CONSUMPTION TREND OF OPIOIDS IN AMBULATORY PATIENTS IN ALBANIA 2014-2019

Objective: The aim of this paper is to evaluate 6‐year trends in community use of prescribed opioid analgesics in Albania, using the Anatomic Therapeutic Chemical Classification-Defined Daily Dose methodology. Methods: We collected the data from the database of the Health Insurance Institute (HII). Analysis of the data includes the period 2014–2019; also, we analyzed the data of import and domestic production of drugs, which represent the real consumption of drugs in the country. These data were subsequently involved in a comparative analysis of the utilization data according to the HII. Results: We report a 2.5 fold increase in opioid utilization over the study period. The maximal rise in consumption refers to fentanyl, oxycodone, and tramadol. Meanwhile, the maximal values of consumption refer to strong opiate, morphine. We note that around 30% of the consumption of this class flows out of the scheme. Furthermore, around 25% of consumption of morphine and oxycodone flows out of scheme too. Meanwhile, the tramadol consumption runs out of the scheme over 200%. Conclusions: The outcomes indicate that patients in Albania have low access to opioids medications mainly because of low opioids availability. A strong opiophobia among the population and the medical professionals constitutes one of the major impediments for efficient palliative care.

CONSUMO DE BENZODIAZEPÍNICOS E OPIOIDES NO PRIMEIRO QUADRIMESTRE DE 2020 EM UMA UNIDADE DE PRONTO ATENDIMENTO DA PARAÍBA

Objetivo: Verificar a dispensação de benzodiazepínicos e analgésicos opioides, classificando-os pelo Anatomic Therapeutic Chemical e quantificando os gastos a partir de valores base da Câmara de Regulação do Mercado de Medicamentos. Método: O estudo foi do tipo transversal, com abordagem quantitativa, desenvolvido na Unidade de Pronto Atendimento de Porte III do município de Campina Grande, durante o mês de abril de 2020. Foram consultadas as planilhas de estoque da Farmácia desse serviço de saúde de urgência e emergência, referentes ao primeiro quadrimestre do corrente ano, para verificação do consumo de benzodiazepínicos e opioides dispensados para os pacientes em atendimento na faixa temporal selecionada, sem contato algum, direto ou indireto, com estes pacientes ou suas informações pessoais. Resultados: Foram dispensados um total de 2882 apresentações farmacêuticas dos medicamentos benzodiazepínicos ou opioides, sendo estes últimos motivo de 62,3% das dispensações. Conclusão: É de grande importância a verificação do uso de medicamentos na sociedade, para melhor entender suas indicações, problemas associados e gastos para manutenção dos tratamentos. Pelo grande número de opioides dispensados em altas concentrações, seria adequada a implementação de programas de educação em saúde para os funcionários, que resultassem sempre no melhor atendimento aos usuários do serviço. Palavras chave: Farmacoepidemiologia. Unidade de Pronto Atendimento. Medicamento de Controle Especial.

Estimates of age specific death rates in people with diabetes and associated multimorbidity using Australian administrative pharmaceutical data

IntroductionEstimating the mortality risk of persons with diabetes can be challenging. Associated conditions such as cardiovascular disease can become the primary cause of mortality and the underlying contribution of diabetes not recorded. Alternative methods to assess mortality risk in people with diabetes would be useful. ObjectiveTo evaluate an Australian pharmaceutical database to identify multi-morbidity cohorts associated with diabetes and determine mortality rates in these groups using prescription exchange cessation as a proxy event for death. MethodsAustralian Pharmaceutical Benefits Scheme data covering the period 2003–14 were used. Persons with diabetes, cardiovascular diseases and dyslipidemia were identified using Anatomic Therapeutic Chemical codes allocated to their recorded dispensed treatments. People with combinations of these conditions were followed and the last recorded prescription exchange used as a proxy event for mortality. Age and gender specific mortality rates and mortality rate ratios for the multi-morbidity cohorts were then calculated from the number of deaths occurring within 10 years. Results346,201 individuals were identified as taking treatments for diabetes, dyslipidemia and cardiovascular conditions in 2004, 86,165 deaths occurred within 10 years of follow up. Overall crude mortality was 26.2/1,000 person years. Age specific mortality rates and rate ratios were calculated for various multi-morbidity groupings. Statin treatments improved the mortality rates associated with diabetes and cardiovascular disease in persons age >54 (Log–Rank <.001). ConclusionsAdministrative pharmaceutical data can be used to identify persons with diabetes and associated multi-morbidities. Proxy mortality events defined by the cessation of treatment can generate mortality rates, providing an alternative perspective for the assessment of mortality risk.

Is Prescription Nonredemption a Source of Poor Health Among the Roma? Cross-Sectional Analysis of Drug Consumption Data From the National Health Insurance Fund of Hungary

Background: The health status of the Roma is inferior to that of the general population. The causes of poor health among this population are still ambiguous, but they include low utilization of healthcare services. Our study aimed to investigate prescription redemptions in segregated Roma colonies (SRC) where the most disadvantaged quartile of Roma people are living.Methods: A cross-sectional study was carried out with data obtained from the National Institute of Health Insurance Fund Management in the settlements belonging to the study area of the “Public Health-Focused Model Program for Organizing Primary Care Services.” The study included 4,943 residents of SRC and 62,074 residents of the complementary area (CA) of the settlements where SRC were located. Crude and age- and sex-standardized redemption ratios for SRC and CA were calculated for each Anatomic Therapeutic Chemical (ATC) group and for the total practice by ATC group. Standardized relative redemptions (RR) with 95% confidence intervals were calculated for SRC, with CA as a reference.Results: The crude redemption ratios were 73.13% in the SRC and 71.15% in the CA. RRs were higher in the SRC than in the CA for cardiovascular, musculoskeletal system, and alimentary tract and metabolism drugs (11.5, 3.7, and 3.5%, respectively). In contrast, RRs were lower in the SRC than in the CA for anti-infective agents (22.9%) due to the poor redemption of medicines prescribed for children or young adults. Despite the overall modest differences in redemption ratios, some ATC groups showed remarkable differences. Those include cardiovascular, alimentary and musculoskeletal drugs.Conclusion: Redemption of prescriptions was significantly higher among Roma people living in SRC than among those living in CA. The better redemption of cardiovascular and alimentary tract drugs was mainly responsible for this effect. These findings contradict the stereotype that the Roma do not use health services properly and that prescription non-redemption is responsible for their poor health.

Analysis of Market Access Agreements in Turkey

BACKGROUND: Reimbursement agencies are increasingly adopting innovative reimbursement approaches for new and expensive technologies. Social Security Institution (SSI), Turkey`s reimbursement agency, established the Alternative Reimbursement Commission (ARC) on February 10, 2016. This study aimed to understand the implementations of market access agreements in recent years in Turkey.METHODS: Decisions of the Health Services Pricing Commission published in the official gazette , and information from the Turkey Pharmaceuticals and Medical Devices Agency, the Abroad Drug List, Health Implementation Communique published by SSI with additional lists, such as the Annex-4A List of Reimbursed Medicines and the Annex-4C Abroad Drug Price List, were used. The data was transferred to Windows Office Excel files, and a descriptive analysis was conducted and evaluated by two market access experts.RESULTS: There were 57 drugs included in the coverage of reimbursement with alternative reimbursement since the application was started in Turkey. 35 of them were added to Annex-4A and 22 of them to Annex-4C. Furthermore, 45.6% of the drugs had an Anatomic Therapeutic Chemical Classification (ATC) code of l-antineoplastic and immunomodulating agents, 28% were orphan drugs, 44 of them had a confidential discount rate, and financial-based agreement models were preferred for nearly all agreements.CONCLUSIONS: Turkey has been implementing market access agreements since mid-2016. In the past 3 years, 57 drugs have been covered for reimbursement under the new implementation. Further analysis should be conducted to understand the decision-making process involved.

Analysis of the level and dynamics of prices in the pharmaceutical market of Saint Petersburg

This article provides detailed results of an in-depth analysis of the price situation in the pharmaceutical market of Saint Petersburg, based on data from the audit of retail sales and hospital purchases, as well as the audit of preferential drug supply in 2012-2019, provided by the research company DSM Group. Using such statistical indicators as weighted average prices, weighted average prices index, Laspeyres price index and structural shifts index, the analysis of the level and dynamics of prices in the drug market of Saint Petersburg as a whole, as well as in its individual segments-retail, hospital and preferential drug provision segment. The results of a comparative analysis of price changes for medicines included in the List of essential and essential medicines and not included in it, for domestic and imported drugs, as well as for medicines belonging to different pharmacotherapeutic groups of Anatomic-therapeutic-chemical classification and located in different price ranges are presented.

Medication reconciliation in admission hospitalization: retrospective study

Objective: to quantify and describe the discrepancies found in medication reconciliation (MR) in patients at hospital admission. Methods: Retrospective study performed from September to November 2018, based on data from the MR of patients at hospital admission of a large hospital in the city of Porto Alegre / RS. MR was shared with nursing (collection of patient’s medication history) and pharmacy (comparison of medication list before and during hospitalization). The referred drugs were classify according to the Anatomic Therapeutic Chemical (ATC) classification in their first level and the discrepancies were classify according to intentionality (intentional and unintentional). Results: 81 patients submitted to MR, and 80% of them had some discrepancy. Of the 328 drugs evaluated, 44.8% presented discrepancies, totaling 147 discrepancies, being intentional (n= 97) and unintentional (n= 50). The omission of medication was the most frequent discrepancies (48.3%). After identify unintencional discrepancies 50% of drug were included in prescription. Cardiovascular drugs and digestive and metabolism drugs were the groups with the highest frequency of discrepancy. Conclusion: Since 80% of prescriptions on hospital admission had some discrepancy regarding the use of medication by patients before hospital admission, it is understood the importance of performing MR as a pharmaceutical service and with the objective of increasing patient safety regarding drug therapy.

Incidence of drug-treated chronic diseases using administrative pharmaceutical data

Background Pharmaceutical data can be used to identify the presence of drug-treated chronic diseases (CD) in individuals using assigned World Health Organization Anatomic Therapeutic Chemical (ATC) classifications of medicines prescribed. ATC codes define treatment domains and provides a method to case define CD that has previously been used to estimate CD prevalence within populations. Main Aim We determined selected CD incidence from an administrative pharmaceutical dataset, and compared them with published CD incidence results. Approach An Australian Pharmaceutical Benefits Scheme (PBS) database covering the period 2003-14 was used for this study. The earliest prescriptions exchanged by individuals for an ATC defined CD were identified and the annual count recorded. These values were combined with Australian population census data to calculate the annual incidence of ATC defined CD. Australian PBS derived incidence estimates (PDI) were compared with published Australian and world incidence data. Results The PDI of 16 chronic diseases were compared with incidence estimates using self-report surveys from the literature. Mean percentage differences between PDI estimates varied greatly when compared to survey data (mean 33% (SD ±79%). Diabetes (-29%), gout (4%), glaucoma (69%) and tuberculosis (14%) showed closer associations. In contrast, PDI estimates (n/1000/year) showed particularly high incidence levels as compared with self-report data for dyspepsia (16.9 v 4.5), dyslipidaemia (11.6 v 5.6) and respiratory illness (17.6 v 2.6). Conclusion Incidence estimates of drug treated chronic disease can be obtained using pharmaceutical data and may be a useful source for a number of conditions. Some PDI differ considerably from survey data. The interpretation of PDI requires context on how a particular CD presents. Accuracy and relevance are likely to depend upon how drug treatments relate to the initial management of the chronic disease.

STANDARDIZATION OF DESCRIPTION OF MEDICAL PRODUCTS

Prerequisites and results of the work carried out by the Scientific Centre for Expert Evaluation of Medicinal Products on the standardization of the values of international non-proprietary, grouping and chemical names of drugs, anatomic-therapeutic-chemical classification, dosage forms, dosage units and other data are presented. The information is reduced to the same unique values in terms of information about identical drugs. This information is required for inclusion in a single directory drugs classifier, created to automate the management of drug purchases and implementation of a system for monitoring the movement of drugs. The work also substantiates the need for further revision and updating of the previously conducted work on the unification of information fields, and the revision of positions that did not previously require processing due to their uniqueness. The prospects for standardization of the description of medicines within the framework of the single market of the countries of the Eurasian Economic Union are outlined.

Drug utilisation trends in a physical rehabilitation hospital

Background/Aim. Drug utilisation monitoring could identify drug-related problems and hence improve the awareness of irrational drug use. The objective of this study was to analyse the drug utilisation patterns in a rehabilitation hospital over the period 2011?2016. Methods. The Anatomic Therapeutic Chemical classification/Defined Daily Dose (ATC/DDD) methodology was used to monitor the drug utilisation expressed as a number of DDD per 100 patient-days (HPD). The values of DDDs were obtained from the World Health Organisation (WHO) Collaborating Centre for Drug Statistics Methodology. Utilisation trends were analysed by means of the Compound Aggregate Growth Rate (CAGR), which is defined as an average annual change rate of some value during the period of interest. Results. The number of patient-days increased during the six years period; the CAGR being1.8% annually. At the same time, the total number of dispensed DDDs as well as the number of DDD/HPD decreased with the CAGR of -2.0% and -3.7% respectively. The average drug cost per patient-day varied from BAM 1.38 in 2013 to 0.95 in 2016; the CAGR being -1.8%. The most utilised drugs belonged to the ATC groups C, A, B, M and N and they contributed to an average of 77% of all drugs used each year. On the top of the list of most utilised drugs were: hydroxocobalamin, thioctic acid, enalapril, diclofenac, amlodipine, acetylsalicylic acid, pantoprazole, paracetamol and bromazepam. Conclusions. The overall drug utilisation in the hospital was modest and almost equal in 2016 compared to 2011. Besides the leading consumption of vitamin B12 and thioctic acid, this study points out some interesting prescribing patterns, such as predominant use of diclofenac over ibuprofen, and overuse of proton pump inhibitors. There is a need for educative interventions among physicians in order to improve their prescribing practice.