The association between lifting an administrative restriction on antidepressant dispensing and treatment patterns in Iceland.

PURPOSE: On March 1st 2009, restrictions on the dispensing of selective serotonin reuptake inhibitors (SSRI) in Iceland were lifted. Incident rates and changes in early discontinuation and switching before and after the change were investigated. METHODS: New users of antidepressants between March 1st 2006 and March 1st 2010 were selected from the Icelandic Prescriptions Database. The study population was split into one intervention cohort (2009) and three comparison cohorts (2006, 2007, and 2008). Incidence rate ratios (IRR) and odds ratios (OR) were used to compare incidence rates and early discontinuation. RESULTS: The overall incidence rates of antidepressant use decreased from 33.10 to 28.71 per 1000 persons per year (IRR 0.87; 95% confidence interval (CI), 0.78-0.97) from the 2006 to the 2009 cohort. The incidence rate for SSRIs did not change over the period. Early discontinuation for SSRIs increased from 30.2% in 2006 to 34.1% in 2009 (OR 1.19; 95% CI 1.06-1.33). CONCLUSIONS: The change in reimbursement does not seem to have affected incidence rates but it may be related to increased early discontinuation, which can lead to increased drug wastage. It might be more clinically rational to initiate patients on smaller supply, allowing for more frequent check-up visits.

Digital venography of the lower extremity.

A digital 33-cm fluoroscopic system equipped with conventional spot-film and digital or video hard-copy capabilities was evaluated for its usefulness in diagnosing deep venous thrombosis of the lower extremities. The impact of different fluoroscopic field sizes, spatial resolution, and contrast variance was measured by using phantoms. The results indicate that the physical characteristics of the digital system are acceptable for lower-extremity venography. Digital fluoroscopic hard copy was compared with conventional spot films in 22 examinations. The digital examinations were as accurate as the conventional examinations. Procedure time, exposure to radiation, film costs, and repeated injections of contrast medium because of errors in exposure were reduced with the digital method. The need for extra technologists was eliminated. The advantages of digital radiographic displays, postprocessing, storage, and transmission were maximized. Digital fluoroscopic examinations were as accurate as conventional spot films and were found to have many advantages.