Zivković Kresimir, Zelić-Kerep Ana, Stimac Danijela, Ozić Sanja, Zivković Nikica
Coll Antropol. 2014 Jun;38(2):717-24.
The lack of Croatian studies which could determine the justifiability of excessive psychopharmaceutical utilization was an encouragement to conduct this research. Furthermore, regarding the conduction of this study, it would be possible to determine whether the trend of drug utilization has increased, decreased or perhaps stabilized. The data on the outpatient utilization of psycholeptics and psychoanaleptics were collected from all Zagreb pharmacies, 2006-2009. Based on the collected data for all N05 and N06 groups of drugs, the defined daily doses (DDD) and DDD per thousand inhabitants per day (DDD/TID) have been calculated using the Anatomical-Therapeutic-Chemical classification (ATC) for 2006, 2007, 2008 and 2009. To indicate the quality of drug prescription the Drug Utilization 90% (DU 90%) method was used. Moreover, in order to determine a more precise quality of individual drug group prescriptions, the indicators have been calculated by determining the proportion of the total utilization of individual therapeutic and pharmacological therapeutic subgroups in DDD/TID a day. The utilization of anxiolytics (N05B) accounts for most of the psycholeptic utilization in the City of Zagreb throughout the entire study period. In the study period, the utilization of antidepressants has slightly increased, by 10.5%, taking the first and the last years of the period into account. In 2006, 5 benzodiazepines and the hypnotic zolpidem, as well as 5 selective serotonin reuptake inhibitors (SSRIs) and 1 third generation antipsychotic (olanzapin) were found in the DU 90% segment. In 2009, the DU 90% segment also comprised 5 benzodiazepines and the hypnotic zolpidem, as well as 6 SSRIs and 1 third generation antipsychotic (olanzapin). In the City of Zagreb, a general insight into the quality of psychopharmaceutical prescriptions indicates stability in comparison to earlier studies. The ratio index of the first generation antipsychotic utilization, compared to the third generation antipsychotics, shows an increase in the quality of prescription. Also, the ratio index of total tricyclic antidepressants (TCA) and SSRI utilization indicates improvement in quality of prescription. The ratio index of the entire outpatient utilization of anxiolytics and antidepressants expressed in DDD/TID unfortunately shows a very mild increase of prescription quality. Benzodiazepines accounted for more than 50% of the outpatient utilization of psychopharmaceuticals throughout the study period, which proves the need for precise guidelines as the most significant means of drug rationalization and utilization. It is necessary to identify priorities and problems in order to solve them successfully, by monitoring drug utilization and prescription on a national level. Results demonstrate that within the primary health care system, there is a need for constant education on rational prescription of this drug group.
克罗地亚缺乏能够确定过度使用精神药物合理性的研究，这促使我们开展此项研究。此外，就本研究的实施而言，有可能确定药物使用趋势是增加、减少还是趋于稳定。2006 - 2009年期间，从萨格勒布所有药店收集了抗精神病药和精神振奋药的门诊使用数据。根据收集到的所有N05和N06类药物的数据，使用解剖学 - 治疗学 - 化学分类法（ATC）计算了2006年、2007年、2008年和2009年的限定日剂量（DDD）以及每千居民每日限定日剂量（DDD/TID）。为了表明药物处方的质量，采用了药物利用90%（DU 90%）方法。此外，为了更精确地确定各个药物组处方的质量，通过确定各个治疗和药理治疗亚组在每日DDD/TID中的总使用比例来计算指标。在整个研究期间，抗焦虑药（N05B）的使用占萨格勒布市抗精神病药使用的大部分。在研究期间，考虑到该时间段的第一年和最后一年，抗抑郁药的使用略有增加，增幅为10.5%。在2006年的DU 90%区间内发现了5种苯二氮䓬类药物和催眠药唑吡坦，以及5种选择性5-羟色胺再摄取抑制剂（SSRI）和1种第三代抗精神病药（奥氮平）。在2009年，DU 90%区间内同样包含5种苯二氮䓬类药物和催眠药唑吡坦，以及6种SSRI和1种第三代抗精神病药（奥氮平）。在萨格勒布市，对精神药物处方质量的总体洞察表明与早期研究相比具有稳定性。第一代抗精神病药与第三代抗精神病药的使用比例指数显示处方质量有所提高。此外，三环类抗抑郁药（TCA）与SSRI总使用比例指数也表明处方质量有所改善。遗憾的是，以DDD/TID表示的抗焦虑药和抗抑郁药整个门诊使用的比例指数显示处方质量仅有非常轻微的提高。在整个研究期间，苯二氮䓬类药物占精神药物门诊使用的50%以上，这证明需要制定精确的指南作为药物合理使用的最重要手段。有必要确定优先事项和问题，以便通过在国家层面监测药物使用和处方来成功解决这些问题。结果表明，在初级卫生保健系统内，需要持续开展关于该药物组合理处方的教育。
