CHANGE IN PRESCRIBING PATTERNS OF GENERAL-PRACTITIONERS IN ITALY BEFORE AND AFTER THE REFORM DRUG-ACT - A CASE-STUDY IN THE CITY OF TURIN

As of January 1994, the introduction of a new classification of the dr ugs to be reimbursed by the National Health Service was approved by th e Italian parliament in order to limit expenditure on pharmaceutical a gents. This has set off a 'cultural revolution', unprecedented in Ital y. The criteria that inspired the expert group charged with attributin g drugs to different classes (Class A: essential, free of charge drugs ; Class B: drugs to be paid for 50% by the patient; Class C: drugs to be paid entirely by the patient) were principally scientific rather th an merely economic or administrative. Expectedly, the creation of Clas s C (drugs not reimbursed by the National Health Service on account I of their insufficiently proven clinical effectiveness, or their unfavo urable cost/benefit ratio with respect to therapeutically equivalent a gents) has provoked remarkable changes in general practitioners' presc ription options, particularly given the fact that many of these drugs were among the most prescribed in Italy. A database including the pres criptions of about 940 general practitioners, dispensed through the 28 0 community pharmacies of the city of Turin, has been analysed for a c omparative sample of time periods in 1993 and 1994, in order to quanti fy the changes that occurred and to qualify them with respect to more relevant therapeutic groups and sentinel drugs.