The Directorate of Health conducts medicine prescription surveillance and promotes the responsible use of medicinal products in Iceland. The Prescription Medicines Register is the primary tool used in this surveillance.
The use of individual medicinal products is conducted at the national level and in comparison with other countries. The emphasis is on addictive drugs. In addition, the Directorate of Health examines cases and determines whether physicians have prescribed medication in violation of law or government instructions.
The Directorate of Health also recommends using pharmaceutical quality indicators in nursing homes. They relate to safety, efficiency, and overall use of medicinal products by residents in nursing homes and are part of the internal monitoring of the homes. Regularly, surveys are conducted in nursing homes on four pharmaceutical quality indicators.
When there is reason to believe that a person has been prescribed a lot of addictive drugs by one or more doctors.
When there is reason to believe that a doctor has prescribed addictive drugs abnormally to himself.
When there is reason to believe that a person has been prescribed more addictive drugs than is expected in a given period.
When there is a suspicion that doctors have prescribed in violation of regulations and laws.
When doctors prescribe medicinal products contrary to instructions or when the amount and combination of medicines within a certain period is potentially dangerous to the patient's health.
When a doctor prescribes medicinal products that they are not authorised to prescribe according to the special drug register or regulations.
If any significant issues arise during the monitoring of prescriptions, the doctor concerned is informed of the comments in writing and an explanation is requested.
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Examples to illustrate different cases:
Prescription pads are stolen. The prescriptions have specific numbers provided by the person reporting the theft. In the Prescription Medicines Register, it is possible to monitor whether the stolen prescriptions appear. This monitoring resulted from cooperation between the Directorate of Health and the Icelandic Medicines Agency.
From time to time, the Directorate of Health receives indications that a patient is prescribed addictive drugs by many doctors. Such behaviour strongly suggests that drugs are being misused.
Monitoring of individual doctors who prescribe a lot of addictive drugs without being able to explain the medical significance.
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Here, one doctor's prescriptions are monitored compared to colleagues in the same speciality to educate doctors and improve their prescribing habits. This type of mapping only takes place with the consent of the relevant doctor and for his information. The personal identity of patients is not disclosed in any way.
This has been done in neighbouring countries with good results and full cooperation with doctors. In this way, doctors can, for example, discover that they prescribe much more of a particular medicine than their colleagues and realise whether it is a conscious decision or whether other factors influence it.
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The Directorate of Health publishes clinical guidelines and other professional recommendations regarding the prescription of drugs. The Prescription Medicines Register is useful for assessing the impact of these guidelines and measures on prescriptions of medicinal products. The register can quickly and safely monitor the effects of these procedures.
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The Medical Director of Health and Public Health Act states that the Medical Director of Health shall observe the developments in the use of medicinal products. The Directorate of Health participates in various international collaborations where statistics are compared between countries, for example, in NOMESCO (Nordic Medico Statistical Committee).
Antibiotics, which have contributed to healing and improved health, have also contributed to increased antibiotic resistance. Antibiotic resistance causes problems in the treatment of infections and consequently has adverse consequences for human health and increases the cost of healthcare. The threat to humans consists of increased illness, premature deaths due to infectious diseases, reduced quality of life, and increased costs of healthcare.
