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High adherence to the ‘Wise List’ treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines
  1. Jaran Eriksen1,2,
  2. Lars L Gustafsson1,2,
  3. Kristina Ateva3,
  4. Pia Bastholm-Rahmner4,
  5. Marie-Louise Ovesjö1,5,
  6. Malena Jirlow6,
  7. Maria Juhasz-Haverinen6,
  8. Gerd Lärfars7,
  9. Rickard E Malmström1,8,
  10. Björn Wettermark1,
  11. Eva Andersén-Karlsson7
    1. 1Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
    2. 2Department of Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
    3. 3Stockholm Drug and Therapeutics Committee, Public Healthcare Services Committee, Stockholm, Sweden
    4. 4Medical Management Centre, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
    5. 5Department of Quality and Development, Södersjukhuset, Stockholm, Sweden
    6. 6Public Healthcare Services Committee, Stockholm, Sweden
    7. 7Department of Clinical Science and Education, Södersjukhuset, Internal Medicine, Karolinska Institutet, Stockholm, Sweden
    8. 8Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
    1. Correspondence to Dr Jaran Eriksen; jaran.eriksen{at}ki.se

    Abstract

    Objectives To present the ‘Wise List’ (a formulary of essential medicines for primary and specialised care in Stockholm Healthcare Region) and assess adherence to the recommendations over a 15-year period.

    Design Retrospective analysis of all prescription data in the Stockholm Healthcare Region between 2000 and 2015 in relation to the Wise List recommendations during the same time period.

    Setting All outpatient care in the Stockholm Healthcare Region.

    Participants All prescribers in the Stockholm Healthcare Region.

    Main outcome measures The number of core and complementary substances included in the Wise List, the adherence to recommendations by Anatomic Therapeutic Chemical (ATC) 1st level using defined daily doses (DDDs) adjusted to the DDD for 2015, adherence to recommendations over time measured by dispensed prescriptions yearly between 2002 and 2015.

    Results The number of recommended core substances was stable (175–212). Overall adherence to the recommendations for core medicines for all prescribers increased from 75% to 84% (2000 to 2015). The adherence to recommendations in primary care for core medicines increased from 80% to 90% (2005 to 2015) with decreasing range in practice variation (32% to 13%). Hospital prescriber adherence to core medicine recommendations was stable but increased for the combination core and complementary medicines from 77% to 88% (2007 to 2015). Adherence varied between the 4 therapeutic areas studied.

    Conclusions High and increasing adherence to the Wise List recommendations was seen for all prescriber categories. The transparent process for developing recommendations involving respected experts and clinicians using strict criteria for handling potential conflicts of interests, feedback to prescribers, continuous medical education and financial incentives are possible contributing factors. High-quality evidence-based recommendations to prescribers, such as the Wise List, disseminated through a multifaceted approach, will become increasingly important and should be developed further to include recommendations and introduction protocols for new expensive medicines.

    • Adherence
    • Drug and therapeutics committee
    • Essential medicines
    • prescribing
    • Rational Use of Medicines
    • Health systems

    This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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    Footnotes

    • Collaborators Tareq Alsaody, Peter Aspelin, Peter Bárány, Harry Beitner, Johan Bratt, Torkel B Brismar, Marja-Liisa Dahl, Ulrika Dahnell, Paulina Dalemo, Christine Fransson, Stina Fransson Sellgren, Jan Hasselström, Roger Henriksson, Rose Marie Hallin, Paul Hjemdahl, Margareta Holmström, Charlotte Höybye, Thomas Kahan, Inga Klarin, Angelica Lindén Hirschberg, Synnöve Lindemalm, Mikael Lördal, Mussie Msghina, Ricard Nergårdh, Christer Norman, Åke Örtqvist, Peter Persson, Magnus Röjvall, Michael Runold, Carl-Olav Stiller, Marie Almvik (Sundström), Leif Tallstedt, Inga Tjäder, Mia von Euler and Rumiana Zlatewa are either the present member of Stockholm DTC or chairing 1 of the 21 expert panels of Stockholm DTC. None of the authors or collaborators listed here has received any salary or economic support for the research presented in this work.

    • Contributors JE contributed to the conception and design of the study, analysis and interpretation of the data, drafted and revised the manuscript. LLG contributed to the conception and design of the study, analysis and interpretation of the data, and revised the manuscript. KA contributed to data acquisition, analysis and interpretation, and revised the manuscript. PB-R contributed to data analysis and interpretation, and revised the manuscript. BW contributed to the conception and design of the study, data acquisition, analysis and interpretation of the data, and revised the manuscript. MJ contributed to data analysis and interpretation, and revised the manuscript. MJ-H contributed to the data acquisition, analysis and interpretation of the data, and revised the manuscript. REM contributed to the conception and design of the study, analysis and interpretation of the data, and revised the manuscript. M-LO contributed to the conception and design of the study, analysis and interpretation of the data, and revised the manuscript. GL contributed to data analysis and interpretation, and revised the manuscript. EA-K contributed to the conception and design of the study, analysis and interpretation of the data, and revised the manuscript. All authors critically revised and approved the final manuscript.

    • Funding This study was in part supported by grants from Karolinska Institutet, Stockholm, Sweden.

    • Competing interests JE is the member of an expert panel of the Stockholm DTC since 2013. KA, PB-R, MJ-H, MJ, M-LO and BW are employed by Stockholm Healthcare Region that finances the Drug and Therapeutics Committee (DTC) issuing the ‘Wise List’ in Stockholm. EA-K served as the chair-woman of Stockholm DTC 2010–2016, LLG as the chairman 2000–2009 and GL is the chair-woman since 2016 and REM deputy chairman since 2016.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement We have used routinely available prescribing data for a selected group of therapeutic classes. More analyses can be made for these medicines as well as for other medicines prescribed in Sweden.

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