Regulation of the apothecary activity in Bosnia and Herzegovina over the Austro-Hungarian period

Aim To present the regulations governing the operation of pharmacies in Bosnia and Herzegovina over the Austro-Hungarian rule (1878-1918). Methods Qualitative secondary data analysis was used. Results The Austro-Hungarian government had found poor population’s health, insufficient health facilities and qualified staff. For a long time, population was treated by old methods of medicine and pharmacy, and directed to folk doctors, healers and herbalists. As early as 1879, orders requesting mandatory possession of a university diploma to practice pharmacy and medicine, thus taking the initial steps to combat quackery. The production and dispensing of medicines became the exclusive competence of pharmacists. The Law on Pharmacies adopted in 1907 comprehensively regulated the apothecary activity. Pharmacy Gremium was founded, the first association of pharmacists with the task of protecting professional interests. All types of quackery were explicitly forbidden to pharmacy staff. Apothecary activity was regulated as a craft, not as a health activity. During this period, pharmacy became a regulated profession with educated and qualified personnel. The number of public pharmacies and qualified staff was growing. In 1878 only one graduated pharmacist was found, while in 1910 in 47 pharmacies there were 79 pharmacy staff. At the end of 1918, the masters of pharmacy were the owners of 48 pharmacies, in 38 cities. Conclusion All enacted regulations contributed to the development and improvement of the apothecary activity over the observed period, and laid the foundations for the future development of the profession

Initiatives to reduce non-prescription sales and dispensing of antibiotics in the Republic of Srpska : findings and implications

Objective: Irrational use of antimicrobials is a major driver of antimicrobial resistance, exacerbated by dispensing antibiotics without a prescription. Our previous study suggested this was a problem in the Republic of Srpska despite legislation. Since then, a number of activities have been initiated. Consequently, the study aimed to ascertain whether these multiple initiatives had reduced this. Methods: Patients visiting all community pharmacies in the Republic from October 2014 to July 2015 presenting with symptoms typical of an acute, viral and mostly uncomplicated upper respiratory tract infection, with results compared to the previous study. If an antibiotic was suggested, the maximum allowance was Euro 3/ pack. Findings: Self-medication with antibiotics significantly decreased from 58% to 18.5% of pharmacies. In both studies, most patients were offered over-the-counter medication. The most common reason for not dispensing an antibiotic was ‘antibiotics can be dispensed with a prescription only’. The penicillins were the most dispensed antibiotic. Fewer patients than the previous study were given instructions about antibiotic use and no discussion on their side-effects. Conclusion: Whilst encouraging that self-medication decreased significantly, 18.5% was disappointing given recent initiatives Fewer instructions about antibiotics if an antibiotic was dispensed was also disappointing. This suggests the need for even stronger enforcement of the laws as well as further training of pharmacy personnel to ensure future appropriate use of medicines

Eight-year study of antibiotic utilisation in the Republic of Srpska (2010-2017 years); findings and implications

Background: There have been multiple initiatives to improve antibiotic utilisation in the Republic of Srpska in recent years including educational activities with all key stakeholder groups, greater scrutiny over self-purchasing of antibiotics and reimbursement restrictions. This study aimed to analyse total antibiotic utilisation following these initiatives including the quality of use and assess whether additional measures are needed. Methods: Analysis of total outpatient antibiotic utilisation from 2010 to 2017 in DIDs based on data obtained from the Public Health Institute of the Republic of Srpska. Quality indicators based on ESAC, ECDC and WHO recommendations and compared with neighbouring countries in the WHO AMC network. Results: Antibiotic utilisation ranged from 15.6 DIDs to 23.1 DIDs, which is encouraging versus other similar neighbouring countries. Penicillins were the most used antibiotics, accounting for approximately 50-55% of total antibiotic utilisation, with amoxicillin the most used (29 – 41% of total utilisation) versus low use of co-amoxiclav (7 - 11% of total utilisation). This compares favourably with other countries. Cephalosporins were the second most used antibiotic class (13-14%) followed by macrolides (8-9 %) and quinolones (8-9 %). Low use of third and fourth generation cephalosporins (10-20% of total cephalosporins) versus first and second generation. However, rising utilisation of co-amoxiclav and azithromycin (5-10% per years), and higher rates of quinolone utilisation in recent years are noted and are now being addressed through additional interventions. Conclusion: Multiple interventions in the Republic of Srpska have helped enhance the appropriate use of antibiotics. Identified concerns are being addressed

Editorial: Effective programs to reduce inappropriate dispensing of antibiotics in community pharmacies especially in developing countries

There are appreciable concerns with growing rates of antimicrobial resistance (AMR) across countries, increasing morbidity, mortality and costs.[1-4] As a result, AMR is increasingly seen as the next pandemic unless timely activities are instigated globally and within countries to reduce inappropriate prescribing and dispensing of antibiotics, thereby reducing AMR. Key activities within countries to reduce AMR include the instigation of the National Action Plans (NAPs); however, these are at different stages of development, implementation and monitoring

Pharmacists’ clinical knowledge and practice in the safe use of contraceptives: real knowledge vs. self-perception and the implications

Background: Pharmacists are often the first healthcare professionals that patients contact with their illnesses and requests for medical information, which is enhanced following the recent COVID-19 pandemic. Community pharmacists are expected and required to possess a broad spectrum of knowledge and skills. Self-assessment of these competencies is needed for their self-improvement. Purpose of the study: To assess pharmacists’ clinical knowledge and practice in the safe use of contraceptives, and to compare the scores obtained by external observation with pharmacists’ self-assessment of their knowledge as well as investigate the significance of preceptorship experiences. Contraceptives was chosen as the subject area in view of high rates of abortions as a means of contraception in Bosnia and Herzegovina. Methods: A questionnaire approach was used. The questionnaire included the following: the first domain contained two case scenarios (safe use of contraceptives), which evaluated clinical knowledge, a second domain in which pharmacists self-assessed their knowledge to resolve cases from the first domain and a third domain that measured the demographics of pharmacists (including experience in preceptorship). Dispensing practice was evaluated in the second domain. The questionnaires were distributed to a convenient sample of 100 pharmacists at the Annual Meeting of Bosnia and Herzegovina Pharmacists. The results were presented as counts (%). The groups (preceptors and non-preceptors) were compared using Mann-Whitney U test, paired assessments were analyzed by Wilcoxon signed-rank test and Spearman’s correlation was used to assess the correlation between variables. Results: Of the 100 pharmacists invited to participate, 84 completed the questionnaire (84 % response rate). There was no agreement between pharmacists’ real knowledge (average score - case 1: 2.71, case 2: 3.3) and their self-assessment (average score - case 1: 3.77, case 2: 3.91). There was no statistically significant difference in the actual knowledge of pharmacists (experienced/non-experienced in precepting), while the difference in the self-assessment was significant between these two groups. Conclusion: Pharmacists appear to overrate themselves, which leads to self-enhancement bias, in which the experience in precepting has some influence. Pharmacists’ capability in performing an objective self-assessment of their clinical knowledge needs to be carefully studied in the future to fully benefit patients

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Polypharmacy among the elderly in the Republic of Srpska : extent and implications for the future

Prescribing of medicines is a fundamental component of care for the elderly. However, increasing concern with polypharmacy and its impact on morbidity, mortality and costs. Analyze long-term prescription use and the prevalence of polypharmacy in the elderly in the Republic of Srpska. Subsequently use the findings to suggest potential future measures. Retrospective study of all elderly patients 2005 to 2010 stratified by age group (3 groups), sex and long term medicine use. Polypharmacy (5 or more medicines) increased from 1.4% of the elderly taking medicines long term to 3.6% by 2010, with 53.6% of elderly taking 2 or more medicines long term. Most prevalent diseases were cardiovascular diseases and diabetes. Most prescriptions were in accordance with recent guidelines. However, concern with appreciable prescribing of digoxin and aminophylline. Whilst polypharmacy rates low in the Republic, increasing rates are a concern. Further studies are planned

Pilot study to evaluate the feasibility of a patient questionnaire for the purpose of investigating the extent of purchasing antibiotics without a prescription in a rural province in South Africa : rationale and implications

Introduction: There are concern with rising rates of antimicrobial resistance (AMR) across countries with the appreciable impact on morbidity, mortality and costs. Among low- and middle-income countries (LMICs), a key driver of AMR is excessive use of antibiotics in ambulatory care, with a critical area being the appreciable selling of antibiotics without a prescription often driven by patient demand and limited knowledge. There is currently conflicting evidence in South Africa regarding this practice. Consequently, there is a need to explore these critical issues among patients especially in more rural areas of South Africa. A pilot study was undertaken to address this. Methodology: A two-step descriptive approach was undertaken. This involved two questionnaires among patients exiting chain and independent community pharmacies followed by cognitive interviews. Results: Overall, 21 patients were approached for an interview, 11 for the first questionnaire (Part 1) and 10 for the second (Part 2). 3 patients declined participation in Part 1 and 2 for Part 2, leaving 8 patients completing each questionnaire. On average, it took 2 minutes 13 seconds to complete both parts. 3 of the 5 patients being dispensed an antibiotic were dispensed one without a prescription, with all 3 patients exiting from independent pharmacies. Key reasons for self-purchasing included money and convenience. There was mixed knowledge regarding antibiotics and AMR among the 8 patients interviewed with Part 2. Overall, there was satisfactory understanding of the Part 1 questions, although some modifications were suggested. Some participants had difficulty with fully understanding the questions in Part 2, with a number of suggestions made to improve this for the main study. Conclusion: There were concerns with the extent of purchasing of antibiotics without a prescription in this pilot study as well as the knowledge of patients regarding antibiotics and AMR. Both areas need addressing, and will be explored further in the main study