Tuire Prami

Opioid use disorder (OUD) is an ever-growing public health issue. Among adolescents and young adults, it is a global public health crisis with an alarming need for comprehensive prevention strategi...

Background: Attention deficit hyperactivity disorder (ADHD) has been associated with comorbid conditions, especially psychiatric comorbidities. On the other hand, getting an ADHD diagnosis has been linked to children’s relative age. The aim of this study was to describe diagnostic patterns of ADHD patients of all ages, and to compare comorbidity and birth month between ADHD patients and matched controls. Methods: This nationwide study cohort included incident ADHD patients with records of ADHD medication and/or ADHD diagnosis in Finland during 2015 to 2020, and with no such records during 2010 to 2014. Four controls were matched with each patient based on age, gender, and place of residence. Results: Altogether 66,146 incident ADHD patients and 256,270 matched controls were identified, and their average follow-up time was 3.5 years. Mean age at the first ADHD diagnosis was 15.9 years for males and 22.3 for females. Prior to being diagnosed with ADHD, patients visited health care remarkably more often than controls. Comorbid diagnoses were the most prevalent at index date, and compared to controls, the prevalence of these comorbidities within 3 years preceding the index date increased more in ADHD patients. The odds of ADHD increased with later birth months across all age-gender groups, except among girls under 6 years of age. The association was more pronounced among males. Conclusion: ADHD is associated with a significant comorbidity burden across all age groups, even before ADHD diagnosis. Individuals who are younger in relative age are more likely to be diagnosed with ADHD.

Aims: The objective was to characterise Finnish adults with type 1 diabetes (T1D) and to explore associations between known risk factors, comorbidities and mortality. Materials and Methods: Individuals with T1D in 2014–2021 were identified from national health care registers, and data on medication and comorbidities were combined with laboratory measurements from hospital data lakes. Comorbidity and risk‐factor associations were examined using Cox regression. Results: We identified 35 574 adults with T1D. The proportion of individuals aged over 70 years increased during the study period from 7.1% to 12.4% and the proportion of insulin pump users from 10% to 17%. Mean haemoglobin A1c (HbA1c) decreased by 1.7 mmol/mol (0.2%) and mean low‐density lipoprotein cholesterol (LDL‐c) by 0.2 mmol/L (7.7 mg/dL) from 2014 to 2021. The proportion of individuals with HbA1c > 75 mmol/mol (> 9.0%) reduced slightly (4%‐points); this improvement was more prominent in insulin pump users (9%‐points). Ketoacidosis was most common in young adults. Prevalence of chronic kidney disease (CKD) increased from 140 (95% CI 136–145) to 168 (95% CI 163–172) per 1000 persons during the study period ( p ‐trend < 0.001). CKD and vascular disease resulted in a multifold increase in the mortality risk, whereas lipid‐lowering and antihypertensive medications reduced this risk ( p < 0.001 for all). Conclusions: The proportion of elderly with T1D is increasing, with no concomitant increase in vascular events. Insulin pump therapy has become more common without a concomitant increase in ketoacidosis incidence. HbA1c and LDL‐c levels improved during the study. Finnish data indicate a shift in T1D demographics, characterised by improved survival, while rates of diabetes‐specific comorbidities remain stable.

Introduction: ADHD is often associated with comorbid psychiatric conditions. Differential diagnosis between other conditions and ADHD is not always clear, and patients are sometimes initially treated for another disorder instead. ADHD diagnosis and appropriate ADHD treatment potentially reduce the need for medication of the other disorder. Reaching high adherence to and persistence with ADHD medication is challenging. This nationwide cohort study aimed to describe not only ADHD medication use but also the use of other drugs in ADHD patients compared to controls. Methods: Nationwide care and prescription registers were used to identify incident ADHD patients of any age between 2015 and 2020. Four controls were matched to each ADHD patient by age, gender, and residence. Analyses included data from 1.1.2010 to 31.12.2021. Results: Study cohort included 66,146 ADHD patients and 256,270 controls, with a total follow‐up of 1,123,412 years. Sustained and extended‐release methylphenidate were the two most commonly used first‐line ADHD drugs across all age groups. Simultaneous use of different ADHD drugs was rare. Primary adherence was very high, with 95% of the patients purchasing their prescribed medication in general and 80% doing so within 10 days. Persistence with medication was the highest among the youngest patients. A decrease in purchases was observed during the summer holidays in school‐age children and adolescents. In adults, antidepressant use often preceded ADHD diagnosis and decreased after ADHD treatment initiation, unlike in controls at the same time. In young children, antibiotics and anti‐inflammatory drug use was higher in ADHD patients than in controls, especially before ADHD identification. Conclusion: As far as we know, this is the first study to describe changes in the use of non‐ADHD medications in relation to ADHD identification. In adults, antidepressant use decreased after ADHD treatment initiation, and in children, antibiotic and anti‐inflammatory use showed more prominent decrease compared to controls of the same age. The data indicated high primary adherence to ADHD medication, and the youngest children remained on continuous ADHD medication the longest. The effect of summer holidays was visible in the purchase data.

Introduction: This study describes epidemiology of attention deficit hyperactivity disorder (ADHD) and use of ADHD medication across all age groups in Finland.Methods: This retrospective study is based on nationwide registers in Finland. The study population included individuals with ADHD diagnosis and/or an ADHD medication record at least once during 2015–2020.Results: The yearly prevalence of ADHD was higher in males than in females and was highest in the age groups of 6‐ to 12‐ and 13‐ to 17‐year‐old males. In 2020, the yearly prevalence was 4.2% in ≤12‐year‐old, 6.7% in 13‐ to 17‐year‐old, 0.7% in ≥18‐year‐old males, and 1.1%, 2.6%, and 0.6%, respectively, in females. The gender‐related differences were greatest among 6‐ to 12‐ and 13‐ to 17‐year‐olds, after which the differences evened out. During the study period from 2015 to 2020, the yearly prevalence more than doubled in each of the five Finnish administrative university hospital areas. The prevalence was higher in males, but the relative growth was higher in females compared to males. The incidence per 100,000 inhabitants was the highest in ≤12‐year‐old males and increased in all age groups and in both genders. The use of medication was more common in males than in females, and the overall proportion of prevalent ADHD patients on medication remained around 80%. Decrease in medication use was observed in connection with the transition from adolescence to adulthood, in both genders.Conclusion: Both prevalence and incidence of ADHD more than doubled in Finland during the study period 2015–2020. This study presents the most comprehensive analysis of national register data at personal‐level linkage in Finland, since it included all age groups, and both diagnosed ADHD patients and individuals receiving medication, not limited to reimbursed medication.

Background The use of new biological medicines as standard treatment is expected to increase substantially and cover new therapeutic indications in the near future. Interchange of biological medicines in pharmacies increases the need for patient guidance. Objectives The study aims to gain a patient perspective on biological medicine users’ needs and wishes regarding patient guidance by exploring what kind of information patients wish to receive and to further investigate the potential differences in needs between originator biological medicine users and biosimilar users. Design A cross-sectional patient survey. Setting Anonymous electronic patient survey was conducted in 88 community pharmacies and via two patient organisations in Finland in 2022. Participants Users of originators and biosimilars of adalimumab, etanercept, filgrastim and pegfilgrastim. Results The majority of the 199 respondents had received instructions from a nurse or a public health nurse on how to use their self-injected medicine. According to the patients, the main factors affecting treatment persistence, apart from treatment effectiveness, were few adverse effects, access to treatment support and an easy-to-use administration device. At treatment initiation, the optimal types of guidance were face-to-face instruction, hands-on practice with injecting the medicine, using the administration device and information on adverse effects. Even though 79% of respondents indicated that they would not have wanted more instruction on using their self-injected medicine, these respondents also expressed that, at the time of treatment initiation, additional information or help would have been needed concerning adverse effects, biosimilars, and biological medicines in general. In general, biosimilar users were more concerned about adverse effects than users of originator products. Conclusion Patients consider information about adverse effects an important part of patient guidance when starting and maintaining self-administered biological therapy. The results highlight the importance of ensuring that up-to-date evidence-based information is readily available to patients from reliable sources.

Background: Finnish authorities have published specific instructions for prescribing, handling, and dispensing unlicensed medicines and for the associated communication with patients. However, there is a clear research gap concerning the quality of medication counselling given by doctors and especially pharmacists to patients who are prescribed unlicensed medicines. The success of such counselling was studied with a survey for both pharmacy staff and patients. Methods: The survey was conducted in 2022 with two electronic semi-structured questionnaires, one for patients (or caregivers of underaged patients) purchasing medicines with special or fixed-term special permits from community pharmacies in Finland and one for the pharmacy staff dispensing such medication. Results: In all, 49% of the 389 pharmacists did not know if the prescribing doctor had given any counselling to the patient, and 52% of the pharmacists had not given any counselling to the patient themselves. Still, 51% of the pharmacists considered that the patient had received sufficient medication counselling. Almost every one of the 36 patients expressed that they had received medication counselling, 61% of them from the prescribing doctor and 53% from a pharmacist. Conclusion: Medication counselling on unlicensed medicines should be improved to ensure their safe and effective use. This survey revealed that many patients did not receive any such medication counselling as required by the Finnish Medicines Decree. Plain Language Summary: If patients need medicines that are not available in their own country, they can be treated with unlicensed medicines imported from abroad.Community pharmacies deliver tens of thousands of packages of unlicensed medicines yearly in Finland, and we wanted to find out whether patients receive appropriate information about their use.We contacted pharmacy staff and patients using unlicensed medicines and conducted an electronic survey to ask about their experiences on whether patients receive sufficient information on these medicines.Almost every patient participating the survey felt that they had received counselling on their unlicensed medication, more often from a doctor than a pharmacist, despite most of the pharmacist responding to this survey had a lot of work experience and dispensed these medicines regularly.Patients have the right to receive supporting information to ensure the effectiveness and safety of their medication, and pharmacists have a crucial role in ensuring this.Based on this study, we suggest that pharmaceutical companies and authorities should provide reliable supporting material on the use of unlicensed medicines for doctors, pharmacists, and patients, bearing in mind the respective information needs of these groups.

Background: From the beginning of the year 2024, gradually implemented amendment to the Medicines Act will enable interchange of biological medicines in pharmacies in Finland. The legislative change aims to reduce health care costs. Methods: Opinions of the biological medicine users regarding substitution in pharmacies and knowledge about biological medicines were determined by a patient survey in community pharmacies and via patient organizations in Finland. Results: In total, 199 users of biological medicines responded to the survey. The respondents did not always know which product they were using, an originator or a biosimilar. This was more prominent among patients with biosimilars determined according to brand names. The more recently the biological medicine had been prescribed, the more likely a biosimilar was in use. Only about 40% of the respondents would enable pharmacies to substitute their biological medicine to a lower cost product. The most common obstacle to the idea of interchange in pharmacies was that the respondents wanted to keep the product the doctor had prescribed for them. In general, biosimilar users were more accepting towards possible interchange than originator users. Conclusion: Although the most recent treatments appear to be initiated with biosimilars, interchange in pharmacies could enable an efficient way to lower health care costs. However, guidance and awareness regarding biosimilars and biological medicines in general would improve patients’ willingness towards the change, but also help pharmacists and prescribing doctors in their meaningful role. Plain Language Summary: The use of biological medicines and the costs thereafter are rapidly growing.In Finland, switching between an originator and a biosimilar currently requires doctor’s prescription, but interchange in pharmacies will be possible in the beginning of year 2024.Due to notable differences in prices between biological medicines, active switching to lower cost products in pharmacies would restrain health care costs remarkably.Oriola Expert Services ran a survey with an electronic questionnaire among patients using biological medicines.Survey data were collected in pharmacies and via patient organizations.Oriola research team found out that patients do not generally know the differences between biological medicines, and if they are using an originator or a biosimilar.Despite the upcoming pharmacy substitution, future cost savings rely on decisions made by doctors at the time of prescribing biological medication.To ensure patient compliance, sufficient patient information about biosimilars is required.

Aims: To characterise and understand the untreated high-risk opioid user population in Finland, and to determine the reasons why these people do not enter treatment. Methods: The study setting was a half-year cross-sectional survey in Finland during 2021–2022. An electronic questionnaire with 24 structured questions was concluded in 16 needle exchange units. Participants were opioid-dependent people without opioid agonist treatment (OAT), and they answered the survey voluntarily and anonymously. Results: Of the 167 respondents, 62% were men, 53% were aged ≤34 years, 66% had used opioids for >6 years, and 78% used drugs intravenously (IV) daily. The most used opioid (95%) was buprenorphine. Most respondents used opioids as self-medication for withdrawal symptoms (75%), or to treat psychological symptoms (59%) or pain (43%). Of them, 70% also used other substances for recreational purposes. The most common named reasons to stay outside OAT were as follows: seeking treatment is too difficult (37%); treatment is too binding (36%); and fear of actions from authorities (23%). Conclusions: For opioid-dependent respondents who would be eligible for OAT in Finland, treatment awareness is limited. These high-risk opioid users also think that the treatment would be too binding. In conclusion, there is a need for increase in general information about, accessibility to, acceptance for and individualisation of OAT.