Pharmaceutical assistance: Territorial consumption of medicines

In 2015, the number of recipes issued by the Provincial Health Service remained fairly constant, standing at around 3.0 million recipes, representing a slight decrease of 2.9 % compared to the previous year. On the other hand, the number of pharmaceutical packages delivered (+ 1.4 %) is increasing as a result of the change, which entered into force in 2014, to the maximum number of prescription packs per recipe.* In per capita terms there are 5.7 recipes per resident and an average per capita of 12.0 packs of medicines. Data on drug use show substantial differences between sexes: 5.1 per capita recipes for men and 6.3 for women; 657 daily doses of medicinal products per 1,000 resident males (equal to 11.0 packs per capita) compared to 716 daily doses per 1,000 South Tyroleans (or 13.0 packs per capita throughout the year). There are also significant differences between the different territorial areas of the province: there is a variability ranging from 4.2 recipes per capita in the district of Val Gardena to a maximum of 6.8 recipes per capita in Bolzano (in 2015 Bolzano is the district that recorded the biggest decrease compared to the previous year in the average number of recipes per capita (in 2014 there were 7.1 recipes per capita)). In line with the provincial trend of recent years, there is a profile of the higher intake of medicines that not only affects the large urban centres such as Bolzano, Merano and Brixen but also some extra-urban areas such as Laives-Bronzolo-Vadena, Val Passiria and Alta Valle Isarco. Brunico, on the other hand, points out, contrary to the major centres, a lower use of pharmacological therapies. In order to observe the exposure of the population to medicines, i.e. the ratio of the number of subjects who received at least one prescription during the year and the reference population, for the Province of Bolzano there is a prevalence of use of 54.1 % (over half of the population took at least one drug during 2015). In older age, drug use remains significantly higher, with at least one pharmaceutical prescription for almost all 75-year-olds (97.0 %), confirming that age is the main predictive factor for drug use. Cardiovascular medicines represent the main therapeutic category in terms of DDD/1000 ab. die (47.2 %), followed by those of the gastrointestinal system and metabolism (12.0 %). Compared to the average dosages in terms of DDD/1,000, residents of the health district of Val Passiria and Laives-Bronzolo-Vadena have for different therapeutic categories (Muscle-Skeletal System, Blood and haemopoietic organs, Dermatology, etc.) the highest consumption within the province: for example, in Val Passiria in the use of general antimicrobials for systemic use, the average dosage per resident population of the district is almost twice as high as the provincial average (21.8 DDD/1000 inhab. versus 11.1 DDD/1000 inhab.) while in Laives-Bronzolo-Vadena there is the highest use of dermatological drugs (3.1 DDD/1000 inhab. versus 2.2 DDD/1000 b.) Statins, used in the treatment of hyperlipidemias, drugs of the cardiovascular therapeutic group and among the most prescribed in the territory, need a constant and continuous use over time in order to be effective in therapeutic terms: an analysis of the statin abandonment rate shows that in the last three years, 21.0 % of treated patients (one patient in 5) have been given treatment, thus reporting inappropriate use of the drug for these cases. Over the last few years, the rate recorded a slight but continuous decline. *Art.26 of Decree-Law No 90/2014, from 2014 provided for an increase in the prescription of medicines up to 6 pieces per single prescription, for chronic patients.