MEDUP – Medicine use & Pharmaceutical policy

Asthma is a common disease with the highest prevalence in groups with lower socioeconomic position. In order to prevent and reduce treatment inequity and contribute to good disease control among people with asthma, knowledge is needed about the extent of barriers to treatment and how the occurrence of barriers differs in different groups in society. The overall aim is to investigate and analyse the frequency of barriers to medical treatment among individuals with asthma in relation to adherence to treatment and asthma status. The project has a focus on vulnerable groups.

Project group: Tove Hedenrud (project  manager), Helle Håkonsen, Pernilla Bjerkeli (Högskolan i Skövde), Henry Ascher, Ronny Larsson, Laura Pazzagli (Karolinska Institute)

It is well known that adherence to chronic prescription drug treatment is about 50%. One of the most common ways to measure adherence is self-report through a questionnaire. There are a large number of validated instruments to measure this, but most lack questions about overuse of medicines and questions about unintentional non-adherence are few. Some instruments are disease-specific and sometimes a large fee is required for availability. No instrument has been validated in Swedish. The aim of the project is to develop a Swedish, generic instrument for measuring adults' self-reported adherence to prescription drug treatment. 

Project group: Tove Hedenrud, Maria Emilsson (Högskolan Väst), Pernilla Bjerkeli (Högskolan i Skövde).

The increasing medicalisation of society has led to a growing dependence on medicines, which entails significant environmental costs. Pharmaceutical residues in water systems have been linked to the development of antibiotic resistance, endocrine disruption in aquatic organisms and reduced biodiversity. Despite the healthcare system's focus on sustainable resource use, the question of how to reduce the environmentally harmful effects of pharmaceutical use has not been resolved. One of our projects addresses this knowledge gap by investigating Swedish citizens' behaviour and willingness to pay for medicines with a lower environmental impact. The project aims to develop a cost-effectiveness framework that takes into account environmental impact, health effects and costs. We are also conducting studies on how pharmacies and other healthcare providers can contribute to more environmentally sustainable use of medicines. 

Project group: Helle Håkonsen (project manager), Christina Ljungberg Persson, Marmar Nekoro (Uppsala University), Carl Bonander (Karlstad University), Simone Dohle (University of Bonn, Germany), Sandy Tubeuf (UCLouvain, Belgium).

The Prospective Population Study of Women in Gothenburg

The Prospective Population Study of Women in Gothenburg started in 1968 by Professor Calle Bengtsson. A representative sample of women aged 38, 46, 50, 54 and 60 years were offered a health survey and answered a number of questionnaires about physical and mental health. Another six health surveys have been conducted, most recently in 2016, and new cohorts of women aged 38 and 50 years have been included. 

In addition to questions about health, there are also questions about medicine use. Ongoing studies include both medicine use over time and methodological studies of the included issues.

Project group: Tove Hedenrud, Helle Håkonsen, Dominique Hange, Gunilla Fernlöf

The Swedish pharmacy system has changed a lot in the last decade and changes may also have taken place in how pharmacies work to maintain patient safety. During inspections of pharmacies in recent years, the Medical Products Agency has found such serious deficiencies in some cases that pharmacies have been forced to close temporarily or close completely because patient safety could not be guaranteed. The aim of the project is to measure the patient safety climate at Swedish pharmacies. This concerns perceptions about policy, procedures and practice in patient safety issues in a workplace or in an organization. Studying the patient safety climate can be an important source of information and can be used as an effective starting point for achieving improvements or for evaluating changes that take place.

Project group: Christina Ljungberg Persson, Björn Södergård, Annika Nordén Hägg

Previous research has shown that not only the number of medicines, but also other factors, affect patients' experience of the burden that medical treatment entails for patients, such as the need to plan to take the medicines. Person-centeredness is an ethical standpoint from which the patient and health professionals work in partnership to achieve the patient's health goals, which could affect how patients experience their medical treatment. In this project, an existing instrument for measuring medicines burden is translated and validated, and then it will be used to study the effects of person-centered care. For further information, please see the project's website: 
Medicines taking – a person-centred approach

Contact person: Joanne Fuller

Financial evaluations are important basis for decisions on the introduction and financing of new medicines, but such evaluations are usually based on studies on defined patient groups and take place in a more organized context than the usual care. Drug-related morbidity, such as side effects, can to some extent be underestimated in such studies that are done before a drug is approved for sale, as they last for a limited time and are limited to certain patient groups. However, the presence of drug-related morbidity can affect the relationship between costs and effects of medical treatment.

An additional factor in normal use that can affect this relationship is adherence to planned treatment. On the other hand, there is little knowledge about how differences in the performance of care affect the perception of and adherence to planned medical treatment. The project studies medicine use and drug-related morbidity from a health economic perspective.

Contact person: Hanna Gyllensten