International trends in clozapine use: a study in 17 countries.

OBJECTIVE: There is some evidence that clozapine is significantly underutilised. Also, clozapine use is thought to vary by country, but so far no international study has assessed trends in clozapine prescribing. Therefore, this study aimed to assess clozapine use trends on an international scale, using standardised criteria for data analysis. METHOD: A repeated cross-sectional design was applied to data extracts (2005-2014) from 17 countries worldwide. RESULTS: In 2014, overall clozapine use prevalence was greatest in Finland (189.2/100 000 persons) and in New Zealand (116.3/100 000), and lowest in the Japanese cohort (0.6/100 000), and in the privately insured US cohort (14.0/100 000). From 2005 to 2014, clozapine use increased in almost all studied countries (relative increase: 7.8-197.2%). In most countries, clozapine use was highest in 40-59-year-olds (range: 0.6/100 000 (Japan) to 344.8/100 000 (Finland)). In youths (10-19 years), clozapine use was highest in Finland (24.7/100 000) and in the publicly insured US cohort (15.5/100 000). CONCLUSION: While clozapine use has increased in most studied countries over recent years, clozapine is still underutilised in many countries, with clozapine utilisation patterns differing significantly between countries. Future research should address the implementation of interventions designed to facilitate increased clozapine utilisation.

[Results of a benchmarking exercise for primary care teams in Barcelona, Spain]. / Resultado de la aplicación del benchmarking en los equipos de atención primaria de Barcelona.

OBJECTIVE: To identify primary care teams (PCT) with the best overall performance and compare these with other PCT with benchmarking methods. DESIGN: Descriptive, cross-sectional study of a set of indictors for the year 2002. SETTING: City of Barcelona (northeastern Spain). PARTICIPANTS: Thirteen seven PCT with more than 2 years' experience, and 771,811 inhabitants in the catchment area. MAIN MEASURES: Indicators were chosen from among those proposed by an advisory group, depending on feasibility of obtaining information. A total of 17 indicators in 4 dimensions were studied: accessibility, clinical effectiveness, case management capacity, and cost-efficiency. Each PCT was scored for each indicator based on the percentile group in the distribution of scores, and for each dimension based on the mean score for all indicators in a given dimension. Overall score for PCT performance was calculated as the weighted sum of the scores for each dimension. As descriptive variables we analyzed time operating under the revised administrative system, patient visits per population served, the population's economic capacity and age of the population. RESULTS. Nine PCT were identified as the benchmark group. Teams in this group had been operating under the revised administrative system for significantly longer than other PCT. In comparison to other PCT, the benchmark group obtained higher scores on all four dimensions, better results on 14 separate indicators, the same results for 1 indicator, and worse results for 2 indicators. CONCLUSIONS. Benchmarking made it possible to identify PCT with the best performance, and to identify areas in need of improvement. This approach is a potentially useful tool for self-evaluation and for stimulating a dynamic for improvement in primary care providers.

[Drug regulation: theory and practice]. / La regulación de los medicamentos: teoría y práctica.

Regulation of drugs from the public administration is an activity which is produced in different countries independently from the sanitary model they own. In the field of public financing of drugs there have been several measures to improve the efficiency of their use. However, the analysis of the impact of these measures is complex and this may justify the shortage of objectivable results, especially at long term. The objective of this study is to perform a systematic review of such measures due to the need to have information about the different alternatives before making a decision. The introduction of an isolated measure is in many cases compensated by other changes in other regulating or aiding fields which suggests the creation of an integral strategy which affects different fields (supply/demand of drugs and prescribers). It seems necessary to suggest a social debate taking as a basis the scientific information available at the moment and promote the taking of decisions which lead to a rational use of the available pharmacological resources.