Ambulantno predpisovanje zdravil za obstruktivne pljučne bolezni v Sloveniji v letu 2008 : diplomska naloga

Gombač, Marinka (author), Kos, Mitja (mentor)

Najbolj razširjeni obstruktivni bolezni pljuč sta astma in kronična obstruktivna pljučna bolezen (KOPB). Ocenjena prevalenca astme pri otrocih v Sloveniji je 5-10 %, pri odraslih v starostnem obdobju 18-65 let pa 16 %. KOPB ima že 10 % ljudi, starejših od 40 let, pri čemer s starostjo delež bolnikov narašča. Pomemben vzrok obstrukcije dihanja je zožitev dihalnih poti kot posledica vnetne reakcije. Poglavitna učinka zdravil za obstruktivne pljučne bolezni sta tako zaviranje vnetja v dihalih in bronhodilatatorno delovanje. Namen raziskave je bil analizirati in ovrednotiti predpisovanje teh zdravil v Sloveniji z željo boljšega obvladovanja bolezni. To smo storili na podlagi zbirke vseh ambulantno predpisanih receptov v letu 2008. Preučevali smo njihove količinske parametre, značilnosti bolnikov, sestavo izdaj in ustreznost predpisovanja. Sintaktični postopki, ki smo jih razvili v programu SPSS in so zapisani v Prilogi, so prenosljivi na novejše zbirke podatkov. V letu 2008 je bilo v Sloveniji izdanih 439.987 receptov z zdravili iz anatomsko-terapevtsko-kemične (ATC) skupine R03 (zdravila za obstruktivne pljučne bolezni), to je 217 receptov na 1.000 prebivalcev. S starostjo bolnikov je upadal delež receptov s salbutamolom, s flutikazonom in z montelukastom, naraščal pa je delež receptov z dolgodelujočimi beta-2 agonisti (DDBA), s kombinacijo fenoterola in ipratropijevega bromida, s kombinacijo DDBA in inhalacijskih glukokortikoidov (IGK), s tiotropijevim bromidom in s teofilinom. Največ receptov je bilo izdanih v zimskih in spomladanskih mesecih. Naredili smo primerjavo z nordijskimi državami; poraba zdravil, merjena v številu definiranih dnevnih odmerkov (DDD) na 1.000 prebivalcev na dan, je bila pri nas manjša, to pa predvsem zaradi manjše porabe inhalacijskih adrenergikov v primerih, ko so bili edine učinkovine v zdravilu. Stroški v breme obveznega zdravstvenega zavarovanja (OZZ) so znašali 17.056.865,02 €, od tega največ za zdravila s kombinacijo DDBA in IGK (7.248.674,37 €). Iz sredstev OZZ so bila v celoti najpogosteje krita zdravila z IGK (v 39,9 %). Izdaje z le olajševalci s temeljnim bronhodilatatornim delovanjem so predstavljale 42,7 % izdaj, izdaje z le preprečevalci s temeljnim protivnetnim delovanjem 22,8 % izdaj, izdaje z olajševalci in preprečevalci hkrati 34,5 % izdaj. Najpogosteje izdana zdravilna učinkovina v monoterapiji je bil olajševalec salbutamol, kombinacija olajševalcev fenoterola in ipratropijevega bromida pa je bila najpogosteje izdana kombinacija dveh zdravilnih učinkovin. Zdravila je prejelo 122.571 bolnikov, med mlajšimi več dečkov in med starejšimi več žensk. Med bolnimi je bilo največ otrok, starih od enega do treh let. Največ bolnikov je bilo v Notranjsko-kraški in Pomurski statistični regiji. Otrokom, starim 5 let in manj, so bili DDBA izdani le 52-krat. Ocenjujemo, da je bilo tudi predpisovanje kombinacije DDBA in IGK otrokom, starim 15 let in manj, v sprejemljivih okvirih. Bolnikom, starim 30 let in manj, ki smo jih opredelili kot astmatično populacijo, so bili v 97 % izdaj DDBA ti izdani skupaj z IGK. Med izdajami DDBA in IGK je bilo 99,3 % izdaj takšnih, da do neustrezne monoterapije z DDBA ni moglo priti.

• Language: Slovenian
• Keywords: zdravilne učinkovine analiza bolnikov analiza receptov analiza zdravil vrednotenje predpisovanja značilnosti bolnikov
• Work type: Undergraduate thesis
• Typology: 2.11 - Undergraduate Thesis
• Organization: FFA - Faculty of Pharmacy
• Place of publishing: Ljubljana
• Publisher: [M. Gombač]
• Year: 2015
• Number of pages: 65 f., I-XXXVIII
• PID: 20.500.12556/RUL-81297
• UDC: 616.248+616.24-007.272(043.2)
• COBISS.SI-ID: 3830385
• Publication date in RUL: 11.04.2016

Secondary language

• Language: English
• Title: Prescriptions at the ambulatory level for obstructive lung diseases in Slovenia in 2008

Abstract

The most common obstructive lung diseases are asthma and COPD. The estimated prevalence of asthma in Slovenia is 5-10 % in children and 16 % in adults aged 18-65 years. There are already 10 % of people older than 40 years with COPD, while the proportion of patients increases with age. An important cause of respiratory obstruction is airway constriction as a result of inflammatory reactions. Therefore the main effects of the active substances for obstructive lung diseases are inhibition of inflammation in the respiratory tract and bronchodilatory action. The aim of this study was to analyze and evaluate the prescribtion of these drugs in Slovenia for a better disease control. The collection of all the prescriptions at the ambulatory level in 2008 was used for this evaluation. Syntax procedures that have been developed in the program SPSS and are described in the Appendix are transferable to the newer database. There were 439.987 prescription drugs from ATC group R03 issued in Slovenia in 2008, that is 217 prescriptions per 1.000 inhabitants. The part of recipes with salbutamol, fluticasone and montelucast desreased with age, while the part of recipes with LABA, combination of fenoterol and ipratropium bromide, combination of LABA and ICS, tiotropium bromide and theophylline increased. Most prescriptions were dispensed in the winter and spring months. We compared our results with the Nordic countries; consumption of drugs, measured in DDD number per 1.000 inhabitants per day was lower for us, mainly due to lower consumption of inhaled adrenergics as the sole active ingredient in the product. Costs charged to OZZ amounted to 17.056.865,02 €, from which most of the funds were used for drugs with a combination of LABA and ICS (7.248.674,37 €). From all the drugs OZZ most often fully covered drugs with ICS (in 39,9 %). Dispenses with healers with mainly bronchodilatation action alone represented 42.7 % of all dispenses, dispenses with controllers with mainly anti-inflammatory action alone represented 22.8 % of all dispenses and dispenses with both healers and controllers represented 34.5 % of all dispenses. The most common active substance in monotherapy was healer salbutamol and the most common dispense of two active substances was the combination of healers fenoterol and ipratropium bromide. 122.571 patients received drugs, of which there were more boys among the young and more women among the old. The most numerous group were 1-3 years old children. Most patients were from Notranjsko-kraška and Pomurska statistical region. LABA were issued only 52 times to children aged 5 years and below. We estimate that also the prescription of combination of LABA and ICS to children aged 15 and below was within acceptable limits. To patients aged 30 years and below and defined as the asthmatic population 97 % of LABA were issued together with ICS. Among the issues of LABA and ICS there were 99.3 % issues with no chance of inappropriate monotherapy with LABA.

• Keywords: asthma COPD medication use evaluation of prescribing patient characteristics