Background: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs.

Methods: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography.

Results: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures.

Conclusions: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment.

PURPOSE: To determine the prevalence of purchase of prescribed antihypertensive and/or serum lipid-reducing pharmaceutical preparations among different age groups, from the age of 45, in the Swedish population. Further, to calculate the percentage of the population, from the age of 60, who purchased these pharmaceuticals without having had a circulatory diagnosis in the Hospital Discharge Register the last 7 years, or having purchased nitrate vasodilators, as an attempt to estimate the proportion of primary preventive treatments. METHODS: A cross-sectional study, of individual data on prescriptions for antihypertensives (C02-C03, C07-C09) and serum lipid-reducing agents (C10), dispensed from July to December 2005 for the Swedish population. Data were obtained from the new Swedish Prescribed Drugs Register. The data were related to population statistics, and linked to data on diagnoses of cardiovascular disease (I00-I99), from the Swedish Hospital Discharge Register 1998-2004. Data on individuals with purchase of antihypertensive or serum lipid-reducing agents, but without a diagnosis of cardiovascular disease, were also linked to purchase of nitrate vasodilators (C01D). RESULTS: Among Swedes of 60 years and above, 53% purchased antihypertensive or serum lipid-reducing pharmaceuticals, and 30% purchased the pharmaceuticals without having been hospitalized for a coronary or cerebrovascular event during the previous 7 years, or having purchased prescribed nitrate vasodilators during 6 months. CONCLUSION: Over half of the Swedish senior population purchased prescribed antihypertensive or serum lipid-reducing drugs during 6 months in 2005. The magnitude of the prevalence points to the importance of intensified follow-up of both adverse effects and of effectiveness of these drugs.

PURPOSE: To present and interpret drug prescription patterns, related to various groups of the population in a Swedish county, in order to estimate the prevalence of drug use in different age groups. METHODS: Data on prescriptions, dispensed March-May 1988-2002, were combined with population statistics of Halland, a county in the south of Sweden, and analysed. Number of defined daily doses (DDD) per 100 inhabitants and day and prescriptions per 100 inhabitants and 3 months were used as indicators of drug prevalence. RESULTS: The total drug exposure in the population of Halland nearly doubled during the 15-year period. The most frequently used drugs overall, in 2002, were psycholeptics (N05), analgesics (N02), antibacterials (J01) and sex hormones (G03). Nearly 30% of the women of 15-69 years were exposed to sex hormones. Multiplied drug prevalence among people above 60 was found for antithrombotic drugs (B01), agents acting on the renin-angiotensin system (C09), sex hormones (G03), serum lipid reducing agents (C10), antidepressants (N06) and drugs for peptic ulcer and GORD (A02B). CONCLUSIONS: The increase in drug prescribing over the 15 years concerned both symptom-related treatments, like hormone replacement therapy, analgesics, antidepressants and drugs for acid-related disorders, as well as preventive treatments, like antithrombotics, lipid-lowering drugs and antihypertensives. The unit DDD/100 inhabitants and day gives a fairly correct measure of the percentage treated for chronic disorders. However, for short-term treatment courses and especially for drug use in children, number of prescriptions/100 inhabitants and adequate period of time, is easier to interpret.

OBJECTIVE: To present the prescribing patterns of general practitioners (GPs) at public primary care centres (PPCCs) in Halland, a county in the south-west of Sweden. GP share of the total prescribing of different drug groups 1988-1997 is presented, as well as changes in patterns. DESIGN: A descriptive prescription study performed 3 months each year in 10 consecutive years. SETTING: Medical service and pharmacies in Halland. SUBJECTS: Prescriptions from about 100 GPs of PPCCs and 550 physicians of various other specialties. MAIN OUTCOME MEASURES: Percentages and absolute numbers of GPs prescribing. RESULTS: GPs prescribed 45% and 51% of the prescriptions from physicians in 1988 and 1997, respectively, while the cost shares were 40% and 42%. An increase in prescriptions was seen both in relative and in absolute numbers (from 117414 in 3 months in 1988 to 161012 in 1995). The increase in cost per DDD (defined daily dose) during the study period was 47% for GPs and 72% for other doctors. CONCLUSIONS: GP prescribing increased in both absolute and relative numbers, while the cost increase per DDD was moderate compared to other physicians.