Trends in the Outpatient Utilization of Antipsychotic Drugs in the City of Zagreb in the Ten-Year Period as a Tool to Assess Drug Prescribing Rationality.

BACKGROUND: The aim was to determine distribution and trends in the outpatient utilization of antipsychotics to evaluate the rationality of antipsychotic drug prescribing during the ten year period. SUBJECTS AND METHODS: The epidemiological method of descriptive and analytical observation was used. Data on drug utilization from Zagreb Municipal Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the World Health Organization Anatomical-Therapeutic-Chemical methodology. The ratio of typical versus atypical antipsychotics served as an indicator on assessing the rationality of the utilization. Data on the use of anticholinergics in the treatment of neuroleptic side effects were also included. RESULTS: Outpatient utilization of antipsychotics showed a declining pattern from 14.17 in 2001 to 8.42 DDD/TID in 2010. The utilization of atypical antipsychotics increased by 60% (from 3.68 to 5.89 DDD/TID), while the utilization of typical antipsychotics decreased by 76% (from 10.49 to 2.53 DDD/TID). The drugs showing the largest increase were olanzapine (from 1.21 to 2.78 DDD/TID) and quetiapine (from 0 to 0.68 DDD/TID). The typical/atypical antipsychotic ratio changed from 1:0.4 in 2001 to 1:2.3 in 2010. A 2.3-fold decrease was recorded in the utilization of anticholinergics (from 2.05 to 0.91 DDD/TID). CONCLUSIONS: Total consumption of neuroleptics significantly decreased. A decrease was also recorded in the utilization of anticholinergics. Study results pointed to two favorable features, i.e. low use of typical antipsychotics and the ratio of typical and atypical antipsychotics. Implementation of the new clinical guidelines for nervous system disorders and updating of the list of reimbursable drugs with the addition of new ones contributed to the observed improvement in the prescribing patterns during the study period. Using the WHO ATC/DDD methodology and rationality indicators in the assessment of trends in the outpatient utilization of psychopharmaceuticals over a ten-year period proved efficient in the evaluation of prescribing rationality.

Implementation of the program of preventive examinations at primary health care in the city of Zagreb 2009-2013.

BACKGROUND: The program covered all persons who had not been in contact with a physician for two years or had failed to notice symptoms themselves or to timely respond to the symptoms observed. The aim of the present study was to analyze the results of the program and try to draw conclusions regarding the necessity further implementation. SUBJECTS AND METHODS: This paper analyzes data on a cohort of 1375 subjects aged 45+, collected on preventive examinations by family physicians during the 2009-2013 period. RESULTS: Results show 24.4% smokers and 15.5% former smokers. Up to three alcoholic drinks per week consumed 18.5% respondents (27.8% male and 11.2% female). Overweight (body mass index 25-30) was recorded in 50.6% and 38.6%, obesity (body mass index >30) in 30.1% and 29.4%, hypertension in 14.6% and 11.8%, isolated systolic hypertension in 20.5% and 17.4%, and isolated diastolic hypertension in 3.3% and 3.0% of male and female subjects, respectively. Suspicion of one or more newly diagnosed disease was recorded in 52.9% (95% CI 50.2-55.5) of study subjects. Fifty-four subjects (7.4%; 95% CI 5.5-9.3) were suspected to have neoplasm and they were immediately referred for further diagnostic evaluation. CONCLUSIONS: Timely manner suspicion of malignant disease is of crucial influence on the course of treatment and outcome of the disease. The study results confirm the importance of continuing the implementation of prevention programs.

Characteristics of self-medication for pain relief among first-year health care students in Zagreb, Croatia.

BACKGROUND: Taking over the responsibility for one's own health and active participation in eliminating the existing health problems is ever more widespread in the world. Self-medication in the form of using any kind of therapy without previous consultation with medical professionals has been ever more common among student populations in many countries. The aim of this study was to determine the attitudes about self-medication for pain relief and features of self-medication in first-year students of the University of Applied Health Studies in Zagreb. SUBJECTS AND METHODS: The study was conducted using an anonymous questionnaire, which was completed by 389 respondents. RESULTS: Taking painkillers in the past year was reported by 74.6% of respondents, significantly more by female students (80.8%); 62.6% of female students used painkillers once a month versus 45.7% of male students taking analgesics once a year. Ibuprofen was preferred by female students and acetylsalicylic acid by male students. Headache was the most common indication for taking painkillers (76.6%), followed by menstrual discomforts in female students (66.2%) and toothache (28.6%). Significant sex differences were recorded in the choice of drugs, indications for self-medication, and frequency of drug use. There were no differences between study courses. CONCLUSIONS: Appropriate student education and improved information transfer between professionals and students are the key elements to ensure judicious, quality and knowledge based use of drugs among students.

Comparison of Psychotropic Drug Prescribing Quality between Zagreb, Croatia and Sarajevo, B&H.

BACKGROUND: The purpose of this paper was to compare outpatient consumption and quality of psychotropic drug prescribing between Croatia and Bosnia & Herzegovina 2006-2010. METHODS: Data on drug utilization from Zagreb Municipal Pharmacy and Sarajevo Public Pharmacy were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using the WHO Anatomical-Therapeutic-Chemical methodology. RESULTS: Total utilization of psychopharmaceuticals increased in both cities; however, it was higher in Zagreb than in Sarajevo throughout the study period. The utilization of psycholeptics increased in Zagreb by 2.4% (from 74.5 to 76.3 DDD/TID) and in Sarajevo by 3.8% (from 62.4 to 64.8 DDD/TID). The utilization of anxiolytics decreased in Zagreb by 2.1% and in Sarajevo by even 18.7%. The utilization of antidepressants increased in both cities with predominance of SSRI over TCA utilization, greater in Sarajevo (96.6%) than in Zagreb (10.2%). The anxiolytic/antidepressant ratio decreased by 11.1% in Zagreb (from 2.87 to 2.55) and by 58.7% in Sarajevo (from 5.66 to 2.34). Outpatient utilization of antipsychotics increased significantly in Sarajevo, predominated by typical ones, whereas in Zagreb the utilization of antipsychotics was stable, predominated by atypical ones. CONCLUSIONS: In Croatia and Bosnia & Herzegovina, there was an obvious tendency to follow western trends in drug prescribing, as demonstrated by the increased use of antidepressants and reduced use of anxiolytics. Despite some improvement observed in the prescribing quality, high use of antipsychotics with dominance of typical antipsychotics in Sarajevo points to the need of prescribing guidelines for antipsychotics.

Distribution and trends in outpatient utilization of generic versus brand name psychopharmaceuticals during a ten-year period in Croatia.

BACKGROUND: Drug 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. METHODS: Using 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. RESULTS: Total 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. CONCLUSIONS: The 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.

A study on utilization of oral contraceptives in the City of Zagreb (2008-2010).

Main aim of this study is to quantify and analyze the utilization and utilization trends of oral hormonal contraceptives in the City of Zagreb, 2008-2010, and to propose potential interventions, if necessary. Data gathered from Zagreb pharmacies were assessed by Anatomical Therapeutic Chemical Classification of drugs and Daily Defined Dose methodology. An alarming decrease in total utilization of hormonal contraceptives by 76% from 2008-2009 was found as the main result of this study. A major decrease by 95.5% in utilization of G03AB04 subgroup, sequential combined oral contraceptives, was noted in the year 2009. The subgroup G03AC0, progesterone-only pill group, showed a stable trend, and it became the most utilized subgroup in 2010, due to the decrease in utilization of both fixed and sequential combined oral contraceptives. Utilization of oral contraceptives in Croatia is not regulated adequately, since such dynamics in utilization can occur unnoticed. Measures need to take place in order to improve this situation. Proposed measures include organized farmacovigilance, prescription based on guidelines, and strict screening for risk factors in women seeking oral contraception. More research is required in Croatia to understand the pattern of utilization of hormonal contraceptives and to find the true cause of decrease in utilization of oral contraceptives.

Cardiovascular drugs consumption--comparison between two Croatian regions, City of Zagreb and Lika-Senj County.

The aim of this paper is to determine the differences in the outpatient consumption of cardiovascular drugs between Croatian regions: the City of Zagreb and Lika-Senj County. The data on the number of packages and the purchase price for each drug have been obtained from all pharmacies in Lika-Senj County and all pharmacies in the City of Zagreb. Defined daily doses/1000 inhabitants/day (DDD/1000/day) was calculated for every drug in accordance with its code name and Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) index of the World Health Organization (WHO) for 2007. For drug combinations without defined daily doses, equivalent doses (ED) were used. The quality of drug prescribing within the group of cardiovascular drugs was assessed using the Drug Utilization (DU90%) method and the adherence of the DU90% segment to the guidelines for prescribing individual drug groups. The statistical significance of differences in results between the City of Zagreb and Lika-Senj County was tested using the chi-square test at the level of statistical significance p < 0.05. The comparison of the share of the five most often prescribed drug groups in Lika-Senj County has shown statistically significant differences when compared to the City of Zagreb (chi2 = 28.93, df = 4, p < 0.001). The total outpatient consumption of cardiovascular drugs in the City of Zagreb and Lika-Senj County differs significantly. The consumption, quality of prescribing drugs and cost/DDD in the City of Zagreb is higher than in Lika-Senj County; in the City of Zagreb, newer and more expensive drugs are prescribed to a higher extent.

A study on the quality of outpatient prescription of psychopharmaceuticals in the City of Zagreb 2006-2009.

The lack of Croatian studies which could determine the justifiability of excessive psychopharmaceutical utilization was an encouragement to conduct this research. Furthermore, regarding the conduction of this study, it would be possible to determine whether the trend of drug utilization has increased, decreased or perhaps stabilized. The data on the outpatient utilization of psycholeptics and psychoanaleptics were collected from all Zagreb pharmacies, 2006-2009. Based on the collected data for all N05 and N06 groups of drugs, the defined daily doses (DDD) and DDD per thousand inhabitants per day (DDD/TID) have been calculated using the Anatomical-Therapeutic-Chemical classification (ATC) for 2006, 2007, 2008 and 2009. To indicate the quality of drug prescription the Drug Utilization 90% (DU 90%) method was used. Moreover, in order to determine a more precise quality of individual drug group prescriptions, the indicators have been calculated by determining the proportion of the total utilization of individual therapeutic and pharmacological therapeutic subgroups in DDD/TID a day. The utilization of anxiolytics (N05B) accounts for most of the psycholeptic utilization in the City of Zagreb throughout the entire study period. In the study period, the utilization of antidepressants has slightly increased, by 10.5%, taking the first and the last years of the period into account. In 2006, 5 benzodiazepines and the hypnotic zolpidem, as well as 5 selective serotonin reuptake inhibitors (SSRIs) and 1 third generation antipsychotic (olanzapin) were found in the DU 90% segment. In 2009, the DU 90% segment also comprised 5 benzodiazepines and the hypnotic zolpidem, as well as 6 SSRIs and 1 third generation antipsychotic (olanzapin). In the City of Zagreb, a general insight into the quality of psychopharmaceutical prescriptions indicates stability in comparison to earlier studies. The ratio index of the first generation antipsychotic utilization, compared to the third generation antipsychotics, shows an increase in the quality of prescription. Also, the ratio index of total tricyclic antidepressants (TCA) and SSRI utilization indicates improvement in quality of prescription. The ratio index of the entire outpatient utilization of anxiolytics and antidepressants expressed in DDD/TID unfortunately shows a very mild increase of prescription quality. Benzodiazepines accounted for more than 50% of the outpatient utilization of psychopharmaceuticals throughout the study period, which proves the need for precise guidelines as the most significant means of drug rationalization and utilization. It is necessary to identify priorities and problems in order to solve them successfully, by monitoring drug utilization and prescription on a national level. Results demonstrate that within the primary health care system, there is a need for constant education on rational prescription of this drug group.

Outpatient consumption of antibiotics in the City of Zagreb (2006-2010).

AIM: To investigate outpatient consumption of antibiotics during the 2006-2010 period in the City of Zagreb and compare it with other European countries. METHODS: Data on outpatient consumption of antibiotics were obtained from all pharmacies in the City of Zagreb. Based on the data obtained, the number of defined daily doses per 1000 inhabitants per day (DDDs/TID) were calculated for each ATC subgroup. Drug Utilization 90% (DU90%) method and ratio indicators were used for the assessment of drug prescribing quality. RESULTS: During the period of five years total antibiotics consumption has declined from 37.38 DDDs/TID in 2006 to 33.28 DDDs/ TID in 2010. The most frequently prescribed subgroup was penicillins (J01C). DU90% segment included 10 out of a total of 32 antibiotics in the year 2006 and 10 out of a total of 23 antibiotics in the year 2010. Leading position in the consumption, in 2006 and 2010, was held by broad-spectrum antibiotics, moreover their consumption increased in 2010. CONCLUSION: Consumption of antibiotics in Zagreb is still very high and is similar to the consumption in European countries with the highest consumption of antibiotics. Reduced consumption of narrow-spectrum antibiotics and unjustified increase in the consumption of broad-spectrum antibiotics suggess that physicians do not follow clinical guidelines.

Nine-year trends in the morbidity of mental disorders and psychotropic drug utilization in Croatia: over-diagnosis and over-utilization?

Overall drug overuse, including psychotropic, is the Croatian reality. Therefore, in between 2000 and 2012, the interventions to control drug overspending were undertaken. The main aims of the study are: to determine the morbidity trends of mental disorders registered in family medicine (FM), the trends in psychotropic drug utilization and to identify whether the trends of utilization have any relation to the interventions. The results indicate that mental disorders represent a high disease burden in Croatia. It was also present a higher burden of psychotropic drug utilization; second ranked in the total drug utilization during the nine-year follow up period. The utilization of psycholeptic's, was even higher; from 2004 to 2008; those drugs were ranked first in terms of utilization. Between 20-25% of Croatia's total health care budget is usually spent on drugs. The interventions that are currently being implemented to control drug utilization have not brought about any changes.

Trends in prescribing in primary care in Croatia, 2000-2012: prescribing volume, costs and regulatory measures.

The rise of pharmaceutical costs is a significant burden to overall health care expenditure. The Croatian Health Insurance Fund (CHIF) in attempts of its containment, use administrative measures directed toward the two greatest generators: pharmaceutical industry, through negotiating prices and periodic revisions of basic and suplemental drug lists, and primary care physicians, through limits in the volume of prescriptions, and annual financial expenditure. The aim of the study was to determine trends in quantity of issued prescriptions and pharmaceutical expanditure from 2000 to 2012. Data were obtained from the CHIF annual reports. Results clearly demonstrate two trends: the increase in quantity of issued prescriptions, together with accompanying rates: number of prescriptions per inhabitants, and per patients, and the increase in total cost of prescriptions until 2004, with their maintenance and slight variations since then. Despite controversies in approach, CHIF succeded in slowing down the costs, primarily by applying measures towards regulation of drug prices.

Trends in statin consumption and cardiovascular mortality in Croatia 2004-2012.

Prescribing of statins showed an increasing trend in all developed countries, during the last two decades. The aim of this study was to research the trends in statin consumption in the period from 2004 to 2012 as well as trends of cardiovascular mortality during the 1990 to 2012 period, and to compare them between Croatia and several neighbouring countries. Data on statin expenditures and consumption expresed in defined daily doses per 1000 inhabitants per day (DDD/TID), were taken from annual reports of Croatian Agency for Medicinal Products and Medical Devices (HALMED). Data on crude mortality rates and standardized cardiovascular mortality rates, were taken from the Croatian Health Statistics Yearbooks. The utilization of statins increased by 196.7% during the observed period, with the highest consumption of atorvastatin and simvastatin. Financial expenditure of statins expanded at much faster rate in comparison with overall drug costs. Cardiovascular mortality rates decreased slightly, while maintaining higher level in comparison with some neighbouring countries.

Outpatient utilization of psychopharmaceuticals: comparison between the cities of Zagreb and Sarajevo (2006-2009).

AIM: To determine the real outpatient utilization of psychiatric drugs in Zagreb (Croatia) and Sarajevo (Bosnia and Herzegovina) and to compare the outpatient utilization of psychiatric drugs between this two cities. METHODS: Data on the outpatient utilization of psycholpetics and psychoanaleptics (N05 and N06) in both cities were received from pharmacies and collected during 2006-2009. Based on the data obtained, a number of DDD and DDD per 1000 inhabitants perday (DDD/1000/day) has been calculated. The data in Zagreb were received from all pharmacies in Zagreb, whereas only 50% of pharmacies in Sarajevo participated, thus an extrapolation of data for Sarajevo was required and accomplished. All drugs were classified according to the ATC system. Based on the data obtained, a number of DDD and DDD/1000/day was calculated for all N05 and N06 drugs. RESULTS: Overall utilization trend was similar between the cities Sarajevo and Zagreb and followed trends in other neighbouring countries. Total consumption of psycholeptics and psychoanaleptics in Sarajevo was 22.6% (on average) lower than in Zagreb, during the 4-year period. CONCLUSION: During the 2006-2009 period the total consumption of psychopharmaceuticals showed increasing trend with peak in 2008 with similar trend between Zagreb and Sarajevo. It is necessary to implement systematic approach to drug utilization monitoring in Sarajevo and Bosnia and Herzegovina in general in order to improve prescribing quality as it is done in Croatia.

Quality of cardiovascular drugs prescribing in Croatia 2003-2008.

The aim of the study was to determine cardiovascular drugs utilization and quality of prescribing in Croatia from 2003 to 2008. Data on the outpatient utilization of cardiovascular drugs in Croatia were collected during 2003-2008. Data on the size and number of packages, were obtained from Croatian institute for Health Insurance (CIHI). Based on the data obtained, the numbers of DDD and DDD per 1000 inhabitants per day (DDD/1000/day) were calculated for all cardiovascular drugs. Quality of drugs prescribing was assessing using Drug Utilization 90% (DU90%) method. Renin-angiotensin system agents showed highest share in the utilization of group C drugs, followed by calcium channel blockers. These two groups of drugs accounted for half of the overall cardiovascular drug utilization. Greatest changes were observed in the groups of renin-angiotensin system agents and hypolipemics. The number of drugs within DU90% segment increased between 2003 and 2008. In the same period Cost/DDD decreased.

Utilization of cardiovascular drugs in Zagreb 2001-2005.

OBJECTIVE: The purpose of this study was to investigate the outpatient utilization of cardiovascular drugs in Croatia, during the period 2001-2005, using the Anatomical Therapeutic Chemical classification of drugs/Defined Daily Dose (ATC/DDD) methodology. METHODS AND RESULTS: Data on outpatient drug utilization were obtained from the Zagreb Municipal Pharmacy to calculate the number of defined daily dose (DDD), and DDD per 1000 inhabitants per day (DDD/1000/day). The drug utilization 90% (DU90%) method was used on drug prescribing quality assessment. Data on hospital admissions were collected from the inpatient database kept at the Zagreb Institute of Public Health. Total utilization of cardiovascular drugs (ATC group C), was between 402.9 Defined Daily Dose per 1000 inhabitants per day (DDD/TID) and 362.9 DDD/TID in Croatia between 2001 and 2005. Agents acting on the renin-angiotensin system (C09) (104.2 DDD/TID) and calcium channel blockers (C08) (80.5 DDD/TID) accounted for more than 50% of drugs used for the treatment of hypertension in 2005. A great increase in the utilization was observed for statins (78.3%). A markedly increasing utilization was recorded for angiotensin-converting enzyme (ACE) inhibitors in combination with hydrochlorothiazide (HCTZ) (40.5%) and angiotensin II antagonists (278%). Comparison of the DU90% segment between 2001 and 2005 revealed pentoxifylline and amiodarone to be absent, whereas cilazapril and ramipril in combination with HCTZ, bisoprolol, valsartan and losartan alone or in combination with HCTZ were added in 2004 and 2005. The total rate of hospital admissions for major cardiovascular events decreased by 18.2%. CONCLUSION: The utilization pattern was improved in 2005, showing a decrease in the number of hospital admissions for major cardiovascular events.

[Pharmacoeconomic indicators of cardiovascular drug utilization in the Republic of Croatia and city of Zagreb in 2008]. / Farmakoekonomski pokazatelji potrosnje kardiovaskularnih lijekova u Republici Hrvatskoj i gradu Zagrebu u 2008. Godini.

BACKGROUND: In comparison with original drugs, generic drugs have the same efficacy but considerably lower price and should therefore be preferred to original drugs on prescribing. The aim of the present study was to assess outpatient utilization and rationality of cardiovascular drug prescribing in the City of Zagreb and Republic of Croatia based on the generic to original drug prescribing ratio. METHODS: Data on the financial indicators and number of cardiovascular drug packages issued in 2008 were obtained from the Croatian Institute of Health Insurance. These data were used to calculate the number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day). The index of generic/original drug utilization was determined for Zagreb and Croatia as a measure for assessment of prescribing rationality; the significance of difference was determined by X2-test. RESULTS: The rate of prescribing original cardiovascular drugs was significantly higher in Zagreb as compared with Croatia as a whole. The index of prescribing generic versus original drugs was 1.20 (249/208 DDD/1000/day) in Zagreb and 1.65 (249/151 DDD/1000/day) in Croatia. Difference in the utilization of generic drugs between Zagreb and Croatia as determined by X2-test (the level of statistical significance was set at P<0.05) was statistically significant (P=0.021). The highest differences were recorded in the most widely prescribed drug groups, i.e. ACE inhibitors with the generic/original drug index of 1.38 in Zagreb and 2.02 in Croatia; and hypolipemics with the generic/original drug index of 0.96 in Zagreb and 1.34 in Croatia. According to financial indicators, the generic/original drug index was 1.44 in Croatia and only 0.96 in Zagreb. CONCLUSION: The significantly greater influence of pharmaceutical industry marketing in Zagreb entailed the significantly higher rate of original drug prescribing, which is associated with considerably greater drug expenses. Measures to stimulate prescribing generic drugs should be launched at the national level.

Emerging risk for viral hepatitis A in Croatian adults.

An objective of the study was to determine the changes in the risk of developing hepatitis A in the 30-years period and discuss the need for vaccination against HAV infection in Croatia and the city of Rijeka comparing incidence of hepatitis A between 1970-1974 and 2000-2004 periods. Hepatitis A declined in both populations and affected more prominently older population groups. Improvement of hygiene and sanitary conditions appears to have decreased hepatitis A incidence among children and adults, but only a seroepidemiological study can give more accurate data as a basis for discussion on the necessity of vaccination as a further measure in reducing hepatitis A incidence.

[Statin prescribing in the City of Zagreb (2001-2006) and their role in secondary prevention of cardiovascular events]. / Trend propisivanja statina u gradu zagrebu od 2001. do 2006. Godine i njihova uloga u sekundarnoj prevenciji kardiovaskularnih komplikacija.

INTRODUCTION: Cardiovascular drugs account for 40% of total outpatient drug utilization in the City of Zagreb. Among them, utilization of the group of hypolipemics showed greatest rise from 2001 to 2006. AIM: The aim of the study was to investigate outpatient utilization of hypolipemics in the City of Zagreb during the 2001-2006 period and to assess the quality of prescribing these drugs in primary health care. METHODS: The number of defined daily doses (DDD) and DDD per 1000 Zagreb inhabitants per day (DDD/1000/day) were calculated on the basis of data on the number of packages of each individual hypolipemic (C10) for each study year. Data on the rate of hospitalization for the leading cardiovascular complications were collected as indirect indicators of the statin prescribing quality. RESULTS: The utilization of hypolipemics was 33.03 DDD/1000/day in 2001 and 72.38 DDD/1000/day in 2006, yielding an almost twofold rise. Two drugs, simvastatin and atorvastatin, predominated in the utilization of statins with 93%. From 2001 to 2006, the utilization of simvastatin showed a 30% increase and that of atorvastatin more than sevenfold increase. During the study period, the overall rate of hospitalization for cardiovascular disorders decreased by 18.5%. CONCLUSION: The decreasing tendency recorded in hospitalization for cardiovascular diseases points to the improved quality of secondary prevention, including statins. The high rate of hospitalization for hypertension reflects inadequate primary prevention of cardiovascular disorders.

Outpatient utilization of psychopharmaceuticals: comparison between Croatia and Scandinavian countries (2001-2003).

The aim was to estimate outpatient consumption of psychotropic drugs in Croatia in correlation with Scandinavian countries. Data on drug utilization, from Zagreb Municipal Pharmacy, were used to calculate the number of defined daily doses (DDD) and DDD per 1000 inhabitants per day (DDD/TID) using Anatomical-Therapeutic-Chemical methodology (ATC) by WHO. Data of the Nordic Medico-Statistical Committee were used for Scandinavian countries. In Zagreb, total utilization of psychopharmaceuticals of 144.9 DDD/TID in 2001, 148.9 DDD/TID in 2002 and 141.9 DDD/TID in 2003. The anxiolytic/antidepressant ratio decreased in Zagreb by 35.19% (7.19 in 2001 and 4.66 in 2003), whereas in Scandinavian countries it showed a constant rate (0.7 in Finland, 0.4 in Denmark and Norway, and 0.3 in Sweden). The three-year utilization patterns show that Croatia has been ever more closely following Scandinavian countries although there have been a notable differences between Croatia and Scandinavian countries.

Outpatient utilization of psychopharmaceuticals in the City of Zagreb 2001-2006.

BACKGROUND: A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained. SUBJECTS AND METHODS: Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality. RESULTS: Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5-fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006. CONCLUSION: Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.