MOST COMMON DIAGNOSES MANAGED IN PUBLIC AND PRIVATE CLINICS

✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✩ ✢

8.2 TYPES OF MEDICATIONS PRESCRIBED

7DEOHVKRZVWKHGLVWULEXWLRQRISUHVFULEHGPHGLFDWLRQVIROORZLQJ7FODVVLÀFDWLRQLQGH[7KLVLV the overall results combining medications from both public and private clinics. Medications constituting at least 0.5 of all prescribed medications are included in the table, and presented by ATC levels in decreasing order of frequency. ‡ 5HVSLUDWRU\V\VWHPDJHQWVZHUHWKHPRVWFRPPRQPHGLFDWLRQSUHVFULEHGDVLWDFFRXQWHGIRU of all medications and prescribed to 60 out of 100 encounters. Antihistamines were the predominant agent and contributed to half of the respiratory medications. ‡ OLPHQWDU\ WUDFW DQG PHWDEROLVP DJHQWV ZHUH WKH QH[W PRVW IUHTXHQWO\ SUHVFULEHG PHGLFDWLRQV The prescription rate of these agents was slightly lower than respiratory medications, at 55 per 100 encounters. ‡ DUGLRYDVFXODUPHGLFDWLRQVFRQWULEXWHGWRRIDOOPHGLFDWLRQVDQGSUHVFULEHGDWDQDYHUDJHRI 32 per 100 encounters. Table 8.2: Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012 ATC Level 1 Number Percentage of all medications n = 359,272 Rate per 100 encounters 95 CI n = 141,593 Rate per 100 diagnoses 95 CI n = 188,944 ATC Level 3 ATC Level 5 Respiratory system 85,063

23.7 60.1 59.8 - 60.3

45.0 44.8 - 45.2

Antihistamines for systemic use 45,882 12.8 32.4 32.2 - 32.6 24.3 24.1 - 24.5 Diphenhydramine, combinations 12,956 3.6 9.2 9.0 - 9.3 6.9 6.7 - 7.0 Chlorphenamine 10,993 3.1 7.8 7.6 - 7.9 5.8 5.7 - 5.9 Loratadine 5,596 1.6 4.0 3.9 - 4.1 3.0 2.9 - 3.0 Cetirizine 5,508 1.5 3.9 3.8 - 4.0 2.9 2.8 - 3.0 Dexchlorpheniramine 4,556 1.3 3.2 3.1 - 3.3 2.4 2.3 - 2.5 Diphenhydramine 3,398 0.9 2.4 2.3 - 2.5 1.8 1.7 - 1.9 Expectorants, excl. combinations with cough suppressants 7,468 2.1 5.3 5.2 - 5.4 4.0 3.9 - 4.0 Bromhexine 4,606 1.3 3.3 3.2 - 3.3 2.4 2.4 -2.5 Nasal decongestants for systemic use 6,841 1.9 4.8 4.7 - 4.9 3.6 3.5 - 3.7 Pseudoephedrine, combinations 6,405 1.8 4.5 4.4 - 4.6 3.4 3.3 - 3.5 Cough suppressants, excl. combinations with expectorants 5,575 1.6 3.9 3.8 - 4.0 3.0 2.9 - 3.0 Combinations 2,350 0.7 1.7 1.6 - 1.7 1.2 1.2 - 1.3 Dextromethorphan 1,897 0.5 1.3 1.3 - 1.4 1.0 1.0 - 1.1 Throat preparations 4,331 1.2 3.1 3.0 - 3.1 2.3 2.2 - 2.4 continued ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✩ ✣ ATC Level 1 Number Percentage of all medications n = 359,272 Rate per 100 encounters 95 CI n = 141,593 Rate per 100 diagnoses 95 CI n = 188,944 ATC Level 3 ATC Level 5 Adrenergics for systemic use 3,975 1.1 2.8 2.7 - 2.9 2.1 2.0 - 2.2 Salbutamol 3,498 1.0 2.5 2.4 - 2.6 1.9 1.8 - 1.9 Adrenergics, inhalants 3,364 0.9 2.4 2.3 - 2.5 1.8 1.7 - 1.8 Salbutamol 2,212 0.6 1.6 1.5 - 1.6 1.2 1.1 - 1.2 Other cold preparations 3,318 0.9 2.3 2.3 - 2.4 1.8 1.7 - 1.8 Decongestants and other nasal preparations for topical use 1,821 0.5 1.3 1.2 - 1.3 1.0 0.9 - 1.0 Alimentary tract and metabolism 77,137

21.5 54.5 54.2 - 54.7

40.8 40.6 - 41.0

Blood glucose lowering drugs, excl. insulins 16,610 4.6 11.7 11.6 - 11.9 8.8 8.7 - 8.9 Metformin 8,839 2.5 6.2 6.1 - 6.4 4.7 4.6 - 4.8 Gliclazide 4,187 1.2 3.0 2.9 - 3.0 2.2 2.2 - 2.3 Glibenclamide 2,334 0.6 1.6 1.6 - 1.7 1.2 1.2 - 1.3 Belladona and derivatives, plain 8,072 2.2 5.7 5.6 - 5.8 4.3 4.2 - 4.4 Butylscopolamine 8,029 2.2 5.7 5.6 - 5.8 4.3 4.2 - 4.3 Antipropulsives 5,816 1.6 4.1 4.0 - 4.2 3.1 3.0 - 3.2 Loperamide 3,314 0.9 2.3 2.3 - 2.4 1.8 1.7 - 1.8 Diphenoxylate 2,502 0.7 1.8 1.7 - 1.8 1.3 1.3 - 1.4 Antacids 5,617 1.6 4.0 3.9 - 4.1 3.0 2.9 - 3.1 Magnesium silicate 2,662 0.7 1.9 1.8 - 2.0 1.4 1.4 - 1.5 Ordinary salt combinations DQGDQWLÁDWXOHQWV 1,660 0.5 1.2 1.1 - 1.2 0.9 0.8 - 0.9 Electrolytes with carbohydrates 5,270 1.5 3.7 3.6 - 3.8 2.8 2.7 - 2.9 Drugs for peptic ulcer and gastro- RHVRSKDJHDOUHÁX[GLVHDVH 5,017 1.4 3.5 3.4 - 3.6 2.7 2.6 - 2.7 Ranitidine 2,160 0.6 1.5 1.5 - 1.6 1.1 1.1 - 1.2 Intestinal adsorbents 4,563 1.3 3.2 3.1 - 3.3 2.4 2.3 - 2.5 Medicinal charcoal 3,113 0.9

2.2 2.1 - 2.3 1.6 1.6 - 1.7

Propulsives 4,441 1.2 3.1 3.0 - 3.2 2.4 2.3 - 2.4 Metoclopramide 2,717 0.8 1.9 1.8 - 2.0 1.4 1.4 - 1.5 Domperidone 1,684 0.5 1.2 1.1 - 1.2 0.9 0.9 - 0.9 continued Table 8.2 continued: Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012 ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✩ ★ ATC Level 1 Number Percentage of all medications n = 359,272 Rate per 100 encounters 95 CI n = 141,593 Rate per 100 diagnoses 95 CI n = 188,944 ATC Level 3 ATC Level 5 Drugs for functional gastrointestinal disorders 3,021 0.8 2.1 2.1 - 2.2 1.6 1.5 - 1.7 Silicones 2,152 0.6 1.5 1.5 - 1.6 1.1 1.1 - 1.2 Insulins and analogues 3,010 0.8 2.1 2.1 - 2.2 1.6 1.5 - 1.7 Insulin human - intermediate acting 1,718 0.5 1.2 1.2 - 1.3 0.9 0.9 - 1.0 Stomatological preparations 2,909 0.8 2.1 2.0 - 2.1 1.5 1.5 - 1.6 Various 1,643 0.5 1.2 1.1 - 1.2 0.9 0.8 - 0.9 Vitamin B-complex, incl. combinations 2,521 0.7 1.8 1.7 - 1.9 1.3 1.3 - 1.4 Ascorbic acid vitamin C, incl. combinations 1,736 0.5 1.2 1.2 - 1.3 0.9 0.9 - 1.0 Ascorbic acid vit C 1,702 0.5 1.2 1.1 - 1.3 0.9 0.9 - 0.9 Drugs for constipation 1,692 0.5 1.2 1.1 - 1.3 0.9 0.9 - 0.9 Cardiovascular system 45,019

12.5 31.8 31.6 - 32.0

23.8 23.6 - 24.0

Lipid modifying agents, plain 12,091 3.4 8.5 8.4 - 8.7 6.4 6.3 - 6.5 Lovastatin 6,417 1.8 4.5 4.4 - 4.6 3.4 3.3 - 3.5 Simvastatin 3,773 1.1 2.7 2.6 - 2.7 2.0 1.9 - 2.1 Selective calcium channel blockers with mainly vascular effects 10,065 2.8 7.1 7.0 - 7.2 5.3 5.2 - 5.4 Amlodipine 8,503 2.4 6.0 5.9 - 6.1 4.5 4.4 - 4.6 ACE inhibitors, plain 7,697 2.1 5.4 5.3 - 5.6 4.1 4.0 - 4.2 Perindopril 5,714 1.6 4.0 3.9 - 4.1 3.0 2.9 - 3.1 Beta blocking agents 5,364 1.5 3.8 3.7 - 3.9 2.8 2.8 - 2.9 Atenolol 3,288 0.9 2.3 2.2 - 2.4 1.7 1.7 - 1.8 Low-ceiling diuretics, thiazides 2,996 0.8 2.1 2.0 - 2.2 1.6 1.5 - 1.6 Hydrochlorothiazide 2,967 0.8 2.1 2.0 - 2.2 1.6 1.5 - 1.6 Nervous system 41,728

11.6 29.5 29.2 - 29.7

22.1 21.9 - 22.3

Other analgesics and antipyretics 35,037 9.8 24.7 24.5 - 25.0 18.5 18.4 - 18.7 Paracetamol 33,958 9.5 24.0 23.8 - 24.2 18.0 17.8 - 18.1 Antipsychotics 1,665 0.5 1.2 1.1 - 1.2 0.9 0.8 - 0.9 Table 8.2 continued: Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012 continued ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✩ ✩ ATC Level 1 Number Percentage of all medications n = 359,272 Rate per 100 encounters 95 CI n = 141,593 Rate per 100 diagnoses 95 CI n = 188,944 ATC Level 3 ATC Level 5 Musculo-skeletal system 39,348

11.0 27.8 27.6 - 28.0

20.8 20.6 - 21.0

QWLLQÁDPPDWRU\DQG antirheumatic products, non- steroids 26,339 7.3 18.6 18.4 - 18.8 13.9 13.8 - 14.1 Diclofenac 9,375 2.6 6.6 6.5 - 6.8 5.0 4.9 - 5.1 Mefenamic acid 7,470 2.1 5.3 5.2 - 5.4 4.0 3.9 - 4.0 Ibuprofen 2,474 0.7 1.7 1.7 - 1.8 1.3 1.3 - 1.4 Naproxen 1,949 0.5 1.4 1.3 - 1.4 1.0 1.0 - 1.1 Topical products for joint and muscular pain 4,959 1.4 3.5 3.4 - 3.6 2.6 2.6 - 2.7 Muscle relaxants, centrally acting agents 4,153 1.2 2.9 2.8 - 3.0 2.2 2.1 - 2.3 Orphenadrine, combinations 3,873 1.1 2.7 2.7 - 2.8 2.1 2.0 - 2.1 Other drugs for disorders of the musculo-skeletal system 2,863 0.8 2.0 2.0 - 2.1 1.5 1.5 - 1.6 Antiinfectives for systemic use 33,584

9.3 23.7 23.5 - 23.9

17.8 17.6 - 17.9

Beta-lactam antibacterials, penicillins 15,070 4.2 10.6 10.5 - 10.8 8.0 7.9 - 8.1 Amoxicillin 8,291 2.3 5.9 5.7 - 6.0 4.4 4.3 - 4.5 Amoxicillin and enzyme inhibitor 3,418 1.0 2.4 2.3 - 2.5 1.8 1.7 - 1.9 Cloxacillin 1,966 0.5 1.4 1.3 - 1.5 1.0 1.0 - 1.1 Macrolides, lincosamides and streptogramins 6,516 1.8 4.6 4.5 - 4.7 3.4 3.4 - 3.5 Erythromycin 3,997 1.1 2.8 2.7 - 2.9 2.1 2.1 - 2.2 Other beta-lactam antibacterials 4,688 1.3 3.3 3.2 - 3.4 2.5 2.4 - 2.6 Cefalexin 2,845 0.8 2.0 1.9 - 2.1 1.5 1.5 - 1.6 Quinolone antibacterials 1,776 0.5 1.3 1.2 - 1.3 0.9 0.9 - 1.0 Dermatologicals 10,467

2.9 7.4 7.3 - 7.5

5.5 5.4 - 5.6

Antifungals for topical use 2,343 0.7 1.7 1.6 - 1.7 1.2 1.2 - 1.3 Emollients and protectives 2,246 0.6 1.6 1.5 - 1.7 1.2 1.1 - 1.2 Corticosteroids, plain 2,084 0.6 1.5 1.4 - 1.5 1.1 1.1 - 1.2 Table 8.2 continued: Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012 continued ✁ ✂ ✄ ☎ ✁ ✆ ✝ ✞ ✟ ✄ ✠ ✁ ✆ ✠ ✁ ✡ ✞ ☛ ✂ ✁ ✂ ✄ ☛ ✂ ✄ ✠ ☛ ☞ ✌ ✍ ☞ ✩ ✤ ATC Level 1 Number Percentage of all medications n = 359,272 Rate per 100 encounters 95 CI n = 141,593 Rate per 100 diagnoses 95 CI n = 188,944 ATC Level 3 ATC Level 5 Blood and blood forming organs 10,454

2.9 7.4 7.2 - 7.5

5.5 5.4 - 5.6

Iron preparations 5,128 1.4 3.6 3.5 - 3.7 2.7 2.6 - 2.8 Iron, multivitamins and minerals 2,485 0.7 1.8 1.7 - 1.8 1.3 1.3 - 1.4 Vitamin B12 and folic acid 2,546 0.7 1.8 1.7 - 1.9 1.3 1.3 - 1.4 Folic acid 2,231 0.6 1.6 1.5 - 1.6 1.2 1.1 - 1.2 Antithrombotic agents 2,542 0.7 1.8 1.7 - 1.9 1.3 1.3 - 1.4 Acetylsalicylic acid 2,236 0.6 1.6 1.5 - 1.6 1.2 1.1 - 1.2 Systemic hormonal preparations, excl. sex hormones and insulins 5,610 1.6

4.0 3.9 - 4.1 3.0 2.9 - 3.0

Corticosteroids for systemic use, plain 5,102 1.4 3.6 3.5 - 3.7 2.7 2.6 - 2.8 Prednisolone 4,160 1.2 2.9 2.9 - 3.0 2.2 2.1 - 2.3 Sensory organs 5,505

1.5 3.9 3.8 - 4.0

2.9 2.8 - 3.0

Antiinfectives, ophthalmologicals 3,267 0.9 2.3 2.2 - 2.4 1.7 1.7 - 1.8 Chloramphenicol 2,563 0.7 1.8 1.7 - 1.9 1.4 1.3 - 1.4 Genito urinary system and sex hormones 3,107 0.9

2.2 2.1 - 2.3 1.6 1.6 - 1.7

Antiparasitic products, insecticides and repellents 1,640 0.5 1.2 1.1 - 1.2 0.9 0.8 - 0.9 Various 612

0.2 0.4 0.4 - 0.5

0.3 0.3 - 0.4 Note: ACE = Angiotensin converting enzyme 7DEOHVKRZVWKHGLVWULEXWLRQRIPHGLFDWLRQVE\PDLQJURXSVRIPHGLFDWLRQVFODVVLÀHGXVLQJ7OHYHO 1 index which were further broken down into public and private clinics for comparison by sectors. ‡ DUGLRYDVFXODU PHGLFDWLRQV ZHUH WKH PRVW IUHTXHQWO\ SUHVFULEHG DJHQWV LQ SXEOLF FOLQLFV 7KH\ contributed to 34.2 of medications in public clinics and given to 84 out of 100 patients. The predominant agents within this group of medications were lipid modifying agents 23 per 100 encounters, calcium channel blockers 19 per 100 encounters and ACE inhibitors 16 per 100 encounters. ‡ 3ULYDWHFOLQLFVUHFRUGHGKLJKHVWSUHVFULSWLRQUDWHVIRUUHVSLUDWRU\PHGLFDWLRQVSHUHQFRXQWHUV Antihistamines formed the majority, and prescribed at an average of 38 per 100 encounters in private clinics. Table 8.2 continued: Prescribed medications by ATC level 1, 3 and 5 in primary care clinics in 2012