DRUG-USE IN ESTONIA IN 1994-1995 - A FOLLOW-UP FROM 1989 AND COMPARISON WITH 2 NORDIC COUNTRIES

Objective: To determine the patterns of drug use in Estonia for the ye ars 1989 and 1994-1995, i.e. for the years before and after the pharma ceutical services in the country changed from a state monopoly to a co mpetitive market. Methods: The wholesale data from Estonia and the def ined daily doses methodology were used. For comparison, national stati stics on medicines from Finland and Sweden for the years 1994-1995 are shown. Results: The general sales of drugs in Estonia decreased almos t twofold in all major pharmacological groups from 1989 to 1994 and su bsequently increased by 10%-30% in 1995. Substantial differences in pa tterns of drug use between Estonia and the two Nordic countries were o bserved. The amount of prescription-only medicines used in Estonia was approximately 25% of that used in Finland and Sweden. The amount of o ver-the-counter drugs used was 61% of that used in Finland and 58% of that used in Sweden. In the drug use patterns in Estonia, some common trends can be noted: (1) persistent traditions, such as the low use of diuretics, beta-blockers, antithrombotics and inhalant anti-asthmatic drugs; (2) changes in prescription preferences - central antiadrenerg ic drugs, pyrazolones, aminoglycosides and barbiturates are being repl aced by calcium channel blockers and angiotensin-converting-enzyme inh ibitors, propionic acid derivatives, cephalosporins and benzodiazepine s, respectively; (3) rapidly increasing use of drugs not prescribed in the 1980s, such as hormonal contraceptives, opioids and antiulcer dru gs, which strongly improves the quality of pharmacotherapy in Estonia. Conclusion: The general trends in Estonia and the two Nordic countrie s are similar - the use of newer and more effective drugs is increasin g and that of older ones decreasing. The changes are more rapid in Est onia than in Finland and Sweden, but, because of a short observation p eriod, the use of newer drugs not yet prevailing. The international di fferences in drug utilization observed in this study may possibly be r elated mainly to the prescription preferences (e.g. therapeutic tradit ions) and less dependent on the respective health care systems (e.g. r eimbursement schemes) and economic state of the country.