Contribution of Slovenian community pharmacist counseling to patients’ knowledge about their prescription medicines: a crosssectional study

Aim To assess patients’ knowledge about prescription medicines they are taking and their view on how much community pharmacist counseling contributed to their knowledge. Methods An observational study was designed to obtain information about patients’ knowledge, their view on pharmacist counseling, and physicians’/pharmacists’ provision of information. This study used a specifically designed questionnaire, which served as an interview guide. 400 patients picking up a prescription medicine were structurally interviewed upon leaving one of the 20 randomly chosen Slovenian pharmacies. The interviews took place in November and December 2013. Results Patients were familiar with general information about the medicines and their application (93%-100% of patients). Knowledge about considerations (16% of patients) and adverse effects (20% of patients) was limited. Factors associated with patient knowledge were physicians’/pharmacists’ adequate provision of information (β = 0.259), patient’s age (β = - 0.149), patient’s education (β = 0.100), and prescription type (β = -0.104). Patients’ responses were mostly consistent with the Summaries of Product Characteristics (72%-96% of responses). However, 42% of responses to the question about taking medicine with meals were incorrect. Pharmacists routinely informed the patients about medication purpose, dose, application rate, and timing of medication (in 72%, 89%, 89%, and 77% of cases, respectively). Other information was rarely offered. Patients with new prescriptions received significantly more counseling (pharmacist counseling score 5.9, 5.2, and 4.7 of maximum 10 for new, regular, and refill prescriptions, respectively, P = 0.001) and obtained adequate labeling (69%, 26%, and 17% of patients for new, regular and refill prescriptions, respectively, P < 0.001) than patients with regular or refill prescriptions. Conclusion Patients were familiar with basic information about administration of their prescription medicines, but lacked knowledge about medication safety. This could be attributed to pharmacist counseling, which primarily focused on medicine use instructions

Nadzor mednarodnih komunikacijskih sistemov : diplomsko delo visokošolskega strokovnega študija Varnost in policijsko delo

Obveščevalna dejavnost je proces zbiranja, obdelave, analize podatkov in posredovanja informacij. Obveščevalne službe zbirajo podatke v različnih okoljih. Informacijska revolucija, predvsem pa razvoj novih komunikacijskih sistemov, je dala obveščevalnim službam nove možnosti pridobivanja informacij, ki potujejo po teh sistemih. Izredno pomemben vir pridobivanja informacij so postali mednarodni komunikacijski sistemi. Zato so obveščevalne službe razvile različne metode in sredstva, ki jim omogočajo nadzor mednarodnih komunikacij. Ker gre v primeru nadzora mednarodnih komunikacij za dejavnost, ki lahko posredno omogoči tudi nadzor nacionalnih komunikacijskih sistemov, je zelo pomembno, kako je ta dejavnost obveščevalnih služb nadzorovana. V Republiki Sloveniji je opredeljenih več oblik nadzorstva nad obveščevalno-varnostnimi službami. Med te oblike nadzorstva spadajo nadzor zakonodajne oblasti, nadzor izvršilne oblasti, nadzor sodne oblasti in nadzor civilne družbe. Če je nadzor nad klasičnimi načini pridobivanja podatkov zadovoljivo urejen, naj bi bil nadzor nad področjem nadzora mednarodnih komunikacij zaradi številnih pravnih nejasnosti, predvsem kdo naj nadzor dovoli, po mnenju zlasti informacijske pooblaščenke neustrezno urejen. Podobne težave imajo tudi obveščevalne službe drugih držav. Še najbolje ima to področje urejena Nemčija v tako imenovanem Gesetzu G-10, v katerem so opisana pooblastila Zvezne obveščevalne službe na področju kontrole pisemskih pošiljk, komunikacij.Intelligence is the process of collection, procession, data analysis and transmittion of information. Intelligence services collect data in various environments. The information revolution, and in particular the development of new communication systems gave new possibilities to intelligence services to obtain information traveling through these systems. An extremely important source of information are now the international communications systems. Therefore, intelligence services have developed various methods and tools that enable them to control international communications. Since surveillance of international communications is an activity, which may indirectly facilitate the control of national communications systems, it is very important how the activities of intelligence services are monitored. There are several forms of supervision over intelligence-security services identified in the Republic of Slovenia. These forms of supervision include control over the legislative power, control of the executive power, control of the judicial power and control of the civil society. The control of the traditional methods of obtaining data is satisfactorily arranged, but the control of international communications due to a number of legal uncertainties, particularly the question who should permit such control, is according to the information commissioner mostly inadequately regulated. Similar problems exist in the intelligence services of other countries. This area is very well regulated in Germany in the so-called Gesetz G-10, which desvribes the powers of the Federal Intelligence Service regarding the control of mail and communications

Initiation of insulin therapy in patients with type 2 diabetes: An observational study

The aim of the study was to assess the initiation of insulin therapy in patients with type 2 diabetes using health claims data on prescription medicines. The study evaluated time to insulin initiation and prescribing patterns of other antidiabetic medicines before and after insulin initiation. Five years after starting non-insulin antidiabetic therapy, 6.4 % of patients were prescribed insulin, which is substantially lower compared to other similar studies. Among all patients who initiated insulin therapy in 2013, 30 % did not continue any other antidiabetic therapy. However, this proportion was lowered to 20 % in 2018. Before insulin initiation in 2018, metformin was prescribed in only 67 % of patients and sulfonylureas in 78 % of patients. Moreover, metformin and sulfonylureas were discontinued after insulin initiation in 26 and 37 % of patients, resp. More attention should be paid to the continuation of oral antidiabetics, particularly metformin, after insulin initiation

Medication adherence and health-related quality of life among patients with chronic obstructive pulmonary disease

This study evaluated medication adherence and health-related quality of life (HRQoL) of Slovenian patients with chronic obstructive pulmonary disease (COPD) and examined the factors associated with HRQoL. Demographic and therapy information was collected from 65 patients through interviews. The St. George’s Respiratory Questionnaire and the Morisky Medication Adherence Scale were used to evaluate HRQoL and adherence, resp. A multiple linear regression model was used to assess the association between the factors and HRQoL. The mean St. George’s Respiratory Questionnaire score (range 0–100, with higher scores indicating lower HRQoL) was 41.4. COPD affected patients’ daily activities more than their social and psychological functioning. Slightly more than 53 % of the patients were optimally adherent, while 12 % were non-adherent. Patients with lower HRQoL had a larger number of medications for concomitant diseases, experienced COPD exacerbation in the last year, and had less education. No statistically significant correlation was found between medication adherence and HRQo

Deprescribing: An umbrella review

This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where deprescribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta-analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications

Influence of novel oral anticoagulants on anticoagulation care management

Anticoagulation treatment was recently improved by the introduction of novel oral anticoagulants (NOACs). Using a combination of qualitative and quantitative methods, this study explores the effects of the introduction of NOACs on anticoagulation care in Slovenia. Face-to-face interviews with key stakeholders revealed evolvement and challenges of anticoagulation care from different perspectives. Obtained information was further explored through the analysis of nationwide data of drug prescriptions and realization of health care services. Simplified management of anticoagulation treatment with NOACs and their high penetration expanded the capacity of anticoagulation clinics, and consequentially the treated population increased by more than 50 % in the last 5 years. The main challenge concerned the expenditures for medicines, which increased approximately 10 times in just a few years. At the same time, the anticoagulation clinics and their core organisation were not affected, which is not expected to change, since they are vital in delivering high-quality care

Kardiovaskularne bolesti u Srbiji - ekonomski teret

Background/Aim. Cardiovascular disease imposes a burden to society in terms of mortality, morbidity and economic losses. The aim of this study was to estimate the economic burden of cardiovascular disease in Serbia in 2009 from the perspective of the society. Methods. For the purpose of the study cardiovascular disease was defined by the International Classification of Diseases, 10th revision, as the following diagnosis: hypertension, coronary heart disease, cardiomyopathy, heart failure and cerebrovascular disease. The prevalence, top-down method was used to quantify the annual cardiovascular costs. Productivity losses were estimated using the human capital approach and the friction cost method. A discount rate of 5% was used to convert all future lifetime earnings into the present value. Results. The total direct costs of cardiovascular disease in 2009 were € 400 million. The results showed that more than half a million working days were lost due to incapacity resulting from cardiovascular diseases, yielding the € 113.9 million. The majority of total costs (€ 514.3 million) were for: medication (29.94%), hospital days (28.97%) and hospital inpatient care - surgical and diagnostic interventions (17.84%). The results were robust to a change in 20% of volume or the unit price of all direct and indirect cost and to discount rate 2% and 10%. Conclusions. The total cardiovascular disease costs in 2009 represented approximately 1.8% of the Serbian gross domestic product. The results of the study would be valuable to health policy makers to bridge the gap between invested resources and needs, in order to improve cardiovascular disease outcomes.Uvod/Cilj. Kardiovaskularne bolesti predstavljaju teret za društvo u smislu mortaliteta, morbiditeta i ekonomskih gubitaka. Cilj ove studije bio je procena ekonomskog značaja kardiovaskularnih bolesti u Srbiji u 2009. godini iz perspektive društva. Metode. Za potrebe istraživanja, kardiovaskularne bolesti su definisane pomoću Međunarodne klasifikacije bolesti, 10. revizija, kao sledeće dijagnoze: hipertenzija, koronarne bolesti, kardiomiopatija, srčana insuficijencija i cerebrovaskularne bolesti. Korišćen je top-down metod, baziran na prevalenciji, kako bi se kvantifikovali godišnji kardiovaskularni troškovi. Troškovi smanjene produktivnosti su procenjeni korišćenjem dva pristupa: pristup ljudskom kapitalu (human capital approach) i metod frikcionih troškova (friction cost method). Za obračunavanje troškova u sadašnju vrednost korišćena je diskontna stopa od 5%. Rezultati. Ukupni direktni troškovi kardiovaskularnih bolesti u 2009. godini iznosili su 400 miliona evra. Rezultati pokazuju da je više od pola miliona radnih dana izgubljeno zbog nesposobnosti usled kardiovaskularnih bolesti, dajući ukupno 113,9 miliona evra indirektne troškove. Većina ukupnih troškova (514,3 miliona evra) bili su za: lekove (29,94%), hospitalizaciju (28,97%) i bolničko lečenje - hirurške intervencije i dijagnostiku (17,84%). Rezultati su bili robusni na promene od 20% u volumenu ili ceni pojedinih kategorija troškova, kao i na primenjenu diskontnu stopu od 2% i od 10%. Zaključak. Ukupni troškovi kardiovaskularnih bolesti u 2009. godini su predstavljali oko 1,8% bruto domaćeg proizvoda. Rezultati studije su značajni za kreiranje zdravstvene politike i premošćavanja jaza između uloženih sredstava i potreba, a u cilju poboljšanja ishoda kardiovaskularnih bolesti

Pharmacy network and access to medicines in selected eastern European countries: comparative analysis

Aim To analyze the pharmacy network (structure and resources) in Bulgaria, Croatia, Serbia, and Slovenia and its relation to public expenditures for medicines. Methods We performed a cross-sectional study using the officially published data for the period 2003-2008 in four selected countries. Data sources were relevant national institutions. Results In 2008, Serbia had 27.5, Bulgaria 66.8, Croatia 59.5, and Slovenia 71.2 pharmacists per 100 000 inhabitants. There was a significant difference in the number of pharmacists per 100 000 inhabitants between all countries except between Bulgaria and Slovenia. The number of inhabitants per one pharmacy was significantly different between all observed countries. The expenditures for medicines per capita in 2008 were between €30.34 in Bulgaria to €137.03 in Slovenia, with a significant difference between all countries except between Bulgaria and Serbia. The number of pharmacists per 100 000 inhabitants and expenditures for medicines per capita were positively correlated in all observed countries, except in Bulgaria. Conclusion There were significant difference in the structure and availability of the pharmacy service in all selected countries. Expenditures for medicines were positively correlated with the number of pharmacists in all countries, except in Bulgaria. Our findings could be valuable to national regulatory bodies for the creation of national drug policies