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  • 1
    Electronic Resource
    Electronic Resource
    Increasing awareness of and behaviour towards periconceptional folic acid consumption in The Netherlands from 1994 to 1995 (1998)
    Springer
    European journal of clinical pharmacology 54 (1998), S. 329-331 
    Details
    ISSN: 1432-1041
    Keywords: Key words Folic acid ; Neural tube defects ; Public health education ; Awareness ; Behaviour
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: In November 1993, Dutch health authorities advised that women planning a pregnancy should take folic acid in the periconceptional period to reduce the risk of fetal neural tube defects. In the autumn of 1995 a national campaign was organized to inform women and health care professionals in a systematic way. Methods: We assessed the awareness and behaviour of women at their first or second antenatal visit in two surveys in the spring of 1994 and the autumn of 1995, in order to evaluate the impact of non-systematic information during that period, and to collect baseline data to evaluate the effect of the national folic acid campaign. The two surveys were carried out in the north and the west of The Netherlands. Results: The proportion of women who had heard of folic acid increased from 28% to 78%. The proportion that used folic acid during any period in pregnancy increased from 7.8% to 26%. The proportion that took folic acid tablets during the whole of the recommended period increased from 0.8 to 4.4%. In the group of women who did not take folic acid, the proportion who did “not like to use anything during pregnancy” decreased, as did the proportion who did “not think it is useful”. Conclusion: In The Netherlands, non-systematic information about periconceptional folic acid use has already led to significant changes in awareness and behaviour before the start of the national folic acid campaign.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050468
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  • 2
    Electronic Resource
    Electronic Resource
    Drug utilisation in Dutch nursing homes (2000)
    Springer
    European journal of clinical pharmacology 55 (2000), S. 765-771 
    Details
    ISSN: 1432-1041
    Keywords: Key words Nursing home ; Drug utilisation ; Elderly
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To quantify and evaluate drug utilisation in a sample of Dutch nursing homes. Methods: A retrospective analysis of computerised medication data of 2355 residents aged 65 years and over from six nursing homes in the Netherlands was performed. For each therapeutic drug group, the number of users was determined. The ten therapeutic groups used most frequently were investigated further. For these, patient characteristics, use of therapeutic subgroups, the average daily dosages and the chronicity of drug use were determined. Chronicity was expressed as the percentage of treatment days divided by the number of residents' days in the nursing home. Results: During the study period, 89%, 77% and 56% of the study population used a drug from the anatomical therapeutic chemical (ATC) main group N (nervous system), A (alimentary tract and metabolism) and C (cardiovascular system), respectively. Eight of the ten therapeutic drug groups prescribed most frequently were used for more than 50% of the time. In particular, psycholeptic drugs, diuretics and laxatives were used chronically (83%, 81%, and 80% of the nursing home stay, respectively). Except for a few drug groups, such as laxatives and diuretics, the prescribed daily dosages were relatively low. Twenty-eight percent of the residents received loop diuretics; these were prescribed in relatively high dosages. Conclusion: Drug utilisation in the nursing homes was high and many drugs were used chronically. In view of the risk of possible adverse effects and drug–drug interactions, the prescribing and dosage of psycholeptic drugs, laxatives, loop diuretics and ulcer-healing drugs should be re-evaluated, carefully.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050012
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  • 3
    Electronic Resource
    Electronic Resource
    Drug use in first pregnancy and lactation: a population-based survey among Danish women (1999)
    Springer
    European journal of clinical pharmacology 55 (1999), S. 139-144 
    Details
    ISSN: 1432-1041
    Keywords: Key words Pregnancy ; Post-partum ; Population-based utilization study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract Objective: To examine the drug prescription pattern in Danish women from 12 weeks prior to conception until 12 weeks post-partum. Method: A drug utilization study based on The North Jutland Prescription Database. The Danish pharmacies use a computerized accounting system for all subsidized drugs and this was linked to the Danish Medical Birth Registry concerning prescription patterns for all women who had given birth in the county of North Jutland from 1991 to 1996. Results: The analysis included 16 001 primiparous women, who had redeemed 34 834 prescriptions prior to, during and after pregnancy. During pregnancy 44.2% of the women received prescriptions for at least one drug. Users received 2.6 prescriptions on average during pregnancy; 5% of the users redeemed 24.2% of all prescriptions. The proportion of women who redeemed prescriptions for more than three different drugs was 2.7%. The majority of prescriptions were for antibiotics (28.7%), gynaecological drugs (13.3%) and anti-asthma drugs (7.6%). The post-partum prescription proportion was 34.0% and the majority of the prescriptions during this period were for penicillins (20.1%), opthalmologicals (15.5%) and corticosteroids for dermatological use (5.7%). Conclusion: A high proportion of the women received drugs during pregnancy. The pattern of drug use within the Anatomical Therapeutical Chemical (ATC) groups changed, i.e. the amount of broad spectrum antibiotics decreased and the proportion of prescriptions for local use increased. A small proportion of women redeemed prescriptions for more than three different drugs during pregnancy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002280050608
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  • 4
    Electronic Resource
    Electronic Resource
    Ad hoc tracing of a cohort of patients exposed to acitretine (Neotigason®) on a nation-wide scale (1992)
    Springer
    European journal of clinical pharmacology 42 (1992), S. 555-557 
    Details
    ISSN: 1432-1041
    Keywords: Acitretine ; Psoriasis ; ad hoc cohort tracing ; pharmacoepidemiology ; postmarketing surveillance ; adverse reaction monitoring
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary Etretinate has been detected in the blood of women taking acitretine. Because of the proven teratogenic effects of etretinate it was decided to try to trace all users of acitretine in The Netherlands via all drug dispensing outlets (1450 community pharmacies, 95 hospital pharmacies and 636 general practitioners). A request for information on the date of birth, sex, type of prescriber, and the number of capsules dispensed yielded a response rate of 87%. In 61% of all the responding dispensing outlets a prescription for acitretine had been filled. Of these 1153 outlets, 40% had dispensed acitretine to one patient and 52% had dispensed it to 2–5 patients. The 2717 patients comprised 1500 men (55%) and 1217 women, with mean ages of 48 and 53 y, respectively. As against 45% of all the male users, 31% of all the women were in the child-bearing age (15–45 y). The average numbers of dispensed capsules was 167 to users of 10 mg capsules, and 107 to users of the 25 mg capsules. In more than 80% of cases acitretine had been prescribed by dermatologists. Because the large majority of inhabitants in The Netherlands use one community pharmacy, and because most of them have automated records, it is possible to trace a cohort of users quickly and almost completely. Because most large-scale problems with adverse reactions are discovered within the first 2 years of marketing, at a time when exposure and morbidity registries are still collecting information, adhoc formation of a cohort in this way may be a useful resource for postmarketing surveillance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00314869
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  • 5
    Electronic Resource
    Electronic Resource
    Drug use in pregnancy: A comparative appraisal of data collecting methods (1993)
    Springer
    European journal of clinical pharmacology 45 (1993), S. 9-14 
    Details
    ISSN: 1432-1041
    Keywords: Drug use ; Complaint profiles ; Pregnancy ; pharmacoepidemiology ; pharmacy records
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Summary We have compared the reliability of the information about drug therapy and pregnancy retrieved by interviewing patients with that distilled from pharmacy records. In the initial phase of each interview we used the internationally accepted open-ended technique, and extended this with an indication-oriented set of questions and then a set of specific drug-oriented questions. These data were then compared with those from pharmacy records on dispensing for the same patients during their pregnancy. The results suggest that if drug consumption during pregnancy is evaluated by interview, one should not restrict oneself to open-ended questions but should include indication-oriented and, when appropriate, drug-oriented questions. Such specific questions offer the opportunity of detecting the use of over-the-counter medication and of constructing drug use/complaint profiles. By contrast, pharmacy records will give better information in case of long recall periods and in patients with multiple and/or repeated drug use. Investigators should use the complementary elements of both techniques where appropriate.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00315343
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  • 6
    Electronic Resource
    Electronic Resource
    Communicating a drug alert (1994)
    Springer
    European journal of clinical pharmacology 47 (1994), S. 125-132 
    Details
    ISSN: 1432-1041
    Keywords: Postmarketing surveillance ; acitretin ; Adverse drug reaction ; etretinate ; communication ; mass media
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology , Medicine
    Notes: Abstract In October 1990, a recall procedure was initiated for the teratogenic drug acitretin, and the recommended post-therapy contraception period after acitretin therapy was extended from 2 months to 2 years due to the possibility of its conversion to the lipophilic compound etretinate. The aim of the present study was to evaluate the communication procedures and their effects as a drug alert from the health authorities, the pharmaceutical company and professional associations of health professionals to the population at risk. A model was used to evaluate communication between three hierarchical levels. Data were obtained via semi-structured interviews and structured questionnaires. Communication procedures were evaluated according to channel characteristics and by analysis of their contents. The effect was measured as whether the drug dispensers identified acitretin users, contacted physicians, and whether physicians communicated in person with the population at risk. The penetration of direct mail from the health authorities and from the pharmaceutical company ranged from 97–98% and 65–94% at Level 2 (health professionals). The population at risk was informed via personal communication with health professionals, and/or the mass media. Of the women at risk, 19% were contacted by a dermatologist, 30% by their GP, and 39% by the pharmacist. 35% was never informed by any health professional. The Dutch health care system is adequately equipped for effective communication between health authorities, pharmaceutical industry and health professionals. Due to problems with identification in terms of past exposure, subsequent personal communication between health professionals and the population at risk was inadequate. Therefore, the role in personal communication of health professionals should be increased, as they can rapidly identify persons at risk as a result of previous exposure. In The Netherlands drug dispensers should have an important role.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00194961
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  • 7
    Electronic Resource
    Electronic Resource
    Drug-utilization study on Curaçao (1993)
    Springer
    Pharmacy world & science 15 (1993), S. 73-78 
    Details
    ISSN: 1573-739X
    Keywords: Antibiotics ; Anti-inflammatory agents ; Curaçao ; Drug utilization ; Netherlands Antilles ; Psychotropic drugs
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The drug use on Curaçao was evaluated with the help of the prescription forms of twelve community pharmacies at Curaçao over a period of three months. The emphasis of the study was on three therapeutic groups: the systemic antibiotics, the psycholeptics and the anti-inflammatory and antirheumatic drugs. Within the group of systemic antibiotics broad-spectrum antibiotics were very frequently prescribed compared with the small-spectrum penicillins. The consumption of psycholeptics, particularly benzodiazepines, on Curaçao is remarkably low in comparison with drug utilization data of Denmark and the Netherlands. In contrast, the number of defined daily doses per 1,000 persons per day of antirheumatic drugs is higher compared with data from these two countries. Within the analysed groups, large differences occur between the two most important kinds of insurance,i.c., the poor people (PP) and social insurance bank (SVB) insurance. The PP-insured patients consume in the case of antibiotics and antirheumatic drugs almost twice as many and in the case of psycholeptics even five times as many as the SVB-insured patients do. A few calculations of prices prove that the extra amount of drugs consumed by PP-insured has important financial consequences.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01874086
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  • 8
    Electronic Resource
    Electronic Resource
    Acitretin (Neotigason®) (1992)
    Springer
    Pharmacy world & science 14 (1992), S. 33-37 
    Details
    ISSN: 1573-739X
    Keywords: Acitretin ; Etretinate ; Metabolism ; Pharmacokinetics ; Retinoids ; Teratogens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract Acitretin was introduced as a replacement for etretinate, the ethyl ester of acitretin. Acitretin is eliminated at a much faster rate than etretinate. Although both drugs are teratogens, the replacement was important especially as it allowed for a much shorter post-medication period in which pregnancy should be precluded. Recent findings showed the presence of etretinate in the plasma of acitretin-treated patients. This article gives a review of known metabolic pathways of the retinoids and tries to elucidate the possible conversion of acitretin into etretinate after acitretin ingestion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01980479
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  • 9
    Electronic Resource
    Electronic Resource
    Handling of risk-bearing drugs during pregnancy (1992)
    Springer
    Pharmacy world & science 14 (1992), S. 38-45 
    Details
    ISSN: 1573-739X
    Keywords: Analgesics ; Antibiotics ; Anticonvulsants ; Cardiovascular agents ; Drug utilization ; Pregnancy ; Prescriptions, drug ; Psychotropic drugs ; Teratogens
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract The drug use of nearly 2,000 pregnant women was evaluated at the level of the individual patient for the drugs belonging to the Australian risk categories B3, C and D. The pattern of changes in the use of these drugs is studied in terms of women who discontinue (d), continue (c) or begin (b) using the drug during pregnancy. The ratios d/(c+b) and d/b were the highest for the drugs belonging to the high-risk groups and the lowest for drugs from the low-risk categories. This suggests a congruence between theoretical knowledge and daily practice. Patients who had already been using a drug for a long time before pregnancy, more frequently continued using that drug than patients who had been using the drug only incidentally before. The described daily dose for the riskful drugs was approximately 20% lower in patients who started to use a drug during pregnancy compared to those who continued drug use. The data from this analysis indicate that the prescribing physician is generally aware of the possible risks of drug use during pregnancy. The d/(b+c) and d/b ratios are shown to be a good measure of prescribing behaviour in relation to pregnancy and can be used to compare knowledge of theory and daily practice.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01980480
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  • 10
    Electronic Resource
    Electronic Resource
    The role of pharmacists in the recruitment of a cohort for postmarketing surveillance (1995)
    Springer
    Pharmacy world & science 17 (1995), S. 126-132 
    Details
    ISSN: 1573-739X
    Keywords: Acitretin ; Data collection ; Dermatologists ; Drug utilization ; Epidemiological methods ; Pharmacists ; Product surveillance, postmarketing
    Source: Springer Online Journal Archives 1860-2000
    Topics: Chemistry and Pharmacology
    Notes: Abstract In October 1990, a recall procedure was issued regarding the drug acitretin. The recommended post-therapy contraception period after acitretin therapy was extended from 2 months to 2 years. For a postmarketing surveillance study, we recruited a cohort from the source population of women aged 15–45 years who were exposed to acitretin. Recruitment occurred through dermatologists, and pharmacists plus dispensing general practitioners. We describe the speed of and the response to the recruitment procedures, and the representativeness of the recruited cohort. We also studied whether the individuals who gave informed consent would have preferred to be recruited by either dermatologists or pharmacists, and whether the information obtained from pharmacists and dispensing general practitioners was valid. This study revealed that pharmacists and dispensing general practitioners (drug dispensers) recruited their subjects rapidly, with no or little selection; they attained a 42% response. Dermatologists recruited their subjects slowly and selectively; they attained a 24% response. The majority of women (60%) recruited by dermatologists would have given their informed consent if they would have been recruited by their pharmacists. Drug dispensers are essential contributors to the recruitment of a study population. We do advise that such recruitment for a postmarketing surveillance study occurs by means of a collaboration between pharmacists and physicians.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01872389
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