[Benzodiazepine consumption in Hvalsø. Can it be further reduced in a region in which earlier intervention reduced consumption by 38 per cent?]. / Benzodiazepinforbruget i Hvalsø. Kan forbruget reduceres yderligere i et område, hvor det tidligere er nedsat med 38%?

Hvalsø is a country town with six general practitioners in five practices. In 1988, as a result of a campaign influencing both doctors and patients, a 38% reduction in the consumption of benzodiazepines, measured as the number of prescribed doses, was achieved. This reduction still persists. We have now attempted to reduce consumption even further by directly influencing the individual users. We gave them written information, insisted on personal attendance for each prescription renewal, and, for use at these consultations, introduced a new benzodiazepine journal for 60% of the users. Registration of the prescribed amounts of benzodiazepines was performed over two three-month periods, before and after the intervention. The final registration was made six months after the intervention period. The number of prescriptions, number of prescriptions per 1000 patients and the number of users remained unchanged. A 20% reduction in the amount of prescribed sedatives (hypnotics) and a 7% reduction in prescribed minor tranquillizers was achieved because of fewer doses per prescription. We conclude, that we did not manage to change the patients' behaviour, expressed as the number of prescriptions per 1000 patients, but the doctors were influenced to write out fewer doses per prescription. Important reductions in consumption may be achieved in primary interventions.

[Drug utilization in Hvalsö. An attempt to change the attitude of the population and physicians to drug use]. / Medicinforbrug i Hvalsø. Forsøg på holdningsaendring i befolkningen og blandt laeger til brug af laegemidler.

All of the prescriptions, a total of 1,876, issued by the five practitioners in Hvalsø in four chosen weeks in 1987/88 were copied. The prescribed drugs, a total of 3,177, were calculated for the individual groups of drugs and corrected for the age distribution among the population as a whole and in the individual doctor's practice. The main results from the following groups of drugs are presented here: hypnotics, drugs for neurosis, antibiotics, drugs for cardiac and circulatory disease, drugs for asthma, contraceptive pills and female sex hormones. By and large, considerably more medicine was prescribed for women than for men. For example, twice as much medicine for insomnia was prescribed for women. This is enough for every fourth woman over the age for 70 years to receive a daily dose of hypnotics. Women appear to commence using hypnotics at the age of 40 years and men at 60 years. Marked differences were found in the patterns of prescription between the individual practitioners and thei is apparently greatest as regards prescriptions for men while the more liberal prescription of hypnotics to women was observed for all of the practitioners. Two groups of drugs were, however, prescribed mostly for men, viz, asthma medicine for all age groups and cardiac and circulatory medicine for persons greater than 60 years. Where all of the groups of drugs were concerned, comparisons were undertaken between the prescription habits of the individual practitioners. The results of this investigation are employed in local health work among the population, in study circle work among the practitioners and as basic ideas for the county drug committee activities.

Antiarrhythmic properties of a neuroleptic butyrophenone, melperone, in acute myocardial infarction. A double-blind trial.

In vitro animal studies suggest melperone, a neuroleptic butyrophenone, to be a type III antiarrhythmic drug according to the classification of Vaughan Williams. It has no negative inotropic effect on cardiac muscle. A double-blind trial of 3 hours' duration was carried out with melperone and placebo in 26 patients admitted to the CCU with suspected acute myocardial infarction (AMI) and ventricular arrhythmias. Melperone, 50 mg i.v., was superior to placebo in reducing the total number of ventricular ectopic beats (VEB) as well as the number of minutes with either frequent, multifocal, R-on-T-type or runs of VEB. The reduction became statistically significant in the second treatment hour in patients with definite AMI. Melperone induced sedation and reduction of systemic BP in most of the patients. Two patients with low initial systolic BP achieved a further reduction and had BP levels below 90 mmHg. Two patients experienced minor side-effects. In conclusion, melperone administered in large i.v. doses to patients with AMI induced sedation, acute BP reduction and some reduction of ventricular arrhythmia. X