[Monitoring utilization of hypolipemic agents using an insurance company database]. / Sledování spotreby hypolipidemik pomocí databáze pojistovny.

Databases of health insurance companies can provide information on the motion of a drug in the society. The present paper examines several databases of health insurance companies and analyzes the development of the consumption of hypolipidemic agents in 1994 through 1998. So-called evaluation databases making it impossible to identify a particular patient and the prescribing physician were prepared for the evaluation. They were obtained from the VZP central health insurance office, VZP district health insurance offices in Hradec Králové and Kladno, and the Zamestnanecká pojistovna Skoda (Employees Health Insurance Company Skoda). It was not necessary to blind the data in the first cohort, in the second one it was carried out by shortening the identification numbers, and in others by introducing artificial identification codes. The consumption was expressed in DDD and in the relative representation in the group. The consumption of the principal groups of hypolipidemic agents (fibrates, statins, sequestrants of bile acids, and derivatives of nicotinic acid) and the individual medicinal substances was evaluated. Relative values of consumption were obtained by calculation to the magnitude of the denominator--the number of the insured, or the number of patients to whom a hypolipidemic agent was prescribed. The consumption was on the increase in all three databases, in four years increasing from approx. 0.4-4DDD/1000 of the insured/day to 16-24DDD/1000 of the insured/day. At the beginning, the main share in the consumption of hypolipidemic agents was represented by fibrates, approx. 90%, but in four years this share decreased to only 60%, whereas in the period under study the share of statins increased up to 30%. Databases of health insurance companies do not significantly differ in the consumption of hypolipidemic agents, which may give evidence of their validity. In the course of the study, an increase in the consumption of hypolipidemic agents, primarily statins, was found. The shift in the consumption of statins corresponds with the available information about the evidence of their therapeutic effectiveness. The average consumption per one patient does not reach 1DDD, which is a signal that probably very few patients receive long-term treatment and that new patients emerge during the year.

[Evaluation of drug utilization from positive lists]. / Hodnocení spotreby léku pri zavádení pozitivních listu.

BACKGROUND: The introduction of positive drug lists (positive lists) is part of the regulating mechanisms which try to reduce the increasing expenditure on drugs. An essential part of these provisions is at present an analysis of the trend of drug consumption. The objective of the work was to introduce and evaluate the method DU 90% which in analyses of drug consumption uses a 90% ratio of preparations of their total consumption. METHODS AND RESULTS: The analysis was focused on prescriptions in medical clinics of the General Faculty Hospital Classification of drugs according to anatomical, therapeutic and chemical groups and the use of defined daily doses made it possible to calculate DU 90% and to prepare a consecutive list of drugs according to costs in different departments. The number of drugs with a defined daily dose was within the range of 280-316. In the interval DU 90% were 116-142 drugs. In all departments there was a practically identical ratio of drugs which were part of the positive list. The greatest expenditure were anti-infectious drugs for systemic use and drugs with an effect an blood and haematopoietic organs. CONCLUSIONS: The advantages of the method DU 90% is its easy application, low cost and possibility to identify controversial lields. This facilitates further qualitative and quantitative evaluation of the standard of pharmacotherapy.

Comparison of drug utilization of most commonly used drugs in Poland and Czech Republic.

Utilization of drugs from the following groups: antibacterial, cardiovascular, gastrointestinal and respiratory tract diseases in Poland and Czech Republic was analyzed. The most commonly sold drugs were among antibacterial drugs, viz., doxycycline (4.5DDD/1000 inh./day in Poland; 3.3 in Czech Republic), co-trimoxazole (Poland-2.9; Czech Republic 2.5), ampicilline and amoxicilline; among gastrointestinal drugs, ascorbic acid (Poland 42.2; Czech Republic 59.3), among respiratory drugs, sodium cromoglicate in Poland and bromhexine in Czech Republic, and among cardiovascular drugs, enalapril in Poland and diuretics with potasium sparing drug in Czech Republic. In general, the leading drugs in Poland and Czech Republic, were the same. All drugs with highest utilization were on the Essential Drug List. Some differences in drug utilization between these two countries could result from the prevalence of particular diseases in each population and physician's prescribing patterns.

Changes in the use of antibacterial drugs in the countries of central and eastern Europe.

Use of systemic antibacterial drugs in the countries of central and eastern Europe (CCEE) has been studied using the defined daily doses (DDD) methodology. For the comparison, national wholesale data from Bulgaria, the Czech Republic, Estonia, Hungary, Lithuania, Slovakia, Slovenia and Romania for the years 1989 and 1992 were used, i.e. for the years before and after the rapid sociopolitical changes in these countries. Substantial differences in the patterns of antibacterial drug use between countries as geographically and economically similar as the CCEE were observed. The general sales of antibiotics varied almost twofold among the CCEE and had decreased in most of the CCEE during the study period. The proportion of tetracyclines in the sales of 1992 ranged from 10% in Slovenia to 49% in Estonia, and that of broad-spectrum penicillins from 6% in Estonia to 40% in Slovenia. The use of narrow-spectrum penicillins varied within the range of 4% in Bulgaria to 38% in Slovakia, and had decreased during the study years in all countries. Aminoglycosides accounted for 5-12% of all antibacterials in Bulgaria, Estonia, Lithuania, Romania and Slovakia in the study period, and these countries, with the exception of Slovakia, also had a high consumption of chloramphenicol. In 1992, by far the most popular antiinfectives in the CCEE were doxycycline, ampicillin and co-trimoxazole, which ranked among the top ten drugs in all countries studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of drug administration in pregnancy on children's school behaviour.

Files with prescription data were used to assess possible behavioural changes in children, whose mothers used benzodiazepines or neuroleptic drugs during the second half of their pregnancy. Prescriptions, bearing the identification number of women resident in one district of Prague, filed in pharmacies during 1974 and the first three months of 1975 represent the first part of the data. During 1984, children born in the appropriate earlier period were searched and linked with the earlier prescription data. A group of 68 children with possible exposure to neuroleptics and a group of 15 children possibly exposed to diazepam during the second half of their intrauterine development were found. Two groups of 55 and 7 children, respectively, born of mothers without exposure to these drugs, were chosen as controls. The teachers of classes attended by these children were addressed by a letter and asked to evaluate their behaviour at school. This was done by means of a form containing analogue scales evaluating different features of behaviour. Each child was compared with its control. The statistical evaluation with Student's t-test, regression analysis and analysis of variance did not reveal any significant difference between both groups and their controls.

[The effect of MONIKA on the utilization of cardiovascular drugs in districts where the system is used]. / Ovlivnení spotreby kardiovaskulárních léciv v okresech, kde probíhá MONIKA.

In six districts of the Czech Republic where the MONICA programme is implemented as well as Hypertension control of the population, the authors compared the drug consumption used in the treatment of hypertension in comparable DDD/1000/D units during the period from September 1984 to August 1985 and the corresponding period two years later. For this purpose four groups were selected according to the ATC classification: diuretics, hypotensive drugs (antihypertensive drugs in the narrower sense of the word), single-component betablockers and fixed combinations of beta-blockers with hypotensive drugs. Six districts selected to match the investigated ones were selected as controls, and the drug consumption was also investigated. The results for the group of diuretics, hypotensive drugs and single component beta-blockers revealed unequivocally a greater increase of consumption in the districts included in the MONICA survey than in the control districts. Only the group of beta-blockers combined with hypotensive drugs revealed a greater increase of consumption in the control districts. The districts with the highest drug consumption in the investigated drug groups is according to other surveys the only one in the country where in recent years a decline of cardiovascular mortality, in particular cerebrovascular mortality, was recorded.

[Prognosis for requirements for oral antidiabetic agents in Bohemia]. / Prognóza potreby perorálních antidiabetik v CSR.

The authors elaborated the prognosis of requirements of oral antidiabetics (PAD) in the CSR, based on the estimate of the number of diabetics, using the method of demographic projection and the estimate of the number of diabetics treated by this therapy. The respective numbers of diabetics are circulated for five-year age-groups, separately for men and women. The need of PAD is derived from the mean daily dose per diabetic patient treated with PAD, separately for biguanides and derivatives of sulphonyl urea. The prognosis respects the basic factors which influence the need of PAD, i.e. the development of the diabetic population, incl. the evolution of its structure, and the development of the attitude to PAD therapy. The application of various assumptions on the future development leads various to variants of the prognosis. Comparison with the actual development is important for evaluation of applied therapeutic methods and for planning purposes. The results of the prognosis indicate that in 1995 the need of PAD in the CSR will vary between 140 and 190% of the consumption in 1980, however, as a result of an uneven development the annual increment could be as high as 19% or there could be a slight drop.

Contribution of clinical pharmacology to a rational use of cardiac glycosides in Czechoslovakia.

In Czechoslovakia, drug utilization studies showed that oral forms of digoxin and lanatoside C are traditionally the most prescribed cardiac glycosides. Our study of the relative bioavailability of the oral form of lanatoside C revealed that the drug has a low and irregular bioavailability making use of this frequently prescribed drug non-rational. The above data definitely contributed to a sharp decrease in the use of the oral form of lanatoside C in our country, which is in agreement with consumption trends in other European countries. However, the use of only drug forms with a good bioavailability is one aspect of new approaches applied in pharmacotherapy with cardiac glycosides resulting in gradual decrease of their consumption as a pharmacological group. Clinical pharmacological evaluation of individual drug forms and postgraduate education in clinical pharmacology of cardiac glycosides contribute significantly--apart from other regulatory measures--to a more rational use of cardiac glycosides in Czechoslovakia.

[What the data on utilization of antiepileptic agents reveals]. / Co nám mohou prozradit údaje o spotrebe antiepileptik.

Using the method of expressing the consumption of anti-epileptic drugs by the number of defined daily doses per 1000 population per day (DDD/1000/d), data covering the three-year period from September 1984 to August 1987 in districts of the Czech Socialist Republic are presented in tables. The mean and liminal values are given for anti-epileptics as a whole and mean values of the phenytoin consumption in region, incl. liminal values of the percentage ratio of Sanepil (phenytoin 80 mg, phenobarbital 18.5 mg) in districts of different regions of the CSR. On the enclosed map for the first annual period districts where this ratio was 25%, 50%, 75% or more (only in the South Moravian region) are hatched. In the subsequent tables are districts with greater changes of this indicator than +5% and -10% in the course of the three years of the investigation. The greatest drop was recorded in the district where there was a new leading neurologist who came from the area of another medical school to the South Moravian region. The authors discuss the influence of the medical school and present results of an enquiry by means of questionnaires among neurologists regarding the place of medical studies of neurologists in the region and views on the advantage of Sanepil, as compared with pure phenytoin.

[Prognosis for insulin requirements in Czechoslovakia]. / Prognóza potreby inzulínu v CSR.

The submitted prognosis of insulin requirements in the CSR is based on the estimated number of type 1 diabetics and the estimated number of insulin treated type 2 diabetics. For the purpose of the prognosis these numbers are calculated for five-year age groups, separately for men and women. In the first approximation the authors assume that in the treatment of type 1 diabetics four typical therapeutic regimes are used which are consistent with conventional therapy and its intensified modification. In type 2 diabetics in the first approximation it is assumed that another four variants of therapeutic regimes will be mostly used which are typical for these patients. The sum of daily doses needed by all patients gives an estimate of the total requirements of the four basic types of insulin. This prognosis respects the basic factors which influence insulin requirements, whereby the basis is the development of the health status of the population. Comparison of different variants of the prognosis of requirements with the actual consumption makes it possible to formulate some conclusions for planning production and for evaluating the used and perspectively foreseen insulin therapy. From the results of the prognosis ensues that in 1995 the insulin consumption in the CSR will vary between 150 and 185% of the consumption in 1980.

[Utilization of cardiac glycosides in Czechoslovakia--does it correspond to need?]. / Spotreba srdecních glykozidu v CSSR--odpovídá potrebe?

The data are given on the consumption of cardiac glycosides (CD) in the CSSR over the past 18 years (1970-1987). Consumption expressed in terms of defined daily doses (DDD) permitted to construct time series of the consumption of this group of pharmacotherapeutic agents as a whole as well as individual CG and to compare the data thus obtained with similar data from abroad. The results indicate that the consumption of CG as a whole culminated in Czechoslovakia in 1983 (27.6 DDD per a population of 1000 per day = 27.6 DDD/1000/d) and that there has been a slow decline ever since. Compared with foreign data, Czechoslovakia's quantitative consumption of CG is roughly between countries noted for traditionally high consumption (GDR 84.8 DDD/1000/d) and those with low consumption (Scandinavian countries with the exception of Sweden, about 10 DDD/1000/d). Unlike Czechoslovakia, however, all other countries with well established CG consumption have been exhibiting a relatively steep and lasting decline in CG consumption since the late 1970s. This reduction reflects modern trends of CG pharmacotherapy, especially stricted consideration of the uses as distinct from the risks of CG administration, as well as some of the recent efforts to terminate long-term CG treatment particularly in vaguely indicated cases. As for individual CG consumption, Czechoslovakia, similarly as other countries, has been favouring more rational prescription of oral digoxin at the expense of the oral form of lanatoside C, while parenteral digoxin has for all practical purposes become a substitute for strophantin.(ABSTRACT TRUNCATED AT 250 WORDS)