Background: Health literacy is an important determinant of health. This concept is under-researched in the Republic of Srpska, Bosnia and Herzegovina. Objectives: To assess health literacy and its association with sociodemographic variables, self-perception of health and the presence of chronic conditions in primary healthcare setting. Methods: In May 2016, a cross-sectional study was executed in two primary healthcare centres. Out of approximately 1500 patients who visited both health centres during four consecutive days, about 800 were eligible. Of these, 110 patients agreed to complete the translated Short Test of Functional Health Literacy in Adults (S-TOFHLA). The influence of demographic, social, economic, and health characteristics (independent variables) on the S-TOFHLA score (dependent variable) was assessed by multiple logistic regression analysis. Results: One questionnaire was incomplete and therefore 109 questionnaires were analysed. Inadequate, marginal, and adequate health literacy were present in 19 (17.4%), 16 (14.7%) and 74 (67.9%) respondents. Adequate health literacy was found predominantly among respondents younger than 55 years and those with a high level of education. Regression analyses showed that low level of education (OR: 5.3), age 55 years and over (OR: 3.9), living in a rural area (OR: 3.7) and having three or more chronic diseases (OR: 2) were independently associated with inadequate or marginal health literacy. Conclusion: In this study performed in two primary healthcare centres in the Republic of Srpska, Bosnia and Herzegovina, low health literacy was associated with low level of education, older age, living in a rural area, and having more chronic diseases.

The objectives of this study were to evaluate patients’ attitudes towards hypertension treatment according to the chronic care model and to assess the implementation of hypertension clinical guidelines in family medicine. The cross-sectional study was carried out in two randomly selected primary health care centers (Bijeljina and Prijedor), respectively in Bosnia and Herzegovina, covering the period between March and April 2016. This study sample consists of 791 respondents with hypertension purposing to measure specific actions and quality of care for hypertensive patients. The Patient Assessment of Chronic Illness Care (PACIC) was used. Treatment for the indicators of hypertension was assessed by analyzing patients' medical charts according to the recommendations of clinical guidelines. More than half of the evaluated indicators of treatment for hypertension were documented in medical charts of 84.07% patients. The average overall PACIC score was 4.18 (SD 0.59), being an average of the separate scores of 4.19 (SD 0.57) in men and 4.17 (SD 0.60) in women. Subscale means of PACIC were as follows: patient activation 4.33, delivery system design 4.36; goal setting 4.03; problem solving 4.51; follow-up and co-ordination 3.67. No statistically significant correlations in the overall score and subscale scores were found by demographic characteristics. Non-smokers had a significantly higher overall score compared to smokers (p = 0.001). As implementation of the guidelines became stronger, the reported PACIC scores rose. Continuing the education of patients in order to achieve better health care outcomes is imperative.

Health literacy (HL) has become an important area of research. The aim of this study was to evaluate the HL of primary healthcare patients in the Republic of Srpska (RS), Bosnia and Herzegovina (B&H) and to identify socioeconomic and health factors associated with HL. This cross-sectional study among 768 patients was conducted in two healthcare centres between March and May 2017, using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Analysis was done using descriptive and inferential statistics (a chi-squared test and logistic regression). Inadequate and marginal HL was found in 34,6% of respondents. Socioeconomic and self-reported health factors were significantly related to HL. An age of 55 years and over (OR 1.02), living in a rural environment (OR 2.25), being divorced (OR 3.32), being insufficiently physically active (OR 1.29), having poor income (OR 1.96), having more than three chronic diseases (OR 1.94), and poor health (OR 1.59) were significantly corelated with inadequate and marginal HL. The results of our study indicate that a low level of HL is related to the elderly, having a divorce, having a rural residence, poor income, having more than three chronic diseases, poor health, and insufficient physical activity. Further evaluation, monitoring, and activities to improve HL are of great importance for patients’ health outcomes.

Rationale, aims and objectives: To translate, culturally adapt and preliminary validate the original English version of the PACIC questionnaire into the Serbian language, in the Republic of Srpska, Bosnia and Herzegovina and to assess the relationship between PACIC scores and clinical guidelines implementation in family medicine.Methods: A cross-sectional study was implemented in 2 primary healthcare centers. The translated PACIC questionnaire was administered to 206 consecutive patients with hypertension, diabetes mellitus and/or chronic obstructive pulmonary disease. The validity and reliability of the Serbian version of PACIC has been tested with face validity, construct validity and internal consistency. The PACIC score and its 5 subscales were tested using Kruskal-Wallis or Mann-Whitney test. The relationship of the PACIC score and guidelines implementation was analyzed by multiple linear regression.Results: The overall PACIC score indicates an implementation of the Chronic Care Model (CCM) occurred “most of the time”. Of the 5 subscales, average scores were highest on “Delivery system/decision support”. CCM in “Follow up/Coordination” occurred sometimes. Cronbach’s alpha coefficient showed a high internal consistency level for the PACIC questionnaire. Kaiser-Meyer-Olkin Measure of Sampling Adequacy is 0.917 and Bartlett’s test of sphericity is significant (p≤0.001). Four factors were identified explaining 69% of total variance.Conclusions: There was a significant relationship between the PACIC score and the implementation of the chronic disease clinical guidelines. The PACIC questionnaire is advanced as a reliable and internally consistent instrument of use in increasing the person-centeredness of care of chronic illness.

Background: In last 2 decades, there have been substantial changes in the utilization patterns of antihypertensive medicines following new clinical trials and the introduction of new treatment guidelines. The aim of this study was to analyze utilization and prescribing patterns regarding antihypertensive medicines in the Republic of Srpska, Bosnia and Herzegovina during an 11-years follow-up according to national and European treatment guidelines.Methods: In this retrospective, observational study, medicine utilization data were analyzed between 2009–2019 period using the ATC/DDD methodology and expressed as the number of DDD/1,000 inhabitants/day (DID/TID). The medicine utilization 90% (DU90%) method was used for determine the quality of prescribing.Results: During the observed period, the use of antihypertensive medicines increased more than 3-times (125.97 DDD/TID in 2009 vs 414.95 DDD/TID in 2019), corresponding to a rise in the prevalence of hypertensive patients from 91.7/1,000 to 186.3/1,000 in the same period. This was mainly driven by increased use of angiotensin converting enzyme inhibitors with 241.69%, beta blockers with 146.87%, calcium channel blockers with 251.55%, and diuretics with 178.95%. Angiotensin receptor blockers were the fastest growing group of antihypertensive medicines in this period and their utilization increased nearly 40 times.Conclusions: The overall antihypertensive medicines utilization was largely influenced by national and ESH/ESC guidelines and strongly corresponded to the positive medicine list of the national health insurance fund. Antihypertensive medicines utilization is comparable with medicine utilization trends in other countries.