Assessment of quarter billion primary care prescriptions from a nationwide antimicrobial stewardship program.

We described the significance of systematic monitoring nationwide antimicrobial stewardship programs (ASPs) in primary care. All the prescriptions given by family physicians were recorded in Prescription Information System established by the Turkish Medicines and Medical Devices Agency of Ministry of Health. We calculated, for each prescription, "antibiotics amount" as number of boxes times number of items per box for medicines that belong to antiinfectives for systemic use (i.e., J01 block in the Anatomical Therapeutic Chemical Classification System). We compared the antibiotics amount before (2015) and after (2016) the extensive training programs for the family physicians. We included 266,389,209 prescriptions from state-operated family healthcare units (FHUs) between January 1, 2015 and December 31, 2016. These prescriptions were given by 26,313 individual family physicians in 22,518 FHUs for 50,713,181 individual patients. At least one antimicrobial was given in 37,024,232 (28.31%) prescriptions in 2015 and 36,154,684 (26.66%) prescriptions in 2016. The most common diagnosis was "acute upper respiratory infections (AURI)" (i.e., J00-J06 block in the 10th revision of the International Statistical Classification of Diseases and Related Health Problems) with 28.05%. The average antibiotics amount over prescriptions with AURI decreased in 79 out of 81 provinces, and overall rate of decrease in average antibiotics amount was 8.33%, where 28 and 53 provinces experienced decreases (range is between 28.63% and -3.05%) above and below this value, respectively. In the most successful province, the highest decrease in average amount of "other beta-lactam antibacterials" per prescription for AURI was 49.63% in January. Computational analyses on a big data set collected from a nationwide healthcare system brought a significant contribution in improving ASPs.

Evaluation of more than one billion outpatient prescriptions and eight-year trend showing a remarkable reduction in antibiotic prescription in Turkey: A success model of governmental interventions at national level.

PURPOSE: To present the antibiotic prescription trend between 2011-2018 at primary healthcare in Turkey in order to evaluate the effects of interventions at national level for providing rational prescription of antibiotics. METHODS: Electronic prescription data of the family physicians collected from January 1, 2011 to December 31, 2018 in 81 provinces of Turkey were recorded through the Prescription Information System and screened for the antimicrobial drugs. The interventions to promote rational antibiotic use during 2011-2018 in Turkey includes reminding the legislation to stop access of antibiotics without prescription, monitoring of antibiotic prescription behaviors of primary healthcare physicians, and education of healthcare workers and the public on the appropriate use of antibiotics. RESULTS: A total of 1 054 261 396 prescriptions for outpatients of all age groups were recorded during this period. Of the prescriptions written by family physcians, 34.94% were containing at least one antibiotic in 2011, which declined to 24.55% in 2018. Antibiotics constituted 13.99% of all the items in prescriptions in 2011 and 10.47% in 2018. Percentage of total antibiotic expenditure to the total drug expanditure decreased from 14.14% to 4.12% during 2011-2018. The most commonly prescribed antibiotics were amoxicillin and enzyme inhibitor combination, cefdinir, and cefuroxime during 2011-2018, with an increasing trend for prescription of first-line antibiotic, amoxicillin, in recent years. CONCLUSIONS: Governmental interventions at national level have contributed to reducing antibiotic prescription and increasing preference of first-line antibiotics at primary healthcare level in Turkey over a course of 8 years. Turkey's model of governmental interventions may set an example for other countries with high consumption of antibiotics, and contribute to the actions against antimicrobial resistance worldwide.

Cost Evaluation of Inhaler Therapies Used in Respiratory Diseases: 1998--2015 Period in Turkey.

BACKGROUND: With the rise in life expectancy, the burden of chronic diseases, including obstructive pulmonary diseases, has increased throughout the world. OBJECTIVES: To evaluate the sales trends of inhaler pharmaceuticals. METHODS: The changes in box sales and sales amounts (in Turkish lira) of inhaler pharmaceuticals during the period 1998 to 2015 were examined and sales were projected for the next 3 years. Pharmaceuticals were classified according to form and pharmacological groups. RESULTS: The sales of inhaler pharmaceuticals have increased rapidly since 2008. The fastest increase in consumption has occurred in short-acting ß2 agonist preparations and nebulizer pharmaceuticals. Inhaled corticosteroid and long-acting ß2 agonist combination sales have been the highest since 2002, when these products entered the Turkish market. CONCLUSIONS: The inhaler pharmaceutical market has grown over the years, and this growth will continue in the future. The increased use of short-acting preparations, which should be used as symptom relievers, indicates that treatment management continues to be inadequate.

Impact of Health Policy Changes on Trends in the Pharmaceutical Market in Turkey.

BACKGROUND: The implementation phase of the Turkish Health Transformation Program (HTP) began in 2003, with the aim of organizing, financing, and delivering health care services effectively, efficiently, and equally. The HTP impacted all clinical and economic outcomes of health, including pharmaceutical sales, by improving access to health services. OBJECTIVES: To understand the impact of five selected major policy changes that made an impact on supply, demand, or price in the pharmaceutical market between 1998 and 2012. METHODS: Monthly sales data (in units and value in US $) of a total of 180 pharmaceuticals covering the period between 1998 and 2012 were used for statistical analysis. Five major policies that could affect health expenditures and the demand and supply of pharmaceuticals were selected and led by the Ministry of Health. A P value of less than 0.05 was considered as the cutoff value for statistical significance. RESULTS: There was a growing trend in pharmaceuticals value and units in years, possibly as a result of the HTP implementation. Supply- and demand-related policies had a negative impact on the trends for value, whereas the pricing policy had a positive impact. CONCLUSIONS: It could be said that the HTP had an impact on units for improved access to health care services. Although this access increased the consumption of pharmaceuticals in units, the policies implemented were successful in controlling pharmaceutical expenditures.

Assessment of the Turkish health care system reforms: a stakeholder analysis.

BACKGROUND: The Turkish health care system has been undergoing a significant transformation with the Health Transformation Program (HTP) since 2003. The HTP's overall objective is to improve governance, efficiency, user and provider satisfaction, and long-term fiscal sustainability of the health care system in Turkey. OBJECTIVES: To systematically evaluate the effects of the HTP Phase I reforms on various stakeholders, and to outline strategic options for the implementation of the second phase of health transformation in Turkey. METHODS: A total of 47 formal structured stakeholder interviews, representing 29 different institutions, are conducted between December 2008 and January 2009. Five main components of the HTP were examined: strengthening of the Ministry of Health (MoH) capacity for stewardship, universal health insurance, reorganizing health service delivery, human resources development, and national health information system. RESULTS AND CONCLUSIONS: There is a general agreement among stakeholders that the progress made thus far is the greatest in the national health information system and the slowest in strengthening the MoH capacity for stewardship. It appears that the HTP has the capacity to deliver cost-effective health care services and the implementation progress, so far, is in congruence with the overall economic development and growth in Turkey.