PubMed Health⌕ Search

Biomedical subjects

Morten Andersen

Publications and source records attributed to Morten Andersen.

At least 37 records · Page 2Linked to original sources
PubMed2005

General practitioners' adoption of new drugs and previous prescribing of drugs belonging to the same therapeutic class: a pharmacoepidemiological study.

AIM: To test the hypothesis that general practitioners (GPs) with high prescribing levels of certain drugs will adopt new drugs belonging to the same therapeutic group faster than those with low prescribing levels. METHODS: The adoption of four new drugs: esomeprazol, selective cyclo-oxygenase-2 inhibitors, new triptans, and angiotensin-II receptor blockers were analysed using population-based prescription data. We used the preference proportion (prescriptions for new rather than older alternatives for the same indication) to measure GPs' adoption rate. Annual prescribing volume and prevalence were used to measure previous prescribing of older drug alternatives. We modelled the preference proportion using multiple linear regression analysis and the prescribing of older drugs as independent variables. We controlled for the GPs' general prescribing level and weighted for practice size. In the first three analyses, we dichotomized data using the median, lower and upper quartile as cut-off point. Next, we grouped data into quartiles and finally, we used continuous data. RESULTS: For esomeprazol and new triptans there was a higher preference for new drugs among "high prescribers", but only when this term was defined as the upper quarter and the upper half of previous prescribing levels, respectively (mean difference in preference proportion: 10.2% (99% confidence interval = 1.3%, 19.1%) and 8.2% (0.2%, 16.2%)). For the remaining two drug classes the associations were weak and almost all statistically nonsignificant. CONCLUSION: There is no consistent association between GPs' level of drug prescribing and their adoption of new drugs of the same therapeutic group.

Adult↗
PubMed2005

Efficacy of sildenafil citrate (Viagra) in men with premature ejaculation.

OBJECTIVES: Premature ejaculation (PE) is the most common ejaculatory dysfunction. We assessed the efficacy of sildenafil to increase the time to ejaculation, improve ejaculatory control, and decrease the postejaculatory erectile refractory time in men with PE. DESIGN AND METHODS: The main study was an 8-week, double-blind, placebo-controlled, parallel group study in men between 18 and 65 years of age with diagnosed PE. A substudy was also conducted using a subset of patients (two-way crossover, one center) before entry to the main study. The primary study measured intravaginal ejaculatory latency (IELT) and responses to the Index of Premature Ejaculation (IPE) questionnaire. The substudy measured vibrotactile stimulation ejaculatory latency time (VTS-ELT) and postejaculatory erectile refractory time. Differences between treatment groups were determined by ancova at the 5% level of significance. RESULTS: The change in IELT (1.6 +/- 6.08 vs. 0.6 +/- 2.07 minutes) and VTS-ELT (2.9 +/- 0.4 vs. 2.4 +/- 0.4 minutes) were higher after taking sildenafil, compared with placebo, but did not reach statistical significance. However, patients who took sildenafil (vs. placebo) reported significantly (P < 0.05) increased ejaculatory control (1.8 +/- 0.3 vs. 1.5 +/- 0.3), increased ejaculatory confidence (2.2 +/- 0.2 vs. 1.9 +/- 0.2), and improved overall sexual satisfaction scores (3.1 +/- 0.2 vs. 2.8 +/- 02) on the IPE, and had a decreased postejaculatory erectile refractory time (3.2 +/- 0.7 vs. 6.4 +/- 0.7 minutes). The most common adverse events for sildenafil (vs. placebo) were headache (15% vs. 1%), flushing (15% vs. 0%), dyspepsia (5% vs. 1%), abnormal vision (5% vs. 0%), and rhinitis (5% vs. 0%). CONCLUSIONS: Although IELT and VTS-ELT were not significantly improved, sildenafil increased confidence, the perception of ejaculatory control, and overall sexual satisfaction, and decreased the refractory time to achieve a second erection after ejaculation in men with PE.

Adolescent↗
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↗
PubMed2003

Rising prevalence of diabetes: evidence from a Danish pharmaco-epidemiological database.

The prevalence of diabetes has increased worldwide. We have undertaken an epidemiological analysis of drug-treated diabetes in a well defined community. We present estimates of prevalence, incidence, and mortality of patients with such diabetes during 1993-, based on data for all 470000 people living in the county of Fyn, Denmark. Although prevalence increased (odds ratio: female, 1.026 [95% CI 1.020-1.032]; male, 1.041 [1.036-1.047]), mortality in those treated declined (rate ratio: female, 0.976 [95%CI 0.952-1.001]; male, 0.966 [0.943-0.990]). We did not identify a clear trend for incidence. Future research into the causes of rising diabetes prevalence should take this fall in mortality into account to avoid incorrect conclusions about the relation between western lifestyle and the growing number of diabetics.

Adolescent↗
PubMed2003

Problems in collecting comparable national drug use data in Europe: the example of antibacterials.

OBJECTIVE: To describe the methodological problems in collecting retrospectively comparable data on drug use and to compare the use of antibacterials in some European countries. METHODS: A spreadsheet was distributed in 2000 through the European Drug Utilisation Research Group (EuroDURG) network, requesting 1994-1999 data on use of antibacterials for systemic use (ATC group J01), from ambulatory, hospital, or total care, aggregated at ATC 4th level, and presented in defined daily doses per 1000 inhabitants per day (in the 1999 ATC/DDD version or specified other version). RESULTS: The network was able to provide national utilization data for two or more years in the requested period from 16 countries (4 only from primary care, 3 both from primary care and total use, and 9 only total use data). The main methodological problems identified were: use of divergent ATC/DDD versions, divergent assignment of DDDs for combination products and the use of unofficial or national DDDs. It was possible to correct for the different ATC/DDD versions to some extent, except for the cephalosporin group (not included in the analysis), as the collection of data at the ATC 4th level precluded recalculation of DDDs. In the seven countries with primary care data the total J01 antibacterials use varied by a factor of 2.5 (Belgium 23.4 and The Netherlands 9.5 DDDs per 1000inhabitants per day). The use of J01A tetracyclines varied fourfold, and the use of J01C penicillins and J01F macrolides and lincosamides approximately threefold. Significant reduction over time was seen in J01A and an increase in J01F. CONCLUSIONS: In the scientific and regulatory community it is still difficult to perform a valid and comprehensive cross-national collection of utilization data on antibacterials. White spots on the European map persist for ambulatory care data, and data are missing for the hospital sector in most countries. For a thorough explanation of the considerable intercountry variability (especially in antibacterial subgroups and time trends analysis) a sustained and concerted effort is necessary to implement a validation process of the ATC/DDD use in the various countries and to adopt a common methodological approach to the collection of utilization data at the substance level (ATC 5th level).

4-Quinolones↗
PubMed2003

A randomized trial of laypersons' perception of the benefit of osteoporosis therapy: number needed to treat versus postponement of hip fracture.

BACKGROUND: Information on the benefits of therapeutic interventions can be ex-pressed in various ways, including relative risk reduction, absolute risk reduction,and number needed to treat (NNT). An alternative to such risk-based measures is postponement of an adverse outcome (eg, hip fracture in the case of osteoporosis). OBJECTIVE: The goal of this study was to examine whether laypersons' perception of the benefit of an osteoporosis therapy differs when it is presented in terms of the NNT to avoid 1 hip fracture compared with the duration of postponement of hip fracture. METHODS: This was a cross-sectional, randomized, controlled trial. Face-to-face interviews of a representative sample of the Danish population were conducted in respondents' homes. Respondents were randomized to receive information about the benefits of a hypothetical osteoporosis intervention either in terms of different magnitudes of NNT (10, 50, 100, or 400) or different durations of postponement of hip fracture (1 month, 6 months, 1 year, or 4 years). Participants were subsequently asked if they would consent to the intervention. RESULTS: A total of 1728 individuals were contacted at home and asked if they would take part in a face-to-face interview; 967 (56%) were successfully interviewed. The age (mean age, 44.5 years; range, 20-74 years) and sex distribution (51% male, 50% female) of the sample was similar to that of the general Danish population. Based on NNTs of 10, 50, 100, and 400, the proportions of respondents who said they would consent to the intervention were a respective 65%,61%, 63%, and 57%. Increasing NNT was not significantly associated with a lower proportion of consent (test for trend chi-square(1)= 0.75; P = NS). Forty-three percent of respondents indicated that the concept of NNT was difficult to understand, and 38% interpreted NNT in a way that was probably incorrect. In terms of postponement of hip fracture by 1 month, 6 months, 1 year, and 4 years, the proportions who said they would consent to the intervention were a respective 25%, 40%, 39%, and 53%. Increasing postponement of hip fracture was significantly associated with higher proportions of consent (test for trend chi-square(1)= 20.09;P < 0.001). Logistic regression analysis found that consenting to therapy was inversely associated with age (NNT: OR, 0.83; 95% CI, 0.72-0.96; postponement of fracture: OR, 0.84; 95% CI, 0.73-0.98) and with the magnitude of benefit presented in terms of postponement of fracture. No other variables were significantly associated with consent to therapy. CONCLUSIONS: When laypersons were presented with brief information about the benefit of a hypothetical osteoporosis intervention and were then offered this therapy, their choices were sensitive to the magnitude of treatment benefit when it was presented in terms of postponement of hip fracture but not in terms of NNT. These findings suggest that it may be easier for laypersons to understand a potential treatment benefit in terms of postponement of fracture rather than NNT.

Adult↗
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↗
PubMed2003

Risk of stroke associated with nonsteroidal anti-inflammatory drugs: a nested case-control study.

BACKGROUND AND PURPOSE: Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with bleeding complications and may affect the risk of hemorrhagic stroke through inhibition of platelet cyclooxygenase-1. We performed a population-based case-control study to estimate the risk of intracerebral hemorrhage, subarachnoid hemorrhage, and ischemic stroke in users of NSAIDs. METHODS: We used a population-based patient registry to identify all patients with a first-ever stroke discharge diagnosis in the period of 1994 to 1999. All diagnoses were validated according to predefined criteria. We selected 40 000 random controls from the background population. Information on drug use for cases and controls was retrieved from a prescription registry. Odds ratios were adjusted for age, sex, calendar year, and use of other medication. To evaluate the effect of various potential confounders not recorded in the register, we performed separate analyses on data from 2 large population-based surveys with more detailed information on risk factors. RESULTS: The cases were classified as intracerebral hemorrhage (n=659), subarachnoid hemorrhage (n=208), and ischemic stroke (n=2717). The adjusted odds ratio of stroke in current NSAID users compared with never users was 1.2 (95% CI, 0.9 to 1.6) for intracerebral hemorrhage, 1.2 (95% CI, 0.7 to 2.1) for subarachnoid hemorrhage and 1.2 (95% confidence interval, 1.0 to 1.4) for ischemic stroke. The survey data indicated that additional confounder control would not have led to an increase in relative risk estimates. CONCLUSIONS: Current exposure to NSAIDs is not a risk factor for intracerebral hemorrhage or subarachnoid hemorrhage. Furthermore, NSAIDs probably offer no protection against first-ever ischemic stroke.

Adult↗
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

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

Maternal vaginal microflora during pregnancy and the risk of asthma hospitalization and use of antiasthma medication in early childhood.

BACKGROUND: Infants with wheezing and allergic diseases have a microflora that differs from that of healthy infants. The fetus acquires microorganisms during birth when exposed to the maternal vaginal microflora. It is therefore conceivable that the maternal vaginal microflora might influence the establishment of the infant flora and, as a consequence, the development of wheezing and allergic diseases. OBJECTIVE: We sought to study the associations between the composition of the maternal vaginal microflora and the development of wheezing and asthma in childhood. METHODS: We performed a population-based cohort study in Denmark. Vaginal samples for bacterial analysis were obtained during pregnancy. A total of 2927 women (80% of the invited women) completed the study and had 3003 live infants. Infant wheezing was assessed as one or more hospitalizations for asthma between 0 and 3 years of age. Asthma was assessed as use of 3 or more packages of antiasthma medication between 4 and 5 years of age. RESULTS: Maternal vaginal colonization with Ureaplasma urealyticum during pregnancy was associated with infant wheezing (odds ratio [OR], 2.0; 95% CI, 1.2-3.6), but not with asthma, during the fifth year of life. Maternal colonization with staphylococci (OR, 2.2; 95% CI, 1.4-3.4) and use of antibiotics in pregnancy (OR, 1.7; 95% CI, 1.1-2.6) were associated with asthma during the fifth year of life. CONCLUSION: The composition of the maternal vaginal micro-flora might be associated with wheezing and asthma in the offspring up to 5 years of age.

Anti-Bacterial Agents↗