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In this study, we have analysed the treatment traditions in a dermatological outpatient clinic, from a gender perspective. Eczema and psoriasis were of similar frequency in male and female patients, while a higher number of female patients had eczema of the hands. Ultraviolet light (UV) treatment was given to a higher number of male patients in all diagnostic groups including eczema of the hands. In addition, a higher number of given treatments was given to the male patients than to the female patients. As for prescriptions to male and female patients from our department and in Stockholm county (1.8 mill.), a much larger amount of preparations for local treatment was received by female patients, especially emollients. Male patients had received more of calcipotriol creme in addition to their being treated more intensively at the clinic. In a sub-group analysis on patients with psoriasis vulgaris on our clinic and in a patient cooperation-based treatment department, we found the same relation between male and female treatment as in the larger group. On follow-up, the number of female patients with psoriasis who were given treatment at our clinic had increased, but the number of treatments given to men was still higher than for female patients. An economic analysis of these findings show a great overweight of clinic-based treatment costs for male patients, while female patients receive emollients for self-care to a greater extent. We conclude that more studies are needed to clarify the basis of these findings.

During a decade various actions have been taken to decrease the use of inappropriate medication for elderly patients in Sweden. The Swedish Health Department has recently compiled guidelines for inappropriate medication that can be used to evaluate medication in nursing homes for elderly. At the beginning of our project we assessed the medication of persons living in 21 nursing homes in the northeastern district of the county Skåne and based on this analysis we decided that one of the actions to take were drug-reviews. For a period of two years an intensified effort was made to improve medical treatment in nursing homes in the district. Seventeen nursing homes, with 181 patients, were willing to participate. The patients' current medications, state of health (including blood pressure and weight) and known diagnosis were evaluated by a pharmacist and a geriatrician. A specific written recommendation on how to modify drug-usage in these patients were sent to the nursing homes. Decisions were then made by the doctors in charge of the patients on which adjustments to make. At the end of the project 127 patients were reevaluated concerning quality and quantity of medication. A comparison was made before and after the drug-review. Positive results were obtained as well as a lower drug cost. An assessment of the patients' state of health, before and after drug-review, showed a tendency towards improvement. We compared our results with those of a Swedish project that used a different method of drug-review with a visiting pharmacist instead of a written recommendation. The changes in the patients' medication before and after drug-review were the same.

There is a six-fold increase in the costs for antiepileptic drug prescriptions in Sweden from 1990 to 2000. This is mainly caused by a gradual increase in the prescribing of new and more expensive drugs, since the total use of antiepileptic drugs, expressed as defined daily doses per 1,000 inhabitants, is almost unchanged during the same time period. A marked variation in the prescribing of new antiepileptic drugs between different counties in Sweden, suggests that the role of the new compounds is still unclear. The cost effectiveness of new antiepileptic drugs in relation to the older drugs requires further evaluation.

In order to minimize the emergence of antibiotic-resistant strains among common pathogens seen in primary care in Stockholm County, the County Medical Officer in 1995 established a multidisciplinary regional STRAMA-group (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance). The group started out by studying antibiotic sensitivity for common pathogens in the County and in Sweden. Then the group analyzed the use of antibiotic drugs and differences in prescribing patterns among different groups of physicians in the County. In order to minimize resistance and achieve the goal of optimal use of antibiotics the group decided to publish guidelines for primary care physicians treating patients with respiratory tract infections (printed in 1997) and urinary tract infections (printed in 1999). In this article we present the guideline for urinary tract infections.

In 1999 the County Medical Officer in Stockholm County established the third regional STRAMA-group (Swedish Strategic Programme for The Rational Use of Antimicrobial Agents and Surveillance of Resistance) to deal with skin and soft tissue infections. The group decided to publish guidelines for physicians in the county, and this third book was distributed among the 7,000 physicians in Stockholm County.