High adherence to the ‘Wise List’ treatment recommendations in Stockholm: a 15-year retrospective review of a multifaceted approach promoting rational use of medicines

Abstract

ObjectivesTo 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.DesignRetrospective 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.SettingAll outpatient care in the Stockholm Healthcare Region.ParticipantsAll prescribers in the Stockholm Healthcare Region.Main outcome measuresThe 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.ResultsThe 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.ConclusionsHigh 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.

Valproic acid utilization among girls and women in Stockholm: Impact of regulatory restrictions

“…For patients with bipolar disorder, a similar recommendation was first introduced in 2012 . The Wise List contains evidence‐based recommendations for prescribers and have high adherence and impact on drug prescribing . A potential additional explanation to drug increased valproic acid initiations may be an increased incidence of bipolar disorder.…”

“…15 The Wise List contains evidence-based recommendations for prescribers and have high adherence and impact on drug prescribing. 16,17 A potential additional explanation to drug increased valproic acid initiations may be an increased incidence of bipolar disorder. The incidence of diagnosed bipolar disorder in Sweden has increased over the last 20 years and was around 4-6/10,000 individuals per year in 2010, with higher numbers in women.…”

Ongoing strategies to improve the management of upper respiratory tract infections and reduce inappropriate antibiotic use particularly among lower and middle-income countries: findings and implications for the future

“…Active communication and dissemination of guidelines is key to enhancing adherence rates 340,384 . Physician/nurse/ pharmacist trust in any guideline produced is also critical to enhance their acceptance 385,386 .…”

Policy Change and the National Essential Medicines List Development Process in Brazil between 2000 and 2014: Has the Essential Medicine Concept been Abandoned?

“…Instead, ‘hard' regulation, through legislation, was viewed as a valued strategy, but in this case, has proven ineffective in counteracting commercial forces to influence prescribing (http://bvsms.saude.gov.br/bvs/saudelegis/gm/2012/prt0533_28_03_2012.html/July 2017; http://www.planalto.gov.br/ccivil_03/_Ato2011-2014/2011/Lei/L12401.htm/July 2017; http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2011/decreto/D7508.htm/July 2017) . It is not surprising therefore that there was limited knowledge and adherence to the EML .…”

“…http://www.planalto.gov.br/ccivil_03/_Ato2011-2014/ 2011/Lei/L12401.htm/July 2017; http://www.planalto.gov.br/cc ivil_03/_ato2011-2014/2011/decreto/D7508.htm/July 2017) [8]. It is not surprising therefore that there was limited knowledge and adherence to the EML [4,7,12,[31][32][33].…”