ONE of the smaller Slovak health insurance companies decided to run a test in mid 2001 by launching the use of prescription record books among its chronically ill patients. The goal was to make the use of drugs by those who saw multiple specialists more transparent. Not only did the test make medicine use safer, the measure also brought the company significant savings.
"The initial call for such a record book came from physicians that shared patients that had several diseases and were treated with several types of medicine. [The doctors] had a problem with the exchange of prescription information," said Slávka Petrušková, chief analyst at Sideria-Istota health insurance, the firm that launched the measure.
The books are simple to implement and do not require costly financial and technical investments. Patients carry them when they visit their doctors, who can use them to record any new treatments they initiate and follow their client's prescription history with other practitioners.
In addition to protecting patients from the potentially dangerous side effects of the combination of various medications, the books had a positive economic effect. "Our costs for prescribed drugs decreased by 14 percent," said Petrušková.
Thanks to such results, the Health Ministry is trying to create a favourable legislative frame for the general introduction of prescription record books.
"The aim is to cut drug costs. Medicine is often prescribed twice," said Angelika Szalayová from the department of drug policy in the Health Ministry.
The books would be optional for insurance companies.
One of the major state health insurance companies, Všeobecná zdravotná poisťovňa (VšZP), is also optimistic about the measure. Milan Velecký, the firm's spokesman, could not specify when the health insurance company would adopt the books, as it is still waiting for the state's direction.
The ministry has already worked out the law, but it has not yet been approved by parliament. Who will pay for the books and which patients will get them has not been revealed either.
According to Velecký, VšZP would pay to print and distribute the prescription books only if they were compulsory for the most costly patients.
"In such a case, the positive effect would be clear and it would be in our interest to introduce them," he said.
If all insured clients are required to carry books, they alone should pay for them, VšZP thinks. "However, we do not suppose that this option will be chosen," added Velecký.
Some physicians argued that the measure would mean just another administrative barrier. The ministry disagrees: "I can imagine that the new measure could be perceived negatively. However, I do not think that it would significantly burden physicians. If [a doctor] has to write a prescription, he can just as well make a note in the book," said Szalayová.
One solution could be to keep such records in an electronic version, as is the case in developed countries. However, because of the high costs of such a system, its implementation in the near future is unlikely.
"Due to the current [low] use of information technologies in physician's offices and the whole healthcare sector, we think the print version is today the only possible alternative. The cost of one of our printed prescription books is Sk10 (Ř.25). In the future, electronic cards could be introduced, but it would require the technological preparation of the whole sector," said Petrušková.
Investment in such technologies could reach billions of crowns. "Not only offices but also all pharmacies and doctor's offices would have to have the facilities to read the electronic cards. I do not think that such an investment is a job for the health insurance companies," added Velecký.
Prescription record books have primarily an informational use. They briefly tell doctors about prescribed medications and whether a patient has actually picked the drugs up from the pharmacy.
Sideria's prescription book includes the name of the insured patient, the codes and address of the patient's general practitioner, and additional information about allergies, blood type, etc. Medication use is recorded chronologically with prescribed dosages and periods.
"Our experience has been positive. Our surveys say that physicians that use complex pharmaceutical treatments and multiple diagnoses and patients who take multiple medications are content in the majority of cases," said Petrušková.
The results of the prescription record books (PRB) project at Sideria-Istota
The number of patients using PRB...........................................................................................1,698
Average monthly medication cost per patient before introducing PRB ...................Sk3,226 (€77.84)
Average monthly medication cost per patient after introducing PRB.......................Sk2,758 (€66.55)
Average monthly decrease in costs of prescribed medications...................................................14%
Average number of packages prescribed to one patient before PRB .........................................11.2
Average number of packages prescribed to one patient after PRB...............................................8.7
Average decrease in number of packages prescribed to one patient ..........................................21%
Source: Sideria-Istota
