Petre Iltchev

Drug-class-specific changes in the volume and cost of antidiabetic medications in Poland between 2012 and 2015

Aim to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012–2015. Methods This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs—in current international dollars, based on purchasing power parity. Results During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues. Conclusions The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Epidemiology of Rheumatoid Arthritis (RA) in rural and urban areas of Poland – 2008–2012

OBJECTIVE The aim of this study is to investigate the morbidity rate due to Rheumatoid Arthritis (RA) in the Polish population during 2008-2012, calculated per 1,000 inhabitants, and taking into account the differences between provincess, area of residence (urban or rural) and gender. MATERIALS AND METHOD From the NFZ IT systems, PESEL number information was obtained for all 17 types of services contracted in 2008-2012, for patients whose main diagnosis in the report was the ICD-10 disease code: M05.X - seropositive rheumatoid arthritis, or M06.X - other rheumatoid arthritis. The number of patients, gender and age were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basis for classifying the patient as a member of an urban or rural population was the Zip Code of the declared place of residence. Urban and rural areas are classified based on administrative criteria provided by the Central Statistical Office: the National Official Register of Territorial Division of the Country (TERYT). RESULTS During the studied period the number of RA patients increased from 173,844-230,892. In urban areas, the most patients were recorded in the Śląskie Province, the least in Lubuskie Province. Patients from rural areas were approx. 1/3(rd) of the total population of patients in Poland. In rural areas, the most patients were recorded in the Mazowieckie Province, the least in Lubuskie Province. The morbidity rate in cities was 5.08 in 2008 and increased to 8.14 in 2012 in rural areas, respectively, it was 3.74 and increased to 3.98. Regardless of the place of residence the women fell ill 3.5 times more frequently. The lowest morbidity rate, both in rural and urban areas, was recorded in the Lubuskie Province, the largest in Świętokrzyskie Province. The the most probable explanation of the highest morbidity rate in the latter province is a worse access to a rheumatologist: in this province there is the lowest number of inhabitants per one employed rheumatologist. CONCLUSION In Poland, the number of RA sufferers is increasing, which is probably a result of increasing life expectancy. In Poland, also exists a differences in morbidity between urban and rural inhabitants. Differences may also derive from undiagnosed cases of the disease.

Glove failure in elective thyroid surgery: A prospective randomized study

OBJECTIVES To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. MATERIAL AND METHODS Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. RESULTS Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). CONCLUSIONS This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

Changes in the morbidity and costs of systemic lupus erythematosus in Poland in the years 2008–2012

Objectives The goal of the article is to present the changes in morbidity and costs of systemic lupus erythematosus (SLE) in Poland in the 2008–2012 period, depending on the province of residence of the patients based on data reported to the public payer – the National Health Fund. Material and methods Based on the ICD-10 code and the patients personal identity number, the number of patients and medical costs (cost of hospitalization, pharmaceutical, medical procedures, dialysis and specialist consultations) were calculated by province (voivodeship) and urban or rural residence. Results Annually on average in the assessed period in Poland approximately 20 000 patients were diagnosed with SLE. The studied group was dominated by women (they were 5.2 times more numerous). The morbidity rate was 52.183 patients per 100 thousand inhabitants. Most patients were in the age range of 48–56 years. Average annual expenses for this group of patients over the examined period were USD 16,327 million. Two times more was expended on patients inhabiting cities, approximately 4 times more on women. Calculated per patient, the average cost of therapy was USD 810.63. Conclusions The population of SLE patients in Poland is highly stable. The results of analysis indicate 1.64 times more frequent occurrence in urban areas, which may be connected with availability of doctors. The SLE treatment costs in Poland are much lower than in other countries, which is related mainly to the fact that therapy with biological drugs is not financed.

Juvenile idiopathic arthritis morbidity rate in rural and urban areas of Poland 2008–2012

OBJECTIVE The aim of this study was to investigate the juvenile idiopathic arthritis (JIA) morbidity rate in the Polish population, calculated per 1,000 inhabitants of a given province, taking into account the differences between urban and rural areas, gender and area of residence (province) 2008-2012. METHOD From the NFZ IT systems information was obtained on the treatment of patients who had M08 and M09 juvenile arthritis, diseases classified elsewhere by the ICD-10 diagnosis code in the settlement report of the hospital. The number of patients, their gender and age at individual diagnoses were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basic for classifying the patient as a member of a urban or rural population was the zip code of the declared place of residence. RESULTS In Poland, the number of patients suffering from juvenile idiopathic arthritis has been increasing since 2008 - from 9.2 thousand in 2008 to 11.4 thousand in 2012. The majority were girls (approx. 62%). Most patients were living in urban areas; in 2008, 5.9 thousand: urban areas - 64% of women and 36% of men; 3.2 thousand: rural areas - 62% of women, 38% of men); in 2012, 7.2 thousand - urban areas); 4.2 thousand - rural areas. The morbidity indicators ranged from 0.195 - 0.357 per 1,000 inhabitants, depending on the year, gender and place of residence (province and commune).

Managing the Risk of Adverse Events Using the Example of a Hospital in Wroclaw

Abstract. Health Care Centres are institutions which, because of their specificity and character, are particularly exposed to various kinds of risk. One of the most important and most frequently used methods of risk management is the black spots method. The research material collected for the study comes from one of the hospitals in Wrocław. All hospital stays of the C22 (Face and Jaw Surgery Ward) and H05 (Injury and Orthopaedics Surgery Ward) settlement groups (DRG) were analysed - a total of 178 hospitalisations. The black spots method was used in the study, which consisted of risk identification, the ordering of threats and proposals for remedial actions. Using the black spots method, it was possible to identify adverse events that occurred during the hospitalisation of patients with H05 and C22 DRGs in the Injury and Orthopaedics Surgery Ward and Facial and Jaw Surgery Ward. In both cases, the treatment costs for patients with complications were higher than for the stays without complications.

Diagnosis-Related Groups (DRG) and Hospital Business Performance Management

Abstract The goal of this article is to present the possibility of using Diagnosis- Related Groups (DRG) in the hospital management process and to analyse the need for business performance management on the part of hospital management staff. The following research methods were used: literature analysis, case studies, and poll analysis. It is not possible to increase the effectiveness of operation of healthcare entities without increasing the importance of IT systems and using DRG more effectively in the management process. Training users in IT and the use of DRGs is important to achieving hospital effectiveness. The increased importance of analyses and planning in a hospital should be reflected in the organisational structure of service providers. Hospital controllers should have a similar role to those present in most companies in other industries.

Differences in Financing of Admission Rooms (ARs) and Hospital Emergency Rooms (ERs) Between the Years 2013 and 2014, Using an Example of a Lodz Municipal Hospital

Abstract The goal of the article is to compare methods of financing ARs and ERs based on the data from the 1st half of 2013 and 1st half of 2014 from the K. Jonscher 3rd Municipal Hospital in Lodz. All the stays in the AR/ER in the 1st half of 2013 and the 1st half of 2014 were analysed. Based on the presented data, it can be clearly seen that the new method of financing AR/ER services proposed by the NFZ will beyond doubt have negative outcomes, and will certainly not improve the financial situation of hospitals.

Comparison of indicators of the use of insulin and oral diabetes medication in a Polish population of patients in urban and rural areas in the years 2008, 2011 and 2012.

INTRODUCTION Diabetes is one of the 10 most important chronic diseases in the world. According to the data of the International Diabetes Federation, in Poland 9% of the population between the ages of 20-79 suffer from diabetes. OBJECTIVE The aim of this study was to investigate the differences in the prevalence of diabetes in urban and rural areas in Poland, and the preparation of a model describing the phenomenon. MATERIALS AND METHOD Differences between urban and rural areas were studied for the occurrence of patients treated with diabetes per 100,000 inhabitants, the number of patients, structure of treatment per the used products, and the costs of reimbursement of treatment products between 2008-2012. Urban and rural cases were compared using zip codes. The basis for classifying a patient as being an inhabitant of an urban or rural area was an urban zip code of the declared place of residence. RESULTS Differences were observed both between various areas of Poland, as well as depending on whether the declared place of residence of the patient was urban or rural. Differences between urban and rural areas within the studied period have increased. The difference in the prevalence of diabetes among the inhabitants of Podlaskie, Śląskie or Świętokrzyskie provinces is striking. CONCLUSION Differences between urban and rural areas which depend on morbidity and detection of patients in the earlier phase of illness, the structures of medical technologies used in the treatment process, the number of purchased pharmaceuticals, enable better monitoring of effectiveness and quality of politics on prevention and treatment of chronic diseases. It is important for the creation of a health policy to devise a system of indicators, which will enable a decrease in the existing differences between regions, and between the urban and rural areas within the provinces.

Hospital Statistics as a Tool for Obtaining Data Necessary in the Healthcare Entity Management Process

Abstract Statistical methods used by healthcare entities enable the collection of various information about the structure and characteristics of treated patients. They are an important source of knowledge, and form a database that plays an important role in entity management theory. In the presented study, we analysed the hospital stays of patients treated in all hospital wards of the 3rd City Hospital in Łodź during 2012. The following, in particular, were taken into account: admittance procedure, discharge procedure, age and sex of hospitalised persons. Patients in over 55% of cases were admitted using the sud- den admittance procedure. At the same time, over 3/4 of the stays ended with a referral for further treatment in ambulatory conditions, and death occurred in approx. 5% of hospitalisations. By comparing the discharge procedures, the percentage of deaths in the Anaesthesiology and Intensive Care Wards can be seen clearly (more than 70%). Internal wards are next in turn (10.6 and 16.6%). The biggest differences in the length of hospitalisation between the studied institution and the NFZ data (which are averaged values from all medical entities in Poland) concern the E77, A49, A48, A87, A33, D18, E16, E61 and G37 groups.