med Andre landsting med betydende engagement i NEPI projekter er Skaraborg, hvor NEPI samarbejder med Skaraborginstituttet om studier af hypertensions- og diabetesbehandling, og Jönköping som i samarbejde med NEPI kortlægger behandlingen af type 2 diabetes og dens konsekvenser. NEPI har påvist, at næsten 300 millioner kroner kan spares årligt i Sverige ved Bjerrum L, Sogaard J, Hallas J, Kragstrup J. Polypharmacy in general practice: differences Vi har anvendt registerdata ved flere studier. I between practitioners. Br J Gen Pract 1999; et receptregisterstudie fandt vi, at selvmord var Blackburn SC, Oliart AD, Garcia-Rodriguez antihypertensiva. Flere registerstudier på LA, Perez-Gutthann-S. Antiepileptics and Malmökohorten af mænd født i 1913 taler for blood dyscrasias: a cohort study. Pharmaco- at behandlede hypertonikere, på trods af overhyppighed af hjerte-karsygdom. I et andet Derby LE, Myers MW, Jick H. Use of dexfen- receptregisterstudie, baseret på OPED, testedes fluramine, fenfluramine and phentermine and the risk of stroke. Br J Clin Pharmacol 1999; farmaka og depression. Ialt 40 publikationer er Ud over de rent epidemiologiske studier er flere eksperimentelle studier i støbeskeen. Et Thomas S, Mann R. Oral contraceptives and forebyggende diabetesstudie med glimepirid myocardial infarction: results of the MICA skal afvikles i Norge og Sverige over fem år. I case-control study. BMJ 1999; 318: 1579-83. et andet studie skal visse perorale antidiabetika afprøves som supplement til patienter som ikke er velregulerede på sulfonylureider. Vi har for TM, Stevenson RJ, Morris AD. Frequency of nylig indledt et skånsk-dansk samarbejde med blood glucose monitoring in relation to gly- Klinisk Farmakologisk Enhed på Bispebjerg, caemic control: observational study with dia- Samfundsfarmaci på Farmaceutisk Højskole i Jick H. A database worth saving. Lancet 1997; Information om NEPI, organisation, rapporter Jick SS, Myers MW, Jick H. Risk of idiopathic cerebral haemorrhage in women on oral con- traceptives with differing progestagen compo-nents. Lancet 1999; 354: 302-3. Danish children. Pediatr Infect Dis J. 1999; 18: Jick H, Garcia-Rodriguez LA, Perez Gutthann S. Principles of epidemiological research on adverse and beneficial drug effects. Lancet Aalykke C, Lauritsen JM, Hallas J, Reinholdt S, Krogfelt K, Lauritsen K. Helicobacter pylori and risk of ulcer bleeding among users of non- Meier CR, Derby LE, Jick SS, Vasilakis C, Jick H. Antibiotics and risk of subsequent case-control study. Gastroenterology 1999; first-time acute myocardial infarction. JAMA Merlo J, Lindberg G, Lindblad U, Lindgren A, Rastam L, Melander A. Utilization of cardio- vascular drugs (blood pressure lowering drugs, lipid lowering drugs and nitrates) and mortality from ischaemic heart disease and stroke. An ecological analysis based on Sweden’s munici-palities. Eur J Clin Pharmacol 1999; 55: 69-76. Myers MW, Jick H. Terfenadine and risk of acute liver disease. Br J Clin Pharmacol 1998; 46: 251-3. Olesen C, Steffensen FH, Sorensen HT, Niel- 4XDQWLWDWLYH $SSURDFKHV WR WKH (YDOXDWLRQ long-term hormone replacement therapy in RI +HDOWK &DUH ,QSXWV ,QWHUQDWLRQDO 3K' Olesen C, Steffensen FH, Nielsen GL, de Jong van den Berg L, Olsen J, Sorensen HT. Drug 6WHG Danmarks Farmaceutiske Højskole, use in first pregnancy and lactation: a popula- tion-based survey among Danish women. The McLaughlin JK, Mellemkjaer L, Steffensen FH, Fraumeni JF Jr. Lipid-lowering medica- tion and risk of cancer. J Clin Epidemiol. Johnston DA, MacDonald TM. Prescription of 7LG 30. november-2. december 1999. acid-suppressing drugs in relation to endo- scopic diagnosis: a record-linkage study. Ali- 6WHG Convention Center, Basel, Schweiz. 1 UPHUH RSO\VQLQJHU European Federation Steffensen FH, Fischer P, Sabroe S. Historical cohort study of in utero exposure to uterotonic drugs and cognitive function in young adult 6XQG 6XQGHUH ‘UHVXQG ± (Q NRQIHUHQFH RP tion-based study of antibiotic prescriptions for 7LOPHOGLQJVIULVW 15. november 1999. 1 UPHUH RSO\VQLQJHU Medicon Valley 0HWKRGRORJLFDO 3HUVSHFWLYHV LQ +HDOWK 6HU YLFHV 5HVHDUFK ,QWHUQDWLRQDO 3K' &RXUVH WK ,QWHUQDWLRQDO &RQIHUHQFH RQ 6\VWHP 6FL 6WHG Dansk Folkeferies Center, Gilleleje. 6WHG Kings College Conference Centre, Uni- 0LOOHQLDO :RUOG &RQJUHVV RI 3KDUPDFHXWL FDO 6FLHQFHV7LG 16.-20. april 2000. 6WHG San Francisco, USA. 1 UPHUH RSO\VQLQJHU E-mail: m.swakhoven@fip.nl (6&3 6SULQJ &RQIHUHQFH RQ &OLQLFDO 3KDU PDF\ &OLQLFDO 3KDUPDF\ 6NLOOV IRU WKH 1HZ 7KHUDSHXWLF +RUL]RQV7LG 11.-13. maj 2000. 6WHG Reykjavik, Island. 1 UPHUH RSO\VQLQJHU E-mail: krisline@shr.is (=president) eller incentiv@itn.is (=conference organizer) Torsdag den 11. november 1999, kl. 9.30-ca. 15.45 efterfulgt af generalforsamling Sted: Institut for Sundhedstjenesteforskning, Syddansk Universitet – Odense Universitet, Winsløwparken 19, stuen, lokale 19.01, 5000 Odense C 10:00 Velkomst ved Anna Birna Almarsdóttir 10:10 Malcolm 7KH %HWWHU 3UHVFULELQJ 3URMHFW $ UDQGRPLVHG FRQWUROOHG WULDO RI VPDOO JURXS HGXFDWLRQ DQG IHHGEDFN ZLWK SUHVFULSWLRQ SURILOHVPharmacare, Ministry of Health and Ministry Responsible for Seniors, Victoria, British Co-lumbia, Canada. 10:55 Frugt- og juicepause 11:15 Malcolm $ UDQGRPLVHG SROLF\ WULDO RI D FKDQJH LQ GUXJ EHQHILWV ± WKH LQWHUIDFH RI Søndergaard: )HHGEDFN RQ SUHVFULSWLRQ SURILOHV 3UHVHQWDWLRQ RI WZR UDQGRPLVHG FRQ WUROOHG VWXGLHVInstitute of Public Health, Clinical Pharmacology, University of Southern Denmark, Main Campus: Odense University. Søndergaard, Hanne Herborg: 3KDUPDF\EDVHG LQWHUYHQWLRQ SURMHFWV 13:30 Anna Birna Almarsdóttir, Almar Grímsson: 2YHUWKHFRXQWHU FRGHLQH XVH LQ ,FHODQG 7KH LP SDFW RI LQFUHDVHG DFFHVVRoyal Danish School of Pharmacy, Copenhagen. 13:45 Poster presentation: Jens Søndergaard, Morten Andersen, Jakob Kragstrup, Lars F. Gram, Bente O. Larsen, David Gaist, Hans-Ulrik Schaffalitzky de Muckadell, Søren H. Sindrup: 9HUEDO DQG ZULWWHQ LQIRUPDWLRQ WR WULSWDQ XVHUV 'HVLJQ RI D UDQGRPLVHG FRQWUROOHG WULDO RQ WKH HIIHFW RQ FRQVXPSWLRQInstitute of Public Health, Clinical Pharmacology, University of Southern Denmark, Main Campus: Odense University. 13:52 Poster presentation: Pia Ehlers, Charlotte M. Ejlersen, Steinunn Gunnarsdottir, Jens Kierkegaard, Kim Kristensen, Bodil Munk Hansen, Bente O. Larsen, Kirsten Nielsen, Aase Nissen, Kirsten Schæfer, Birgit Toft, Keld Vægter. 8VH RI GUXJ GDWDEDVHV ± WKH 'DQLVK ZD\Funen County, Health Secretariat, Odense. 14:00 Pause: Kaffe, te, kage og posterbeskuelse 14:20 Jesper 7KH ILGHOLW\ FRHIILFLHQW $ PHDVXUH RI WKH FRPSOHWHQHVV RI LQWHUYHQWLRQ GDWD Department of Medicine C, Odense University Hospital. 14:35 Bente Krag Ingvardsen, Claudia Ranneris: 7KH XVH RI YLDJUD LQ 'HQPDUN 14:50 Nana Thrane, Charlotte Olesen, Henrik Toft Sørensen, Henrik Carl Schønheyder: 3UHYLRXV DQWLELRWLF FXUHV DV ULVN IDFWRU IRU DQWLPLFURELDO UHVLVWDQFH DPRQJ EDFWHULD LQ WKH PLGGOH HDU LQ The Danish Epidemiology Science Centre, University of Aarhus. 15:15 Charlotte Olesen, Charlotte Søndergaard, Nana Thrane, Gunnar Lauge Nielsen, Lolkje de Jong-van den Berg, Jørn Olsen: 'R SUHJQDQW ZRPHQ XVH GLVSHQVHG PHGLFDWLRQV" &RPSDULVRQ RI H[SRVXUH GDWD REWDLQHG LQ D SUHVFULSWLRQ GDWDEDVH DQG E\ LQWHUYLHZ The EuroMAP Group. The Danish Epidemiology Science Centre, University of Aarhus. 15:30 Pia Knudsen, Ebba Holme Hansen: <RXQJ ZRPHQ¶V XVH RI 665,V ± IURP RQH VWLJPD WR Royal Danish School of Pharmacy, Copenhagen. 100 kr. for medlemmer og 200 kr. for ikke-medlemmer. Betalingen dækker udgifter til mad og drikke. Center for Klinisk Farmakologi i Odense (CeKFO) 5000 Odense C Tlf.: 6550 3788 E-mail: h-horneberg@cekfo.sdu.dk Torsdag den 11. november 1999, umiddelbart efter årsmødet Institut for Sundhedstjenesteforskning, Syddansk Universitet – Odense Universitet, Winsløwparken 19, stuen, lokale 19.01, 5000 Odense C (1'(/,* '$*625'(1 1. Valg af dirigent og referent. 2. Formandens 3. Udvalgsberetninger (ingen udvalg p.t.). 4. Regnskab og kontingentfastsættelse. 5. Valg af bestyrelse. -HVSHU +DOODV $QQD %LUQD $OPDUVGyWWLU RJ )OHPPLQJ +DOG 6WHIIHQVHQ træder ud af bestyrelsen. 0RUWHQ $QGHUVHQ sidder endnu en periode. Følgende personer stiller op til bestyrelsen: -HQV8OULN 5RVKROP RJ -HQV 7¡OE¡O 0RUWHQVHQ 6. Valg af revisor. 7. Samarbejde med Dansk Epidemiologisk Selskab. 8. Eventuelt Yderligere oplysninger: Morten Andersen, Klinisk Farmakologi, IST, Syddansk Universitet, Winsløwparken 19, 5000 Odense C Tlf. 65 50 37 91. E-mail: m-andersen@cekfo.sdu.dk Anna Birna Almarsdóttir, Inst. for Samfundsfarmaci, DFH, Universitetsparken 2, 2100 Kbh. Ø. )(('%$&. 21 35(6&5,37,21 352),/(6 35(6(17$7,21 2) 7:2 5$1'20,6(' &21752//(' 678',(6-HQV 6¡QGHUJDDUG ! 0' 5HVHDUFK 8QLW RI *HQHUDO 3UDFWLFH DQG &OLQLFDO 3KDUPDFRORJ\! 8QLYHUVLW\ RI 6RXWKHUQ 'HQPDUN 2GHQVH &DPSXV %DFNJURXQG There is only limited knowledge about the effects of sending prescription profiles to GPs. Also, the GPs’ attitude towards this kind of intervention has not been examined. 2EMHFWLYH To test the effects of different levels of clinical detailing in prescription profiles. To test the importance of the topic on the effect on prescription profiles. To test the effects of combining prescription profiles with guidelines. To gain knowledge about the GPs’ attitudes towards prescription profiles 0HWKRGV Two randomised, controlled studies on prescription profiles were carried out by means of the OPED database, which covers all reimbursed medicine at the level of the individual user in the County of Funen (approx. 470.000 inhabitants). All GPs (305) in the County of Funen participated in both trials. In the first trial, topics for intervention were polypharmacy and antiasthmatics. The GPs were randomised to one of three groups: a group receiving data on polypharmacy, a group receiving summarised data on antiasthmatics and a group receiving anonymised data on listed individual patients’ consumption of drugs. In the second trial, the topic for intervention was antibiotics. All GPs’ received guidelines about prescription of antibiotics. The GPs were randomised to either an intervention group receiving feedback on prescription data or a control group. The GPs’ attitudes towards the intervention were recorded and qualitative interviews were conducted. There will not be presented any final results. 3+$50$&< %$6(' ,17(59(17,21 352-(&76 +DQQH +HUERUJ 7RYH *XVWDIVVRQ %LUWKH 6¡QGHUJDDUG 3KDUPDNRQ 'DQLVK &ROOHJH RI 3KDUPDF\ 3UDFWLFH %DFNJURXQG Research and development in Danish pharmacies has in the 90’ies focused on the con-cept of pharmaceutical care. Pharmaceutical care is a continuous quality improvement function aimed at the drug use system. It focuses on inadequate managing of drug therapy, in particular failure to rec-ognize and resolve drug related problems before they become morbidities. The hypothesis is that working with isolated factors is an inadequate approach to preventing drug related morbidities (thera-peutic failure as well as adverse events). The overall purpose is to ensure optimal quality of life (clini-cal and psycho-social outcomes) for individual patients and health economic outcomes from the soci-ety perspective. All participants in the drug use system, including primary care actors such as GP’s, pharmacists, nurses and the patients themselves are seen as essential resources. ,QWHUYHQWLRQV Two pharmacy based intervention projects have been carried out testing two different models of pharmaceutical care: a disease specific and a non-disease specific pharmacy based model. Both projects are part of multi-country European research programs.  4XDOLW\ LPSURYHPHQW RI GUXJ WKHUDS\ IRU DVWKPD SDWLHQWV LQ 'HQPDUN The project ran for 12 months in 1994-95. It involved 500 asthma patients, 16 intervention and 15 control pharmacies in col-laboration with 139 GP’s. The patients had on average 10 encounters lasting 45 minutes.  ,PSURYLQJ WKH ZHOOEHLQJ RI HOGHUO\ SDWLHQWV YLD FRPPXQLW\ SKDUPDF\ EDVHG SKDUPDFHXWLFDO FDUHThe project ran for 18 months in 1997-98. It involved 524 patients receiving five or more drugs and aged >65 years. The patients had on average 6 encounters lasting 40 minutes. In both projects the intervention consisted of individual counseling encounters where the pharmacist would monitor outcomes and drug related problems, provide individual action plans and patient edu-cation according to individual needs and wants, and if needed refer therapeutic problems to GP’s. 5HVXOWV The asthma project showed beneficial effects on the following outcome measures: Asthma symptom status, days of sickness, quality of life, use of short acting Beta-agonists, use of inhaled Cor-ticosteroids, knowledge and inhalation errors. Cost-effect ratios improved by a factor of five. Peak-flow and satisfaction did not show improvement relative to the control group. The elderly project is currently being analyzed. Preliminary results show that intervention patients have significantly better quality of life and symptom scores, fewer problems with medicines, fewer contacts with GP’s and decreased use of Benzoediazepines. Other indicators of drug use and knowl-edge, compliance and general satisfaction showed no difference between the groups. Satisfaction with information improved. &RQFOXVLRQ Comparing results from the two models it appears that the asthma model has worked as intended whereas the model for the elderly patients had less impact on drug therapy quality than an-ticipated. 29(57+(&2817(5 &2'(,1( 86( ,1 ,&(/$1' 7+( ,03$&7 2) ,1&5($6(' $&&(66$QQD %LUQD $OPDUVGyWWLU‚ $OPDU *UtPVVRQÁ ‚'DQPDUNV )DUPDFHXWLVNH +¡MVNROH 8QLYHUVLWHWVSDUNHQ   .¡EHQKDYQ ‘ 'DQPDUN Á$/%$6 /WG 3KDUPDFHXWLFDOV DQG +HDOWK 3ROLF\ &RQVXOWDQF\ $JHQF\ 5H\NMDYtNXUYHJXU   +DIQDUIMRUGXU ,VODQG %DFNJURXQG The objective of this study was to test the assumption that liberalising community pharmacy ownership in Iceland would lead to increased irrational use of over-the-counter pain reliev-ers containing codeine. 0HWKRGV Based on this assumption we built and tested a model using an interrupted time series de-sign that contrasts the monthly sales data for over-the-counter pain relievers containing codeine before and after the legislation took effect. 5HVXOWV The total use of over-the-counter pain relievers containing codeine as well as those contain-ing paracetamol and codeine has risen steadily throughout the period under study. The interrupted time series did not show a substantial effect from the legislative change on the use of all over-the-counter codeine pain relievers, paracetamol with codeine, and acetylsalicylic acid with codeine com-binations. &RQFOXVLRQ The assumption that increased access leads to irrational use of over-the-counter medicines is not substantiated in the case of over-the-counter pain relievers containing codeine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n 1992, sumatriptan was launched in Denmark as the first drug in a new class of drugs. The main indication is migraine and cluster headache. Pharmacoepidemiological studies have shown that a minority of the patients are responsible for a large proportion of the total use, and inappropriate use is common. One method in changing the use of drugs is giving information to the patients. However, only a very few valid trials on the subject have been carried out. Odense Pharmacoepidemiological Database (OPED) covers all reimbursed medicine at the level of the individual user. For each prescription, the brand, quantity, the patient’s civil registration number, the form and quantity of the drug are recorded. $LP To develop and measure the effect of combined verbal and written information on inappropriate use of triptanes. 0HWKRG All pharmacies in the County of Funen have been invited to participate in the study. The pharmacies are randomised to either a control or an intervention group. The staff at the pharmacies is invited to follow courses on migraine. A pamphlet on triptanes has been elaborated. The pamphlet will be handed out at the pharmacies and to the patients given additional verbal information on the subject. The core message is that if the patients have an inappropriate consumption, they should discuss it with their GP. The intervention is planned to last 3 months, with 6 months follow-up (YDOXDWLRQ Effect on individual consumption will be measured by means of OPED. In order to throw light on attitudes towards this kind of intervention, a questionnaire has been developed. 86( 2) '58* '$7$%$6(6  7+( '$1,6+ :$< 3LD (KOHUV &KDUORWWH 0 (MOHUVHQ 6WHLQXQQ *XQQDUVGRWWLU -HQV .LHUNHJDDUG .LP .ULVWHQVHQ %RGLO 0XQN +DQVHQ %HQWH 2 /DUVHQ .LUVWHQ 1LHOVHQ $DVH 1LVVHQ .LUVWHQ 6FK IHU %LUJLW 7RIW .HOG 9 JWHU ) Lægemidler er en væsentlig behandlingsteknologi i almen praksis. Det afspejler sig blandt andet i de kvalitetsudviklingsaktiviteter der er i gang i alle amter. Amtskonsulenterne indgår ofte i projektgrupper med praktiserende læger, hvor udarbejdet materiale om de enkelte lægers ordinationsmønstre indgår som en naturlig del af et projektforløb. Brugen af de amtslige receptdatabaser til dokumentation af den faktiske ordinationsadfærd får de praktiserende læger til at reflektere over egne ordinationsvaner. Det kan dermed være med til at bane vejen for lægernes deltagelse i forskningsbaserede interventioner. Der præsenteres forskellige eksempler på anvendelsen af data fra amternes receptdatabaser og de sammenhænge som anvendelsen foregår i: - variationer i ordinationsniveau; sammenligning mellem amter (7 udvalgte ATC-grupper) - analyse af den køn- og aldersstandardiserede udvikling i sygesikringens medicinudgifter - guidelines; antibiotika - medical audit; psykiske problemer i almen praksis - brugerperspektivet; Ahormon-audit@ , spørgeskema til kvinder, borgermøder - datalink mellem lægemiddelordinationer og andre aktiviteter; astma/lungefunktionsmåling - ordinationsprofil for den enkelte praksis Amtskonsulenterne har via kvalitetsudviklingsaktiviteter og det indbyrdes netværk en bred erfaring på lægemiddelområdet. De forskere med interesse for lægemiddelordinationer eller lægemiddelinterventioner, som endnu ikke har etableret forbindelse til amtskonsulentnetværket, inviteres til at kontakte os med henblik på gensidig inspiration og eventuelt samarbejde. Amternes receptdatabaser Apotekerne afleverer hver måned edb-registrerede oplysninger om samtlige receptekspeditioner til sygesikringen. I forbindelse med indlæsning af data i receptdatabasen tilføjes supplerende oplysninger om receptudsteder, lægemiddel og patient, således at der for hver receptekspedition er oplysning om: - receptudsteder:ydernummer/sygehusafdelingskode, ydertype (fx. almen praksis), speciale - lægemiddel : varenr., definerede døgndoser, pakningsstørrelse, dispenseringsform og pris - patient: køn, alder, bopælskommune og bopælsamt For recepter fra almen praksis om lægemidlet er ordineret til en patient tilmeldt receptudstederens praksis I modsætning til Lægemiddelstyrelsens landsdækkende database er amternes receptdatabase valideret mht. bopælsamt og det er registreret om recepter udstedt af alment praktiserende læger er ordineret til patienter tilmeldt receptudstederens praksis. Til gengæld findes der i amternes receptdatabaser ingen individbaserede data, og for ikke-tilskudsberettiget medicin foreligger der overhovedet ingen patientoplysninger. Amtslige puljer til kvalitetsudvikling, forebyggelse og lokal efteruddannelse i almen praksis Siden 1. april 1995 er der i henhold til et overenskomstprotokollat for almen praksis og amterne afsat puljemidler (4,23 kr. pr. gruppe 1-sikret pr. år) til kvalitetsudviklingsarbejde, forebyggelsesaktiviteter og lokale efteruddannelsesaktiviteter. Denne finansieringsmulighed har bidraget til at øge aktiviteten på området. Amtskonsulenter på lægemiddelområdet *) En liste over samtlige amtskonsulenter/kontaktpersoner bliver udleveret på temadagen. 7+( ),'(/,7< &2()),&,(17 $ 0($685( 2) 7+( &203/(7(1(66 2) ,17(59(17,21 '$7$-HVSHU +DOODV &HQWHU IRU .OLQLVN )DUPDNRORJL 6\GGDQVN 8QLYHUVLWHW 2GHQVH %DJJUXQG Mange apoteker tilbyder interaktionsscreening og lignende ydelser. Effektiviteten af disse er afhængige af, om kunderne bruger samme apotek fra gang til gang. Tilsvarende overvejelser gælder lægernes muligheder for visse kvalitetsbetonede interventioner. 0HWRGH Trofasthedskoefficienten for en apotekskunde (thk-apo) er den andel af alle hans recepter, som indløses på det mest benyttede apotek. Tilsvarende kan en thk-yder defineres som den andel af en persons recepter, som er udskrevet af den mest brugte yder. Studiet tilstræbte at estimere thk-apo og thk-yder for befolkningen og at karakterisere variationen i thk. Datagrundlag var 2.8 millioner recepter registreret i OPED i 1998. 5HVXOWDWHU Thk-apo var 91.6% og thk-yder var 87.8% i gennemsnit. Begge thk steg med alderen og var vidtgående uafhængigt af køn. Thk-apo faldt med stigende urbanisering. Den andel af lægemiddelforbruget, som ligger uden for mest brugte apotek og yder var karakteriseret ved hhv akutte tilstande og specialistbehandling. En analyse af warfarininteraktioner viste ofte samme apotek men ikke samme yder for interagerende præparater. .RQNOXVLRQHU Både apoteker og receptudstedere har godt datagrundlag for interventioner mod interaktioner. Analysen af warfarininteraktionerne tyder dog på, at thk næppe er den væsentligste determinant for optræden af interaktioner. 7+( 86( 2) 9,$*5$ ,1 '(10$5.
%HQWH .UDJ ,QJYDUVHQ 3K' DQG &ODXGLD 5DQQHULHV 06F 'DQLVK 0HGLFLQHV $JHQF\ &RSHQKDJHQ 'HQPDUN %DFNJURXQG Viagra, which is a new drug used for treatment of impotence, was introduced in Den-mark October 5 1998. Since then Viagra has been prescribed to many men. The use of Viagra in com-bination with organic nitrates is contraindicated since it can lead to severe drops in blood pressure. The aim of this study was to evaluate 1) the use of Viagra among Danish men and 2) the number of men receiving both Viagra and organic nitrates during the analysis period. 0HWKRGV Patient specific data on all prescriptions to men (aged 16-94 years) of Viagra alone and in combination with organic nitrates were obtained from the Register of Drug Statistics at the Danish Medicines Agency. The analysis period covered the 4th-quarter of 1998 and the 1st- and 2nd-quarter of 1999. 5HVXOWV The total turnover of Viagra during the analysis period was 20.6 Mio DKr. In the 4th-quarter of 1998 the turnover of Viagra was 8.6 Mio DKr. The sales decreased by 29 % to 6.0 Mio DKr in the 1st-quarter of 1999 and remained unchanged at 6,0 Mio DKr in 2nd-quarter of 1999. 13,903 men received Viagra in the 4th-quarter of 1998. 36% and 8 % fewer men received Viagra in the 1st- and 2nd-quarter of 1999, respectively. In total approximately 21,230 men received at least one pre-scription of Viagra during the analysis period. Viagra was predominantly prescribed to men aged be-tween 55 and 64, followed by men aged between 65 and 74. In the 4th-quarter of 1998 approximately 5 times as many men received Viagra as compared to other drugs against impotence. The difference was less pronounced in the 1st- and 2nd-quarter of 1999, where only 4 times as many men received Viagra contra other drugs against impotence. More men were treated for impotence in all three quarters of the analysis period as compared to the same quarters the year before (21,230 and 8,930 respectively). Among the men receiving Viagra in the 4th-quarter of 1998 about 134 men also received at least one nitrate preparation. In the 1st- and 2nd-quarters of 1999 only 50 and 46 men, respectively, received both Viagra and organic nitrates. Other antihypersentive medications have been prescribed to men receiv-ing Viagra, mostly ACE-inhibitors and calcium channel blockers. About 340 men received at least 3 different kind of antihypertensive medications in the 4th-quarter of 1998 decreasing to 174 and 155 in the 1st- and 2nd-quarter of 1999 respectively. &RQFOXVLRQ The total turnover of Viagra and the number of men receiving Viagra decreased from the 4th-quarter of 1998 to the 1th-quarter of 1999. While the turnover of Viagra remained unchanged in the 2nd-quarter of 1999 the number of men receiving Viagra decreased further in the 2nd-quarter of 1999. The number of men receiving at least one prescription of medications used to treat impotence was greater in 4th-quarter of 1998 and the two first quarters of 1999 as compared to the same quarters the year before. Despite being contraindicated men were prescribed both Viagra and nitrate preparations in the same quarter. However the number of men receiving both drugs in the same quarter decreased during the analysis period. 7,'/,*(5( $17,%,27,.$.85( 620 5,6,.2)$.725 )25 $17,0,.52%,(/ 5(6,67(16 %/$1'7 %$.7(5,(5 , 0(//(0‘5(7 +26  c5,*( %‘51 1DQD 7KUDQH &KDUORWWH 2OHVHQ Ã+HQULN 7RIW 6¡UHQVHQ +HQULN &DUO 6FK¡QKH\GHU &HQWHU IRU (SLGHPLRORJLVN *UXQGIRUVNQLQJ $DUKXV 8QLYHUVLWHW 'HQ PHGLFLQVNH )RUVNQLQJVHQKHG 5LQJN¡ELQJ $PW .OLQLVN PLNURELRORJLVN DIGHOLQJÃ $DOERUJ 6\JHKXV %DJJUXQG Undersøgelse af sammenhæng mellem antibiotikaforbrug og resistensmønster er vigtige, også i en population som den danske med lavt forbrug af antibiotika. Et stort antal studier i udlandet rapporterer deskriptive data vedrørende stigende hyppighed af resistente bakterier i mellemøret hos førskolebørn. Få studier sammenkæder oplysninger om individuelt antibiotikaforbrug og antimikrobiel resistens. Registre baseret på administrativt indsamlede oplysninger er billige og valide datakilder, som sikrer ensartet information gennem tidsperioder ved gentagne studier. 0DWHULDOH Via cprnummer bliver oplysninger fra 'Laboratorieinformationssystemet, klinisk mikrobi-ologisk afdeling, Aalborg Sygehus', koblet med data fra 'Den farmakoepidemiologiske Receptdata-base, Nordjyllands Amt'. Studiepopulationen er 0-5 årige børn, som i perioden 1.4.1997-31.3.1999 fik foretaget deres 1. ørepodning i Nordjyllands Amt. For det enkelte barn er forbrug af systemisk antibi-otika i perioden 2-90 dage før podning sat i relation til antimikrobiel resistens hos beta-lactamaseproducerende luftvejsbakterier, Hæmophilus influenzae (HI) og Branhamella catarrhalis (BC). )RUPnO Formålet er 1) estimere risiko for resistens hos HI og BC i relation til antal antibiotikakure i perioden før podning og 2) undersøge sammenhæng mellem antibiotikatype og resistens hos HI og BC. 5HVXOWDWHU 48% af de ialt 2144 børn med ørepodning havde modtaget mindst een antibiotikakur i den forudgående periode. 6,7% af HI bakteriestammerne var resistente for ampicillin. Odds ratio (95% CI), for resistens var 1,3 (0,7-2,5) hvis barnet havde fået 1 kur (reference= 0 recepter), 1,5 (0,7-3,4) ved 2 kure og 2,2 (0,3-19,1) ved 4 kure forud for podningen. Odds ratio for resistens var 2,9 (0,8-10,1) hvis barnet udelukkende havde fået bredspektret penicillin sammenlignet med børn som kun havde fået behandling med penicillin V i perioden. 91,2% af BC var resistente for penicillin. Alle stammer blandt børn med 3 og 4 kure var resistente. .RQNOXVLRQ Undersøgelsen viser en tendens til at antal af antibiotikakure har betydning for resisten-sudvikling hos det enkelte barn. Odds ratio øges med stigende antal kure, dog fandt vi ingen resistente stammer blandt børn med 3 kure. Behandling med bredspektret penicillin synes at inducere resistens hyppigere end smalspektret penicilin. '2 35(*1$17 :20(1 86( ',63(16(' 0(',&$7,216" (;32685( '$7$ 2%7$,1(' ,1 $ 35(6&5,37,21 '$7$%$6( $1' %< ,17(59,(: &KDUORWWH 2OHVHQ &KDUORWWH 6¡QGHUJDDUG 1DQD 7KUDQH *XQQDU /DXJH 1LHOVHQ /RONMH GH -RQJYDQ GHQ %HUJ -¡UQ 2OVHQ 7KH (XUR0$3 *URXS 7KH 'DQLVK (SLGHPLRORJ\ 6FLHQFH &HQWUH 8QLYHUVLW\ RI $DUKXV 7KH 0HGLFDO 5HVHDUFK 8QLW 5LQJNM¡ELQJ &RXQW\ 5HVHDUFK 8QLW RI &OLQLFDO (SLGHPLRORJ\ $DOERUJ +RVSLWDO 'HQPDUN 'HSDUWPHQW RI 6RFLDO 3KDUPDF\ DQG 3KDUPDFRHSLGHPLRORJ\ *URQLQJHU 8WUHFKW ,QVWLWXWH IRU 'UXJ ([SORUDWLRQ *8,'(  8QLYHUVLW\ RI *URQLQJHQ 7KH 1HWKHUODQGV %DFNJURXQG Non-compliance with prescribed medication is a well-known problem in clinical practice. Compliance proportions for prescribed medications are about 50%, and compliance may be lower among pregnant women due to fear of adverse fetal effects. Besides of limiting the therapeutical benefits, non-compliance may result in erroneous conclusions in studys where exposure information are based solely on prescription data. $LPV To analyse; 1) compliance of drugs dispensed during pregnancy, 2) the proportion of exposed women who were captured by using The North Jutland Prescription Database (NJPD) as the only source of exposure, and 3) whether maternal age, smoking and drinking habits were predictors of compliance. 0HWKRGV The NJPD was used to identify all prescriptions dispensed during pregnancy for 2041 women who were enrolled in the Danish National Birth Cohort (BICO) in the county of North Jutland, Denmark. Compliance was defined as the percentage of concordance between exposure in NJPD and BICO. The number exposed who were actually captured by using NJPD as the only source of exposure data was defined as NJPDCapture. 5HVXOWV The overall compliance of drugs dispensed during pregnancy were 47% (95% CI; 43,50), ranging from 0 to 100% within ATC groups. The NJPD identified 19% of the exposures identified in BICO. However NJPDcapture differed within ATC groups and over the counter drugs accounted for many of the “false negatives”. Neither maternal smoking, drinking habits nor age were found to correlate with compliance in this study.
&RQFOXVLRQ The overall compliance of prescribed drugs was low and women were exposed to many other drugs than those identified in NJPD. Our study indicates that for many drug groups, the computer-recorded prescription is an inadequate definition of exposure. NJPD and BICO provided complementary information and the combination improved the validity of exposure information obtained in both datasets.
6 86( 2) 665,V  )520 21( 67,*0$ 72 $127+(5.QXGVHQ 3LD +DQVHQ (EED +ROPH 5R\DO 'DQLVK 6FKRRO RI 3KDUPDF\ 'HSDUWPHQW RI 6RFLDO 3KDUPDF\ 8QLYHUVLWHWVSDUNHQ   &RSHQKDJHQ ‘ 'HQPDUN 7HO      )D[      (PDLO SLQL#PDLOGIKGN ,QWURGXFWLRQ While the consumption of psychotropic drugs in general has declined, the use of SSRIs (Selective Serotonin Reuptake Inhibitors) has increased drastically since their introduction as a new generation of antidepressants in Denmark in 1986.Prescription statistics have shown a tendency towards a younger group of users and a less pronounced gender difference than seen in other groups of psychotropic drugs. The concept of having an emotional condition has an unfavourable public image; moreover the treatment with psychotropic drugs also implies specific connotations. The word ‘happiness-pill’ has frequently been used about the SSRIs in the media and this might convey a stereotype image of the users. In order to understand the mechanisms underlying the use, it is important to know how the users themselves view the medicine and their use and how they have developed this view. Research on this topic has to be carried out from a user perspective. The reason for choosing young women in this study is that very little is known about this group of SSRI consumers although the group is growing. $LP The purpose of this study was to explore young women’s perceptions of and attitudes towards SSRIs and through analysis identify themes which were found to be important in the use of SSRIs. 6DPSOH Inclusion criteria: Danish women in the age group between 18 and 34 who use SSRIs. Exclusion criteria: Hospitalisation at the time of the interview and misuse of psychotropic drugs. 0HWKRG The informants were found through five pharmacies in the Copenhagen area. Based on prescriptions, the pharmacy identified potential participants and handed out a contact letter from the researcher. The women who wanted to participate then contacted the researcher and signed a letter of consent. Eleven semi-structured in-depth interviews were conducted and taped in the women’s homes. Each interview lasted approximately one hour. The interviews were transcribed verbatim. All data was read thoroughly, then coded and themes identified. Further coding based on these themes was conducted making conceptual linkages. The project had ethical committee approval. )LQGLQJV Among the themes identified were: How the women experienced themselves before and after getting the prescription. How they thought society looked upon their emotional condition and the medication. How they managed information concerning their emotional condition and taking medicine. Looking through these themes, a common underlying feature was a conception of stigmatisation1. Not only was the stigmatisation related to having an emotional condition but also to the use of antidepressants. A part of this feature was also in which way the women were handling this stigmatisation. &RQFOXVLRQ The deviation from what is considered normal in our society leaves the people using SSRIs with a stigma. This has an impact on the use. The women accepted to take the medicine. Thereby they went from one stigma, connected to having an emotional condition, to another stigma that was easier for them to handle– namely the use of SSRIs. The women were concealing both the condition and the medicine use from most people in their social circle. This was a result of the women's own anticipation of the stigma and the fear of the reactions if revealing it. 1Goffman, Erving (1963) 6WLJPD 1RWHV RQ WKH 0DQDJHPHQW RI 6SRLOHG ,GHQWLW\ Harmondsworth: Penguin. 86( 2) +25021( 5(3/$&(0(17 7+(5$3<    ,1 )81(1 &2817< '(10$5. $ 3+$50$&2(3,'(0,2/2*,&$/ ,19(67,*$7,21 2) 87,/,6$7,21 $1' &203/,$1&(-RKQ /DUVHQ ! -HQV 6RQGHUJDDUG 0RUWHQ $QGHUVHQ  'HSDUWPHQW RI &OLQLFDO 3KDUPDFRORJ\ 5HVHDUFK 8QLW RI *HQHUDO 3UDFWLFH! 8QLYHUVLW\ RI 6RXWKHUQ 'HQPDUN 2GHQVH 'HQPDUN %DFNJURXQG Despite the well-established effect of hormone replacement therapy (HRT) on peri- and postmenopausal hormone deficiency sequelae (osteoporosis, cardiovascular disease and climacteric symptoms), HRT use seems to be sporadic and persistence with treatment low. Aim of this study was to describe the development of HRT use and compliance over the last six years. 0HWKRGV All HRT prescriptions from 1993 through 1998 were retrieved from the Odense Pharmacoepidemiological Database (OPED), a prescription database covering 470,000 inhabitants (240,000 women) in 1995 in Funen, Denmark. 5HVXOWV Total consumption increased from 4,57 mio to 5,35 mio doses/year. Annual prevalence among females increased from 95.0 to 105.3/1,000/year, whereas the incidence decreased from 25.1 to 16.7/1,000/year. Mean age at start of treatment was 52.2 years, which was constant during the study period. A five-year follow-up of persistence with HRT will be presented. 'LVFXVVLRQ Considering the rising evidence of the overall benefits of HRT it is surprising that the in-cidence decreased during the study period. This may be explained by the increased focus on the risk of long-term development of cancer and thromboembolic diseases. In light of the increased preva-lence, however, duration of treatment seems to have increased during the observation period.

Source: http://www.farmakoepi.dk/nyhedsbreve/epifyt10.pdf

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Failure to handle more than one internal representation in visual detection tasks Andrei Gorea*† and Dov Sagi‡ *Laboratoire de Psychologie Expe´rimentale, Centre National de la Recherche Scientifique & Rene´ Descartes University, 71 Ave. Edouard Vaillant, 92774Boulogne-Billancourt, France; and ‡Department of Neurobiology͞Brain Research, Weizmann Institute of Science, Rehovot, 76100

Microsoft word - 5.6.f.niere.doc

5.6. Fragen zu Niere und Wasserhaushalt Wasserhaushalt (3) Die Teilchenkonzentration (Osmolarität) des Extrazellulärraums kann durch äußere Faktoren beeinflusst werden. Wie ändert sich in den folgenden Fällen die Osmolarität des EZR? Geben Sie jeweils eine Begründung. a) häufiges Erbrechen b) starkes Schwitzen c) achtstündige Skitour bei kalter, trockener Luft. Lösung a

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