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Legeshopping - indikator for legemiddelmisbruk?: En registerstudie
Nordic Council of Ministers, Nordic School of Public Health NHV.
2008 (Norwegian)Independent thesis Advanced level (degree of Master (Two Years))Student thesisAlternative title
Doctor-shopping – an indicator of prescription drug abuse? : A register study. (English)
Abstract [no]

Bakgrunn: Misbruk av vanedannende legemidler er et viktig folkehelseproblem. Enkelte pasienter går fra lege til lege og driver såkalt legeshopping for å skaffe seg mest mulig av denne typen legemidler. Dette er et problem i forhold til å kunne begrense legemiddelmisbruket i befolkningen. Fastlegeordningen, som ble innført i Norge i 2001, er blant annet ment å skulle begrense mulighetene til legeshopping. Det er ikke tidligere gjort studier som kan kartlegge omfanget av legeshopping i en befolkning, verken i Norge eller andre land.

FORMÅL: Kartlegge omfanget av legeshopping i befolkningen i Norge, og forsøke å klarlegge i hvilken grad bruk av flere leger kan skyldes shopping etter legemidler eller andre årsaker.

MATERIALE OG METODE: Studere data fra det norske Reseptregisteret (NorPD) for kalenderåret 2004, som blant annet viser antallet leger benyttet, mengde utlevert av det aktuelle legemiddelet og samtidig mengde utlevert av benzodiazepiner og opioider for alle brukere av de vanedannende legemidlene diazepam, karisoprodol og kodein kombinasjoner sammenlignet med alle brukere av de ikke-vanedannende legemidlene esomeprazol, metformin og salbutamol.

RESULTATER: De aller fleste pasienter bruker kun en eller to leger for å få utlevert samme legemiddel i løpet av ett kalenderår. Andelen som bruker tre eller flere leger er imidlertid mer enn dobbelt så høy for de vanedannende legemidlene som for de ikke-vanedannende, og for de som bruker fem eller flere leger, er andelen nesten ti ganger større. Med økende antall leger som er benyttet, er dessuten økningen i både utlevert mengde av legemidlet og samtidig mengde utlevert av benzodiazepiner og opioider langt mer uttalt for de vanedannende legemidlene enn for de ikke-vanedannende.

KONKLUSJON: Det foregår etter innføringen av fastlegeordningen fortsatt en begrenset, men klar legeshopping blant pasienter som ønsker å få tak i mest mulig av vanedannende legemidler. Dette forhold må tas alvorlig av både de forskrivende legene og helsemyndighetene.

Abstract [en]

BACKGROUND: Abuse of prescription drugs is an important public health issue. Some patients go from one physician to another in so-called doctor-shopping (or physician-shopping) with the intention to have as much as possible of addictive drugs prescribed. This is a problem when trying to restrict prescription drug abuse in the population. The Regular General Practitioner (RGP) Scheme which was introduced in Norway in 2001 had among other things the intention to counteract doctor-shopping. So far there are no studies in Norway or other countries that have presented estimates of the proportions of patients that practice doctor-shopping.

AIM: To explore the extent of doctor-shopping in the population in Norway and try to unveil if the use of several doctors is primarily a prescription drug shopping or if it has other reasons.

MATERIAL AND METHODS: Data from The Norwegian Prescription Database (NorPD) for the year of 2004 was studied. The register includes information on the number of doctors used by individual patients and the amount of drug dispensed. There is also information about concomitant use of opioids and benzodiazepines. Users of the addictive drugs diazepam, carisoprodol and codeine combinations were compared to users of the non-addictive drugs esomeprazole, metformin and salbutamol.

RESULTS: Most patients use only one or two doctors for prescription of the same drug over a period of one year. However the proportion of patients who uses three or more doctors for the addictive drugs is more than twice the comparable proportion of patients using the non-addictive drugs. For those who uses five or more doctors the proportion is nearly ten times larger. The amount of dispensed drug increases considerably more by increasing number of doctors used for users of the addictive drugs than for the users of the non-addictive drugs, as do the amount of concomitantly dispensed opioids and benzodiazepines.

CONCLUSION: Also after the introduction of the Regular General Practitioner (RGP) Scheme in Norway doctor-shopping is still going on to a limited but significant extent by patients who appear to have the intention to get as much as possible of addictive drugs. This is a public health issue that has to be taken seriously by both prescribing doctors and health authorities.

Place, publisher, year, edition, pages
2008. , 49 p.
Series
Master of Public Health, MPH, ISSN 1104-5701 ; MPH 2008:21
Keyword [en]
Doctor-Shopping/Physician-Shopping, Prescription Drug Abuse, Addictive Drugs, the Regular General Practitioner Scheme, the Norwegian Prescription Database (NorPD)
Keyword [no]
legeshopping, legemiddelmisbruk, vanedannende legemidler, fastlegeordningen, Reseptregisteret
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:norden:org:diva-3176OAI: oai:DiVA.org:norden-3176DiVA: diva2:724249
Presentation
2007-06-08, Nordic School of Public Health NHV, Box 12133, 402 42 Göteborg, Sweden, 00:00 (Norwegian)
Supervisors
Note

ISBN 978-91-85721-60-3

Available from: 2014-06-12 Created: 2014-06-12 Last updated: 2015-01-30Bibliographically approved

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