Réka Viola

Reasons for polypharmacy among psychiatric patients

Introduction: Increasing attention has recently been focused on polypharmacy, which is often referred to as an indicator of irrational drug consumption. Although polypharmacy is an important risk factor for problems arising from drug therapies, certain health concerns and conditions or patient-specific factors may justify the need for polypharmacy. In recent years there no data have been published regarding polypharmacy in Hungary.Objective: The authors examined the frequency of polypharmacy among psychiatric patients. The study also looked at the extent to which comorbidity and demographic characteristics (age, gender) were responsible for the multiple drug use.Methods: An inpatient database of the year 2001 at the psychiatric department was analysed. Based on the standard definition of polypharmacy the authors enrolled into the polypharmacy group those patients who were on more than five drugs as part of chronic and simultaneous therapy. The data were analysed with the SPSS 9.0 statistics program package.Results: Among the psychiatric patients included in the study (N=984) the frequency of polypharmacy was 33.6%. Significant correlation was found between the investigated factors (age, gender, comorbidity) and polypharmacy. On the basis of OR-values, comorbidity was the strongest inducer of polypharmacy.Conclusion: Polypharmacy cannot be fundamentally regarded as unnecessary drug use. Numerous facts prove that in certain diseases and conditions adequate polypharmacy is necessary.

Evaluation of the psychometric properties of the Hungarian quality of life in depression scale.

The paper describes the adaptation and psychometric evaluation of the Hungarian version of the quality of life in depression scale. The adaptation procedure involved: bilingual translation; field-testing for face and content validity; and assessment of instruments reliability and construct validity. The new language version was shown to be well-accepted by respondents and to have excellent psychometric properties.

Treatment of acute cystitis in Hungary: comparison with national guidelines and with disease-specific quality indicators

Abstract Background: The aim of this study was to compare Hungarian antibiotic use in acute cystitis with the internationally developed disease-specific quality indicators and with the national guidelines. Methods: The aggregated national-level data on systemic antibiotic use was purchased from the National Health Fund Administration. The study period was January–June 2007. Antibiotic use in acute cystitis was evaluated by means of the defined daily dose (DDD) methodology. Quality indicators of antibiotic prescribing proposed by the European Surveillance of Antimicrobial Consumption (ESAC) team were the usage rate of recommended antibacterials and the usage rate of quinolones. Adherence to the available national guidelines was determined. Results: For acute cystitis, 1.06 DDD per 1000 inhabitant-days antibiotic use was recorded. The ESAC recommended antibiotic use in cystitis (23.3%) was well below the recommended range (80–100%). The consumption of fluoroquinolones was 56.2%, which exceeded the recommended range (0–5%) more than 10 times. The adherence rate to the Hungarian guidelines ranged between 59.3% and 74.2%. Conclusions: As both investigated disease-specific quality indicators were well outside the acceptable ranges, some inappropriateness of antibiotic use in cystitis seems to be present. Adherence rates to the different national guidelines were also moderate, but due to the general recommendation of quinolones, values should be interpreted with caution. New transparent guidelines – issued by the Hungarian Society of Family Physicians – should be introduced in Hungary, recommending quinolones only for second-line therapy.

Quantitative disparities in outpatient antibiotic exposure in a Hungarian county

OBJECTIVES Although antibiotic utilization data expressed in defined daily doses (DDDs)/1000 inhabitants/day are often available for a given period and area, the actual antibiotic exposure of the population is rarely explored. We aimed to identify the real antibiotic exposure of the inhabitants of one Hungarian county. METHODS The patient-level dispensing data for 2005 for Csongrád County were retrieved from the database of the Hungarian National Health Fund Administration. The number of antibiotic users was quantified, and differences in antibiotic use (quantity and frequency) were explored. Disparities were revealed by Lorenz curves. A new form of Lorenz curve was also introduced. The DDD values for 2005 were used. RESULTS In 2005, a total of 486 115 antibiotic prescriptions were redeemed, and 3 329 385 DDDs were dispensed to 213 748 different patients; 50.3% of the inhabitants of Csongrád County (total population 424 615) took antibiotics. The average consumption of 1-, 2-, 3-, 4- and 5-time users was 7.5, 14.6, 21.0, 26.9 and 32.2 DDDs per user, respectively. Lorenz curves (including the new form of Lorenz curve) demonstrated the existence of disparities in antibiotic use. One percent of the users with the heaviest consumption were responsible for 6.9% of the total use and redeemed antibiotic prescriptions nine times or more during 2005. CONCLUSIONS Disparities in antibiotic use were detected: half of the inhabitants were exposed to antibiotics, and among antibiotic users, the quantity of antibiotics that they redeemed displayed great variance, mainly due to differences in the prescribing frequency. Special attention should be paid to those with frequent antibiotic use (five times or more annually).

Treatment of Community-Acquired Pneumonia in Adults: Analysis of the National Dispensing Database

Crude national ambulatory antibiotic dispensing data (2007–2011) of adult patients (aged between 20 and below 65 years) with CAP were obtained and expressed as DDD per 1000 inhabitants and per day (DID). European quality indicators of antibiotic prescribing were calculated and adherence rate to the national CAP guideline was assessed. Antibiotic use for CAP in adults ranged between 0.27 and 0.30 DID in various years. The most frequently used antibacterials were levofloxacin, co‐amoxiclav and clarithromycin. Antibiotic use in CAP was compliant with the European recommendations in 6.4% in 2007, which decreased to 4.9% by 2011, in contrast to the optimal compliant range of 80–100%. The consumption of fluoroquinolones mounted up to ~40% in both genders, which exceeded the recommended range (0–5%) substantially. National guideline also favoured the use of macrolides in the empiric therapy of CAP in otherwise healthy adults; hence, guideline‐concordant antibiotic use ranged between 24.0–32.3%. Agents that were contra‐indicated in the empiric therapy of CAP were also used in 6.5–9.0% in various years. These data reflect some worrisome figures and trends in the outpatient antibiotic treatment of adults with CAP. Clarified and updated national guidelines focusing on outpatients and incentives/regulations to increase guideline concordance are warranted.

Hungarian Hospital Antibiotic Consumption at the Regional Level, 1996–2005

Background:Regional variations in antibiotic consumption in outpatients have been reported previously, but nothing is as yet known about the regional distribution of antibiotic consumption in the hospital sector in Hungary. This study was designed to explore regional variations and investigate determinants of antibiotic consumption in hospital care in Hungary.Materials and Methods:Regional distribution-based antibiotic sales data were obtained for a 10-year period (1996–2005) for the 20 Hungarian counties. Systemic antibacterial use (Anatomical Therapeutic Chemical code: J01) was expressed as the number of defined daily doses (DDD) per 100 patient-days. The multiple linear regression model was applied to investigate the determinants of regional differences in hospital antibiotic consumption. Independent variables related to health care access, utilization of hospital resources, doctors’ workload, type of hospital care provided, and patient’s characteristics and infections were considered as possible determinants, and data on these variables were obtained for 2 years (2004, 2005). We also tested the association between hospital and ambulatory care antibiotic consumption in Hungarian regions using the Pearson correlation test.Results:For each year during the 1996–2005 study period, there were large and stable variations in total hospital antibiotic consumption (e.g., min–max1996: 16.0–28.2; min–max2005: 15.2–32.2 DDD per 100 patient-days) depending on the region. In the two developed models (Model 1 and Model 2), the number of reported infections accounted for 53% of the observed regional variations in hospital antibiotic consumption (Model 1), and the number of reported infections together with the case-mix index were responsible for 61% (Model 2) . Total antibiotic consumption in hospitals showed a positive correlation (R = 0.71, p = 0.002) with total antibiotic consumption in ambulatory care.Conclusion:The case-mix index and the number of reported infections explained some of the observed regional variations. However, the moderate value of the models in explaining these regional variations suggest that determinants which could not be explored in this preliminary study may also contribute to regional differences. Future studies should aim at collecting data for each individual hospital as well as data on possible determinants for hospital antibiotic consumption.

National trend of antidepressant consumption and its impact on suicide rate in Hungary.

The aim of this study was to analyse the changes in the amount and structure of Hungarian antidepressant consumption at national and regional level, furthermore to investigate the possible relationship between antidepressant sales and trends in suicide rates using regional data.

Variations and determinants of antibiotic consumption in Hungarian adult intensive care units.

The aim of this work was to study the use of systemic antibacterials and its possible determinants in Hungarian intensive care units (ICUs).

Evaluation of ambulatory antibiotic use in Hungary using drug-specific quality indicators

INTRODUCTION Rational use of antibiotics is an important tool in combating antibiotic resistance. AIM The aim of the authors was to evaluate the quality of ambulatory antibiotic use in Hungary. METHOD Crude antibiotic sales data for the period between 1996 and 2010 were converted into DDD (Defined Daily Dose) per 1000 inhabitants and per year. The recently developed and validated drug-specific quality indicators were used to evaluate antibiotic use. RESULTS Beside constant quantity (18.0±1.8 DDD/1000 inhabitants/day), the authors detected major changes in the composition of antibiotic use. Ratios of the consumption of broad to narrow spectrum beta-lactams and macrolides increased eight-fold (1996: 2.2 vs. 2010: 15.8) and consumption of fluoroquinolones tripled. Out of the ten surveyed drug-specific quality indicators, Hungary belonged to the European elite in case of three, while considering the remaining seven, Hungary ranked among the weak or weakest European countries. CONCLUSION In quantity Hungary an ambulatory antibiotic use resembles to Scandinavian countries while it mimics antibiotic consumption patterns of southern countries.

[Hungarian adaptation of a questionnaire for determining depression-specific quality of life].

Bevezetes: A QLDS (Quality of Life in Depression Scale) egy, a depresszios betegek eletminősegenek meghatarozasara alkalmas kerdőiv, melyet az elmult evekben szamos nyelvre adaptaltak. Jelen munka celja a kerdőiv magyar nyelvű adaptacioja, ezaltal az első magyar nyelvű, valid depressziospecifikus eletminőseg-merce letrehozasa. A kerdőiv adaptalasa harom fazisbol allt; forditas, probainterjuk keszitese (face validity, content validity) es a kerdőiv pszichometriai tesztelese. Celkitűzes: A QLDS magyar nyelvű adaptalasa, tovabba pszichometriai tesztelese. Modszer: A kerdőiv forditasa az un. „kettős (dual) modszer” alkalmazasaval tortent. A depresszios betegek bevonasaval keszitett probainterjuk (field-test interview) azt vizsgaltak, hogy a kerdőiv alakilag es nyelvileg megfelelő-e. A pszichometriai teszt (postal survey) soran a kerdőiv megbizhatosagat (test-retest reliability), homogenitasat (internal consistency) es szakmai validitasat (construct validity) hataroztuk meg. Eredmenyek: A probainterjuba bevont...INTRODUCTION The Quality of Life in Depression Scale (QLDS) is a widely used outcome measure available in a large number of languages. No measure of quality of life was available for use with depressed patients in Hungary and a decision was taken to adapt the QLDS for this purpose. The adaptation of a questionnaire for use in a new language involves three stages; translation, testing for face and content validity and assessment of the translated measures psychometric properties. OBJECTIVES To adapt the QLDS for use in Hungary and to evaluate its psychometric properties. METHOD The dual panel method was used to translate the QLDS into Hungarian. The translation was tested for face and content validity by interviews conducted with depressed patients. Finally, a test-retest postal survey was conducted to determine internal consistency, reproducibility and construct validity. RESULTS Interviews conducted with 25 patients indicated that the QLDS was an appropriate measure and that it was well accepted and completed. The postal survey ( n = 50) showed that the measure had good internal consistency (Cronbachs alpha-coefficients were 0.95 at both administrations) and that the test-retest reliability (0.89) indicated good reproducibility with limited random measurement error. Correlations of QLDS scores with those for the Nottingham Health Profile sections were as expected, providing evidence of convergent and divergent validity. CONCLUSION Given the acceptability of the Hungarian version of QLDS to depressed patients and the excellent psychometric properties of the adapted questionnaire it is concluded that the adaptation was successful. The measure is suitable for use in clinical practice and studies involving depressed patients in Hungary.