Practice of prescribing antipsychotics in schizophrenia during 2013-2018 based on data from the National Health Fund

AIM

The aim of the study was to analyse the prescribing pattern of antipsychotic drugs in patients with schizophrenia during the years 2013-2018.

METHOD

Schizophrenia is analysed as one of the diseases with the highest rate of Disability-Adjusted Life Years - DALY. In this study, the unitary data of the National Health Fund (NFZ) reported in the years 2013-2018 were used. Adult patients were identified by their Personal Identification Number (PESEL), and the antipsychotics were identified by the European Article Number (EAN). The study included 209,334 adults who were diagnosed with F20 to F20.9 (according to ICD-10) and were prescribed at least one antipsychotic within a year. The active substances of prescribed antipsychotic medication have been divided into typical (first generation), atypical (second generation) and long-acting injectable antipsychotics (both first and second generation). The statistical analysis contains descriptive statistics for selected sections. A linear regression, one-way analysis of variance and t-test were used in the study. All statistical analyses were performed using R, version 3.6.1 and Microsoft Excel.

RESULTS

In the years 2013-2018, the number of patients in the public sector diagnosed with schizophrenia increased by 4%. The largest increase was recorded among persons diagnosed with other schizophrenia (F20.8). In the analysed years, the number of patients who were prescribed second-generation oral antipsychotics increased significantly as well as the number of patients who were prescribed long-acting antipsychotics, especially the secondgeneration agents (risperidone LAI, olanzapine LAI). The most prescribed first-generation antipsychotics included: perazine, levomepromazine and haloperidol with a downward trend for each; and the most common second-generation drugs included: olanzapine, aripiprazole and quetiapine. A noteworthy finding was an extremely high increase in the frequency of prescribing haloperidol in the form of depot.

CONCLUSIONS

Extending the study to include information on applied prescriptive practice in the private sector would provide a fuller picture of the studied phenomenon.

Organisational units providing psychiatric services for adults - an analysis based on National Health Fund data for 2010-2016

OBJECTIVES

The aim of this publication is to analyze the organizational units of mental healthcare for adults based on the data on the services reported to the National Health Fund in 2010-2016.

METHODS

The following organizational forms of care were analyzed: mental health outpatient clinics, general psychiatric wards, general day care psychiatric wards, community mental health teams, and psychiatric emergency rooms. These organizational units were analyzed in terms of their number, utilization and accessibility. In addition, a preliminary simulation of the expected Mental Health Centers was carried out.

RESULTS

In Poland, in 2010-2016, the number of mental health service providers under contracts with the National Health Fund increased by 5%. The most robust growth was observed for community mental health teams, whose number increased by 282%. However, this organizational form was used by a marginal (1.9%) percentage of patients. The highest rate of admission to general psychiatric wards was observed in districts where a general psychiatric ward and a mental health clinic were available with no day care psychiatric wards or community mental health teams. Asmall number of entities providing comprehensive care was in operation in 2016. The preliminary simulation has shown that in 2016 a total of 156 MentalHealth Centers should have been in operation, assuming that each of them would have provided care for 200,000 inhabitants.

CONCLUSIONS

It would be advisable to analyze the exact geographic distribution of units, human resources in individual organizational units, and to take financial outlays for mental healthcare in their various forms into consideration.

Oncological Diseases and Social Costs Considerations on Undertaken Health Policy Interventions

The growing incidence and prevalence of civilization diseases is prompting national and transnational entities to seek instruments that would reverse epidemiological trends. Not without significance is the need to design such solutions that are going to provide an improved relation between the costs incurred to maintain health or recovery and the profit for citizens of continuing to function in good health. In its strategic documents, the European Union indicates the most important development goals in each financial perspective and the tools necessary to achieve them. In the Europe 2020 strategy, a cohesion policy was indicated as an important tool for the implementation of development goals, focusing on supporting activities leading to the equalisation of economic and social conditions in all regions of EU countries. The implementation of one of the three basic priorities of the Europe 2020 strategy, which is inclusive growth-supporting an economy with a high level of employment and ensuring social and territorial cohesion-assumes, among others, that in 2020, the population at risk of poverty and social exclusion will decrease by 20 million and that the employment rate in the EU will increase to 75%. Meeting the objectives will not be possible without a holistic coordinated approach to healthcare at the national and regional level in accordance with the principle of "health in all policies". It also requires the involvement of various sources of financing, including structural funds. The EU's prioritisation of the problems related to ensuring decent conditions for achieving health resulted in the mobilisation of structural funds for actions taken in the healthcare sector. Of particular importance are those actions which are taken to prevent, alleviate, and prevent oncological diseases. An additional contribution to undertaking actions aimed at preventing oncological diseases are the high and often neglected social costs incurred by societies. The goal of the article was to identify and evaluate actions taken in this area in Poland. It was achieved by analysing the literature on the subject and statistical data, and conducting induction based on the above-mentioned sources.

An analysis of psychiatric services provided to adults in 2010-2014 based on the National Health Fund data

OBJECTIVES

Analyzing the indices that allow to improve population health by, for example, improving the quality of healthcare services and increasing accessibility to these services is among the priorities of the World Health Organization (WHO). This is of particular importance in Poland, as the psychiatric care reform is being carried out in accordance with the National Mental Healthcare Program guidelines. The aim of the study is to analyze mental health services provided to adults and reported to the National Health Fund in 2010-2014.

METHODS

In the present study, we expanded the information included in the second part of the maps of health needs. In addition to the evaluation of services provided to adults in 2014, we presented an analysis of services in 2010-2014. According to these data, there was a continuous increase both in thenumber of individuals provided with services for psychiatric disorders and in the total number of provided services. There was an increase in the number of patients treated for mood disorders, neurotic disorders, stress-related and somatic disorders, as well as addictions.

RESULTS

The increase in the total number of services was mainly seen for outpatient types of care. The reasons why in 2014 there was a resurgence in psychiatric hospitalizations and in the hospitalization rate per 100 thousand adults remains unclear.

CONCLUSIONS

Our results indicate the need for further support of the development of psychiatric care using multidirectional efforts within an integrated model for solving health problems. An overall analysis of services provided in psychiatric care requires access to information on services funded from non-public sources and expanding the reported information.