Impact of clinical pharmacology on health care: Serbian experience

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Dear Sirs, During the recent 7th Congress of the European Association for Clinical Pharmacology and Therapeutics, held in Poznan, Poland, serious concerns were expressed by leading invited speakers on the future of clinical pharmacology as a discipline [1]. Their joint conclusion was that clinical pharmacologists in the majority of developed European countries are less and less involved in health care [2]. ‘‘It is the retreat from the bedside into the laboratory that is responsible’’ for the discipline’s decline, one of the speakers said ominously [3]. However, this trend is not taking place in all European countries. In some Eastern European countries, clinical pharmacology is still very much a patientbased discipline, with a significant impact on health care. It is that impact that keeps the discipline alive and prosperous, as can be seen from the Serbian experience. The status and impact of clinical pharmacology on health care in Serbia was investigated in two ways: by field survey and by questionnaire. In the field survey, 38 hospitals and health centers (two tertiary health care hospitals, three mixed tertiary/secondary health care hospitals, and 33 health centers, each consisting of a secondary care hospital plus a primary health care facility) were visited twice during the years 2002 to 2005, and the anonymous questionnaire was sent to 78 available clinical pharmacologists (out of 90 registered) from November 2004 to January 2005. While the field survey confirmed that the tertiary care and the mixed tertiary/secondary care hospitals had three to four clinical pharmacologists each, and four health centers had one clinical pharmacologist each, the questionnaire showed that 50% of the respondents (60 clinical pharmacologists) worked in the health care system, half of them as full-time employees. Both the field survey and the questionnaire indicated that the following services were given by clinical pharmacologists in the Serbian health care system: drug/patient problem consultations, drug information, chairing of drug and therapeutics committees, intensive monitoring of adverse drug effects, therapeutic drug monitoring, formulation of hospital drug policies, auditing of prescribing practice, design of postmarketing studies, continuing medical education, predispensing control of prescribing, and drug utilization analyses. The scope of health care services given by clinical pharmacologists was the largest in the two tertiary care hospitals with independent departments of clinical pharmacology. There is a growing trend in the number of services given, as can be seen from the data from the Center for Clinical and Experimental Pharmacology, Clinical Center ‘‘Kragujevac,’’ for a 10-year period (Fig. 1). Due to good organization of work within the departments, the drug management process in both hospitals was advanced (active drug and therapeutics committees, more than 60 local guidelines adopted), and the availability of all necessary drugs was achieved within the limits of modest drug budgets. Both hospitals had drug formularies completely agreed upon by other clinicians that yet were not far from the World Health Organization’s essential drugs model list (for instance, Clinical Center ‘‘Kragujevac’’ had 338 different drug entities and 584 formulations in total, with 6.08 euros spent for drugs per one bed-day in 2004; the available budget for 2004 was 5.94 euros per one bed-day). With predispensing control of prescribing (in Clinical Center ‘‘Kragujevac,’’ errors were found in about 12% of prescriptions, and drug dispensing was corrected appropriately), continuing medical education, and auditing of prescribing practice, clinical pharmacologists in these S. M. Jankovic (&) AE D. R. Milovanovic University of Kragujevac and Center for Clinical & Experimental Pharmacology, Clinical Center ‘‘Kragujevac’’, Kragujevac, Serbia & Montenegro