Balázs Hankó

Trends in the non-steroidal anti-inflammatory drug market in six Central–Eastern European countries based on retail information†

The objective of this study was to evaluate the non‐steroidal anti‐inflammatory drug market of six Central and Eastern European countries. Trends and similarities were compared across the examined countries.

Antidiabetic Drug Utilization in Hungary

Objective: To evaluate the utilization trends of antidiabetics in Hungary.Method: The analysis includes the drugs of antidiabetic therapy which were registered between 1998 and 2002 in Hungary. The consumption of antidiabetic drugs was analyzed by the ATC/Defined Daily Dose (DDD) method. The data used in this study were derived from the National Health Insurance and from MIS Consulting Company.Results: Between 1998 and 2002, the total consumption of antidiabetics increased by 41.8%, and reached 47.59 DDD/1000 inhabitants/day in 2002. The consumption of oral antidiabetics (OAD) increased by 33.41% (33.86 DDD/1000 inhabitants/d ay in 2002), while in the case of insulin the increase was 67.8% (13.74 DDD/1000 inhabitants/day). Sulphonylureas were the most frequently used class (21.11 DDD/1000 inhabitants/day in 2002). Glibenclamide was the most frequently used antidiabetic drug (12.63 DDD/1000 inhabitants/day in 2002).Conclusion: The insulin class had greater emphasis in therapy. Among OAD, the consumption rate of sulphonylureas decreased and the consumption rate of Biguanides and acarbose increased. By 2002 metformin replaced 90% of the buformin in use. The limited effect of therapeutic recommendations could explain these changes, although the out-of-date buformin and the non-micronized glibenclamide were still in use in 2002.

The need for community pharmacists in oncology outpatient care: a systematic review

Background One-third of all deaths in Europe each year are attributable to cancer. Issues relating to cancer care, therefore, will continue to expand. To manage the increased challenges—including doctor shortages, an ageing population, and rural distribution of supplies—community pharmacists will likely be required to assume responsibility within oncology care. Aim of the review To assess the need for further investigation into quantity and utility of community pharmacists’ interventions in assisting oncology outpatients. Methods Initial search terms for identifying relevant literature within the PubMed database were informed by four key questions. Study selection for the systematic review was performed based on inclusion and exclusion criteria, which were defined a priori using the PICO tool. Literature searches identified 2470 papers, for which titles and abstracts were reviewed. Of these, 220 papers were retained for detailed analysis. The full texts of these manuscripts were then screened by applying the inclusion criteria. The remaining 68 papers were included in the systematic review. Results Several models of pharmacists’ interventions in inpatient, medium, and outpatient care have proven to be successful, have been consistently efficacious, and have positively influenced patient outcomes. Importantly, the quantity of scientific research, and thus of reported beneficial outcomes, in outpatient care is much lower than that conducted for inpatient and medium care. Conclusion Based on our findings, we suggest that further investigation of community pharmacists’ interventions into oncology outpatient assistance is necessary, and that further research should be conducted to address this need.

Systemic Measures and Legislative and Organizational Frameworks Aimed at Preventing or Mitigating Drug Shortages in 28 European and Western Asian Countries

Drug shortages have been identified as a public health problem in an increasing number of countries. This can negatively impact on the quality and efficiency of patient care, as well as contribute to increases in the cost of treatment and the workload of health care providers. Shortages also raise ethical and political issues. The scientific evidence on drug shortages is still scarce, but many lessons can be drawn from cross-country analyses. The objective of this study was to characterize, compare, and evaluate the current systemic measures and legislative and organizational frameworks aimed at preventing or mitigating drug shortages within health care systems across a range of European and Western Asian countries. The study design was retrospective, cross-sectional, descriptive, and observational. Information was gathered through a survey distributed among senior personnel from ministries of health, state medicines agencies, local health authorities, other health or pharmaceutical pricing and reimbursement authorities, health insurance companies and academic institutions, with knowledge of the pharmaceutical markets in the 28 countries studied. Our study found that formal definitions of drug shortages currently exist in only a few countries. The characteristics of drug shortages, including their assortment, duration, frequency, and dynamics, were found to be variable and sometimes difficult to assess. Numerous information hubs were identified. Providing public access to information on drug shortages to the maximum possible extent is a prerequisite for performing more advanced studies on the problem and identifying solutions. Imposing public service obligations, providing the formal possibility to prescribe unlicensed medicines, and temporary bans on parallel exports are widespread measures. A positive finding of our study was the identification of numerous bottom-up initiatives and organizational frameworks aimed at preventing or mitigating drug shortages. The experiences and lessons drawn from these initiatives should be carefully evaluated, monitored, and presented to a wider international audience for careful appraisal. To be able to find solutions to the problem of drug shortages, there is an urgent need to develop a set of agreed definitions for drug shortages, as well as methodologies for their evaluation and monitoring. This is being progressed.

Pharmaceutical care for patients with acute myocardial infarction in Hungary.

OBJECTIVE To obtain informationon the main causatives of acute myocardialinfarction (AMI), the background needs to be analyzed. Our aim was to identify those pharmaceutical aspects of this polymorbidity where the pharmacist can contribute. Earlier and recent European and Hungarian studies show similar results: cardiovascular (CV) death is still the leading cause of mortality. The quality of life is much lower and life expectancy is shorter in the investigated Borsod-Abaúj Zemplén county population compared to the whole of the country. After pharmaceutical care has been defined, its role should be established. METHODS A retrospective hospital-based survey was carried out. Medical records of 659 patients treated for myocardial infarction at the 1st Department of Internal Medicine-Cardiology of Borsod-Abaúj-Zemplén County Hospital and University Hospital were analyzed. Data were obtained using the MedWorkS integrated hospital information system and were selected based on Social Security Number (TAJ) and The International Statistical Classification of Diseases and Related Health Problems (ICD). We focused on the therapy and medication of patients. RESULTS The obtained results are consistent with those of previous Hungarian studies (OLEF 2000) and statistical analyses. Based on the present study we suggest that pharmacists should work more closely with the medical staff. In studying the medication, we concentrated on antiplatelet therapy and studied the use of aspirin alone compared to aspirin plus clopidogrel. Of the 659 patients only 172 received aspirin as a preventive agent. We noticed that during this study only a low number of patients received ASA treatment and it could be seen in the outcome of the illness. We also found that dual antiplatelet therapy did not decrease the incidence of reinfarction in patients with AMI. DISCUSSION In this study the theory (guidelines, other studies) and the clinical practice of the therapy and medication of AMI were compared. ASA therapy did not produce any significant effect. Our results are similar to those studies which concluded that ASA did not decrease the risk of cardiovascular events. CONCLUSION Most patients with AMI suffer from polymorbidity. Since the occurrence of underlying chronic diseases is high, not only AMI must be treated, but therapy and medication must be complex. Complex therapeutic management is the key to the success of pharmaceutical care in the community pharmacy following hospital treatment.