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MEDUP – Medicine use & Pharmaceutical policy

Research group

Short description

MEDUP is a research group and a network for people who do research on medicine use and pharmaceutical policy. Research areas of interest are which medicines are used by different population groups, how they are used, outcomes of use, and factors affecting use at the individual and societal level.

Prescribing and use of medicines is largely influenced by policies that regulate availability and accessibility of medicines, which makes it important to study both the positive and negative effects of policies from different perspectives.

The field of science is social pharmacy, a multidisciplinary field, and the research is based on different perspectives: users / patients, professions, populations and society. The research group has an interest in and competence in both quantitative and qualitative research methods.

Medicines is the most common treatment for different diseases. The actual use of medicines is affected by many factors on an individual- and societal level. For instance an individuals´ beliefs about advantages and disadvantages with the treatment and if they want to use the prescribed medicine. Pharmaceutical policies also have an impact on the treatment and use of medicines, and studying attitudes to and effects of such policies is also part of the research group's interest. One example is the re-regulation of the pharmacy market and the possibility of buying over-the-counter (OTC) medicines from other retailers. An increased knowledge of influencing factors and the actual use of medicines provides researchers, decision-makers, and health professionals with an improved basis for pharmacoepidemiological studies, for policy decisions and for treatment of ill health and treatment of the individual patient.

Studying and analyzing the use of medicines with valid methods is one of the research group's main strengths, but MEDUP has conducted research in all sub-areas of of social pharmacy research:

  • Prescribing, use of medicines, and different outcomes of use
  • Strategies to improve medicine use in society: pharmaceutical policies and pharmaceutical interventions in pharmacies and healthcare
  • The pharmacy professions, pharmacy practice and collaboration with other healthcare professionals
  • Development of research methods in the field

Ongoing projects

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, Henric Rhedin, Ronny Larsson.

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. The instrument will be available through Creative Commons.

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

There is incontestable evidence that pollution from pharmaceuticals has environmental effects limiting the diversity of nature. The aim of this project is to investigate the Swedish population’s choice and preferences for medicines with different environmental risks and willingness to pay for preventive measures. Previous research indicate that the Swedish people to a certain extent are aware of the negative effects of pharmaceuticals in nature and are willing to contribute positively to the environment. In this project, we raise the question of how far this willingness extends.

Are people in Sweden willing to weigh the effect of the medicine against its environmental impact? Are we willing to pay a higher price for medicines in return for more efficient water purification systems? Is there a will to emphasize environmental factors when the authorities decide whether a new medicine should be included in the benefit system?

Project group: Helle Håkonsen (project manager), Tove Hedenrud, Henric Rhedin, Christina Ljungberg Persson, Simone Dohle (University of Cologne).

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, Karolina Andersson Sundell, 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