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Biomedical subjects

J Straand

Publications and source records attributed to J Straand.

At least 19 recordsLinked to original sources
PubMed2001

[Acid-related disease in the population of two Norwegian municipalities--diagnosis and drug therapy].

BACKGROUND: The introduction of acid suppressant, cytoprotective and prokinetic drugs represented major progress in the treatment of acid-related diseases. In Norway, these drugs were reimbursed by the National Insurance System (NIS) from 1986. However, even if the distribution of the various diagnostic indications for prescribing were lacking, this reimbursement was stopped in 1995. The aim of this study was to describe prescriptions for presumed licensed diagnostic indications of these drugs for a defined population, and analyse them with regard to patients characteristics, verified (endoscopic) diagnoses, and therapeutic guidelines. MATERIAL AND METHODS: All prescriptions issued in 1994 to inhabitants of Lindesnes and Mandal Municipalities (17,105 inhabitants) were retrospectively retrieved from the pharmacies and the NIS. The medical records of the local endoscopy units and roentgen laboratories were subsequently searched for information on diagnostic procedures and final diagnosis leading to the prescriptions for these patients. RESULTS: A total number of 1,128 prescriptions (87,905 DDDs) were issued to 441 patients (3% of the population at risk; mean age 63 years; 55% men), and more commonly for the elderly (for 11% of those aged 80 years or more). Diagnostic procedures were documented for 93% of the patients (upper endoscopy in 404, 92%). Diagnostic indications for prescribing were reflux oesophagitis (48%), duodenal ulcer (24%), gastric ulcer (13%), and dyspepsia with normal endoscopic findings (12%). The drugs issued were H2-receptor antagonists (59%), proton pump inhibitors (31%), and cisapride (10%). 8% of the patients were long-term users of an NSAID. Of the 441 patients, drug treatment was issued to 38 with normal endoscopic findings and to 31 patients in whom we could not document examination by endoscopy or X-ray. INTERPRETATION: This study supports that the prevalence of dyspeptic complaints calling for drug treatment increases with patient age. With minor exceptions we found that the prescribing practice for the different diagnoses is in accordance with established therapeutic guidelines.

Adolescent↗
PubMed2000

[Benzodiazepines--quality assurance of prescriptions in own general practice].

BACKGROUND: Even if benzodiazepines are recommended for short-term use, they are prescribed for years. Doctors often feel uncomfortable about this. MATERIAL AND METHODS: In this audit the prescription of benzodiazepines by one general practitioner was studied on the basis of the medical records, a mailed questionnaire to patients, and special benzodiazepine consultations which included diagnostic assessment. 17 long-term benzodiazepine users were given a follow-up which included general information, personal advice and alternative treatment aimed at discontinuing their use of benzodiazepines. RESULTS: 76 out of 754 patients had received prescriptions for a benzodiazepine during the previous three years. The questionnaire was completed by 63 patients. The results revealed that the treatment had originally been initiated by a general practitioner in 78% of the cases, most commonly for anxiety (40%), sleeping difficulties (23%), or depression (10%). Their doctor had previously suggested benzodiazepine withdrawal in 46% of the patients. One third were long-term users. 46% of these had used this medication more than ten years; 90% suffered from chronic illness. After 17 months, 47% of the patients had stopped using benzodiazepines while another 29% used significantly less than before. INTERPRETATION: A broad and individually tailored intervention towards patients in general practice may be a useful tool in reducing long-term use of benzodiazepines.

Adult↗
PubMed2000

Drug treatment of heart failure--do nursing-home residents deserve better?

OBJECTIVE: To describe and assess drug treatment of heart failure (HF) in nursing-home residents. DESIGN: Descriptive cross-sectional study. Individual patient information was obtained from the medical records and drug-dispensing cards. SETTING: Nursing homes in Bergen, Norway. MAIN OUTCOME MEASURES: Demographic data, diagnostic data (main diagnoses, diagnostic indications for the drugs used), medications (drugs, dosage and duration of use). RESULTS: Data were gathered from 23 of 27 obtainable institutions representing 1552 residents (86% of the Bergen nursing-home population); 469 (30%) of the residents used drugs for HF, the majority of whom (293 patients) were treated with furosemide only. Supplementary angiotensin-converting enzyme (ACE) inhibitors (predominantly in sub-target doses) were provided to 17% of the HF patients. About one out of four used drug combinations which we considered to be potentially harmful for HF patients. CONCLUSIONS: ACE inhibitors are probably under-utilised for HF in nursing-home residents. Potentially harmful drug combinations commonly occur. Both diagnosis and drug treatment for HF should be challenged in the nursing-home setting.

Aged↗
PubMed1999

[The HOT study].

Explore the source record for details and available documents.

Antihypertensive Agents↗
PubMed1999

Elderly patients in general practice: diagnoses, drugs and inappropriate prescriptions. A report from the Møre & Romsdal Prescription Study.

BACKGROUND: Elderly patients are particularly vulnerable and most at risk of suffering adverse drug reactions, which are often caused by inappropriate prescribing practice. Gaining insight into physicians' drug prescribing patterns in order to identify prescribing problems is the fundamental first step in trying to improve the quality of prescribing. OBJECTIVES: We aimed to describe drug prescribing in general practice for elderly patients, using patients' age and sex, encounters, indications for prescribing and the occurrence of some predefined inappropriate drug prescriptions. METHODS: A cross-sectional, descriptive study was conducted in the Norwegian county of More & Romsdal. All patient contacts (n = 16 874) and prescriptions (n = 16 774) issued during two months in general practice were recorded. In defining inappropriate prescriptions, explicit criteria were used. RESULTS: Prescriptions (of which 72% were repeat) were issued during two-thirds of all contacts, and 63% were for females. Seventy per cent of all prescriptions were made up by the ten most commonly prescribed therapeutic groups, for which the three most frequent diagnostic indications for prescribing comprised between 47 and 89% of all diagnoses for prescribing each of them. About one in six patients who received a benzodiazepine tranquillizer was concurrently prescribed another benzodiazepine for sleeping problems. In total, 13.5% of all prescriptions met at least one of the criteria listed for pharmacological inappropriateness. CONCLUSION: Inappropriate drug prescriptions for elderly patients are common in general practice. Since the majority of the prescribing practice is made up by rather few diagnoses and drugs, improved practice for only a few may nevertheless have a large impact on the total profile.

Age Distribution↗
PubMed1999

Influence of prescription patterns in general practice on anti-microbial resistance in Norway.

BACKGROUND: The global pandemic of antibiotic resistance is causing considerable concern, and a major reason for the growing world-wide resistance problem is the overuse of anti-infective drugs, especially the use of broad spectrum antibiotics. This is still a relatively minor problem in most of the Nordic countries where the consumption of antibiotics is less than half of that reported from southern Europe and the United States of America (USA). AIM: To describe the resistance pattern among common respiratory tract pathogens in Norwegian general practice, the national consumption of antibiotics, and GPs' prescription patterns for respiratory tract infections. To offer some suggestions as to why Norway has maintained a favourable situation regarding resistant microbes during the past 10 years. METHODS: An analysis of the prescription patterns in Norwegian general practice. RESULTS: There is a low total prescription volume of antibiotics compared with other countries. Penicillin V is the most commonly used antibiotic for the most common airway diseases in general practice in Norway. CONCLUSION: Although there is a low prevalence of antibiotic resistance in Norway, there is still a great potential for reducing the unnecessary antibiotic prescribing for the most common respiratory illnesses.

Anti-Bacterial Agents↗
PubMed1998

Prescribing systemic antibiotics in general practice. A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To describe general practitioners' (GPs) prescribing patterns for antibiotics and to compare them with therapeutic guidelines. DESIGN: Cross-sectional, observational study. SETTING: In the Norwegian county Møre & Romsdal the GPs recorded all contacts with patients and prescriptions during two months. SUBJECTS: 69,843 contacts with 56,758 prescriptions, of which 7905 were for systemic antibiotics. MAIN OUTCOME MEASURES: Prescriptions in relation to diagnosis, kind of consultation, and patients' age and sex. RESULTS: 61% of all antibiotic prescriptions were for females, 26% were issued during indirect contacts, and 14% were repeat prescriptions. Phenoxymethylpenicillin was prescribed most frequently (32%), followed by co-trimoxazole (19%), tetracyclines (18%), erythromycin (16%), and penicillins with extended spectrum (6%). Urinary tract infection was the most frequent diagnosis for antibiotic prescribing (24%), followed by acute bronchitis (13%), ear infections (9%), upper respiratory tract infections (8%), and acute tonsillitis (8.2%). A regression analysis showed that first-time consultations for tonsillitis and otitis, but not for acute bronchitis and pneumonia, patient age 13-64 years, female physician, urban practice location, and a fixed. GP salary were associated with the prescribing of phenoxymethylpenicillin in contrast to other antibiotics. CONCLUSION: Antibiotics are often prescribed for viral infections (e.g., acute bronchitis). Broad spectrum antibiotics are often prescribed for diagnoses where penicillin is recommended as first choice. The issue of antibiotic misuse should be addressed more explicitly in general practice.

Adolescent↗
PubMed1998

Drug prescribing for children in general practice. A report from the Møre & Romsdal Prescription Study.

To investigate general practitioners' drug prescribing patterns for children (0-12 y), an observational, cross-sectional study was conducted in Western Norway. Seven thousand, two hundred and twenty-nine GP-patient contacts during which 5222 drugs were prescribed, were included for analysis. The highest prescribing rates were for boys < 2 y (82.1 prescriptions per 100 contacts). Two-thirds of all prescriptions were for drugs in main groups respiratory system or systemic anti-infectives. The 20 most commonly prescribed agents comprised 75% of all prescriptions. The 20 most frequently recorded diagnoses for prescribing comprised 81% of all. Phenoxymethylpenicillin was the most frequently prescribed antibiotic for otitis, tonsillitis and sinusitis, while erythromycin was used most often for bronchitis and pneumonia. Antibiotics were prescribed in more than 8/10 contacts for tonsillitis, sinusitis, acute bronchitis and pneumonia, and in two-thirds of all contacts for urinary tract infections. Sixty-five percent of the antibiotic prescriptions for urinary tract infections were for co-trimoxazole.

Chi-Square Distribution↗
PubMed1997

[10,850 general practice consultations with elderly patients. From diagnosis-prescription-examination in Møre and Romsdal].

Over a period of two months in 1988 and 1989 general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. Participation was close to 100%. We report data from 10,850 surgery consultations with elderly patients (65 years and older). 60% of the consultations involved female patients, and 58% of the patients were 65-74 years old. New diagnoses were made in one-third of the cases; two-thirds were follow-ups. The most common groups of diagnoses were cardiovascular (28%), musculoskeletal (13%), psychiatric (8%) and respiratory diseases (8%). Almost 10% of all consultations were for hypertension. Drugs were prescribed in 45% of all cases. 27% of all prescriptions were for cardiovascular drugs, and 25% were for drugs for the nervous system. The 20 most common diagnoses made up more than half of the total number of diagnoses. Almost 70% of all prescriptions were for the ten most common therapeutic groups.

Aged↗
PubMed1997

[1384 house calls to elderly patients in family practice. From diagnosis-prescriptions-examination in Møre and Romsdal].

Over a period of two months in 1988 and 1989 all general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. We report data from 1,384 house calls to elderly patients (65 years and older). House calls made up 11.3% of all face-to-face contacts between general practitioners and elderly patients. 59% of the visits were to female patients, and 60% were to patients 75 years and older. 23% of the house calls took place during weekends, and new diagnoses were made in 58% of the cases. The most common groups of diagnoses were cardiovascular (21%), respiratory (16%), and musculoskeletal diseases (13%). Drugs were prescribed for 42% of the house calls. 28% of all drugs prescribed were for the nervous system, while 26% were antibiotics for systemic use. Most house calls were made because of acute illnesses. Our results suggest that preventive home visits to the elderly are rarely, if ever, performed in general practice.

Aged↗
PubMed1997

[Patient encounters in general practice. An epidemiological survey in Møre and Romsdal].

In 1988 and 1989 all general practitioners (GPs) in Møre & Romsdal recorded all encounters with patients over a period of two months. The participation rate was close to 100% and a total of 90,458 encounters were recorded. Of all encounters 61% involved female patients. Female GPs had more female patients than their male colleagues (71% versus 59%). The discrepancy was most pronounced for sex-specific diagnoses. Home visits accounted for 9% of all direct encounters, an increase from the 5-6% reported in the 1970s. 37% of all contacts occurred by phone or messenger. The diagnostic distribution compares well with Olav Rutle's findings in 1978. Cardiovascular diseases, however, seem to have become less prominent since that time. The most frequent ICPC diagnoses were musculoskeletal (17%), respiratory (14%), cardiovascular (12%), and psychiatric (12%). Respiratory diseases dominated among children, musculoskeletal diseases among adults, and cardiovascular diseases among the elderly.

Adolescent↗
PubMed1997

General practitioners' drug prescribing practice and diagnoses for prescribing: the Møre & Romsdal Prescription Study.

We have examined the prescribing patterns among general practitioners (GPs) in a Norwegian county in relation to the patients' age and sex and the diagnosis for prescribing. Altogether 69,843 contacts with patients were recorded during which 56,758 items were prescribed. The average number of items prescribed per patient contact was 0.81 (male 0.76, female 0.83). Diazepam, the compound analgesic of paracetamol (i.e. acetaminophen) and codeine, and triazolam were the three most frequently prescribed drugs for females as compared to phenoxymethylpenicillin, paracetamol/codeine and diazepam for males. Insomnia was the most frequently recorded diagnosis for prescribing. Listed second were upper respiratory tract infections (males) and anxiety (females). Hypertension was the number three diagnosis. The twenty most frequently prescribed items accounted for 48.5% of all drugs prescribed and the twenty most frequently recorded diagnoses for prescribing accounted for 61.7% of all diagnoses. This makes it possible to analyze a substantial part of the GPs' total prescribing by focusing on a few drugs or diagnoses.

Adult↗
PubMed1997

Drug prescribing during direct and indirect contacts with patients in general practice. A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To describe general practitioners' (GPs) prescribing patterns during direct contacts (DC) vs. indirect contacts (IC) with respect to the patients (age and sex), diagnoses, and drugs. DESIGN: Descriptive study. SETTING: In the Norwegian county Møre & Romsdal, the GPs recorded all contacts with patients and prescriptions during two months. SUBJECTS: 69843 contacts with patients (42202 DC; 24983 IC) during which 56758 prescriptions were issued. MAIN OUTCOME MEASURES: Prescriptions (drugs, strength of tablets, amount prescribed, initial/repeat). Diagnoses for prescribing. RESULTS: 72 drugs were prescribed per 100 DC; 93 per 100 IC. The drugs prescribed most frequently during DC were CNS-drugs (19%), antibiotics (18%), and respiratory drugs (14%); and during IC, CNS-drugs (34%), cardiovascular (16%), and respiratory drugs (12%). More prescriptions during IC were repeat (IC, 79%; DC, 37%). 57% of all CNS-drugs were issued during IC (90% of which were repeat prescriptions). 25% of the antibiotics were issued during IC (70% of which were initial prescriptions). CONCLUSION: The GPs' prescribing patterns during DC and IC are different, which probably reflects that different health problems are handled during DC and IC. Prescription studies should address both settings. Our findings raise concern about the medical foundation for antibiotic and psychotropic prescribing during IC.

Adolescent↗
PubMed1997

Are prescribing patterns of diuretics in general practice good enough? A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To examine general practitioners' (GPs) prescribing patterns of diuretics with respect to indications, drugs and doses to reveal possible needs for prescribing audits. DESIGN: Observational, cross-sectional study. SETTING: The Norwegian county Møre & Romsdal. SUBJECTS: 1896 prescriptions for diuretics prescribed by GPs during two months. MAIN OUTCOME MEASURES: Prescriptions (drugs, strength of tablets, volume prescribed, directions for use). Diagnoses for prescribing. RESULTS: Furosemide was prescribed most frequently (48.7%) followed by the compound diuretic of hydrochlorothiazide and amiloride (26.4%), thiazides and related drugs (13.0%), and spironolactone (5.8%). Diuretics were mainly prescribed for hypertension (48.4%), congestive heart failure (35.6%), and oedemas (e.g. orthostatic) (6.1%). The patients' mean age was 69.2 years; two of three were females. When thiazides and related drugs were prescribed for hypertension, we found that the daily dose was excessive in 37.2% of the cases. In congestive heart failure, furosemide was prescribed in about four of five cases, while bumetanide was prescribed in 1.5% of the cases. CONCLUSION: Our findings indicate that GPs need more knowledge about low-dose diuretic therapy in hypertension, about different diuretic regimens in heart failure, and about non drug treatment for orthostatic oedema. Clinical pharmacology regarding diuretics should be given priority in the vocational training and continuing education for GPs.

Adolescent↗
PubMed1997

General practitioners' prescribing patterns of benzodiazepine hypnotics: are elderly patients at particular risk for overprescribing? A report from the Møre & Romsdal Prescription Study.

OBJECTIVE: To compare general practitioners' (GPs) prescribing patterns of benzodiazepine hypnotics with current recommendations. DESIGN: Observational, cross-sectional study. SETTING: The Norwegian county Møre and Romsdal. SUBJECTS: 3452 prescriptions for benzodiazepine hypnotics prescribed by GPs for patients aged 20 years and older during two months. MAIN OUTCOME MEASURES: Prescriptions (strength of tablets, amount prescribed given in Defined and Prescribed Daily Doses: DDDs and PDDs, directions for use); initial or repeat, patients (age, sex); kind of GP-patient contact during prescribing. RESULTS: 68.4% of the prescriptions for benzodiazepine hypnotics were for women; 52.7% were for patients aged 65 or older (65+); 59.9% were issued during indirect contacts; 81.9% were repeat prescriptions. The amount of drug per prescription increased with patients' age: 65+ received on average 69.9 DDDs (76.9 PDDs) per prescription compared with 34.4 DDDs (37.1 PDDs) for young adults (20-29 years). About four of five prescriptions were for the "strong" (i.e. 1 tablet = 1 DDD) sleeping pills irrespective of patients' age and type of prescription (initial or repeat). Written directions for use were: "to be taken daily" in 55.1%, and "only if required" in 38.0% of the prescriptions. Written information on duration of "cure" was only found in one case. CONCLUSIONS: GPs' prescribing patterns are not in accordance with recommended dosage and duration of treatment; this pattern is most pronounced for elderly patients.

Adult↗