Clinical Pharmacology and Patients' Empowerment in Slovakia

ABSTRACT

Introduction: The empowerment of patients is considered to be one of the cornerstones of modern days rational pharmacotherapy. In Slovakia (SR), the continued, concerted professional and lay activities to this effect started about two decades ago, with strong involvement of the discipline of clinical pharmacology (CP). Objectives: To report on developments and unique experiences gained in fostering patients' empowerment in SR, a country having undergone considerable economic, political, and health care transitions ever since the 1990ies. Methods: Developing a practice-oriented analysis and subsequent synthesis of lessons learned, based upon the insiders' factual and conceptual information and knowledge of the country's developments and their driving, and slowing down forces and factors, as seen in the pertinent international contexts. Results: The developments leading to ever more pronounced and practical empowerment of patients in Slovakia were much enhanced, and even politically supported, after the launching of unprecedented multifaceted transitions following the Velvet Revolution in 1989. Setting up independent patients' organizations, their coming together forming the alliances and, later on, establishing common associations (such as Association for the Protection of Patients' Rights in SR (AOPP;see www.aopp.sk)) aimed at fostering patients' rights (that felt under some pressures from the deep transitional changes occurring within the health care system), were paralleled by growing academic and political interest (e. g., national Patients' Rights Charter approved by the SR Government in 2001), as well as by SR patients' representatives taking part in various international initiatives and organizations (e. g., EPF, ELPA, EUPATI, etc.). Starting from quickly developing informal contacts, consultations, increasingly professional discussions, and help in education (incl. issues of better access to modern pharmacotherapy modalities), SR's CP(-ists) became involved in mutual activities fostering patients' and patients' representatives' education, such as regular annotated courses Patient and Medicaments at the Slovak Medical University in Bratislava, invitations to annual CP conferences and other meetings. In 2015, EUPATI.sk was established. In 2017, a national, multistakeholder project Medicaments with Reason started, led by AOPP, with the Slovak Society of CP being its scientific guarantor. Successful long-term collaboration of AOPP with SR CP(-ists) and other stakeholders, including payers (health insurance companies in SR), Slovak Chamber of Pharmacists, politicians, academia, and some of the leading SR media, brought about more effective patients' representatives' involvement in legislation activities, high-level health policies negotiations, diagnostic and therapeutic standards and guidelines development, and a more adequate media coverage. These aspects, including collaborations with CP(-ists), were further strengthened during the Covid-19 pandemic. A patients' representative became a regular member of the newly established national SR Clinical Trials Ethics Committee (established under EU CTs Reg. No. 536/2014). Conclusion: Empowerment of patients ascertained by fostering longterm collaborations and synergies among decisive stakeholders involved, including important professional contributions of CP(-ists), as shown by decades-long experience in Slovakia, can contribute in a substantial manner to continuous, patient-friendly optimization of the national medicinal drugs policies and development of national pharmacotherapy standards and guidelines.