The consumption of the drugs included in the Model List of Essential Drugs (ED) of WHO was studied in the United Regional Clinical Hospital of Varna for the first time. The purpose of the study was to estimate the consumption of these drugs in the hospital as a whole as well as in every hospital division. The monthly variations of the consumption were analyzed according to the specific activity of these divisions. The mean ED consumption by the patients in all the divisions was calculated. Those of them with the highest frequency of ED usage recommended in the Model List were presented. Certain conclusions about the benefit of the introduction of this Model List of ED and its importance for some hospital pharmaco-economic factors were drawn

Belcheva, A.

Eliseev, V.

Milev, E.

English

Varna Medical University Press: Journals

I Scripta Scientifica Medica, vol 31 (1999), pp. 121-124 Copyright © Medical University, Varna ESSENTIAL DRUGS AND THEIR R O L E IN T H E HOSPITAL DRUG CONSUMPTION IN T H E UNITED REGIONAL CLINICAL HOSPITAL-VARNA IN 1997 V. Eliseev, E . Milev*, A. Belcheva* United Regional Clinical Hospital of Varna and ^Department of Pharmacology, Medical University of Varna, Varna The consumption of the drugs included in the Model List of Essential Drugs (ED) of WHO was studied in the United Regional Clinical Hospital of Varna for the first time. The purpose of the study was to estimate the consumption of these drugs in the hospital as a whole as well as in every hospital division. The monthly variations of the consumption were analyzed according to the specific activity of these divisions. The mean ED consumption by the patients in all the divisions was calculated. Those of them with the highest frequency of ED usage recommended in the Model List were presented. Certain conclusions about the benefit of the introduction of this Model List of ED and its importance for some hospital pharmaco-economic factors were drawn. Key words: Essential drugs, drug consumption, monthly drug variation, town of Varna pi New developments in social life and related changes in the business envi-ronment lead to restructuring the drug market and rationaling the roles of com-panies and consumers. These changes put new requirements to the governmental hospitals' behaviour. The elaboration of a drug policy taking into account the speci-ficity of each hospital becomes a major riority. A substantial element of the hos-pital drug policy is the elaboration and approval of a list of used drugs. It is based international and local standards exist-Vddress for correspondence: . Milev, Dept. of Pharmacology, Medical University of Varna, 55, Marin Drinov St., 3G-9002 Varna, BULGARIA E-mail: pharmac@asclep.muvar.acad.bg ing in this field and on the particular needs of every clinic or hospital. Regardless of the limitation of physicians' access to drugs and the resulting decreased freedom in their clinical practice it is extremely impor-tant to the rationalization of the drug con-sumption. Since 1977, the World Health Or-ganization (WHO) regularly assesses the consumption of drugs and recommends to medical community these of them that, because of their effectiveness, safety, in-contestable therapeutic qualities and good pharmacoeconomical profile, have be-come a reliable treatment standard. They are included in the Model List of W H O and are known as Essential Drugs ( E D ) . They meet the needs of the majority of the V. Eliseev, Е. Milev, A. Belcheva population and are available at every mo­ment and level in the health care system. The Bulgarian Model List for hospital drug use is based on them, too. A widely known weakness of the hospitals in Bulgaria is the use of too many drugs per patient (polypragmasia) which can be classified as irrational and "infatuation in fashion". At the same time, W H O has long ago proved that the necessary hospital medi­cations are between 100 and 200, de­pending on the place of the hospital in the national health care system. That is why the hospital lists can become a major and rational regulator of the drug therapy, par­ticularly until the approval of criteria of Good Clinical Practice (GCP) . The aim of this study is to assess the extent to which the use of drugs in the United Regional Clinical Hospital of Varna (URCH-Varna) conforms to the Model List of E D of W H O , Revision of Decem­ber, 1995 (3), and whether the prescrip­tion of the E D has a priority over that of the others. MATERIAL AND METHODS The subject of this trial is the drug use of all medications prescribed in the URCH-Varna during the period from Janu­ary 1,1 997 till December 31,1997 with exception of those either used for less than 9 months, or provided as humanitarian aid. A total of 510 drugs from all pharmaco­logical groups according to the Hospital drug list are included. The medications are divided into three groups taking into ac­count their conformity to the Model List of E D of W H O . Statistical methods (variation analysis, Student's f-criterion) are used to compare the groups (2). RESULTS AND DISCUSSION The monthly consumption of 510 medications in U R C H - Vama in 1997 was established and compared to the Model List of E D of WHO. A total of 265 medi­cations of 172 drug substances were E D , which represented only 52 % of the cases. The variation in the monthly consumption of the drugs in the three studied groups was statistically insignificant. The ratio be­tween the variation in the monthly con­sumption of drugs and the average one could serve as a criterion for the assess­ment of the stability of preservers' pref­erence to a particular medication (or medi­cations). This statement was based on the argument that the more frequent and regu­lar the preference of a large group of pre­scribes to a given drug, the less the varia­tion in the monthly consumption (Table 1). The established average variation in the monthly drug consumption in URCH-Varna during 1997 was of 78,96 % 34,36 and indicated the absence of stable preferences to particular drugs. The value for 1995 was of 72,78 34,37. Con­sequently, there were no quantitative changes in the pathology that could seri­ously influence on the regularity in the use of the drugs, respectively on its average variation. The established value of monthly variation could hardly be considered as 122 Essential drugs and their role in . able 1 Consumption of drugs in URCH-Varna in 1997 Drugs used in U R C H Group one Prescribed drugs (total) Group two E D Group three Non-ED n 510 265 245 Mean variation 78,96 % 79,78 % 78,08 % Standard deviation 34,36 % 37,97 % 30,03 % Statistical significance p>0,10 p>0,10 significant because the role of financial and commercial factors could not be ignored. The variation in the consumption of non-essential drugs was less than that of E D and that of all the drugs, regardless the fact that their number is less. The difference was statistically insignificant. The study could not establish any substantial difference in the preferences of the physicians to E D or non-ED. This is a disappointing statement as it stresses the disparity in the criteria of drug quality and effectiveness between Bulgarian medical community and the W H O experts. Since its creation twenty years ago, the Model List of W H O has been modified six times. The total number of the active substances included has, however, never exceeded 220. The Bulgarian specialists still can not make their choice of really useful and relatively safe medications among the large number of drugs available on the market. This explains the polypragmasia and irra-tional drug use in URCH-Varna already detected in our previous studies (1). CONCLUSIONS 1. The drug use in URCH-Varna proves to be irrational, not only from the quantitative but also from the qualitative point of view, because only about 50 % of the drugs are essential. 2. The established disparities are most probably due to the lack of adequate appraisal of the long-term effectiveness, safety and reliable therapeutic qualities df drugs on the part of the physicians. 3. The absence of nationally ac-cepted criteria for G C P imposes the ap-plication of the Bulgarian Model list of the hospital drug use as a harder, including administrative, criterion for rational thera-peutic policy. 4. The limitation of the drugs avail-able in the hospital pharmacy remains the most important means for overcoming the irrationality in the choice of drug therapy and, as the world experience indicates, represents a totally pertinent and legally approved component of the hospital man-agement. 123 V. Eliseev, Е. Milev, A. Belcheva REFERENCES 1. Е л и с е е в , В . и д р . В: I V Нац. конгр. фармакол. София, Х.1997 г.- 2. Медицинска статистика. Под ред. Д . С е п е т л и е в и Т. П а с к а л е в . София, Медицина и физкултура, 1968 г.- 3. Essential Drugs: WHO Model List: Revised in De­cember 1995. WHO Drug Inform., 9, 1995 No 4. Роля на основните лекарствени средства ("Essential drugs") в болничното лекарствено потребление на ОРКБ-Варна през 1997 г. В. Елисеев, Е. Милев*, А. Белчева* ОРКБ-Варна и *Катедра по фармакология, Медицински университет-Варна Резюме: За пръв път в ОРКБ-Варна бе проучена консумацията на лекарствените средства, включени в моделната листа на СЗО за "Essential drugs" (ED). Целта на проучването бе да се определи консумацията на тези лекарствени средства в болницата като цяло и за всяко болнично отделение. Анализирани бяха месечните вариации в потреблението в зависимост от специфичната дейност на тези отделения. Изчислена бе средната консумация на E D от пациентите във всички отделения. Представени бяха отделенията с най-висока честота на използване на препоръчаните в ED-листата медикаменти. Направени бяха някои изводи за полезността от въвеждането на моделната листа за "Essential drugs" и значението й за някои фармако-икономически фактори на болницата. 124 

ESSENTIAL DRUGS AND THEIR ROLE IN THE HOSPITAL DRUG CONSUMPTION IN THE UNITED REGIONAL CLINICAL HOSPITAL-VARNA IN 1997

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ESSENTIAL DRUGS AND THEIR ROLE IN THE HOSPITAL DRUG CONSUMPTION IN THE UNITED REGIONAL CLINICAL HOSPITAL-VARNA IN 1997

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