Norgep - Legemiddelhåndboka

Det er likevel ingen tvil om at legemiddelbruk har bidratt til økende gjennomsnittlig levealder og bedre livskvalitet for mange, spesielt i den eldre delen av befolkningen. Men enkelte legemidler, eller kombinasjoner av legemidler, har spesielt stor risiko for bivirkninger eller negative interaksjoner hos de eldre.

Når risikoen ved legemiddelbruk er antatt å overstige nytten, har vi det vi kaller «potensielt uhensiktsmessig legemiddelbruk». Det er utviklet flere sett med kriterier for slik potensielt uhensiktsmessig legemiddelbruk.

Som fastlege og sykehjemslege i flere kommuner i Finnmark, Akershus, Oslo og Østfold observerte jeg at legemiddelbruk kunne ha stor betydning i både positiv og negativ effekt hos de eldre. Jeg syntes også det var store individuelle variasjoner mellom den enkelte leges forskrivningspraksis, en ikke unaturlig konsekvens av en mangel på evidens og retningslinjer på området. I arbeidet med denne avhandlingen, utgående fra Allmennmedisinsk forskningsenhet ved Universitetet i Oslo, fikk jeg gjøre et dypdykk i dette temaet.

Første artikkel 3 i doktorgraden er en farmakoepidemiologisk studie basert på data fra Reseptregisteret. Resultatet var at mer enn en av tre 34,8 prosent av de eldre fikk minst en potensielt uhensiktsmessig forskrivning i løpet av Risikoen var større for kvinner enn for menn, med en alderskorrigert odds ratio på 1.

Dataene inneholdt ikke informasjon om medisiner forskrevet fra leger i sykehus og sykehjem, men fra spesialister utenfor sykehus, allmennleger og legevaktsleger. Likevel kunne vi konkludere at en tredjedel av den norske hjemmeboende befolkningen over 70 år var berørt av dette.

Artikkel to 4 i avhandlingen omhandler en stor tre-runders konsensusprosess med Delphi-metoden. For sykehjemssektoren fantes ingen kriterier for uhensiktsmessig legemiddelbruk foruten Beers-kriteriene for sykehjem, utviklet i USA i 5. Disse var lite relevante for norske forhold, også fordi legemiddelbruken varierer en del mellom ulike land, spesielt når det gjelder psykofarmaka.

En del av legemidlene på Beers liste har ikke vært i bruk i Norge. Vi fikk med 80 deltakere i vår konsensusprosess; sykehjemsleger, kliniske farmakologer, geriatere og erfarne farmasøyter.

Forfatterne av artikkelen fungerte som facilitatorer og utarbeidet det opprinnelige forslaget til 27 kriterier for potensielt uheldig legemiddelbruk i sykehjem, basert på NORGEP-kriteriene, litteratursøk og våre egne kliniske erfaringer. Hele undersøkelsen foregikk anonymt via et nettbasert surveyverktøy. Deltakerne fikk oppgitt en begrunnelse for hvert kriterium, samt to eller flere aktuelle referanser. De skulle score den kliniske relevansen av hvert kriterium på en skala fra én til ti.

I tillegg kunne de komme med kommentarer og forslag til nye kriterier. På grunnlag av deltakernes forslag i første runde ble sju nye kriterier lagt til.

Av disse var 25 sykehjemsleger. Som forsidemotiv på mynten benyttes kongeportrettet av Harald V slik det har vært brukt på sirkulasjonsmynter med spesialpreg de senere år. Vestly ble født. I tillegg inneholder settet års-medaljen Proofsettet kan nå forhåndsbestilles.

Opplag KUN maks sett Pris: Myntsettet fra inneholder årets krone utgitt i forbindelse med markeringen av årsjubileet for Anne-Cath Vestlys fødsel. Navn etter designer: George T. Morgan Denne mynten er utgitt ved flere myntverk, oftest hvert år.

Skanfil-tilbud denne måned. Sist innkomne mynter og sedler. Album og Samlerutstyr. Enkeltfrimerker Europa. Frimerker og postkort. Mynter og sedler. Velkomsttilbud - kun til nye medlemmer. Bli medlem. Side 1 av , totalt treff 1 2. Artikkelnr: 5. Velg antall 1. Artikkelnr: 4.

Artikkelnr: 20 kroner. Artikkelnr: kroner. Artikkelnr: Proofsett. Proofsettet fra inneholder årets krone utgitt i forbindelse med markeringen av årsjubileet for Anne-Cath Vestlys fødsel.

Hjem Det helsevitenskapelige fakultet Institutt for farmasi Mastergradsoppgaver i farmasi Vis innførsel. JavaScript is disabled for your browser. Some features of this site may not work without it.

Legemiddelbruk i sykehjem. Åpne thesis. Dato Type Master thesis Mastergradsoppgave. To nye undersøkelser påviser …. Forskning Like god effekt av behandling med antidepressivt medikament for eldre Like god effekt av behandling med antidepressivt medikament for eldre.

Eldre får like god effekt av behandling med antidepressivet citalopram som voksne på lindring, livskvalitet og funksjon i hverdagen, viser ny studie. Avsluttet prosjekt Sykehusinnleggelser hos personer med utviklingshemning, en registerstudie Sykehusinnleggelser hos personer med utviklingshemning, en registerstudie.

Voksne og eldre med utviklingshemning har høyere sykelighet enn befolkningen generelt. Undersøkelser fra andre land viser at voksne personer med …. Nordic Studies on Alcohol and Drugs Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals.

Fant du det du lette etter? Ja Nei. Vil du hjelpe oss med å forbedre aldringoghelse. Bare fortsett med det du skulle gjøre. Forskningsprosjekt Innføring av strukturert medisingjennomgang i norske sykehjem Vitenskapelig tittel: Psychotropic drug use in the elderly living in nursing homes- associations with clinical symptoms and the influence of a structured drug review Prosjektbeskrivelse: Prosjektets formÃ¥l er Ã¥ fÃ¥ mere kunnskap om legemiddelforbruk i norske sykehjem, spesielt psykofarmaka.

Gjennom et randomisert kontrollert studie vil prosjektet studere hvilken innflytelse en strukturert legemiddelgjennomgang har på forskrivningsrate og pasientenes fysiske og mentale helse. Prosjektet vil benytte seg av NorGeP, et nytt verktøy utviklet i , som skal hjelpe sykehjemsleger med å avdekke ikke hensiktsmessig eller potentielt farlig forskrivning.

Til tross for nøye oppfølging av medisinering i sykehjem, er bruk av NorGeP ikke en del av dagens praksis.

Regarding the prescription of three or more concomitant psychotropic medications, odds ratio for females was 1. Residents with the best performance in activities of daily living, and residents residing in long-term wards, had higher risk of using three or more psychotropic drugs.

Use of multiple psychoactive drugs increased the risk of falls in the course of an acute episode of infection or dehydration odds ratio 1. Conclusions: Prevalence of potentially inappropriate medications in nursing homes according to the NORGEP-NH was extensive, and especially the use of multiple psychotropic drugs.

The high prevalence found in this study shows that there is a need for higher awareness of medication use and side effects in the elderly population. Trial registration: Retrospectively registered. Abstract Background: Frail residents in the nursing home sector call for extra care in prescribing.

Publication types Clinical Trial Observational Study. In an expert panel, a three-round Delphi consensus process was conducted via survey software. Altogether 80 participants — specialists in geriatrics or clinical pharmacology, physicians in nursing homes and experienced pharmacists — agreed to participate in the survey.

Of these, 62 completed the first round, and 49 panellists completed all three rounds Main outcome measures. In the first round panellists could also suggest new criteria to be included in the process. For each criterion, degree of consensus was based on the average Likert score and corresponding standard deviation SD. A list of 34 explicit criteria for potentially inappropriate medication use in nursing homes was developed through a three-round web-based Delphi consensus process.

Degree of consensus increased with each round. No criterion was voted out. Suggestions from the panel led to the inclusion of seven additional criteria in round two. The NORGEP-NH list may serve as a tool in the prescribing process and in medication list reviews and may also be used in quality assessment and for research purposes. Nursing home residents are frail and thus are especially prone to medication side effects and drug interactions.

This paper describes a three-round Delphi process, resulting in a list of drugs, dosages, and drug combinations to be avoided in nursing home residents for safety reasons. The nursing home NH population of Western countries has become increasingly frail and ill, with specific and extensive needs in terms of health care. The majority of patients have multiple diseases with an average of four active diagnoses, four out of five residents have extensive needs for assistance in carrying out activities of daily living [ 2 ], and four out of five have dementia [ 3 ].

In general, the elderly population is more prone to medication side effects and drug—drug interactions [ 4 ]. Still there is often limited research evidence of effects and side effects, because most randomized, controlled trials on drug treatment are conducted in younger populations where comorbidities and polypharmacy are common exclusion criteria. Various lists of explicit criteria for pharmacological inappropriateness have been developed to guide clinical practice and for assessing the extent of potentially inappropriate medication PIM use in the elderly [ 5 , 6 ].

The Beers criteria were developed in the US in for NH residents [ 7 ] and later for a general population [ 8—10 ]. The Norwegian General Practice NORGEP criteria are another list of explicit criteria for pharmacological inappropriateness, targeting home-dwelling elderly seen in general practice [ 13 ]. Some studies have shown an impact of inappropriate drug regimens on health care outcomes like hospital admission rates [ 16 , 17 ], self-perceived health status [ 18 ], and health-care utilization [ 19 ], while others have found no association between PIMs and the length of hospital stay [ 18 ].

Two studies found no association between PIMs and mortality [ 16 , 20 ]. In one study, inappropriate medication use increased the risk of adverse drug events when measured by the STOPP criteria; however, when applying the Beers criteria the correlation was not significant [ 21 ]. There is a need for more evidence as to the clinical relevance of the different lists of explicit criteria when it comes to effect on patient-related health outcomes.

In the present study we aimed at establishing an updated and clinically relevant tool for assessing medication use in NH residents. We conducted a three-round consensus process using the Delphi technique [ 22 ]. The Delphi technique is a structured communication technique where a panel of experts answers questions, most often in the form of a questionnaire, to which there are no scientifically proven correct answers [ 22 ]. The idea is that a group of experts, participating individually and anonymously, will give a more valid approach than experts one by one, and that consensus is reached through consecutive rounds in which participants are shown average responses made by the panel in previous rounds.

Altogether, the number of eligible doctors in the five groups was A total of 92 doctors responded to the invitation, and 80 agreed to participate Figure 1. The Delphi process, setting, and participants. The three rounds of the Delphi process were completed between August and March The survey was conducted via the software SurveyMonkey ® Madison, WI, US , and the participants were sent an e-mail with a link to the survey.

In first round they were exposed to 27 statements, suggesting criteria for inappropriate medication use in NH residents. The proposed criteria were based on the NORGEP criteria [ 13 ] and the knowledge and experience of the authors, who also carried out a comprehensive literature search for each suggested criterion. A few of the criteria from the NORGEP list have since their publication been taken off market and a few of them were shown to be of little clinical relevance in a subsequent pharmacoepidemiological national study [ 14 ] and these criteria were not included here.

Other criteria given as single drug criteria in the NORGEP were here listed as drug classes first-generation tricyclic antidepressants [TCAs], first-generation antihistamines, and neuroleptics. Each statement was presented with a brief explanation and up to three literature references. A commentary box was provided beneath each criterion.

In addition, the participants were encouraged to suggest additional criteria and references. A new literature search was performed before the authors decided whether or not to include criteria proposed by the panellists in the first round.

The revised list of criteria was presented to the panellists in round two, in which average relevance scores from the first round were included. In the second round there was still room for comments but not for suggesting additional criteria.

In the third round average scores for each criterion in round two were enclosed and the panellists were asked only to score without comments. A link for opting out was provided in each mail. SDs described the degree of discordance through the three rounds.

Statements were included in the final list if the mean score minus one SD exceeded 5 in round three. Subgroup analyses were performed comparing scores made by the NH physician group with corresponding scores made by the rest of the panel. Because frequency distributions were skewed towards the right and thus were not normally distributed, Mann—Whitney U-tests were employed to analyse differences in consensus between the two groups. The participants were assumed independent of each other, since the survey was conducted via Internet and not in a face-to-face group.

Since there was no intervention as such and all correspondence and comments were anonymous the NSD assessed that the study did not need explicit approval by the Regional Committee for Medical and Health Research Ethics. We received altogether 92 responses from 34 Oslo nursing home physicians, nine members of the Reference Group for NH medicine some of whom also were physicians in Oslo nursing homes , 13 members of NFKF, 38 members of NGF, and all five pharmacists.

Of these, 80 participants agreed to take part in the survey out of which 52 completed all three rounds and 49 provided complete data see Figure 1. Five participants gave reasons for not completing the survey; the rest opted out by not responding to it. Of the 49 participants completing all three rounds, 15 The other 24 All proposed criteria were included in the final list Table I.

For all criteria the SD was reduced from first to third round, reflecting fewer outliers at the lower end of the scale. For criteria 27—29, a safe strategy for re-evaluation is first to taper dosage, then stop the drug while monitoring clinical condition; 9 risperidone, olanzapine, quetiapine, aripiprazole; 10 behavioural and psychological symptoms in dementia. Notes: 1 The clinical relevance for each of the criteria is scored from 1 to 10 by a panel of experts during a three-round consensus process.

Figures are mean scores with standard deviation, MS SD. Through all three rounds 27 criteria were assessed three times by the panel while seven were scored twice, resulting in 95 means altogether see Table II. This three-round Delphi process, carried out among 80 participants, resulted in a list of 34 criteria for potentially inappropriate medication use in NHs. Both the degree of consensus and the average scores for clinical relevance increased throughout the Delphi process.

A Delphi technique is said to be useful when a problem does not lend itself to precise analytical techniques, but can benefit from subjective judgements on a collective basis [ 22 ]. However, the initial 27 suggestions, and the seven criteria suggested by the panel, are all based on a combination of experience among both the authors and the panel and evidence from the literature. All suggestions have been scrutinized through literature searches and relevant references were provided to the panel during the consensus process.

The standard deviations of the means can be interpreted as a measure of the degree of discord among the participants. Still, a larger SD implies that a larger number of participants scored well below the mean. The Delphi technique in itself can be said to be conservative in the respect that it takes quite a lot for a proposed criterion to be rejected. The main reasons for the Delphi method to fail are imposing monitor views and preconceptions upon the respondent group, and ignoring and not exploring disagreements [ 22 ].

In a case with a high degree of disagreement, as seen by a high SD, the average minus SD will thus be lower than in a case with a high general agreement and thus a low SD. In this way, a controversial criterion will be less likely to be included in the list than a less controversial.

Still no criterion was voted out through the three rounds. The survey was lengthy, with a lot of text and many references, and this might have added to the withdrawal percentage. However, participants who completed all three rounds were in large part active throughout the process, providing numerous comments and suggestions for further references in both rounds one and two, thus giving the impression of an involved and independent panel.

It has been argued that one of the most critical aspects when designing a Delphi survey is the selection of qualified experts [ 22 ]. In some earlier surveys, among them the Beers consensus process and its later updates [ 7 , 8 , 10 ], the recruitment process differed from the present study in that the panel consisted of considerably fewer, hand-picked experts: 12 and six in the case of Beers criteria for NHs.

At present there is no vocational training leading to a clinical speciality within NH medicine in Norway. To check for robustness with regard to this matter we tested the average scores and the development of consensus throughout the survey's three rounds for these participants versus the rest of the panel.

The final list of explicit criteria would have been unaltered had only either one of the two participant groups undertaken the survey.

It has been suggested that the term should be adopted internationally by researchers and practitioners engaged in this area [ 27 ]. Three criteria in this latter group concern preventive drug use when expected remaining life span is short: one concerning the use of preventive medication in general, the other two concerning the use of, respectively, bisphosphonates and statins.

One can argue that the two latter criteria are redundant. However, since there was consensus to include all three criteria throughout the survey, they were included in the final list. A similar argument applies to using NSAIDs in different combinations, all of which could have been substituted by a single general criterion. However, since some of the combinations are particularly risky, the combination criteria still may serve a purpose in attracting attention to these potential threats.

Because this represented relatively new knowledge at the time of the survey, the lower score can be viewed as healthy scepticism, as one could argue that more research was needed.

After this study was completed, new research has strengthened the evidence for the clinical relevance of avoiding this combination, which is associated with increased risk for fractures [ 28 , 29 ]. In a previous study we found that one-third of the total population of home-dwelling elderly in Norway were exposed to at least one PIM over the course of one year, according to a modified version of the NORGEP criteria [ 14 ].

The present list, although primarily developed for the especially frail patients in nursing homes, can also be useful as a tool for GPs undertaking medication reviews for elderly patients outside institutions.

There is a need for more research on the effects of implementing the NORGEP-NH and similar lists with explicit criteria in clinical practice on outcomes like quality of life, morbidity, and mortality. The authors would like to thank all the participants of this Delphi study for their interest, effort and time. The authors report no conflicts of interest.

The authors alone are responsible for the content and writing of the paper. National Center for Biotechnology Information , U.

Scand J Prim Health Care. June, ; 33 2 : — Author information Article notes Copyright and License information Disclaimer. Corresponding author. E-mail: on. Copyright © The Author s. This article has been cited by other articles in PMC.

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Background: Real gloryhole residents in the nursing home sector call for extra care in prescribing. The norgep of this study was to employ the NORGEP-NH Criteria to study the extent of potentially inappropriate medication use among nursing home residents and explore possible associated factors. Methods: Cross-sectional observational norgep study from residents norgep nursing homes in norgep county of Vestfold, Norway. Data collected included residents' demographic and clinical real escorte.no and regelmessig kryssord medications, regular and on demand.