The Role of Clinical Pharmacology for the Family Physician in Croatia

Klinička farmakologija (KF) nastala u Hrvatskoj 1970.-ih godina danas je važan čimbenik u borbi za adekvatno i racionalno propisivanje lijekova. Njezine su funkcije praktične, nastavne i istraživačke. Liječnik obiteljske medicine (LOM) trebao bi se koristiti njezinim uslugama u svim navedenim zadacima koji su usko povezani. Racionalna farmakoterapija uvjetovana je redovitim, objektivnim i kritičkim obavješčivanjem. Ono, prisutno već u dodiplomskoj nastavi, mora se nastaviti u poslijediplomskoj nastavi i stalnom usavrπavanju medicinara i farmaceuta. Obavješčivanje se mora temeljiti na “medicini osnovanoj na dokazima”, istraživanju propisivanja i potrošnje lijekova. LOM propisuje 80% ukupno potrošenih lijekova pri čemu sekundarna i tercijarna zdravstvena zaštita često ne igra optimalnu ulogu. Objektivni izvori informacija imaju u nas (Pharmaca, Bilten o lijekovima) dugu tradiciju, no nedovoljno su prošireni pa je njihov utjecaj na propisivanje suboptimalan. Farmakoterapijski priručnik još ne izlazi redovito. Konkretni savjeti o farmakoterapiji, dobivanje povratnih obavijesti kod prijavljivanja nuspojava načini su pomoći i koristi KF za LOM. U ispitivanju nekih lijekova (novih ili ispitivanja novih aspekata primjene starih, što se teško može provesti bez pomoći LOM-a) suradnja KF i LOM-a vrlo je važna. KF će surađivati s LOM-om i u ocjeni racionalnosti propisivanja i adekvatnosti savjeta specijalista. Isto će biti slučaj u zajedničkome djelovanju u različitim povjerenstvima za lijekove od onog HZZO-a do pojedinih bolničkih povjerenstava. I u Ministarstvu zdravstva ta bi suradnja trebala biti prisutna. Bez LOM-a nemoguće je donositi propise i zakone koji se tiču obiteljske medicine. KF treba obiteljskog liječnika jednako kao on nju. U obostranom je interesu da se bolje iskoriste mogućnosti koju ta suradnja pruža.The development of clinical pharmacology (CP) started in Croatia in 1970-ies. CP today is an important factor in a constant fight for appropriate and rational drug prescribing. Its functions are practical (services), educational and investigational (research). Family physician (FP) should use all these closely related functions for his/her own sake. The basic condition for rational prescribing is regular, objective critical information on drugs. It, present already in the undergraduate studies, must be continued in the postgraduate studies and especially in continuous education of FP and pharmacists as well. Drug information must be based on feedback of prescribing profiles, which should be continuously analysed, and necessary measures (in the first place of the educational nature) taken. FP prescribes 80% of drugs used in Croatia, often under the not optimal influence of secondary and tertiary specialists. Objective source of information (Pharmaca, Drug bulletins) have a long tradition in Croatia but they reach only an insufficient number of FP. Their influence on prescribing is suboptimal and the National formulary still does not appear regularly. Counselling in individual cases and feedback information when reporting adverse reactions are examples of help offered to FP by CP. In clinical trials (of new agents or in investigation of new aspects of use old agents which often cannot be performed without FP) the collaboration of CP and FP is very important. CP must collaborate with the FP in the evaluation of its prescribing and the rationality of advices coming from specialists. The same is true in the work in various drug committees beginning with that of the Croatian Institute for Health Insurance (CIHI) and hospital drug committees. This collaboration should be present also in the various bodies of the Ministry of health. Without FP no law, rule or bylaw, which concerns his work, should be prepared! CP needs FP and vice versa. It is in interest of both that they use the possibilities that this collaboration enables