Medication use in rest and nursing homes in Belgium. - KCE

20 Medication use in Nursing Homes KCE reports 47
1.5 AGGREGATED DATA ON MEDICATION USE AND
EXPENDITURES IN REST AND NURSING HOMES IN
BELGIUM
The Farmanet database contains prescriptions dispensed from community-based
pharmacies in Belgium. Prescriptions dispensed from hospital pharmacies as well as
expenditures for other categories of care can be obtained from the IMA-database with
claims data on all expenditures categories. Both databases contain information on
reimbursements of RIZIV/INAMI and out-of-pocket payments by the residents for
prescription medication.
The present study is the first to show national estimates of medication use and
expenditures for elderly residents of rest and nursing homes in Belgium. Section 1.5.1
provides data on medication use by major drug classes. In the Anatomical Therapeutic
Chemical (ATC) Classification System drugs are classified into different groups
according to the organ or system on which they act and their chemical, pharmacological
and therapeutic properties. Drugs are divided into groups at 5 different levels ee .
Section 1.5.2 gives a general overview of the expenditures of prescribed and reimbursed
medication used by elderly residents of rest and nursing homes for the year 2004. We
calculated the expenditures for the health insurance reimbursed by RIZIV/INAMI as well
as the out-of-pocket payments for the residents. Medicines are reimbursed on a feefor-service
basis in Belgium ff . The basis for reimbursement is classification within
categories fixed by Royal Decree. The classification reflects the social importance of the
drug, pharmacotherapeutic criteria and price criteria.
For this population-based description of medication use in Belgian rest and nursing
homes, only the data of drugs sold by community pharmacists to these homes are taken
into account. A minor part of homes buy their drugs through hospital pharmacies. The
hospital pharmacy data did not allow us to distinguish in a reliable way between the
medication prescribed in inpatient or day case treatment from the medication delivered
to the rest or nursing home of the resident. Moreover, this latter category also contains
the dispensing of some expensive drugs which is legally exclusively reserved for hospital
pharmacies. This bias in our estimates will lead to a small underestimation of global
medication use. The utilization data are not expected to be influenced by the retailer s
circuit chosen by homes. To estimate the distribution of drug utilization, the Defined
Daily Dose (DDD) is used as estimate for the maintenance dose per day per drug used
for its principal indications in adults. In the Farmanet data, DDDs adapted to the
Belgian situation are used gg . To calculate the overall expenditures of prescribed and
reimbursed medication, we include the hospital pharmacy data.
1.5.1 Use of medication by different levels of ATC group
The four main ATC1 classes of drug consumption in elderly people living in Belgian rest
en nursing homes are related to the cardiovascular, nervous, gastrointestinal and
respiratory system (figure 1.5). These four classes are described in more detail in this
section. A lengthy table containing the 100 most frequently used drugs (ATC5) is
presented in Appendix 4 (table 4.1).
ee
See http://www.whocc.no/atcddd/ for more information.
ff
Since July 1, 2006 a large part of hospital drugs are financed on a lump sum basis replacing the fee for
service practice.
gg
See http://www.bcfi.be for more details.