Original Title: Evaluación de los factores relacionados con el gasto farmacéutico en Atención Primaria y la calidad de la prescripción en enfermedades crónicas

Authors' objectives: Main objective To assess the prescription of medications used to treat high blood pressure and diabetes mellitus, two of the main chronic diseases that are diagnosed and controlled in primary care. Secondary objectives 1. To analyze the quality of the prescription according to indicators compiled in the Clinical Management Contract of Osakidetza (Basque Health Service). 2. To describe the high blood pressure and diabetes medication prescription rates among family doctors of the Basque Country. 3. To determine the relationship between the prescription of high blood pressure and diabetes drugs and the correct control of these diseases. 4. To analyze the association between the consumption of medications and the socio-economic deprivation index of the different health areas of the Basque Country.

Authors' results and conclusions: The average pharmaceutical expenditure generated by prescriptions made out by Basque Country family doctors in 2011 amounted to €2,294,884.6 per quota, with an expenditure per person of €203.5. The average price per packaging is €13. The prescription of high blood pressure medications amounted to 272±90.2 DDD (dose per 1,000 inhabitants and day), and that of diabetes medications amounted to 43.8±90.2 DDD (dose per 1,000 inhabitants and day). With respect to the control of these pathologies, 36.1% of high blood pressure patients presented a good control of blood pressure figures, and 29.2% of the diabetic patients presented a good control of the glycosylated hemoglobin figures (HbA1c). There is a moderately negative correlation between pharmaceutical expenditure and prescription quality (r=-0.434; p less-than 0.0001) and between expenditure/person and generic medication prescription (r=0.222; pless-than 0.0001). With regards to the socio-economic deprivation index and the prescription of high blood pressure medications, a greater and statistically significant consumption of drugs is observed in the health zones of the 2nd and 5th quintile of this index. In the case of diabetic patients it is also verified that the most socio-economically underprivileged sectors present a greater consumption of diabetes drugs CONCLUSIONS – There is a statistically significant correlation between physicians who have a lower pharmaceutical expenditure and higher prescription quality. – The medical quotas with the least expenditure per person prescribe a higher percentage of generic medications and a smaller number of new medication packages, but which do not afford therapeutic improvements. – The physicians who prescribe more medications from the Pharmacotherapeutics Primary Health Guide have a higher prescription quality and generate less pharmaceutical expenditure. – The use of high blood pressure medications improves blood pressure control, although the correlation between expenditure and good control is not very high. – The greater use of diabetics medications improves glucose control, but the correlation between expenditure and good control is low. – The consumption of generic medications is greater in the more underprivileged social sectors and the use of new medications (with higher prices) is lower. – The consumption of high blood pressure and diabetes drugs in population sectors with a higher socio-economic levels is greater.

Authors' methods: The prescriptions made out by 1395 Basque Country family doctors in 2011 are reviewed (2,038,536 inhabitants) and billed by the pharmacy offices. The variables related to the medical quota (population of employed workers and pensioners) and the pharmaceutical prescription (expenditure and no. of doses-inhabitant-day). Thee quantitative factors are compared with the qualitative indicators of the Clinical Management Contract of Osakidetza: percentages of generic medication prescriptions, percentage of use of new medications that do not afford therapeutic improvements, percentage of use of medications recommended in the Pharmacotherapeutics Primary Health Care Guide of Osakidetza and global prescription quality index. The consumption of high blood pressure and diabetes drugs is assessed, as well as the correct control of high blood pressure and diabetes patients, according to criteria included in the Preferential Offer of the Health Department. Finally, the correlation between expenditure in these 2 pharmacological groups and the socio-economic deprivation index is studied by physicians and by Health Regions

Project Status: Completed

Year Published: 2016

URL for published report: https://www.ogasun.ejgv.euskadi.eus/r51-catpub/es/k75aWebPublicacionesWar/k75aObtenerPublicacionDigitalServlet?R01HNoPortal=true&N_LIBR=051912&N_EDIC=0001&C_IDIOM=es&FORMATO=.pdf

English language abstract: An English language summary is available

Publication Type: Other

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>