Smorgasbord: Sweden Day 12: LIF & Apotekens Services

15 April 2010
Stockholm, Sweden
Sodermalm
LIF & Apotekens Services

LIF (pronounced leaf):
We started off the morning with Par and ended up with Per. Par talked to us for a bit about the LIF organization and his role as compliance officer. Per talked to us about FASS which is the Swedish drug information system. FASS stands for something like Pharmacy Specialty Services. This book began as a reference for physicians and pharmacists but has expanded to include veterinarians and patients. There is an abbreviated, though still expansive, volume for patients. The vet version is more pocket-sized as they actually carry these books with them.

The FASS is updated regularly and also has an online version which everyone in Sweden has access to for free. The book is organized by grouping medications into various classes. Each medication is identified by the ATC number which tells what class its in, what strength it is, etc.

One of the best features of the FASS is the My FASS option which can be found online. Patients can list their medications, search for drug interactions, and access the Fass online. The scheduling feature is perhaps the best and certainly one of the most advanced features of the site. Patients can enter their medications as well as their medication schedules and set up SMS (text) notifications. This is an amazing feature especially for drugs which are weekly, every other week, or monthly which are more difficult for patients to remember.

We went to lunch with Par. Amadou met us once the three of us had gotten to dessert. Amadou is a bit directionally challenged, but he finally made it. I have to say that this is one of the best meals I’ve had in Stockholm. I had the fish casserole which sounded good--and it definitely sounded better than blood pudding—

but it looked and tasted even better than it sounded!

I attribute this to the fact that it came with these awesome croutons and shaved parmesan cheese. There was also this little bowl of mayonnaise. I keep thinking that it’s going to gross me out that I actually incorporated that into my meal, but it hasn’t yet…Man, it was excellent!

Josh had the Swedish meatballs with a side of lingonberries in their own little jar. Be jealous when you see the photos =)

We also had a little chocolate truffle for dessert which was quite tasty.

After lunch, we had some free time, so we did a little shopping. I also needed to take a bathroom break and finally found a free bathroom (it’s 5-10 kronor to use public restrooms) in a place called Gunnarson’s Konditori.

After using the restroom, it would have been rude for me not to give them some business, so I indulged in a mixed berry mousse dessert thing. This was super awesome.

After lunch, we visited Apotekens Services which is the information technology service support center. Previously, when Swedish pharmacies were part of the monopoly, all of the systems were run by this company. Now this computer service has been extracted from Apoteket AB and made a separate service. There is a group of tech folks who examine all proposed computer services that the new pharmacies are using to make sure that they are compatible with the existing system. They do this by survey, as most new programs are some version of the original with changes. If no changes have been made in the area, then this part is certified and only the parts where changes have been made need to be checked by the service. (The attached photo is actually a dentist...novacaine in that syringe, perhaps? I like to think of that as a pharmacist immunizing...an imaginary patient or the wall. Take your pick =)

The reason why the technologies have to be compatible is because Apotekens Services also manages a shared national database for prescriptions. Currently, Sweden’s prescriptions are delivered 80% electronically. This took some time to implement, but Apotekens Services have found that prescribers, patients, and pharmacies prefer this e-prescribing system (makes sense, right?). This means less interaction between the pharmacies and the physicians as well as fewer errors in transcription of the prescription. All e-prescriptions are sent to a central repository. The patient then goes to the pharmacy of his or her choice, and the pharmacy can access the prescription to fill it. (P. S. This means there is no calling for a copy from one pharmacy to another!)

There are some technicalities about who has access to this information. The patient has access to all of it, and the pharmacist can print the information out for the patient. Prescribers can only see what they have prescribed, not everything that the patient has been prescribed by all physicians. There is a separate repository for dispensed prescriptions that the physican and pharmacist can also have access to, but only with the permission of the patient. This service is paid for by the pharmacies, but they are required to do so, and a separate service regulates the price.

We also learned that there is a separate service being developed as a drug utilization review which flags the pharmacist if there is any variety of drug-drug, drug-disease, etc. interactions. This takes into account prescriptions that the patient could have on hand at the time. Prescriptions are kept for only 15 months in this repository, so it cannot be used for historical purposes.

After this, Josh and I took the Tunnelbana to Globen. This is the largest spherical structure in the world. It took them 2 years to build it. It is 130 meters above sea level. You can see all of Stockholm from an spherical glass elevator which travels up to the top of the Globe and back down.

I get kind of nervous about heights, but this wasn’t nearly as bad as I thought. The view was really spectacular!

Somehow I talked Josh into visiting that Konditori again…I’ve gotta take a hiatus from the desserts in Lulea…I had a Princess cake which is a traditional Swedish dessert. Josh had pecan pie with ice cream.

For dinner, we took the advice of our Globen elevator operator and went to Amida Kolgrill which is a Kebab place on Sodermalm. The smell of the food cooking was awesome, and the taste of it was pretty good as well.