1. Nordic prescription registers Finland
Leena K Saastamoinen
The Social Insurance Institution (Kela)
Finland
NorPEN October, 2011

2. Essential demographics
Size of population on July 31st 2011
See Statistics Finland
Certain population data is available also from Kela, e.g. control population

3. Relevant host institution(s)
The Social Insurance Institution (Kansaneläkelaitos, Kela)
Prescription register
Special Reimbursement Register
National Institute of Health and Welfare (Terveyden ja hyvinvoinnin laitos, THL)
Hospitalisation
Statistics Finland

4. Helsinki

5. Prescription Register in Finland
Since 1994
Whole population (5.4 mio)
For drug reimbursement purposes

6. Prescription variables, what is covered?
Drug user
HETU ID-code
IKA Age at the end of the yea
SP Gender
SYNTPV Date of birth
SVUOSI Year of birth
KUOLPV Date of death
ASKU Municipality of residence at the end of the year
SHP Hospital district at the end of the year
Prescriber 
SVNUMERONumber of the doctor
ERKOT Main speciality of the doctor during the year
TYOP Data on working place in the year in question

7. Prescription variables, what is covered?
Drug
ATC ATC-code
OTPVM Purchase date
VNRO Nordic product number (Package size, strength, pharmaceutical form available under product number)
PLKM Number of purchased packages
KUST Cost of the drug (EUR cent)
KORV Reimbursement/refund of the drug (EUR cent)
KAKORV Additional refund after yearly ceiling (EUR cent)
DDD Number of DDD’s in the purchase
Other
Dose dispensing
Generic substitution, switching

8. Prescription variables, what is not covered?
Dosing instruction (only in free text for latest 1,5 years)
Indication (only in free text for latest 1,5 years, if the doctor has recorded any indication – e.g. SSRI: no indication in 16 %, tricyclics: 55 %, others: 23 %)

9. Coverage of prescription database
All residents
Only reimbursed prescriptions (including clinical nutrients and basic ointments for long term care)
Not covered:
OTC drugs
Drugs prescribed in hospitals

10. Groups poorly covered Oral contraceptives
New active substances which are not yet included in reimbursement system
Eye and ear drops for short term use
Small packages of benzodiazepines

11. Data on diagnoses
Data on hospitalisation from THL since 1969 (Poistoilmoitusrekisteri, hoitoilmoitusrekisteri HILMO)
Data on open care contacts, AVOHILMO since 2011 (THL)

12. Data on diagnoses
Special reimbursement eligibility register
Kela
Since 1964
Person code, age, gender, place of residence...
Number of disease
Diagnosis complete since 2000
E.g. Cancers, BP, asthma, diabetes...

13. Linkage Individual level data available for scientific research
Permissions have to be applied from each institution
Data is e.g. Transferred from Kela to THL and linked there before submitting to the researchers
If possible, the person codes are removed after linking (the key can be saved)

14. Practicalitities Approvals
Ethics approval are not required for plain registry studies
Approvals from each institution
Kela (in English):
THL (In English): application forms in English available from arto.vuori (a) thl.fi
Help
Costs
The more data on different years and different data sources, the more expensive data
Time
3-4 months from Kela (one year?)

15. A few examples of papers
Zoëga H, Furu K, Halldórsson M, Thomsen PH, Sourander A, Martikainen JE. Use of ADHD drugs in the Nordic countries: a population-based comparison study. Acta Psychiatr Scand May;123(5):360-7
Martikainen JE, Saastamoinen LK, Korhonen MJ, Enlund H, Helin-Salmivaara A. Impact of restricted reimbursement on the use of statins in Finland: a register.based study. Med Care Sep;48(9):761-6.
Foulon V, Svala A, Koskinen H, Chen TF, Saastamoinen LK, Bell JS. Impact of regulatory safety warnings on the use of antidepressants among children and adolescents in Finland. J Child Adolesc Psychopharmacol Apr;20(2):
Rikala M, Hartikainen S, Sulkava R, Korhonen MJ. Validity of the Finnish Prescription Register for measuring psychotropic drug exposures among elderly Finns: a population-based intervention study. Drugs Aging Apr 1;27(4):337-49
Helin-Salmivaara A, Lavikainen PT, Korhonen MJ, Halava H, Martikainen JE, Saastamoinen LK, Virta L, Klaukka T, Huupponen R. Pattern of statin use among 10 cohorts of new users from 1995 to 2004: a register-based nationwide study. Am J Manag Care Feb;16(2):116-22
Koskinen H, Martikainen JE, Maljanen T. Antipsychotics and antidepressants: an analysis of cost growth in Finland from 1999 to Clin Ther Jun;31 Pt 1:
Haukka J, Suvisaari J, Tuulio-Henriksson A, Lönnqvist J. High concordance between self-reported medication and official prescription database information. Eur J Clin Pharmacol Nov;63(11):