scholarly journals GPs’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2021 ◽  
pp. BJGPO-2020-0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Norwegian Prescription Database ◽  
To Receive

BackgroundAntidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment.AimTo investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and to what extent sex and age influence the association.Design & settingA nationwide registry-based cohort study was undertaken in Norway from 2014–2016.MethodThe study comprised all residents of Norway born before 1996 and alive in 2015. Information was obtained on all new depression diagnoses in general practice in 2015 (primary care database) and data on all dispensed depression medication (Norwegian Prescription Database [NorPD]) 12 months after the date of diagnosis. Independent variables were education, sex, and age. Associations with drug treatment were estimated using a Cox proportional hazard model and performed separately for sex.ResultsOut of 49 967 patients with new depression (61.6% women), 15 678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (hazard ratio [HR] = 0.93; 95% confidence interval [CI] = 0.88 to 0.98) than women with low education. No such differences appeared among men. Women aged 20–29 years were more likely to be treated with drugs than those aged 30–59 years, and women aged ≥70 years were more likely to receive drugs (HR = 1.65; 95% CI = 1.54 to 1.77) than those aged 20–29 years. The pattern was similar but less pronounced for men.ConclusionEducational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be explored.

scholarly journals General practitioners’ drug treatment for depression by patients’ educational level: registry-based study

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0122
Author(s):  
Anneli Borge Hansen ◽  
Valborg Baste ◽  
Oystein Hetlevik ◽  
Inger Haukenes ◽  
Tone Smith-Sivertsen ◽  
...  
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Highly Educated ◽  
Cox Proportional Hazard ◽  
Gender And Age ◽  
Norwegian Prescription Database ◽  
To Receive

Background: Antidepressant drugs are often prescribed in general practice. Evidence is conflicting on how patient education influences antidepressant treatment. Aim: To investigate the association between educational attainment and drug treatment in adult patients with a new depression diagnosis, and how gender and age influence the association. Design and setting: Nationwide registry-based cohort study, Norway, 2014-2016. Method: The study comprised all residents of Norway born before 1996 and alive in 2015. We obtained information on all new depression diagnoses in general practice in 2015 (Primary Care Database) and data on all dispensed depression medication (Norwegian Prescription Database) 12-months after the date of diagnosis. Independent variables were education, gender, and age. Associations with drug treatment were estimated using a Cox proportional hazard model, for genders separately. Results: Out of 49,967 patients with new depression (61.6% women), 15,678 were dispensed drugs (30.4% women, 33.0% men). Highly educated women were less likely to receive medication (Hazard Ratio (HR) =0.93, 95% CI (0.88 – 0.98)) than women with low education. No such differences appeared among men. Women aged 20-29 were more likely to be treated with drugs than those aged 30-59, and women aged 70+ were more likely to receive drugs (HR=1.65, (1.54 – 1.77)) than those aged 20-29. The pattern was similar but less pronounced for men. Conclusion: Educational differences in antidepressant therapy among women may reflect different treatment approaches that clinicians should be aware of to avoid unintended variation. Reasons for this variation and consequences for quality of treatment should be

Secondary sexual dysfunction with antidepressant treatment: Study on 50 patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S591-S591
Author(s):  
O.W. Muquebil Ali Al Shaban Rodriguez ◽  
S. Ocio León ◽  
M. Gómez Simón ◽  
M.J. Hernández González ◽  
E. Álvarez de Morales Gómez-Moreno ◽  
...  
Keyword(s):  
Side Effects ◽  
Sexual Dysfunction ◽  
Treatment Adherence ◽  
Antidepressant Treatment ◽  
Antidepressant Drugs ◽  
Sexual Side Effects ◽  
Competing Interest ◽  
The Relationship ◽  
Transversal Study

IntroductionThe side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.ObjectivesTo estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.MethodologyTransversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.ResultsTwenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).ConclusionsThe high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The Efficacy of Cognitive Therapy in Depression: A Treatment Trial Using Cognitive Therapy and Pharmacotherapy, each Alone and in Combination

1981 ◽  
Vol 139 (3) ◽  
pp. 181-189 ◽  
Author(s):  
I. M. Blackburn ◽  
S. Bishop ◽  
A. I. M. Glen ◽  
L. J. Whalley ◽  
J. E. Christie
Keyword(s):  
General Practice ◽  
Drug Treatment ◽  
Cognitive Therapy ◽  
Cognitive Theory ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Extensive Study ◽  
Response To Treatment ◽  
Treatment Trial ◽  
Independent Observer

SummaryWe report an extensive study which compares cognitive therapy, antidepressant drugs and a combination of these two, in depressed patients seen either in general practice or an out-patient department. One-hundred and forty patients were screened for primary major depression and 64 patients completed the trial. All were rated on seven measures of mood, including independent observer-rated and self-rated depression and scales of anxiety and irritability. Patients were randomly assigned to cognitive therapy, antidepressants or a combination of the two. The antidepressant drug group did less well in both hospital and general practice and combination treatment was superior to drug treatment in both hospital and general practice. In general practice, cognitive therapy was superior to drug treatment. The presence of endogenous features did not affect response to treatment. The results are discussed in terms of Beck's cognitive theory of depression and factors of presumed causal importance of depression in general practice.

Aspirin As Secondary Prevention in Patients With Colorectal Cancer: An Unselected Population-Based Study

2016 ◽  
Vol 34 (21) ◽  
pp. 2501-2508 ◽  
Author(s):  
Simer J. Bains ◽  
Milada Mahic ◽  
Tor Åge Myklebust ◽  
Milada Cvancarova Småstuen ◽  
Sheraz Yaqub ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Secondary Prevention ◽  
Multivariable Analysis ◽  
Population Based ◽  
Prescription Database ◽  
Cox Proportional Hazard ◽  
Norwegian Population ◽  
Incidence And Mortality ◽  
Norwegian Prescription Database ◽  
Unselected Population

Purpose Regular use of aspirin (acetylsalicylic acid) is associated with reduced incidence and mortality of colorectal cancer (CRC). However, aspirin as primary prevention is debated because of the risk of hemorrhagic adverse effects. Aspirin as secondary prevention may be more justified from a risk-benefit perspective. We have examined the association between aspirin use after the diagnosis of CRC with CRC-specific survival (CSS) and overall survival (OS). Materials and Methods An observational, population-based, retrospective cohort study was conducted by linking patients diagnosed with CRC from 2004 through 2011 (Cancer Registry of Norway) with data on their aspirin use (The Norwegian Prescription Database). These registries cover more than 99% of the Norwegian population and include all patients in an unselected and consecutive manner. Exposure to aspirin was defined as receipt of aspirin prescriptions for more than 6 months after the diagnosis of CRC. Multivariable Cox-proportional hazard analyses were used to model survival. The main outcome measures of the study were CSS and OS. Results A total of 23,162 patients diagnosed with CRC were included, 6,102 of whom were exposed to aspirin after the diagnosis of CRC (26.3%). The median follow-up time was 3.0 years. A total of 2,071 deaths (32.9%, all causes) occurred among aspirin-exposed patients, of which 1,158 (19.0%) were CRC specific. Among unexposed patients (n = 17,060), there were 7,218 deaths (42.3%), of which 5,375 (31.5%) were CRC specific. In multivariable analysis, aspirin exposure after the diagnosis of CRC was independently associated with improved CSS (hazard ratio [HR], 0.85; 95% CI, 0.79 to 0.92) and OS (HR, 0.95; 95% CI, 0.90 to 1.01). Conclusion Aspirin use after the diagnosis of CRC is independently associated with improved CSS and OS.

scholarly journals Prescription of antidepressants to patients on opioid maintenance therapy – a pharmacoepidemiological study

2011 ◽  
Vol 21 (1) ◽  
Author(s):  
Ingeborg Hartz ◽  
Jørgen G. Bramness ◽  
Svetlana Skurtveit
Keyword(s):  
Drug Therapy ◽  
Prescription Drugs ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Antidepressant Drug ◽  
Antidepressant Drugs ◽  
Defined Daily Dose ◽  
Prescription Database ◽  
Depression And Anxiety ◽  
Norwegian Prescription Database ◽  
Antidepressant Use

<p><em><strong>Background and aims</strong></em>: Depression and anxiety are commonly reported among patients in opioid maintenance treatment (OMT). The aim of the present study was to describe aspects of prescription of antidepresant drug therapy among patients on OMT. Our research questions were: 1) What is the prevalence of antidepressant use according to age and gender? 2) Which antidepressants are used? 3) How are antidepressants used in terms of reimbursement codes, dispensed dose and duration of therapy?</p><p><em><strong>Methods</strong></em>: Pharmacoepidemiological data were retrieved from the complete national Norwegian Prescription Database which contains information on all prescription drugs (such as Anatomical Theraputical Chemical (ATC)-code, Defined Daily Dose (DDDs)), dispensed at pharmacies to individual patients. Norwegian OMT-patients (N=4374, 3035 men and 1339 women) who received methadone mixture, buprenorphine capsules or combined buprenorphine-naloxone capsules for at least 6 months in 2009 were included. Prevalence of antidepressant use in the studied patients was measured in terms of retrieval of prescriptions.</p><p><em><strong>Results:</strong></em> During 2009 21.7% of the studied patients filled at least one prescription for an antidepressant drugs (men: 21.2%; women: 22.9%). The subgroup of antidepressants most frequently dispensed was selective serotonin reuptake inhibitors (SSRIs) (33%), followed by the sedative antidepressants mianserin and mirtazapin (22%) and tricyclic antidepressants (TCAs) (20%). Except for TCAs, prescriptions of all antidepressant subgroups were reimbursed for either anxiety or depression in 90% of the cases. Overall, 46.9% of the antidepressant users were prescribed antidepressants in the category &lt; 1 DDD per day and/or treatment &lt; 3 months, with no gender difference.</p><p><em><strong>Conclusions</strong></em>: About one out of five OMT-patients filled a prescription for an antidepressant drug in 2009. Above 90% had their prescriptions reimbursed for either depression or anxiety. Use at low doses and/or sporadic use among half of the antidepressant users may reflect poor compliance or use for other maladies than the reimbursed disease code. Drug therapy for depression and anxiety among OMT-patients seems to be in line with recommendations for use; the SSRIs constitute the recommended drugs of choice due to their better effect/side effect profile, compared to the older antidepressants such as the TCAs.</p>

scholarly journals DIABNOR – a register study of medical quality in diabetes health care

2013 ◽  
Vol 23 (1) ◽  
Author(s):  
Geir Joner
Keyword(s):  
Health Care ◽  
Drug Treatment ◽  
Marital Status ◽  
Patient Group ◽  
Diabetes Care ◽  
Prescription Database ◽  
Treatment Goals ◽  
Medical Quality ◽  
Quality Of Diabetes Care

The purpose of creating the DIABNOR register is to study the quality of diabetes care in Norway. We will study the prevalence of serious complications ("hard endpoints") and what kind of treatment patients receive and how these vary with age, gender, ethnicity, education and place of residence. It is a crosssectional study based on data from all hospital contacts in Norway between 2004 and 2010, linked to the National Prescription Database (NorPD) containing information on all drug treatment patients receive, not only from hospitals but also from general practitioners. Data are also linked to Statistics Norway for collecting information about ethnicity, social status and marital status. Development of quality indicators (QI) for diabetes is also an objective of the project, including indicators to measure compliance with guidelines and achievement of treatment goals. The researchers behind the project believe it is important to measure quality and differences in health care in order to improve the prognosis in this patient group

scholarly journals Consultations and antibiotic treatment for urinary tract infections in Norwegian primary care 2006–2015, a registry-based study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Lars Emil Aga Haugom ◽  
Sabine Ruths ◽  
Knut Erik Emberland ◽  
Knut Eirik Ringheim Eliassen ◽  
Guri Rortveit ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Urinary Tract ◽  
Antibiotic Treatment ◽  
Urinary Tract Infections ◽  
Health Concern ◽  
Prescription Database ◽  
Antibiotics Use ◽  
Norwegian Prescription Database ◽  
Tract Infections

Abstract Background Extensive use of antibiotics and the resulting emergence of antimicrobial resistance is a major health concern globally. In Norway, 82% of antibiotics is prescribed in primary care and one in four prescriptions are issued for the treatment of urinary tract infections (UTI). The aim of this study was to investigate time trends in antibiotic treatment following a consultation for UTI in primary care. Methods For the period 2006–2015 we linked data from the Norwegian Registry for Control and Payment of Health Reimbursements on all patient consultations for cystitis and pyelonephritis in general practice and out-of-hours (OOH) services, and data from the Norwegian Prescription Database on all dispensed prescriptions of antibiotics. Results Altogether 2,426,643 consultations by attendance for UTI took place in the study period, of these 94.5% for cystitis and 5.5% for pyelonephritis. Of all UTI consultations, 79.4% were conducted in general practice and 20.6% in OOH services. From 2006 to 2015, annual numbers of cystitis and pyelonephritis consultations increased by 33.9 and 14.0%, respectively. The proportion of UTI consultations resulting in an antibiotic prescription increased from 36.6 to 65.7% for cystitis, and from 35.3 to 50.7% for pyelonephritis. These observed changes occurred gradually over the years. Cystitis was mainly treated with pivmecillinam (53.9%), followed by trimethoprim (20.8%). For pyelonephritis, pivmecillinam was most frequently used (43.0%), followed by ciprofloxacin (20.5%) and sulfamethoxazole-trimethoprim (16.3%). For cystitis, the use of pivmecillinam increased the most during the study period (from 46.1 to 56.6%), and for pyelonephritis, the use of sulfamethoxazole-trimethoprim (from 11.4 to 25.5%) followed by ciprofloxacin (from 18.2 to 23.1%). Conclusions During the 10-year study period there was a considerable increase in the proportion of UTI consultations resulting in antibiotic treatment. Cystitis was most often treated with pivmecillinam, and this proportion increased during the study period. Treatment of pyelonephritis was characterized by more use of broader-spectrum antibiotics, use of both sulfamethoxazole-trimethoprim and ciprofloxacin increased during the study period. These trends, indicative of enduring changes in consultation and treatment patterns for UTIs, will have implications for future antibiotic stewardship measures and policy.

scholarly journals Variation in general practitioners’ depression care following certification of sickness absence: a registry-based cohort study

2020 ◽  
Author(s):  
Sharline Riiser ◽  
Inger Haukenes ◽  
Valborg Baste ◽  
Tone Smith-Sivertsen ◽  
Øystein Hetlevik ◽  
...  
Keyword(s):  
General Practice ◽  
Cohort Study ◽  
Sickness Absence ◽  
Linear Models ◽  
Demographic Data ◽  
Educational Status ◽  
Depression Care ◽  
Personalized Care ◽  
Highly Educated ◽  
To Receive

Abstract Background Depression is more prevalent among women and people with low socio-economic status. Uncertainties exist about how general practitioner (GP) depression care varies with patients’ social position. Objective To investigate associations between patients’ gender and educational status combined and GP depression care following certification of sickness absence. Methods Nationwide registry-based cohort study, Norway, 2012–14. Reimbursement claims data from all consultations in general practice for depression were linked with information on socio-demographic data, social security benefits and depression medication. The study population comprised all individuals aged 25–66 years with taxable income, sick-listed with a new depression diagnosis in general practice in 2013 (n = 8857). We defined six intersectional groups by combining educational level and gender. The outcome was type of GP depression care during sick leave: follow-up consultation(s), talking therapy, medication and referral to secondary care. Associations between intersectional groups and outcome were estimated using generalized linear models. Results Among long-term absentees (17 days or more), highly educated women were less likely to receive medication compared to all other patient groups [relative risk (RR) ranging from 1.17 (95% confidence interval 1.03–1.33) to 1.49 (1.29–1.72)] and more likely to receive talking therapy than women with medium [RR = 0.90 (0.84–0.98)] or low [RR = 0.91 (0.85–0.98)] education. Conclusions Our findings suggest that GPs provide equitable depression care regarding consultations and referrals for all intersectional groups but differential drug treatment and talking therapy for highly educated women. GPs need to be aware of these variations to provide personalized care and to prevent reproducing inequity.

scholarly journals Increased risk of hip fracture among older people using antidepressant drugs: data from the Norwegian Prescription Database and the Norwegian Hip Fracture Registry

2013 ◽  
Vol 42 (4) ◽  
pp. 514-520 ◽  
Author(s):  
Marit Stordal Bakken ◽  
Anders Engeland ◽  
Lars B. Engesæter ◽  
Anette Hylen Ranhoff ◽  
Steinar Hunskaar ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Older People ◽  
Antidepressant Drugs ◽  
Prescription Database ◽  
Increased Risk ◽  
Norwegian Prescription Database

Opioids for outpatients with cancer in their last year of life: A nationwide pharmacoepidemiological study

2016 ◽  
Vol 12 (1) ◽  
pp. 25 ◽  
Author(s):  
Siri Brelin, MD ◽  
Olav M. Fredheim, MD, PhD ◽  
Jon H. Loge, MD, PhD ◽  
Svetlana Skurtveit, PhD ◽  
Tom B. Johannesen, MD, PhD ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Prescription Database ◽  
Prescription Data ◽  
Pharmacoepidemiological Study ◽  
Patients With Cancer ◽  
Sociodemographic Data ◽  
Norwegian Prescription Database ◽  
Study Population ◽  
To Receive ◽  
Cancer Diseases

Objective: Opioids are the main pharmacological treatment for moderate-to-severe cancer pain. Few longitudinal studies have examined the prescription prevalence (PP) of opioids to patients with cancer. The aims of the study were to examine 1) changes in the PP of opioids from 2005 to 2009 among outpatients with cancer who were in their last year of life and 2) associations between the PP of opioids and medical and sociodemographic factors.Design: Retrospective, registry-based, national study.Patients: This study used data on all patients with cancer who died 2005-2009, combining the following three complete nationwide registries; prescription data from the Norwegian Prescription Database, data on cancer diseases from the Cancer Registry of Norway, and sociodemographic data from Statistics Norway.Results: The study population consisted of 44,579 adults (mean age 72 years at death, 54 percent males). The opioid PP increased from 74 to 82 percent during the study period. Oxycodone had the highest PP, and increased from 39.8 to 48.5 percent during the period, whereas the PP of morphine declined from 29.0 to 27.3 percent. The PP for fentanyl remained stable at 17 percent. The PP of opioids increased toward death with higher PP during the last 3 months of life compared to previous 3-month periods. Older patients (>60) were less likely to receive opioids, while prostate or pancreatic cancer increased the odds for opioid prescriptions (p < 0.001, Odds ratio [OR] 2.60 and OR 1.98, respectively).Conclusion: The PP increased yearly during the study period. Use of oxycodone increased while that of morphine decreased.

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