Tomasz Grodzicki
Zdrowie Publiczne i Zarządzanie, Tom 9, Numer 1, 2011, s. 110 - 118
https://doi.org/10.4467/20842627OZ.11.008.0345The analysis of the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge
Background: It is thought that at least one medication is taken by up to 60% of elderly people. What is more, in US elderly people living in the community take on average four medications, while home-care residents take averagely seven drugs a day. The above-mentioned facts, in the light of current demographic changes of the structure of population, indicate the growing cost of ambulatory drug therapy of the elderly.
Aim of the study: To analyze the costs of one month of ambulatory drug therapy in the group of elderly aged 80 and over following hospital discharge. Moreover, the relation between the number of pills and drugs taken in general, concomitant illnesses and costs of therapy were assessed.
Materials and methods: The retrospective analysis of medical documentation of 116 patients aged 80 and over was performed. The costs of therapy were calculated accordingly to the prices published in The Drug Index. Co-morbid illnesses were classified accordingly to the International Classification of Diseases (ICD-10). Analysis in the age subgroups was performed.
Results: Mean age was 85.2 ± 4.2y-rs, group consisted of 62 women and 27 men; 27 patients were excluded from further analysis. Mean number of prescribed drugs was 7.6 ± 2.9 (min.–max.: 1–16), mean number of prescribed pills was 8.8 ± 4.3 (min.–max.: 0–23). Patients in the examined group suffered from 5.8 ± 2.0 chronic diseases averagely. Mean cost of one month of ambulatory drug therapy was 135.9 ± 95.7 PLN (min.–max.: 1,96–625,9 PLN). Significant relations between the costs of ambulatory drug therapy and the number of chronic diseases (r = 0.51, p < 0.0001) as well as the number of pills (r = 0.68, p < 0.001) and drugs (r = 0.74, p < 0.001) were observed. The differences in the subgroups were observed.
Conclusions: The high co-morbidity observed in the elderly results in the need for taking a great number of drugs and consequently causes high costs of ambulatory drug therapy. When planning ambulatory treatment, it is important to analyze the patients’ and their families’ financial situation, and when necessary provide economical support.
Tomasz Grodzicki
Zdrowie Publiczne i Zarządzanie, Tom 7, Numer 2, 2009, s. 120 - 127
About 40% of men and 25% of women in Poland are smokers and smoking causes approximately 50 000 premature deaths annually. According to the WHO experts, a tobacco cessation short intervention program provided by primary care physicians is one of the most important prevention measures. In 2004 National Cardiovascular Disease Prevention Program was launched as a procedure funded by National Health Funds (NFZ), which included the identification of smokers, assessment and treatment of smoking habit. In 2007, the Polish Forum of Prevention issued guidelines that can serve as an effective framework for tobacco cessation intervention in primary care clinics.
The aim of this paper is: 1) evaluation the effectiveness of primary care in professional assistance for smoking patients, 2) evaluation of the impact of the NFZ program on frequency of professional consultations on smoking cessation and evaluation of the impact of the NFZ program on smoking prevalence. There were 66 primary care clinics which were recruited to participate the project; 33 clinics participated in NFZ program, the remaining 33 constituted a control group.
Random sample of persons at age 35–55 years was selected from all persons registered in each clinic. Eligible for the study were patients free of cvd for whom medical records were available from January 1st 2005 at least. Finally 3940 patients in NFZ clinics, 3162 patients in control clinics were included. For each eligible patient medical records were reviewed and information was collected using a standard questionnaire.
All patients were invited for a visit in the clinic. Finally, 2314 persons from the NFZ clinics and 2107 persons from the control clinics participated were examined.
That effectiveness of the routine management of smoking cessation in primary care practices was very low. Equally in the NFZ clinics and the control group about 45% of participants were current smokers. Only 15% of patients had recorded information on smoking status in medical documentation and no significant difference between the NFZ clinics and the control group was observed. The NFZ program increased identification of smoking patients (up to about 80%). Physicians and nurses provided advising to 80% and 30% patients, respectively and the other measures to facilitate smoking cessation were used in small proportion of patients. For instance nicotine replacement therapy, including bupropion, was advised to less than 10% of smokers.
With the exception to distribution of leaflets which were distributed more frequently in patients of clinics which participated in the NFZ program (22.5%) as compared to control clinics (12.8%), there were no statistical differences in proportion of patients getting professional assistance or other intervention measures between the studied groups. The NFZ program appeared to play important role in identification of smokers. However, the program was not effective enough in treatment of patients addicted to smoking. There is a need to supply the NFZ program by more effective procedure, a kind of structured intervention, which would allow to lower smoking prevalence in primary care patients.