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Rational use of antibiotics Polypharmacy

Rational use of antibiotics Polypharmacy Jana Mrak, Jurij Fürst, Boris Kramberger, Nena Bagari Bizjak The National Health Insurance Institute of Slovenia Workshop on best practices for promoting the rational use of medicine Utrecht, 23. – 24.6.2011. Agenda.

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Rational use of antibiotics Polypharmacy

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  1. Rational use of antibiotics Polypharmacy Jana Mrak, Jurij Fürst, Boris Kramberger, Nena Bagari Bizjak The National Health Insurance Institute of Slovenia Workshop on best practices for promoting the rational use of medicine Utrecht, 23. – 24.6.2011

  2. Agenda • Prescription/costs of drugs in Slovenia through the years • Progression in rationalising use of antibiotics • Increasing problem of polypharmacy

  3. Health Insurance in Slovenia – basic data Public system of compulsory health insurance (CHI) in Slovenia: • CHI covers entire population (2 million of inhabitants) • CHI follows basic principles - universal coverage, solidarity, equity, etc. • cost-sharing arrangement (copayments, voluntary insurance for copayments) • Health Insurance Institute of Slovenia (ZZZS) - single provider of CHI • Two large fields of benefits: - health services - cash benefits

  4. Health Insurance in Slovenia – basic data Health Care Expenditures (2010): • All: 3, 242 billion €; 9,0 % GDP; 1.535€ per capita • Public: 2,293 billion €; 6,4 % GDP; 1.109 € per capita (71 %) • Private: 0,949 billion €; 2,6 % GDP; 426 € per capita (29 %) CHI/ZZZS expenditures (2010): • 2,347 billion €; 6,5 % GDP • health care services: 70,6 % • drugs, medical devices, other exp.: 17,3 % • cash benefits: 10,0 % • ZZZS administrative exp.: 2,1 %

  5. Health Insurance in Slovenia – basic data Expenditures for drugs (2010): 1. Prescription drugs: • All prescription expenditures: 469,6 mio € - 229,2 € per capita • CHI/ZZZS expenditures: 312,9 mio € - 147,8 € per capita; 13,3 % of CHI/ZZZS expenditures 2. Drugs in hospitals (2010): • Cca 100 mio €

  6. Reimbursed Rx drugs prescription & expenditure Izdatki Poraba

  7. Prescribing in 2010

  8. Poraba antibiotikov J01 v Evropi (Podatki ESAC)

  9. Prescription of antibiotics in Slovenia

  10. Macrolids: prescription and resistance of S. pneumoniae1995 - 2010 Paragi M, Čižman M, Kastrin T, Mioč M. Infektološki simpozij 2011

  11. Prescription of antibiotics 2001 - 2010

  12. Prescription of antibiotics in children and in adults in 2008 65%

  13. Prescription of antibiotics in children and in adults 2001 in comparison to 2008 - 28% - 18%

  14. No of GPs per antibiotics DDD per standard patient

  15. Actions taken • Joint programme: ZZZS, Department for Medicines and University Clinic for Infectious Diseases • KOL: • Cinical guidelines → promotion with lectures (domestic congresses, roundtables) • Articles in Zdravniški vestnik (professional journal) • ZZZS, Department for medicines: • Bulletin Recept (info about drugs on the market, pricing included, paralels) • Lectures on congresses and round tables with doctors (trends in prescribing antibiotics on national and regional level) • Doctors profiling and systematical work with high prescribers (academical detailing/supervision) • Leaflets for patients (atb not alwas needed)

  16. Quality prescribing – general practitioners information about responsible prescribing Working group RN 26.b: Substantive-methodological group:Nena Bagari Bizjak, Jurij Fürst, Boris Kramberger, Majda Povše, Jana Mrak IT-technical group: Alojzija Čehovin, Peter Ščurk, Andrej Vovk, Dušan Bihar Ljubljana, 19.4.2011

  17. Quality prescribing – con’t • 1200 GPs involved in the project • Eight Indexes of quality prescribing – launched in may 2011: • economical (costs) and • qualitative (frequency of prescribing e.g. antibiotics, polypharmacy) • Standardization for patients age and sex • Relative comparison: • average for each index • scale for all indexes together • Included are reimbursed Rx drugs without very expensive drugs initated by specialists (>2000 €/year per person)

  18. Averagevalueofreceiptswithouthcostlydrugsperinhabitant in age groupsdividedbysex in 2008 € Starostna skupina

  19. Polypharmacy - an increasing problem

  20. No of GPs per patients with more than 10 pharmacological subgroups (ATC 4)

  21. No of GPs per patients with ≥ 5 ≤ 10 pharmacological subgroups (ATC 4)

  22. Facts about Polypharmacy • Doctors seem not to see it as an increasing problem, nor do patients? • Relationship between GPs and specialists: • Which medicines are necessary, which can be left out • Problem of guidelines • Superiority of specialists opinion? • Health insurance policy card has ecripted information about the medicines patient has got in a pharmacy (info that is not used) • Institutions for elderly people • Academic detailing/supervision not effective (lack of knowledge, …??)

  23. Polypharmacy - new approach different from current needed.

  24. Thank you for your attention!

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