Similar to the Netherlands, GPs in Denmark act as gatekeeper to second line health care and provide most of the medical care.
DENMARK
Similar
to the Netherlands, GPs in Denmark act as gatekeeper to second line health care
and provide most of the medical care. The majority (97%) of citizens are
assigned a GP, who generate 90% of the prescriptions. Although initiatives have
been taken to create GP databases, the most important source for
pharmacoepi-demiological studies in Denmark to date constitute data from the
Danish pharmacies that became increas-ingly computerized in the 1990s and have
allowed for the establishment of regional and national prescrip-tion registries
(Gaist et al., 1997). As part of its
tax funded health care for all inhabitants, the Danish NHS provides medical
attendance free of charge and reim-burses 50% of all expenditure on a wide
range of prescribed medicines independently of the presenters income and
employment status. Measured in defined daily doses, 73% of all medication sold
in Denmark in 1996 was on prescription (Gaist et al., 1997).
The
Danish NHS is divided into 16 sections. Each community pharmacy collects data
on all prescription drugs and forwards data on reim-bursable medicines to their
local NHS section on a monthly basis. These data form the basis for the two prescription
registries, the Odense University Pharmaco-epidemiological Database (OPED) and
the Pharmaco-epidemiological Prescription Database of North Jutland (PDNJ)
(Sorensen and Larsen, 1994; Gaist et al.,
1997). Publications from these databases are numerous and can be obtained from
the depart-mental websites.
A
third prescription register was established in 1995, the Register of Drug
Statistics (RDS) at the Medicines Division of the National Board of Health,
that collects information on all pharmacy transac-tions of prescribed drugs
independent of reimburse-ment status and covers the entire population of 5.2
million inhabitants. Since 2003, study-specific access to these data is
available through National Board of Health.
Denmark
has a long tradition in registration; church files were established in 1645,
and in 1968 the Danish Civil Registration System was established. This civil
registration system, which is updated daily, is used in all registries and
comprises the civil registration number (CRN), civil status, CRN of
father/mother/children, death data, immigration and emigration. These data
allow for exact assessment of follow-up time of all citizens. Other nationwide
registries in Denmark are the hospital discharge registry, the cancer registry,
birth registry, mortality files and the social registries.
The
OPED database covers the county of Funen (population approximately 470 000)
persons, and PDNJ covers the county of Jutland and other (approx-imately 1.6
million persons) and together they cover a representative sample of 40% of the
Danish popula-tion (Nielsen et al.,
1996; Gaist et al., 1997).
Dispens-ing claims data that are collected in the systems comprise a unique
patient identifier, the CRN, that allows longitudinal tracking of the patient
through different layers of the health care system, the date of dispensing, the
product code (unique for brand, quan-tity and formulation) and ATC code. The
computer-ized drug-dispensing histories contain data concerning the dispensed
drug, type of prescriber, dispensing date and dispensed amount. The prescribed
dosing regi-men (and therefore legend duration) is not recorded in the systems.
Over-the-counter medication and non-reimbursed drugs (such as sedatives,
hypnotics, oral contraceptives and laxatives) or in-hospital drugs use are not
registered. Population data are obtained from the Central Registration System
every 6 months to track migration or date of death. Completeness of reimbursed
dispensed drugs has proven to be good (Gaist et al., 1997).
Prescription
data have been linked to local, regional and national hospitalization discharge
data, cancer registries, psychiatric registry, death and birth registries for
specific projects through the CRN in the PDNJ database (Nielsen et al., 1999; Olesen et al., 1999; Thrane and Sorensen, 1999;
Dalton et al., 2000; Fonager et al., 2000; Larsen et al., 2000; Sorensen et al., 2000). For a more recent list of
publications, the website
‘www.clin-epi.dk’ should be visited.
Almost
all the OPED studies are based on prescrip-tion data only (Gaist, 1999; Bjerrum
and Bergman, 2000). Odense University Pharmaco-Epidemiological Database and
Prescription Database of North Jutland are public institution research
registries. Data can be accessed upon approval of a protocol by the Steering
Committees.
Data
from the national prescription database can be linked to the hospital discharge
registry, the cancer registry, birth registry, mortality files and social
registries on the basis of the CRN. The Danish hospi-tal discharge registry
comprises data on 99.4% of all discharges from Danish hospitals and includes
the CRN code, dates of admission and discharge, the surgical procedures
performed and up to 20 diag-noses classified according to the ICD-10
classification of diseases (Andersen et
al., 1999). Access can be obtained for specific projects, but all analyses
must be done in Statistics Denmark or by modem. Statistics Denmark links the
registries and deletes the CRN. As there is no access to the CRN, paper records
validation is not possible. Currently, the procedure for getting access to the
data might take up to 6 months and is project related.
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