The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

Wettermark, Björn; Hammar, Niklas; MichaelFored, C.; Leimanis, Andrejs; Olausson, Petra Otterblad; Bergman, Ulf; Persson, Ingemar; Sundström, Anders; Westerholm, B; Rosén, Måns

doi:10.1002/pds.1294

Cited by 1,406 publications

(1,305 citation statements)

References 23 publications

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“…In brief, individuals with incident diabetes were identified through linkage of a 10-digit national personal identification number with six local and national registers: the Malmö HbA 1c register, the Regional Diabetes 2000 register of the Scania region [25], the Swedish National Diabetes Register [26], the Swedish National Inpatient Register [27], the Swedish Cause of Death Register [28] and the Swedish Prescribed Drug Register [29]. Apart from being captured in these registers, individuals with incident diabetes could also be captured by having a fasting plasma glucose concentration ≥ 7 mmol/l or a 120 min plasma glucose value of > 11.0 mmol/l in subpopulations of the MDC participating in a MDC re-examination [30] or the Malmö Preventive Project re-examination.…”

Section: Methodsmentioning

confidence: 99%

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Svensson

Kitliński

et al. 2017

Diabetologia

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Aims/hypothesis Sleep duration is a risk factor for incident diabetes mellitus and CHD. The primary aim of the present study was to investigate, in sex-specific analyses, the role of incident diabetes as the possible biological mechanism for the reported association between short/long sleep duration and incident CHD. Considering that diabetes is a major risk factor for CHD, we hypothesised that any association with sleep duration would not hold for cases of incident CHD occurring before incident diabetes ('non-diabetes CHD') but would hold true for cases of incident CHD following incident diabetes ('diabetes-CHD'). Methods A total of 6966 men and 9378 women aged 45-73 years from the Malmö Diet Cancer Study, a populationbased, prospective cohort, who had answered questions on habitual sleep duration and did not have a history of prevalent diabetes or CHD were included in the analyses. Incident cases of diabetes and CHD were identified using national registers. Sex-specific Cox proportional hazards regression models were stratified by BMI and adjusted for known covariates of diabetes and CHD. Results Mean follow-up times for incident diabetes (n = 1137/ 1016 [men/women]), incident CHD (n = 1170/578), nondiabetes CHD (n = 1016/501) and diabetes-CHD (n = 154/ 77) were 14.2-15.2 years for men, and 15.8-16.5 years for women. In men, short sleep duration (< 6 h) was associated with incident diabetes (HR 1.35, 95% CI 1.01, 1.80), CHD (HR 1.41, 95% CI 1.06, 1.89) and diabetes-CHD (HR 2.34, 95% CI 1.20, 4.55). Short sleep duration was not associated with incident non-diabetes CHD (HR 1.35, 95% CI 0.98, 1.87). Long sleep duration (≥ 9 h) was associated with incident diabetes (HR 1.37, 95% CI 1.03, 1.83), CHD (HR 1.33, 95% CI 1.01, 1.75) and diabetes-CHD (HR 2.10, 95% CI 1.11, 4.00). Long sleep duration was not associated with incident non-diabetes CHD (HR 1.33, 95% CI 0.98, 1.80). In women, short sleep duration was associated with incident diabetes (HR 1.53, 95% CI 1.16, 2.01), CHD (HR 1.46, 95% CI 1.03, 2.07) and diabetes-CHD (HR 2.88, 95% CI 1.37, 6.08).Akiko Kishi Svensson and Thomas Svensson contributed equally to this study. Electronic supplementary materialThe online version of this article (https://doi.org/10.1007/s00125-017-4464-3) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Section: Methodsmentioning

confidence: 99%

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Svensson

Kitliński

et al. 2017

Diabetologia

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“…Therefore, what can be done to improve adherence and subsequent patient care? Several methods have been shown to help enhance rational prescribing, centering on the four Es: education, engineering, economics, and enforcement [15]. This approach includes providing information and continuous medical education in combination with feedback on prescribing patterns.…”

Section: Regional Variations and Adherence To National Guidelinesmentioning

confidence: 99%

“…The establishment of the Swedish National Prescribed Drug Register in 2005 has created new opportunities for studies on the rational prescribing of antiasthmatic drugs [15]. This register includes all drugs dispensed to the entire Swedish population.…”

Section: Introductionmentioning

confidence: 99%

Regional variation and adherence to guidelines for drug treatment of asthma

Arnlind¹,

Wettermark²,

Nokela³

et al. 2009

Eur J Clin Pharmacol

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Aims To describe the utilization of antiasthmatic drugs in Sweden and to explore regional variations in drug utilization and adherence to guidelines for rational drug prescribing of antiasthmatics and their rationale. Methods Data on antiasthmatic drugs dispensed between July 2005 and December 2008 to all Swedish citizens aged between 18 and 44 years were obtained from the Swedish National Prescribed Drug Register. The period prevalence was determined by analyzing the number of users/1000 inhabitants, and the incidence by analyzing the number of new users after an 18-month drug-free wash-out period. Three drug-related indicators were used to assess the adherence to guidelines. All measures were analyzed by gender and region. Results A total of 161,000 patients were dispensed antiasthmatics in 2007, corresponding to a prevalence of 4 and 6% among men and women, respectively; the incidence rates were 2 and 3%, respectively. The total drug utilization and adherence to guidelines varied between regions. The total drug expenditures of antiastmatics were 258 million SEK (28 million euro), with fixed dose combinations accounting for 46% of the expenditure. No relation was found between models for allocating prescribing budgets or clear Drug and Therapeutics Committee recommendations and adherence to guidelines. Conclusion There are large regional variations in the utilization of antiasthmatics between Swedish regions, with substantial room for improvement in the adherence to guidelines. New methods of influencing physician behavior may be needed in the future to enhance adherence.

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“…Data from the Swedish Prescribed Drug Register were used [27]. The register includes prescribed drugs purchased at all Swedish pharmacies and thereby excludes drugs used in hospitals or purchased over the counter.…”

Section: Data Descriptionmentioning

confidence: 99%

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

Lesén

Petzold

Andersson

et al. 2009

Eur J Clin Pharmacol

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Purpose The indicator "concurrent use of three or more psychotropic drugs" has been used as a measure of quality in drug use among the elderly. The aim of our study was to assess to what extent the indicator captures the use of specific psychotropics associated with an increased risk of adverse events among the elderly, i.e., potentially inappropriate psychotropic drugs (PIP). Methods All individuals aged 75 years and older in Sweden purchasing prescribed psychotropic drugs in 2006 constituted the study population (n=384,904). Data on purchased psychotropic drugs from the Swedish Prescribed Drug Register were used. The overlap between individuals with the indicator and individuals using PIP was assessed with sensitivity, specificity, positive and negative predictive values and likelihood ratio as outcome measures. Results Among the psychotropic drug users, 15% had the indicator and 39% used PIP. The proportion of individuals with the indicator among all individuals using PIP was 27% (sensitivity). The proportion of individuals without the indicator among all individuals not using PIP was 93% (specificity). The positive predictive value was 72%, and the negative predictive value was 67%. Differences in outcome measures were observed between different categories of PIP. Conclusions The indicator "concurrent use of three or more psychotropics" can be technically easy to use, but PIP is more specific. Three quarters of all individuals who used PIP in this study were not captured by the indicator.However, two thirds of all individuals with the indicator used PIP. When selecting instruments to assess appropriateness in drug therapy in the elderly, clinical relevance should be balanced against convenience of use.

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The new Swedish Prescribed Drug Register—Opportunities for pharmacoepidemiological research and experience from the first six months

Cited by 1,406 publications

References 23 publications

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Incident diabetes mellitus may explain the association between sleep duration and incident coronary heart disease

Regional variation and adherence to guidelines for drug treatment of asthma

To what extent does the indicator “concurrent use of three or more psychotropic drugs” capture use of potentially inappropriate psychotropics among the elderly?

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