engleski

Applying DU90% on Essential drugs Adherence to WHO Essential drug list: a potential indicator for assessing the quality of prescribing

The WHO Essential Drugs list includes 316 drugs that should satisfy the health care needs for the majority of the population. The core list presents a minimum medicine needs for a basic health care system listing the most efficacious, safe and cost-effective medicines for priority conditions. The complementary list presents essential medicines for priority diseases, for which specialized diagnostic/ monitoring and medical care/training are needed. Drugs marked with a square symbol are those with similar clinical performance within a pharmacological class (mee-too drugs) ; the listed one is usualy the cheapest. Model lists are informational and educational tools originally intended for developing countries, but an increasing number of developed countries also use the key components of the essential drugs concept. We evaluated the quality of outpatient drug use in Croatia and Sweden, focusing on drugs accounting for 90% of the use - Drug Utilization 90% (DU90%)- in Defined Daily Doses and adherence to the WHO Essential drug list. DU90% methodology is a further development of “ Top-10” list and focuses on drugs that account for 90% of the prescribed volume. It focuses on the bulk of prescribing. Data on dispensed prescription and OTC drugs were collected from the wholesalers in Croatia and the National Corporation of Pharmacies in Sweden for 2003. In Croatia, 95 substances (25% of 388) accounted for 90% of the use compared to174 (21% of 828) in Sweden. The adherence within DU90% was 39% in Croatia and 33% in Sweden. Including in the list all the alternatives for drugs marked with a square symbol, the adherence rose to 72% in Croatia and 49% in Sweden. Although the total adherence was similar between the countries, there were substantial differences in the range of drugs used in some therapeutic areas. The low adherence in both countries was partly explained by mee-too drugs and extensively used drugs not included in the list (e.g. PPIs, SSRIs and statins). The DU90% profiles provided a quick overview of potentials for improvement in both countries but also a reflection on the relevance of the WHO Essential Drug list.

DU90 methodology; essential drug list

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