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Open access

Tomaž Nerat and Mitja Kos

Analiza Neprimernega Predpisovanja Zdravil Starostnikom v Sloveniji na Podlagi Beersovih in Larochevih Meril

Namen: Zaradi velikega števila starostnikov, kijemljejo zdravila, je bil cilj analize ugotoviti razširjenost neprimernega predpisovanja zdravil v letu 2006 med starostniki v Sloveniji. Za analizo neprimernega predpisovanja smo izbrali merila Beers 2002 in merila Laroche 2007 in Skupna merila neprimernega predpisovanja.

Metode: Analiza je bila opravljena na anonimizirani zbirki podatkov Zavoda za zdravstveno zavarovanje Slovenije o izdaji ambulantno predpisanih zdravil v letu 2006. Analizo z merili Beers 2002 smo opravili na vzorcu starostnikov, starih 65 let in več, analizo z merili Laroche 2007 in s Skupnimi merili pa na vzorcu starostnikov, starih 75 let in več.

Rezultati: Po merilih Beers 2002 je 22,41 % starostnikov prejelo vsaj eno neprimerno učinkovino, po merilih Laroche 2007 25,72 %, po Skupnih merilih pa 35,95 %. Glede na objavljene raziskave so deleži dokaj visoki. Delež receptov z neprimerno predpisanimi zdravili (glede na vse recepte) je v primeru analize z merili Beers 2002 znašal 3,43 %, v primeru z merili Laroche 2007 4,01 % in na podlagi Skupnih meril 6,03 %. Deleži so višji kot na Hrvaškem, predvsem zaradi večjega števila zdravil, ki jih uporabljamo v Sloveniji. Ugotovili smo tudi, da se verjetnost, da bolnik prejme neprimerno zdravilo, povečuje s številom predpisanih zdravil.

Zaključek: Kljub ugotovljenemu dokaj visokemu deležu neprimernega predpisovanja so mnenja v objavljeni literaturi glede vpliva na zdravstveno stanje starostnikov deljena. Pomembno je poudariti, da naj bi merila bila pomoč zdravnikom pri izbiri zdravljenja in ne kot zapoved. Prav tako so namenjeni uporabi v farmakoloških in epidemioloških študijah. Predlagani so načini, kako zmanjšati delež neprimernega predpisovanja zdravil.

Open access

Natasa Kos, Boris Kos and Mitja Benedicic

Abstract

Background

The number of patients with malignant brain tumours is on the rise, but due to the novel treatment methods the survival rates are higher. Despite increased survival the consequences of tumour properties and treatment can have a significant negative effect on the patients’ quality of life. Providing timely and appropriate rehabilitation interventions is an important aspect of patient treatment and should be started immediately after surgery. The most important goal of rehabilitation is to prevent complications that could have a negative effect on the patients’ ability to function.

Conclusions

By using individually tailored early rehabilitation it is often possible to achieve the patients’ independence in mobility as well as in performing daily tasks before leaving the hospital. A more precise evaluation of the patients’ functional state after completing additional oncologic therapy should be performed to stratify the patients who should be directed to complex rehabilitation treatment. The chances of a good functional outcome in patients with malignant brain tumours could be increased with good early medical rehabilitation treatment.

Open access

Andrej Janzic and Mitja Kos

Abstract

Anticoagulation treatment was recently improved by the introduction of novel oral anticoagulants (NOACs). Using a combination of qualitative and quantitative methods, this study explores the effects of the introduction of NOACs on anticoagulation care in Slovenia. Face-to-face interviews with key stakeholders revealed evolvement and challenges of anticoagulation care from different perspectives. Obtained information was further explored through the analysis of nationwide data of drug prescriptions and realization of health care services. Simplified management of anticoagulation treatment with NOACs and their high penetration expanded the capacity of anticoagulation clinics, and consequentially the treated population increased by more than 50 % in the last 5 years. The main challenge concerned the expenditures for medicines, which increased approximately 10 times in just a few years. At the same time, the anticoagulation clinics and their core organisation were not affected, which is not expected to change, since they are vital in delivering high-quality care.

Open access

Tomaž Nerat and Mitja Kos

Abstract

Introduction: Diabetes prevalence and costs are rising on aglobal scale. Therefore, it is necessary to periodically conduct cost studies for assessing the healthcare burden impact. In Slovenia, the last type 2 diabetes cost assessment was conducted in 2006, not including all diabetes complication costs. The aim of this study was to revise, update and compare to previously published datadirect healthcare costs of type 2 diabetes in Slovenia with additional complications costs consideration.

Methods: The study was performed from the healthcare payer perspective using the bottom-up approach, was prevalence based and estimated direct medical costs.

Results: We estimated total yearly direct medical costs of type 2 diabetes in Slovenia to 99,120,419 euro with annual per capita costs of 834.70 euro. The highest cost shares were attributed to cardiovascular complication costs (21,683,919 euro), diabetes co-medication (20,977,269 euro) and diabetes treatment medication (18,505,015 euro). Highest yearly costs per complication (all cases, all occurrences) were estimated for dialysis I and III (9,162,635 euro), stroke first year costs (4,951,306 euro) and congestive heart failure first year costs (4,879,533 euro). Yearly per one patient, the complication costs were highest for kidney transplantation, followed by dialysis I and III (78,621.25 euro and 36,797.73 euro)

Conclusions: In comparison to the costs published in the literature before, our estimated total yearly direct medical costs were comparable, although annual per capita costs were assessed lower than elsewhere. Further, regarding the complication costs estimations, our assessed expenses were comparable to those published in other countries.

Open access

Nejc Horvat, Igor Locatelli, Mitja Kos and Ana Janežič

Abstract

This study evaluated medication adherence and health-related quality of life (HRQoL) of Slovenian patients with chronic obstructive pulmonary disease (COPD) and examined the factors associated with HRQoL. Demographic and therapy information was collected from 65 patients through interviews. The St. George’s Respiratory Questionnaire and the Morisky Medication Adherence Scale were used to evaluate HRQoL and adherence, resp. A multiple linear regression model was used to assess the association between the factors and HRQoL. The mean St. George’s Respiratory Questionnaire score (range 0-100, with higher scores indicating lower HRQoL) was 41.4. COPD affected patients’ daily activities more than their social and psychological functioning. Slightly more than 53 % of the patients were optimally adherent, while 12 % were non-adherent. Patients with lower HRQoL had a larger number of medications for concomitant diseases, experienced COPD exacerbation in the last year, and had less education. No statistically significant correlation was found between medication adherence and HRQoL.

Open access

Tanja Mesti, Biljana Mileva Boshkoska, Mitja Kos, Metka Tekavčič and Janja Ocvirk

Abstract

Background. The aim of the study was to estimate the direct medical costs of metastatic colorectal cancer (mCRC) treated at the Institute of Oncology Ljubljana and to question the healthcare payment system in Slovenia.

Methods. Using an internal patient database, the costs of mCRC patients were estimated in 2009 by examining (1) mCRC direct medical related costs, and (2) the cost difference between payment received by Slovenian health insurance and actual mCRC costs. Costs were analysed in the treatment phase of the disease by assessing the direct medical costs of hospital treatment with systemic therapy together with hospital treatment of side effects, without assessing radiotherapy or surgical treatment. Follow-up costs, indirect medical costs, and nonmedical costs were not included.

Results. A total of 209 mCRC patients met all eligibility criteria. The direct medical costs of mCRC hospitalization with systemic therapy in Slovenia for 2009 were estimated as the cost of medications (cost of systemic therapy + cost of drugs for premedication) + labor cost (the cost of carrying out systemic treatment) + cost of lab tests + cost of imaging tests + KRAS testing cost + cost of hospital treatment due to side effects of mCRC treatment, and amounted to €3,914,697. The difference between the cost paid by health insurance and actual costs, estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009, was €1,900,757.80.

Conclusions. The costs paid to the Institute of Oncology Ljubljana by health insurance for treating mCRC with systemic therapy do not match the actual cost of treatment. In fact, the difference between the payment and the actual cost estimated as direct medical costs of hospitalization of mCRC patients treated with systemic therapy at the Institute of Oncology Ljubljana in 2009 was €1,900,757.80. The model Australian Refined Diagnosis Related Groups (AR-DRG) for cost assessment in oncology being currently used is probably one of the reasons for the discrepancy between pay-outs and actual costs. We propose new method for more precise cost assessment in oncology.