BackgroundDrug costs increasingly pose a burden upon the otherwise inadequate health care resources and rational drug utilization is an important segment of every national health policy. Optimal patient care should be the goal of rational pharmacotherapy, whereby the economic burden of treatment is just one of the elements to be considered on choosing appropriate therapy.The aim of this study was to determine distribution and trends in the outpatient utilization of generic versus brand name psychopharmaceuticals and to evaluate the rationality of prescribing psychopharmaceuticals during a ten-year period.MethodsUsing the World Health Organization Anatomical-Therapeutic-Chemical classification/Defined Daily Doses (ATC/DDD) methodology, the number of DDD was calculated from data collected from pharmacies on the number and size of drug packages. The ratio of generic and brand name drug costs served as an indicator on assessing the rationality of drug utilization.ResultsTotal cost for psychopharmaceuticals increased by 20.1%, more for brand name than for generic agents (32.7% vs. 7.4%). The highest share of generic psychopharmaceuticals as compared with brand name drugs according to DDD per 1000 inhabitants per day (DDD/1000/day) was in the group of psycholeptics (83.6% in 2001 vs. 82.2% in 2010), most in hypnotics and sedatives, and least in antipsychotics. The share of generic psychopharmaceuticals in total drug utilization according to financial indicators decreased by 9.6% and according to DDD/1000/day by 12%. The greatest decrease was in antidepressants, i.e. by 33.8% according to financial indicators and by 46% according to DDD/1000/day; and in antipsychotics by 30.9% according to DDD/1000/day, while showing an increase by 8.5% according to financial indicators. In the therapeutic subgroup of mood stabilizers, the share of generic drugs in total drug utilization declined by 32% according to DDD/1000/day, but increased by 25.1% according to financial indicators.ConclusionsThe lack of uniform national guidelines and the still strong impact of pharmaceutical industry marketing continue favoring the rise in prescribing brand name antidepressants and antipsychotics. Depression, schizophrenia and bipolar diseases are complex diseases. As a result, specific measures are needed to encourage the prescribing of generic psychopharmaceuticals.
Issue/problem Mental disorders account for the largest and fastest growing categories of the burden of disease in Croatia. Around 30% of the population has experienced some form of mental illness in the past year. 32% of them had more than one mental health problem. 50% of mental disorders arise by the age of 14. School medical doctors in Croatia are in the position to do early recognition of mental disorders during regular check-ups of school children. It is very important that the health care system helps people to be aware of early signs of mental health problems and enable people to get the timely treatment. According to those facts, Croatian Institute of Public Health starts the preparation for implementing screening for mental health risks of school children. The screening will be implemented by the school medical teams for all students as part of regular yearly check-ups in the 5th and 8th grade of elementary school and 1st grade of secondary school. The screening will be carried out using the YP-CORE questionnaire, which measures the degree of general mental distress. Students at increased risk will be referred to Mental Health Departments in County Public Health Institutes. Mental Health Department’s team of experts, which includes psychiatrist, nurse and psychologist, will carry out further diagnostic and treatment. Education of school staff, which includes teachers, school psychologists, special educators, social workers, nurses who are in direct contact with the children will also take place. Parents also should be educated on early recognition of mental disorders and should be recognized as partners in diagnostics and therapy throughout the child’s life. Lessons Early recognition of mental disorders leads to a reduction of psychological distress and increased feelings of control over one’s health. Key messages Early recognition of mental disorders leads to a reduction of psychological distress and increased feelings of control over one’s health. School staff and parents should be partners in earliy recognition and treatment of mental disorders of school childrens.
Irrational prescribing and preference to more expensive drugs have been reported in Zagreb. Therefore, the risk of resistance of microorganisms to beta-lactamase antibiotics, macrolides and quinolones could be expected. Prescribing patterns should be changed by introducing national guidelines on rational antibiotic prescribing, monitoring and evaluation of their implementation. Additional continuing education of physicians and pharmacists from independent sources should be organized and proper education should be provided to patients.
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