Insulin wastage in ambulant practice.

The total insulin consumption in 162 insulin-requiring diabetic patients was calculated from the prescriptions of purchased insulin for 1979-80. The mean daily consumption was 58.6 U, whereas the actual dose injected was 41.7 U. A mean of 1.9 doses was injected daily, which yields a loss per dose of 8.9 U (SD +/- 7.9). The dose loss was independent of age and sex and only marginally dependent on insulin dose. Visual impairment increased the loss. From a direct study of 101 patients while drawing their usual morning dose of insulin into the syringe, the following major factors underlying insulin wastage emerged: (1) expulsion of surplus insulin into the air instead of into the vial, when adjustment of the insulin dose is made; (2) use of syringes with a separate needle instead of new low-dead-space syringes; and (3) unnecessary use of 2-ml syringes for doses of insulin less than or equal to 40 U (less than or equal to 1 ml).

Animal consumption of antibiotics and chemotherapeutic drugs in Sweden during 1980, 1982 and 1984.

The total animal consumption of antibiotic and chemotherapeutic drugs in Sweden during 1980, 1982 and 1984 has been studied. The study also included coccidiostatic, antiparasitic and antimycotic drugs. The total animal consumption during the years mentioned was 66.1, 68.8 and 72.6 tons of active substance, respectively, and the amount of antibacterial drugs for therapy was 28.7 (43.4%), 29.1 (42.5%) and 34.1 (47.0%) tons, respectively. Tetracycline, penicillin, sulphonamide and aminoglycoside were the four major groups of antibiotics used for therapy of bacterial infections in animals. The consumption was related to the metabolic bodyweights of animals which were the potential consumers. A comparison was also made with the corresponding human consumption during 1980. The data on antibiotic consumption can be divided by county and compared to the animal population and disease situation in each county. This study thus offers a good base for further investigations on different aspects of the use of antibiotics.

The Diagnosis and Therapy Survey October 1978-March 1983, health care consumption and current drug therapy in Sweden with respect to the clinical diagnosis of gastritis.

Demographic epidemiology, current drug therapy and the health care resources required by patients clinically considered to have gastritis were studied during a four and a half year period-October 1978 to March 1983. The investigation was based on data from the Diagnosis and Therapy Survey, an on-going nation-wide sample study covering all out-patient care in Sweden. Gastritis was found to account for 1.9% of all out-patient consultations and for 30% of those for gastrointestinal disorders. The corresponding figures for peptic ulcer disease were 0.2% and 4%, respectively. The estimated minimum number of annual consultations for gastritis was 47 per 1,000 inhabitants. The majority of the consultations were dealt with in general practice, where gastritis was the fifth most common diagnosis. Drug therapy was considered to be indicated in 92% of the consultations. Antacids were prescribed in 77%, anticholinergic/spasmolytic drugs in 36% and histamine H2-receptor antagonists in 4%. The clinical diagnosis of gastritis was found to be the major indication for antacids and anticholinergic drugs and accounted for a substantial proportion of H2-receptor antagonist prescriptions. The patient groups with gastritis and duodenal ulcer showed a similar age distribution, with a mean age of about 50 years. In the gastritis group, the two sexes were equally represented, but in the duodenal ulcer group there was a predominance of men. The results of the Diagnosis and Therapy Survey indicate that the patient group with symptoms traditionally denoted as gastritis in clinical practice constitutes a major health care problem in our community.(ABSTRACT TRUNCATED AT 250 WORDS)

Relation between drug utilization and morbidity pattern.

Do drug utilization data, versus other health care data--such as causes of death and sick reports, discharge diagnoses, and number of days on the sick list--give a similar picture of the health status in Sweden? Though a number of discrepancies exist between these sources of information, analyses show that the similarities between the pictures they give of the health status are considerable, provided due consideration is given the facts that--for self-evident reasons--certain illnesses and injuries are not to be found in all the sources.

Overprescribing iron tablets to elderly people in Sweden.

Iron should not be prescribed to middle-aged men or older women with anaemia unless the possibility that the iron deficiency is caused by a gastrointestinal tumour has been considered. Thus the prescribing of iron to elderly people was investigated by studying four different prescription statistics and by reviewing records. Over one in 10 women aged over 65 were prescribed iron tablets. Men and women in the oldest age groups were prescribed iron most frequently. The reasons for prescribing iron were examined at a rural health centre. Out of 327 records of patients who were prescribed iron during 1975, 157 were randomly selected and reviewed. Only 18 out of 48 (38%) patients aged 45-75 (men) and 55-75 (women) and 29 out of 109 (27%) aged over 75 years had probable or possible iron-deficiency anaemia as established from the records. Only nine (19%) of the younger patients had a plausible reason for the anaemia other than a bleeding tumour. Ten (9%) of the older patients were considered to be inoperable cases. Thus, according to the records, only 18 (17%) of the patients over 75 years and nine (19%) of those in the younger age group have been prescribed iron. About 70% of all the patients were considered not to have iron deficiency; 7% had had iron deficiency previously, and 20% probably had anaemia as a result of chronic disease; for 43% no real reason for the iron prescription could be found in the record. Thus it is concluded that iron is overprescribed in Sweden, particularly for elderly people. It should not be prescribed until the possibility of a bleeding gastrointestinal tumour has been excluded.

The clinical diagnosis of 'gastritis'. Aspects of demographic epidemiology and health care consumption based on a nationwide sample survey.

The health care resources required by patients clinically considered to have gastritis were studied during a 3-year period. The assessment was based on data from a nationwide sample study covering all outpatient care in Sweden. Gastritis, the fourth commonest diagnosis in general practice, accounted for 2% of all outpatient consultations and for 31% of those for gastroenterological disorders. The estimated minimal number of annual consultations for gastritis was 4500 per 100,000 inhabitants. Seventy-two per cent of the patients with gastritis had previously sought medical advice for similar symptoms. Our results indicate that the patient group traditionally denoted as gastritis constitutes a major health care problem in our community, which should be met by a thorough epidemiological, clinical, and laboratory characterization.

The clinical diagnosis of gastritis. II. Aspects of current therapy and drug consumption.

Patients with a clinical diagnosis of 'gastritis' or non-ulcer dyspepsia were studied as to the extent and pattern of drugs prescribed from October 1978 through September 1981. This was permitted by the Diagnosis and Therapy Survey, an ongoing nationwide sample study, covering all outpatient care in Sweden. In 98% of the consultations a drug was considered to be indicated. Antacids were prescribed in 76%, an anticholinergic drug in 40%, and a histamine-H2-receptor antagonist (cimetidine) in 3%. The latter figure seemed to increase during the 3-year study period, concomitant with a decrease in the prescription rate of anticholinergic drugs. Gastritis was the major indication not only for antacids and anticholinergic drugs but also for cimetidine, accounting for 35% of all cimetidine prescriptions. Total sales of these drugs in 1981 amounted to about SKR 150 million. Antacids comprised 57%, anticholinergic/spasmolytics 22%, and cimetidine 21% of this amount. The extensive drug use is remarkable considering the lack of convincing data from randomized controlled clinical trials supporting a therapeutic effect of any drug regimen in gastritis. More such trials in well-defined patient groups are therefore greatly needed.

Therapeutic traditions in Northern Ireland, Norway and Sweden: I. Diabetes. WHO Drug Utilization Research Group (DURG).

A questionnaire survey was carried out to explore differences in the approach to treatment of patients with Type II diabetes between physicians in Northern Ireland, Norway and Sweden, and to discover to what extent it could account for the three-fold difference in drug use between the countries. A representative sample of 400 physicians in each country was asked to give their opinions on the choice of therapy for three model cases designed to cover the spectrum of treatment - from diet alone to insulin. Significantly more Swedish (65%) than Northern Irish (51%) and Norwegian (52%) doctors suggested diet alone for uncomplicated diabetes recently discovered in a middle aged, overweight man. For symptomatic diabetes in a 76 year old over-weight woman with few retinal microaneurysms, the majority of physicians in all three countries suggested treatment with sulphonylureas. Biguanides were here a more common alternative in Northern Ireland than in Scandinavia. For suspected secondary treatment failure in a 63 year old woman with no signs of complications, insulin was suggested by 71% of the Norwegian doctors but only by 44 and 49% of those in Northern Ireland and Sweden, respectively. General practitioners tended to suggest oral treatment earlier and to maintain it longer than hospital physicians. The study has demonstrated significant differences in the approach to treatment of Type II diabetes mellitus between physicians in the three countries. However, the differences were more prominent in the choice of drugs than in the threshold of drug treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Therapeutic traditions in Northern Ireland, Norway and Sweden: II. Hypertension. WHO Drug Utilization Research Group (DURG).

A questionnaire survey based on hypertension case histories was performed among a representative sample of 400 GP's and hospital doctors in Northern Ireland, Norway and Sweden, countries having markedly different utilization of antihypertensive drugs. We found a greater propensity to start antihypertensive drug treatment in Northern Ireland than in Norway and Sweden. This was true both in mild diastolic and isolated systolic hypertension. Yet the utilization of antihypertensive drugs in Sweden is about 60% higher than in Northern Ireland and 30% higher than in Norway. Swedish physicians preferred beta-blockers as their first choice to a greater extent than physicians in Northern Ireland and Norway who selected thiazides more often. In general, the choice of drugs agreed with the sales and prescribing patterns in the three countries. Besides providing more insight in therapeutic traditions the study indicates that the lower prescribing of antihypertensive drugs in Northern Ireland, and to some extent in Norway, compared to Sweden, might be due to differences in true or apparent morbidity.