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Background: Patient harm is a global problem that causes hundreds of millions of hospitalizations every year. Part of the problem is medicinal harm, many of which are preventable. One way to improve rational treatment is the use of clinical pharmacists within healthcare. By conducting medication reviews medical related problems can be identified and actions set in before further harm is made. Those directly impacted by any complication are the patients, yet in Sweden studies have focused on experiences of health personnel. To promote person-centered care, it is therefore important to focus on patients’ point of view. Aim: To explore inpatients’ knowledge about and experiences with clinical pharmacists. Method: Individual semi-structured interviews with inpatients from a Swedish hospital. The patients had met with a clinical pharmacist earlier in the day and were asked questions related to that meeting. Interviews were audio-recorded, transcribed, and qualitative analyzed withthematic analysis. Results: In total 20 patients were interviewed from four different wards: 55 % were female and the average age was 75 years (41-89 years). Four main themes were identified: 1) Earlier knowledge about clinical pharmacists; 2) Pharmacists integration into care; 3) Personal traits of a pharmacist; and 4) Patient benefit of the meeting. Conclusion: Inpatients’ knowledge about clinical pharmacists is low and few expect to meet one during hospitalization. Still, the general impression is mostly positive, and patients appreciate both the person and the context. Future research should focus on how to promote clinical pharmacists to increase patient awareness and their involvement in care.

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Bakgrund: Vitamin D är ett steroidvitamin och tillförs oss från vissa livsmedel eller syntetiseras när vår hud utsätts för solen. Inuti cellerna fungerar det som en transkriptionsfaktor för en grupp gener. 1,25-dihydroxivitamin D3 (1,25D3) är den aktiva vitamin D-metaboliten, men den cirkulerar mest i kroppen som 25-dihydroxivitamin D3 (25D3). ER-stress uppstår när proteinsyntesen inte fungerar för att försöka rädda cellen. Tidigare studier har föreslagit en skyddande effekt av vitamin D på ER-stress.  Syfte: Syftet med denna studie var att undersöka effekterna av metaboliter av vitamin D på ER-stress i PC3 och NSC34-celler. Metoder: PC3-celler och NSC34-celler behandlades med 1,25D3 eller 25 D3 i kombination med ER-stressorn tunicamycin. Stressnivåerna mättes med realtids-PCR med BiP som biomarkör för ER-stress och CYP24A1 som biomarkör för D-vitamininduktion. Resultat: Resultaten från qPCR-analysen var varierande och motsägelsefulla i de behandlade PC3-cellerna. Den genomsnittliga dubbla skillnaden i uttrycket av BiP för tunikamycin-behandlade celler var endast något större än för celler behandlade med en kombination av tunicamycin och 1,25D3 eller 25D3. När det gäller NSC34-celler verkar kombinationen av tunicamycin och en vitamin D-metabolit öka ER-stressen. När celler behandlades med tunicamycin minskade metabolismen av D-vitaminmetaboliterna. Slutsats: Denna studie ger information om inte bara effekten av den tidigare studerade 1,25D3 på ER-stress, utan även effekten av 25D3. Studien antyder också en tidigare okänd biologisk funktion av 25D3, vilket utmanar tidigare antaganden om en inaktiv metabolit.

Background: The last decades, advances in drug development have resulted in many biological drugs being launched on the market. There is limited knowledge of how they are being used. The aim of this study was compare volumes and expenditure of biologics in between 2017 and 2021 to get an overview of the most used biologicals in Stockholm, Sweden.   Methods: Descriptive cross-sectional analyses were made om data for region Stockholm on utilization and expenditure of biologics 2017 and 2021. Data were collected using databases on dispensed drugs and hospital sales from Socialstyrelsen and Region Stockholm, respectively. Measurement units used in the study were Defined Daily Doses, amount of sold packages and total expenditure in Swedish crowns.  Results: Volumes of biologics have increased over time.  Also cost of most biologic drugs increased except for the cancer drug trastuzumab. TNF-a inhibitors were the biologics accoutning for the highest cost. Some of the drugs were sold either by prescription or hospital sales only.   Conclusion: Volumes and expenditure of biologics increase in use and belong to the top-drugs by expenditure. Further research and analyses are needed to assess the appropriateness.

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ABSTRACT  BACKGROUND: Access to medicine is a basic human right and one of the fundamentals of an efficient healthcare system. Therefore, many countries have developed different models to ensure that their citizens have access to affordable and good quality medicines. According to the Swedish reimbursement model, all patients receive free medicines when passing a threshold of 2400 SEK (Year 2022) of co-payment. However, providing free access to medicines without co-payment while at the same time avoiding overuse is a challenge.   AIM: The main aims of this study were to describe the proportion of patients reaching the threshold for no co-payment and to investigate if there is an increase in the amount of dispensed prescription only medications after reaching the threshold within the Swedish reimbursement model.  METHOD: A retrospective cross-sectional registry-based study was conducted using data on all dispensed prescriptions in Sweden during the period 2012-2017. The proportion of patients reaching the threshold was described annually by age and sex. Volumes of drugs dispensed measured in DDD were assessed for all major ATC 2nd level groups three month before and three months after patients reached the threshold, respectively.  RESULT: A total of 32,4 Million persons purchased prescription medicines during the period. One third of them (33%) reached the threshold and utilize the benefit of free cost. On average a 30% increase in volumes of dispensed medications were observed when comparing dispensing some therapeutic groups before and after the threshold was reached. CONCLUSION: Access to quality assured medicines is a key factor in determining the overall quality and equity of a healthcare system. However, it is important to ensure the balance between cost, affordability, and rational use. This study showed that 33% of all patients reach the threshold for free medicines annually with no gender difference and indicated that some patients purchase more drugs after reaching the threshold. Further studies are needed to assess whether this is rational or not.

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