title: The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm.
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.
authors.affiliation: Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden. lars-l.gustafsson@ki.se
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
authors.forename: Björn
authors.initials: B
authors.lastname: Wettermark
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Eva
authors.initials: E
authors.lastname: Andersén-Karlsson
authors.forename: Ulf
authors.initials: U
authors.lastname: Bergman
authors.forename: Jan
authors.initials: J
authors.lastname: Hasselström
authors.forename: Lars-Olof
authors.initials: LO
authors.lastname: Hensjö
authors.forename: Paul
authors.initials: P
authors.lastname: Hjemdahl
authors.forename: Ingrid
authors.initials: I
authors.lastname: Jägre
authors.forename: Margaretha
authors.initials: M
authors.lastname: Julander
authors.forename: Bo
authors.initials: B
authors.lastname: Ringertz
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmidt
authors.forename: Susan
authors.initials: S
authors.lastname: Sjöberg
authors.forename: Folke
authors.initials: F
authors.lastname: Sjöqvist
authors.forename: Carl-Olav
authors.initials: CO
authors.lastname: Stiller
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Törnqvist
authors.forename: Rolf
authors.initials: R
authors.lastname: Tryselius
authors.forename: Sigurd
authors.initials: S
authors.lastname: Vitols
authors.forename: Christer
authors.initials: C
authors.lastname: von Bahr
mesh_terms: D000553:Ambulatory Care; D001294:Attitude to Health; D003142:Communication; D003362:Cost-Benefit Analysis; D003625:Data Collection; D004363:Drug Utilization / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D018954:Drugs, Essential; D005569:Formularies as Topic; D017408:Guidelines as Topic; D006801:Humans; D010606:Pharmacy and Therapeutics Committee; D010820:Physicians; D011320:Primary Health Care; D013548:Sweden
chemical_list: D018954:Drugs, Essential