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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Background and Objective: According to the guidelines for diabetic care in Gotland, SGLT2-inhibitors and GLP-1-analogues are recommended as an add-on treatment for when metformin in monotherapy, exercise and diet recommendations are insufficient. The aim of this study was to gain a better understanding of the effect of SGLT2-inhibitors and GLP-1-analogues on HbA1c and weight changes in patients with type II diabetes in Gotland. In addition, an overview of respective antidiabetics prescriptions in patients from Wisby Söder Health Center was performed. Study design: A retrospective quantitative study with data from three health centers in Gotland. The study population included diabetes type II patients who were prescribed SGLT-inhibitors or GLP-1-analogues during the period 2018-06-30 to 2020-06-30. This study collected data from Wisby Söder Health Center which further was used for the compilation of data from two previous student projects performed at Visby Norr and Visborg Health Center. Results were presented descriptively, a linear regression-analysis and ANOVA-test was performed. Setting: The study was conducted at Visborg, Visby Norr and Wisby Söder Health Center. Main outcome measures: The primary outcome was the change in HbA1c and weight changes as a secondary outcome. Another objective was to identify the proportion of patients with insufficient treatment defined as <10 mmol/mol HbA1c-reduction with either drug.  Results: In total, 134 patients with SGLT2-inhibitors and 182 patients with GLP-1-analogues were included. The mean HbA1c-reduction for SGLT2-inhibitor was 11 mmol/mol (±13,5 95% KI 6,9-11,2) and for GLP-1-analogues 12 mmol/mol (±14,5 95% KI: 6,9-11,1). For each drug the mean weight reduction was 3 kg (±3). There was no correlation between age and HbA1c-changes.   Conclusion: In conclusion, similar HbA1c and weight reductions were achieved with the respective drugs as in previous studies. However only about 50% of the population achieved a HbA1c-decrease with >10 mmol/mol. This indicates that further measures might need to be taken to optimize diabetes care in Gotland.

Introduction: Single inhaler triple therapy (SITT) is used as maintenance therapy in servereCOPD. SITT is available as dry-powder inhalers (DPIs) and pressured metered-dose inhalers(pMDIs). pMDIs have a more harmful impact on the climate compared to DPIs. Aim: To map changes in the prescription of SITT in Sweden and to compare regionaldifferences regarding the climate impact of the treatments. Methods: A mapping of recommended SITT DPIs (ATC-code: R03AL08) and pMDIs (R03AL09,R03AL11) in all 21 regions. Changes in SITT prescriptions between 2018 and 2022 were retrieved from the national statistical database and used for the climate impact calculations.The regional drug committees were interviewed to discuss factors influencing theprescription of inhalers. Results: Ninety percent of the regions (n=19/21) recommended DPI as the first choice SITT. The use of pMDIs increased from 0.6 to 3.3 patients per 1,000 inhabitants and DPIs from 0.3to 2.2 patients per 1,000 inhabitants during the same period. The climate impact from SITT was significantly higher in 2022 than in 2018. The climate impact for DPIs increased from 9,370 kg CO2e in 2018 to 84,297 kg CO2e in 2022. The climate impact for pMDIs increased from 291,630 kg CO2e in 2018 to 2,765,651 kg CO2e in 2022. Increased recognition of SITT and annual treatment recommendation updates were factors influencing the SITT prescriptions found in the interviews.Conclusion: The SITT use in Sweden has increased since 2018. DPIs are widelyrecommended but pMDIs are more common. There are large regional differences in theprescription and climate impact, and most of the climate impact originates from the pMDIs. Follow-up of the SITT prescriptions at a regional level is proposed to reduce the climateimpact.

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