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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 33 (1987), S. 1-6 
    ISSN: 1432-1041
    Keywords: drug sales ; self-medication ; over-the-counter sales ; analgesics ; laxatives ; vitamins ; topical steroids
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The over-the-counter (OTC) sales of drugs were estimated by subtraction of sales on prescription and to hospitals from total drug sales in Sweden during the period 1976–1983. Increased sales of antitussives and decreased sales of expectorants characterized cough remedies. Making topical nasal decongestants available as OTC drugs immediately resulted in a large and increasing volume of OTC sales. Among analgesics, sales of acetaminophen and acetylsalisylic acid + caffeine combinations increased, while those of other groups decreased. Drugs for disorders of the alimentary tract were second to analgesics in the numbers of packs sold; amongst them antacids and laxatives dominated. Laxative sales decreased due to decreased sales of stimulant preparations. Vitamin C and multivitamin preparations dominated OTC vitamin sales. The sales of topical corticosteroids, only available as OTC drugs during the last quarter of 1983, were substantial. The OTC drug sales statistics reflect patterns of self-medication and may be used to monitor this important part of health care.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 50 (1996), S. 27-30 
    ISSN: 1432-1041
    Keywords: Key words Defined daily dose ; Minimum marketed dose; pharmacoepidemiology ; equipotential dose ; average daily dose ; prescribed daily dose
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract. Objective. As employment of different dose standards would be impractical and confusing, the aim of this article is to compare the defined daily dose (DDD) with some more recently proposed standards, namely, the minimum marketed dose (MMD), the equipotential dose (ED), the average daily dose (ADD), and the non-standard prescribed daily dose (PDD). Methods. Literature review, critical comparative analysis. Results. The DDD, defined by an independent scientific committee assisting the WHO Collaborating Centre for Drugs Statistics Methodology, has been employed in a large number of national and international comparative studies at the population level, usually as number of DDDs per 1000 inhabitants per day. However, the DDD can also be used at the individual level. The PDD, not being a standard unit, can be appropriately used in a second step to explain differences detected by the DDD methodology. Conclusions. 1A globally accepted dose standard unit is important in drug utilisation studies, particularly if different investigations are to be compared. None of the alternatives seemed to offer any advantage over the DDD. Hence there is reason to advocate use of the DDD as the sole standard dose unit in all pharmacoepidemiologic studies. A globally accepted dose standard unit is important in drug utilisation studies, particularly if different studies are to be compared [1]. As units of costs, packages or prescriptions are inadequate for obvious reasons, the defined daily dose (DDD) concept was introduced many years ago [2]. A DDD of a drug is defined by an independent scientific committee assisting the WHO Collaborating Centre for Drug Statistics Methodology, following an extensive review of the literature, as the assumed average daily dose of a drug for its main indication in adults [1, 3]. For comparative use the number of DDDs sold or prescribed is generally given as per 1000 inhabitants per day [1]. As such it has been used in a large number of studies and statistics on drug utilisation at the population level. However, the DDD may also be used at the individual level (see below). Recently, some alternative standard dose concepts have appeared, such as the minimum marketed dose (MMD) [4], the equipotential dose (ED) [5] and the average daily dose (ADD) [6]. As employment of different dose standards would be impractical and confusing, the present report assessed the possible advantages and disadvantages of MMD, ED and ADD relative to those of the DDD. The non-standard prescribed daily dose (PDD) is also discussed.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1041
    Keywords: diabetes ; therapy ; antidiabetic drugs ; therapeutic traditions ; questionnaire survey ; drug utilization ; international differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A questionnaire survey was carried out to explore differences in the approach to treatment of patients with Type II diabetes between physicians in Northern Ireland, Norway and Sweden, and to discover to what extent it could account for the three-fold difference in drug use between the countries. A representative sample of 400 physicians in each country was asked to give their opinions on the choice of therapy for three model cases designed to cover the spectrum of treatment — from diet alone to insulin. Significantly more Swedish (65%) than Northern Irish (51%) and Norwegian (52%) doctors suggested diet alone for uncomplicated diabetes recently discovered in a middle aged, overweight man. For symptomatic diabetes in a 76 year old overweight woman with few retinal microaneurysms, the majority of physicians in all three countries suggested treatment with sulphonylureas. Biguanides were here a more common alternative in Northern Ireland than in Scandinavia. For suspected secondary treatment failure in a 63 year old woman with no signs of complications, insulin was suggested by 71% of the Norwegian doctors but only by 44 and 49% of those in Northern Ireland and Sweden, respectively. General practitioners tended to suggest oral treatment earlier and to maintain it longer than hospital physicians. The study has demonstrated significant differences in the approach to treatment of Type II diabetes mellitus between physicians in the three countries. However, the differences were more prominent in the choice of drugs than in the threshold of drug treatment. The results also fit with qualitative but not with quantitative differences in drug sales between the countries, suggesting that important differences may exist in the prevalence of clinically recognized Type II diabetes.
    Type of Medium: Electronic Resource
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  • 4
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 39 (1990), S. 207-210 
    ISSN: 1432-1041
    Keywords: drug use ; defined daily dose (DDD) ; estimation of drug use ; prescription monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary To evaluate the accuracy of the DDD per 1000 inhabitants per unit time as an estimate of the fraction of drug users within a population, DDD figures have been compared with the proportion of apparent drug users, i.e. individuals in the population for who a prescriptions had been dispensed. An individual-based prescription monitoring project provided the necessary data for eight drugs representing continuous long-term medication, short-term medication and medication falling in between those two categories. For digoxin, the long-term drug, the number of DDD/1000 inhabitants/day was about 40% below the proportion of apparent drug users. The DDD figure for antibiotics ranged from 4% below to 28% above the apparent users, and for the remaining drugs it ranged from 17% below (bendroflumethiazide, 1982) to 80% below (naproxen, 1985). The DDD methodology is a valuable first step in overall drug use measurement, but for more precise estimates of drug use it must be supplemented by other techniques.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1041
    Keywords: Drug utilisation ; Standardisation ; defined daily dose (DDD) ; cardiovascular data ; age
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract In drug utilisation studies, the units of defined daily doses (DDD) and DDD/1000 inhabitants per day standardise for differences in dosage and population size, but not for age-related differences in drug utilisation. There is no consensus as to how age standardisation of DDD data should be carried out. Using cardiovascular drug utilisation data from Sweden and Spain, the current study compared the outcome of different methods of age standardisation. Both indirect methods (based on a comparison of observed and expected drug usage) and direct methods (using different weighting for the age categories) were used. The largest impact of standardisation was seen for diuretics. The crude rate for men and women combined was 26 DDD/1000 inhabitants per day in Costa de Ponent and 98 DDD/1000 inhabitants per day in Värmland. The corresponding figures when standardising the Costa de Ponent population were 26 and 58, respectively. Using the equivalent average rate (EAR) method, the rate for Värmland was 129 DDD/1000 inhabitants per day. Lesser but still important differences were found for β-adrenoceptor and antihypertensives. Thus, the results of standardisation differ depending on which method is used and which drugs are evaluated. EAR is recommended for direct standardisation because of its ease of use and because it does not require the choice of a standard population.
    Type of Medium: Electronic Resource
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  • 6
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 33 (1987), S. 7-13 
    ISSN: 1432-1041
    Keywords: drug prescription ; cost of drugs ; age dependency ; population study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Drug prescribing in Sweden under the National Insurance Act has been continuously recorded since 1974. A random sample of 1 in 288 is drawn from the about 24 million prescriptions issued yearly and the following data are recorded: dispensing pharmacy, type of prescription, year and month of dispensing, year of birth and sex of the patient, trade name, quantity, dosage, and price of the drug. The numbers of prescriptions of drugs free of charge increased by 32% between 1974 and 1983, while that of price deducted drugs decreased by 7%. The national cost of drugs rose sharply during the period. The per capita cost of drugs to persons aged ≥75 years was more than eight-fold higher than for persons aged ≤14 years. A two-fold difference in the number of prescription items was found between women and men, and there were nine- to tenfold differences between age-groups. Total prescribing varied modestly over time, as did the prescribing to most patient groups and for most groups of drugs. Exceptions to this were prescribing to children, particularly of antiallergic drugs for which a 50% increase was observed between 1974 and 1975, mainly due to increased prescribing of phenylpropanolamine. The recording of prescriptions as described is useful for early identification of new patterns of drug use and for mapping drug utilization and drug dosages in different age groups. The system is particularly powerful as a complement to other methods for recording drug use in Sweden, e.g. wholesale sales statistics and individual prescription monitoring in the county of Jämtland. Together these systems offer a unique data base for drug utilization studies.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1432-1041
    Keywords: antihypertensive drugs ; antidiabetic drugs ; prescribing practice ; utilization ; Northern Ireland ; Norway ; Sweden
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The amount of antihypertensive and antidiabetic drugs based of defined daily doses per 1000 inhabitants per day varies two to three fold between Northern Ireland, Norway, and Sweden. We explored whether variations based on the universally applied defined daily doses might be accounted for by national differences in the actual average prescribed daily doses. Use of prescribed daily doses for antihypertensive drugs resulted in Northern Irish and Norwegian consumption figures which were respectively 40 and 21% lower than the Swedish one, compared to 38 and 25% when defined daily doses were used. The effect of population age-sex differences on the gross defined daily doses per 1000 inhabitants per day figures was determined by applying the Northern Irish or Norwegian age-sex group proportions to Swedish age-sex specific sales data. Taking population differences into account would have resulted in antihypertensive drug use being 21 rather than 38% less in Northern Ireland and 18 rather than 25% less in Norway. Also adjustment for prescribed daily doses left an unexplained difference of 23% between Sweden and Northern Ireland and 14% between Sweden and Norway. For oral antidiabetics use of prescribed daily doses resulted in a Northern Irish — Swedish difference of 62% compared to 67% when defined daily doses were used. Simultaneous adjustment for population differences and prescribed to defined daily dose variations left a 52% difference.
    Type of Medium: Electronic Resource
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  • 8
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 38 (1990), S. 329-334 
    ISSN: 1432-1041
    Keywords: prescription monitoring ; drug dosage ; Sweden ; Jämtland
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Prescribed doses of drugs for which individualisation of dosage is deemed necessary were recorded from one national and one local Swedish prescription monitoring study for the years 1976, 1982 and 1985. Dose patterns were analysed in order to determine whether the practice of individualising drug doses had become more widely adopted by physicians. Amongst drugs eliminated primarily by metabolism, (propranolol and amitriptyline were prescribed in highly variable doses (30-fold or more). The three commonest doses of these agents accounted for about 60% of the prescriptions. In general, doses decreased with increasing patient age. Prescribing practices for piroxicam differed markedly from those of propranolol and amitriptyline, with one fixed dose of piroxicam accounting for about 90% of all prescriptions. For drugs eliminated mainly by renal excretion (digoxin, cimetidine and atenolol) there was an 8–10-fold variation in the prescribed doses. The most frequent dose of these drugs accounted for 40–60% of the prescriptions. Doses of cimetidine and atenolol were lowered only in the oldest patients. The doses of digoxin decreased more evenly with increasing age, and were reduced in elderly patients on long-term maintenance therapy. The difference in digoxin dose between young and old patients increased during the study period. Prescription monitoring as a method for following-up drug usage may be instrumental in evaluating the effect of drug educational efforts.
    Type of Medium: Electronic Resource
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  • 9
    Electronic Resource
    Electronic Resource
    Springer
    European journal of clinical pharmacology 40 (1991), S. 495-500 
    ISSN: 1432-1041
    Keywords: Psychotropic drugs ; drug utilisation ; geographical differences ; prescribing habits
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Marked differences in the utilisation of psychotropic drugs between the three major urban areas in Sweden were recorded from four sources of information: drug supplies from wholesalers to pharmacies, drug supplies to hospitals for in-patient use, drugs sold on prescription for out-patient use, and out-patient consultation and drug prescribing as recorded by physicians. The total sales of psychotropics in the counties of Gothenburg (110,8 defined daily doses per 1000 inhabitants per day) and Malmö (102,1) were much higher than in the county of Stockholm (73,4), with about 25% of the difference being accounted for by diazepam. Differences in the total sales of psychotropics were not explained by any differences in hospital sales, which amounted to about 10% in all counties. Prescription sales differed due to the higher average number of DDD (defined daily doses) per prescription in Gothenburg and Malmö than in Stockholm (total psychotropics 8 and 15%, respectively), and especially because of the higher number of prescriptions per inhabitant (about 40 and 30–35%, respectively). There was no substantial difference in the pattern of diagnoses between areas, but there was a noticeable difference with regard to prescriber category, as psychiatrists accounted for more of the prescriptions in Stockholm than in Gothenburg and Malmö. The results raise questions about over- and under-treatment of mental disorders and about abuse of drugs. In order to explain the geographical differences in psychotropic drug sales morbidity patterns and prescribing practices should be further explored.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-1041
    Keywords: Key words Codeine ; Propoxyphene ; Utilisation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objectives: To assess (1) whether the utilisation of codeine or propoxyphene differs among the three major Swedish cities (Stockholm, Göteborg and Malmö) and between urban and semirural areas; (2) if so, whether it co-varies with the utilisation of other potentially dependence-promoting drugs, benzodiazepines; (3) what influence age, gender and socioeconomic factors have on the prescribing of the two narcotic analgesics; and (4) whether different codeine-prescriber categories have different prescribing habits. Methods: In Sweden, all pharmacies are owned by one corporation, Apoteket AB. This corporation collects, stores and compiles statistics on all drug sales in Sweden, and data are available both on national, regional, county and municipal levels. The employed unit is defined daily dose (DDD) per 1000 inhabitants per day. Using the pharmacy computer system while dispensing a drug, prescription patterns can be elucidated. This system describes the number of drug items dispensed, drug amounts and age and gender of patients. Furthermore, data from another, ecological study were used to relate codeine and propoxyphene utilisation to that of benzodiazepines and to various socioeconomic data available from records of the city of Malmö. Results: The utilisation of analgesics in Sweden has increased during a 10-year period. The withdrawal of over-the-counter combinations containing aspirin and low-dose codeine in 1990 resulted only in a transient decrease of codeine use. The utilisation of codeine in Malmö and Göteborg was considerably higher than that in Stockholm and in the rest of Sweden, including the surroundings of Malmö. In Malmö and Göteborg, codeine was most often prescribed by private physicians to middle-aged persons, particularly women. Districts in Malmö with a high utilisation of codeine were associated with unfavourable socioeconomic conditions and a high utilisation of benzodiazepines. The utilisation pattern of propoxyphene showed less or no such deviations. Conclusion: The results suggest an inappropriate use of codeine in two major cities in Sweden.
    Type of Medium: Electronic Resource
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