Assessment of the quality of antibiotics prescription in a regional health system

ObjetivosEl uso inadecuado e indiscriminado de los antibióticos es uno de los principales factores que contribuye a la aparición de resistencias bacterianas. En 2007 el Proyecto europeo de vigilancia del consumo de antimicrobianos (ESAC) estableció unos indicadores para evaluar la calidad de uso de los antibióticos. Se analiza la calidad de la prescripción de antibióticos en La Rioja en 2017, por variables epidemiológicas (edad, sexo y estacionalidad) y económicas (precio del antibiótico y nivel de renta).Material y métodosDispensaciones mensuales de antibióticos (J01) mediante receta oficial y mutuas, con los que se calcularon tasas poblacionales de número de recetas prescritas por cada 1.000 habitantes y los valores de 9 indicadores de calidad (por familias de antibióticos, grupos de edad, sexo y renta), definidos por el ESAC, calificando como «muy alta», «alta», «baja» y «muy baja» la calidad de prescripción.ResultadosLa calidad de la prescripción de antibióticos en La Rioja en 2017 resultó «alta» en antibióticos dispensados mediante receta oficial (18,55 dosis diarias definidas por 1.000 habitantes DHD) y «baja» mediante mutuas (21,79 DHD). Al incluir la receta privada (26,02 DHD) la calidad fue «muy baja» atendiendo a los márgenes indicados por el ESAC. Se detectaron altas tasas de prescripción de, entre otros: antibióticos de amplio espectro para hombres de más de 45 años, penicilinas para mujeres entre 25 y 39 años, quinolonas para pensionistas y cefalosporinas en renta alta.ConclusionesLa calidad de la prescripción de antibióticos está determinada no solo por variables epidemiológicas, como la edad o el sexo, sino también por variables económicas, como la renta del paciente y el precio del antibiótico.ObjectivesThe inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the onset of antimicrobial resistance. In 2007, the European Surveillance of Antimicrobial Consumption (ESAC) project established certain indicators to assess the quality of antibiotic use. We analysed the quality of antibiotic prescription in La Rioja (Spain) in 2017, using epidemiological (age, sex, seasonal nature) and financial variables (price of the antibiotic and income level).Material and methodsUsing data on monthly distributions of antibiotics (J01) through official prescriptions and prescriptions from medical insurance companies, we calculated the population rates for the number of prescriptions per 1000 inhabitants, as well as the values of 9 quality indicators (by antibiotic family, age group, sex and income), defined by ESAC, classifying the prescription quality as very high, high, low and very low.ResultsThe quality of antibiotic prescriptions in La Rioja in 2017 was high for antibiotics dispensed through official prescriptions (18.55 daily defined doses per 1000 inhabitants [DID]) and low for those dispensed through medical insurance companies (21.79 DID). When we included private prescriptions (26.02 DID), the quality was very low, taking into account the margins indicated by ESAC. We detected high rates of prescription for broad-spectrum antibiotics for men older than 45 years, penicillins for women aged 25 to 39 years, quinolones for pensioners and cephalosporins for high-income patients.ConclusionsThe quality of antibiotic prescription is determined not only by epidemiological variables, such as age and sex, but also by financial variables, such as patient income and antibiotic price

Healthcare rationing in Spain: framework, descriptive analysis and consequences

This paper describes the main healthcare rationing policies implemented in Spain over the last 2 decades, and analyses the consequences of these policies on the healthcare system, patients, healthcare practitioners, the pharmaceutical industry and policymakers. The primary explicit healthcare rationing policies utilised in Spain include a catalogue that defines the healthcare rights of citizens. However, the existing system may lead to inequity between regions, and is not structured to direct resources towards the most cost-effective options. Health technology assessment requires further work before it can be utilised widely for the development of rationing strategies. Selective reimbursement of drugs and drug co-payments provide only short-term results and appear to have little long-term impact on expenditure. Implicit rationing instruments, especially waiting lists, have had a significant effect on healthcare quality and the welfare of citizens, and have contributed to keeping the Spanish healthcare budget under control. Newer regulations should integrate some form of economic evaluation within the policy-making processes associated with healthcare. Further research is needed to identify those efficient and equitable rationing instruments that are most likely to improve health interventions for an aging society that is increasingly demanding of health services

Cost-effectiveness analysis of the treatment with enalapril of chronic heart failure in Spain [Análisis coste efectividad del tratamiento con enalapril de la insuficiencia cardíaca crónica en España.]

The aim of this study is to analyse in terms of cost-effectiveness the utilisation of enalapril as part of chronic heart failure therapy in Spain. A computer spread sheet based upon the results of the treatment arm of the SOLVD (Studies on Left Ventricular Dysfunction) study was used, with costs and epidemiologic data referred to Spain. Epidemiologic data are extrapolations from either studies performed in other countries or estimates from hospital and outpatient clinics utilisation, and economic data are taken from Spanish studies. The time horizon of the study was set at four years, and results are referred to year 1993. Widespread use of enalapril increases survival in 1.7 months per individual or in 5-10,000 years for the whole population. It generates net savings for the health system estimated in 1,500 to 3,000 million pesetas, also in four years. Using enalapril as part of the standard therapy for chronic heart failure generates an increase both in saved years of life and quality of life, and is associated with net savings for the health system