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Nordic prescription registers Finland

Nordic prescription registers Finland. Leena K Saastamoinen The Social Insurance Institution (Kela) Finland NorPEN 12.-13. October, 2011. Essential demographics. Size of population on July 31st 2011 5 388 417 See Statistics Finland http://www.stat.fi/til/vrm_en.html

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Nordic prescription registers Finland

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  1. Nordic prescription registersFinland Leena K Saastamoinen The Social Insurance Institution (Kela) Finland NorPEN 12.-13. October, 2011

  2. Essentialdemographics • Size of population on July 31st 2011 5 388 417 • See Statistics Finland http://www.stat.fi/til/vrm_en.html • Certain population data is available also from Kela, e.g. control population

  3. Relevant host institution(s) • The Social Insurance Institution (Kansaneläkelaitos, Kela) • Prescription register • Special Reimbursement Register • National Institute of Health and Welfare (Terveyden ja hyvinvoinnin laitos, THL) • Hospitalisation • Statistics Finland

  4. Helsinki

  5. Prescription Register in Finland • Since 1994 • Wholepopulation (5.4 mio) • For drugreimbursementpurposes

  6. Prescription variables, what is covered? Drug user • HETU ID-code • IKA Age at the end of the yea • SP Gender • SYNTPV Date of birth • SVUOSI Year of birth • KUOLPV Date of death • ASKU Municipality of residence at the end of the year • SHP Hospital district at the end of the year Prescriber • SVNUMERONumber of the doctor • ERKOT Main speciality of the doctor during the year • TYOP Data on working place in the year in question

  7. Prescription variables, what is covered? Drug • ATC ATC-code • OTPVM Purchase date • VNRO Nordic product number (Package size, strength, pharmaceutical form available under product number) • PLKM Number of purchased packages • KUST Cost of the drug (EUR cent) • KORV Reimbursement/refund of the drug (EUR cent) • KAKORV Additional refund after yearly ceiling (EUR cent) • DDD Number of DDD’s in the purchase Other • Dose dispensing • Generic substitution, switching

  8. Prescription variables, what is not covered? • Dosing instruction (only in free text for latest 1,5 years) • Indication (only in free text for latest 1,5 years, if the doctor has recorded any indication – e.g. SSRI: no indication in 16 %, tricyclics: 55 %, others: 23 %)

  9. Coverage of prescription database • All residents • Only reimbursed prescriptions (including clinical nutrients and basic ointments for long term care) • Not covered: • OTC drugs • Drugs prescribed in hospitals

  10. Groupspoorlycovered • Oralcontraceptives • New activesubstanceswhicharenotyetincluded in reimbursementsystem • Eye and eardrops for shorttermuse • Small packages of benzodiazepines

  11. Data on diagnoses • Data on hospitalisation from THL since 1969 (Poistoilmoitusrekisteri, hoitoilmoitusrekisteri HILMO) • Data on open care contacts, AVOHILMO since 2011 (THL)

  12. Data on diagnoses • Special reimbursement eligibility register • Kela • Since 1964 • Person code, age, gender, place of residence... • Number of disease • Diagnosis complete since 2000 • E.g. Cancers, BP, asthma, diabetes...

  13. Linkage • Individual level data available for scientific research • Permissions have to be applied from each institution • Data is e.g. Transferred from Kela to THL and linked there before submitting to the researchers • If possible, the person codes are removed after linking (the key can be saved)

  14. Practicalitities Approvals • Ethics approval are not required for plain registry studies • Approvals from each institution • Kela (in English): http://www.kela.fi/in/internet/english.nsf/NET/161109114227HJ?OpenDocument • THL (In English): http://retki.stakes.fi/EN/Permitsanddataprotection/ApplicationMSH/Applying.htm, applicationforms in Englishavailablefromarto.vuori (a) thl.fi Help • http://retki.stakes.fi/EN/index.htm Costs • The more data on different years and different data sources, the more expensive data Time • 3-4 months from Kela (one year?)

  15. A fewexamples of papers • Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE. Use of ADHD drugs in the Nordiccountries: a population-basedcomparisonstudy. Acta PsychiatrScand. 2011 May;123(5):360-7 • Martikainen JE, Saastamoinen LK, Korhonen MJ, Enlund H, Helin-Salmivaara A. Impact of restrictedreimbursement on the use of statins in Finland: a register.basedstudy. MedCare. 2010 Sep;48(9):761-6. • Foulon V, Svala A, Koskinen H, Chen TF, Saastamoinen LK, Bell JS. Impact of regulatorysafetywarnings on the use of antidepressantsamongchildren and adolescents in Finland. J ChildAdolescPsychopharmacol. 2010 Apr;20(2):145-50. • Rikala M, Hartikainen S, Sulkava R, Korhonen MJ. Validity of the FinnishPrescriptionRegister for measuringpsychotropicdrugexposuresamongelderlyFinns: a population-based intervention study. DrugsAging. 2010 Apr 1;27(4):337-49 • Helin-Salmivaara A, Lavikainen PT, Korhonen MJ, Halava H, Martikainen JE, Saastamoinen LK, Virta L, Klaukka T, Huupponen R. Pattern of statinuseamong 10 cohorts of new usersfrom 1995 to 2004: a register-basednationwidestudy. Am J ManagCare. 2010 Feb;16(2):116-22 • Koskinen H, Martikainen JE, Maljanen T. Antipsychotics and antidepressants: an analysis of cost growth in Finland from 1999 to 2005. ClinTher. 2009 Jun;31 Pt 1:1469-77 • Haukka J, Suvisaari J, Tuulio-Henriksson A, Lönnqvist J. Highconcordancebetweenself-reportedmedication and officialprescriptiondatabaseinformation. EurJ ClinPharmacol. 2007 Nov;63(11):1069-74

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