Antibiotic prescription for acute respiratory infections in preschool children in family medicine

Vodeće bolesti u djece predškolske dobi u Hrvatskoj su bolesti respiratornog sustava (oko 35%), kao i razlog za neopravdano propisivanje antibiotika. Cilj: procijeniti opterećenost ordinacija obiteljske medicine (OOM) tijekom zimskih mjeseci zbog akutnih respiratornih infekata (ARI) djece predškolske dobi, te istražiti povezanost propisivanja antibiotika sa sociodemografskim pokazateljima, zdravstvenim stanjem i zdravstvenim navikama djece, te karakteristikama konzultacije. Ispitanici i metoda:. Prospektivno istraživanje provedeno je u tri OOM, u Zagrebu kroz tri zimska mjeseca od 01. 12. 2013. - 28. 02. 2014. Obuhvaćeno je 265 djece predškolske dobi. Podaci su prikupljeni iz e-medicinskih kartona u upitnik sastavljen za ovo istraživanje. Rezultati: 105 (39,6%) djece tijekom zimskih mjeseci je posjetilo svoga liječnika zbog 146 slučajeva ARI. Antibiotik je dobilo njih 27 (25,7%). Propisivanje antibiotika je bilo statistički značajno više kod djece: starijih roditelja (pmajki = 0,002, počevi = 0,05), onih koji imaju kronične bolesti (p = 0,03), te onih koji češće posjećuju liječnika obiteljske medicine (LOM) (p < 0,001). U 21/28 antibiotik je propisao LOM i to prilikom prve posjete. Najviše antibiotika je ropisano u ponedjeljak, djeci između 5-6 godina koja su toga dana kasnije došla. Antibiotik je češće propisivan djeci s višim vrijednostima CRP-a (p = 0,017) i leukocita (p = 0,043). Najčešće dijagnoze za propisivanje antibiotika su bile: u 9/28 slučajeva nesupurativna upala srednjega uha (H65), u 8/28 akutni tonzilitis (J03), te u 4 slučaja podjednako zbog akutnog sinusitisa (J01) i akutnog bronhitisa (J20). Najčešće su propisivani penicilinski antibiotici (21/28). Logistička regresija je povezala propisivanje antibiotika s većim brojem djece u obitelji, djecom koja pohađaju vrtić, te s djecom za koje roditelji smatraju da su osjetljivija. Zaključak: Rezultat ovoga istraživanja o učestalosti propisivanja antibiotika za ARI djece predškolske dobi sukladan je rezultatima istraživanja provedenih u zemljama s niskom stopom propisivanja antibiotika. Bolja edukacija liječnika i izrada smjernica koje bi im pomogle u procesu odlučivanja o propisivanju antibiotika može unaprijediti primjerenost propisivanja, kao i senzibilizaciju javnosti.Leading diseases in preschool children in Croatia are diseases of the respiratory system (about 35%), as well as the leading reason for unjustified antibiotics prescription. Objective: To investigate the burden of family medicine practices during the winter months due to RTI in preschool children and to assess the prescription of antibiotics in relation to socioeconomic factors, health status and health habits of children and characteristics of the consultation. Patients and methods: The prospective study was conducted in three family medicine practices in Zagreb during three winter months from 1st December 2013 – 28th February 2014. The sample included 265 preschool children. Data were collected from the e - medical records in a questionnaire compiled for this study. Results: 105 (39.6 %) children during the winter months visited their general practitioners for about 146 RTI episodes. In 25.7% of these episodes an antibiotic was issued. Prescription of antibiotics was significantly higher in children: with older parents (pmum = 0.002, pdad = 0.05), with chronic diseases (p = 0.03 ), frequent attendees (p < 0.001). 21/28 antibiotics were prescribed on the first visit. Most antibiotics were prescribed on Monday and often to the children who came later that day and older children between 5-6 years. The antibiotics were often prescribed to children with higher CRP values (p = 0.017) and leukocytes (p = 0.043). The most common diagnoses for the prescribed antibiotics were: in 9/28 cases acute otitis media (H65), 8/28 acute tonsillitis (J03), and 4 cases of acute sinusitis (J01) and acute bronchitis (J20). Penicillin was the most prescribed antibiotic (21/28). Logistic regression analyses also predicted a correlation between antibiotic prescriptions and families with many children, children who attend nursery, and children with higher parental perception of child vulnerability. Conclusion: The results of our study about the frequency of antibiotic prescription to preschool children for RTI correspond to investigations conducted in countries with low antibiotic prescription rate. Better education of doctors and the development of guidelines which would help them in the decision-making process in terms of antibiotics prescription may even reduce the rate of prescription as well as sensitize the public

ATTITUDES AND KNOWLEDGE OF GENERAL PRACTITIONERS ABOUT IRRITABLE BOWEL SYNDROME

Dijagnosticiranje sindroma iritabilnog crijeva (SIC) je često problem liječniku obiteljske medicine (LOM) jer se oslanja na simptome bez konkretnih bioloških biljega. Cilj rada bio je ispitati stavove i znanja LOM u prepoznavanju i liječenju pacijenata oboljelih od SIC-a. Ispitivanje je provedene na 51 LOM koji u skrbi imaju 87.000 pacijenata od kojih oko 1.530 sa SIC-om, iz dva doma zdravlja u Zagrebu, temeljem upitnika sastavljenog za ovo istraživanje. Upitnik je sadržavao pitanja o stavovima LOM-a, znanju o SIC-u temeljem vignette i općenito. U usporedbi s drugim bolnim stanjima, LOM imaju najmanje samopouzdanja, najmanje zadovoljstva, troše puno vremena i najteže im je dijagnosticirati i liječiti pacijente oboljele od SIC-a. U prikazu slučaja temeljem vignette LOM su točno odgovorili da se radi o SIC-u (84 %) i najviše bi ih dalo dijetetski savjet i pratili pacijenta (67%). Za dijagnozu SIC-a najveći dio liječnika smatra nužnim uzeti u obzir dijagnostičke kriterije, isključiti alarmantne simptome i napraviti osnovne laboratorijske pretrage (39 %). Većina LOM smatra SIC funkcionalnim poremećajem crijeva (92 %), 63 % liječnika koristi dijagnostičke kriterije za SIC, a 61 % ih je upoznato s Rimskim III kriterijima za SIC. Gastroenterologa bi konzultiralo 53 % LOM u slučaju nesigurnosti u dijagnozu i 35 % LOM kod neučinkovitosti liječenja. Većina (51 %) u liječenju SIC-a prepisuje farmakoterapiju za funkcionalne poremećaje crijeva. LOM su pokazali veliko znanje u prepoznavanju i dijagnosticiranju SIC-a, ali u odnosu na druga bolna stanja imaju malo amopouzdanja, malo zadovoljstva, troše puno vremenai najteže im je dijagnosticirati i liječiti pacijente oboljele od SIC-a. Potrebna je daljnja edukacija s aktivnijim pristupom u obliku radionica koje bi uz unaprjeđenje znanja mogle utjecati i na promjenu stavova.Diagnosing irritable bowel syndrome (IBS) is often a problem for general practitioners (GPs) because they rely on symptoms without specifi c biological markers. The objective was to examine the attitudes and knowledge of GPs in identifying and treating patients with IBS. The study included 51 GPs who take care of 87,000 patients, approximately 1,530 of them with IBS, on the basis of a questionnaire developed for this study in two health centers in Zagreb. The questionnaire contained questions with a case vignette on GP attitudes and knowledge about IBS. In comparison with other pain conditions, GPs were found to have least confi dence and pleasure, while spending a lot of time and fi nding it most diffi cult to diagnose and treat patients suffering from IBS. In the case vignette, GPs answered correctly that it was IBS (84%) and most of them would give dietary advice and follow up the patient (67%). For the diagnosis of IBS, most physicians considered necessary to take diagnostic criteria into account, exclude alarming symptoms and do basic laboratory tests (39%). Most GPs considered IBS to be a functional bowel disorder (92%), 63% used diagnostic criteria for IBS, and 61% were familiar with the Rome III criteria for IBS. Gastroenterologists would be consulted by 53% of GPs in case of uncertain diagnosis and 35% of GPs for therapeutic ineffi ciency. In the treatment of IBS, most GPs (51%) prescribe pharmacotherapy for functional bowel disorders. The authors conclude that GPs showed great knowledge in recognizing and diagnosing IBS, but compared to other painful conditions they have little self-confi dence and pleasure. They spend a lot of time and fi nd it most diffi cult to diagnose and treat patients suffering from IBS. Additional education is needed with a more proactive approach in the form of workshops, which may bring change in their attitudes and improve their knowledge

ATTITUDES AND KNOWLEDGE OF GENERAL PRACTITIONERS ABOUT IRRITABLE BOWEL SYNDROME

Dijagnosticiranje sindroma iritabilnog crijeva (SIC) je često problem liječniku obiteljske medicine (LOM) jer se oslanja na simptome bez konkretnih bioloških biljega. Cilj rada bio je ispitati stavove i znanja LOM u prepoznavanju i liječenju pacijenata oboljelih od SIC-a. Ispitivanje je provedene na 51 LOM koji u skrbi imaju 87.000 pacijenata od kojih oko 1.530 sa SIC-om, iz dva doma zdravlja u Zagrebu, temeljem upitnika sastavljenog za ovo istraživanje. Upitnik je sadržavao pitanja o stavovima LOM-a, znanju o SIC-u temeljem vignette i općenito. U usporedbi s drugim bolnim stanjima, LOM imaju najmanje samopouzdanja, najmanje zadovoljstva, troše puno vremena i najteže im je dijagnosticirati i liječiti pacijente oboljele od SIC-a. U prikazu slučaja temeljem vignette LOM su točno odgovorili da se radi o SIC-u (84 %) i najviše bi ih dalo dijetetski savjet i pratili pacijenta (67%). Za dijagnozu SIC-a najveći dio liječnika smatra nužnim uzeti u obzir dijagnostičke kriterije, isključiti alarmantne simptome i napraviti osnovne laboratorijske pretrage (39 %). Većina LOM smatra SIC funkcionalnim poremećajem crijeva (92 %), 63 % liječnika koristi dijagnostičke kriterije za SIC, a 61 % ih je upoznato s Rimskim III kriterijima za SIC. Gastroenterologa bi konzultiralo 53 % LOM u slučaju nesigurnosti u dijagnozu i 35 % LOM kod neučinkovitosti liječenja. Većina (51 %) u liječenju SIC-a prepisuje farmakoterapiju za funkcionalne poremećaje crijeva. LOM su pokazali veliko znanje u prepoznavanju i dijagnosticiranju SIC-a, ali u odnosu na druga bolna stanja imaju malo amopouzdanja, malo zadovoljstva, troše puno vremenai najteže im je dijagnosticirati i liječiti pacijente oboljele od SIC-a. Potrebna je daljnja edukacija s aktivnijim pristupom u obliku radionica koje bi uz unaprjeđenje znanja mogle utjecati i na promjenu stavova.Diagnosing irritable bowel syndrome (IBS) is often a problem for general practitioners (GPs) because they rely on symptoms without specifi c biological markers. The objective was to examine the attitudes and knowledge of GPs in identifying and treating patients with IBS. The study included 51 GPs who take care of 87,000 patients, approximately 1,530 of them with IBS, on the basis of a questionnaire developed for this study in two health centers in Zagreb. The questionnaire contained questions with a case vignette on GP attitudes and knowledge about IBS. In comparison with other pain conditions, GPs were found to have least confi dence and pleasure, while spending a lot of time and fi nding it most diffi cult to diagnose and treat patients suffering from IBS. In the case vignette, GPs answered correctly that it was IBS (84%) and most of them would give dietary advice and follow up the patient (67%). For the diagnosis of IBS, most physicians considered necessary to take diagnostic criteria into account, exclude alarming symptoms and do basic laboratory tests (39%). Most GPs considered IBS to be a functional bowel disorder (92%), 63% used diagnostic criteria for IBS, and 61% were familiar with the Rome III criteria for IBS. Gastroenterologists would be consulted by 53% of GPs in case of uncertain diagnosis and 35% of GPs for therapeutic ineffi ciency. In the treatment of IBS, most GPs (51%) prescribe pharmacotherapy for functional bowel disorders. The authors conclude that GPs showed great knowledge in recognizing and diagnosing IBS, but compared to other painful conditions they have little self-confi dence and pleasure. They spend a lot of time and fi nd it most diffi cult to diagnose and treat patients suffering from IBS. Additional education is needed with a more proactive approach in the form of workshops, which may bring change in their attitudes and improve their knowledge

Prescribing antibiotics to preschool children in primary health care in Croatia

The use of antibiotics depends on cultural and socioeconomic factors, physician's characteristics as well as on microbiological considerations. Aim of our study was to asses antibiotic prescription among preschool children in primary health care in Croatia in relation to socioeconomic factors, symptoms and diagnoses, and type of health care provider. Retrospective longitudinal survey was conducted in 7 teaching primary health care offices in the Croatian capital of Zagreb during 2004, among 1700 preschool children. Antibiotics were prescribed to 611 (46%) children. Significantly more antibiotics were prescribed to boys (66.7%, P = 0.024) and to children whose parents had lower educational level. Most frequently antibiotics were prescribed for the symptoms such as fever (32%), cough (32.5%), nasal discharge (12%), and for the diagnoses such as respiratory diseases (J00-J99) (40%), infectious and parasitic diseases (A00-A99) (31%), and diseases of the middle ear and mastoid (H60-H95) (15%). Logistic regression analyses also predicted correlation of antibiotic prescriptions with socioeconomic factors, symptoms and diagnoses and health care of pediatrician. Prescription of antibiotics for preschool children in primary health care in Croatia related to socioeconomic factors, type of health care provider, certain symptoms and diagnosis groups which should be taken into account when assessing and planning primary health care for preschool children

Prescribing nonsteroidal anti-rheumatics in family medicine

Uvod: Prema izvješću Hrvatske agencije za lijekove i medicinske proizvode (HALMED), za 2012. prema potrošnji lijekova, po terapijskim skupinama nesteroidni antireumatici (NSAIR) (M01) zauzimaju 8. mjesto sa 42,43 DDD/1000 stanovnika/dan. Cilj: Istražiti propisivanje NSAIR u ordinaciji obiteljske medicine s obzirom na: indikacije, duljinu terapije, nepoželjne komorbiditetne bolesti i nepoželjne kombinacije lijekova, adjuvantnu terapiju, te njihovu potrošnju. Ispitanici i metode: U tri ordinacije obiteljske medicine koje u skrbi imaju 5.716 ispitanika, provedeno je retrospektivno longitudinalno istraživanje u razdoblju od 1. 1. 2011 do 31. 12. 2011. Uzorak je činilo 1194 ispitanika kojima je propisan NSAIR. Sastavljen je upitnik koji je sadržavao demografske podatke, kliničke podatke, te podatke o dnevno definiranim dozama (DDD) NSAIR. Podaci za upitnik, te podaci o potrošnji NSAIR i ukupnoj potrošnji dobiveni su iz e-kartona u medicinskom informatičkom sustavu Medicus.net. Rezultati: NSAIR je propisan kod 21% (1194) ispitanika. Dva ili više NSAIR dobilo je 14% ispitanika. Najčešći razlog propisivanja NSAIR su koštano-mišićne bolesti (67,8%). Prosječna duljina trajanja terapije je 49,2 DDD (st. dev 62,0). Duljina terapije povećava se sa starošću ispitanika. Najčešće propisivan NSAIR je ibuprofen (31,6%). Najčešći nepoželjni komorbiditet su kardiovaskularne bolesti 38,4%), a nepoželjna interakcija s diureticima (34,1%). Od adjuvantne terapije benzodiazepini su propisani u 43%, a opioidni analgetici u 15,8% ispitnika. Inhibitori protonske pumpe (IPP) su propisani tek u 13,5% ispitnika. Udio nesteroidnih antireumatika u ukupnoj potrošnji iznosi oko 2%. Zaključak:NSAIR su propisani prečesto svakom petom ispitaniku i predugo. Preko polovine ispitanika imalo je nepoželjnu komorbiditetnu dijagnozu za primjenu NSAIR i koristilo lijekove s nepoželjnom interakcijom s NSAIR. Preporuke za daljnje istraživanje je istražiti mjere ishoda propisivanja NSAIR –a kod bolesnika s nepoželjnim komorbiditetima i nepoželjnim interakcijama, te temeljem toga izračunati stvarnu cijenu koju generira propisivanja NSAIR-a.According to HALMED (Croatian agency for medical products and medical devices) the consumption of NSAID (M01) occupied eighth place with 42.43 DDD/1000 inhabitants/day in 2012. Objective: To investigate the frequency of NSAIDs in GP offices regarding: participation in drug expenditure, indications, duration of therapy, unwanted comorbid diseases and drug interactions. Patients and methods: Retrospective longitudinal study of a sample of 5,716 patients from three GP offices was carried out in a one-year period (1.1.2011-31.12.2011). The sample included 1,194 patients with prescribed NSAID. A questionnaire designed for this investigation included questions about patients\u27 demographic and social characteristics, clinical information and the pattern of NSAID prescription (subgroup and DDD). Data were taken from computerized medical records in the information system Medicus.net. Results: NSAIDs were prescribed to 21% of patients. Musculoskeletal diseases (67.8 %) were the most common reason to prescribe NSAID. The average duration of the therapy was 49.2 DDD (SD 62.0). The most commonly prescribed NSAID was ibuprofen (31.6%). Two or more NSAIDs were prescribed to 14 % of respondents. The most common unwanted comorbidities were cardiovascular (38.4 %), and then gastrointestinal (17%) followed by renal diseases (1%). The most common unwanted drug interaction was with diuretics (34.1%). NSAIDs participated with about 2 % in total drug expenditure in GP offices. Conclusion: NSAIDs were prescribed to every fifth patient too often and too long. More than a half of the patients had unwanted comorbid diagnoses. The recommendation for further investigation is to investigate the outcome measures of prescribed NSAID among patients with unwanted diseases and drug interactions and to calculate real expenditure which generated NSAID prescription

Prescribing nonsteroidal anti-rheumatics in family medicine

Uvod: Prema izvješću Hrvatske agencije za lijekove i medicinske proizvode (HALMED), za 2012. prema potrošnji lijekova, po terapijskim skupinama nesteroidni antireumatici (NSAIR) (M01) zauzimaju 8. mjesto sa 42,43 DDD/1000 stanovnika/dan. Cilj: Istražiti propisivanje NSAIR u ordinaciji obiteljske medicine s obzirom na: indikacije, duljinu terapije, nepoželjne komorbiditetne bolesti i nepoželjne kombinacije lijekova, adjuvantnu terapiju, te njihovu potrošnju. Ispitanici i metode: U tri ordinacije obiteljske medicine koje u skrbi imaju 5.716 ispitanika, provedeno je retrospektivno longitudinalno istraživanje u razdoblju od 1. 1. 2011 do 31. 12. 2011. Uzorak je činilo 1194 ispitanika kojima je propisan NSAIR. Sastavljen je upitnik koji je sadržavao demografske podatke, kliničke podatke, te podatke o dnevno definiranim dozama (DDD) NSAIR. Podaci za upitnik, te podaci o potrošnji NSAIR i ukupnoj potrošnji dobiveni su iz e-kartona u medicinskom informatičkom sustavu Medicus.net. Rezultati: NSAIR je propisan kod 21% (1194) ispitanika. Dva ili više NSAIR dobilo je 14% ispitanika. Najčešći razlog propisivanja NSAIR su koštano-mišićne bolesti (67,8%). Prosječna duljina trajanja terapije je 49,2 DDD (st. dev 62,0). Duljina terapije povećava se sa starošću ispitanika. Najčešće propisivan NSAIR je ibuprofen (31,6%). Najčešći nepoželjni komorbiditet su kardiovaskularne bolesti 38,4%), a nepoželjna interakcija s diureticima (34,1%). Od adjuvantne terapije benzodiazepini su propisani u 43%, a opioidni analgetici u 15,8% ispitnika. Inhibitori protonske pumpe (IPP) su propisani tek u 13,5% ispitnika. Udio nesteroidnih antireumatika u ukupnoj potrošnji iznosi oko 2%. Zaključak:NSAIR su propisani prečesto svakom petom ispitaniku i predugo. Preko polovine ispitanika imalo je nepoželjnu komorbiditetnu dijagnozu za primjenu NSAIR i koristilo lijekove s nepoželjnom interakcijom s NSAIR. Preporuke za daljnje istraživanje je istražiti mjere ishoda propisivanja NSAIR –a kod bolesnika s nepoželjnim komorbiditetima i nepoželjnim interakcijama, te temeljem toga izračunati stvarnu cijenu koju generira propisivanja NSAIR-a.According to HALMED (Croatian agency for medical products and medical devices) the consumption of NSAID (M01) occupied eighth place with 42.43 DDD/1000 inhabitants/day in 2012. Objective: To investigate the frequency of NSAIDs in GP offices regarding: participation in drug expenditure, indications, duration of therapy, unwanted comorbid diseases and drug interactions. Patients and methods: Retrospective longitudinal study of a sample of 5,716 patients from three GP offices was carried out in a one-year period (1.1.2011-31.12.2011). The sample included 1,194 patients with prescribed NSAID. A questionnaire designed for this investigation included questions about patients\u27 demographic and social characteristics, clinical information and the pattern of NSAID prescription (subgroup and DDD). Data were taken from computerized medical records in the information system Medicus.net. Results: NSAIDs were prescribed to 21% of patients. Musculoskeletal diseases (67.8 %) were the most common reason to prescribe NSAID. The average duration of the therapy was 49.2 DDD (SD 62.0). The most commonly prescribed NSAID was ibuprofen (31.6%). Two or more NSAIDs were prescribed to 14 % of respondents. The most common unwanted comorbidities were cardiovascular (38.4 %), and then gastrointestinal (17%) followed by renal diseases (1%). The most common unwanted drug interaction was with diuretics (34.1%). NSAIDs participated with about 2 % in total drug expenditure in GP offices. Conclusion: NSAIDs were prescribed to every fifth patient too often and too long. More than a half of the patients had unwanted comorbid diagnoses. The recommendation for further investigation is to investigate the outcome measures of prescribed NSAID among patients with unwanted diseases and drug interactions and to calculate real expenditure which generated NSAID prescription

DEPRESSION PREVALENCE AND ESTIMATION OF PSYCHOSOCIAL PARAMETERS WITHIN ADULT POPULATION IN CITY OF ZAGREB

Background: There is no data on depression prevalence in Croatia. The aim of this study was to establish the prevalence and psychosocial risk factors of depression in the adult population of the Croatian capital Zagreb, particularly in patients suffering from Depressive episode (F32) and Recurrent depressive disorder (F33). Subjects and methods: A cross-sectional study was preformed on a representative sample for city of Zagreb drawn from 10 family physicians’ offices with 17290 patients. From standardized medical files, the family physicians sorted out data of patients with depression, both Depressive episodes (F32) and Recurrent depressive disorder (F33), classified according to ICD 10. Psychosocial parameters were assessed according to the core questions for the management of psychosocial risk factors recommended by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice. Results: The prevalence of depression was 2.2%. Recognized socioeconomical parameters were: female sex (74.7%), middle age 45-65 years (40.7%), married (55.3%), high school education (59.2%), retired (54.5%), and average economical status (73.6%). As regards social isolation: depressive patients were not living alone (71.5%), they had help in case of illness (80.9%), and had no problems with their partner (36.8%). Work stress parameters were estimated between 5 and 6. Life satisfaction was estimated mean ± SD=4.57±1.72. Logistic regression analysis showed a significant association between higher education and physicians’ perception as “more depressed and more difficult” patients with Recurrent depressive disorder (F33). Family physicians were unfamiliar with the genealogical disease burden for 45% of depressive patients, whether they had closed confident for 21.93% and problems with partner for 30.80%. Conclusion: Depression had a prevalence of 2.2%. It was poorly recognized, as were some psychosocial factors especially genealogical disease burden. This suggests the need for implementation of special intervention methods of developing the family physicians‘skills in adopting the psychosocial approach to depressive patients with a focus on recognized psychosocial risk factors

COMPARISON OF DEPRESSION TREATMENT AMONG DIFFERENT AGE GROUPS IN PRIMARY CARE SETTING

Background: The aim of this study was to explore the association between age and care of patients with depression in primary care setting. A comparison was made among the groups of elderly patients, middle aged patients and younger patients with diagnosis of depressive episode (F32). Subjects and Methods: Patients (17.290) from ten GP offices in the city of Zagreb formed the representative sample for this study according to the estimated depression prevalence in Europe of 5%. A group of 231 (60%) patients with diagnosis Depressive episode (F32), out of 383 patients with Depression diagnosis according to ICD-10, were reviewed and extracted from GPs’ standardized medical files. They were divided in three age groups: 65 years (n=76). Data were tracked longitudinally and obtained retrospectively for one-year period from 1st January to 31th December 2009. Pharmacotherapy was classified according to the Anatomical Therapeutic Chemical (ATC) classification index. Results: The youngest and the oldest age group mainly used only one drug in their therapy (47% vs- 64%), but middle age group almost equally used one or two drugs (42 vs 45%). About 50% of all patients used SSRIs. Benzodiazepines were used most frequently in middle and in the oldest age group (71% vs 60%). The most frequent combinations of antidepressants in the youngest age group were SSRIs and combination of SSRIs and benzodiazepines; in middle age group it was combination of SSRIs and benzodiazepines and benzodiazepines; and in the oldest benzodiazepines, and SSRIs. Benzodiazepines were used mainly discontinuously in oppose to significant continuous usage in middle age group (P 0,043). In the oldest age groupe, depression diagnose was mostly given by GP and the most frequent therapy was combination of pharmacotherapy and GP\u27s support. Unaided clinical assessment of depression outcome by GP did not differ significantly between age groups although some differences existed. Conclusion: Number and sort of antidepressants as well as sort of physician: GP or psychiatrist differed between age groups of depressed patients. Further investigation of specifical depression treatment compared with outcome measures should give answer whether those differences are justified