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This MiniReview shows that both WHO and IUPHAR very early recognized that there is a gap between the availability of academic expert knowledge in pharmacology and its utilization in health care. Many initiatives have been taken to bridge this gap, but still 12 European countries do not recognize clinical pharmacology as a medical speciality because the profession has failed to develop defined functions in patient care. A first priority for EACPT therefore ought to be to promote clinical pharmacology as a medical speciality recognized by the European Union. The pharmacological services listed in Table 7 that focus on drug problems agree well with those that were recently prioritized in the IUPHAR/ WHO/ CIOMS manifesto to correct a major weakness in the health care of today in order to promote rational use of drugs. [ABSTRACT FROM AUTHOR]

The number of registered drugs, and drug expenditure are increasing rapidly in Europe, and within the European Union (EU) there are no longer any regulations requiring that new drugs have to be better than old ones. At the same time, pharmacoepidemiological studies in Europe and USA show that adverse drug reactions now may account for up to 10% of the admissions of patients to internal medicine wards at a cost of hundreds of millions of US dollars annually. This represents a considerable increase compared to 20 years ago. A partial explanation is the many shortcomings of many clinical trials and their relevance for health care. Adverse drug reactions are often poorly studied and documented in these studies and very seldom included in health economical analyses of the value of new drugs. Pharmacovigilance is product- rather than utilization-oriented and quite invisible in clinical medicine. This is regrettable, since up to 50% of adverse drug reactions (ADRs) are dose-dependent and thus preventable. Hopefully, the rapid progress in molecular and clinical pharmacogenetics will provide new tools for clinicians to choose and dose drugs according to the individual needs of patients. [ABSTRACT FROM AUTHOR]

Debrisoquine and S-mephenytoin hydroxylation polymorphisms were studied in 156 unrelated native Estonians. The hydroxylation phenotypes were assessed by coadministration of mephenytoin with debrisoquine or dextromethorphan. The frequency of the poor metaboliser phenotype of debrisoquine/dextromethorphan was 4.5% (95% confidence interval 1.2-7.8%), and that of mephenytoin was 3.9% (95% confidence interval 0.9-6.9%) among Estonians, which is very similar to what has been reported in other Caucasian populations. [ABSTRACT FROM AUTHOR]

The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients. [ABSTRACT FROM AUTHOR]