17-19 october 2016, Barcelona Key issues about the contract formulation CORINNE ZARA PHARMACY DEPARTMENT BARCELONA HEALTH REGION 1
Barcelona Health Region: a brief description 5 million people 32 hospitals 216 primary care teams 77 mental Health centres(adults/infants) 50 nursing homes 2
Key issues about the contract formulation between payers (CatSalut) and health providers It includes budget, quality and safety considerations Territorial approach: interface management Accordance between guides and evaluation documents with the objectives Quality indicators based on drug selection and drug exposition Address the new drug prescriptions towards suitability and usefulness Incorporate Health Outcomes (wherever possible) 3
Pharmaceutical Quality Prescription Index Objective To intervene the incorporation of innovation, drug selection and drug exposition Population All Stakeholders Transversal: primary care, hospital, mental Health, nursing home Which Field? Antidiabetics Hypertension Osteoporosis Depression Anxiolytics/hypnotics Proton Pump Inhibitors From 18 territories 9 100% 4 75% 3 50% 2 25% 4
IQF 2015 ÀREES DE GESTIÓ ASSISTENCIAL GENER-DESEMBRE 2015 Àrea de Gestió Assistencial Puntuació BASAL gener-desembre 2015 IQF OBJECTIU 2015 Vallès Oriental Central 98 95 98 Baix Montseny 83 73 83 Baix Llobregat Litoral i Viladecans 78 74 79 Baix Vallès 77 72 78 Maresme Central 73 66 74 Barcelona Dreta 68 65 70 Barcelona Litoral Mar 65 70 67 Barcelona Esquerra 65 64 67 Baix Llobregat Nord 64 63 66 Vallès Occidental Est 60 54 63 Barcelonès Nord i Baix Maresme 58 57 61 Barcelona Nord 52 56 56 Baix Llobregat Centre i Fontsanta -L'H N 48 52 53 Garraf 47 52 52 L'Hospitalet Sud i el Prat de Llobregat 46 51 51 Baix Llobregat Litoral i Sant Boi 46 45 51 Alt Penedès 32 38 40 Vallès Occidental Oest 29 39 37 5
New drugs that may have better alternatives: MATMA MATMA: New drugs (registered during last 5 years) avaluated by the Catalan Quality Agency and no suitable as a first choice in any condition 6
MATMA prescription During the 2015, the MATMA represent a 1,13% of total items dispensed in the Barcelona Health Region Distribution is different regarding to care in: Primary care 1,07% Hospital 2,45% Mental health 0,09% 7
Polimedication Objective: To endorse medication review process measuring number of safety events by patient Stakeholders primary care, hospital, mental health, nursing home Population Chronic complex patients and polimedicated patients (>10drugs) that may be expose to drugs with additional risk Which field? Medication not recommended in old people (Beers) Drugs without value (citicolina, chondroprotectors) Duplicity (benzodiazepines, IECA,/ARA II; 3 or more anticholinergic in old people; two or more IECA/ARA 2) Risk combination (anticoagulants+ antiplatelet without PPI;ISRA+diuretic+NSAIDs; antiplatelet or anticoagulant+nsaid without PPI) Contraindicated related to the diagnosis (coxib+diclofenac in cardiac patients) Excessive duration (antipsychotics in dementia for more 6 months; benzodiazepines for more 6 months) A comparative analysis between April and December 2015 shows: 8
Safety events in Chronic complex patients PCC april 2015 PCC december 2015 Territories Number of patients Safety events by patient Number of patients Safety events by patient Baix Llobregat Centre i Fontsanta -L'H N 4.266 0,63 3.584 0,60 L'Hospitalet Sud i el Prat de Llobregat 2.030 0,58 1.726 0,58 Barcelonès Nord i Baix Maresme 5.458 0,70 4.842 0,67 Maresme Central 3.391 0,65 3.007 0,61 Vallès Occidental Est 4.278 0,68 3.727 0,65 Barcelona Esquerra 6.535 0,74 5.736 0,70 Barcelona Nord 6.589 0,68 5.754 0,63 Alt Penedès 1.018 0,72 889 0,65 Garraf 1.230 0,64 1.071 0,54 Baix Llobregat Litoral i Viladecans 975 0,66 846 0,64 Baix Llobregat Litoral i Sant Boi 822 0,64 684 0,62 Baix Llobregat Nord 1.449 0,76 1.293 0,66 Vallès Occidental Oest 4.606 0,88 4.032 0,75 Baix Montseny 398 0,62 365 0,60 Baix Vallès 2.689 0,64 2.376 0,61 Vallès Oriental Central 3.453 0,64 3.040 0,60 Barcelona Dreta 5.235 0,72 4.590 0,64 Barcelona Litoral Mar 3.195 0,61 2.731 0,58 TOTAL 96.784 0,69 85.091 0,64 9
Hospital interface with other stakeholders Objective To promote communication between the hospital and the rest of health providers in order to coordinate drug utilization Population Hospital patients Stakeholders Hospital specialists Which Field? Innovation drugs that may be considered necessary in some patients (but not in general population neither first line) January - June 2016 3.295 MATMA Missatges over 32.033 MATMA prescriptions 10,3% 10
Health Outcomes Objective: To measure treatment outcomes Population Patients with treatment (chronic or naïf) Stakeholders Hospital pàtients in treatment (chronic or naif) Which Field? AIDs (HIV) Hepatitis C (HC) Rheumatoid arthritis (RA) RA: % patients with good results in DAS 28 22/25 hospitals HC: % viral sostened viral load 18/25 HIV: % viral load undetectable 19/19 11
Mental Health: Antipsychotics Objective To control cost and quality of the prescription Population All attended patients in mental health centres (MHC) Stakeholders Mental Health Providers (MHP) Which field? Antipsychotics (cost/ddd) combination for 3 or more antipsychotics Cost/DDD<3,2 32/43 MHC Antipsychotic combination <4% 36/43 MHC 12
About the budget Objective To promote efficiency between all the stakeholders Population All Which Field Capitative Assignment Model that includes : Epidemiological variables Morbidity variables (CMBD) Provider assumed 10% risk of profits or losses regarding exceeds or remains from budget Stakeholders Primary care, hospital, mental health, nursing home From 18 TERRITORIES 8 remained below budget and earned 10% of the difference 10 remained above budget and paid 10% of the difference 13
Electronic prescription utilization Electronic prescription 98% Primary Care Centres 89% Hospitals 99% Mental Health Centres 98% Nursing Home December 2015 Not to be considered in future contracts objectives... 14
Thank you czara@catsalut.cat 15