1. 1 Monitoring medical prescription in the Opole Voivodeship Branch of the NFZ Roman Kolek M.D.

2. 2 Plan of the presentation  Monitoring medical prescription;  The experience of the Opole Voivodeship Branch of the NFZ in monitoring the prescription and reimbursement of medicines;  Analyses carrier out at the Opole Voivodeship Branch of the NFZ – recent observations.

3. 3 TASKS OF THE NFZ DIRECTLY RELATED TO THE MONITORING OF MEDICAL PRESCRIPTION  Reimbursement for pharmacies (on the basis of correctly prepared and verified pharmacy reporting – collective and particular)  Control over issue and processing of medical prescriptions  Strictly controlling activities towards doctors, health care centres, pharmacies  Detecting misuse and abuse of medicines  Monitoring the quality of pharmacotherapy  Comparison of the effectiveness and safety of the application of medicines in comparable populations  Enabling doctors to compare and self-evaluate (self-audit) themselves and to improve treatment methods

4. 4 Information available in the system  ID of the pharmacy  Number assigned to prescription in processing  Prescription number (if present)  Identifier of the patient (if present)  Identifier of the medicine (magistral, EAN)  Number of packages dispensed  Payment code for the medicine  Prescription issue date  Doctor identifier (license number)  Date of acceptance of prescription for processing  Type of prescription (imp.doc., „various”, RUM, etc.)  Date of issue of medicine  identifier of the NFZ Voivodeship Branch of the patient  Additional rights of the patient  EAN code of the medicine (if present)  Value of issued packages  Amount of reimbursement  Identifier of health service provider

5. 5  RUM – use of medical services books and data obtained from it - advantages. Data to the level of the patient  Allocation of costs, quantities of medicines, types of medicines...  Specification to the level of primary health care physician on whose list the patient is placed, Improved electronic supervision and typing for control, Scientific analysis,  Supervision of the patient over medical prescription,  Increased awareness of doctors  Need to authorise services – the initiative of the Opole Voivodeship Branch of the NFZ... Experience of the Opole Voivodeship Branch of the NFZ

6. 6 Costs of reimbursement of medicines at the Opole Voivodeship Branch of the NFZ 5.68% annual average growth 22.43% annual average growth 27.16% growth

7. 7 The Opole project implemented by the Opole Regional Mutual Health Care Fund in 2001 ”Implementation Programme for Rational Medicines Management in Primary Health Care”

8. 8 Costs of the programme for the Opole Regional Mutual Health Care Fund  Reporting in respect of prescribed medicines in primary health care;  Comparison of data from all outpatient clinics;  Conclusion: Increased awareness of doctors

9. 9 Internet portal ”The Medical and Financial Analyser” Pilot project IT Department of the Opole Voivodeship Branch of the NFZ May 2005

10. 10 Main objective of the project  To create a system for influencing medical prescription through making available a tool that allows each doctor to get acquainted with the financial results of his/her therapeutic choices and to compare himself/oneself directly with other doctors of the same specialization.

11. 11 Particular objectives (1)  To establish an Internet portal for doctors and health service providers – authorised access to information on services provided by doctors and costs of medicines reimbursed by them,  To update the data in the portal cyclically (on a quarterly basis),  To systematically improve the quality of data incoming from pharmacies,  To monitor the interest of doctors in this information through registering every visit to the portal,

12. 12 Particular objectives (2)  To widen the scope of information presented in the portal by adding medical services (advice, hospital stays, orthopaedic items, sanatoriums),  Introduction of a formulary based on EBM principles,  To educate doctors in respect of the fundamentals of pharmacoeconomics based on specific examples from own databases,  To forward information concerning pharmaceutical companies whose medicines an interested doctor prescribes.

13. 13 The home page of the analyser http://www.nfz-opole.pl/analizy

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15. 15 ”The Friendly Pharmacy” A programme dedicated to pharmacists, doctors, patients. June 2005

16. 16 Objectives of the programme  To supplement the earlier initiatives of the Opole Voivodeship Branch of the NFZ; The expectations of patients, of the media, The expectations of doctors,  To direct the competition between pharmacies towards increasing the information for the patient, who is interested in lowering the costs of extra payments for medicines (e.g. the campaign „a medicine for a grosz” and other promotions);  To counteract wasting medicines.

17. 17 ”The Friendly Pharmacy” Programme  The launching of a portal in the largest local daily newspaper http://www.tanilek.nto.pl http://www.tanilek.nto.pl  Portal of the Opolskie voivodeship http://www.wrotaopolszczyzny.pl; http://www.wrotaopolszczyzny.pl  Information printed in the local press;  Making software available to interested doctors. Discussion of the goals of the campaign at the meeting of the District Medical Council in Opole.

18. 18 Perspectives in the of view of the Opole Voivodeship Branch of the NFZ (1)  closer cooperation with the entire medical community – ”The Medical and Financial Analyser”,  increased interest of pharmacists in offering cheaper counterparts– ”The Friendly Pharmacy”,  use of optimum treatment models which must be voiced by medical experts,

19. 19 Perspectives in the view of the Opole Voivodeship Branch of NFZ (2)  The costs of refund are just and as many as one of the types of costs borne by NFZ – balancing all the costs to the patient’s level and applying!!!  Primary health care financing modification Incentive-based system with the use of cost data, „Task-based financing”, Greater responsibility, but also financial link (elimination of unnecessary benefits).

20. 20 „Measure what is measurable, and make measurable what is not so.” Galileo Galilei (1564-1642)

21. 21  Development of a new manner of financing treatment of patients suffering from diabetes, basing on data of diabetes drugs refunds,  Analysis of the quantity and groups of antibiotics used within age groups in the region and training of doctors,  …

22. 22 Antibiotics consumption related to S. pneumoniae drug resistance in the EU 1998-2001 Source: Emerging Infectious Diseaseses Vol 8, No 3, March 2002 PL FR PL FR

23. 23 Average number of antibiotic treatments as part of primary health care in the Kędzierzyński-Kozielski Poviat per 100 medical visits as part of primary health care in Opole Voivodeship Branch of NFZ 01.11.2005 to 30.04.2006 Voivodeship average -14.48 prescriptions/100 visits TOTAL NUMBER OF PRESCRIPTIONS PER 100 PRIMARY HEALTH CARE VISITS TOTAL NUMBER OF PRESCRIPTIONS PER 1 PRIMARY HEALTH CARE PATIENT

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25. 25 Thank you for your attention