Antibiotics and the quality indicators for outpatient antibiotic use in Slovakia.

The aims of this study was to compare the data on the consumption of antibiotics in the outpatient care sector for Slovakia from 2019 to 2020 and to calculate quality indicators for outpatient antibiotic use. The data source on the consumption of antibiotics (ATC group J01), is the sales data from the NCZI. The main indicator describing the consumption of antibacterials for systemic use is the number of DDDs per 1000 inhabitants per day (DID). The data released by the European Centre for Disease Protection were used as the source for antibiotic consumption for 2019. The most frequently consumed antibacterials for systemic use in the outpatient care sector in 2020 were other beta-lactam antibacterials (J01D); macrolides, lincosamides and streptogramins (J01); and betalactam antibacterials, penicillins (J01C), with the levels of 3.30 DID, 3.30 DID and 3.27 DID, respectively. Consumption levels of 1.66 DID for tetracyclines (J01A), 1.14 DID for quinolone antibacterials (J01M), 0.41 DID for sulfonamides and trimethoprim (J01E), 0.07 DID for other antibacterials (J01X), and 0.01 DID for other antibiotics (J01B, J01G and J01R combined) can be seen. Overall, antibiotic consumption in the outpatient care sector did significantly change in Slovakia from 2019 to 2020 as a result of the COVID-19 pandemic.

Application of inhaled drugs from the pharmacists point of view.

The basis of asthma and chronic obstructive pulmonary disease (COPD) treatment is inhalation therapy, which brings several benefits and its success is based on the correct inhalation technique. AIM: The primary aim of the research was to find out what percentage of patients could apply their medicines properly, what inhalation systems were preferred in the treatment of these respiratory diseases, what most common mistakes in the inhalation technique patients made when using inhalers as well as what was patients approach to the possibility of being educated by a community pharmacist. METHODS: Essential data to accomplish the goal were obtained by a questionnaire survey in which 102 respondents (patients) participated. The anonymous questionnaire consisted of 18 questions focusing on the inhalation systems that patients use and particular steps that need to be taken when inhaling the medicine. RESULTS: 83.33 % of patients with bronchial asthma and 9.8 % of patients with chronic obstructive lung disease (COPD) participated in the study. “Inhaler” was the most prescribed out of all the other kinds of inhalators, used by 54.9 % of respondents. It turned out that up to 63 % of the respondents using MDIs or DPIs had encounetered some kind of error when inhaling their drugs. The most common mistake with both types of inhalation systems was not holding their breath for sufficient time (5 to 10 seconds) after inhaling from the inhaler. Dry-powder inhalers (DPIs) proved to be used more erroneously compared to aerosol dispensers (MDIs). CONCLUSION: The obtained results showed that errors in the inhalation technique seem yet to be a hot issue for more than half of patients with respiratory diseases. Pharmacists have a great potential to improve the situation by giving pieces of advice and instructions regarding the proper application of medicines to help patients to enhance the performance of inhalation and thus increase the treatment efficiency.

Evaluation of adherence to treatment in patients suffering from diabetes mellitus.

BACKGROUND: Diabetes mellitus type 2 (DM) is a disease which is becoming pandemic these days. A successful treatment of chronic diabetes mellitus depends on early diagnosis and proper treatment. Just as the role of the doctor in treating the disease is important, so the community pharmacist plays an important role in taking the initiative in motivating patients to adhere to individual treatment regimes. OBJECTIVE: The main aim of the study was to analyze and assess patient adherence to pharmacological or non-pharmacological treatment, including the influence of the community pharmacist on that. METHOD: All necessary data for the assessment were collected by anonymous questionnaire survey methods conducted within 7 months, as well as by personal consulting among pharmacists and patients. The results were assessed according to patients gender and age. RESULTS: 117 respondents got involved in the survey, with 67 (57%) females and 50 (43%) males. The majority were aged 60-74 (48%), 84% suffered from diabetes mellitus type 2. Adherence to non-pharmacological treatment (regime and dietary measures) was 96% in females and 76% in males according to gender, and over 80% in each age category. Adherence to pharmacological treatment was up to 83% in females and 79% in males. According to age, over 70% adhered to pharmacological treatment all the time in each age category (except for 75+), with up to 88% aged 60-74. CONCLUSION: According to the outcomes, we can observe that in our selected sample of patients the majority followed pharmacological or non-pharmacological treatment. The pharmacist also plays an important role in improving adherence to treatment. By providing patients with their expertise and professional knowledge while drug dispensing or individual conselling, the pharmacist can motivate the patient to follow not only pharmacological but also non-pharmacological treatment and thereby increase patient adherence itself to treatment.

INTRODUCTION OF HEALTH TECHNOLOGY ASSESSMENT FOR MEDICINES IN SLOVAKIA.

OBJECTIVES: The aim of our study was to describe approaches to health technology assessment (HTA) for medicines in the Slovak healthcare system and the related decision-making processes concerning reimbursement for medicines. METHODS: Analysis of the Slovak legislative framework related to HTA and the reimbursement process for medicines was performed. Additionally, current practices of the Working Group for Pharmacoeconomics, Clinical Outcomes and Health Technology Assessment of the Slovak Ministry of Health were evaluated. RESULTS: In Slovakia, there is always at least one treatment available in each determined therapeutic class with no co-payment. HTA is becoming an established method for the evaluation of cost-effectiveness of medicines in Slovak healthcare policy. The majority of decision makers within Slovakia support the idea of increased use of and the quality and efficiency of HTA methods. However, it is crucial to overcome several practical barriers to facilitate progress in the field of HTA in the Slovak Republic. CONCLUSIONS: It can be seen that participation within the European Network for Health Technology Assessment (EUnetHTA JA 2 and EUnetHTA JA 3 projects) has significantly improved the quality of the process of HTA in Slovakia. Further legislative activities in this field are required due to the approved strategy for European Union cooperation on HTA.

[The quality of life of patients suffering from the osteoporosis]. / Kvalita zivota pacientov trpiacich osteoporózou.

Osteoporosis (OP) is a systemic skeletal disease characterized by an imbalance of bone remodelling process due to the prevalence of osteoresorption over osteosynthesis. As a result of these changes, the decrease in bone mass and density occur followed by an increase in fracture risk1). Its clinical manifestation is initially asymptomatic but in the course of time it is quite the contrary - really severe (bone pain, movement disorders, fractures) with a lot of further adverse consequences, including death2). The presented study deals with the impact of osteoporosis and its consequences on the quality of life of patients. The research is focused on patients diagnosed with or treated for osteoporosis that is to say by non-uniform etiology. By questioning of the sample of 128 patients evaluating various dimensions of the patients quality of life (physical condition, mental state, and social status, overall satisfaction with life and health state) and tracking patients satisfaction with the therapy as well. By analysing the results, we found that osteoporosis affects the quality of life, especially physical state of health because up to 31.25% of patients say that they have suffered from every days backaches. It affects social life in the member of 7.81% patients, and 28.13% patients say that biggest problem with osteoporosis is the loss of free movement and possible fracture.Key words: osteoporosis quality of life pharmacotherapy questionnaire survey fractures.

[Identifying and solving drug-related problems in terms of the community pharmacist]. / Identifikácia a riesenie farmakoterapeutických problémov z pohladu verejného lekárnika.

The issue of drug related problems (DRPs) has been known and dealt with in many studies for a long time. It is primarily due to the fact that drug-related problems have the potential to increase patients morbidity and mortality in particular. The issue of identifying and solving drug-related problems in the area of pharmacotherapy by community pharmacists in the Slovak Republic, unlike in other European countries such as the Netherlands and the United Kingdom, is still at the beginning and gradually developing. The aim of the survey was to obtain information from pharmacy practice concerning the current state and possible solutions of potential risks of medicines in the form of drug-related problems of patients from community pharmacists point of view as well as to find out the role and status of community pharmacists in identifying and solving drug-related problems. A questionnaire survey using a sample of 237 respondents, its statistical processing and evaluation revealed the drug-related problems frequency met at their patients (the most common types of DRPs, their causes and subsequent intervention), as well as the opinions of community pharmacists on their current possibilities of (legislative, material, personnel, time) solving and risk-rating therapies for patients.

Reinitiation and Subsequent Discontinuation of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among New and Prevalent Users Aged 65 Years or More with Peripheral Arterial Disease.

Angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs) are recommended in the treatment of arterial hypertension in patients with peripheral arterial disease (PAD). The aims of our study were: (a) to analyse the extent of reinitiation and subsequent discontinuation in older hypertensive PAD patients non-persistent with ACEIs/ARBs; (b) to determine patient and medication factors associated with reinitiation and subsequent discontinuation; and (c) to compare these factors between prevalent and new users. The analysis of reinitiation was performed on a sample of 1642 non-persistent patients aged ≥65 years with PAD newly diagnosed in 2012. Patients reinitiating ACEIs/ARBs were used for the analysis of subsequent discontinuation identified according to the treatment gap period of at least 6 months without any prescription of ACEI/ARB. In the group of non-persistent patients, 875 (53.3%) patients reinitiated ACEIs/ARBs during a follow-up (24.8 months on average). Within this group, subsequent discontinuation was identified in 414 (47.3%) patients. Being a new user was associated with subsequent discontinuation, but not with reinitiation. Myocardial infarction during non-persistence and after reinitiation was associated with reinitiation and lower likelihood of subsequent discontinuation, respectively. Being a prevalent or a new user is associated with the use of medication also after initial discontinuation.

Monitoring of effectiveness of some preventive measures against influenza.

In our study we dealt with the frequently occurring influenza virus that infects humans regardless of age or sex. The flu is not of importance only in health problems but also in the economic ones, such as the treatment costs and patients' ability to work. We focused particularly on the most effective preventive measure against the virus, which is vaccination and the risk groups that are the most vulnerable ones to the virus. One of the objectives of this research was to identify the advantages and disadvantages of vaccination against influenza and available risks of vaccination within a group of 390 patients. We studied a group of 195 vaccinated patients and we tried to determine the effect of the vaccines used in these patients, and to compare this group with the same number of unvaccinated patients. The goal of the research was to identify the advantages and disadvantages of the vaccination against influenza, and the potential risks resulting from the vaccination. Based on our results, we found out that out of 195 vaccinated patients, only 4% returned to the doctor with the flu. Unvaccinated patients, however, visited the doctor four times more frequently, regardless of age. The resulting morbidity ratios clearly showed the importance, effectiveness and safety of the vaccination not only in high-risk groups, but also in people that are "out-of-danger", because the current flu virus spreads by droplet infection very quickly. Appropriate education and increased awareness among the population in Slovakia could improve the general attitude towards the vaccination against influenza and the vaccination rate (Slovakia 12%) could raise to a percentage comparable to that of the EU countries (France 30%, England 32%, the Netherlands 28% and Germany 26%).

Gender Differences in Non-Persistence with Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers among Older Hypertensive Patients with Peripheral Arterial Disease.

The beneficial effects of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in hypertensive patients with peripheral arterial disease (PAD) depends on long-term persistence. The aims of our study were to analyse gender differences in non-persistence with ACEIs/ARBs, and to identify the characteristics associated with the likelihood of non-persistence. Our study cohort included 7080 hypertensive patients (4005 women and 3075 men) aged ≥65 years, treated with ACEIs/ARBs, in whom PAD was diagnosed between 1 January and 31 December 2012. Non-persistence was identified according to a treatment gap of 6 months without ACEI/ARB prescriptions. The characteristics associated with non-persistence were identified using the Cox regression model. At the end of the 5-year follow-up, 23.2% of the whole study cohort, 22.3% of men, and 23.9% of women were non-persistent with ACEIs/ARBs, with no significant gender differences in persistence. While a number of characteristics were associated with non-persistence, only three characteristics had consistent, statistically significant associations in both genders: being a new ACEI/ARB user increased the likelihood of non-persistence, and general practitioner as index prescriber and increasing the overall number of medications decreased the likelihood of non-persistence. Information on the differences in characteristics that are associated with non-persistence between genders may help to better identify patients for whom special attention should be paid to improve their persistence.

The Impact of Reimbursement Practices on the Pharmaceutical Market for Off-Patent Medicines in Slovakia.

Background: The aim of this study was to investigate the impact of selected legislative initiatives and their implementation for off-patent medicinal products in Slovakia compared with the rest of the Visegrád Group (V4 countries). Methods: We analyzed the development of applications for the reimbursement of generic and biosimilar drugs. Particular emphasis was placed on a) the availability and penetration of biosimilars from 2006 to 2020 in Slovakia, b) a comparative analysis of biosimilars in V4 countries based on the national reimbursement lists of medicinal products for August 2021. Data relating to the sales of generic and biosimilar medicines in Czechia, Hungary, Poland, and Slovakia were based on the IQVIA MIDAS MAT July 2021. Results: The number of applications for the reimbursement of generic drugs decreased from 296 in 2016 to 165 in 2020. In financial terms, the sales of generic medicines in Slovakia increased from 21.7% in 2015 to 22.3% in 2020. Over the same period, the sales of generic drugs in Poland fell from 40.4% in 2015 to 35.0% in 2020, from 26.2 to 22.1% in Hungary, and from 29.6 to 20.4% in Czechia. When considering the 66 biosimilars registered by the European Medicines Agency 38 drugs (58%) were available on the Slovak market as of August 1, 2021; this compared to 32 drugs (48%) in Poland, 38 drugs (58%) in Hungary, and 40 drugs (61%) in Czechia. In financial terms, the sales of biosimilars in Slovakia increased from 0.94% in 2015 to 2.00% in 2020. Over the same period, the sales of biosimilars in Poland increased from 0.59% in 2015 to 1.29% in 2020, from 0.72 to 2.23% in Hungary, and from 0.76 to 2.15% in Czechia. Conclusion: To intensify the use of generic and biosimilar medicines, we suggest the comprehensive re-evaluation of combinations of the three-threshold entry, the amount of mandatory price reductions, and external reference pricing requirements (as the average of the three lowest prices among the official prices of a medicinal product in other Member States) for generic and biosimilar drugs. We also suggest cancellation of the exception from the fixed co-payment of the insured.

Consumption of Antibacterials for Systemic Use in Slovakia: A National Study and the Quality Indicators for Outpatient Antibiotic Use.

This paper aims to analyse the consumption of antibiotics in the Slovak health care system from 2011 to 2020. The data source on the consumption of antibiotics is sales data from SUKL and NCZI. The study employed the ATC/DDD Index and focused on the consumption of antibiotics in the primary care sector. Total antibiotic consumption decreased from 19.21 DID in 2011 to 13.16 DID in 2020. Consumption of beta-lactamase-sensitive penicillins, expressed as a percentage of the total consumption of antibiotics, decreased from 8.4% in 2011 to 4.2% in 2020. Consumption of the combination of penicillins, including beta-lactamase inhibitor, expressed as a percentage of the total consumption of antibiotics, increased from 16.2% in 2011 to 17.9% in 2020. Consumption of third- and fourth-generation cephalosporins, expressed as the percentage of the total consumption of antibiotics, increased from 2.0% in 2011 to 4.6% in 2020. Consumption of fluoroquinolones, expressed as the percentage of the total consumption of antibiotics, decreased from 10.7% in 2011 to 8.6% in 2020. Overall, antibiotic consumption significantly changed in Slovakia from 2011 to 2020. The ratio of the consumption of broad-spectrum to the consumption of narrow-spectrum penicillins, cephalosporins and macrolides decreased from 14.98 in 2011 to 13.38 in 2020.