Community pharmacy and primary health care in Sweden - at a crossroads
The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital (“online doctors”) and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.
Health Resource Guide: Sweden. export.gov, 2019. Available at: https://2016.export.gov/industry/health/healthcareresourceguide/eg_main_116247.asp (accessed Feb 29, 2020).
Sveriges Kommuner och Regioner. [Financial report, October 2019]. Available at: https://rapporter.skr.se/ekonomirapporten-oktober-2019.html?action=search&query=prim%C3%A4rv%C3%A5rden (accessed Feb 29, 2020).
Statistics Sweden (SCB). System of Health Accounts 2018. Available at: https://www.scb.se/en/finding-statistics/statistics-by-subject-area/national-accounts/national-accounts/system-of-health-accounts-sha/pong/statistical-news/system-of-health-accounts-2018/ (accessed Apr 14, 2020).
Sveriges Riksdag. [Swedish Health and Medical Services Act (1982:763]. Available at: https://www.riksdagen.se/sv/dokument-lagar/dokument/svensk-forfattningssamling/halso--och-sjukvardslag-1982763_sfs-1982-763 (accessed Mar 1, 2020).
The Commonwealth Fund. International Health Care System Profiles. The Swedish Health Care System, 2016. Available at: https://international.commonwealthfund.org/countries/sweden/ (accessed Mar 1, 2020).
Socialstyrelsen. [Assessment of supply and demand of licensed health care and dental practiitioners. The National planning support 2019]. Available at: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2019-2-14.pdf (accessed Apr 24, 2020).
Socialstyrelsen. [About open comparisons of health care, 2019]. Available at: https://www.socialstyrelsen.se/statistik-och-data/oppna-jamforelser/halso-och-sjukvard/om-oppna-jamforelser-halso--och-sjukvard/ (accessed Mar 28, 2020).
Swedish Association of Local Authorities and Regions. The National Board of Health and Welfare. Quality and Efficiency in Swedish Health Care. Regional comparisons 2012. Available at: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/statistik/2013-5-7.pdf (accessed Apr 2, 2020).
Regeringskansliet, Socialdepartementet. [The National medicine strategy 2016-18]. Available at: https://www.regeringen.se/contentassets/5522c1b4dd164170b0d77344ed6990d8/nationella-lakemedelsstartegin-2016-2018.pdf (accessed Apr 26, 2020).
Statistics Sweden (SCB). [The population of Sweden. 2020]. Available at: https://www.scb.se/hitta-statistik/sverige-i-siffror/manniskorna-i-sverige/sveriges-befolkning/ (accessed Apr 26, 2020).
Sveriges Kommuner och Regioner. [Agreement on Good and local care 2020]. Available at: https://skr.se/halsasjukvard/kunskapsstodvardochbehandling/primarvardnaravard/overenskommelseomengodochnaravard.28402.html (accessed Mar 18, 2020).
Government Offices of Sweden, 2018. [Good quality, local health care – A primary care reform]. (SOU 2018:39). Available at: http://www.sou.gov.se/wp-content/uploads/2018/06/Summary-SOU-2018.39_Final2.pdf (accessed Mar 18, 2020).
Regeringskansliet. [Good and local care. A reform for a sustainable health care system]. (SOU 2020:19), 2020. Available at: http://www.sou.gov.se/wp-content/uploads/2017/08/SOU_2020_19_webb.pdf (accessed Apr 2, 2020).
Regeringskansliet. [Digi-physical care choice. Accessible primary health care based on need and continuity]. (SOU 2019.42). p.35-50. The patient choice scheme needs to become digi-physical. Available at: https://data.riksdagen.se/fil/747A19F6-5B75-4598-8AB6-E3573327056B (accessed Mar 26, 2020).
Socialstyrelsen. [Patient medication reviews in the elderly, prescribed five or more medicines – a guidance for health care. 2013]. Available at: https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/vagledning/2013-3-18.pdf (accessed Mar 20, 2020).
Österberg M. [Clinical pharmacists in local care.Report on pharmacists in home health care]. Region Sörmland, 2019.
Gröndal H. [Positive effects, challenges and development possibilities. Patient medication reviews with pharmacist support in primary health care in Västmanland Region]. Rapport, 2019.
Sveriges Apoteksförening. [Branch report 2019]. Available at: http://www.sverigesapoteksforening.se/wp-content/uploads/2019/04/Arsrapport_Apoteksforeningen_2019_webb-kopia.pdf (accessed Mar 9, 2020).
eHälsomyndigheten. [Electronic expert support (EES)]. Available at: https://www.ehalsomyndigheten.se/tjanster/ees/ (accessed Mar 31, 2020).
Hammar T, Lidström B, Petersson G, Gustafson Y, Eiermann B. Potential drug-related problems detected by electronic expert support system: physicians' views on clinical relevance, Int J Clin Pharm. 2015;37(5):941-948. https://doi.org/10.1007/s11096-015-0146-8
Apoteksgruppen. [Advice and support for you living with COPD]. Available at: https://www.apoteksgruppen.se/recept/frisq/ (accessed Apr 20, 2020).
TNS Sifo och SA Service AB, 2014.
Tandvårds- och Läkemedelsförmånsverket (TLV). [Pharmaceutical service in community pharmacy]. 2019. Available at: https://www.tlv.se/om-oss/om-tlv/rapporter/arkiv/2019-12-20-farmaceutisk-tjanst-pa-oppenvardsapotek.html (accessed Mar 25, 2020).
The Dental and Pharmaceutical Benefits Agency (TLV). Welcome to the TLV. Available at: https://www.tlv.se/in-english.html (accessed Mar 25, 2020).
Läkemedelsverket. [Pharmacy indicators, a continued development work. Report from the Medical Products Agency March 31, 2015]. Available at: http://web02.lv.episerverhosting.com/upload/om-lakemedelsverket/rapporter/Apoteksindikatorer-fortsatt-utvecklingsarbete-Rapport-final.pdf (accessed Apr 14, 2020).
Westerlund T, Bardage C, Barzi S, Berggren A-L, Ring L, Bernsten C. Developing patient-oriented quality indicators for Swedish community pharmacy practice – a government commission. Presentation at the FIP Congress, Bangkok, Thailand, 2014. Abstract available at: https://www.fip.org/abstracts?page=abstracts&action=item&item=10389 (accessed Mar 1, 2020).
Tandvårds- och Läkemedelsförmånsverket (TLV). [Indicators aimed at measuring community pharmacy practice. 2019]. Available at: https://www.tlv.se/download/18.6ddff38416f1a7ef2ed167bd/1576836930048/rapport_dec_ 2019_forstudie_indikatorer_mata_oppenvardsapotekens_verksamhet.pdf (accessed Apr 27, 2020).
Sveriges Farmaceuter. [About The Swedish Pharmacists Association]. Available at: https://www.sverigesfarmaceuter.se/OmSverigesFarmaceuter/ (accessed Mar 25, 2020).
Sveriges Farmaceuter. [Vision and strategic plan until 2025. 2019]. Available at: https://www.sverigesfarmaceuter.se/OmSverigesFarmaceuter/vad-tycker-sveriges-farmaceuter/vision-och-strategisk-plan-2025/ (accessed Mar 25, 2020).
Apotekarsocieteten. [The Swedish Pharmacy Society’s policy program in the field of pharmaceuticals]. Stockholm, 2019. Available at: https://www.apotekarsocieteten.se/wp-content/uploads/2018/06/Apotekarsocietetens-policyprogram-för-läkemedelsområdet-antaget-av-fullmäktige-20180526.pdf (accessed Mar 21, 2020).
NEPI. Nätverk för läkemedelsepidemiologi. [About NEPI]. Avaiable at: http://nepi.net/OmNEPI1.htm (accessed Mar 31, 2020.
Furängen A, Hoffmann M. [NEPI’s collaboration project]. Stockholm, 2017. Available at: http://nepi.net/res/dokument/NEPIs-samverkansprojekt-slutrapport-exkl-bilagor-2-7.pdf (accessed Mar 31, 2020).
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