INTRODUCTION: In 2011 clinical pharmacy (CP) almost did not feature in the Czech Republic. As the complexity of pharmacotherapy increased, the need for comprehensive medication reviews (CMR) became increasingly important which led to extension of pharmacy practice beyond merely drug-oriented pharmacy-based services. AIM: To outline the development, implementation and outcomes of the methodology that established standards for CP practice in the Czech Republic and which contributed to establishing CP as an independent postgraduate specialization with its own workplaces and full-time employment positions. SETTING: Inpatient and outpatient healthcare settings in the Czech Republic. DEVELOPMENT: Legislative changes in 2011 incorporated CP care into the healthcare system and the national CP methodology was published in 2014. Proactive screening of the medication lists and patient healthcare documentation was introduced. Results of CMRs are discussed with attending physicians and the plans for drug therapy adjustment are added to patient documentation. Clinical pharmacists have become standard partners for physicians on medical wards and outpatient facilities. A comprehensive clinical postgraduate training program (fully interlinked with accredited CP wards) has been established to maintain high standards of CP care. IMPLEMENTATION: Based on the CP care methodology approved by professional medical and pharmaceutical societies and accepted by the Ministry of Health and health insurance companies, three inpatient procedures and one outpatient procedure became eligible for reimbursement thus facilitating the further development of CP practice and independent CP departments. Currently, the Czech Republic has 58 CP facilities and nearly 200 specialized clinical pharmacists. EVALUATION: The provision of CP care according to current national guidelines was shown to provide an effective and cost-effective approach by the results of two extensive studies; the calculated economic cost-benefit ratio was determined at 1:3-4.2. The number of clinical pharmacy specialists and facilities is steadily increasing. CONCLUSION: The development of methodological approach accompanied by changes concerning reimbursement in the Czech Republic have led to the establishment of a stable and well-defined environment for clinical pharmacists to become full-time experts in both inpatient and outpatient settings. Clinical pharmacists are now recognized as skilled experts who are respected for their valuable contribution to inter-professional cooperation within medical teams.

• Klíčová slova
• Clinical pharmacy, Cost–benefit analysis, Inpatients, Legislation, Medication review, Medication therapy management, Outpatients, Reimbursement,
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Previous research has raised concerns about high prevalence of drug-related problems, polypharmacy and inappropriate benzodiazepine prescribing in nursing homes (NHs) and confirmed lack of studies from Central and South-Eastern Europe. The aim of our study was to determine the prevalence and characteristics of polypharmacy, hyperpolypharmacy and inappropriate benzodiazepine prescribing in NH residents in Croatia. METHODS: Data from 226 older NH residents from five Croatian NHs were collected using the InterRAI Long-Term Care Facilities assessment form. The prevalence and determinants of polypharmacy/hyperpolypharmacy and patterns of inappropriate benzodiazepine prescribing were documented. RESULTS: The prevalence of polypharmacy (49.6%) and hyperpolypharmacy (25.7%) among NH residents was high. In our study, 72.1% of NH residents were prescribed at least one psychotropic agent, 36.7% used 2-3 psychotropics and 6.6% used 4+ psychotropics. Among benzodiazepine users (55.8%), 28% of residents were prescribed benzodiazepines in higher than recommended geriatric doses, 75% used them for the long term and 48% were prescribed concomitant interacting medications. The odds of being prescribed polypharmacy/hyperpolypharmacy were significantly higher for older patients with polymorbidity (6+ disorders, proportional odds ratio (POR) = 19.8), type II diabetes (POR = 5.2), ischemic heart disease (POR = 4.6), higher frailty (Clinical Frailty Scale (CFS ≥5); POR = 4.3) and gastrointestinal problems (POR = 4.8). CONCLUSIONS: Our research underscores the persistent challenge of inappropriate medication use and drug-related harms among older NH residents, despite existing evidence and professional campaigns. Effective regulatory and policy interventions, including the implementation of geriatrician and clinical pharmacy services, are essential to address this critical issue and ensure optimal medication management for vulnerable NH populations.

• Klíčová slova
• Nursing home residents, geriatric deprescribing, inappropriate benzodiazepine prescribing, polypharmacy/hyperpolypharmacy, psychiatric polypharmacy/hyperpolypharmacy,
• MeSH
• benzodiazepiny * terapeutické užití   škodlivé účinky   aplikace a dávkování   MeSH
• domovy pro seniory statistika a číselné údaje   MeSH
• lékařská praxe - způsoby provádění statistika a číselné údaje   normy   MeSH
• lidé MeSH
• nevhodné předepisování * statistika a číselné údaje   MeSH
• pečovatelské domovy * statistika a číselné údaje   MeSH
• polypharmacy * MeSH
• prevalence MeSH
• psychotropní léky terapeutické užití   škodlivé účinky   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Chorvatsko epidemiologie   MeSH
• Názvy látek
• benzodiazepiny * MeSH
• psychotropní léky MeSH