The ‘Wise List’– A Comprehensive Concept to Select, Communicate and Achieve Adherence to Recommendations of Essential Drugs in Ambulatory Care in Stockholm

Authors

  • Lars L. Gustafsson,

    1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
    2. Clinical Pharmacology Services, Karolinska University Hospital, Stockholm, Sweden
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  • Björn Wettermark,

    1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
    2. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Brian Godman,

    1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
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  • Eva Andersén-Karlsson,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
    2. Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
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  • Ulf Bergman,

    1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
    2. Clinical Pharmacology Services, Karolinska University Hospital, Stockholm, Sweden
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  • Jan Hasselström,

    1. Storvreten General Practice Centre, Tumba, Sweden
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  • Lars-Olof Hensjö,

    1. Inera Ltd, National Information Services for Swedish Healthcare, Stockholm, Sweden
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  • Paul Hjemdahl,

    1. Clinical Pharmacology Services, Karolinska University Hospital, Stockholm, Sweden
    2. Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Solna, Stockholm, Sweden
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  • Ingrid Jägre,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Margaretha Julander,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Bo Ringertz,

    1. Division of Rheumatology, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Solna, Stockholm, Sweden
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  • Daniel Schmidt,

    1. Department of Internal Medicine, St Göran Hospital, Stockholm, Sweden
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  • Susan Sjöberg,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Folke Sjöqvist,

    1. Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
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  • Carl-Olav Stiller,

    1. Clinical Pharmacology Services, Karolinska University Hospital, Stockholm, Sweden
    2. Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Solna, Stockholm, Sweden
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  • Elisabeth Törnqvist,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Rolf Tryselius,

    1. Regional Drug and Therapeutics Committee, Medical Knowledge Centre, Stockholm County Council (Healthcare Region), Stockholm, Sweden
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  • Sigurd Vitols,

    1. Clinical Pharmacology Services, Karolinska University Hospital, Stockholm, Sweden
    2. Clinical Pharmacology Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Solna, Stockholm, Sweden
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  • Christer von Bahr,

    1. Section of Clinical Pharmacology, Department of Internal Medicine, Södersjukhuset, Stockholm, Sweden
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  • for the Regional Drug Expert Consortium

    Corresponding authorSearch for more papers by this author

  • Please contact the corresponding author on questions related to a tentative English version of the Wise List 2010.

  • The Regional Drug Expert Consortium also includes Peter Aspelin, Jonas Bergh, Peter Ekman, Carl-Gustaf Elinder, Johan Franck, Urban Hellgren, Angelica L. Hirschberg, Seher Korkmaz, Michael Lagerkranser, Gerd Lärfars, Lena Lundeberg, Rickard Malmström, Åke Örtqvist, Marie-Louise Ovesjö, Georgios Panagiotidis, Jan Persson, Peter M. Persson, Michael Runold, Gunilla Sundelin, Leif Tallstedt, Matti Viitanen, Mia von Euler, Katarina Wide.

Author for correspondence: Lars L. Gustafsson, Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, SE-141 86 Stockholm, Sweden (fax +46 858581070, e-mail lars-l.gustafsson@ki.se).

Abstract

Abstract:  The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a ‘Wise List’ by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the ‘Wise List’; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the ‘Wise List’ among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The ‘Wise List’ consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The ‘Wise List’ was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the ‘Wise List’ in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.

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