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L Bjerrum

Publications and source records attributed to L Bjerrum.

At least 19 recordsLinked to original sources
PubMed2000

[Resistance testing in general practice--is it valid?].

Resistance of uropathogenic bacteria to antibiotics is an increasing problem in primary health care. The aim of this study was to evaluate antibacterial susceptibility testing of uropathogenic when performed in general practice. Urine specimens with a known quantity of typically uropathogenic bacteria were sent to 25 general practices. The predictive values of testing a bacterial strain as susceptible ranged from 0.89 (nitrofurantoin) to 1.00 (sulphamethizole), and the predictive value of testing a bacterial strain as resistant ranged from 0.55 (trimethoprim) to 0.90 (nitrofurantoin). If susceptibility testing is to be widely implemented in general practice it would be necessary to improve the validity.

Anti-Bacterial Agents↗
PubMed2000

[Big differences in the frequency of polypharmacy between physicians].

Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalisation. When the number of drugs is five or more (major polypharmacy), a significant risk may be present. We analysed the prevalence of major polypharmacy among listed patients, and identified possible predictors of major polypharmacy related to the practice. Prescription data were retrieved from the Odense Pharmaco-epidemiological Database and the age and sex standardised prevalence rate of major polypharmacy was calculated for each practice (n = 173). Possible predictors of major polypharmacy related to the GPs were analysed by backward stepwise linear multiple regression. A six-fold variation between practices in the prevalence of major polypharmacy was found, i.e. from 16 to 96 per 1000 listed patients (median: 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation.

Adult↗
PubMed2000

Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions.

OBJECTIVE: We examined to what extent the evidence of the relative gastrointestinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was implemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stockholm, Sweden, areas with accurate computerised information on prescriptions purchased by defined populations. METHODS: We ranked each NSAID by purchased volume in defined daily doses during September 1996 and compared it with the ranking of gastrointestinal complications from a meta-analysis of controlled epidemiological studies published between 1986 and 1994. We restricted our comparison to those NSAIDs that accounted for 90% of the use and within this DU90% segment we determined the proportion of "high risk" (azapropazone, ketoprofen, piroxicam) and "low risk" (ibuprofen, diclofenac) drugs with respect to gastrointestinal toxicity. RESULTS: In Funen, Denmark, we found the best NSAID profile (63% low risk/11% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk). CONCLUSION: Our study suggests that factors other than evidence-based medicine had a dominating impact on the use of prescription NSAIDs in 1996.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Wide variation in the number of different drugs prescribed by general practitioners. A prescription database study.

OBJECTIVES: To investigate the number of different drugs prescribed per dispensing unit and to analyse the influence of practice characteristics on this number. DESIGN: Register analysis based on the Odense Pharmacoepidemiological Database (OPED). SETTING: General practices in the County of Funen, Demnark. SUBJECTS: 173 general practices (99 single-handed and 74 group practices). MAIN OUTCOME MEASURES: Number of different drugs prescribed per dispensing unit. RESULTS: The number of different drugs prescribed per dispensing unit varied nearly fourfold (range 102-381) and four practice characteristics were able to predict 74% of this variation. Practices with several doctors, a high number of patients listed per doctor, a high percentage of elderly individuals, and a heavy workload showed the highest number of different drugs prescribed. CONCLUSION: As the quality of drug prescribing is associated with the use of a limited number of drugs, it is suggested that GPs should agree on a formulary containing the most essential drugs in primary health care.

Age Factors↗
PubMed1999

[Polypharmacy estimated by means of a population-based prescription database].

The aim was to investigate estimators of polypharmacy (PP) from a population based prescription database. Data were retrieved from Odense Pharmacoepidemiological Database and contained a 10% random sample (n = 26,977) of drug users in 1994. PP was defined as simultaneous treatment with different drugs, and the duration of treatment was calculated from the date of purchase and the number of defined daily doses prescribed. This estimator was compared with an estimator based on the number of drugs purchased during a three month period. On an average day 8.7% were exposed to minor PP (two to four drugs) and 1.2% to major PP (five or more drugs). Purchase of five or more drugs during a three month period predicted episodes of major PP with a positive predictive value of 80%. Epidemiological measures of multiple drug use can be estimated from a prescription database. Conceptually, an estimator based on the number of simultaneously used drugs is preferable, but the number of drugs purchased during a three month period may be a useful alternative estimator.

Databases, Factual↗
PubMed1999

Polypharmacy in general practice: differences between practitioners.

BACKGROUND: Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalization. When the number of concurrently used drugs totals five or more (major polypharmacy), a significant risk may be present. AIM: To analyse the interpractice variation in the prevalence of major polypharmacy among listed patients, and to identify possible predictors of major polypharmacy related to the practice. METHOD: Prescription data were retrieved from the Odense Pharmacoepidemiological Database, and individuals subject to major polypharmacy were identified. The age- and sex-standardized prevalence rate of major polypharmacy was calculated for each practice in the County of Funen in Denmark (n = 173), using the distribution of age and sex of the background population as a reference. The practice characteristics were retrieved from the Regional Health Insurance System. Possible predictors of major polypharmacy related to the general practitioners (GPs) were analysed using backward stepwise linear multiple regression. RESULTS: A six-fold variation between the practices in the prevalence of major polypharmacy was found (16 to 96 per 1000 listed patients; median = 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation. CONCLUSION: A substantial part of the variation in major polypharmacy between practices can be explained by predictors related to practice.

Adult↗
PubMed1999

Validity of susceptibility testing of uropathogenic bacteria in general practice.

Resistance of uropathogenic bacteria to antibiotics is an increasing problem in primary health care. The aim of this study was to evaluate antibacterial susceptibility testing of uropathogenic bacteria when performed in general practice. Urine specimens with a known quantity of typically uropathogenic bacteria were sent to 25 general practices. The predictive values of testing a bacterial strain as susceptible ranged from 0.89 (nitrofurantoin) to 1.00 (sulphamethizole), and the predictive value of testing a bacterial strain as resistant ranged from 0.55 (trimethoprim) to 0.90 (nitrofurantoin). Interventions to improve the validity of susceptibility testing are desirable if the test should be incorporated in the diagnostic armamentarium in general practice.

Anti-Infective Agents, Urinary↗
PubMed1998

[Antabus treatment in general practice. A pharmaco-epidemiological study of prescription patterns based on a prescription database].

Denmark has a long tradition for the use of alcohol-aversive drugs in the treatment of alcoholism, most commonly disulfiram (Antabuse). The purpose of this study was to examine the prescription patterns for disulfiram in Danish general practice on an individual level. By means of a prescription database we analysed 150,787 prescriptions on reimbursed medicine to persons who had redeemed prescriptions for alcohol-aversive drugs during the period 1.1.1993 to 31.12.1995 in the County of Funen. Prevalence of disulfiram treatment was 12 per 10,000 inhabitants, three-year prevalence 75 per 10,000 inhabitants and incidence 21 per 10,000 inhabitants per year. Eighty-seven percent of treatments were stopped at (or before) the expiration of one prescription, and relapse was frequent (46%).

Adult↗
PubMed1998

Polypharmacy: correlations with sex, age and drug regimen. A prescription database study.

OBJECTIVE: To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly prone to PP. METHODS: Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during 1994 presented by inhabitants in the county of Funen (n = 466567). The number of individuals concurrently using two to four drugs (minor PP) and five or more drugs (major PP) was calculated on a random day in 1994. Drugs were classified according to the Anatomical Therapeutical Chemical (ATC) classification index. The main therapeutic class (second level of the ATC code) was used as an indicator for the type of health problem. A stepwise backwards logistic regression was used to identify predictors of major PP. Odds ratios were calculated for different drug classes, and the age and sex of all drug users. RESULTS: On a random day, 8.3% of the population were exposed to minor PP and 1.2% to major PP. The prevalence of PP increased with age, and from the age of 70 years, two thirds of all drug users were PP users. Drug use was 50% more prevalent among women than men, but over the age of 70, the sexes did not differ in the prevalence of major PP. Many different drug combinations were found, and among major PP users (n = 5443), two thirds had their own unique drug regimen, different from all other drug users. Cardiovascular drugs and analgesics were often involved in PP among the elderly, while asthma drugs, psychotropic drugs and anti-ulcer drugs were predominant among young individuals exposed to PP. The odds ratio (OR) for major PP was substantially increased for individuals treated for cardiovascular diseases (OR, 4.5), anaemia (OR, 4.1) and respiratory diseases (OR, 3.6). CONCLUSIONS: PP is widespread in the population. Clinicians and organisers who are responsible for quality assurance programmes should intensify their surveillance of the groups most prone to PP (the elderly and those using analgesics or drugs for cardiovascular disease, anaemia, asthma and diabetes).

Adolescent↗
PubMed1998

Polypharmacy and the risk of drug-drug interactions among Danish elderly. A prescription database study.

OBJECTIVE: To analyze the use of all subsidized prescription drugs with special attention to the elderly (> or = 70 years of age), including their use of drug combination generally accepted as carrying a risk of severe interactions. DESIGN: Descriptive prevalence study. SETTING: Odense Pharmacoepidemiological Database, Denmark. The fourth quarter of 1994. SUBJECTS: All inhabitants in the county of Funen, Denmark. MAIN OUTCOME MEASURES: Prevalence of drug use for persons < 70 and > or = 70 years of age including number of drugs used and of drug combinations. Occurrence of 45 drug combinations generally accepted as carrying a risk of severe interactions. RESULTS: Among persons less than 70 years, 67.9% used none, 16.5% used one drug and 15.6% used two or more prescription drugs. The corresponding prevalences for the elderly were 35.7%, 15.9% and 48.4%. The 26,337 elderly patients with at least two drugs used 21,293 different combinations. Of the elderly patients who had purchased > or = two drugs, 4.4% had combinations of drugs carrying a risk of severe interactions. CONCLUSIONS: Most elderly use drugs and usually several drugs concomitantly. The elderly form a heterogeneous group of drug users. Drug combinations carrying a risk of severe interactions are relatively frequent.

Aged↗
PubMed1997

[Waiting time for epicrises in Funen County. Analysis of the effect of the practitioners' routine].

The hospital discharge report plays an important role in the communication between hospital and general practice. However, the discharge report is often sent several days after discharge, and may not be received when the patient first visits his general practitioner after discharge. An intervention to reduce this delay was carried out between November 1993 and July 1994 at all hospital departments (n = 35) in the County of Funen, Denmark. The intervention consisted of a detailed evaluation of all routines concerning discharge reports followed by initiatives to reduce the waiting time. Criteria and standards for waiting time and quality of discharge reports were stated and evaluated before and after the intervention. As standard for waiting time, at least three-quarters of all discharge reports should be received by the general practitioner within ten days after discharge. Before the intervention half of all departments met this standard. After the intervention two-thirds met the standard. The quality of discharge reports was acceptable both before and after the intervention. This study shows that it was possible to reduce the delay of discharge reports by an intervention made in collaboration between hospital and general practice.

Aftercare↗
PubMed1997

Methods for estimating the occurrence of polypharmacy by means of a prescription database.

OBJECTIVE: Concurrent use of multiple drugs (polypharmacy, PP) may cause health risks such as adverse drug reactions, medication errors and poor compliance. The objective of this study, based on data from a prescription database, was to evaluate estimators of PP in the general population. METHODS: Data were retrieved from Odense Pharmaco-epidemiological Database (OPED) and consisted of all prescriptions in 1994 from a 10% random sample of drug users (n = 26,977) in the county of Funen, Denmark. For each prescription, the period of consumption was calculated by setting the duration of treatment to equal the amount of drug purchased, as measured in defined daily doses (DDD), thereby assuming a daily intake of one DDD. PP was defined as overlapping periods of consumption for different drugs. A Venn diagram was used to illustrate and compare this estimator of PP with two other indicators of multiple-drug use: the number of drugs purchased in 3 months and the mean number of drugs used in 1 year. A receiver operating curve (ROC) was used to evaluate the possibility of predicting episodes of PP from the number of drugs purchased in 3 months. RESULTS: The proposed estimator of PP was robust towards changes in DDD. On an average day in 1994, the prevalence of PP was 9.9% and the standard deviation (SD) between days was 0.3%. Two to four drugs (minor PP) were used by 8.7% of the population (SD, 0.2%) and five or more drugs (major PP) by 1.2% (SD, 0.1%). The number of individuals displaying PP for the first time in 1994 stabilised after approximately 6 months, resulting in an incidence of major PP of 0.2% and of minor PP of 1.2% per month. For individuals exposed to PP, the median number of days of exposure was 61 and 10.5% were exposed for more than 350 days of the year. Purchase of five or more drugs in the first 3 months of 1994 predicted episodes of major PP in the same year with a positive predictive value of 80%. CONCLUSION: Epidemiological measures of multiple drug use can be estimated from data in a prescription database. From a conceptual point of view, an estimator based on the number of simultaneously used drugs (calculated from the date of purchase and the number of DDD) is preferable, but the number of drugs purchased in a 3-month period may also be a useful estimator.

Databases, Factual↗
PubMed1997

The waiting time distribution as a graphical approach to epidemiologic measures of drug utilization.

The emergence of large, computerized pharmacoepidemiologic databases has enabled us to study drug utilization with the individual user as the statistical unit. A recurrent problem in such analyses, however, is the overwhelming volume and complexity of data. We here describe a graphical approach that effectively conveys some essential utilization parameters for a drug. The waiting time distribution for a group of drug users is a charting of their first prescription presentations within a specified time window. For a drug used for chronic treatment, most current users will be captured at the beginning of the window. After a few months, the graph will be dominated by new, incident users. As examples, we present waiting time distributions for insulin, ulcer drugs, systemic corticosteroids, antidepressants, and disulfiram. Appropriately analyzed and interpreted, the waiting time distributions can provide information about the period prevalence, point prevalence, incidence, duration of use, seasonality, and rate of prescription renewal or relapse for specific drugs. Each of these parameters has a visual correlate. The waiting time distributions may be an informative supplement to conventional drug utilization statistics, and possibly also a useful screening tool for unusual prescribing patterns.

Adrenal Cortex Hormones↗
PubMed1996

[Benzodiazepine prescriptions in general practice. An analysis of the pattern of use in first time users].

The aim of the study was to describe first time users of benzodiazepines and to analyze the extent of benzodiazepine prescriptions the following four years. Benzodiazepine prescriptions were issued to 2262 persons in Svendborg during the period February-March 1990 (Study-base: Inhabitants in Svendborg in 1990: n = 40,868). The incidence of first time users was 10 per 1000 person-years. Ninety percent of first time users seemed to be psychologically healthy persons. The most frequent indications were anxiety (1/3), insomnia (1/3), or crisis (1/4). After four years 98% of first time users had ceased their use of benzodiazepines. Most of the patients ceased benzodiazepine medication on their own initiative. The doctor stopped the medication in 11% of the cases. The risk of a "repeat prescription syndrome" in continuation of the first prescription of a benzodiazepine seemed to be negligible among psychologically healthy persons.

Adult↗
PubMed1994

[Varying prescriptions of benzodiazepines in general practice].

The aim of this study was to describe differences in patterns of benzodiazepine prescription in Svendborg. All benzodiazepine prescriptions filled by the two pharmacies in Svendborg between February and 31 March 1990 were registered. During the period, 3364 prescriptions were issued to 2262 persons (1837 tranquillizers and 1272 sedatives). General practitioners provide about 90% of benzodiazepine prescriptions. Practices with a high prescription level accounted for four times as many prescriptions as did practices with a low prescription level. By comparing the prescription level and the composition of the practice population we found that practices with a high prescription level had more women and elderly people enrolled than had the practices with a low prescription level. After standardization for age and sex the difference was reduced from 3.8 to 2.8, but practices with many elderly and female patients still provided more benzodiazepine prescriptions. Major benzodiazepine consumers (> 2 DDD/per day) constricted for 8.8% of the total amount of consumers and accounted for about 25% of the benzodiazepines prescribed during the investigation period. The number of major consumers enrolled in a practice varied between 2.8 to 13.0 per/1,000 patients. The difference in the prescription pattern could to a certain extent be explained by this difference, but there would still be a difference that can not be accounted for in our study. However, we anticipate that this variation could be due to differences in procedures and attitudes to the prescription of benzodiazepines.

Adult↗
PubMed1993

[Prescription of benzodiazepines in general practice].

General practitioners are responsible for about 90% of all prescriptions for psychotropic drugs which benzodiazepines account for approximately 75%. In order to obtain a quantitative and qualitative assessment of the consumption in Svendborg, all benzodiazepine prescriptions were registered during a two-month period (February and March 1990). A total of 3364 prescriptions were issued to 6% (2262 persons) of the population. Of these, 1837 (54.6%) were prescriptions for tranquillizers, 1272 (37.8%) for hypnotics and 255 (7.6%) for both tranquillizers and hypnotics. The prevalence of benzodiazepine users increased with age and women were responsible for about 2/3 of the total consumption. Small but frequent prescriptions were issued to the younger users of benzodiazepines while older users generally received prescriptions for greater quantities at longer intervals. One in four persons over 80 years of age used sedatives. On account of the pharmaceutical, social and economic consequences of the widespread use of benzodiazepines in the elderly population, restrain should be observed in prescribing benzodiazepines.

Adult↗
PubMed1992

[Why do patients change physicians?].

The purpose of this investigation was to describe why patients change their general practitioners (GP) by the means of questionnaires. Questionnaires were given 357 patients who had changed GPs in 1990 and 206 (58%) returned the questionnaire. The most common reasons were dissatisfaction with the quality of the service provided, too little time allowed or lack of communication between patient and doctor. Women accounted for approximately 75% of the total number and preferred female GPs, whereas men who changed doctors probably did so because they wanted to have the same GP as their families. The frequency of change was about 1% and most of the patients had stuck to the same GP for several years before changing.

Adolescent↗