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Biomedical subjects

Jakob Kragstrup

Publications and source records attributed to Jakob Kragstrup.

At least 19 recordsLinked to original sources
PubMed2004

Cancer patients' share in a population's use of opioids. A linkage study between a prescription database and the Danish Cancer Registry.

The aim of this study was to 1) assess cancer patients' share in a population's use of opioids and how much it influences the total use, and 2) analyze trends in the population's use of "weak" and "strong" opioids during a five-year period. Person-identifiable data on opioid prescriptions and cancer diagnoses from a Danish county (n approximately 470,000) were retrieved from a prescription database, OPED, and The Danish Cancer Registry from 1993-1997 (identifying 23,843 cancer patients). In a given year, 14% of the population's opioid users were cancer patients, and they received 23% of the total opioid consumption. Over time, the number of patients using weak opioids increased and the number using strong opioids decreased among both cancer patients and non-cancer patients. Cancer patients' consumption of strong opioids increased dramatically in 1996-1997, almost accounting for the entire increase in the whole population's consumption of strong opioids.

Data Collection↗
PubMed2003

Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.

OBJECTIVE: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i). the variation in general practitioners' prescribing of ADs by comparing with prescribing of other drug groups and (ii). whether the general prescribing behaviour, practice activity and demography are associated with the AD prescribing. METHODS: Analysis of AD prescribing patterns among 174 general practices (93.5%) in the County of Funen, Denmark. Age- and sex-standardised 1-year incidences and prevalences of AD prescribing for patients listed were calculated using individual prescription data from Odense University Pharmacoepidemiologic Database. Data about health services and practice demography were obtained from the Health Insurance Register. The variation in AD 1-year prevalence was compared with other drug groups by a variation index (90%/10% percentile). Univariate linear regression analysis was used to examine associations between practice characteristics and prescribing. RESULTS: The 1-year prevalence of AD prescribing varied sixfold, no more than the prevalence of five other drug groups. Practices with high yearly: general prescribing prevalence, mean number of drugs per medicated patient, number of surgery consultations/100 patients and counsellings/100 surgery consultations showed the highest yearly prevalence of AD prescribing. Single-handed practices had higher AD prescribing rates than partnerships. The relative use of selective serotonin re-uptake inhibitors and other new ADs showed only little variation (10% and 90% percentiles as close as 66-86%), but practices with high 1-year prevalence and incidence most often chose the new ADs. CONCLUSION: Analysis of inter-practice variation showed no extraordinary quality problems with regard to AD prescribing, but does not exclude that there might be problems. The general prescribing pattern of the general practitioners seems essential to their attitude to AD prescribing. The relationship between counselling and prescribing was a feature specific to ADs and deserves further investigation. Quality indicators are needed to understand differences in AD prescribing, and studies based on prescription data have to be supplemented with individual clinical data.

Adult↗
PubMed2003

[Increased use of lipid-lowering agents after implementation of clinical guidelines in general practice].

INTRODUCTION: The preventive efforts with respect to ischaemic heart disease are inadequate, and particularly an under-use of lipid-lowering drugs (LLDs) has been demonstrated. The aim of this study was to examine if the prescribing of LLDs increased after an intervention. The intervention consisted of clinical guidelines on prevention of ischaemic heart disease sent to all general practitioners nationwide, accompanied by a change of reimbursement rules for LLDs. MATERIAL AND METHODS: The clinical guidelines were made by the Danish College of General Practitioners and sent out simultaneously with the introduction of less restrictive reimbursement rules for LLDs in December 1998. Prescriptions for lipid-lowering drugs were analysed based on prescription data in the Odense University Pharmacoepidemiological Database. RESULTS: The consumption of LLDs increased significantly after the intervention. The incidence rate ratio (before/after) was 1.43 (1.35-1.52). Prior to the intervention there was an average annual increase in the prevalence of LLD users of 0.2%. After the intervention the prevalence increased by 0.4%. For patients with diabetes, the figures were 1.2% and 2.3% and for patients with ischaemic heart disease 5.0% and 8.1%, respectively. DISCUSSION: Clinical guidelines on prevention of ischaemic heart disease accompanied by a change of drug reimbursement rules had a significant influence on the prescribing of LLDs. The number of persons treated with LLDs is, however, still too low.

Coronary Disease↗
PubMed2003

Mailed prescriber feedback in addition to a clinical guideline has no impact: a randomised, controlled trial.

OBJECTIVE: To evaluate the impact of feedback on the prescribing of antibiotics supplementary to clinical guidelines in the treatment of respiratory tract infections. DESIGN: Randomised, controlled trial with GPs allocated to one of two groups. The first group received clinical guidelines on the treatment of respiratory tract infections plus postal feedback with aggregated data on their prescribing patterns for antibiotics. The second group served as controls for the first group and received the guidelines only. SETTING: 299 GPs representing 181 practices with 455,843 listed patients in the County of Funen, Denmark. MAIN OUTCOME MEASURES: Effects on GP prescribing patterns were measured by means of a prescription database and followed for a period of 2 years with 2 outcome measures: 1) the antibiotic prescription rate and 2) the fraction of prescriptions for narrow-spectrum antibiotics. RESULTS: The addition of feedback had no impact on GP prescribing patterns. CONCLUSION: Postal disseminated prescriber feedback in addition to a clinical guideline on the diagnosis and treatment of respiratory tract infections does not influence GP prescribing patterns. Interventions aimed at improving performance in general practice should go beyond just giving GPs information on whether they are living up to standards.

Anti-Bacterial Agents↗
PubMed2003

Exposure to potential drug interactions in primary health care.

OBJECTIVE: To analyse the prevalence of potential drug interactions, and to identify patients particularly prone to drug interaction. DESIGN: Database study (Odense University Pharmacoepidemiologic Database). SETTING: Individuals exposed to polypharmacy in 1999 were examined for potential drug interactions. SUBJECTS: Inhabitants of the County of Funen (n = 471 732). MAIN OUTCOME MEASURES: Prevalence of potential drug interactions. RESULTS: One-third of the population were exposed to polypharmacy and among these 15% were exposed to drugs carrying a risk of harmful interaction. Among the elderly with polypharmacy, 25% aged 60-79 years and 36% over 80 years received drugs carrying the risk of interaction. Among individuals exposed to potential drug interaction, 62% were exposed only to one drug interaction and 38% to two or more different drug interactions. The drugs accounting for the highest number of potential interactions were diuretics, NSAIDs, ACE-inhibitors, digoxin, oral antidiabetics, calcium channel blockers, anticoagulants and beta-blockers. When focusing only on major drug interactions, potassium-sparing diuretics and oral anticoagulants were the most frequently involved drugs. CONCLUSION: Elderly patients exposed to polypharmacy should be kept under intensified monitoring as they are at increased risk of clinically significant drug interactions.

Adult↗
PubMed2003

Insufficient use of lipid-lowering drugs and measurement of serum cholesterol among patients with a history of myocardial infarction.

BACKGROUND: The effect of lipid-lowering drugs (LLDs) on coronary heart disease is well documented, particularly in patients with established ischaemic heart disease. However, intensity of the use of these drugs is low. The aim of this linkage study was to analyse the use of serum cholesterol measurements and LLDs among patients with a history of myocardial infarction (MI) in a Danish population. METHODS: Information on serum cholesterol values was retrieved from the hospital's Department of Clinical Chemistry for all patients from the Odense municipality and four surrounding municipalities (213,868 inhabitants) hospitalised at Odense University Hospital for MI between 1994-1997. Information on LLD use was obtained from a prescription database. Only patients alive at discharge were included in the investigation. The total observation period was from 1993-1998. RESULTS: In all, 1,018 patients were eligible for observation and 39% of the patients who met the criteria for LLD reimbursement (MI and serum cholesterol >5.4 mmol/L) started treatment. Relatively more males than females and relatively more patients under the age of 70 years were treated. Patients above the age of 70 years were prescribed these drugs at a slower rate. CONCLUSIONS: More attention to the insufficient use of lipid-lowering drug treatment in patients with established coronary heart disease is needed.

Adult↗
PubMed2002

[General practitioners' perception of disease risks and benefit of prevention].

INTRODUCTION: Uncertainty and risk are central issues in relation to health and health care services. Healthy individuals do not necessarily fall ill, despite the presence of risk factors. Doctors, health service administrators, and patients are more inclined to choose interventions against risk factors, when information about the effects is presented in terms of relative risk reductions rather than absolute risk reductions. The aim of the study was to gain better insight into how general practitioners (GPs) perceive risk of disease, and whether this perception depends on the risk reduction being presented in absolute or relative terms. MATERIAL AND METHODS: Questionnaires with clinical episodes were sent to 1500 Danish GPs. The GPs were randomised into four groups of 375, all of whom received the same case history with information about risk reduction achieved through medical treatment phrased in terms of either relative risk reduction, absolute risk reduction, number needed to treat, or all of the aforementioned terms of risk reduction. The GPs were asked whether they would recommend medical treatment as primary prevention, knowing the case history and expected risk reduction. RESULTS: The GPs' attitude towards recommending medical treatment depended on the phrasing of risk reductions. Of the doctors who received all information on risk reductions, 72% would definitely or probably recommend medication, whereas 91% would recommend medication if only information about relative risk reduction was given, and 63% would recommend medication if information was given in terms of absolute risk reduction or number needed to treat. DISCUSSION: To advise patients rationally, knowledge of the patients' preferences, as well as consideration of all available measures of risk reductions, is needed.

Attitude of Health Personnel↗
PubMed2002

[Cardiovascular risk factors. Different evaluations by physicians and patients].

INTRODUCTION: General practitioners have an important role in the prevention of cardiovascular disorders, and it is a precondition for motivating patients to preventive issues that doctors are aware of the prevalent risk factors. The aim of the study was to analyse agreement between patients' and general practitioners' (GPs) perception of risk factors and overall risk of ischemic heart diseases (IHD). MATERIAL AND METHODS: The data consisted of records from an audit in May 1999. The GPs (n = 26) registered all enquiries from patients with IHD (n = 252) and a sample of healthy individuals (n = 1239). Both doctors and patients were asked to register the occurrence of cardiovascular risk factors (smoking, weight, stress, family history) and they were asked to evaluate the state of health and to estimate the overall risk of IHD. The agreement was evaluated by Kappa statistics. RESULTS: The level of agreement between GPs and patients varied from 70 to 97 per cent. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs. (> 50 years). Disagreement was predominantly caused by a lower detection rate of the risk factors by the GPs. The patients' perception of overall risk of IHD was badly correlated to doctors' perception. Generally, patients perceived the overall risk of IHD lower than their doctors, and in more than half of the patients with a perception of low risk the GP estimated the risk as high. DISCUSSION: Patients and GPs have different perceptions of the risk of IHD. This may be due to the fact that GPs do not have all the information about their patients' lifestyle. It may also be due to different perception of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating cardio-preventive issues and the meaning of risk factors. Interventions should be considered to improve risk communication in general practice.

Aged↗
PubMed2002

[Physical training as treatment of reduced functional ability in frail 75+ year-olds living at home. A randomized intervention study in general practice with technological assessment elements].

INTRODUCTION: The aim of this study was to establish the value of physical training as a treatment of reduced physical ability in frail, elderly patients living at home. MATERIAL AND METHODS: 46 community-dwelling frail elderly patients (> 74 years) participated in a randomised, controlled intervention study. The intervention group was transported to training, whilst the control group was not activated. All had their physical functional ability determined using SF-36, Berg's Balance Scale, 10 m walking test and muscle strength test. RESULTS: The intervention group had a significant improvement in functional ability measured by means of Berg's Balance Scale, walking test, muscle strength test and SF-36 (p < 0.01) compared with the control group. The average cost per patient was estimated at 121 DKK per training session, equivalent to 1452 DKK for a 12-week training period. DISCUSSION: The establishing of a "multi-component-training" as a treatment offer, to which general practitioners could refer their patients, would involve some costs, but savings due to reduced nursing care can be expected.

Activities of Daily Living↗
PubMed2002

[Secondary prophylaxis in general practice for patients with ischemic heart disease].

INTRODUCTION: We examined the extent to which the Danish College of General Practitioners' guidelines of 1998, "Prevention of ischaemic heart disease in general practice--with special focus on dyslipidaemia", are complied with in the secondary preventive care of patients with ischaemic heart disease. MATERIAL AND METHOD: Twenty-six general practitioners from Ringkjøbing County registered all patients with ischaemic heart disease consecutively over three weeks in May 1999. One hundred and ten patients had suffered acute myocardial infarction, 141 had ischaemic heart disease without acute myocardial infarction. Blood pressure, total cholesterol, and use of cardiovascular drugs were registered. RESULTS: In patients with previous acute myocardial infarction, 66% had had their serum cholesterol measured within the past year; 76% were being treated with acetylsalicylic acid, 46% with beta-blockers, and 27% with lipid-lowering drugs. Of the patients with previous myocardial infarction and a serum cholesterol level > or = 5.0 mmol/l, 33% took lipid-lowering drugs. DISCUSSION: The present study demonstrates that in some areas actual treatment practice does not always comply with the given recommendations. In particular the frequency of cholesterol measuring and treatment with beta-blockers and lipid-lowering drugs show that continued, targeted quality development is required.

Anticholesteremic Agents↗
PubMed2002

Detailed postal feedback about prescribing to asthma patients combined with a guideline statement showed no impact: a randomised controlled trial.

OBJECTIVE: To evaluate the effects of postal feedback with clinically relevant data on general practitioners' prescribing compared with feedback with aggregate data on prescribing patterns of asthma drugs. METHODS: The study was a randomised, controlled trial. The general practitioners (GPs) in the County of Funen, Denmark (292 GPs representing 178 practices) were randomised to one of three groups receiving different forms of prescriber feedback. The first group received detailed and clinically relevant data on asthma drug prescribing patterns and a guideline statement. These data included tables with counts of asthma patients following classification of each individual's consumption of inhaled beta2-agonists and use of inhaled steroids. The second group received aggregate data on asthma drug prescribing patterns and a guideline statement, and the third group received feedback on an unrelated subject and served as control for the other groups. Each GP received prescriber feedback three times within a 6-month period. The last two letters with prescriber feedback had updated information with the purpose of showing changes in prescribing patterns. Effects were followed for a period of 1 year. The main outcome measures were change in fraction of asthmatics treated with inhaled steroids and incidence rate of treatment with inhaled steroids. RESULTS: The three groups had similar baseline characteristics. None of the two types of feedback on prescribing of asthma drugs had a statistically significant impact on GPs' prescribing patterns. CONCLUSION: Mailed prescriber feedback of detailed and clinically relevant data with a guideline statement, without revealing patient identities, has little or no impact on prescribing patterns.

Adolescent↗
PubMed2002

Why has postal prescriber feedback no substantial impact on general practitioners' prescribing practice? A qualitative study.

OBJECTIVE: To better understand the reasons for lack of impact of sending feedback on prescribing pattern to general practitioners (GPs). METHODS: Semi-structured interviews with GPs who had all participated in intervention studies addressing effects of prescriber feedback. Interviews were audiotaped and fully transcribed. Transcripts were studied repeatedly and coded into categories in order to produce meaningful patterns. RESULTS: None of the GPs believed they altered prescribing practice after they received prescriber feedback. Unsolicited prescriber feedback was perceived as violating the GPs' autonomy. The GPs wanted to decide for themselves what data should be sent to them. Aggregated data were difficult to interpret, and GPs did not regard it as a problem that their practice pattern deviated from that of other practices. There was a mistrust of the validity of data, and the GPs wanted to be able to identify the patients with a need for optimised therapy directly from the information provided in the prescriber feedback. In addition they wanted advice on how to optimise therapy. CONCLUSION: Postal prescriber feedback (not revealing the patients' identities) is not effective because it does not motivate GPs to change nor does it address the barriers to change. Prescriber feedback requested by the GPs may be more effective, however, if it includes identities of inappropriately treated patients combined with relevant advice on how to optimise prescribing.

Attitude of Health Personnel↗
PubMed2002

[Ambulance transportation and prehospital treatment in connection with admission for suspected acute myocardial infarction].

INTRODUCTION: The aim was to describe ambulance transportation and pre-hospital treatment in connection with admission for suspected acute myocardial infarction. MATERIAL AND METHODS: For all patients with suspected acute coronary syndrome who were urgently admitted to the Cardiological Department, Odense University Hospital between 3 August 1998 and 6 December 1998, information about ambulance transportation and pre-hospital treatment was collected through interviews with the patients and study of ambulance records, admission notes, and hospital medical records. In addition, details of the regarding response times were obtained from Falck's emergency service and from nurses' papers. RESULTS: Altogether 279 patients (83%) were transported by ambulance. Half the ambulances arrived at the hospital after 34 minutes (range 11-140 minutes), but every third ambulance took more than 40 minutes to reach the hospital. The pre-hospital treatment of all the patients was: oxygen 69%, nitroglycerin sublingually 46%, nitrous oxide 2%, defibrillation 1.4%, acetylsalicylic acid 9%, morphine injection 8%, and ECG monitoring 57%. CONCLUSION: The study showed that there were quality problems, as every third ambulance took more than 40 minutes to reach the hospital. It also showed that acetylsalicylic acid and morphine were used only to a limited extent in a pre-hospital situation.

Ambulances↗
PubMed2002

High persistence of statin use in a Danish population: compliance study 1993-1998.

AIMS: Several studies have found that compliance with lipid-lowering drug (LLD) treatment is low. However, the results of these studies were based on crude measures of compliance. The aim of this study was to describe compliance with statin treatment by analysing prescription patterns on an individual level in a population-based prescription database over a 6 year period. METHODS: For incident statin users, all prescriptions for statins and drugs indicating cardiovascular disease or diabetes were retrieved from the OPED prescription database covering a population of about 470,000 inhabitants. Treatment was considered discontinued if the interval between two prescriptions exceeded number of tablets prescribed, plus 30 days. Compliance was assessed in terms of persistence and continuity. Persistence was defined as the period from the first prescription date to the date of discontinuation. Continuity was defined as the number of days with treatment (=number of tablets) divided by the total number of days in the period of persistence. RESULTS: 11% of the study cohort only received a single statin prescription. Survival analyses revealed a median persistence of 41 months. Less than 15% of the patients had more than 20% days without therapy within the period of persistence. Patients under 45 years without drug indicators of cardiovascular disease or diabetes presented the lowest compliance. CONCLUSIONS: The study showed good compliance with statin treatment in terms of persistence and continuity. A high percentage of the youngest patients, however, seemed to discontinue treatment before obtaining the full benefit in terms of decreased risk of coronary heart morbidity and mortality.

Adolescent↗
PubMed2002

Methodological problems in comparing audits from the Nordic countries. A critical review of results from audit on Nordic general practitioners' management of patients with psychiatric problems.

In 1998, an audit on psychiatric problems in general practice was conducted in four Nordic countries. Five-hundred-and-sixty general practitioners participated and made registration according to the Audit Project Odense method. This paper describes the methodological problems related to international differences in the organisation of health care, recruitment of general practitioners and the registration of contacts. Nordic differences in this audit gave rise to inspiring discussions at national meetings, but methodological problems remain to be resolved if the results are to prove useful in scientific reporting.

Family Practice↗