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Jakob Kragstrup

Publications and source records attributed to Jakob Kragstrup.

At least 19 recordsLinked to original sources
PubMed2006

[How participation in a clinical trial affects doctors' choice of treatment].

In a retrospective cohort study, the effects of participation in a company-sponsored clinical trial on asthma drug prescribing were investigated. Ten trial-conducting practices were compared with 165 control practices. Conducting the trial did not influence guideline adherence measured as the prevalence of inhaled corticosteroid use among users of inhaled beta2-agonists. However, participation in the trial led to an increased preference for sponsor's drugs.

English Abstract↗
PubMed2006

[Skin prick tests of patients with hay fever carried out in general practices compared with those carried out in a specialist outpatient clinic].

INTRODUCTION: The aim of our study was to assess whether general practitioners and their staff (practices) who had attended a short CME course with technical instruction in the skin prick test could diagnose and treat unselected patients with allergic rhinoconjunctivitis at the same quality level as the allergy outpatient clinic. MATERIAL AND METHODS: We performed a multicentre study with the participation of 38 general practices and the Allergy Centre at Odense University Hospital (OUH). After a two-day course for the general practitioner and his practice staff, every practice performed a skin prick test on 10 consecutive adult patients with symptoms of allergic rhinoconjunctivitis during the spring and summer. A standardised questionnaire was also filled in and sent to the Allergy Centre, where the patient subsequently had another skin prick test carried out. The results of the tests were determined in duplicate and then compared. RESULTS: No significant differences in the quality of the skin prick test for 10 allergens or histamine control were found between the general practice and the Allergy Centre. Discordant results were found in 9%, i.e., a positive result either at the practice or the Allergy Centre, but not at both. CONCLUSION: After a training course, general practitioners and their staff are fully able to perform and validate skin prick tests for inhalation allergens.

Adult↗
PubMed2006

How conducting a clinical trial affects physicians' guideline adherence and drug preferences.

CONTEXT: General practitioners are frequently involved in clinical trials sponsored by pharmaceutical companies but the effects of participation on their prescribing patterns have not been evaluated. OBJECTIVE: To determine how conducting a company-sponsored clinical trial influenced physicians' adherence to international treatment recommendations and their prescribing of the pharmaceutical company's drugs. DESIGN, SETTING, AND PATIENTS: Observational cohort study in Funen County, Denmark, comparing 10 practices that were conducting a trial on asthma medicine with 165 control (non-trial-conducting) practices. The study population included 5439 patients treated with asthma drugs from the trial-conducting practices and 59,574 patients from the control practices. Practices conducted the trial between April 26, 2001, and October 7, 2002. MAIN OUTCOME MEASURES: Adherence to guidelines measured as use of inhaled corticosteroids among asthma patients. Prevalence of use of the company's drugs and the trial sponsor's share of the total volume of asthma drugs prescribed. RESULTS: The baseline proportion of asthma patients using inhaled corticosteroids was 68.5% in trial-conducting and 69.1% in control practices. Conducting the trial did not influence guideline adherence (odds ratio [OR] after 2 years, 1.00; 95% confidence interval [CI], 0.84-1.19). In trial-conducting practices, the sponsoring company's share of the total prescribed volume of asthma drugs increased compared with control practices (6.7%; 95% CI, 3.0%-11.7%). This could be attributed to a significantly higher preference for the company's inhaled corticosteroids (OR, 1.26; 95% CI, 1.04-1.54) and trends toward increased prescribing of the company's other asthma drugs. CONCLUSION: Conducting a trial sponsored by a pharmaceutical company had no significant impact on physicians' adherence to international treatment recommendations but increased their use of the trial sponsor's drugs.

Anti-Asthmatic Agents↗
PubMed2006

Narrow and wide prescribers among general practitioners: a cohort study of drug formularies used for new treatments.

OBJECTIVE: The aims of this study were to analyse (1) if it is possible to classify general practitioners (GPs) or groups of practitioners (practice units) as overall narrow or wide prescribers and (2) to what extent the size of practice drug formularies is associated with general prescribing behaviour, practice activity and demography. METHODS: Data were retrieved from the Odense University Pharmacoepidemiologic Database (OPED) and the prescribing patterns of 177 practice units were analysed in a 4-year period including 2000 and 2003. We characterised the drug repertoire for new treatments using a Formulary Diversity Scale based on two formulary measures, the DU 90% and the Formulary Selectivity Index. Multiple regressions were used to analyse the association between formulary size and practice characteristics. RESULTS: The final Formulary Diversity Scale comprised 15 therapeutic drug groups and 151 different analogues. The average score based on the DU 90% segment was 46 drugs (range: 28-65) corresponding to 30% of drugs available. Using the Formulary Selectivity Index the average diversity score was 0.70. Practices with a high number of patients and a high percentage of elderly patients were more likely to use a wide range of drugs. CONCLUSION: The Formulary Diversity Scale revealed wide variation between practice units, indicating the existence of both overall narrow and wide prescribers among GPs. The number of patients attending the practice and the percentage of elderly patients were directly associated with the use of more analogues.

Cohort Studies↗
PubMed2006

Analysing duration of episodes of pharmacological care: an example of antidepressant use in Danish general practice.

Analysing duration of treatment episodes has become a standard task in many pharmacoepidemiological studies. However, such analyses are often carried out in a rather simplistic manner and more subtle issues are often ignored. In this paper, methods of analysing duration treatment episodes beyond simple analyses allowing investigation of the risk for certain events over time are demonstrated. In particular, the use of cumulative incidence functions, cause-specific hazard functions, hazard rate models and expected mortality in analysing duration of episodes is presented. We used these statistical techniques in analysing the early treatment history of patients who started a regular treatment with antidepressant drugs in the primary health care sector in Denmark. We have extracted some important features: The risk of discontinuing and switching treatment was very high around 10 weeks after starting treatment. After discontinuing the first treatment period, many patients soon started a second treatment period depending on the duration of the first treatment period with highest risk around 10 weeks. The mortality rate among the patients in treatment was about three times higher than the expected mortality. The risk of dying immediately after stopping treatment was about twice the expected mortality. The analysis suggests that: (1) there is a critical period for a first discontinuing, switching and restarting treatment around 10 weeks, (2) the GPs prescribing habits have more influence on the patterns than patient or drug characteristics, (3) over time Danish GPs tend to prolong the duration of first treatment period and avoid longer treatment breaks.

Adult↗
PubMed2006

Economic evaluation of empirical antisecretory therapy versus Helicobacter pylori test for management of dyspepsia: a randomized trial in primary care.

OBJECTIVES: An economic evaluation was performed of empirical antisecretory therapy versus test for Helicobacter pylori in the management of dyspepsia patients presenting in primary care. METHODS: A randomized trial in 106 general practices in the County of Funen, Denmark, was designed to include prospective collection of clinical outcome measures and resource utilization data. Dyspepsia patients (n = 722) presenting in general practice with more than 2 weeks of epigastric pain or discomfort were managed according to one of three initial management strategies: (i) empirical antisecretory therapy, (ii) testing for Helicobacter pylori, or (iii) empirical antisecretory therapy, followed by Helicobacter pylori testing if symptoms improved. Cost-effectiveness and incremental cost-effectiveness ratios of the strategies were determined. RESULTS: The mean proportion of days without dyspeptic symptoms during the 1-year follow-up was 0.59 in the group treated with empirical antisecretory therapy, 0.57 in the H. pylori test-and-eradicate group, and 0.53 in the combination group. After 1 year, 23 percent, 26 percent, and 22 percent, respectively, were symptom-free. Applying the proportion of days without dyspeptic symptoms, the cost-effectiveness for empirical treatment, H. pylori test and the combination were 12,131 Danish kroner (DKK), 9,576 DKK, and 7,301 DKK, respectively. The incremental cost-effectiveness going from the combination strategy to empirical antisecretory treatment or H. pylori test alone was 54,783 DKK and 39,700 DKK per additional proportion of days without dyspeptic symptoms. CONCLUSIONS: Empirical antisecretory therapy confers a small insignificant benefit but costs more than strategies based on test for H. pylori and is probably not a cost-effective strategy for the management of dyspepsia in primary care.

Adult↗
PubMed2006

Intensive community pharmacy intervention had little impact on triptan consumption: a randomized controlled trial.

OBJECTIVE: To evaluate the impact of an intensive pharmaceutical care campaign targeting inappropriate use of triptans. DESIGN: Randomized controlled trial. SETTING: 22 community pharmacies in the County of Funen, Denmark. SUBJECTS: A total of 1123 triptan users at intervention pharmacies and 1340 at control pharmacies. INTERVENTION: Intervention pharmacy staff received information on migraine and other types of headache, detection of inappropriate triptan use and other drug-related problems, and techniques for establishing a dialogue with patients. Intervention consisted of a folder and a structured dialogue with the pharmacy staff. The folder included questions aimed at detecting overuse and inappropriate triptan use. MAIN OUTCOME MEASURES: Change in average triptan consumption in doses per month measured by means of a prescription database with information on all purchases of reimbursed drugs at the level of the individual patient. RESULTS: Overall, intervention had no statistically significant short-term impact on patients' consumption of triptans either among incident users (intervention/control ratio 1.02; 95% confidence interval 0.95 to 1.12), or among prevalent users (1.02; 0.97 to 1.08). No effects were observed after 6 and 9 months, apart from a possible borderline effect after 9 months among prevalent users with intermediate triptan consumption (0.93; 0.87 to 1.00). CONCLUSION: The pharmaceutical care campaign did not reduce the use of triptans.

Adult↗
PubMed2006

Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?

OBJECTIVE: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. PARTICIPANTS AND DESIGN: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. SETTING: The island of Funen/Denmark. MAIN OUTCOME MEASURES: Main outcome--hospital death. Intermediate outcome--TD. RESULTS: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups. CONCLUSION: Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.

Adolescent↗
PubMed2005

General practitioners choose within a narrow range of drugs when initiating new treatments: a cohort study of cardiovascular drug formularies.

OBJECTIVE: The aims of this study were (1) to develop and evaluate a new method for investigating personal drug formularies in general practice and (2) to test the hypothesis that there is a difference between personal drug formularies for incident and ongoing drug use. METHODS: In 2002, we studied prescribing patterns of beta-blockers, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin-II antagonists and statins in the County of Funen, Denmark (180 general practices, 472,000 inhabitants). For each practice, we distinguished between an incident drug formulary consisting of prescriptions for new users and an ongoing drug formulary including prescriptions for patients already in treatment. Prescription data were retrieved from the Odense University Pharmacoepidemiologic Database (OPED). Four different formulary measures were evaluated and used for comparing incident and ongoing drug use. RESULTS: General practitioners' (GPs') incident drug formularies comprised significantly fewer drugs than their ongoing drug formularies for all drug groups except angiotensin-II antagonists. The difference in the total number of drugs used was between 1.8 and 3.3. We found differences between 0.5 and 1.6 analogues in the DU 90% (number of analogues accounting for 90% of the prescribed volume measured in defined daily doses) segment and the formulary selectivity index between 0.05 and 0.12. The preference for the most prescribed analogue was 9-18% higher among incident patients. The formulary selectivity index was highly correlated with the other formulary measures and quantified both range and skewed distribution of drug choice. CONCLUSION: Analysing GPs' prescriptions to incident patients is a simple and inexpensive method for studying their own current personal drug formularies. GPs choose within a narrow range of analogues for incident patients.

Adrenergic beta-Antagonists↗
PubMed2005

Cancer patients' first treatment episode with opioids: a pharmaco-epidemiological perspective.

GOAL: The factors underlying the choice of opioids for cancer patients in primary care are largely unknown. Our aim was to describe cancer patients' first treatment episode with opioids in relation to disease characteristics and clinical course. PATIENTS AND METHODS: During 1997 and 1998, a population-based cohort of 4,006 incident cancer patients from a Danish county was identified. The patients were followed up from diagnosis to death or until 31 December 2003, and data on their use of opioids were obtained from a prescription database. MAIN RESULTS: Eventually, 54% of the cancer patients became incident users of opioids. Opioid treatment was initiated close to the diagnosis date in 20% of the patients. Most incident users (57%) were not terminal when they began using opioids, and 44% survived the first treatment episode. Of those who died, 70% received opioids in their terminal phase. The incidence rates of new opioid users were inversely related to the 5-year cancer survival period. A weak opioid was the first choice in 64% of the non-terminal users and in 43% of the terminal ones. No statistically significant differences in opioid use were found between men and women. CONCLUSIONS: Opioid use in cancer patients was not confined to the terminal course. Treatment with opioids should be viewed as a dynamic condition, with patients shifting between periods of use and non-use. The aggressiveness of the cancer and the presence of metastases were characteristics found to be strong determinants of opioid use.

Aged↗
PubMed2005

Use of opioids in a Danish population-based cohort of cancer patients.

Until recently, Denmark has had the highest use of strong opioids per capita in the world. Our aim was to analyze cancer patients' use of opioids in this population by linkage between the Danish Cancer Register and a prescription database. The changes in opioid use from 1994 to 1998 in the entire cohort of cancer patients (n=24,190) in a Danish county (n approximately 470,000) were analyzed. The overall consumption of opioids increased from 20 kg to 37 kg oral morphine equivalents (omeq) per year. The average consumption increased from 7.6 to 10.7 g omeq/opioid user/year. The annual proportion of users increased from 17% to 20%. The proportion of patients who were alive 2 years after their first opioid prescription increased from 38% to 55%. Increased awareness towards pain treatment, with earlier initiation of opioid treatment and higher doses to the cancer patients, could be major explanations for the increase in the cancer patients' use of opioids.

Aged↗
PubMed2005

Characteristics of middle-aged and elderly women with urinary incontinence.

OBJECTIVE: To describe the prevalence of urinary incontinence and to find characteristics useful in general practice for identifying middle-aged and elderly women with the problem. DESIGN: Cross-sectional interview study. SETTING: Population-based samples of Danes. SUBJECTS: A total of 5795 women older than 45 years (46+ years). MAIN OUTCOME MEASURES: Prevalence of incontinence and clinical characteristics assessed by standardized interview questions. RESULTS: The overall prevalence of urinary incontinence was 20% among women less than 60 years of age and 44% among those older than 80 years. Increasing age was highly associated with both forms of incontinence (stress and urge). High body mass index (BMI), chronic lung disease, and stroke were also associated with both forms, while number of children was associated with stress incontinence only. Predictive models show that 56% of women characterized by high age (older than 80 years) and overweight (BMI higher than 30) will suffer from urinary incontinence. The low-risk group defined by these two parameters (aged 46-60 years and not overweight) still had a 19% prevalence in the last month. CONCLUSION: The prevalence of urinary incontinence increased with age. Even in the low-risk groups the problem was very common in old age. Questions about incontinence should, therefore, be asked in relevant consultations with all elderly female patients.

Age Factors↗
PubMed2005

General practitioners' adoption of new drugs and previous prescribing of drugs belonging to the same therapeutic class: a pharmacoepidemiological study.

AIM: To test the hypothesis that general practitioners (GPs) with high prescribing levels of certain drugs will adopt new drugs belonging to the same therapeutic group faster than those with low prescribing levels. METHODS: The adoption of four new drugs: esomeprazol, selective cyclo-oxygenase-2 inhibitors, new triptans, and angiotensin-II receptor blockers were analysed using population-based prescription data. We used the preference proportion (prescriptions for new rather than older alternatives for the same indication) to measure GPs' adoption rate. Annual prescribing volume and prevalence were used to measure previous prescribing of older drug alternatives. We modelled the preference proportion using multiple linear regression analysis and the prescribing of older drugs as independent variables. We controlled for the GPs' general prescribing level and weighted for practice size. In the first three analyses, we dichotomized data using the median, lower and upper quartile as cut-off point. Next, we grouped data into quartiles and finally, we used continuous data. RESULTS: For esomeprazol and new triptans there was a higher preference for new drugs among "high prescribers", but only when this term was defined as the upper quarter and the upper half of previous prescribing levels, respectively (mean difference in preference proportion: 10.2% (99% confidence interval = 1.3%, 19.1%) and 8.2% (0.2%, 16.2%)). For the remaining two drug classes the associations were weak and almost all statistically nonsignificant. CONCLUSION: There is no consistent association between GPs' level of drug prescribing and their adoption of new drugs of the same therapeutic group.

Adult↗
PubMed2005

To what extent do mass media health messages trigger patients' contacts with their GPs?

BACKGROUND: A recent Cochrane review concluded that mass media intervention may play an important role in influencing the use of health services, but little is known about the effects of unplanned untargeted information in the media. AIM: To investigate the influence of messages in mass media about health issues on patients' contacts with their GPs. DESIGN OF STUDY: A case crossover design study comparing the frequency of receiving mass media health messages in a period before contact with a GP versus the frequency in matching control time periods for the same individuals. The outcome measure was the odds of patients having received health messages in the period before they contacted their GP, compared to the odds in the control periods. SETTING: The practices of 21 single-handed Danish GPs. METHOD: Three hundred and twenty-two patients between 18 and 91 years of age were interviewed by telephone after an unscheduled contact with a GP, and 148 patients were interviewed again 3-6 months later. Health media messages were only recorded if patients could remember the topics. RESULT: More than a third (35%) of the patients remembered receiving health media messages in the week before contact. No significant relationship (odds ratio = 1.2, 95% confidence interval = 0.5 to 2.6) between health messages and contact with GPs could be observed. CONCLUSION: In the absence of health campaigns and drug advertisements, mass media health messages seldom directly trigger patients to consult their GPs.

Adolescent↗
PubMed2005

Population-based study of place of death of patients with cancer: implications for GPs.

BACKGROUND: A majority of patients with cancer who are seriously ill have a preference of dying at home. However, only a minority of patients actually die at home in most Western countries. AIM: To explore factors associated with place of death in an unselected population of patients with cancer. DESIGN OF STUDY: Case-control study. SETTING: County of Funen, Denmark. METHOD: Register linkage from six Danish healthcare registers. RESULTS: The GP's home visit during the last 3 months before death was inversely associated with dying in hospital (adjusted odds ratio [OR] = 0.08, 95% confidence interval [CI] = 0.06 to 0.12) and so were community nurses visiting the home (OR = 0.36, 95% CI = 0.26 to 0.48). Furthermore, being married (OR = 0.68, 95% CI = 0.56 to 0.85), and age at death of 40-65 years (OR = 0.70, 95% CI = 0.56 to 0.90) seemed to have an effect. Hospital death was associated with survival time of less than 1 month (OR = 2.27, 95% CI = 1.69 to 3.13). Type of cancer, sex, or residence (urban versus rural) were not associated with a hospital death in this multivariate analysis. CONCLUSIONS: Dying at home was, to a higher extent, associated with GP visit and, to a lesser extent, community nurse visit than with clinical and sociodemographic characteristics of patients with cancer. In our view, these findings indicate the importance of the GP in particular. To increase the opportunity to die at home, more research is needed on the role of the GP and the interface between GPs and other providers of health care at home for patients who are terminally ill with cancer.

Adolescent↗
PubMed2004

Early discontinuation of antidepressants in general practice: association with patient and prescriber characteristics.

BACKGROUND: Most antidepressant treatment is initiated and continued in general practice but, despite current guidelines, treatment duration is often short among patients with depression. Discontinuation may, however, be caused by a complexity of factors, but so far research has focused on drug effects, adverse effects and drug regimens. OBJECTIVE: Our aim was to analyse whether early discontinuation of first-time antidepressant treatment in general practice may be predicted by (i) social position and psychiatric history of the patient; and (ii) demography, practice activity and the general prescribing behaviour of the GP. METHODS: Early discontinuation, i.e. that patients do not purchase antidepressants in the 6 months following first prescription, was analysed using established databases. Among patients presenting in 174 general practices in Funen County, Denmark, 4860 adult first-time users of antidepressants were identified (regardless of diagnosis). The inclusion period was January 1998-June 1999. RESULTS: One in three patients did not purchase antidepressants in the 6 months following first prescription, but rates were higher among those prescribed tricyclic compared with new generation antidepressants. Patients' age and sex did not have an influence, but early discontinuation was more frequent among patients of low socio-economic status and patients prescribed in practices characterized by high prescribing rates. No association with psychiatric history was observed. CONCLUSION: Early discontinuation is frequent in general practice, and patients of low social status are at greater risk. Adherence-promoting strategies should pay attention to the high prescribing doctors. Further studies may answer the question of whether the association between doctors' prescribing behaviour and early discontinuation is a feature specific to antidepressants or a more general phenomenon.

Adolescent↗