MEDICATIONS USED TO TREAT UPPER RESPIRATORY TRACT INFECTION AND COMMON COLD

Transcription

1 MEDICATIONS USED TO TREAT UPPER RESPIRATORY TRACT INFECTION AND COMMON COLD

2 TABLE OF CONTENT OUR TPA MODEL FOR COMPREHENSIVE PBM SOLUTION PURPOSE OF THE DRUG UTILIZATION REVIEW (DUR) BACKGROUND ABOUT UPPER RESPIRATORY TRACT INFECTIONS AND COMMON COLD METHODOLOGY STUDY DISCUSSION CONCLUSION WHAT S NEXT?

3 PHARMACY BENEFIT MANAGEMENT SOLUTION O Page 3 Our leading TPA utilizes a comprehensive solution to take care of the patient's health. ONLINE PHARMACY PORTAL FOR PRESCRIPTION/CLAIM SUBMISSION EXPERT RULES SYSTEM TO DETECT POSSIBLE INTERACTIONS PRIOR TO DISPENSING THE DRUG CLINICAL PHARMACISTS SUPPORTED BY PHYSICIAN-STAFFED PHARMACY AND THERAPEUTICS COMMITTEE INTERVENTION PROGRAMS BUILT AROUND EVIDENCE-BASED MEDICINE COMPREHENSIVE ANALYTICS PROGRAM TO IMPROVE EXPERT RULES AND IDENTIFY AREAS FOR IMPROVED DRUG USAGE TO ACHIEVE BETTER CARE AND VALUE FOR THE PATIENT Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

4 PURPOSE OF THE STUDY Page 4 Using our TPA comprehensive solution, Upper Respiratory Tract Infections & Common Cold Prescriptions were collected and analyzed for: ANTIBIOTICS PRESCRIBING PATTERNS OVER THE COUNTER MEDICATIONS (OTCS) USAGE DIAGNOSES CODING ARRAY DRUG INTERACTIONS AGE INCOMPATIBILITY DUPLICATION OF THERAPY DRUG DAILY DOSE ABOVE RECOMMENDED RANGE Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

5 BRIEF HISTORY ABOUT UPPER RESPIRATORY INFECTIONS AND COMMON COLD Page 5 Upper Respiratory Tract Illness (URI) includes diseases of the nose, para-nasal sinuses, adenoids, tonsils, naso-pharynx and Eustachian tubes. URIs are the most common seasonal infection and ranges from pharyngitis to sinusitis, epiglottis, laryngo-tracheitis and the common cold. Viruses rather than bacteria represent the major cause for these infections % of the patients worldwide continue to be prescribed antibiotics for URTIs. Typically, viral URTIs require only supportive care rather than antibiotic treatment. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

6 METHODOLOGY O OG Page 6 1. The retrospective study included all prescriptions dispensed between and including all age groups. 2. Patients obtained these medications from our TPA pharmacy network. 3. Only claims linked to a diagnosis code pertaining to upper respiratory tract infections (URTI) and common cold (CC) were analyzed. 4. Out of all the submitted prescriptions, atotal number of 15,699 prescriptions were dispensed to 9,512 individuals diagnosed with URTI or CC. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

7 METHODOLOGY O OG Page 7 The gender distribution was 50% females and 50% males. Age distribution ranged from infancy to 95 years of age. STUDY DESIGN For clinical evaluation, a retrospective analysis for all pharmaceutical prescriptions for patients diagnosed with URTI or CC in the period August 2014 to August The definition of CCs and URTIs was based on ICD-10-WHO codes. Codes were submitted by dispensing pharmacies based on physician documentation. INCLUSION CRITERIA Patients diagnosed with and prescribed drugs for URTI and CC were included in the study Patients of either sex All ages EXCLUSION CRITERIA All Prescriptions i not associated with ihurti and CC ICD code COST ANALYSIS For Cost Analysis, costs were calculated based on the medication price lists published and shared by the Ministry of Public Health in Lebanon from August 2014 until August Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

8 S Page 8 The percentage of prescriptions with the respective ICD 10 WHO code is as shown in the table: ICD Code Description Claims distribution (%) J06.9 Acute upper respiratory infection, 30% unspecified R05 Cough 21% J03.9 Acute tonsillitis, unspecified 20% J01.9 Acute sinusitis, unspecified 15% J00 Acute nasopharyngitis [common 10% cold] J04.0 Acute laryngitis 1% J02.9 Acute pharyngitis, unspecified 0.5% J02.0 Streptococcal pharyngitis J11.0 Influenza with pneumonia, virus not identified R07.0 Pain in throat J06.8 Other acute upper respiratory infections of multiple sites J01.00 Acute maxillary sinusitis iti 2.5% J03.0 Streptococcal tonsillitis Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

9 S Page 9 All prescriptions had at least one ICD code entered by the pharmacist. In total, out of all the insured members at our TPA who had pharmacy prescriptions, 9,512 individuals had been diagnosed with URTI and CC and received 15,699 prescriptions. The total approved amount was $552,362. Cost per prescription: $35 Top five physicians specialties by approved amount are: General Practitioners> Pediatricians> ENT> Family Doctor and Internal Medicine. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

10 S Page 10 Approved amount of Antibiotics amounted to = $219,335 (40%) Antibiotics Approved amount of OTCs amounted to= $140,694 (25%) Approved amount of Gastrointestinal amounted to = $36,064 (6.5%) Approved amount of EENT amounted to= $31,770 (5.7%) Approved amount of Anti-Asthmatics amounted to= $24,240 (4.4%) Rest of Approved Amount 18.4% distributed between different medicinal families. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

11 S Page 11 Drug Classes 18.40% 4.40% 5.70% 6.50% 40% Antibiotics OTCs GI drugs EENT drugs Anti-asthmatics Other 25% Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

12 S Page 12 Prescription/Claim count by top pharmacological families Claim Count Across Time by HIC3 Class for CEPHALOSPORINS - 2ND GENERATION, CEPHALOSPORINS - 3RD GENERATION, PENICILLINS and 1 more Legend CEPHALOSPORINS - 2ND GENERATION CEPHALOSPORINS - 3RD GENERATION PENICILLINS QUINOLONES August 2014 October 2014 December 2014 February 2015 April 2015 June 2015 August 2015 Month of Transaction Date The trend of Sort Metric for Transaction Date Month. Color shows details about Compare By. The data is filtered on Disease Description, Doctor Name, Doctor Specialty Description, Gender, Gtc Desc, Hic3 Desc, AGE, ATC from FDB, FDBcode2, Transaction Date and Action (Show Spend by Subcat). The Disease Description filter keeps 13 of 13 members. The Doctor Name filter keeps 2,508 of 2,508 members. The Doctor Specialty Description filter keeps 59 of 59 members. The Gender filter keeps FEMALE and MALE. The Gtc Desc filter keeps 39 of 39 members. The Hic3 Desc filter keeps 204 of 204 members. The AGE filter ranges from 0 to 99. The ATC from FDB filter keeps 380 of 380 members. The FDBcode2 filter keeps 849 of 849 members. The Transaction Date filter ranges from 8/1/2014 to 8/1/2015. The Action (Show Spend by Subcat) filter keeps 4 Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

13 S Page 13 Top antibiotics pharmacological families by approved amount Approved Amount Across Time by HIC3 Class for CEPHALOSPORINS - 2ND GENERATION, CEPHALOSPORINS - 3RD GENERATION, PENICILLINS and 1 more 12K 11K 10K 9K 8K Legend CEPHALOSPORINS - 2ND GENERATION CEPHALOSPORINS - 3RD GENERATION PENICILLINS QUINOLONES 7K 6K 5K 4K 3K 2K 1K 0K August 2014 October 2014 December 2014 February 2015 April 2015 June 2015 August 2015 Month of Transaction Date The trend of Sort Metric for Transaction Date Month. Color shows details about Compare By. The data is filtered on Disease Description, Doctor Name, Doctor Specialty Description, Gender, Gtc Desc, Hic3 Desc, AGE, ATC from FDB, FDBcode2, Transaction Date and Action (Show Spend by Subcat). The Disease Description filter keeps 13 of 13 members. The Doctor Name filter keeps 2,508 of 2,508 members. The Doctor Specialty Description filter keeps 59 of 59 members. The Gender filter keeps FEMALE and MALE. The Gtc Desc filter keeps 39 of 39 members. The Hic3 Desc filter keeps 204 of 204 members. The AGE filter ranges from 0 to 99. The ATC from FDB filter keeps 380 of 380 members. The FDBcode2 filter keeps 849 of 849 members. The Transaction Date filter ranges from 8/1/2014 to 8/1/2015. The Action (Show Spend by Subcat) filter keeps 4 Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

14 S Page 14 Cost per prescription/claims for the top pharmacological families Cost Per Claim Across Time by HIC3 Class for CEPHALOSPORINS - 2ND GENERATION, CEPHALOSPORINS - 3RD GENERATION, PENICILLINS and 1 more QUINOLONES 30 Legend CEPHALOSPORINS - 2ND GENERATION CEPHALOSPORINS - 3RD GENERATION PENICILLINS August 2014 October 2014 December 2014 February 2015 April 2015 June 2015 August 2015 Month of Transaction Date The trend of Sort Metric for Transaction Date Month. Color shows details about Compare By. The data is filtered on Disease Description, Doctor Name, Doctor Specialty Description, Gender, Gtc Desc, Hic3 Desc, AGE, ATC from FDB, FDBcode2, Transaction Date and Action (Show Spend by Subcat). The Disease Description filter keeps 13 of 13 members. The Doctor Name filter keeps 2,508 of 2,508 members. The Doctor Specialty Description filter keeps 59 of 59 members. The Gender filter keeps FEMALE and MALE. The Gtc Desc filter keeps 39 of 39 members. The Hic3 Desc filter keeps 204 of 204 members. The AGE filter ranges from 0 to 99. The ATC from FDB filter keeps 380 of 380 members. The FDBcode2 filter keeps 849 of 849 members. The Transaction Date filter ranges from 8/1/2014 to 8/1/2015. The Action (Show Spend by Subcat) filter keeps 4 Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

15 S Page 15 Patient count of the top pharmacological families Patient Count Across Time by HIC3 Class for CEPHALOSPORINS - 2ND GENERATION, CEPHALOSPORINS - 3RD GENERATION, PENICILLINS and 1 more Legend CEPHALOSPORINS - 2ND GENERATION CEPHALOSPORINS - 3RD GENERATION PENICILLINS QUINOLONES August 2014 October 2014 December 2014 February 2015 April 2015 June 2015 August 2015 Month of Transaction Date The trend of Sort Metric for Transaction Date Month. Color shows details about Compare By. The data is filtered on Disease Description, Doctor Name, Doctor Specialty Description, Gender, Gtc Desc, Hic3 Desc, AGE, ATC from FDB, FDBcode2, Transaction Date and Action (Show Spend by Subcat). The Disease Description filter keeps 13 of 13 members. The Doctor Name filter keeps 2,508 of 2,508 members. The Doctor Specialty Description filter keeps 59 of 59 members. The Gender filter keeps FEMALE and MALE. The Gtc Desc filter keeps 39 of 39 members. The Hic3 Desc filter keeps 204 of 204 members. The AGE filter ranges from 0 to 99. The ATC from FDB filter keeps 380 of 380 members. The FDBcode2 filter keeps 849 of 849 members. The Transaction Date filter ranges from 8/1/2014 to 8/1/2015. The Action (Show Spend by Subcat) filter keeps 4 Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

16 S Page 16 Cost per claim across time by patient gender Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

17 S Page 17 Age bracket distribution for antibiotics prescribed to treat URTIs and CCs Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

18 S Page 18 Examples: AGE INCOMPATIBILITY Dimetindene+Phenylephrine Nasal Drops prescribed to a one year old child- drug was rejected due to age incompatibility (minimum age is 6yrs) DRUG-DRUG INTERACTION Clarithromycin 500mg was prescribed with simvastatin 10mg DUPLICATION OF THERAPY Paracetamol 250mg suppositories prescribed along with Paracetamol Baby & Infant syrup; both drugs were approved upon checking modality of use. Copyright 2014 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

19 STUDY DISCUSSION Page 19 Drugs play an important role enhancing human health and promoting overall wellbeing. Antibiotics represented 40% of drug costs for patients diagnosed with URTI. Breakdown by drug family was: Penicillin (14.5%) Third generation cephalosporin (9%) Quinolones (7.5%) Second generation cephalosporin (3.7%). The overall average cost of a URI/CC-associated prescription is 35$. 2 As demonstrated by graph titled Age Bracket Distribution for Antibiotics, the two highest age brackets where antibiotics are being prescribed include the 0-4 year age bracket and the year age bracket. The same study was carried out in two other countries in the region and unfortunately similar behavior was noticed. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

20 CONCLUSION C O Page 20 Drug utilization demonstrates that antibiotics were frequently used as a first line of treatment for URIs and CC, which is not recommended in medical literature These conditions are self-limiting limiting illnesses that require minimum antibiotics usage. Following evidence-based guidelines will decrease the amount of bacterial resistance and lead to cost-effective use of medications. With the TPA collecting all the medical, demographic and pharmaceutical data over the years and with the support of its clinical pharmacists and Pharmacy and Therapeutics Committee along with algorithms proper patient care is achieved. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

21 WHAT S NEXT? Page 21 Awareness campaigns to remind all healthcare providers about the importance of selecting antibiotics rationally based on the nature of the disease and the condition of the patient. UTILIZING SUCH TYPE OF DATA ANALYSIS AND WITH THE SUPPORT OF REGULATORS AND MINISTRIES SPECIFIC PARAMETERS CAN BE SET ON THE SYSTEM TO AUTOMATICALLY REJECT DRUGS BEING USED FOR URTI AND CC ICDS AND SEND THE CLAIMS FOR FURTHER REVIEW. THE ABOVE IS JUST ONE SIMPLE EXAMPLE THE SAME CAN BE DONE TO ANY DISEASE OR ILLNESS HYPERTENSION, DIABETES, ETC. Copyright 2015 GlobeMed All rights reserved. No part of this presentation in all its property may be used or reproduced in any form without a written permission

22 THANK YOU