Filenews 11 February 2023 - by Marilena Panayi
The least clutter, as can be seen, prevails in medical prescriptions for medicines registered in the GHS software. Duplicate prescriptions for the same drug with different strength in the same patient, corresponding drugs in one prescription, huge amounts of packaging that end up in the trash. "It is imperative that doctors check the prescriptions they have for their patients, because we are wasting money and medicines", emphasizes the president of the Federation of Cyprus Patients' Associations, Marios Kouloumas and indicates that "for decades we have been trying to combat polypharmacy, but as it seems, we feed it ourselves".
"Every day we are faced with phenomena that lead to abuses", a pharmacist from Nicosia told "F", while a colleague from Larnaca referred to "gaps in the GHS software that cause abuses and waste in themselves".
>> Repeated prescriptions that include corresponding medications: That is, as a pharmacist from Limassol explained to "F", "the doctor in the same prescription, for the same patient, prescribes in essence the exact same medicine and these cases, unfortunately, are not few".
>> There are duplicate prescriptions for the same drug, but with different strength for the same patient: That is, as another pharmacist from Paphos mentioned, "the doctor has a prescription for example with a strength of 10mg for his patient and has a second one for 20mg. Sometimes they tell us, sometimes they are not sure and they take both to talk to their doctor afterwards. Other times, we talk to the doctor. If we succeed we talk to him, if not, we are in a difficult position. There are also cases when another person comes to take the medications and because he does not know which of the two he needs, he takes both. On the other hand, even if I refuse to give both, the citizen can go to another pharmacy and execute the second prescription."
>> There are large packages in repeated prescriptions: That is, there are packs of 100 tablets and the patient may only need one tablet/pill per day. This means that with one package he can meet his needs for a quarter. "Doctors could only put two packages for this particular drug in repeated prescriptions, not six because the prescriptions are six-month."
>> There is a great waste of medicines that are mainly given to the elderly: That is, as a pharmacist from Limassol mentioned, "for example, we see in prescriptions, 4 and 5 packages of inhalers for a month. But the recipes are there and they are repetitive. We know this because in too many cases, they return them to us in bags and we do not know what to do with them. It happened to me that when he died as an elderly man his daughter brought me here 30 packages of a certain inhaled preparation."
>> They take medicines through the GHS to send them to their loved ones abroad or to get them to their children who are students in the countries where they study: According to pharmacists, mainly foreigners, who are registered with the GHS, take the medicines and then send them to their relatives in their country of origin. But there are other cases where doctors prescribe widely used drugs "and parents tell us that their son or daughter will take them with them to the country they are studying. That is, we may be talking about a cortisone ointment or antibiotics, because the student may need them."
>> Doctors prescribe for services not covered by the GHS or for medicines recommended outside the GHS by a doctor: All pharmacists made reference to citizens entering their pharmacy and "submit at that time to their personal doctor to prescribe them, for example antibiotics, because the dentist told them or some people while they are in pharmacies ask the doctor or his secretary to issue them a prescription for medicines which have been recommended to them by a doctor who is not part of the GHS".
"Unacceptable phenomena that affect all of us"
At the OSAK, the president of the organized patients said, "bags of medicines often arrive that are left in the glove compartments of the homes of citizens who are either deceased or no longer need them. If we consider, after what pharmacists constantly report to the OSAC, how much waste is made, we will find that all these unacceptable phenomena affect all of us".
Cyprus, he recalled, "unfortunately for decades has been trying to beat polypharmacy. In words – it seems – both patients and doctors, we are all very good. In practice, we are probably not doing very well. On the other hand, Cyprus is in the top two places along with Greece, in terms of antibiotic use. And reports arrive near us about our students, who leave Cyprus, carrying antibiotics with them. We don't think that a young person in his 20s or 25s doesn't need to have antibiotics with him, because we never understood that a simple flu doesn't need antibiotics."
On the other hand, said Marios Kouloumas, "unfortunately, we notice that there is also clutter on the part of doctors. When we see corresponding drugs in a prescription, when we see that we are prescribing without thinking about the stock that will be transported to a citizen's home and we do not calculate that a patient can cover a six-month period with only two packages and we register for six, it means that we are not protecting the GHS at all."
For the phenomena, "that patients ask their personal doctors to prescribe for drugs recommended outside the GHS by doctors, it must be said that this is illegal. The citizen makes a choice. He says "I will go to a non-GHS doctor". It must also bear the consequences of this choice. But on the other hand, the responsibility also lies with the personal doctors who respond."
For all this, "the HIO must assume its own share of responsibility. It needs to check the recipes registered in the software. Let there be some understanding between HIO and pharmacists, because these phenomena also affect pharmacists. It is not a matter that professionals will "nail" other professionals. It is a matter of protecting the GHS."
INTERVENTION
Then we talk about over-prescription
We had refrained from publishing the above reports of pharmacists in the previous weeks, due to the pending issue between pharmacists and HIOs. However, now that the matter is hopefully over, I believe that it is the obligation of the HIO to proceed with proper research in the GHS software and to invite all doctors to check the prescriptions they have registered. When we talk about , which has led to a fall in the unit price at which pharmacists are paid, we must also bear in mind all these phenomena. Over-prescription and waste are not in any of our interests. It is GHS money. That is, ours.
