The prevalence of self-reported underuse of medications due to cost for the elderly: results from seven European urban communities.

BACKGROUND: The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities. METHODS: The data were collected in a cross-sectional study ("ABUEL, Elder abuse: A multinational prevalence survey") in 2009. Randomly selected people aged 60-84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2%. Ethical permission was received in each country. RESULTS: The results indicate that 3.6% (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7%, n = 99) and Portugal (4.3%, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany - 2.0%, Italy - 1.6%, Sweden - 1.0%, Greece - 0.6%, Spain - 0.3%). Females refrained more often from buying medications than males (2.6% vs. 4.4%, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship. DISCUSSION: These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study. CONCLUSIONS: Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.

Somatic complaints and refrain from buying prescribed medications. Results from a cross-sectional study on people 60 years and older living in Kaunas (Lithuania).

BACKGROUND: The use of medicines by elderly people is a growing area of concern in social pharmacy. A significant proportion of older people do not follow the recommendations from physicians and refrain from buying prescribed medications. The aim of this study is to evaluate associations between self-rated health, somatic complaints and refraining from buying prescribed medications by elderly people. FINDINGS: Data was collected in a cross-sectional study in 2009. We received 624 completed questionnaires (response rate - 48.9%) from persons aged 60-84 years living in Kaunas (Lithuania). Somatic complaints were measured with the 24 item version of the Giessen Complaint List (GBB-24). Logistic regression (Enter model) was used for evaluation of the associations between refraining from buying medications and somatic complaints. These associations were measured using odds ratio (OR) and calculating the 95% confidence interval (CI).The mean scores in total for the GBB scale and sub-scales (exhaustion, gastrointestinal and cardiovascular) were lowest among respondents who did not refrain from buying prescribed medications (means for GBB-24 scale: 21.04 vs. 24.82; p=0.001). Logistic regression suggests that somatic complaints were associated with a increased risk of refraining from buying prescribed medications (OR=1.35, 95% CI=1.15-1.60). CONCLUSIONS: Somatic complaints were significantly associated with the decision to refrain from buying prescribed medications.

Causes of refraining from buying prescribed medications among the elderly in Kaunas, Lithuania.

BACKGROUND AND OBJECTIVE: Accessibility to medications among the elderly is a source of concern in Lithuania and beyond. However, there are no studies carried out on this topic in Lithuania. Therefore, the aim of this study was to evaluate the causes of refraining from buying prescribed medications among the elderly in Kaunas, Lithuania. MATERIAL AND METHODS: The data were collected in a cross-sectional ABUEL study in 2009. A total of 624 filled-in questionnaires (response rate, 48.9%) from the elderly aged 60-84 years living in Kaunas (Lithuania) were received. For evaluation of the impact of explanatory variables on the analyzed event (binary dependent variable), an Enter model of logistic regression was used. RESULTS: The study showed that 32.7% of the respondents refrained from buying prescribed medications. The most common reasons (respondents could select several options) for this decision were financial problems (48.0%), disappearance of problems (40.7%), and fear of side effects (22.5%). Refraining from buying prescribed medications was positively associated with age (OR, 0.85; 95% CI, 0.74 to 0.99). Higher education was associated with a reduced risk of refraining from buying prescribed medications due to financial problems (OR, 0.49; 95% CI, 0.31 to 0.78) and an increased risk of refraining from buying medications due to the disappearance of health problems (OR, 1.75; 95% CI, 1.15 to 2.68). An opposite association with worries about daily expenses was observed. CONCLUSIONS: Study has revealed that one-third of the elderly refrained from buying prescribed medications, and the main reasons for this were financial problems and disappearance of health problems.

Nonadherence to medications among pharmacy clients and their attitude toward medications kept a medicine cabinet at home.

OBJECTIVES: To assess self-reported adherence among pharmacy clients and to detect if there are any differences in medication use or storage between genders. MATERIAL AND METHODS: The data were collected by means of questionnaires. A standard 45-item questionnaire was developed and used to assess adherence and nonadherence to medications. It was distributed to all pharmacy customers who entered pharmacies chosen by us. RESULTS: Of the 162 (45 men and 117 women) pharmacy clients participating in the study, 36.42% were considered nonadherent. No significant difference in adherence rates between genders was observed (P>0.05). Women more often named themselves as being responsible for a medicine cabinet at home (P<0.001) and used more sources of information on medications (P<0.05). Women also more frequently checked the expiry date of medications in a medicine cabinet home than men (P<0.05). CONCLUSIONS: The problem of nonadherence to medications exists among pharmacy clients. There is no significant difference in the rate of self-reported adherence between male and female pharmacy clients. Women are the ones named as responsible for a medicine cabinet at home. They also are important health decision makers. Women are more interested in information on medicines and their use; therefore, this demand should be satisfied.

[Antimicrobial activity of soft and purified propolis extracts]. / Tirstojo ir isgryninto propolio ekstrakto antimikrobinis aktyvumas.

OBJECTIVE: To evaluate the antimicrobial activity of soft and purified propolis extracts. STUDY OBJECT AND METHODS: Antimicrobial activity of soft and purified propolis extracts was determined with reference cultures of Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Klebsiella pneumoniae ATCC 33499, Pseudomonas aeruginosa ATCC 27853, Proteus mirabilis ATCC 12459, Bacillus subtilis ATCC 6633, Bacillus cereus ATCC 8035, and fungus Candida albicans ATCC 60193. Microbiological tests were performed under aseptic conditions. Minimum inhibitory concentration (MIC)--the highest dilution of preparation (the lowest concentration of preparation) that suppresses growth of reference microorganisms--was determined. RESULTS: Concentration of phenolic compounds in soft propolis extract that possesses antimicrobial activity against gram-positive (Staphylococcus aureus, Enterococcus faecalis) and gram-negative bacteria (Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis) is 0.587+/-0.054 mg and 0.587+/-0.054-0.394+/-0.022 mg (P>0.05) and in purified propolis extract--0.427+/-0.044 mg and 0.256+/-0.02 mg (P>0.05). Klebsiella pneumoniae is most resistant to soft propolis extract when the concentration of phenolic compounds is 1.119+/- 0.152 mg and to purified propolis extract when the concentration of phenolic compounds is 1.013+/-0.189 mg (P>0.05). Spore-forming Bacillus subtilis bacteria are more sensitive to soft and purified propolis extracts when the concentration of phenolic compounds is 0.134+/-0.002 mg and 0.075+/-0.025 mg, respectively, and Bacillus cereus--when the concentration is 0.394+/-0.022 mg and 0.256+/-0.02 mg (P>0.05). Sensitivity of fungus Candida albicans to soft and purified propolis extracts is the same as Bacillus subtilis. Encapsulated bacterium Klebsiella pneumoniae is most resistant to antimicrobial action of soft and purified propolis extracts as compared with gram-positive Staphylococcus aureus and Enterococcus faecalis bacteria (P<0.05), gram-negative Escherichia coli, Pseudomonas aeruginosa, and Proteus mirabilis (P<0.05), spore-forming Bacillus subtilis and Bacillus cereus bacteria (P<0.05), and fungus Candida albicans (P<0.05). There is no statistically significant difference between antimicrobial effect of soft propolis extract and purified propolis extract on gram-positive bacteria, gram-negative bacteria, spore-forming bacteria, encapsulated bacteria, and Candida fungus. CONCLUSIONS: Soft and purified propolis extracts possess antimicrobial activity. They could be recommended as natural preservatives in the manufacture of pharmaceutical products.

[Technology of extract improving the immune system]. / Imunine sistema gerinancio ekstrakto technologijos ypatybes.

The article deals with the production of the extract of Echinacea purpurea herbs when selecting an extractant concentration, the size of particles in a raw material and the method of extraction. Using 60% (v/v) ethanol for production of the immune system enhancing extract, the extract becomes green due to pigmental substances; therefore, 60% (v/v), 70% (v/v), and 96% (v/v) ethanol was not used for extraction. It is recommended to use 50% (v/v) ethanol for extraction. Using 40% (v/v) ethanol not all active substances are extracted and resistance of the extract to microbial contamination is weaker. It was determined that the method of repercolation should be used to yield the largest amount of active substances. The largest amount of active substances in the immune system enhancing extract was obtained when the flow speed of extract was 0.2 ml/min. The quality of extract was tested within the period of 26 months by the monitoring of following parameters: appearance of the extract, refraction index, relative density, ethanol concentration, the amounts of dry residue and chicoric acid. The analysis was carried out every three months. The samples of the extract remained stable during storage: no alterations of color, smell or taste were observed. Some of the samples had deposits, which is quite natural in the production of drugs from herbal material, as they have no influence on the quality of the drug (the amounts of active substances were found to be within acceptable limits). On the basis of the obtained results, the period of expiry of the immune system enhancing tincture was confirmed to be 2 years.

[The need for creating a patient medication record system and characteristics of its application in community pharmacies]. / Iraso apie paciento bukle sistemos sukurimo poreikis ir jos diegimo ypatybes visuomenes vaistinese.

UNLABELLED: The objectives of this study were to explore the need for an information system of patient's medication record in pharmacies, where pharmacists could find all information about patient's condition, diseases and used medicines; to find out internet and information technologies usage in pharmacies. METHODS: In order to evaluate the demand for a specialized information system the method of a questionnaire-based survey was used. RESULTS: Obtained answers indicated that an information system could be useful in pharmacies and information technologies would facilitate information exchange among different institutions directly responsible for the treatment of patients.

[Documentation of good distribution practice of medicines and its implementation in Lithuanian drug distribution companies]. / Geros vaistu platinimo praktikos dokumentai ir ju rengimas Lietuvos vaistu platinimo imonese.

Good Distribution Practice of medicinal products for human use is a quality warranty system, which includes requirements for purchase, receiving, storage and export of drugs, intended human consumption. A drug is a specific product and its mishandling is dangerous to human health and life. Therefore it is necessary to strictly control the movement of the drug from the producer to the consumer so that poor quality drugs do not have access to the market. Good Distribution Practice rules set the general requirements for good wholesale distribution practice of drugs, intended for human consumption. In order for company to meet the specified requirements, the drug distribution company must have all suitable and necessary premises, machinery, equipment, the required number of employees and specified documentation. The preparation of the Good Distribution Practice documentation is one of the most important and complex aspects when implementing the Good Distribution Practice in the companies. The article deals with the analysis of results obtained during the research of drug distribution companies in Lithuania. The research revealed that drug distribution companies put emphasis on the equipment of storage premises. Less attention is being paid to the preparation of the documents of Good Distribution Practice. The article thus presents the analysis of Good Distribution Practice documents prepared by the drug distribution companies.

[Analysis of possibilities of pharmaceutical care elements implementation in Lithuanian community pharmacies]. / Farmacines rupybos elementu igyvendinimo Lietuvos visuomenes vaistinese galimybiu analize.

OBJECTIVE: Objective of this survey--possibilities of implementation of pharmaceutical care elements in daily work of Lithuanian community pharmacies. All pharmacists have to ensure the best quality of pharmaceutical services which they render to their patients. Pharmacists also must improve the quality of pharmaceutical services, according to recommendations of pharmaceutical care. For a start they should implement at least separate elements of pharmaceutical care if they are going to provide pharmaceutical care services in their community pharmacies in the future. That's why this survey was designed to clarify the possibilities of implementation of separate pharmaceutical care elements in to daily work of community pharmacies. MATERIAL AND METHODS: Material of this survey--pharmaceutical services rendered in Lithuanian community pharmacies. This survey has an analytical character and was accomplished with questionnaire. Chiefs of community pharmacies were asked to complete of questionnaire. We gave 150 questionnaires and received answers from 128 pharmacists. RESULTS: After gathered data analysis we found out that only 2% of pharmacies are almost prepared and well equipped for provision of pharmaceutical care services; however, they still have to rearrange their facilities. CONCLUSIONS: Lithuanian community pharmacies are not ready to work according to recommendations of pharmaceutical care today. Some elements of pharmaceutical care (such as blood pressure measurement, provision of written information for patient, etc.) are already implemented by almost all Lithuanian community pharmacies. If pharmacists want to provide pharmaceutical care services they should create a database of patient medication records in pharmacy. Unfortunately Lithuanian pharmacists do not have such databases today. Only with such databases there is a possibility to render pharmaceutical services of the best quality.

[The research of quality of patient counselling and resources of pharmaceutical information in community pharmacy]. / Paciento konsultavimo kokybes tyrimas ir farmacines informacijos gavimo saltiniai visuomenes vaistineje.

THE OBJECTIVE: To learn patients opinion about quantity and quality of patient counselling in pharmacy. Also, to explore usage of pharmacy information systems (PIS) in pharmacies; find out internet usage in pharmacy daily activities and it's determinants. METHODS: Random anonymous questionnaire method. RESULTS: Obtained answers indicated, that in pharmacy patients receive essential information about medicines usage, however, explanatory information is not sufficient. All pharmacies in Lithuania daily use PIS, more than a half of market is occupied by "Skaitos kompiuteriu servisas" PIS ("SKS Vaistai"). Sixty percent of Lithuanian pharmacies have internet connection; 50% of all personnel of pharmacies use internet in their work. In this time pharmacies of Lithuania are not satisfied of with any PIS, and attempt to compensate shortage of information in other ways.

[Patient medication record in pharmacy: development of specialized information system and possibilities of its application in Lithuanian community pharmacies]. / Paciento medicininis irasas vaistineje: informacines sistemos kurimas ir jos pritaikymo galimybes Lietuvos visuomenes vaistinese.

OBJECTIVES: To examine whether the managers of Lithuanian community pharmacies need a special information system for the creation of patients' medication record in the pharmacy. To design the system and to analyze the possibilities of its application. RESEARCH MATERIALS AND METHODS: In order to determine the need for a specialized information system a questionnaire-based survey of pharmacies managers was used. During the development of information system the detailed requirements analysis was performed and basing on this analysis the architecture of the system and its user interface were designed. System was built using "Microsoft Access 2000" and "Visual Basic 6" development tools. RESULTS: Survey revealed that managers of community pharmacies require an information system for the creation of patients' medication record in the pharmacy. The design of the system was prepared and the initial version was built. Examinations of the developed system showed that it could be used to form the patient information database, which would improve the quality of service. CONCLUSION: The developed information system or its analogue should be used in community pharmacies because absence of the patients medical records database makes it impossible to implement the recommendations of good pharmacy practice.