The Use of a Decision Support System in Swedish Pharmacies to Identify Potential Drug-Related Problems-Effects of a National Intervention Focused on Reviewing Elderly Patients' Prescriptions

Trends in Drug Duplications in Swedish Older Adults: A Nationwide Register Study from 2006 to 2021

BACKGROUND

Drug duplication (DD), the use of two identical drugs simultaneously, is a medication error increasing the risk of adverse drug events. We describe the trends and implicated drugs in potential DD in older adults in Sweden from 2006 to 2021.

METHODS

We conducted a register-based, repeated cross-sectional study of all older adults (aged ≥65 years) dispensed drugs at a community pharmacy in 2006-2021. DD was defined as a ≥30-day overlap of two dispensations of drugs with the same 5th level (chemical substance) Anatomical Therapeutic Chemical (ATC) classification, but with different brand names, within a 3-month period each year.

RESULTS

Among Swedish older adults with ordinary prescriptions (i.e. multidose excluded; n ≈ 1,200,000-1,600,000 per year), the prevalence of potential DD increased from 5.2% to 10.6% in 65- to 79-year-olds and from 7.0% to 11.7% in those aged ≥80 years. The drug groups (ATC level 3; pharmacological subgroup) most frequently implicated in DD in 2006 were β-blocking agents, angiotensin-converting enzyme (ACE) inhibitors, and calcium channel blockers, and in 2021 Vitamin B12 and folic acid, β-blocking agents and angiotensin II receptor blockers.

CONCLUSIONS

DD represents a common but unnecessary and potentially hazardous medication error. Our results indicate that during the last two decades, the prevalence has almost doubled in older adults with ordinary prescriptions, reaching 11% in 2021. More national efforts are needed to revert this trend, including a nationally available complete drug list for all patients, and prescriber support to detect DD.

Medicines postpartum in Sweden and coverage in Janusmed Breastfeeding

PURPOSE

The purpose of this article is (1) to investigate which medicines are prescribed and dispensed to women the first 6 months postpartum, (2) to identify medicines dispensed postpartum but not recommended during breastfeeding, and (3) to find medicines commonly dispensed postpartum, but not currently included in Janusmed Breastfeeding.

METHODS

In this register-based cohort study covering births between January 2017 and August 2019, the Swedish Medical Birth Register (MBR), the Prescribed Drug Register, and Janusmed Breastfeeding were linked to identify medicines dispensed to women during the first 6 months postpartum, and how they are covered and classified in Janusmed Breastfeeding.

RESULTS

During the first 6 months postpartum, 66% of women purchased at least one prescription medicine from the pharmacy. The most common medicines were contraceptive agents, analgesics, antibiotics, and glucocorticoids. A third of the 30 most commonly dispensed medicines have no information available about the safety of use in breastfeeding. The most dispensed medicines, where the database advises against use in breastfeeding, included several antitussive agents, a local anaesthetic, and several gestagens. The most commonly dispensed medicines not covered by the Janusmed Breastfeeding were medicines for dry eyes, for assisted reproduction, and HIV.

CONCLUSION

Prescribed medicines compatible with breastfeeding are more common during the first 6 months postpartum than medicines not compatible with breastfeeding, but medicines which lack evidence for safety in breastfeeding are still commonly used.

Potential Drug-Related Problems in Pediatric Patients-Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden

The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0-12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

Patients' Use and Perceptions of a Drug-Drug Interaction Database: A Survey of Janusmed Interactions

Janusmed interactions is a drug-drug interactions (DDI) database available online for healthcare professionals (HCP) at all levels of the healthcare system including pharmacies. The database is aimed at HCP but is also open to the public for free, for those individuals who register for a personal account. The aim of this study was to investigate why and how patients use the database Janusmed interactions, how they perceive content and usability, and how they would react if they found an interaction. A web-based questionnaire was sent by email to all users who had registered for Janusmed interactions as a “patient” (n = 3219). A total of 406 patients completed the survey (response rate 12.6%). The study shows that there is an interest among patients to use a DDI database to check their own or a relative’s medication. The respondents found the database easy to use and perceive they understand the information aimed at HCP. Most patients stated they would talk to their HCP if they found an interaction and not adjust their treatment by themselves. However, the respondents in this study are actively searching for information and seem to have high health literacy. Thus, the findings are not generalizable for the general population.