Patient characteristic, perceived health and drug prescription in primary care

Abstract: Patients have increased demands for information and involvement in decision-making including drug selection.  At the same time, society needs to limit costs, e.g. for subsidized drugs, thus entailing a challenge to in particular primary care. The overall aim of this thesis was to describe different factors influencing drug prescription in primary care and perceived health.In a register study, the actual costs of prescribed subsidized drugs at five health care centers (HCCs) in areas of varying socioeconomic status (SES) were compared to the assigned drug budget. It revealed that HCCs with many citizens in the catchment area with low SES showed a deficit at year’s end. HCCs in areas with citizens with a higher SES showed a surplus.In another register study, the prescription of drugs at lower or higher price levels for the diagnoses of chronic obstructive bronchitis, depression, diabetes and osteoporosis was studied. Drug prescription was then compared with individual factors for age, sex, education, income and country of birth, and whether the care provider was private or public. It was found that certain individual and provider factors appear to influence the prescribing of drugs of different price levels.To investigate patient involvement in the decision to start long-term drug treatment, respondents who had recently begun taking medication were interviewed. The study showed that patient participation was important, but that participation implied different things to different patients. One view was that participation could be achieved without sharing the decision-making process, whereas another view was that participation was more or less willingness to become involved in decision-making. Prerequisites for patient participation were knowledge in the relevant area and trust in the physician.A fourth study examined how individuals aged 65-80 years rated their health. The study showed that health was assessed much lower in respondents with depressive symptoms compared to those without corresponding symptoms. Health was also assessed as worse for people with hypertension and in those treated with drugs for depression and hypertension. Health was perceived as better in the younger age groups, in individuals with higher educational levels, and for men. Drug prescription in primary care is controlled, in addition to medical necessity, by economic constraints, and that patients need an opportunity to influence decisions about their care and treatment. However, economic constraints make it difficult for physicians to support patients in their choice of medication. This may influence patient adherence to medication.