Pekez-Pavlisko Tanja, Racic Maja, Kusmuk Srebrenka
Family Medicine Clinic "Tanja Pekez-Pavlisko", Kutina, Croatia.
Faculty of Medicine, Department for Primary Health Care and Public Health, University of East Sarajevo, East Sarajevo, Bosnia and Herzegovina.
Front Public Health. 2017 Nov 8;5:295. doi: 10.3389/fpubh.2017.00295. eCollection 2017.
During the transition processes, the Western Balkan countries were affected by conflicts and transition-related changes. Life expectancy in these countries is lower, while the mortality from non-communicable diseases (NCDs) is higher in comparison with western and northern parts of Europe. The primary aim of this study was to analyze the treatment possibilities for the most common NCDs in the Western Balkan countries. The secondary aim was to understand and compare the policies regarding prescribing-related competencies of family physicians.
In June and July 2017, a document analysis was performed of national positive medicines lists, strategic documents, and clinical guidelines for the treatment of the most frequent NCDs; arterial hypertension, diabetes, hyperlipidemia, asthma, and chronic obstructive pulmonary disease (COPD). All text phrases that referred to medicines prescribing were extracted and sorted into following domains: medicine availability, prescribing policy, and medication prescribing-related competencies.
Possibilities for treatment of arterial hypertension, diabetes, hyperlipidemia, asthma, and COPD vary across the Western Balkan countries. This variance is reflected in the number of registered medicines, number of parallels, and number of different combinations, as well as restrictions placed on family physicians in prescribing insulin, inhaled corticosteroids, statins and angiotensin II receptor blockers (ARBs), without consultant's recommendation.
Western Balkan countries are capable of providing essential medicines for the treatment of NCDs, with full or partial reimbursement. There are some exceptions, related to statins, newer generation of oral antidiabetic agents and some of the antihypertensive combinations. Prescribing-related competences of family physicians are limited. However, this practice is not compliant to the practices of family medicine, its principles and primary care structures, and may potentially result in increased health-care financial ramifications to both the system and patients due to frequent referrals to the specialists.
在转型过程中，西巴尔干国家受到冲突和与转型相关的变化影响。这些国家的预期寿命较低，而非传染性疾病（NCDs）的死亡率高于欧洲西部和北部地区。本研究的主要目的是分析西巴尔干国家最常见非传染性疾病的治疗可能性。次要目的是了解和比较关于家庭医生处方相关能力的政策。
2017年6月和7月，对国家积极药品清单、战略文件以及治疗最常见非传染性疾病（动脉高血压、糖尿病、高脂血症、哮喘和慢性阻塞性肺疾病（COPD））的临床指南进行了文献分析。提取所有提及药品处方的文本短语，并分类到以下领域：药品可及性、处方政策和与药物处方相关的能力。
西巴尔干国家在动脉高血压、糖尿病、高脂血症、哮喘和慢性阻塞性肺疾病的治疗可能性方面存在差异。这种差异体现在注册药品数量、仿制药数量、不同组合数量以及在没有顾问建议的情况下对家庭医生开具胰岛素、吸入性糖皮质激素、他汀类药物和血管紧张素II受体阻滞剂（ARBs）的限制上。
西巴尔干国家有能力提供用于治疗非传染性疾病的基本药物，全部或部分予以报销。存在一些例外情况，涉及他汀类药物、新一代口服抗糖尿病药物和一些抗高血压组合。家庭医生的处方相关能力有限。然而，这种做法不符合家庭医学的实践、其原则和初级保健结构，并且由于频繁转诊至专科医生，可能会给系统和患者带来增加的医疗保健财务影响。
