Charlotte: This morning we departed Motovun, and visited the Euphrasian Basilica in Porec (pronounced Pour-eck) where we also met our tour guide for the next few days, Aleksandra Paic. We toured the Basilica and made the long trek to the top of the bell tower to get our first view of the coast. After a mini tour of the city we were given free time to explore. We had lunch in a fjord off of the Adriatic where we had the opportunity to try any sea food items we wanted.
After lunch we went to the city of Rovinj (pronounced Row-veen) where we visited another Catholic Church. We had free time in Rovinj and then we stopped at an abandoned castle outside of the city on the way back to the hotel. The castle ruins were really cool! The castle was abandoned many centuries ago due to plague. It was situated on the top of a mountain and the view was gorgeous! After we explored the ruins we traveled back to Montovun where we had dinner on our own.
Ben: I guess this is as good of a time as any to continue my discussion of pharmacy. In my previous post, I talked about the wide scale, macro view of pharmacy as it is in Croatia. Today I’m going to bring the scope in to a more micro, functional view of how the pharmacy operates. Again, I’m going to do my best to compare it to the American system, and then try to show you how all of this is relevant to public health.
We’ll start today where the prescription normally starts: the doctor’s office. Croatia employs socialized healthcare (about which I’ve heard a wide range of opinions, but I’ll leave that for someone else to touch on), so when you get sick, you go to whatever doctor you wish to see, and in most circumstances, they will write you a prescription. The physical prescription basically requires all of the same elements that are required on a prescription in America: patient’s name, date of birth, medication, dosage, frequency, amount, and refills allowed (so far so good). The piece of paper that each prescription is written on is also color coded to correspond to how the medication will be covered by insurance: Blue = free medication (completely covered), red = partially covered (copayment required), and a 3rd (yellow I think) that the insurance doesn’t cover at all (these are special case medications that are usually very expensive).
Once a patient has their prescription, they take it to a pharmacy to be filled, just like America. However, that’s about where the similarities stop (and some of the health issues begin). Before I dissect the Croatian pharmacy, I want to point out that they are somewhat behind America in terms of technology in the pharmacy. A few decades behind, actually. According to what Mr. Pharm. Spec. Maja Bernasek told me in our meeting, all labels on prescriptions are written in by hand. No computer generated labels, just pen and sticky paper. This is not really a problem, unless the pharmacist has poor handwriting (such as me). The problem is that there is no continuous electronic record of medications that the patient is taking, and there is no medication cross checking run through a computer. This can potentially lead to many serious (and deadly) drug interactions, just because the pharmacists do not have an electronic record of what medications each patient is taking or is allergic to.
When MPS Bernasek told me this, my jaw hit the floor. I cannot imagine working as a pharmacist and not having these tools at my disposal. I would love to see some statistics on the number of deaths in Croatia due to drug interactions, but as of now I have been unable to find any (in America, drug interactions kill thousands of people, injure millions, and cost the healthcare industry billions of dollars each year). The good news is that pharmacies are slowly trying to incorporate these computer systems into place (unfortunately, cost is a preventative issue).
Aside from an obvious lack of technology inside the pharmacy, the process runs about the same as it does in America: a patient drops the prescription off, the pharmacist fills it and then checks it, and then the pharmacist dispenses the medication to the patient. When they hand the medication over to the patient, the pharmacist counsels them on any pertinent information relative to the prescription. At this point, any information the pharmacist passes along to the patient comes either from memory, or from any medical text they might have on hand. Again, this is due to a lack of technology. In America, practically every pharmacy has access to internet based medical data, as well as computer-printed medication labels that automatically list any pertinent information the pharmacist should inform the patient about. Hopefully this will change with time.
There was one very important item that I particularly like about pharmacies in Croatia: patient privacy rights. In America, we have HIPAA (The Health Information Portability and Accountability Act of 1996), which, if violated, offenders can face criminal and civil charges. In Croatia, they have some very similar laws that require pharmacists to maintain discretion with sensitive health-related information, and violations of this are also punishable by law. This is definitely a step in the right direction, as it helps bolster the defense against disease-based discrimination.
So, to wrap this up for today, Croatia has a functional healthcare system that allows for any citizen that is in need of medical attention to be taken care of. Although the pharmacies may be lacking in cutting edge technology, the pharmacists themselves work very hard to ensure that the proper care is given to each and every one of their patients. They are a crucial cog in the healthcare machine of Croatia.
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