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Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Naples,

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Presentation on theme: "Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Naples,"— Presentation transcript:

1 Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Enrica Menditto, PhD CIRFF, Department of Pharmacy, University Federico II Naples, April Action A1 Action A1 Prescription and adherence to treatment

2 AHA Strategic Implementation Plan: The Pillars

3 Action Group A1 Partners

4 AIFA Consortium Coordinator AIFA Consortium Coordinator Andalusian Regional Ministry of Health and Social Welfare Andalusian Regional Ministry of Health and Social Welfare Aston University UK Aston University UK APSS, (Regional Health Provider Trento Province) APSS, (Regional Health Provider Trento Province) CIRFF, University of Naples CIRFF, University of Naples Department of Health and ConsumerAffairs of the Basque Government Department of Health and ConsumerAffairs of the Basque Government Department of Health, Social Services and Public Safety Northern Ireland Department of Health, Social Services and Public Safety Northern Ireland Education, Health and Society Foundation Murcia Education, Health and Society Foundation Murcia General Council of pharmacists Spain General Council of pharmacists Spain GIRP European Association of Pharmaceutical Fullline Wholesalers, Brussels, Belgium GIRP European Association of Pharmaceutical Fullline Wholesalers, Brussels, Belgium GSK GSK Healthy Ageing Network Northern Netherlands (HANNN) Healthy Ageing Network Northern Netherlands (HANNN) Hospital de Getafe Spain Hospital de Getafe Spain LST Universidad Politecnica Madrid Spain Coordinator LST Universidad Politecnica Madrid Spain Coordinator Medical university of Warsaw Medical university of Warsaw Merck Serono Merck Serono NHS Scotland Coordinator NHS Scotland Coordinator University Coimbra University Coimbra ParkinsonNet (Radboud University Nijmegen Medical Centre) ParkinsonNet (Radboud University Nijmegen Medical Centre) Perugia University Perugia University UCC Cork Ireland UCC Cork Ireland University Coimbra Portugal University Coimbra Portugal Veneto Region Italy Veneto Region Italy Partners –members of Action Group A1

5 A1 Action Plan: General Objectives ACTIONS OBJECTIVES Decision Support Tools Dispensing & Prescribing Interventions Monitoring 1 – Improve Patient Adherence to Care Plans Counseling & Education Online services Social networks 2 – Empower Patients and care givers 2 – Empower Patients and care givers Electronic prescription Best-practices Service models Training 3 – Deliver improvements in the health care systems Evidence Guidelines 4 - Research and methodology Data repositories Networking 5 – Fostering Communication

6 Action Plan and CIRFF Commitment Objectives Action Plan General Objectives 4. Research and methodology on adherence 5. Foster communication between different partners/actors in the healing and caring process to improve adherence foster communication 1. Improve patient adherence to care plans, including medication and healthy habits CIRFF Commitment Objectives Develop a model to evaluate adherence on large population databases, especially focusing on: Correlation between poor adherence and negative clinical outcomes Correlation between poor adherence and negative clinical outcomes Optimal Proportion of Days Covered (PDC) threshold to assess adherence levels Optimal Proportion of Days Covered (PDC) threshold to assess adherence levels Predictive factors of discontinuation Predictive factors of discontinuation Cost-effectiveness of enhancing adherence levels Cost-effectiveness of enhancing adherence levels Develop a remote monitoring system of adherence levels based on prescription refill data in patients affected by chronic diseases Develop a web-based platform to report and deliver information about adherence State of Play In 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 proposals CIRFF Commitment Partners CIRFF, Department of Pharmacy, Federico II Unina CIRFF, Department of Pharmacy, Federico II Unina Lara Natale Lara Natale Campania Region Health Care Authority Maddalena Illario Maddalena Illario Adelaide Ipppolito Federico II University Hospital R&D Unit Carolina Di Somma Department of Carolina Di Somma Department of Clinical and Molecular Endocrinology Federico II Unina Guido Iaccarino Guido Iaccarino Department of Medicine and Surgery, University Hospital Salerno.

7 Campania Region: Outpatient Pharmaceutical Comsumption Age group % of Population % of Pharmaceutical Expenditures DDD/1000 inh, die All ages 100 Children ( 0-17 y) Non elderly adults (18-64 y) Non elderly adults (18-64 y) Elderly (65 + y) Rationale for prescription and adherence action at regional level Source: CIRFF report Campania Region 2011

8 Chronic Disease and polytherapy Age group % of Population with chronic conditions % of Pharmaceutical Expenditure All ages 27. % 83.1 % Elderly (65 + y) 81.9 % 94.6 % Source : Own elaboration based on CIRFF data. Rationale for prescription and adherence action at regional level

9 Poor adherence: relevance Time to Discontinuation* of Chronic Therapy Classes Source : Own elaboration based on CIRFF data. * 30 days gap allowed

10 The Opportunity: Adherence improves health and reduces costs Sorce: Sokol et al. 2005

11 Tools : administrative databases observational model Population database Prescription Resources utilization CostsEffectiveness Pharmacoepidemiology Drug utilization Pharmacoeconomics

12 Our experiences -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): Lipid lowering therapy -Cammarota s, de Portu S, Riegler S, Citarella A, Menditto E, Mantovani LG. Predictors of non-persistence on statin treatments in Italy: A retrospective - Citarella 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 diabetes -The 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 drugs - Casula 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 press -Miscellaneous on drug therapy -Proton 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): 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 methods -Menditto E, Citarella A, Cammarota S, Sabatella C, Riegler S. Lutilizzo dei database amministrativi per la ricerca di base e la programmazione sanitaria: lesperienza dellASL Salerno 2. GIFF 2009; 2 (1) : Menditto E, Citarella A. Valutazione economica dello studio IDEAL. Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): de Portu S, Menditto E, Mantovani LG. Valutazione economica dello studio CARDS, aggiornamenti. Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): de Portu S, Cammarota S, Menditto E, Mantovani LG. Valutazione economica dello studio AVERT Farmeconomia e percorsi terapeutici 2007; 8 (Suppl 2): 31-35

13 Measuring adherence Pharmacoepidemiology and drug safety, 2006

14 The use of administrative databases to monitor adherence allows to detect in real-life scenario: - drug exposure in a population over time -levels of adherence to medication - predictive factors of discontinuation- establish risk definitions to tailor interventions -correlation between poor adherence and negative clinical outcomes -cost-effectiveness of enhancing adherence levels Our Action : Adherence Monitoring System (AMS)

15 Patients Registry Patient encrypted Code Patient encrypted Code Birth date Birth date Gender Gender Withdrawal date Withdrawal date Pharmaceutical Records Patient encrypted Code Patient encrypted Code Drug AIC code Drug AIC code Drug ATC code Drug ATC code Prescription date Prescription date Dispensation date Dispensation date Amount of boxes Amount of boxes Hospital Discharge Records Patient encrypted Code Patient encrypted Code Hospitalization date Hospitalization date Discharge date Discharge date Admission type Admission type Discharge type Discharge type DRG DRG Main diagnosis Main diagnosis Concomitant diagnosis Concomitant diagnosis Data Banks and Information Systems Patient encrypted Code–details – Pharmaceutical prescriptions – Hospitalizations

16 Adherence Monitoring System DB Reporting

17 Expected results Improving quality of care for patients Improving quality of care for patients Drug comsumption razionalization Drug comsumption razionalization Improving knowledge about adherence issues Improving knowledge about adherence issues Improving interaction among patients, physicians and pharmacists Improving interaction among patients, physicians and pharmacists

18 Drugs don't work in patients who don't take them. C. Everett Koop, MDC. Everett Koop, MD Enrica MendittoNaples, April


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