BackgroundDespite a variety of efficient and cost-effective antihypertensive medication, hypertension remains a serious health and economic burden. High consumption of cardiovascular drugs in the Slovak Republic does result neither in better hypertension control nor in significant decrease in cardiovascular mortality. At the same time, Slovakia has alarmingly low patients’ adherence to medication intake. Studies have shown the efficiency of short messaging service (SMS) reminders to improve patients’ adherence and health outcomes at low costs. Since SMS is popular among Slovaks, this approach may be feasible also in Slovakia. The primary objective is to assess if daily SMS reminders of antihypertensive medication intake provided by pharmacists in addition to the standard pharmaceutical care increase the proportion of adherent older hypertensive ambulatory patients.MethodsThe SPPA trial is a pragmatic randomized parallel group (1:1) trial in 300 older hypertensive patients carried out in community pharmacies in Slovakia. Trial pharmacies will be selected from all main regions of Slovakia. Trial intervention comprises daily personalized SMS reminders of medication intake embedded into usual pharmaceutical practice. The primary outcome is a combined adherence endpoint consisting of subjective self-reported medication adherence via the eight-item Morisky Medication Adherence Scale (MMAS-8) and objective pill count rate. Secondary outcomes include: change in the MMAS-8; comparison of adherence rates using pill count; change in systolic blood pressure; and patient satisfaction. Also, direct treatment costs will be evaluated and a cost-effectiveness analysis will be carried out.DiscussionThe SPPA trial engages community pharmacists and mobile health (mHealth) technologies via evidence-based pharmaceutical care to efficiently and cost-effectively addresses current main healthcare challenges: high prevalence of hypertension; overconsumption of cardiovascular medicines; low adherence to medication treatment; and resulting uncontrolled blood pressure. The results may identify new possibilities and capacities in healthcare with low additional costs and high value to patients.Trial registrationClinicalTrials.gov, NCT03105687. Registered on 07 March 2017.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2063-8) contains supplementary material, which is available to authorized users.

Slovakia is a country where the purchase of OTC (over the counter) medicines outside the pharmacy is not allowed by the government. This study aimed at evaluating patients' satisfaction and acceptance of community pharmacists. Customer's behaviour and expectations influencing the purchase of prescription and OTC medicines were analyzed. A structured questionnaire having 15 multiple-choice questions was used to analyze the descriptive parameters. Data collection lasted from January to February 2014. The sample size consisted of 357 high-school educated individuals under 40 years of age. The survey showed that the prescription and OTC medicines were bought equally. The participants reported a 96.0%, 96.3% and 90.2% satisfaction rate with willingness and approach of the community pharmacist, pharmacy services and provision of drug information respectively. As for the OTC medicines, 89.5% people considered the pharmacist an expert: 88.2% purchased medicines with pharmacist's recommendation, 97.8% needed a professional counselling and 97.2% required a pharmacist's guidance. As for the prescription drugs, only 72.1% considered the pharmacist an expert: 96.3% suggested that physician's prescription was significant and 88.3% considered pharmacist's guidance in the process of selection of prescription medicines nonessential. A comprehensible and respectable conversation was highly expected in regards to both the OTC and prescription medicines.

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Due to the economic changes and fast progress in health technologies countries face the challenge of rapidly growing health expenditures. Drug policies focus on identification of the most problematic areas for implementation of cost-effective measures. For this purpose, they need to be provided with accurate analyses of health expenditures and drug utilization. Primary aim of this study was to analyze health expenditures of Slovak Republic in regards to factors, which are considered to have the largest influence on provision of health care. Secondarily we focused on providing a brief drug utilization analysis. Our study confirmed that since 2000 Slovakia invests a larger share of GDP in health care, while in 2013 overall health expenditure amounted 5.6 million EUR (7.6% of GDP). Despite recent growth (233.6 % since 2000), Slovakia remains under OECD average in regards to health expenditures per capita (PPP, USD). However, it is on the 2 nd place among V4 countries. Patients' share of the overall health expenditures is increasing 12.8 times faster than public reimbursement. Up to 1.5 million EUR was spent on pharmaceuticals in 2013. The most utilized group of drugs in terms of DIDs and sales were cardiovascular drugs. JEL Classification Number: I50, DOI: http://dx.doi.org/10.12955/cbup.v4.763

A 3 4 7 -A 7 6 6 A621 only 5.5%. ConClusions: The indication of CRP/CRP-POCT-test before antibiotic prescription not only prevents the development of antibiotic resistance, it is also cost-effective. The reduction of antibiotic prescription to 35.0% by increasing the CRP/CRP-POCT-test indication to 26.2% saved a total of 135.4 EUR per 100 patients.