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The ‘Wise List’– A Comprehensive Model for Drug and Therapeutics Committees to Achieve Adherence to Recommendations for Essential Drugs Among Prescribers?

In this issue of the journal, Gustafsson et al. [1] describe the history and key policy elements of the Stockholm County Council’s approach to achieve adherence to independent essential drug recommendations by branding and marketing a booklet called the ‘Wise List’, directed to prescribers (general practitioners and specialists) and the public. For the Swedish capital region (2 million inhabitants), the concept includes a coherent policy for selection of just over 200 cost-effective essential drugs to be used for primary and hospital inand outpatient care. The ‘Wise List’ concept has been consistently developed and expanded during the last 20 years. It is combined with continuous medical education, electronic access to recommendations, follow-up of adherence as well as with financial incentives. Most importantly for the success of this concept is the involvement of the prescribers, respected and independent drug experts and the public. In addition, the access to recommendations has been provided at point of care by using emerging information technology tools such as decision-support systems [2]. The approach is centered around the ‘Wise List’ (Kloka Listan in Swedish), a drug formulary of essential medicines published as a booklet for patient care in the whole Stockholm health care region and accessible for prescribers in electronic health records and at the independent and regional website for drug information. Behind this publication stand regional and local multidisciplinary teams of participating physicians, pharmacists and clinical pharmacologists. The power of the concept of the ‘Wise List’ stems from the development of a consistent and transparent procedure for recommending drugs across pharmacotherapeutic areas by involving clinical pharmacologists, competent in critical drug evaluation, and taking the leadership to assure trust in the quality and the independence of the selection of drugs [3]. There is a strong emphasis on implementation including academic detailing programmes and reaching out to practising physicians. Through public information campaigns, the patients are informed of the existence and the value of the ‘Kloka Listan’. This work shows that it is feasible to change prescribing habits to reach as much as 87% adherence to recommendations in the ‘Wise List’ among primary health care centres in 2009. The lesson is that a comprehensive approach with a 10-year perspective is needed. The addition of knowledge databases on drug-drug interactions and dosage instructions increased the power of this concept, as computerised information is now widely accessible at the point of care in the form of decision support systems to further enhance adherence. The approach of the Swedish Stockholm County Council has been implemented in most of the other health care regions of Sweden, albeit sometimes only partially. Other Basic & Clinical Pharmacology & Toxicology, 108, 221–223 Doi: 10.1111/j.1742-7843.2011.00684.x