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Biomedical subjects

Jakob Kragstrup

Publications and source records attributed to Jakob Kragstrup.

At least 37 records · Page 2Linked to original sources
PubMed2004

Does the early adopter of drugs exist? A population-based study of general practitioners' prescribing of new drugs.

OBJECTIVE: To analyse associations between indicators for adoption of new drugs and to test the hypothesis that physicians' early adoption of new drugs is a personal trait independent of drug groups. METHODS: In a population-based cohort study using register data, we analysed the prescribing of new drugs by Danish general practitioners. Angiotensin-II antagonists, triptans, selective cyclo-oxygenase-2 antagonists and esomeprazol were used in the assessment. As indicators of new drug uptake, we used adoption time, cumulative incidence, preference proportion, incidence rate and prescription cost and volume. For each measure, we ranked the general practices. Ranks were pair-wise plotted, and Pearson's correlation coefficient ( r) was calculated. Next, we analysed the correlation between ranks across different drug classes. RESULTS: For all indicators, the general practitioners' adoption of one group of drugs was poorly associated with adoption of others ( r</=0.49), indicating that early adoption of one type of drugs is not associated with early adoption of another. For all drug groups, adoption time adjusted for practice size was only weakly associated with other indicators ( r: -0.56 to -0.27). Indicators, based on cost and volume of drugs, were highly correlated ( r: 0.96-0.99), and the others correlated reasonably well ( r: 0.51-0.91). CONCLUSIONS: Within drug groups, indicators of drug adoption, except for adoption time, correlate reasonably well. However, the theory that physicians' early adoption of new drugs is a personal trait independent of the type of drug could not be confirmed. The notion of the early-drug-adopting general practitioner may be mistaken.

Cohort Studies↗
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↗
PubMed2004

Consultation with the general practitioner triggered by advice from social network members.

OBJECTIVE: To investigate whether advice from a person's social network triggers contact with the general practitioner (GP). DESIGN: Case-crossover design comparing the frequency of advice given to seek medical attention in the period before contact with a GP and the frequency in matching control time periods for the same individual. SETTING: Twenty-one Danish GPs working in single-handed practices. SUBJECTS: 322 patients, aged between 18 and 91 years, were interviewed by telephone after an unscheduled visit to their GP; 148 were interviewed again 3-6 months later. MAIN OUTCOME AND MEASURES: The odds of individuals consulting their GP after receiving advice from network members in the period before they contacted their GP compared with the odds of those consulting their GP in the control period(s). RESULTS: Being advised by others to seek medical attention increased the likelihood of seeking primary health care approximately fivefold--single men received advice significantly less frequently (7%) than women (18%) and cohabiting men (32%). CONCLUSION: Advice from other social network members to seek medical attention is a frequent and influential cue prompting individuals to contact their GP.

Cross-Over Studies↗
PubMed2004

Estimating incidence and prevalence of episodes of care in general practice.

OBJECTIVES: To develop methods for prospective registration and analysis of episodes of care (one or more contacts about the same health problem). To compare estimates of point prevalence and incidence of hypertension among a group of elderly patients by means of an elaborate coding of episodes and a new method based on routine coding of contact diagnoses. DESIGN: Prospective longitudinal cohort study. SETTING: General practice in Denmark. SUBJECTS: 31 GPs and 1722 patients 70+ years of age. MAIN OUTCOME MEASURES: During the course one year, data were registered in the doctors' electronic medical record systems. Registration included ICPC diagnoses and codes for diagnostic and therapeutic procedures. Individual contacts were linked into episodes of care by the recording physician. Prevalence and incidence were calculated from the GPs' registration of episodes of care and from contact registration by means of a new method, "the waiting time distribution". RESULTS: Estimates of incidence (2.1 per 100 patient years) and point prevalence (21.2 per 100 patients) of episodes of hypertension care could be calculated when the GPs actively linked contacts into episodes. Based on simple contact registration it was possible to calculate similar estimates. CONCLUSION: A full registration of episodes of care is time-consuming and complicated. Incidence and point prevalence of chronic conditions, however, may be estimated from simple coding of contact diagnoses.

Aged↗
PubMed2004

Reproducibility and validity of simple questions to identify urinary incontinence in elderly women.

BACKGROUND: Epidemiologic studies are dependent on simple and valid questions to assess the prevalence and type of urinary incontinence. OBJECTIVE: To examine the reproducibility and validity of two standardized questions seeking to identify stress and urge incontinence among elderly women. METHODS: A random sample of 421 women 75 years or older living in the center of Odense, Denmark, were invited to participate, and 223 (53%) accepted a first interview in their home. A sample of 154 women were selected for a second interview with the same questions [accepted by 144 (94%)]. The second visit also included a long open interview about incontinence and was followed by a prospective registration of leakages. RESULTS: In the first interview 39% (95% confidence interval (CI) 34-47%) of the elderly women reported incontinence. The reliability of the questions was acceptable [kappa of 0.81 (95% CI 0.34-0.89)] with percent agreement of 90% (95% CI 84-95%) between first and second interviews for all incontinence (stress and/or urge). When the open interview was used as a "gold standard," the questions showed acceptable validity: a sensitivity of 0.91 (95% CI 0.86-0.96) and a specificity of 0.86 (95% CI 0.80-0.92) for all incontinence. CONCLUSION: Standardized questions about incontinence give reproducible answers and produce information that is comparable to a long open interview.

Aged↗
PubMed2004

Genetic and environmental influences on urinary incontinence: a Danish population-based twin study of middle-aged and elderly women.

BACKGROUND: Familial clustering has been reported for urinary incontinence (stress and urge), but different etiologies for the two types of incontinence have been suggested. OBJECTIVE: The aim of this study was to estimate the relative influence of genetic and environmental factors on stress, urge, and mixed incontinence among elderly and middle-aged women. METHODS: This is a population-based classical twin study of 1168 female twin pairs [548 monozygotic (MZ) and 620 dizygotic (DZ)] from a middle-aged (46-68 years) and an old (70-94 years) cohort identified in the Danish Twin Registry. Urinary incontinence was assessed with the help of two validated questions identifying stress and urge incontinence in interviews. RESULTS: For urge incontinence, the tetrachoric correlation was significantly higher for MZ twins, compared to that for DZ twin pairs in both middle-aged [0.51 (95% CI: 0.26-0.71) versus -0.22 (95% CI: -0.59-0.18)] and elderly [0.50 (95% CI: 0.27-0.68) versus 0.28 (95% CI: 0.02-0.42)], indicating genetic effects. The heritability of urge incontinence was 42% (95% CI: 16-63%) among middle-aged women and 49% (95% CI: 29-65%) among the elderly. Moreover, mixed incontinence had a substantial genetic component. The role of genetic factors was less clear in stress incontinence. CONCLUSIONS: Genetic factors play a substantial role in the development of urge and mixed incontinence, whereas the role of genetic factors in stress incontinence is less prominent.

Aged↗
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↗