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This umbrella review examined systematic reviews of deprescribing studies by characteristics of intervention, population, medicine, and setting. Clinical and humanistic outcomes, barriers and facilitators, and tools for deprescribing are presented. The Medline database was used. The search was limited to systematic reviews and meta-analyses published in English up to April 2022. Reviews reporting deprescribing were included, while those where depre-scribing was not planned and supervised by a healthcare professional were excluded. A total of 94 systematic reviews (23 meta--analyses) were included. Most explored clinical or humanistic outcomes (70/94, 74 %); less explored attitudes, facilitators, or barriers to deprescribing (17/94, 18 %); few focused on tools (8/94, 8.5 %). Reviews assessing clinical or humanistic outcomes were divided into two groups: reviews with deprescribing intervention trials (39/70, 56 %; 16 reviewing specific deprescribing interventions and 23 broad medication optimisation interventions), and reviews with medication cessation trials (31/70, 44 %). Deprescribing was feasible and resulted in a reduction of inappropriate medications in reviews with deprescribing intervention trials. Complex broad medication optimisation interventions were shown to reduce hospitalisation, falls, and mortality rates. In reviews of medication cessation trials, a higher frequency of adverse drug withdrawal events underscores the importance of prioritizing patient safety and exercising caution when stopping medicines, particularly in patients with clear and appropriate indications.

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BACKGROUND: The European Health Literacy Questionnaire (HLS-EU-Q47) is a self-assessment tool for standardised measurement of health literacy. AIM: To translate HLS-EU-Q47 into the Slovenian language and to investigate its reliability and validity in Slovenia. METHOD: HLS-EU-Q47 was translated into Slovenian, back-translated, and subjected to a pilot test. The accepted Slovenian version of the questionnaire was mailed to 2500 randomly selected adult residents of the Republic of Slovenia. Reliability was examined using Cronbach's alpha for the 1-, 3-, 4-, and 12-factor models addressing health literacy, three main health contexts, four health information processing competencies, and 12 combinations, respectively. Validity was explored with confirmatory factor analysis, univariate analysis, and multiple linear regression. RESULTS: A total of 517 responses were collected (21% response rate). The highest Cronbach's alpha was obtained for the 1-factor model (0.950), followed by the 3-, 4-, and 12-factor models. In the confirmatory factor analysis, the 12-factor model provided the most valid results (CFI 0.812; RMSEA 0.067, CI 0.065 to 0.070), followed by the 3-, 4-, and 1-factor models. In the multiple regression model, only the association between self-assessment of health and the health literacy index was statistically significant (p < 0.001). CONCLUSION: The Slovenian version of HLS-EU-Q47 is a reliable instrument for measuring health literacy. All models of the questionnaire showed reasonable model fit, but none fully satisfied all validity criteria. Respondents differentiated better between the three main health contexts (health care, disease prevention, and health promotion) than the four health information processing competencies (access, understand, appraise, and apply).

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Background Medication literacy refers to the ability of individuals to safely and appropriately access, understand and act on basic medication information. It is vital for correctly and safely using medications. General health literacy measures do not adequately address specific skills for medication literacy, and there are no general, self-administered, performance-based instruments for assessing patients' medication literacy. Objective The aim was to develop and validate a self-administered performance-based questionnaire measuring functional medication literacy and to evaluate functional medication literacy among the Slovenian general population. Setting A random sample of adult Slovenian residents received the questionnaires at their home addresses. Method The initial content was derived from medication counselling literature. Thirteen patients and 14 healthcare professionals provided feedback about its comprehensibility, comprehensiveness, and difficulty thus supporting content and face validity. The developed questionnaire, comprising 30 items divided into 5 categories (dosage, adverse effects, interactions, precautions, and other information), was sent to a random sample of 1500 adult Slovenian residents. The overall validity of the questionnaire was assessed via reliability, criterion and discriminant validity using the Kuder-Richardson Formula 20, multiple linear regression and Mann-Whitney test. Descriptive statistics were used to evaluate medication literacy. Main outcome measure The psychometric properties of the questionnaire (reliability, content, face, criterion, and discriminant validity); level of functional medication literacy. Results A total of 402 residents returned eligible questionnaires (26.8% response rate). The Kuder-Richardson Formula 20 reliability coefficient for the whole questionnaire was 0.823. One item that did not demonstrate discriminant validity was deleted. Criterion validity was supported by a significant association between age and medication literacy (ß = - 0.303). Income (ß = 0.243) and current self-perceived health (ß = 0.187) also were associated with medication literacy. The median of medication literacy score was 24 out of 29 points. Dosage-related items requiring understanding of long text instructions and the use of numeracy skills received the most incorrect answers. Conclusion A performance-based questionnaire measuring functional medication literacy among a general population with supported validity was developed. Slovenian residents encountered difficulties when dealing with items requiring prose literacy and numeracy skills, especially related to dosing. Special attention should be paid to low-income elderly with poor self-perceived health.

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BACKGROUND: Pharmaceutical Care Network Europe (PCNE) proposed a definition and classification system (type 1, 2a, 2b, 3) for medication review in 2016. However, to date, a description of the implementation and remuneration of such procedures across Europe is lacking. OBJECTIVE: The aim of this study was to describe the medication review procedures and the level of implementation and remuneration in community pharmacies across Europe. METHODS: An online survey was developed to characterize medication review procedures (PCNE classification), level of implementation (considering regional or national) and remuneration by a third party. This survey was sent to a purposive sample of three individuals per country, with a working background in community pharmacy, pharmacy practice research, or health policy to ensure reliable data. Data triangulation was used and consensus sought between the responses. RESULTS: Data were received from 34 out of 44 targeted European countries (November 2016-October 2017) [response rate = 77%]. Overall, 55.9% of the countries provided at least one type of medication review as an implemented service or project. Type 1 medication review (based on the medication history) was provided in 13 countries, type 2a (medication history + patient interview) in 14, type 2b (medication history + clinical data) in two, and type 3 medication review (medication history + patient interview + clinical data) in four countries. Ten of the mentioned services or projects were remunerated by a third-party. CONCLUSION: Substantial heterogeneity was observed across Europe in various aspects, including the procedures, implementation level and remuneration obtained. Type 1 and 2a medication review services seem to be more feasible to implement in the community pharmacy than type 2b and 3. A large number of medication review projects were ongoing in community pharmacies, which suggests that new medication review services could become implemented in the coming years.

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BACKGROUND: Pharmacist-led cognitive services (PLCS) are increasingly necessary in primary care as a response to patient-centered care. However, the implementation rate and remuneration models of PLCS are either absent or superficially described in the literature. OBJECTIVE: The aim of this study is to review the implementation of PLCS in primary care across Europe and explore the associated third-party paid remuneration models. METHODS: A cross-sectional study was conducted using an online survey sent to representatives of 44 European countries. The survey listed 21 PLCS and asked respondents to report the availability of the service, the rate of implementation and the existence of remuneration. To ensure credible data, data triangulation was sought using three representatives per country, representing backgrounds of community pharmacy, pharmacy practice research and health policy. Subsequently, data was validated, and consensus sought. RESULTS: Data were collected between November 2016 and October 2017 from 34 different countries across Europe (79%). Provision of medicines' information (94.1%), generic substitution (85.3%), provision of emergency oral contraception (70.6%) and point-of-care testing (67.7%) were the services reported as the most widely disseminated in European primary care. Medication review was the most disseminated among advanced services (55.9%). Medication review, adherence support and monitoring, prescription renewal, opioid substitution and travel medicine had the highest implementation rates reported. Half of the participating countries mentioned models of remuneration, predominantly based on a fee-for-service, with less frequent reports of pay-for-performance or mixed models of remuneration. CONCLUSIONS: The availability of PLCS is increasing and varying in scope across Europe. There is wide variation in the implementation level of services across Europe and a lack of valid data. Remuneration of PLCS is also spreading but no clear pattern was found that relates service provision to payment.

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Background Medication review is important in an era, in which polypharmacy is increasing. To date, no agreed international definition of medication review exists. Objective The aim was to reach agreement on an internationally applicable definition of medication review. Setting An international group of experts in medication review. Methods A working group of the Pharmaceutical Care Network Europe (PCNE) was established to agree on a definition including a classification of medication review. First, a survey with the aim of systematically gathering viewpoints on a definition of medication review was conducted. Second, a workshop was held to achieve an agreement. Finally, during the General Assembly of PCNE, the definition was approved. To ensure a better understanding of the scope and the considerations behind the definition, a position paper was created. Main outcome measure An internationally agreed definition of medication review. Results 58 PCNE members from 20 different countries completed the online survey. Then, 22 participants from 11 different countries (not only PCNE members) elaborated the final definition during a workshop. The final PCNE version agreed was: "Medication review is a structured evaluation of a patient's medicines with the aim of optimising medicines use and improving health outcomes. This entails detecting drug-related problems and recommending interventions". Overall, the consensus process included 225 people from 35 countries and resulted also in a classification of medication review taking into account the type and source of available information. Conclusion Involvement of an international community from research and practice and the use of a systematic process led to an agreement on the term medication review and on a classification valid for all settings and professions.

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This study evaluated medication adherence and health-related quality of life (HRQoL) of Slovenian patients with chronic obstructive pulmonary disease (COPD) and examined the factors associated with HRQoL. Demographic and therapy information was collected from 65 patients through interviews. The St. George's Respiratory Questionnaire and the Morisky Medication Adherence Scale were used to evaluate HRQoL and adherence, resp. A multiple linear regression model was used to assess the association between the factors and HRQoL. The mean St. George's Respiratory Questionnaire score (range 0-100, with higher scores indicating lower HRQoL) was 41.4. COPD affected patients' daily activities more than their social and psychological functioning. Slightly more than 53 % of the patients were optimally adherent, while 12 % were non-adherent. Patients with lower HRQoL had a larger number of medications for concomitant diseases, experienced COPD exacerbation in the last year, and had less education. No statistically significant correlation was found between medication adherence and HRQoL.

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BACKGROUND: Adverse drug events due to drug-drug interactions (DDIs) represent a considerable public health burden, also in Slovenia. A better understanding of the most frequently occurring potential DDIs may enable safer pharmacotherapy and minimize drug-related problems. OBJECTIVES: The aim of this study was to evaluate the prevalence and predictors of potential DDIs among outpatients in Slovenia. METHODS: An analysis of potential DDIs was performed using health claims data on prescription drugs from a nationwide database. The Lexi-Interact Module was used as the reference source of interactions. The influence of patient-specific predictors on the risk of potential clinically relevant DDIs was evaluated using logistic regression model. RESULTS: The study population included 1,179,803 outpatients who received 15,811,979 prescriptions. The total number of potential DDI cases identified was 3,974,994, of which 15.6% were potentially clinically relevant. Altogether, 9.3% (N = 191,213) of the total population in Slovenia is exposed to clinically relevant potential DDIs, and the proportion is higher among women and the elderly. After adjustment for cofactors, higher number of medications and older age are associated with higher odds of clinically relevant potential DDIs. The burden of DDIs is highest with drug combinations that increase risk of bleeding, enhance CNS depression or anticholinergic effects or cause cardiovascular complications. CONCLUSION: The current study revealed that 1 in 10 individuals in the total Slovenian population is exposed to clinically relevant potential DDIs yearly. Taking into account the literature based conservative estimate that approximately 1% of potential DDIs result in negative health outcomes, roughly 1800 individuals in Slovenia experience an adverse health outcome each year as a result of clinically relevant potential interactions alone.

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This article presents the results of mapping the Slovenian pharmacy curriculum to evaluate the adequacy of the recently developed and validated European Pharmacy Competences Framework (EPCF). The mapping was carried out and evaluated progressively by seven members of the teaching staff at the University of Ljubljana's Faculty of Pharmacy. Consensus was achieved by using a two-round modified Delphi technique to evaluate the coverage of competences in the current curriculum. The preliminary results of the curriculum mapping showed that all of the competences as defined by the EPCF are covered in Ljubljana's academic program. However, because most EPCF competences cover healthcare-oriented pharmacy practice, a lack of competences was observed for the drug development and production perspectives. Both of these perspectives are important because a pharmacist is (or should be) responsible for the entire process, from the development and production of medicines to pharmaceutical care in contact with patients. Nevertheless, Ljubljana's graduates are employed in both of these pharmaceutical professions in comparable proportions. The Delphi study revealed that the majority of differences in scoring arise from different perspectives on the pharmacy profession (e.g., community, hospital, industrial, etc.). Nevertheless, it can be concluded that curriculum mapping using the EPCF is very useful for evaluating and recognizing weak and strong points of the curriculum. However, the competences of the framework should address various fields of the pharmacist's profession in a more balanced way.

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Background Classifying drug-related problems increases pharmacists' awareness of patients' drug-related needs and supports the development of counselling skills through increased awareness of the nature and frequency of drug-related problems. No standardised classification system was used in daily pharmacy practice in Slovenia. Objective To translate, upgrade and validate the Pharmaceutical Care Network Europe (PCNE) classification V 6.2 for use in Slovenian community pharmacies. Setting Expert panel meetings at the Faculty of Pharmacy and home-based classification validation. Methods The PCNE classification V 6.2 was translated to Slovenian language by forward-backward translation procedure. An expert panel consisting of nine practicing pharmacists upgraded the content of the translated version. Thirty-one community pharmacists validated this version with the PCNE set of 18 patient cases by coding problems, risk factors and interventions they believed were present in each case. The expert panel discussed the results and upgraded the classification accordingly. Afterwards, 33 community pharmacists validated the upgraded version with a set of 40 actual Slovenian pharmacy patient cases. Based on the results, the expert panel formed a final version of the classification. Main outcome measure Coding consistency between community pharmacists. Results The expert panel performed some major modifications to the PCNE classification V 6.2: the potential problem was added as a sub domain to problems domain; the term adverse drug event was used instead of adverse drug reaction; the causes domain was renamed to risk factors and its sub domains were organized into prescribing, dispensing and use of drugs; dispensing errors were specified; use of drugs was organized into intentional and unintentional use of drugs; the sub domains in the interventions domain were divided according to the communication and agreement with the prescriber. The average coding consistencies in the first validation study were 75 % (±16 %) for problems, 74 % (±20 %) for risk factors and 94 % (±10 %) for interventions. The average coding consistencies in the second validation study were 83 % (±16 %) for problems, 85 % (±17 %) for risk factors and 80 % (±20 %) for interventions. Conclusion A drug-related problem classification for use in Slovenian community pharmacies was developed based on The PCNE classification V 6.2. The validation studies demonstrated high coding consistencies.

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AIM: To assess patients' knowledge about prescription medicines they are taking and their view on how much community pharmacist counseling contributed to their knowledge. METHODS: An observational study was designed to obtain information about patients' knowledge, their view on pharmacist counseling, and physicians'/pharmacists' provision of information. This study used a specifically designed questionnaire, which served as an interview guide. 400 patients picking up a prescription medicine were structurally interviewed upon leaving one of the 20 randomly chosen Slovenian pharmacies. The interviews took place in November and December 2013. RESULTS: Patients were familiar with general information about the medicines and their application (93%-100% of patients). Knowledge about considerations (16% of patients) and adverse effects (20% of patients) was limited. Factors associated with patient knowledge were physicians'/pharmacists' adequate provision of information (ß=0.259), patient's age (ß=- 0.149), patient's education (ß=0.100), and prescription type (ß=-0.104). Patients' responses were mostly consistent with the Summaries of Product Characteristics (72%-96% of responses). However, 42% of responses to the question about taking medicine with meals were incorrect. Pharmacists routinely informed the patients about medication purpose, dose, application rate, and timing of medication (in 72%, 89%, 89%, and 77% of cases, respectively). Other information was rarely offered. Patients with new prescriptions received significantly more counseling (pharmacist counseling score 5.9, 5.2, and 4.7 of maximum 10 for new, regular, and refill prescriptions, respectively, P=0.001) and obtained adequate labeling (69%, 26%, and 17% of patients for new, regular and refill prescriptions, respectively, P<0.001) than patients with regular or refill prescriptions. CONCLUSION: Patients were familiar with basic information about administration of their prescription medicines, but lacked knowledge about medication safety. This could be attributed to pharmacist counseling, which primarily focused on medicine use instructions.

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OBJECTIVES: Firstly, to assess paracetamol-related counselling. Secondly, to evaluate the patient's approach as a determinant of counselling and to test the acceptability of the simulated patient method in Slovenian pharmacies. METHODS: The simulated patient methodology was used in 17 community pharmacies. Three scenarios related to self-medication for headaches were developed and used in all participating pharmacies. Two scenarios were direct product requests: scenario 1: a patient with an uncomplicated short-term headache; scenario 2: a patient with a severe, long-duration headache who takes paracetamol for too long and concurrently drinks alcohol. Scenario 3 was a symptom-based request: a patient asking for medicine for a headache. Pharmacy visits were audio recorded and scored according to predetermined criteria arranged in two categories: counselling content and manner of counselling. The acceptability of the methodology used was evaluated by surveying the participating pharmacists. RESULTS: The symptom-based request was scored significantly better (a mean 2.17 out of a possible 4 points) than the direct product requests (means of 1.64 and 0.67 out of a possible 4 points for scenario 1 and 2, respectively). The most common information provided was dosage and adverse effects. Only the symptom-based request stimulated spontaneous counselling. No statistically significant differences in the duration of the consultation between the scenarios were found. There were also no significant differences in the quality of counselling between the Masters of Pharmacy and Pharmacy Technicians. The acceptability of the SP method was not as high as in other countries. CONCLUSION: The assessment of paracetamol-related counselling demonstrates room for practice improvement.

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OBJECTIVE: To identify content of pharmacy performance relevant to patient satisfaction. SETTING: Interviews with pharmacy users were conducted at their homes. The Delphi meeting was run at the Faculty of Pharmacy, Ljubljana, Slovenia. METHOD: A two-phase process was employed. In Phase I, interviews with 43 pharmacy users were conducted to identify patients' experiences and expectations relating to pharmacies. The content analysis of their responses resulted in a list of themes from which items were generated. In Phase II, a 10 member expert panel was employed in a two round Delphi technique to rate the importance of each item for the patient satisfaction. MAIN OUTCOME MEASURE: Themes derived from the interviews and their importance for patient satisfaction as assessed by the expert panel. RESULTS: Seventy-nine themes were generated from the survey responses which were grouped into four main categories: 'Relations', 'Counseling', 'Physical facilities and location' and 'Process'. In total, 69 items were generated. The expert panel rated 84% of generated items as very or somewhat important. CONCLUSION: The qualitative study provides insights on the content of pharmacy performance relevant to patients. Identified categories encompass a wide range of issues that contribute to patient satisfaction with pharmacy performance.

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The objective of this study was to develop a psychometrically valid, multidimensional, self-administered, general questionnaire measuring patient satisfaction with pharmacy performance for outpatients. A multiphase development process was employed to attain this goal. In Phase I, questionnaire's content was generated using interviews with pharmacy users regarding their experiences and expectations relating to pharmacies. In Phase II, the content and format of the questionnaire was defined in a two-round modified Delphi study, where an expert panel estimated importance of generated items for patient satisfaction. In Phase III, the initial validation of the questionnaire, which included a random sample of 5,400 patients coming out of the selected pharmacies, took place. The outcome of the development process is a questionnaire that focuses on issues expressed as important by patients, takes into account services as well as the supporting structure, and includes items relevant to an individual pharmacy and demonstrates satisfactory psychometric properties.

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