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Introduction: Taking medicines can induce risks leading to negative health issues that can grow in accordance with the number of medicines used. Many studies on the prevalence of polypharmacy have been carried out in other countries, but such studies are lacking in Iceland. The aim of this study was to analyse the prevalence of polypharmacy in primary care in the Reykjavik metropolitan area., Methods: The study population consisted of individuals who had been prescribed five or more drugs by physicians in primary care in the Reykjavik metropolitan area during the study period. Data was collected on all drug prescriptions for individuals in the area. Those who had five or more drugs prescribed in the primary healthcare database from 1 January 2010 through 31 December 2019 were included in the study. According to Statistics Iceland, the total number of inhabitants in the area was 200.907 in 2010 and 228.222 in 2019., Findings: The prevalence of polypharmacy increased gradually in 2010-2019, or by 37.9% during this period. Patients with polypharmacy were 9.8% (19.778) at the beginning of the study in 2010 and increased to 13.6% (30.970) in 2019. A clear association was observed between age and polypharmacy, and the study showed polypharmacy to be more common among women. The study findings revealed that the greatest relative increase in polypharmacy was among young people from 20-49 years of age. ATC class analysis showed a sharp increase in the first and third levels of the ATC subgroups., Conclusion: The findings suggest polypharmacy to be common in the Reykjavik metropolitan area. Similarly, its prevalence seems to be increasing in younger patients. It is important to gain a better understanding of the reasons for the development of polypharmacy and evaluate the increasing medicalisation in society. The underlying reasons, as well as the effects of polypharmacy, can lead to both positive and negative health outcomes.

Introduction: High blood pressure (HT) is one of the main risk factors for cardiovascular diseases which in 2010 caused one third of all mortality in the world. Untreated, HT can cause stroke, myocardial infarction, heart failure, dementia, kidney failure, atherosclerosis and eye diseases. The main aim of this study was to find out how HT is treated in primary care in the capital area of Iceland., Material and Methods: The study is a descriptive retrospective cross-sectional study covering the years 2010, 2014 and 2019. Information about all patients over 18 years old diagnosed with HT were gathered from computerised medical records at every primary care center in the Capital area., Results: The number of individuals diagnosed with HT increased during the study period and the mean age did also increase. The sex ratio changed with more men diagnosed than women. Of 25.873 patients diagnosed with HT in the year 2010, 63.4% received drug treatment. In 2019 this percentage had dropped 60.9% (p<0,001). Of those on antihypertensive drug treatment the proportion receiving one, two or three drugs remained same from 2010-2019. The most common group of drugs used were diuretics (C03), beta-blockers (C07), calcium channel blockers (C08) and renin-angiotensin-aldosteron-system (RAAS) inhibitors (C09). The proportion af these drug groups changed significantly during the study. Fever patients were treated by diuretics (p<0,001) or beta-blockers ((p<0,001) but the number treated by calcium channel blockers (p<0,01) or RAAS inhibitors increased (p<0,001). During the whole stud period 44.1% of the patients reached the target goals. The proportion of patients who reached the target goals in different health care center was specifically for the year 2019. Just over 41% of HT patients reached the targets goals. However, two health care centers achieved notably different results with only one third of the patients attaining the goals., Conclusion: As has recently been shown in epidemiologic studies hypertension in Iceland is both underdiagnosed and undertreated although the country ranks high on both counts in international comparison. Furthermore, the fact that under half of hypertensive patients in general practice in the capital area reach the targeted treatment goals, cannot be considered an acceptable. Thus, it is of immense importance to improve both the diagnosis and the treatment of HT.

Introduction: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions., Material and Methods: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel., Results: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software., Conclusion: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients' drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

Introduction: In recent decades there has been a notable increase in the prescription of opioids in western countries. With this rise in use of opioids the risk of side effects, opioid abuse and deaths linked to opioids have become more apparent. The increase in opioid prescription may partly stem from a change in attitude in relation to pain management. Research has shown that pain is among the most common reasons people seek medical care and chronic pain is prevalent. Iceland is leading the Nordic countries in opioid prescriptions., Objective: To examine prescriptions of opioids in primary car in Iceland for all age group from 2008 to 2017., Methods: The research included all opioid prescription in every health clinic in the capital area in Iceland the between 2008 and 2017. Population in the capital area in this time period was between 201 and 222 thousand people. Data was collected from medical records database of the primary health care and approximatley 68.000 individuals had received a prescription for opioids during the research period., Results: During the research period there was a 17,2% (p<0,01) increase in DDD/1000 inhabitants/day (Defined daily dose) for opioids. About a third of those who got the prescription were men and that ratio did not change during the period. proportionately, the biggest change in DDD/1000 inhabitants/day was in the age group made of people 90 years old and older, about 40,5% ((p<0,01)). The biggest increase in number of people getting a prescription for opioids was in the age group 30-39, about 25,5% ((p<0,01)). Number of prescriptions increased in every category of opioids, measured in DDD/1000 inhabitants/day,15,3% ((p<0,01)) in parkódin, 20,7% ((p<0,01)) in parkódín forte, 4,7% (p<0,01)) in tramadol and 85,6% (p<0,01) in the strongest opioids., Discussion: the evolution of prescriptions for every type of opioid to the clients of the health clinics in the capital area that occured in the years from 2008 to 2017, proportionately highest for the strongest opioids, should encourage a review of pain treatment within the health clinics and development within that field.

Background: The prevalence of gestational diabetes mellitus (GDM) has been rapidly increasing in Iceland and 19% of women who gave birth at Landspítali - University hospital in 2018 were diagnosed with GDM. Women who develop GDM in pregnancy have an increased risk of recurrence in future pregnancies, as well as an increased risk for developing type 2 diabetes mellitus later in life. Obesity and a sedentary lifestyle are known risk factors for the development of GDM. Prescribing physical activity has become an available treatment option in all Icelandic primary healthcare centres. The aim of this study was to examine the effect of prescribing postpartum exercise for women with a history of GDM on their physical activity level, quality of life, BMI and biochemical markers typical for metabolic syndrome., Materials and Methods: Women who delivered from 1st January 2016 to 30th June 2017 and sought prenatal care at healthcare centres within the Primary Health Care of the Capital Area were offered participation in the study. Participants were randomly divided into two groups, with one group being prescribed physical activity for five months while the other group received standard treatment of care. Blood tests (fasting blood sugar, HbA1c, cholesterol and insulin levels), BMI, general activity level and the patient's quality of life were measured at both three and eight months postpartum., Results: 84 women participated, 45 were assigned to the treatment group and 39 to the control group. General activity levels increased significantly in the treatment group, but no significant changes were seen in their blood test values. The treatment suggested an improvement trend in the women's BMI and quality of life, but the results were not significant. Women who breastfed had significantly lower insulin levels than women not breastfeeding. There was a stronger positive correlation between BMI and insulin levels than between fasting blood sugar levels and insulin levels., Conclusion: Prescribing physical activity after delivery for women with a history of GDM significantly increased their general activity level and breastfeeding seems to have a lowering effect on insulin levels.

Background: According to research findings, the financial crisis hitting Iceland in the autumn of 2008 caused both economic and health-related effects on the Icelandic population. It has been well known that the Icelandic population uses more antidepressants, anxiolytics and hypnotics compared to other Nordic countries. The aim of this research was to study the trend in prescription for these drugs by the Primary Health Care of Reykjavik capital area to young adults, during the years prior to and following the crisis., Method: In this cross-sectional study, data were gathered on all medical prescriptions of antidepressants, anxiolytics and hypnotics, prescribed by the Primary Health Care of Reykjavik capital area to people aged 18-35, during 2006-2016. While Reykjavík capital residents in the specified age group were approximately 55 thousand during the research period, this study included data on approximately 23 thousand individuals, received from the Icelandic electronical medical record system "Saga" used by the Primary Health Care., Results: Research results demonstrate a significant average annual increase of prescribed defined daily doses (DDD) for all three medication categories during the research period; 3% (p<0,001) for anxiolytics, 1.6% (p<0,001) for hypnotics and 10.5% (p<0,001) for antidepressants. Between 2008-2009, prescribed daily doses of anxiolytics increased by 22.7% (p<0,001), where a 12.9% (p<0,001) increase was seen for women and 39.5% (p<0,001) increase for men. Of those men who were prescribed anxiolytics in 2009, 35% had no history of such prescriptions the previous year. From 2006-2008 an average annual increase of 13.6% (p<0,001) was seen in prescribed daily doses of hypnotics, whereof 24.4% (p<0,001) increase was seen for men and 7.8% (p<0,001) for women., Conclusions: This study demonstrates a significant increase in prescribed amount of hypnotics and anxiolytics during the years prior and after the economic crisis, with more prominent results amongst men compared to women. This trend was however not observed for antidepressants, which could suggest an overall tendency towards short- and fast acting drug prescriptions as a treatment for challenging difficult personal circumstances during the economic crisis in Iceland.

Introduction: Elderly people are a rising population in Iceland. With higher age the likelihood of drug consumption increases and thus drug therapy problems. Pharmaceutical care has been established abroad, where the pharmacist works in collaboration with other healthcare professionals to reduce patients' drug therapy problems. The aim of this research was to study the number and types of drug therapy problems of older individuals in primary care in Garðabær, by providing pharmacist-led pharmaceutical care in collaboration with general practitioners., Methods: Five general practitioners selected patients, 65 years and older, and asked the pharmacist to provide them with pharmaceutical care service. The pharmacist provided pharmaceutical care using a well-defined process., Results: A total of 100 patients participated in the research, 44 men and 56 women. On average the pharmacist identified two drug therapy problems per patient. The most frequent drug therapy problem was related to noncompliance (30.1%), next was adverse drug reaction (26.7%) and the third was unnecessary drug therapy (18.2%). Almost all pharmacist comments were accepted by the general practitioners (90.3%)., Conclusions: Our results reveal that a pharmacist providing pharmaceutical care makes, on average, two comments regarding each drug therapy. In almost all cases the general practitioners accept the comments.

Aims: To study how general practitioners diagnose and treat adult patients with community acquired pneumonia (CAP) and evaluate outcomes., Method: Retrospective chart review for one year on patients 18 years and older diagnosed with CAP in three different primary care centers in Iceland., Results: A total of 215 patients were diagnosed with CAP. Of those 195 were both diagnosed and treated in the primary health care and 20 patients were referred for specialized care. Mean age was 50.3 years (SD= 21.0) and 126 (65%) of the patients were women. Most patients had been ill for less than a week and did not have a previously diagnosed lung disease. Cough was the most common symptom (71%) and 96% had abnormal chest auscultation. Vital signs were frequently not recorded. A chest radiograph was done in third of the cases and showed abnormality in over 80%. Most patients (94%) were treated with antibiotics usually extended spectrum penicillin. Phone consultations were the most common form of communication after diagnosis and about 12% of subjects had their antibiotics changed and about 10% had a chest radiograph done after diagnosis had been made. There was no mortality from CAP during the study period., Conclusions: CAP was diagnosed clinically and managed in primary care in most cases. CAP was more common in women and a minority of patients had underlying lung diseases. Vital sign measurements were used less than expected. Broad spectrum antibiotics were widely used for treatment. CAP had no mortality.

Aim: To study if and how physicians use the irritable bowel syndrome (IBS) diagnostic criteria and to assess treatment strategies in IBS patients., Methods: A questionnaire was sent to 191 physicians regarding IBS criteria, diagnostic methods and treatment. Furthermore, 94 patients who were diagnosed with IBS underwent telephone interview., Results: A total of 80/191 (41.9%) physicians responded to the survey. Overall, 13 patients were diagnosed monthly with IBS by specialists in gastroenterology (SGs) and 2.5 patients by general practitioners (GPs). All the SGs knew of the criteria to diagnose IBS, as did 46/70 (65.7%) GPs. Seventy-nine percent used the patient's history, 38% used a physical examination, and 38% exclusion of other diseases to diagnose IBS. Only 18/80 (22.5%) physicians used specific IBS criteria. Of the patients interviewed, 59/94 (62.8%) knew they had experienced IBS. Two out of five patients knew IBS and had seen a physician because of IBS symptoms. Half of those received a diagnosis of IBS. A total of 13% were satisfied with treatment. IBS affected daily activities in 43% of cases., Conclusion: Half of the patients with IBS who consulted a physician received a diagnosis. Awareness and knowledge of diagnostic criteria for IBS differ between SGs and GPs.

Introduction: Even though smoking has decreased significantly over the last few years, the majority of Icelanders 40 years of age or older have a history of smoking. Limited information is available on respiratory symptoms and diagnosis of chronic obstructive lung diseases (COPD) in this group., Material and Methods: During a four week period at the Akureyri Primary Care Center all individuals above the age of 40 were given a questionnaire on smoking, respiratory symptoms and medical treatment. There were a total of 416 individuals and the response rate was 63%. Spirometry was done on those who had smoked., Results: Of the 259 responders, 150 (57,9%) had a history of smoking. In this group 117 (45,2%) had quit but 33 (12,7%) were still smoking. Of those that had a history of smoking 16% had COPD according to spirometry results and 2/3 did not have a previous diagnosis. Respiratory symptoms were more common with increasing obstruction. Of the smokers 26% had never been advised by a physician to stop smoking. A total of 14,3% of the whole group had a previous diagnosis of emphysema, chronic obstructive pulmonary disease or chronic bronchitis. Altogether 23,5% had previously been diagnosed with asthma, asthmatic bronchitis or allergic bronchitis., Conclusion: A history of smoking was common among the primary care patients. One in six who had a smoking history were found to have COPD and the majority were unaware of the diagnosis. Respiratory diagnoses were common. By spirometric evaluation many smokers are diagnosed with previously unknown COPD.