3Action Group A1 Partners The partners involved in the action come from several countries and the Italian stakeholders represent the 15%.AIFA, Italian Medicines Agency represents one of the coordinator of the Action
4Partners –members of Action Group A1 AIFA Consortium CoordinatorAndalusian Regional Ministry of Health and Social WelfareAston University UKAPSS, (Regional Health Provider Trento Province)CIRFF, University of NaplesDepartment of Health and ConsumerAffairs of the Basque GovernmentDepartment of Health, Social Services and Public Safety Northern IrelandEducation, Health and Society Foundation MurciaGeneral Council of pharmacists SpainGIRP European Association of Pharmaceutical Fullline Wholesalers, Brussels, BelgiumGSKHealthy Ageing Network Northern Netherlands (HANNN)Hospital de Getafe SpainLST Universidad Politecnica Madrid Spain CoordinatorMedical university of WarsawMerck SeronoNHS Scotland CoordinatorUniversity CoimbraParkinsonNet (Radboud University Nijmegen Medical Centre)Perugia UniversityUCC Cork IrelandUniversity Coimbra PortugalVeneto Region Italy
5A1 Action Plan: General Objectives ACTIONSOBJECTIVESDecision Support ToolsDispensing & PrescribingInterventionsMonitoring1 – Improve Patient Adherence to Care PlansCounseling & EducationOnline servicesSocial networks2 – Empower Patientsand care giversElectronic prescriptionBest-practicesService modelsTraining3 – Deliver improvements in the health care systemsEvidenceGuidelines4 - Research and methodologyData repositoriesNetworking5 – Fostering Communication
6Commitment Objectives Action Plan and CIRFF Commitment ObjectivesAction PlanGeneral Objectives4. Research and methodology on adherence5. Foster communication between different partners/actors in the healing and caring process to improve adherence foster communication1. Improve patient adherence to care plans, including medication and healthy habitsCIRFFCommitment ObjectivesDevelop a model to evaluate adherence on large population databases, especially focusing on:Correlation between poor adherence and negative clinical outcomesOptimal Proportion of Days Covered (PDC) threshold to assess adherence levelsPredictive factors of discontinuationCost-effectiveness of enhancing adherence levelsDevelop a remote monitoring system of adherence levels based on prescription refill data in patients affected by chronic diseasesDevelop a web-based platform to report and deliver information about adherenceState of PlayIn timeframe Nov2012-Jan2013; Feb-Jun2013; Jul-Dec. We have collected data from regional Health Agency and created a population database ready to be used. We are currently defining cohorts of study, focusing on osteoporosis, diabetes, CHF, hypertension.Consultation ongoing with partners.Gathering platform design proposalsCIRFFCommitment PartnersCIRFF, Department of Pharmacy, Federico II UninaLara NataleCampania Region Health Care AuthorityMaddalena IllarioAdelaide IpppolitoFederico II University Hospital R&D UnitCarolina Di Somma Department ofClinical and Molecular EndocrinologyFederico II UninaGuido IaccarinoDepartment of Medicine and Surgery, University Hospital Salerno.
7% of Pharmaceutical Expenditures Rationale for prescription andadherence action at regional levelCampania Region: Outpatient Pharmaceutical ComsumptionAge group% of Population% of Pharmaceutical ExpendituresDDD/1000 inh, dieAll ages100Children (0-17 y)18.104.22.168Non elderly adults ( y)67.546.544.6Elderly (65 + y)16.050.253.4Source: CIRFF report Campania Region 2011
8with chronic conditions % of Pharmaceutical Expenditure Rationale for prescription andadherence action at regional levelAge group% of Populationwith chronic conditions% of Pharmaceutical ExpenditureAll ages27. %83.1 %Elderly (65 + y)81.9 %94.6 %Chronic Disease and polytherapySource : Own elaboration based on CIRFF data.
9Poor adherence: relevance Time to Discontinuation* of Chronic Therapy Classes* 30 days gap allowedSource : Own elaboration based on CIRFF data.
10Adherence improves health and reduces costs The Opportunity:Adherence improves health and reduces costsSorce: Sokol et al. 2005
12Our experiences - Antiosteoporosic drugs Antihypertensive therapy The pharmacoeconomic impact of amlodipine use on coronary artery disease. de portu S, Menditto E, Scalone L, Bustacchini S, Cricelli C, Montovani LG. Pharmacological research 54 (2006)Pharmacoeconomic consequences of amlodipine besylate therapy in patients indergoing PTCA. Rossetti F, De portu S, Menditto E, Scalone L, Bustacchini S, Cricelli C, Montovani LG. Pharmacological Research 53 (2006)- Cost-effectiveness analysis of bisoprolol treatment for heart failure. Di Stasi F, Scalone L, De Portu S, Menditto E, Mantovani LG. Ital Heart J Dec;6(12):950-5Lipid lowering therapyCammarota s, de Portu S, Riegler S, Citarella A, Menditto E, Mantovani LG. Predictors of non-persistence on statin treatments in Italy: A retrospectiveCitarella A, Mantovani LG, Cammarota S, Menditto E, Riegler S, de Portu S. Pharmacoeconomic consequences of losartan therapy in patients undergoing Diabetes End-Stage Renal Disease. Value in Health 2009; Vol.12 (n. 7): A406.Therapy for diabetesThe burden of hospitalization related to diabetes mellitus: a population-based study. De Berardis G, D'Ettorre A, Graziano G, Lucisano G, Pellegrini F, Cammarota S, Citarella A, Germinario CA, Lepore V, Menditto E, Nicolosi A, Vitullo F, Nicolucci A; DADA (Diabetes Administrative Data Analysis) Study Group. Nutr Metab Cardiovasc Dis Jul;22(7):- Antiosteoporosic drugsCasula M, Filippi A, Flacco E, Gambera M, Manzoli L, Menditto E, Orlando V, Piccinelli R, Tragni E, Catapano A. Assessment and potential determinats of compliance and persistence to anti-osteoporosis therapy in Italy..Iolascon g, Capaldo A, Orlando V, Menditto E. Persistence at one year of anti-osteoporotic drugs in southern italy: Analysis of administrative databases Clinical Cases 2013 in pressMiscellaneous on drug therapyProton pump inhibitors prescribing following the introduction of generic drugs. Cammarota S, Bruzzese D, Sarnelli G, Citarella A, Menditto E, Riegler S, Savino IG, Vozzella L, Piccinocchi G, Napoli L, Arpino G, Cuomo R. Eur J Clin Invest Oct;42(10):P Comella, L Franco, R Casaretti, S de Portu, E Menditto. Emerging role of capecitabine in gastric cancer. Pharmacotherapy 2009;29(3):Pharmaco-economic consequences of losartan therapy in patients undergoing diabetic end stage renal disease in EU and USA. de Portu S, Citarella A, Cammarota S, Menditto E, Mantovani LG.Clin Exp Hypertens. 2011;33(3):174-8.Menditto E, Citarella A, Cammarota S, de Portu S, S.Mantovani L G, Riegler S. Prevalence, incidence and persistence of antidepressant drug prescribing in the Italian general population: retrospective database analysis, Value in Health 2009; Vol.12 (n. 7): A353.Miscellaneous on methodsMenditto E, Citarella A, Cammarota S, Sabatella C, Riegler S. L’utilizzo dei database amministrativi per la ricerca di base e la programmazione sanitaria: l’esperienza dell’ASL Salerno 2. GIFF 2009; 2 (1) :Menditto E, Citarella A. Valutazione economica dello studio IDEAL. Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): 23-26de Portu S, Menditto E, Mantovani LG. Valutazione economica dello studio CARDS, aggiornamenti. Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): 36-40de Portu S, Cammarota S, Menditto E, Mantovani LG. Valutazione economica dello studio AVERT Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): 31-35
13Measuring adherencePharmacoepidemiology and drug safety, 2006
14Our Action : Adherence Monitoring System (AMS) The use of administrative databases to monitor adherence allows to detect in real-life scenario:- drug exposure in a population over timelevels of adherence to medicationpredictive factors of discontinuation- establish risk definitions to tailor interventionscorrelation between poor adherence and negative clinical outcomescost-effectiveness of enhancing adherence levels
15Pharmaceutical Records Hospital Discharge Records Data Banks and Information SystemsPatients RegistryPatient encrypted CodeBirth dateGenderWithdrawal datePharmaceutical RecordsPatient encrypted CodeDrug AIC codeDrug ATC codePrescription dateDispensation dateAmount of boxesHospital Discharge RecordsPatient encrypted CodeHospitalization dateDischarge dateAdmission typeDischarge typeDRGMain diagnosisConcomitant diagnosisData Set CIRFFPatient encrypted Code–details – Pharmaceutical prescriptions – Hospitalizations