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Utilisation of prescription and over-the-counter triptans: a cross-sectional study in Stockholm, Sweden
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences. Stockholm Cty Council, Publ Healthcare Serv Comm, Dept Healthcare Dev, Box 6909, SE-10239 Stockholm, Sweden..
Univ Copenhagen, Dept Pharm, Sect Social & Clin Pharm, Univ Parken 2, DK-2100 Copenhagen, Denmark..
Stockholm Cty Council, Publ Healthcare Serv Comm, Dept Healthcare Dev, Box 6909, SE-10239 Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Med Management Ctr, Berzelius Vag 3, SE-17177 Stockholm, Sweden..
Stockholm Cty Council, Publ Healthcare Serv Comm, Dept Healthcare Dev, Box 6909, SE-10239 Stockholm, Sweden.;Karolinska Univ Hosp, Clin Pharmacol, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Ctr Pharmacoepidemiol, Dept Med Solna, Karolinska Inst,Clin Epidemiol Unit T2, SE-17176 Stockholm, Sweden..
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2016 (English)In: European Journal of Clinical Pharmacology, ISSN 0031-6970, E-ISSN 1432-1041, Vol. 72, no 6, p. 747-754Article in journal (Refereed) Published
Resource type
Text
Abstract [en]

Triptans are widely used in acute migraine, and in some countries, they are also available over-the-counter (OTC). In Sweden, sales have increased for both prescription and OTC triptans. This study aimed to describe current prescribing and utilisation patterns of prescription and OTC triptans in Stockholm, Sweden. Register data from 4759 patients dispensed triptans in 2014 were used to study documented diagnosis of migraine, concomitant acute and preventive treatment for migraine, and contraindications. Survey data from 49 patients purchasing OTC triptans in three pharmacies were used to capture physician-diagnosed migraine, concomitant acute and preventive treatment for migraine, a behaviour of combining or alternating between prescription and OTC triptans, and pharmacy counselling rates. Among the prescription triptan users, 52 % had a recorded diagnosis of migraine, 48 % had no other acute treatment, preventive treatment was rare (12 %) and contraindications were found in 2 % of the patients. Among the OTC triptan users, the majority (63 %) had been diagnosed by a physician and had a history of prescription triptan use, but combining or alternating between OTC and prescription triptans was rare. Concomitant acute treatment was reported in 53 % and preventive treatment was rare (4 %), despite high self-reported migraine frequencies. Some off-label use was detected, despite moderate to high counselling rates. Triptans are prescribed with attention to safety but with poor recording of migraine diagnosis. OTC triptan users generally have a history of prescription triptan use. Preventive treatment rates are low in both groups. Strategies to discern patients who need other treatment options should be considered.

Place, publisher, year, edition, pages
2016. Vol. 72, no 6, p. 747-754
Keyword [en]
Triptans, Over-the-counter, OTC, Drug utilisation, Prescription, Survey
National Category
Pharmaceutical Sciences
Identifiers
URN: urn:nbn:se:uu:diva-298065DOI: 10.1007/s00228-016-2028-yISI: 000376245600014PubMedID: 26922586OAI: oai:DiVA.org:uu-298065DiVA: diva2:944878
Available from: 2016-06-30 Created: 2016-06-29 Last updated: 2018-01-19Bibliographically approved
In thesis
1. Surveys and services: The feasibility of conducting research in Swedish community pharmacies
Open this publication in new window or tab >>Surveys and services: The feasibility of conducting research in Swedish community pharmacies
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

For the past decades, there has been a shift in community pharmacy practice from dispensing and compounding towards provision of pharmacy services. Research is important to generate evidence for new services within pharmacy practice. Pharmacy practice research can be divided in two main themes: research related to pharmacy as a data source and to the pharmacy as the object of research, respectively.

The purpose of this thesis is to increase the understanding of the conditions required for successful involvement of Swedish community pharmacy staff in pharmacy-based research, and to evaluate the data generated through a certain type of research: pharmacy-based patient surveys on drug utilization.

Specific aims were to evaluate if there is a selection bias in drug utilization surveys conducted in Swedish community pharmacies, to explore the experiences of pharmacists either conducting the surveys or recruiting patients to research on adherence-promoting services, and to describe barriers and facilitators to conducting research in community pharmacies.

Data were collected via pharmacy-based patient surveys, dispensing data, individual interviews, a cross-sectional staff survey and focus group interviews.

In community pharmacy-based surveys or services research, with the dispensed drug as the trigger for inclusion, patients aged 75 years or older are underrepresented since they less often visit the pharmacy to redeem their prescriptions themselves. Due to their perceived workload, dispensing pharmacists sometimes avoid including patients perceived as complex due to age, polypharmacy or communication difficulties. These processes contribute to a healthy selection effect in both types of research and pharmacy services not reaching the patients in most need of support with their medication.

The pharmacists were generally positive to conducting surveys and being involved in services research, but reported a perceived lack of sufficient communication and research skills, and a lack of time.

Since competing commercial priorities hamper pharmacists’ research involvement, separate research funding is an important facilitator. For surveys to include all eligible patients, services to be relevant for both practice and patients and to target the patients in most need of support with their medication, research collaboration with healthcare, other professions and across pharmacies is also necessary.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2018. p. 67
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 244
Keyword
Pharmacy, Community pharmacy, Pharmaceutical services, Drug utilization research, Survey, Patient, Pharmaceutical care, Feasibility, Sweden
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-338811 (URN)978-91-513-0213-3 (ISBN)
Public defence
2018-03-10, Auditorium Minus, Museum Gustavianum, Akademigatan 3, Uppsala, 10:00 (English)
Opponent
Supervisors
Available from: 2018-02-16 Created: 2018-01-19 Last updated: 2018-02-16

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