Drug therapy of cardiovascular risk factors: guidelines versus reality in primary health care service.

AIM To determine the monthly costs of prescription drugs for the treatment of hypertension, hypercholesterolemia, and diabetes mellitus and their share in the total prescription drugs expenditures allowed by the Croatian Institute for Health Insurance. METHODOLOGY Hypertension, hypercholesterolemia, and diabetes mellitus were diagnosed in 4,916 patients in three general practitioner (GP) offices in the Zagreb area in January 2005. The monthly cost of medications prescribed by the GPs for the treatment of these three diseases was obtained by summarizing the prices of all antihypertensive, lipid-lowering, and antidiabetic drugs prescribed in one month. The monthly medication costs for each disease separately and all three diseases together were compared with the total prescription drug expenditures approved by the Croatian Institute for Health Insurance. RESULTS Hypertension was diagnosed in 1,112 (22.6%), hypercholesterolemia in 324 (6.5%), and diabetes mellitus in 359 (7.3%) patients. Monthly cost of all medications prescribed for these three diseases accounted for 81.2% of the total amount approved for medications by the Croatian Institute for Health Insurance. Antihypertensive drugs accounted for 51.1%, antidiabetic drugs for 11.7% for, and lipid-lowering treatment for 18.4%. The medications were prescribed most often to patients older than 65 years (93.6%). CONCLUSION GPs are strongly obligated by the annual contract with the Croatian Institute for Health Insurance to keep the medication expenses within the approved amount. However, the approved amount is spent mostly on the drug treatment of hypertension, hypercholesterolemia, and diabetes mellitus as the main cardiovascular risk factors.

[1]  F. Lobo,et al.  Direct health care costs of diabetic patients in Spain. , 2004, Diabetes care.

[2]  C. Thomas,et al.  Health plans' strategies to control prescription drug spending. , 2004, Health affairs.

[3]  Karolina Kalanj,et al.  Croatian pharmaceutical sector reform project: rational drug use. , 2004, Croatian medical journal.

[4]  P. Byrns,et al.  Changing Prescribing Patterns and Increasing Prescription Expenditures in Medicaid , 2004, The Annals of Family Medicine.

[5]  B. Pitt Generic drugs in cardiology: will they reduce health care costs? , 2004, Journal of the American College of Cardiology.

[6]  R. Watson,et al.  EU wants every member to develop a “roadmap” for ehealth , 2004, BMJ : British Medical Journal.

[7]  S. Tonstad,et al.  Undertreatment and overtreatment with statins: the Oslo Health Study 2000–2001 , 2004, Journal of internal medicine.

[8]  T. Marshall Coronary heart disease prevention: insights from modelling incremental cost effectiveness , 2003, BMJ : British Medical Journal.

[9]  D. Schwartz,et al.  The prevalence and cost of diabetes in metropolitan France: what trends between 1998 and 2000?*. , 2003, Diabetes & metabolism.

[10]  Daniel W. Jones,et al.  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. , 2003, JAMA.

[11]  H. Hense,et al.  Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. , 2003, JAMA.

[12]  M. Rayner,et al.  The economic burden of coronary heart disease in the UK , 2002, Heart.

[13]  S. Nolan,et al.  What every physician should know about generic drugs. , 2002, Family practice management.

[14]  A. Liebl,et al.  Kosten des Typ-2-Diabetes in Deutschland , 2001 .

[15]  J. Robertson HANDBOOK OF HYPERTENSION , 1984, The Lancet.

[16]  J. Tanne Electronic prescribing could save at least 29bn dollars. , 2004, BMJ.

[17]  J. Bring,et al.  Bmc Family Practice the Role of Guidelines and the Patient's Life-style in Gps' Management of Hypercholesterolaemia , 2004 .

[18]  S. Mendis Challenges for the management of hypertension in low-resource settings. , 2003, Ethnicity & disease.

[19]  M. Massi-Benedetti,et al.  The Costs of Type 2 Diabetes Mellitus in Italy , 2003, Treatments in endocrinology.

[20]  A. Liebl,et al.  [Costs of type 2 diabetes in Germany. Results of the CODE-2 study]. , 2001, Deutsche medizinische Wochenschrift.

[21]  David R. Wood,et al.  Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. , 2001, European heart journal.