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Consumption of drugs in Slovenia Jurij Fürst ZZZS – Dpt. for Drugs

Explore the role of clinical pharmacologists in shaping health insurance policies, reimbursement decisions, and prescribing audits in Slovenia. Learn about drug consumption trends, audits, expenditures data, and the importance of responsible prescribing practices.

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Consumption of drugs in Slovenia Jurij Fürst ZZZS – Dpt. for Drugs

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  1. Consumption of drugs in Slovenia Jurij Fürst ZZZS – Dpt. for Drugs 10th Congress of the European Association for Clinical Pharmacology and Therapeutics 26-29 June 2011

  2. The role of clinical pharmacologist in health insurance • Reimbursement decisions • Audits (examination) of prescribing • Education on rational (responsible) prescribing

  3. Reimbursement • Reimbursement • Reference pricing for interchangeable drugs (and not for therapeutic groups) • Therapeutic value, relative effectiveness • Negotiations (esp. risk-sharing agreements) • Prescribing limitations • For hospitals: reimbursement of expensive drugs (> 5000 €/patient/year) - no budget, only clinical criteria

  4. Prescribing & Dispensing • All dispensed prescriptions available on-line in the whole health-care sector • Repeat dispensing(just started) • No compulsory generic prescribing nor substitution • With co-insurance, there is no co-payment, no participation!

  5. Somehealthcareand drugs expenditures data in 2010

  6. Europe’s health spending per capita, 2008 Source OECD Health Data 2010

  7. Europe’s pharmaceutical spending per capita Source OECD Health Data 2010

  8. Pharmaceutical spending and national income, 2009 Source OECD Health Data 2010

  9. Pharmaceutical (prescriptions) spending and Slovenian national income, 1990 - 2010 Compulsory + add-on insurance Compulsory insurance Source OECD Health Data 2010

  10. Consumption of prescription drugs and expenditures Expenditures Consumption

  11. Share of “expensive” drugs (>2.000 €/patient/year)

  12. Consumption of drugs in DDDs per “consumer” in 2001 - 10 +52 %

  13. Polypharmacy

  14. Hypnotics and sedatives: Share of population in 2009

  15. Anxiolytics: Share of population in 2009

  16. Anxiolytics: Consumption in DDD/TID in 2001-10 - 38 %

  17. Antidepressants: Consumption in DDD/TID in 2001-10 + 300 %

  18. Consumption of antibiotics J01 in Europe (ESAC DATA, 2008)

  19. Consumption of antibiotics J01 in DDD/TID - 30 %

  20. Antibiotics: Regional consumption in DDD/TID in 2001-10

  21. Consumption of antibiotics inchildren and adults in 2001 and 2008 in DID - 28% - 18%

  22. Macrolides: consumption and resistance of S. pneumoniae in 1995 - 2010 Paragi M, Čižman M, Kastrin T, Mioč M. Infektološki simpozij 2011

  23. Education For health care professionals: • Health Insurance is involved in under- and post-graduate curriculum of medicine and pharmacy • Active participationon meetings, congresses • Publications • Health Insurance bulletin “Recept” • Pharmacotherapy groups for general practitioners For public: • Safe use of drugs (flyers etc.)

  24. Audits • Financial-medical audits of: • accounting of medical services • prescribing drugs and medical devices • decisions on sick leaves • accounting of drugs in the pharmacies • 40 medical doctors and 5 pharmacists • Financial penalty (fine) can be imposed

  25. Audits of prescribing drugs • Similar to academic detailing: • Formal aspect: • Evidence in medical file • Medical aspect • Therapeutic indication • Dose • Combinations • Polypharmacy • Patients with most prescriptions (In 2010, the winner received 331 prescriptions)

  26. Results of our activities and despite of them • Decreased consumption of antibiotics and anxiolytics • Significantly increased consumption of most other therapeutic groups with polypharmacy, esp. in the elderly • Good experiences with pharmacotherapy groups • The audits focus mostly on the formal aspect, not enough knowledge for a medical one! • There is a need for more clinical pharmacologists, more activities and new approaches!

  27. Project: Responsible (rational) prescribing – prescribing indicators Indicators: • Expenditures index according to structure (age and sex) of population • Average price of DDD • DDD per standardized person • DDD per person: • Antibiotics • Anxiolytics • PPIs • No. of persons with 5 – 10 INN • No. of persons with > 10 INN

  28. Indicator: Prescribing of antibiotics No. of DDD’s per patient

  29. Indicator: Patient with ≥ 5 < 10 drugs

  30. Conclusions To improve the quality of prescribing, there is urgent need for: • More knowledge of clinical pharmacology among decision makers and auditors at the Health insurance and among prescribers, • Continuous education (pharmacotherapy groups), • More high-quality feed-back information, • We should focus mostly on polypharmacy at the elderly.

  31. Thank you for your attention!

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