Medicine Availability and Prescribing Policy for Non-Communicable Diseases in the Western Balkan Countries

Abstract

BackgroundDuring 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.MethodsIn 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.ResultsPossibilities 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.ConclusionWestern 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.

An Overview of the Reimbursement Decision-Making Processes in Bulgaria As a Reference Country for the Middle-Income European Countries

“…Significant variations exist in uptake of biosimilars in Europe, which could be overcome with implementation of specific procedures and measures ( 29 ). While Western Balkan countries has proved through the years that are capable to ensure reimbursed medicines for patients with non-communicable diseases with some exceptions ( 30 ), there is still gaps in the knowledge about the patients access to innovative medicines in these countries. Study published in 2017 highlighted the large disparities in access to innovative therapy for metastatic melanoma among the European countries mostly in the Eastern European region ( 31 ).…”

Serum biomarkers associated with malnutrition and nutritional risk in elderly primary care patients: A cross-sectional study from Bosnia and Herzegovina

“…In many countries, family physicians provide primary health care to older adults due of a lack of geriatricians. The high number of patients with multimorbidity and the burdens placed on the primary healthcare system by rising epidemic of non-communicable disease leave very little time for physicians to look for problems that elderly patients usually do not report if not specifically asked about ( 8 ), and that require the use of a time-/cost-effective approach to nutritional assessment ( 9 ).…”