Drug utilization studies as support to decisions in drug policy in Estonia

Abstract: The main purpose of the present studies was to describe the use of drugs in Estonia in an international perspective and to study factors determining changes in drug utilization. An important aim of evaluating drug utilization in Estonia was to use the data as a management instrument in areas where initiatives should be taken towards improved use of drugs. In the 1980's, many of the new groups of effective drugs reached Estonia with a considerable delay and were used only in modest quantities, if at all. On the other hand, several drugs were widely used in Estonia although they were no longer considered to be the drugs of choice in the Nordic Countries because of their high risk to benefit ratios. By 1995 the availability of more effective drugs decreased the use of additional or alternative drugs with unproven efficacy and unfavourable safety profile. Studies on drug use in three university hospitals in Estonia, Spain and Sweden revealed, that international differences in the hospital use of antibiotics, analgesic and psychotropic drugs were not in the frequency of use, but rather in the prescription preferences. A separate international study described both similarities and differences in the choice and dosage of psychotropic drugs in the treatment of schizophrenic patients in psychiatric clinics and confirmed, that polypharmacy with multiple neuroleptics, additional anticholinergics and benzodiazepines is an international phenomenon. In comparison of drug use data to the choice of other therapeutic alternatives it was shown, that the low utilization of effective drug treatment for ulcer disease in Estonia occured at the price of a high frequency of surgical interventions. Data on the use of drugs on national and institutional levels has been used in planning and management of reforms of pharmaceutical services, in regulatory decisions and reimbursement policies, in under- and postgraduate teaching, in the development of hospital formularies and therapeutic guidelines. Drug utilization studies have been used to monitor the results and evaluate the impact of intervention strategies.