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  • geographical differences  (3)
  • Diabetes  (2)
  • Estonia  (2)
  • international differences  (2)
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  • 1
    ISSN: 1432-1041
    Keywords: Drug use ; Estonia ; Nordic countries ; geographical difference ; wholesale data
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Wholesale data from Estonia covering all drug supplies during the period 1983–1989 have been studied using the defined daily dose (DDD) methodology. The use of all major pharmacological groups was compared with the corresponding statistics from the Nordic countries. The patterns of drug use showed large differences between the Nordic countries and Estonia. Many drugs were used in large quantities in Estonia although they are no longer considered to be first-line medications in the Nordic countries because of their high risk to benefit ratio. These included the pyrazolones (phenylbutazone, aminophenazone), chloramphenicol, aminoglycoside antibiotics, and Rauwolfia alkaloids. On the other hand, several groups of effective drugs were available in Estonia only in limited amounts, including the histamine (H2) receptor antagonists, hormonal contraceptives, beta-adrenoceptor antagonists, angiotensin converting enzyme inhibitors, and cephalosporins. There were also differences in the use of non-steroidal anti-inflammatory drugs, blood pressure lowering agents, and anti-asthmatic drugs. Amongst the factors influencing drug usage it appears that economic status, the ordering and invoicing routines of the pharmaceutical services, and therapeutic traditions were the main reasons for the differences found.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1432-1041
    Keywords: Diabetes ; antidiabetic drugs ; drug utilization ; prescribing habits ; geographical differences ; methodology
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary In a comparison of three European countries Sweden utilized more antidiabetic drugs than Northern Ireland and Norway. Swedish wholesale figures for a quarter of a year used for the comparison were based on “daily doses”/1000 inhabitants/day. In order to validate the Swedish figures, a defined geographical area was investigated in 1972–1973, the island of Gotland with 54000 inhabitants. Antidiabetic drugs distributed on a wholesale basis were compared with those distributed on a prescription basis. Additional information was gathered (interviews, questionnaires, hospital records etc.) from a sample of patients (n=54) and their prescribing doctors (n=37). There was good agreement between the wholesale and prescription figures for oral antidiabetic drugs over a three month period (30.0 vs 29.8 “daily doses”/1000 inhabitants/day), but this did not apply to insulin (5.9 vs 7.2) unless a longer time period was studied. The average daily doses prescribed were higher than the theoretically derived “daily doses”. Combination antidiabetic drug therapy was preseribed for 28% of the patients. Thirteen different oral antidiabetics were issued during the study period, four of which constituted 90% of the total. Phenformin, the second most commonly prescribed oral antidiabetic drug was prescribed by 33 doctors, and metformin was prescribed by only 14 doctors. Few patients were treated with diet alone and few doctors could obtain assistance from a dietician. There was little or no evidence that patients failed to comply with the prescriptions, but by contrast they adhered poorly to written dietary instructions.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1432-1041
    Keywords: hypertension ; hypertensive therapy ; drug utilization ; therapeutic traditions ; international differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary A questionnaire survey based on hypertension case histories was performed among a representative sample of 400 GP's and hospital doctors in Northern Ireland, Norway and Sweden, countries having markedly different utilization of antihypertensive drugs. We found a greater propensity to start antihypertensive drug treatment in Northern Ireland than in Norway and Sweden. This was true both in mild diastolic and isolated systolic hypertension. Yet the utilization of antihypertensive drugs in Sweden is about 60% higher than in Northern Ireland and 30% higher than in Norway. Swedish physicians preferred beta-blockers as their first choice to a greater extent than physicians in Northern Ireland and Norway who selected thiazides more often. In general, the choice of drugs agreed with the sales and prescribing patterns in the three countries. Besides providing more insight in therapeutic traditions the study indicates that the lower prescribing of antihypertensive drugs in Northern Ireland, and to some extent in Norway, compared to Sweden, might be due to differences in true or apparent morbidity.
    Type of Medium: Electronic Resource
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  • 4
    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.
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  • 5
    ISSN: 1432-1041
    Keywords: Key words Drug utilization ; Estonia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To determine the patterns of drug use in Estonia for the years 1989 and 1994–1995, i.e. for the years before and after the pharmaceutical services in the country changed from a state monopoly to a competitive market. Methods: The wholesale data from Estonia and the defined daily doses methodology were used. For comparison, national statistics on medicines from Finland and Sweden for the years 1994–1995 are shown. Results: The general sales of drugs in Estonia decreased almost twofold in all major pharmacological groups from 1989 to 1994 and subsequently increased by 10%–30% in 1995. Substantial differences in patterns of drug use between Estonia and the two Nordic countries were observed. The amount of prescription-only medicines used in Estonia was approximately 25% of that used in Finland and Sweden. The amount of over-the-counter drugs used was 61% of that used in Finland and 58% of that used in Sweden. In the drug use patterns in Estonia, some common trends can be noted: (1) persistent traditions, such as the low use of diuretics, beta-blockers, antithrombotics and inhalant anti-asthmatic drugs; (2) changes in prescription preferences – central anti-adrenergic drugs, pyrazolones, aminoglycosides and barbiturates are being replaced by calcium channel blockers and angiotensin-converting-enzyme inhibitors, propionic acid derivatives, cephalosporins and benzodiazepines, respectively; (3) rapidly increasing use of drugs not prescribed in the 1980s, such as hormonal contraceptives, opioids and antiulcer drugs, which strongly improves the quality of pharmacotherapy in Estonia. Conclusion: The general trends in Estonia and the two Nordic countries are similar – the use of newer and more effective drugs is increasing and that of older ones decreasing. The changes are more rapid in Estonia than in Finland and Sweden, but, because of a short observation period, the use of newer drugs not yet prevailing. The international differences in drug utilization observed in this study may possibly be related mainly to the prescription preferences (e.g. therapeutic traditions) and less dependent on the respective health care systems (e.g. reimbursement schemes) and economic state of the country.
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  • 6
    ISSN: 1432-1041
    Keywords: Diabetes ; insulin ; sulphonylureas ; biguanides ; drug utilization ; geographical differences
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary The consumption of insulin and oral antidiabetic drugs was measured at the gross sales level in Sweden and Norway and at the prescription level in Northern Ireland. “Agreed daily doses” were used as units of comparison, which defined as follows: insulin 40 I.U., tolbutamide 1 g, acetohexamide 500 mg etc. Consumption was expressed as the number of “agreed daily doses” per 1,000 inhabitants per day. This provided a rough estimate of the number of subjects for whom the drug had been prescribed per 1,000 population. The data were collected during the three months April – June 1971. Marked differences in the consumption of antidiabetic drugs were found between the three countries and also between areas within each country. The consumption of insulin was similar in Norway and Northern Ireland (3.5 and 3.9 agreed daily doses per 1,000 inhabitants per day), but almost twice as high in Sweden. In Norway much lower use was found in certain rural areas. The variation in the consumption of oral antidiabetic drugs was even more marked. Surprisingly, consumption was considerably higher in Sweden (15.8) than in the nearby Norway (7.3), and was even lower in Northern Ireland (4.3). The major use was of sulphonylureas, especially chlorpropamide. Within the countries there was marked regional variation in the choice of individual biguanides and sulphonylureas. The data are discussed in relation to such factors as the incidence of diabetes, the sole use of dietary treatment etc. It is concluded that studies in depth, which link the actual use of drugs by patients to diagnosis, diabetic symptoms and clinical outcome of treatment are necessary in order to explore the reasons behind the marked geographical differences and to define a rational drug policy. However, the methods described in the study may be used for early detection of gross national differences in drug utilization, the further investigation of which may reveal to be of great public health interest.
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  • 7
    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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