PPIs (Proton-pump inhibitors) offers the best treatment for acid related diseases. The predominant indications for PPI prescription are:

• GERD
• eradication of H. pylori-infection in combination with antibiotics
• H. pylori-negative peptic ulcer 
• healing of and prophylaxis against NSAID/COXIB--induced gastroduodenal lesions 
• acid hypersecretory states such as Zollinger-Ellisons syndrome.

The market for PPIs continues to expand in most countries. A significant over- and misuse of PPIs prevails in hospital care as well as in general practice. The predominant reasons for and mechanisms behind the over- and misuse of PPIs are well recognised. The most important consequences of this overprescription of PPIs are increasing medical costs and risk for long-term adverse side effects. Continued education and dedicated information are key factors to guide physicians, medical personnel and patients to adopt to generally accepted principles for and balanced use of PPIs.

Protonpumpshämmare är den bästa behandlingen försyrarelaterade störningar.

De viktigaste indikationerna för protonpumpshämmare är gastroesofageal refluxsjukdom (GERD), eradikationav H pylori-infektion i kombination med antibiotika, H pylori-negativa magsår och läkning av och profylax mot NSAID-/coxib-inducerade magsår, hypersekretoriska sjukdomstillstånd som Zollinger–Ellisons syndrom.

Marknaden för protonpumpshämmare fortsätter attväxa i de flesta länder.

Ett stort antal internationella publikationer dokumenterar att överförskrivning av protonpumpshämmarefortsätter att vara mycket utbredd, både inom och utanför sjukhus, och utan tendens att minska.

De främsta orsakerna till överförskrivning av protonpumpshämmare är väl kända och tydligt definierade.

De två viktigaste konsekvenserna av överförskrivning är skenande läkemedelskostnader och risk för biverkningar.

Utbildning och information är nyckeln till att vägledasjukhusläkare, primärvårdsläkare och allmänhet till rättanvändning av protonpumpshämmare.

How do we want to organize health centres? 838Swedish general practitioners’ attitudes to a personal patient list.

In Swedish primary care patients are registered at health centres where different professions, such as general practitioners (GPs), nurses, assistant nurses, counsellors, physiotherapists, psychologists and biomedical analysts, work. In an international comparison personal physician continuity is low in Sweden. Several governmental inquiries propose that patients register with one GP or a care team. Do Swedish GPs want a personal patient list and how should this best be realised? A web survey was distributed to the members of the Swedish Union of General Practitioners and was answered by 838 GPs. 91% wanted a personal patient list if reasonably sized, the option to limit their list, and shared responsibility for the list with colleagues or a team. To be able to plan the working day themselves and designated time for collegial dialogue was considered essential for increased efficiency, well-being and reduced risk of patients harm due to their doctor's knowledge gaps.

Sverige presterar i internationell jämförelse sämst avseende personlig läkarkontinuitet. Personliga patientlistor kan öka kontinuiteten, men vad tycker svenska allmänläkare?

838 allmänläkare besvarade en webbenkät. 91 procent av svarande under 66 år önskade en personlig patientlista om den är rimligt stor, ca 1 160 personer. Ansvaret för listan bör delas inom ett arbetslag av läkare eller ett team. Tid för kollegial dialog är nödvändig för effektivitet, trivsel och patientsäkerhet.

Sverige skulle behöva 11 150 allmänläkare. I dag finns 5 000. Radikala satsningar för rekrytering av läkare till primärvården krävs, liksom övergångslösningar, till exempel listning på andra specialister och på team.

Overloading of the emergency departments in hospitals is, in Sweden, a common problem that is often blamed on lack of access to primary care.  We have conducted a cross-sectional study comprising more than 40% of the 347 837  inhabitants of Region Jönköping with access to complete individual data on healthcare consumption, personal doctor continuity, socio-economics, and accessibility data for all of the regions health centres. Individuals with high personal continuity at their own health centre had significantly fewer emergency room visits compared to those with the lowest continuity: for younger adults 55% and for elderly 34% fewer emergency room visits. Access to doctor consultations or to counselling nurses in primary care was not associated with a lower number of emergency room visits. Our results show the importance of personal doctor continuity also for the group of younger adults.

Hög personlig läkarkontinuitet i primärvård var förenad med lägre antal läkarbesök på akutmottagningar.

Sambandet mellan hög personlig läkarkontinuitet och lägre antal läkarbesök på akutmottagning var störst för gruppen yngre vuxna.

God tillgänglighet till läkarbesök på vårdcentral var inte förenad med lägre antal akutmottagningsbesök.

God tillgänglighet till telefonrådgivning av sjuksköterska på vårdcentral var inte förenad med lägre antal akutmottagningsbesök.

Studier har visat på högre vårdkvalitet och minskad total resursförbrukning vid hög kontinuitet i vården. 

Personlig kännedom mellan läkare och patient bidrar till ökat ansvarstagande från läkaren och ökad tillit hos patienten.

En ny svensk primärvårdsorganisation kan kombinera organisatoriska faktorer så att både kontinuitet och tillgänglighet till vård ökar.

In a recent study of more than 500 000 hospitalisations, doctors with personal knowledge of their patients used less resources, more often discharged them to their own home and their patients had lower mortality. Furthermore, other studies have shown that personal continuity increases patient satisfaction as well as compliance and reduces costs for medical services and visits to emergency services. In a Swedish context we discuss how a combination of organizational factors and personal listing on physicians and continuity of care favour personal knowledge between physician and patient and contribute to a primary care that works well for both the frail elderly and the healthy young.

Knowledge development and paradigm shift for peptic ulcer disease is described over a fifty-year period using four levels of knowledge that place demands on the healthcare organization. When medical knowledge reached a healing level, continuity became subordinate. However, accessibility to treatment became more important. An important task for future healthcare will be to define and create broader knowledge structures. Efficiency losses can occur when control instruments apply to medical problems at low levels of knowledge which are not mature for this.

Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms.

Den medicinska kunskapsutvecklingen har genomgått stora förändringar under de senaste femtio åren. Den ökade kunskapen har påverkat arbetsfördelningen mellan sjukhusvård och primärvård. Dessutom har flera vårdorganisatoriska reformer ägt rum under denna tid. Exempelvis övertogs ansvaret för allmänläkarverksamheten av landstingen från staten 1963. År 1970 hade Sverige högst andel av antalet slutenvårdsplatser i Europa. Samma år ändrades ersättningssystemet för läkare till en fast lön. Fyrtio år senare var andelen slutenvårdsplatser lägst i Europa. Under denna tidsperiod ökade antalet vårdcentraler från ett tjugotal till cirka 1200. Omfördelningen från sjukhusvård till primärvård och öppna vårdformer har liksom den medicinska kunskapsutvecklingen haft konsekvenser för relationerna mellan sjukhus och primärvård. Primärvård har traditionellt definierats med ett organisatoriskt perspektiv medan sjukhusspecialiteter i huvudsak har definierats från ett medicinskt kunskapsområde (1). Men både primärvård och sjukhusspecialiteter har ansvar för medicinska problem på låg och hög kunskapsnivå.

Background. The purpose of this study was to analyse whether the parallel life situation between stroke patients and their informal caregivers (dyads) shown in cross-sectional studies prevails also in a longitudinal perspective.Methods. A total of 377 Swedish stroke patients, aged 65 years, and their 268 informal caregivers were followed from hospital admission and one year on. Analyses were based on patient interviews, functional ability (MMSE) score, Nottingham Health Profile (NHP) score, Hospital Anxiety and Depression (HAD) score, self-rated health score, and the Gothenburg Quality of Life (GQL) activity score. Similar information was obtained by postal questionnaires from informal caregivers, also including information on the nature and amount of assistance provided and on Caregiver Burden (CB) score.Results. Before index admission informal caregivers provided care on average 5 h per week and after discharge 11 h per week (P < 0.0001). Support volume was associated with patient sex (more for men), low patients functional ability, low received municipal social service support, closeness of patient-caregiver relation, and short distance to patients home. Significant positive associations within the dyads were found for HAD anxiety score (P < 0.0001), total NHP score (P < 0.0001), and GQL activity score (P < 0.0001) after adjustment for patients age, sex, functional ability, and patient-caregiver relationship. CB score increased with amount of informal caregiver support, patients age, and with low functional ability and low amount of municipal social service support. All these associations were constant across time.Conclusions. There was an association within the dyads regarding anxiety score, NHP score, and activity score. CB score was generally high.

Objective. To explore views and attitudes among general practitioners (GPs) and researchers in the field of general practice towards problems and challenges related to treatment of patients with multimorbidity. Setting. A workshop entitled Patients with multimorbidity in general practice held during the Nordic Congress of General Practice in Tampere, Finland, 2013. Subjects. A total of 180 GPs and researchers. Design. Data for this summary report originate from audio-recorded, transcribed verbatim plenary discussions as well as 76 short questionnaires answered by attendees during the workshop. The data were analysed using framework analysis. Results. (i) Complex care pathways and clinical guidelines developed for single diseases were identified as very challenging when handling patients with multimorbidity; (ii) insufficient cooperation between the professionals involved in the care of multimorbid patients underlined the GPs impression of a fragmented health care system; (iii) GPs found it challenging to establish a good dialogue and prioritize problems with patients within the timeframe of a normal consultation; (iv) the future role of the GP was discussed in relation to diminishing health inequality, and current payment systems were criticized for not matching the treatment patterns of patients with multimorbidity. Conclusion. The participants supported the development of a future research strategy to improve the treatment of patients with multimorbidity. Four main areas were identified, which need to be investigated further to improve care for this steadily growing patient group.

Background: It has been reported that there is a difference in drug prescription between males and females. Even after adjustment for multi-morbidity, females tend to use more prescription drugs compared to males. In this study, we wanted to analyse whether the gender difference in drug treatment could be explained by gender-related morbidity. Methods: Data was collected on all individuals 20 years and older in the county of Ostergotland in Sweden. The Johns Hopkins ACG Case-Mix System was used to calculate individual level of multi-morbidity. A report from the Swedish National Institute of Public Health using the WHO term DALY was the basis for gender-related morbidity. Prescription drugs used to treat diseases that mainly affect females were excluded from the analyses. Results: The odds of having prescription drugs for males, compared to females, increased from 0.45 (95% confidence interval (CI) 0.44-0.46) to 0.82 (95% CI 0.81-0.83) after exclusion of prescription drugs that are used to treat diseases that mainly affect females. Conclusion: Gender-related morbidity and the use of anti-conception drugs may explain a large part of the difference in prescription drug use between males and females but still there remains a difference between the genders at 18%. This implicates that it is of importance to take the gender-related morbidity into consideration, and to exclude anti-conception drugs, when performing studies regarding difference in drug use between the genders.