[Utilization of generic drugs in Spain and Catalonia: possibilities of savings]. / Implantación de medicamentos genéricos (EFG) en España y Cataluña: posibilidades de ahorro.

OBJECTIVES: To analyze the degree of utilization of generic drugs in Spain and Catalonia. To determine real savings and scope for further savings due to the use of generic drugs. DESIGN: Descriptive, crossover study. SETTING: Public health prescription in Spain and Catalonia in June of 1999 and in Catalonia from January to June of 1999. MEASUREMENTS AND MAIN RESULTS: In June of 1999, the market share of generic drugs in Spain was 1.15% in units and 0.91% in pesetas of the hole drug prescription. The most used were oral ranitidine, oral diclofenac and oral amoxicillin. Catalonia, in this period, has a greater relative utilization of generic drugs, specially in psychotherapeutic agents like alprazolam and fluoxetine. During the first semester of 1999 only in 9.9% of the occasions where generic drugs could be used, were they actually prescribed. Specifically, the drug most used in its generic form was oral diclofenac with 27.1% of the all possible prescriptions. The real savings generated by the generic drugs were 0.2% of the public pharmaceutical bill, and the theoretical capacity of savings with the current generic offer were 2.3%. CONCLUSIONS: There is a low but fast-rising utilization of generic drugs in Spain and Catalonia. Nevertheless the possibilities of savings are at the moment, in relative terms, small. A greater use of them and specially a diversification of the offer is necessary to achieve important relative savings in the overall pharmaceutical bill.

Implantación de medicamentos genéricos (EFG) en España y Cataluña: posibilidades de ahorro / Utilization of generic drugs in spain and catalonia: possibilities of savings

Objetivo. Estudiar el grado de implantación de las especialidades EFG en España y Cataluña. Conocer el ahorro generado y teóricamente generable a partir de la oferta de EFG disponibles. Diseño. Estudio descriptivo, transversal. Emplazamiento. Prescripción por receta de la Seguridad Social en España y Cataluña en junio de 1999 y en enero-junio de 1999 para Cataluña. Mediciones y resultados principales. En junio de 1999, la participación de las EFG en España fue el 1,15 por ciento en envases y un 0,91 por ciento en importe sobre el total de la prescripción. Las EFG más prescritas fueron ranitidina oral, diclofenaco oral y amoxicilina oral. En ese período Cataluña presenta una utilización relativa de EFG mayor, especialmente en psicofármacos como alprazolam y fluoxetina. Durante el período enero-junio de 1999, de las prescripciones realizables como EFG en Cataluña tan sólo un 9,9 por ciento fue prescrito como tal. En concreto, el principio activo más prescrito como EFG fue el diclofenaco oral, con un 27,1 por ciento de las prescripciones. El ahorro generado por las EFG fue sólo de un 0,2 por ciento y la capacidad de ahorro teórica no utilizada (al no prescribir un EFG en lugar de una especialidad de marca) fue del 2,3 por ciento sobre el importe PVP del total de la prescripción. Conclusiones. La implantación de los genéricos en España y Cataluña es baja, pero está incrementándose con rapidez. Sin embargo, la capacidad de ahorro es actualmente todavía baja respecto al gasto total. Se precisa una mayor utilización y especialmente una mayor diversificación de la oferta EFG para conseguir un impacto relativo importante sobre la factura farmacéutica (AU)

[The factors that influence the use of antibiotics in primary care]. / Factores que influyen sobre la utilización de antibióticos en atención primaria.

OBJECTIVE: To identify factors influencing volume, quality and power of antibiotic prescription in primary care. DESIGN: Descriptive, crossover study. SETTING: Sanitary Region Coast of Ponent, 1992. PARTICIPANTS: They were studied 468 practitioners of primary care attention. 68 practitioners were excluded by various reasons. MEASUREMENTS AND MAIN RESULTS: The factors studied were: factors coming from the practitioner, the centre, and the assisted population. The following parameters were analysed: amount of prescribed antibiotics in DDDs, election level ("antibiotic power") and percentage of DDDs of low intrinsic value. It was used for the comparison of means, Student-Fisher t test and the confidence intervals of the difference. Also it was used the step-wise multiple regression analysis. Greater use of antibiotics. The variability can be explained through regression in a 45.7% in function of the doctors factors, not integrated in a team, older, doctor who works in a rural centre, of young population and of smaller revenue. Greater antibiotic power. It's explained in a 5.09% by the medical factors like man, that works in a not educational centre and of greater population revenue. Greater percentage of DDDs of low intrinsic value. It's greater in doctors not specialized in family care, permanent job, of greater age, men, not reformed professional and not of an educational centre. CONCLUSIONS: The volume of prescription of antibiotics and in minor extent its quality of prescription are in some part justified by variables coming from the practitioner, the centre and the assisted population. The antibiotic power mainly doesn't.

[Is the profile of antihypertensive drug utilization justified?]. / Está justificado el perfil de utilización de fármacos antihipertensivos?

OBJECTIVE: To describe the use of drugs to combat hypertension and to assess prescription in function of their counterindications to diuretics and beta blockers. DESIGN: A descriptive cross-sectional study by means of an outside audit of clinical records. SETTING: 11 urban Health Districts opened before 1991. PARTICIPANTS: 326 histories of adult hyperintense patients under pharmacological treatment were chosen at random (June-December, 1994). MEASUREMENTS AND MAIN RESULTS: Data were gathered on age, sex, present and former medication, reason for change, and counter-indications to diuretic or beta blocker treatments. Average age was 64.7 (SD 11.6); 66% were women. 437 active principles (AP) were used, of which Enalapril (68 patients) and Captopril (67) were the most common. 203 patients (62.3%; Cl 95%, 57.0-67.5) took one AP; 90 (27.6%; Cl 95%, 22.8-32.5) took two APs; 30 (9.2%), three APs; and 3 (0.9%), four APs. 47.8% of monotherapy was performed with ACE inhibitors; 27.6% with calcium antagonists; 15.3% with diuretics; 7.9% with beta blockers and 1.5% with alpha inhibitors. Diuretics were the drugs most commonly used in association. CONCLUSIONS: There is little use of diuretics and beta blockers, but two-thirds of the prescription of other treatments are justified by a counter-indication to first-choice drugs.

[Drug prescriptions in Catalonia following the Decree of Selective Financing of Drugs]. / La prescripción farmacéutica en Cataluña tras el Decreto de Financiación Selectiva de Medicamentos.

OBJECTIVES: To assess the consequences of the Selective Financial Decree for prescription drugs in Catalonia. METHODS: Observational longitudinal study of the registry of prescribed pharmaceutical specialties that were charged to the Catalan Service of Health, from august 1991 to July 1994. 243.8 million of prescriptions were analyzed. RESULTS: Between the 12 months prior to the Decree and the 12 months following, the number of drug prescriptions was reduced by 10%. As a whole, the drugs included in the decree were loosing sales before the Decree; 38% of then were not been prescribed at all during the period studied. The main groups affected by the Decree were, vitamins associations, stimulants an associations with cough suppressants, mainly with a low therapeutic value. There has only been and important and clear substitution effect in antianemic and cough suppressants associations. CONCLUSION: In general, substitutions between pharmaceutical groups were few and positive.

[Relationship between the physician's profile and transient work incapacity of his patients]. / Relación entre el perfil del médico de cabecera y la incapacidad laboral transitoria de sus pacientes.

OBJECTIVE: To discover the relation between doctor's profile and his patient's unfitness for work. DESIGN: This was an observational crossover study. SETTING: Regional health authorities of Sant Feliu (Barcelona). PARTICIPANTS: 30 general practitioners throughout the whole of 1992. MEASUREMENTS AND MAIN RESULTS: Temporary doctors concede significance less unfitness for work (p = 0.002), and less unfitness motivated by flu (p = 0.028) than the others. Doctors belonging to the morning shift concede more upper respiratory infectious process (p = 0.03) than doctors belonging to the afternoon shift. Younger doctors and those specialised in family practice concede less unfitness for work motivated by flu than the others (p = 0.020) and (p = 0.019) respectively. CONCLUSIONS: The doctor's stability of work is the most influential factor analysed of the unfitness for work of his patients.

[Determining factors of the quality of prescription measured in intrinsic value and its potential use]. / Factores condicionantes de la calidad de la prescripción, medida en valor intrínseco y grado potencial de uso.

OBJECTIVE: To determine whether the following factors-medical training in family practice, age of the doctor, health care organization and percentage of patients over 65 years--influence the quality of pharmaceutical prescription as measured in terms of its intrinsic value and potential use of the prescription. DESIGN: Descriptive cross study. SITE. Regional health authorities of Costa de Ponent. Barcelona. PARTICIPANTS: 400 general practitioners throughout the whole of 1992. MAIN MEASUREMENTS AND RESULTS: Doctors belonging to the new health system and specialising in family practise, present higher intrinsic value and potential use of the prescription (statistically confirmed), as well as a greater concentration of prescription of the top 100 prescribed medicines. Doctors no more than 40 years old had better prescription but no statistical differences were found. An aged population had nearly no influence. CONCLUSIONS: The characteristics of the doctor (organization, training) are conditioning factors in the quality of pharmaceutical prescription.