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Bjerkeli, P. J., Vicente, R. P., Mulinari, S., Johnell, K. & Merlo, J. (2018). Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data. Clinical Epidemiology, 10, 1657-1665
Open this publication in new window or tab >>Overuse of methylphenidate: an analysis of Swedish pharmacy dispensing data
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2018 (English)In: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, p. 1657-1665Article in journal (Refereed) Published
Abstract [en]

Purpose: To identify overuse of methylphenidate and to investigate patterns of overuse in relation to sociodemographic and clinical characteristics. Patients and methods: Swedish national, pharmacy dispensing data were analyzed for all 56,922 individuals aged 6-79 years, who filled a methylphenidate prescription between 2010 and 2011. Overuse was defined as having above 150% days covered by the dispensed amount during 365 days from the first prescription fill, assuming use at the maximum recommended daily dose. Results: In total, 4,304 individuals (7.6% of the methylphenidate users) were categorized as overusers. The risk of overuse increased with age (OR for 46-65 years vs 6-12 years 17.5, 95% CI 14.3-21.3), and was higher in men (OR 1.4, 95% CI 1.3-1.5) and individuals with low income (OR 1.1, 95% CI 1.0-1.2), as well as in individuals with an attention deficit hyperactivity disorder (ADHD) diagnosis (OR 1.4, 95% CI 1.3-1.6), health care visits (OR 1.3, 95% CI 1.2-1.4), previous ADHD medication use (OR 2.6, 95% CI 2.4-2.8), and previous diagnosis of mental and behavioral disorders due to psychoactive substance use (OR 2.1 95% CI 2.0-2.3). Conclusion: Among individuals using methylphenidate in Sweden, 7.6% receive amounts that are larger than what they should have a medical need for, assuming that they were using the maximum recommended daily dose 365 days per year. Notably, the prevalence of overuse was associated with previous diagnosis of alcohol and drug misuse. The prevalence was also positively associated with higher age and previous use of ADHD medication. These findings may point toward a link between exposure time and overuse. However, future studies with long-term data are needed to investigate this.

Place, publisher, year, edition, pages
Dove Press, 2018
Keywords
methylphenidate, prescription drug diversion, pharmacoepidemiology, attention deficit disorder with hyperactivity, prescription drug overuse
National Category
Social and Clinical Pharmacy Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Substance Abuse
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-16472 (URN)10.2147/CLEP.S178638 (DOI)000450387500001 ()2-s2.0-85057745789 (Scopus ID)
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2019-09-30Bibliographically approved
Bjerkeli, P. J., Mulinari, S., Zettermark, S. & Merlo, J. (2018). Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden. European Journal of Clinical Pharmacology, 74(2), 209-218
Open this publication in new window or tab >>Sociodemographic patterns in pharmacy dispensing of medications for erectile dysfunction in Sweden
2018 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 74, no 2, p. 209-218Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The purpose of this study is to investigate the relationship between sociodemographic factors and pharmacy dispensing of medications for erectile dysfunction (ED) in the general population of middle-aged and elderly men. By considering a number of medical conditions that could promote or contraindicate use of ED medication, the analysis could help capture prescription patterns that might not be explained by medical needs.

METHODS: Individual-level pharmacy dispensing data from 2006 for a population-based cohort of 216,148 men aged 45-79 years in the county Scania, Sweden, were analysed. Multiple logistic regression was applied, and area under the receiver operating characteristic curve (AUC) was calculated to quantify the discriminatory accuracy (DA) of the associations. National trends in pharmacy dispensing of ED medication between 2006 and 2016 were also analysed.

RESULTS: Pharmacy dispensing of ED medication increased between 2006 and 2016, particularly among men aged 65-79 years (from 6.8 to 9.2%). Dispensing of ED medication was positively associated with higher socioeconomic position, and divorced and widowed men were more likely to fill a prescription with ED medication than married men. These associations remained after adjusting for medical conditions. The DA of the associations was, however, rather low (AUC = 0.69 among 45-64 year olds and AUC = 0.65 among 65-79 year olds).

CONCLUSIONS: Pharmacy dispensing of ED medication seem linked to the individuals socioeconomic position, age and marital status suggesting sociodemographic disparities in the pharmacy dispensing targeting sexual function. However, the low DA of the associations shows the limited capacity of these factors to predict ED medication use at the individual level.

Keywords
Drug utilisation research, Erectile dysfunction, Masculinity, Pharmacoepidemiology, Phosphodiesterase type 5 inhibitors
National Category
Health Sciences
Research subject
Individual and Society VIDSOC
Identifiers
urn:nbn:se:his:diva-14622 (URN)10.1007/s00228-017-2361-9 (DOI)000419893700008 ()29101427 (PubMedID)2-s2.0-85032835006 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2019-09-30Bibliographically approved
Mårdby, A.-C., Schiöler, L., Andersson Sundell, K., Bjerkeli, P., Lesén, E. & Jönsson, A. K. (2016). Adherence to antidepressants among women and men described with trajectory models: a Swedish longitudinal study. European Journal of Clinical Pharmacology, 72(11), 1381-1389
Open this publication in new window or tab >>Adherence to antidepressants among women and men described with trajectory models: a Swedish longitudinal study
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2016 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, no 11, p. 1381-1389Article in journal (Refereed) Published
Abstract [en]

The purpose of this study are to analyse adherence to antidepressant treatment over 2 years in Sweden among women and men who initiated treatment with citalopram and to identify groups at risk of non-adherence using trajectory models. The study population, including individuals 18-85 years who initiated citalopram use between 1 July 2006 and 30 June 2007, was identified in the Swedish Prescribed Drug Register and followed for 2 years. Adherence was estimated with continuous measure of medication acquisition (CMA) and group-based trajectory modelling, a method which describes adherence patterns over time by estimating trajectories of adherence and the individual's probability of belonging to a specific trajectory. The study population included 54,248 individuals, 64 % women. Mean CMA was 52 % among women and 50 % among men (p < 0.001). Five different adherence patterns (Trajectories) were identified. Similar proportion of women and men belonged to each Trajectory. Around 29 % of the women and 27 % of the men belonged to the Trajectory which showed full adherence throughout the 2-year study period. The other four Trajectories showed adherence that declined to different degrees and at different stages in time. Having low socioeconomic status was more common among individuals in Trajectories showing declining adherence than in the adherent Trajectory. Using trajectory modelling, five Trajectories describing different patterns of adherence to citalopram treatment over time were identified. A large proportion discontinued treatment early and having low socioeconomic status increased the risk of being non-adherent.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Medication adherence, Swedish prescribed drug register, Gender, Antidepressants, Trajectory models
National Category
Social and Clinical Pharmacy Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Physical Activity, IT and Health
Identifiers
urn:nbn:se:his:diva-13073 (URN)10.1007/s00228-016-2106-1 (DOI)000385175700011 ()27488388 (PubMedID)2-s2.0-84982854124 (Scopus ID)
Available from: 2016-11-03 Created: 2016-11-03 Last updated: 2019-11-12Bibliographically approved
Bjerkeli, P. J., Jönsson, A. K., Lesén, E., Mårdby, A.-C. & Sundell, K. A. (2016). Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users. PLoS ONE, 11(5), Article ID e0155465.
Open this publication in new window or tab >>Refill Adherence in Relation to Substitution and the Use of Multiple Medications: A Nationwide Population Based Study on New ACE-Inhibitor Users
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 5, article id e0155465Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Generic substitution has contributed to economic savings but switching products may affect patient adherence, particularly among those using multiple medications. The aim was to analyse if use of multiple medications influenced the association between switching products and refill adherence to angiotensin-converting-enzyme (ACE) inhibitors in Sweden.

STUDY DESIGN AND SETTING: New users of ACE-inhibitors, starting between 1 July 2006 and 30 June 2007, were identified in the Swedish Prescribed Drug Register. Refill adherence was assessed using the continuous measure of medication acquisition (CMA) and analysed with linear regression and analysis of covariance.

RESULTS: The study population included 42735 individuals whereof 51.2% were exposed to switching ACE-inhibitor and 39.6% used multiple medications. Refill adherence was higher among those exposed to switching products than those not, but did not vary depending on the use of multiple medications or among those not. Refill adherence varied with age, educational level, household income, country of birth, previous hospitalisation and previous cardiovascular diagnosis.

CONCLUSION: The results indicate a positive association between refill adherence and switching products, mainly due to generic substitution, among new users of ACE-inhibitors in Sweden. This association was independent of use of multiple medications.

National Category
Health Sciences
Identifiers
urn:nbn:se:his:diva-14624 (URN)10.1371/journal.pone.0155465 (DOI)000376286100051 ()27192203 (PubMedID)2-s2.0-84971425317 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved
Bjerkeli, P. J., Mulinari, S. & Merlo, J. (2016). Testosterone prescribing in the population — a short social epidemiological analysis in Sweden. Pharmacoepidemiology and Drug Safety, 25(1), 11-15
Open this publication in new window or tab >>Testosterone prescribing in the population — a short social epidemiological analysis in Sweden
2016 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 25, no 1, p. 11-15Article in journal (Refereed) Published
Abstract [en]

PURPOSE: In recent years, there has been an increased interest for use of pharmaceutical testosterone among elderly men. However, it is still scarcely studied if this use is conditioned by socioeconomic factors in the general population of elderly men.

METHODS: Using individual-level data from a population-based cohort of men aged 65-84 years in the County Scania, Sweden, we analysed testosterone use in 2006 in relation to demographic and socioeconomic factors by means of multiple logistic regression. We also analysed national data at the ecological level to investigate trends in prescribing between 2006 and 2014.

RESULTS: The prevalence of testosterone use in Sweden among 65- to 84-year-old men increased by 83%, from 3.3 per 1000 men in 2006 to 6.0 in 2014. Testosterone use was more than twice as common in men in the highest income quintile compared with those in the lowest (0.68% versus 0.25%, odds ratio 2.69 and 95% confidence interval 1.80-4.02). Besides in the high-income group, testosterone use was highest in 65- to 69-year-old men, divorced men and, specially, in men with a previous hospital diagnose of hypogonadism.

CONCLUSIONS: Our findings show socioeconomic inequities in prescription of testosterone. This is a short analysis based on limited data, but because information on this topic is scarce, our analysis adds a relevant piece of evidence and highlights the need for further research.

Keywords
Testosterone, drug utilisation research, hypogonadism, off-label use, pharmacoepidemiology
National Category
Health Sciences
Identifiers
urn:nbn:se:his:diva-14625 (URN)10.1002/pds.3836 (DOI)000370057000003 ()26216248 (PubMedID)2-s2.0-84953839529 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved
Hedenrud, T., Babic, N. & Jonsson, P. (2014). Medication overuse headache: self-perceived and actual knowledge among pharmacy staff. Headache, 54(6), 1019-1025
Open this publication in new window or tab >>Medication overuse headache: self-perceived and actual knowledge among pharmacy staff
2014 (English)In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 54, no 6, p. 1019-1025Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to investigate knowledge about medication overuse headache (MOH) among pharmacy staff.

BACKGROUND: MOH is a public health problem both in Sweden and in many other countries. Persons with MOH have limited contact with health care, and medications used are to large extent over-the-counter (OTC) medications. Therefore, pharmacists have an important role in, eg, advising these individuals about their medication use. Little is, however, known about the actual level of knowledge about MOH among pharmacy staff, which determines the quality of their advice to MOH sufferers.

METHODS: A total of 326 questionnaires were distributed to 44 pharmacies in Gothenburg, Sweden. The questionnaire included background questions, questions about advice on headache treatment, source of knowledge about MOH, and questions on self-perceived and actual knowledge on MOH.

RESULTS: The response rate was 70%. A majority of the pharmacy staff (90.6%) considered themselves to have knowledge about MOH to some or a greater extent. Almost half had learned about MOH through their university/vocational education. Only 8.6% knew that all 5 headache medications listed in the questionnaire can cause development of MOH, but 40% responded correctly on which treatment advice one can give a person with MOH. Actual knowledge on treatment advice differed significantly between groups of self-perceived knowledge.

CONCLUSION: The knowledge on MOH is insufficient among pharmacy staff, but with the proper knowledge, pharmacy staff is well positioned to effect both primary and secondary prevention of MOH. We suggest not only increasing educational efforts about MOH within pharmacy programs but also continuing education at the pharmacies for all staff. Further, it is also important to increase knowledge among pharmacy customers.

Keywords
Sweden, knowledge, medication overuse headache, pharmacy staff
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:his:diva-14626 (URN)10.1111/head.12350 (DOI)000337640200007 ()24766349 (PubMedID)2-s2.0-84902369022 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved
Jonsson, P., Jakobsson, A., Hensing, G., Linde, M., Moore, C. D. & Hedenrud, T. (2013). Holding on to the indispensable medication –a grounded theory on medication use from the perspective of persons with medication overuse headache. Journal of Headache and Pain, 14, Article ID 43.
Open this publication in new window or tab >>Holding on to the indispensable medication –a grounded theory on medication use from the perspective of persons with medication overuse headache
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2013 (English)In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 14, article id 43Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Medication overuse headache (MOH) is a chronic headache disorder, caused by overuse of acute medication. To date, it remains unclear why some people overuse these medications. The aim of this qualitative study was to explore how individuals with MOH use medications and other strategies to manage headaches in their daily lives, and their thoughts about their own use of acute medication. Our intention was to develop a theoretical model about the development of MOH, from the perspective of those with MOH.

METHODS: Data collection and analysis were conducted according to grounded theory methodology. The participants were recruited via newspaper advertisements. Fourteen persons with MOH were interviewed in individual qualitative interviews.

RESULTS: The basic process leading to medication overuse was holding on to the indispensable medication. The acute medication was indispensable to the participants because they perceived it as the only thing that could prevent headaches from ruining their lives. The participants perceived headaches as something that threatened to ruin their lives. As a result, they went to great lengths trying to find ways to manage it. They tried numerous strategies. However, the only strategy actually perceived as effective was the use of acute medication and they eventually became resigned to the idea that it was the only effective aid. The acute medication thus became indispensable. Their general intention was to use as little medication as possible but they found themselves compelled to medicate frequently to cope with their headaches. They did not like to think about their medication use and sometimes avoided keeping track of the amount used.

CONCLUSIONS: This qualitative study adds understanding to the process via which MOH develops from the perspective of those having MOH. Such knowledge may help bridge the gap between the perspectives of patients and health-care professionals.

National Category
Health Sciences
Identifiers
urn:nbn:se:his:diva-14627 (URN)10.1186/1129-2377-14-43 (DOI)000320037600003 ()23697986 (PubMedID)2-s2.0-84879853365 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved
Jonsson, P., Linde, M., Hensing, G. & Hedenrud, T. (2012). Sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache. Journal of Headache and Pain, 13(4), 281-290
Open this publication in new window or tab >>Sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache
2012 (English)In: Journal of Headache and Pain, ISSN 1129-2369, E-ISSN 1129-2377, Vol. 13, no 4, p. 281-290Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to analyse sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache (MOH). A cross-sectional, population survey was conducted, in which 44,300 Swedes (≥15 years old) were interviewed over telephone. In total, 799 individuals had MOH. Of these, 47 % (n = 370) only used over-the-counter medications. During the last year, 46 % (n = 343) had made a headache-related visit to their physician and 14 % (n = 102) had visited a neurologist. Among individuals aged <30 years, the number of days/month with headache was greater than the number of days with medication use, whereas the opposite was true for those ≥30 years. Both the proportion using prophylactic medication and the proportion having consulted a neurologist were smaller among those who only had elementary school education than among those with higher education (p = 0.021 and p = 0.046). Those with a lower level of education also had a higher number of days/month with headache and with medication use than those with a higher educational level (p = 0.011 and p = 0.018). The MOH-sufferers have limited contacts with health-care and preventive measures thus need to include other actors as well. Particular efforts should be directed towards those with low educational levels, and more research on medication use in relation to age is required.

Keywords
headache, medication-overuse headache, epidemiology, educational status, medication use, health-care contacts
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:his:diva-14628 (URN)10.1007/s10194-012-0432-y (DOI)000304210100005 ()22427000 (PubMedID)2-s2.0-84861474593 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-11Bibliographically approved
Jonsson, P., Hedenrud, T. & Linde, M. (2011). Epidemiology of medication overuse headache in the general Swedish population. Cephalalgia, 31(9), 1015-1022
Open this publication in new window or tab >>Epidemiology of medication overuse headache in the general Swedish population
2011 (English)In: Cephalalgia, ISSN 0333-1024, E-ISSN 1468-2982, Vol. 31, no 9, p. 1015-1022Article in journal (Refereed) Published
Abstract [en]

AIMS: The aim was to estimate the prevalence of medication overuse headache (MOH) in Sweden and to analyze the occurrence of this disorder in different population groups.

METHODS: A total of 44,300 randomly selected individuals (55% women), aged 15 years and above, were interviewed in a national telephone survey, using a standardized questionnaire including the International Headache Society criteria for MOH and questions about sociodemographic factors, headache history and medication use.

RESULTS: In Sweden, 3.2% (95% confidence interval (CI) 3.1-3.4), n = 1428) suffer from chronic daily headache (CDH) and out of those, 56% (n = 799) have MOH. The prevalence of MOH is 1.8% (95% CI 1.7-1.9). The mean age of onset was higher among men than women as well as among those with tension-type headache as primary headache compared to those who originally had migraine. A multivariate analysis showed that socioeconomic factors such as having a low level of education and/or a low household income were associated with MOH.

CONCLUSIONS: This is the first Swedish population-based study of MOH and we conclude that MOH is a significant public health problem in Sweden, as it is in other parts of the world.

Keywords
Chronic daily headache, epidemiology, medication overuse headache, prevalence, socioeconomic status
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:his:diva-14629 (URN)10.1177/0333102411410082 (DOI)000292842600007 ()21628444 (PubMedID)2-s2.0-80051969471 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-11Bibliographically approved
Hedenrud, T., Jonsson, P. & Linde, M. (2008). Beliefs about medicines and adherence among Swedish migraineurs. The Annals of Pharmacotherapy, 42(1), 39-45
Open this publication in new window or tab >>Beliefs about medicines and adherence among Swedish migraineurs
2008 (English)In: The Annals of Pharmacotherapy, ISSN 1060-0280, E-ISSN 1542-6270, Vol. 42, no 1, p. 39-45Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The problem of low adherence to drug therapy is as prevalent in migraine as in any other disorder, with important consequences for the patient, such as impaired quality of life and absence from work. Beliefs about medicines have been identified as one of the most significant factors for adherence.

OBJECTIVE: To analyze whether beliefs about medicines and medication-related factors are associated with adherence to prophylactic drug therapy among migraineurs at a Swedish tertiary care clinic.

METHODS: A questionnaire was distributed to migraineurs visiting a tertiary care clinic in Sweden. All participants had recently been prescribed prophylactic medicine. The questionnaire was comprised of background questions, questions about disease characteristics, perceived effects, and adverse effects of migraine medications used, the Beliefs about Medicines questionnaire, and the Medication Adherence Report Scale. Medication-related variables, collected from patients' records with consent, were also included. Logistic regression analysis was performed to analyze the association between beliefs about medicines, medication-related variables, and adherence to prophylactic drugs.

RESULTS: Of the 174 participants in the study, 64% were considered to be adherent to their prescribed prophylactic medicine. Users of beta-blockers were significantly more adherent compared with patients using other drugs (eg, tricyclic antidepressants [TCAs] or antiepileptics); the reverse was true for patients taking TCAs. Respondents with the lowest level of education (<or=9 y) expressed less concern about drugs and had a higher necessity-concerns differential compared with respondents with a higher educational level. In the final regression model, no variable was significantly associated with adherence.

CONCLUSIONS: About one-third of the migraineurs did not adhere to their prophylactic drugs. Beliefs about medicines and medication-related factors could not predict nonadherence. We recommend further research on medication-related variables in relation to adherence among migraineurs.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:his:diva-14631 (URN)10.1345/aph.1K354 (DOI)000252350400005 ()18073328 (PubMedID)2-s2.0-38049013691 (Scopus ID)
Available from: 2018-01-05 Created: 2018-01-05 Last updated: 2018-01-08Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0003-4616-9525

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