Drug Use in Patients with Non-Communicable Chronic Diseases and Health Outcomes in Nonghan Hospital, Udonthani

Abstract

Objective: 1) To analyze the utilization patterns and trends in the quantity and expenditure of drugs for non-communicable chronic diseases (NCDs) in Nonghan Hospital; 2) to identify factors associated with quantity and expenditure of drug use; and 3) to analyze trends in health outcomes in terms of controlled blood sugar and controlled blood pressure, and hospital readmissions of patients who received the NCD drugs.  Methods: This research was a retrospective study using electronic data on outpatient visits, inpatient admissions and outpatient drug prescribing in the fiscal years of 2015-2018 within Nonghan Hospital in five groups of diseases (that were able to prevent or reduce hospitalization by outpatient cares) identified by World Health Organization’s Anatomical, Therapeutic, and Chemical (ATC) classification system including antidiabetics (A10), antihypertensive agents (C02, C03, C07, C08 and C09), antiepileptics (N03), antiasthmatics (R03A, R03BA, R03C), and drugs for chronic obstructive pulmonary disease (R03BB). Data were analyzed using a time-series analysis for time trends and linear regressions for identifying associated factors.  Results: In 2015, 2016, 2017 and 2018, the average number of NCD drugs per prescription was 6.14, 5.96, 5.56 and 5.60 items, respectively, which had a statistically decreasing trend (P<0.001). Over the same periods, the prescriptions of more than 5 drug items decreased but statistically non-significant (P>0.05) from 15.59% in 2015 to 14.05, 14.08 and 13.60% in 2016, 2017 and 2018. However, the total quantity of drug use in patients receiving the NCD drugs had a significantly increasing trend (P<0.05) with an average annual growth of 57 defined-daily doses (DDDs). Regarding drug groups, the largest quantity of drug use was 474 DDDs of antihypertensive agents in 2018, which grew by 70 DDDs annually from 2015, followed by the annual growth of 58 DDDs of antidiabetics. Overall drug expenditure in patients receiving the NCD drugs had a significantly increasing trend (P<0.05) with the annual growth of 147 Baht per patient. Patients receiving antiepileptics had the highest expenditure growth with an average annual rate of 223 Baht, followed by those receiving antidiabetics, antiasthmatics and antihypertensive agents with the rate of 218, 148 and 127 Baht, respectively. Factors associated with the increases in quantity and expenditure of drug use were the use of NCD drugs, followed by ages more than 60 years. Regarding health outcomes, patients with controlled blood pressure increased among those receiving antihypertensive agents. In a contrary, the proportion of patients with controlled blood sugar among those receiving antidiabetics decreased. Furthermore, 28-day readmissions to the hospital had an increasing trend in the patients who received antidiabetics and drugs for chronic obstructive pulmonary disease and had a decreasing trend in those receiving antihypertensive agents.  Conclusions: The total quantity of drug use increased and resulted in an increase in drug expenditure, but health outcomes among those with antidiabetics were not adequate.