PRESCRIBING CHANGES IN ANXIOLYTICS AND ANTIDEPRESSANTS IN SLOVENIA

Background: The ratio of anxiolytics to antidepressants is an indicator of the quality of treatment of depression and anxiety in primary care. The objective of the study was to investigate the prescription of anxiolytics and antidepressants among Slovenian family physicians, including patient demographics and possible time-trends. Subjects and methods: An exploratory survey and register-based analysis of anxiolytic and antidepressant prescriptions in 2005 and 2008 was performed. Drugs included in the study were classified according to an Anatomical-Therapeutic-Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 practice population per day. Descriptive analysis of anxiolytic/antidepressant ratio by patients’ age, gender and region of residency was performed. Results: Total amount of prescribed antidepressant drugs increased by 45% during the observed 3-year period, while total prescribing of anxiolytics decreased by 14%, leading to the anxiolytics/antidepressants ratio diminishing from 1 to about 0.5. The highest reduction in the ratio was observed in the northeast region, characterised by high social deprivation and one of the highest suicide rates in Europe. The highest prescribing of anxiolytics and antidepressants was observed in the central region around the capital Ljubljana. Conclusions: The reduction of anxiolytic prescribing and increase in antidepressant prescribing indicates improvement in prescribing practice of Slovenian family physicians. There are big variations in prescribing among different Slovenian regions, which are attributable to the number of psychiatrists and access to psychiatric treatment

Time Trends in Prescribing Habits of Anxiolytics and Antidepressants in Slovenian Family Practices (with Emphasis on Elderly Patients)

The aim of the study was to investigate prescription of anxiolytics and antidepressants among Slovenian family physicians regarding drug class with an emphasis on the elderly population and possible time-trends. Exploratory survey and register-based analysis of anxiolytic and antidepressant prescriptions of one hundred family physicians in Slovenia was performed in 2005 and 2008. Drugs included in the study were classified according to the Anatomical-Therapeutic- Chemical (ATC) drug classification system, and ATC data were used to calculate defined daily doses (DDD) per 1,000 practice population per day. The most often prescribed anxiolytics and antidepressants were identified and anxiolytic/ antidepressant ratio was estimation by patient age-group for the two studied years. Benzodiazepines showed highest share in the overall utilization of psychotropic drugs. The ratio between short- and long-acting benzodiazepines decreased by about one tenth during the observed period. Long-acting benzodiazepines were prescribed more often to the older patients. The decrease in anxiolytic/antidepressant ratio from 2005 to 2008 was the smallest in the elderly population. Further research is needed to ascertain the prescribers’ attitudes in order to devise strategies to further improve prescribing performance in elderly patients

Neonatal encephalopathy: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data.

To improve comparability of vaccine safety data, the acute neonatal encephalopathy working group has developed a case definition and guidelines neonatal encephalopathy applicable in study settings with different availability of resources, in healthcare settings that differ by availability of and access to health care, and in different geographic regions

An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries.

BACKGROUND: Evidence briefs for policy (EBPs) represent a potentially powerful tool for supporting evidence-informed policy-making. Since 2012, WHO Evidence-Informed Policy Network (EVIPNet) Europe has been supporting Member States in developing EBPs. The aim of this study was to evaluate the process of developing EBPs in Estonia, Hungary and Slovenia. METHODS: We used a rapid appraisal approach, combining semi-structured interviews and document review, guided by the Medical Research Council (MRC) process evaluation framework. Interviews were conducted with a total of 20 individuals familiar with the EBP process in the three study countries. Data were analysed thematically, and emerging themes were related back to the MRC framework components (implementation, mechanisms of impact, and context). We also reflected on the appropriateness of this evaluation approach for EVIPNet teams without evaluation research expertise to conduct themselves. RESULTS: The following themes emerged as important to the EBP development process: how the focus problem is prioritized, who initiates this process, EBP team composition, EBP team leadership, availability of external support in the process, and the culture of policy-making in a country. In particular, the EBP process seemed to be supported by early engagement of the Ministry of Health and other stakeholders as initiators, clear EBP team roles and expectations, including a strong leader, external support to strengthen EBP team capacity and cultural acceptance of the necessity of evidence-informed policy-making. Overall, the evaluation approach was considered feasible by the EBP teams and captured rich qualitative data, but may be limited by the absence of external reviewers and long lag times between the EBP process and the evaluation. CONCLUSIONS: This process occurs in a complex system and must be conceptualized in each country and each EBP project in a way that fits local policy-making culture, priorities, leadership and team styles, roles and available resources. The use of a rapid appraisal approach, combining qualitative interviews and document review, is a feasible method of process evaluation for EVIPNet member countries

Prescribing of benzodiazepines among slovenian family physicians

Background: In spite of their side effects, benzodiazepines are the most frequently prescribed psychotropic drugs in family medicine. The objective of this study was to investigate the possible association between physician characteristics, practice structure and practice population size with the pattern of prescribing benzodiazepines among Slovenian family physicians. Methods: We studied a representative sample of 100 family physicians using a combination of self-administered questionnaire, demographic data and data on prescribing provided by the Institute of Public Health of the Republic of Slovenia. The characteristics potentially influencing frequent prescribing were investigated by multiple linear regression analysis. Results: The estimated annual benzodiazepine consumption in Slovenia is nearly 3-fold lowerthan in the United Kingdom. Benzodiazepines were found to be less frequently prescribed by physicians with lower numbers of registered patients,as well as by female physicians, younger physicians, physicians followig the specialist training, those with short length of service, and by physicians working in large towns of the central healthcare region. The physicians\u27 age and access to computerised decision-making support for drug management at the workplace were found to be significantly associated with increased prescription of benzodiazepines compared to the volume of prescribed psychotropic drugs. Conclusions: The results indicate that family physicians in Slovenia prescribe appropriate amounts of benzodiazepines. Benzodiazepines are less frequently prescribed in practices with less workload, by younger and female family physicians, in practices located in central Slovenia and by family physicians with online access to information at their workplace.Izhodišča: Kljub stranskim učinkom so benzodiazepini najpogosteje predpisani psihofarmaki v družinski medicini. Z raziskavo smo ocenjevali povezanost značilnosti zdravnikov, značilnosti ambulantnega dela in velikosti populacije bolnikov s predpisovanjem benzodiazepinov pri slovenskih zdravnikih družinske medicine. Metode: Na reprezentativnem vzorcu stotih zdravnikov družinske medicine smo z multiplo linearno regresijo ocenili, kateri dejavniki vplivajo na pogosto predpisovanje benzodiazepinov. Rezultati: Zdravniki družinske medicine v Sloveniji predpišejo v povprečju skoraj trikrat manj benzodiazepinov kot v Veliki Britaniji. Manj pogosto so benzodiazepine predpisovali zdravniki z manjšim številom opredeljenih bolnikov, zdravnice, mlajši zdravniki, specializanti, zdravniki s krajšo delovno dobo in zdravniki v večjih krajih v osrednjem delu države. Delež benzodiazepinov med vsemi recepti za psihofarmake je bil večji pri starejših zdravnikih in zdravnikih, ki na delovnem mestu niso imeli dostopa do spletne informacijske podpore pri predpisovanju zdravil. Zaključek: Zdravniki družinske medicine v Sloveniji zmerno predpisujejo benzodiazepine. Manjše predpisovanje je povezano z manjšimi delovnimi obremenitvami, ženskim spolom, nižjo starostjo, umeščenostjo ambulante v centralnih delih Slovenije in dostopom do spletne informacijske podpore pri predpisovanju zdravil na delovnem mestu

Additional file 1 of An evaluation of the evidence brief for policy development process in WHO EVIPNet Europe countries

Additional file 1: Appendix S1. Data collection tool for semi-structured interviews. Appendix S2. Composition of EBP teams in each study country