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The drug-specific indicator »drugs that should be avoided in older people«, defined by the National Board of Health and Welfare of Sweden, is part of a large set of indicators of potentially inappropriate prescribing used for benchmarking in health care and in research. In this study, 149 consecutive primary care patients (75-99 years of age, 62 percent female, 0-20 drugs in the medication list) were included. Their medication lists were screened for potentially inappropriate drugs according to the indicator at issue, including long-acting benzodiazepines, drugs with anticholinergic action, tramadol, propiomazine, codeine, and glibenclamide. Medically justified actions related to these drugs were determined by two specialist physicians in consensus. In all, 29 patients had 32 drugs listed in the indicator, 7 of which, in 6 patients, were deemed relevant to act upon before the next regular physician visit, e.g. the annual control of chronic conditions. For the remaining 25 drugs, in 23 patients, no such related action was medically justified prior to the next regular visit. Using the area under the receiver operating characteristic (ROC) curve, the indicator did not outperform chance to identify inadequately managed drug treatment, defined as the consensus decision by two specialist physicians that some action related to the full medication could be medically justified prior to the next regular visit: 0.56 (95% CI: 0.46-0.66). In conclusion, the indicator »drugs that should be avoided in older people« did not warrant action from a medical perspective for four out of five patients, and could not differentiate between adequately and inadequately managed drug treatment.

Skewed information about medicines in social media influence the healthcare-patient contact. Healthcare staff need situation adapted evidence that can be linked to patient data. For 20 years Sweden has provided praised Pharmacological Knowledge Bases (PKB). They include »Janusmed drug-drug interactions«, »Janusmed drugs and birth defects« and »e-Ped (electronic pediatric) instructions and drug dosage control«. PKBs need to be better integrated into digital tools adhering to a national guide for optimal interface presentation of information. They should be produced by medical editors and delivered through a national digital highway. Experts need to adhere to a policy for handling conflicts of interest and evaluate that information is appreciated and used. PKBs should be accessible as a public good for healthcare staff, students and the public to support personalized medical care.

Opioid prescription changes in Sweden 2000-2015 In contrast to the well-established »opioid epidemic« in the US, very little is known about how the prescription of opioids in Sweden has developed during the last decade. Aggregated data from the open Statistical database of the Swedish Board of Health and Welfare were analyzed descriptively. The yearly prevalence of opioid prescription did not change 2006-2015, but there were dramatic shifts in the choice of opioids. During this period, dextropropoxyphene was pulled off the market. Tramadol was used by fewer individuals (-54 % over the decade), but dosages expressed as Defined Daily Dose/patient/year (DDD/pat/y) increased (+41 %). In contrast, oxycodone and morphine were used by more individuals (+465 % and +137 %, respectively), but DDD/pat/y decreased during the period (-56% and -54%). Studies on non-aggregated data from available registries are needed to further elucidate the circumstances and possible consequences of these shifts in opioid prescription patterns.

A common understanding of roles and responsibilities regarding both individual prescriptions and the patient's full list of treatments, including the responsibility for monitoring of treatment, is necessary to have for physicians treating the same patient. Qualitative studies of attitudes expressed by Swedish physicians have identified at least four different roles of a physician when prescribing drugs. A model on how to share responsibility in different situations of drug prescribing is described. The described model on how to share responsibilities between different physicians treating the same patient with drugs constitutes the basis for a joint recommendation by the Swedish Medical Association and the network of Swedish Drug and Therapeutics Committees.

New drugs and new discoveries--such as those concerning the use of individual genetic profiles to help customize dosages--have refined drug treatment. Drug companies' marketing efforts as well as patients' views and wishes influence physicians in their choice of treatment. Drug-drug interactions continue to be a common cause of admissions to hospitals. Instantaneous access to a patient's complete drug list and to reliable medical information in a computer-based drug-prescribing system will help ensure patient safety. It will also contribute to evidence-based choice of pharmacological principle, drug, method of administration and dosage and to better agreement between patient and doctor.

Prescribers today encounter increasing demands for up-to-date knowledge of medical advances and drug therapies, and for a straightforward dialogue with patients. Cost-effective drug treatment calls for fast and intuitive access to information about drugs, treatment strategies and patient data. There are several computer-based drug-prescribing systems in Sweden. Information independent of the drug industry is wanting, as are uniform national standards for medical content and functionality. Decision-support systems must facilitate decisions about therapy, drug distribution and intake, as well as quality work, i.e. support the entire process which defines an effective drug therapy. A very important feature is access to a patient's drug list showing all current drugs. This joint initiative by county councils aims at drawing up a national Swedish specification of requirements for a suitable decision-support system and at creating a national entity responsible for distributing unbiased information from a unique database to a range of computerized medical records systems.