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Background: Medication non-adherence jeopardises the effectiveness of chronic therapies and negatively affects financial sustainability of healthcare systems. Available medication adherence-enhancing interventions (MAEIs) are utilised infrequently, and even more rarely reimbursed. The aim of this paper was to review reimbursed MAEIs across selected European countries. Methods: Data on reimbursed MAEIs were collected from European countries at the ENABLE Cost Action expert meeting in September 2021. The identified MAEIs were analysed and clustered according to their characteristics, direct vs. indirect relation to adherence, and the targeted adherence phase. Results: Out of 12 contributing countries, 10 reported reimbursed MAEIs, 28 in total, of which 20 were identified as MAEIs targeting adherence directly. Reimbursed MAEIs were most often performed by either doctors (n = 6), nurses (n = 6), or pharmacists (n = 3). The most common types of MAEIs were education (n = 6), medication regimen management (n = 5), and adherence monitoring feedback (n = 4). Only seven reimbursed MAEIs were technology-mediated, whereas 11 addressed two interlinked phases of medication adherence, i.e., implementation and persistence. Conclusion: Our review highlights the scarcity of reimbursed MAEIs across the selected European countries, and calls for their more frequent use and reimbursement.

Introduction: Current literature lacks detailed understanding of the reimbursement framework of medication adherence enhancing interventions (MAEIs). As part of the ENABLE COST Action, the EUREcA (“EUropen REimbursement strategies for interventions targeting medication Adherence”) study aimed to provide an in-depth overview of reimbursed MAEIs currently available in European countries at national and regional levels and to pave the way for further MAEIs to be implemented in the future. Methods: A web-based, cross- sectional survey was performed across 38 European countries and Israel. The survey questionnaire was developed as a result of an iterative process of discussion informed by a desk review. The survey was performed among invited ENABLE collaborators from June to July 2021. Besides descriptive analysis, association between country income and health care expenditure, and the availability of reimbursed MAEIs were also assessed. Results: The survey identified 13 reimbursed MAEIs in nine countries: multi-dose drug dispensing (n = 5), medication review (n = 4), smart device (n = 2), mobile application (n = 1), and patient education (n = 1). The median GDP per capita of countries having ≥1 reimbursed MAEI was significantly higher compared to countries having no reimbursed adherence intervention (33, 888 EUR vs 16, 620 EUR, respectively ; p = 0.05). Conclusions: Our findings highlight that to date only a small number of MAEIs have been reimbursed in European countries. Comprehensive health technology assessment recommendations and multi- stakeholder collaboration could help removing barriers related …

Warfarin therapy can significantly affect patients’ quality of life and cause therapy discontinuation. This study aimed to investigate the effect of the pharmacists’ interventions on the health-related quality of life (HRQoL) in older rural patients on warfarin therapy. Eligible older patients from rural area of Croatian province Slavonia were randomized into the intervention and control groups and followed for six months. Repeated education and a follow-up plan were provided to the participants in the intervention group, and if needed, the pharmacist intervened to optimize warfarin therapy. Secondary analysis on HRQoL data are presented here. Main outcome measure was Duke anticoagulation satisfactions scale questionnaire score. In total, 131 participants finished the study (median age 73 years; 51.1% male). Participants in the intervention group scored significantly lower (median being 86.5 and 66.0 in the control and intervention groups, respectively; p 2 = 65.5%, P Clinicaltrials.gov (ID: NCT03212898), 11/07/2017, retrospectively registered.

Iva Bu&zcaron;an&ccaron;i&cacute;,1,2 Patricia Dragovi&cacute;,3 Tajana Iva Pejakovi&cacute;,1 Luka Markulin,4 Maja Ortner-Had&zcaron;iabdi&cacute;2 1City Pharmacies Zagreb, Zagreb, 10 000, Croatia; 2Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, 10 000, Croatia; 3Prima Pharme Pharmacies, Zagreb, 10 000, Croatia; 4Pharmacy Unit, Psychiatric Hospital Ugljan, Ugljan, 23275, Ugljan Island, CroatiaCorrespondence: Maja Ortner-Had&zcaron;iabdi&#x0107Centre for Applied Pharmacy, Faculty of Pharmacy and Biochemistry, University of Zagreb, Domagojeva 2, Zagreb, 10 000, CroatiaTel +385 16461800Email mortner@pharma.hrPurpose: To explore how adult patients perceive deprescribing in a country with developing pharmaceutical care.Patients and Methods: This was a multicenter cross-sectional study conducted in ten community pharmacies across Croatia. Community-dwelling adults 40 years and older, taking at least one prescription medication long term, were invited to participate. The revised and validated Patients’ Attitude Towards Deprescribing Questionnaire was used to investigate community-dwelling adults’ opinions on potential medication discontinuation. Questions regarding the patients’ perception of pharmacist competences and involvement as well as patients’ preferences in deprescribing were added. Collected data were analyzed using IBM SPSS Statistics using descriptive and inferential statistical analysis. Binary logistic regression was used to explore potential predictive factors of willingness to have medication deprescribed. All tests were performed as two-tailed and a p < 0.05 was considered statistically significant.Results: A total of 315 adults aged 40 years and older completed the questionnaire. Majority of participants, 83.81% (95% CI, 79.72% to 87.90%) stated that they were satisfied with their medications, and 83.81% (95% CI, 79.72% to 87.90%) would be willing to deprescribe one or more medications. Participants expressed a positive attitude toward pharmacists’ competences (68.89%, 95% CI, 63.75% to 74.03%) and involvement in deprescribing (71.11%, 95% CI, 66.08% to 76.14%). Participants who stated specific medication as deprescribing preference were more likely show dissatisfaction with current medication and show greater willingness to have medication deprescribed. Three factors were found to be associated with a positive attitude towards deprescribing: low concerns about stopping factor score (aOR 0.54, 95% CU=0.35– 0.84; p=0.006), low appropriateness factor score (aOR 0.62, 95% CI=0.39– 0.98; p=0.039), and a positive opinion on pharmacist involvement (aOR 2.35, 95% CI=1.18– 4.70; p= 0.016).Conclusion: This study showed the patient’s willingness for deprescription as well as their positive attitude towards pharmacists being involved in the process. Results favour transition to a patient-centred care and shared-decision making model.Keywords: stopping medications, patient preference, pharmacist, transition

AIMS Community-based pharmacists are an important stakeholder in providing continuing care for chronic multi-morbid patients, and their role is steadily expanding. The aim of this study is to examine the literature exploring community-based pharmacist-initiated and/or -led deprescribing and to evaluate the impact on the success of deprescribing and clinical outcomes. METHODS Library and clinical trials databases were searched from inception to March 2020. Studies were included if they explored deprescribing in adults, by community-based pharmacists and were available in English. Two reviewers extracted data independently using a pre-agreed data extraction template. Meta-analysis was not performed due to heterogeneity of study designs, types of intervention and outcomes. RESULTS A total of 24 studies were included in the review. Results were grouped based on intervention method into four categories: educational interventions; interventions involving medication review, consultation or therapy management; pre-defined pharmacist-led deprescribing interventions; and pharmacist-led collaborative interventions. All types of interventions resulted in greater discontinuation of medications in comparison to usual care. Educational interventions reported financial benefits as well. Medication review by community-based pharmacist can lead to successful deprescribing of high-risk medication, but do not affect the risk or rate of falls, rate of hospitalisations, mortality or quality of life. Pharmacist-led medication review, in patients with mental illness, resulting in deprescribing improves anticholinergic side effects, memory and quality of life. Pre-defined pharmacist-led deprescribing did not reduce healthcare resource consumptions but can contribute to financial savings. Short follow-up periods prevent evaluation of long-term sustainability of deprescribing interventions. CONCLUSION This systematic review suggests community-based pharmacists can lead deprescribing interventions and that they are valuable partners in deprescribing collaborations, providing necessary monitoring throughout tapering and post-follow-up to ensure the success of an intervention.

Aging population is at increased risk of negative health outcomes due to the use of potentially inappropriate medications. This study aimed to evaluate the anticholinergic and sedative medication burden and its correlation with patients’ sociodemographic and health-related characteristics in older patients. Setting and Method: Data for this observational, cross- sectional study were collected using the EUROAGEISM H2020 ESR 7 project protocol in three community pharmacies in Zagreb. Presented data are preliminary and include 84 adults aged 65 + years who were able and willing to give their informed consent. Collected data were analysed using IBM SPSS v 20. Main outcome measures: Drug Burden Index (DBI) ; clinical and functional factors (hospitalizations, falls and emergency department visits during last year, mobility and strength, frailty score, number of used medications and self-reported health). Results: 84 respondents were included in the study (67.9% female ; median age 73 (interquartile range 68–80)). Polypharmacy (5 + medications) was identified in 67.8% patients and 51.2% used 1 + medication from DBI list. Women were prescribed DBI medications more often (59, 6% vs 33, 3% ; p = 0, 024) and had DBI index higher than men (0.62 ± 0.72 vs 0.24 ± 0.44) (p = 0, 004). The most commonly prescribed DBI drug classes were anxiolytics (58.6%), mostly benzodiazepines, followed by antidepressants and analgesics. The most prevalent were sedative DBI medications ; diazepam 22.6%, alprazolam 13.1%, tramadol 8.3%, zolpidem 6.0%, respectively, while the only anticholinergic medication was trospium, prescribed to 3.6% of patients. A positive correlation was observed between DBI index and the number of prescribed medications and frailty score (ρ = 0.51, p < 0.001 ; ρ = 0.26, p = 0.019, respectively), while correlation found between DBI index and self-reported health was negative (ρ = −0.32, p = 0.003). Conclusion: Higher DBI was found in women and participants with polypharmacy. Patients with higher DBI scored higher on frailty test, and reported their health status as worse. These findings indicate additional attention is needed when providing care to these patients and warrants considering the need for potential deprescribing. Grant support: the EUROAGEISM H2020-MCSF-ITN- 764632 project, INOMED project (CZ.02.1.01/0.0/0.0/18_069/0010046), PROGRESS Q42, Faculty of Pharmacy, Charles University (KSKF-2 Assoc. Prof. Fialova) and SVV 260, 417.

Background Community pharmacists can play an important role in optimizing warfarin treatment, which is very important in vulnerable patient groups such as the elderly patients in rural areas. Objective To evaluate the impact of a community pharmacist’s interventions on the quality of anticoagulation in elderly rural patients receiving warfarin. Setting A community pharmacy in Donji Miholjac in Croatia’s province of Slavonia. Method We conducted a prospective randomized trial. Eligible patients were recruited at the pharmacy and randomized into two groups. All participants were followed up monthly for a period of 6 months. Repeated education and a follow up plan were provided to the participants in the intervention group, and their general practitioners were contacted to correct the warfarin dose or to avoid drug interactions. Main outcome measure Time in therapeutic range (TTR) calculated by the Rosendaal method. Results A total of 140 patients were randomized and 131 patients finished the study, 65 patients in the intervention group. Median age was 73 years. At the end of the followup period, the median TTR was significantly higher in the intervention group (93 vs. 31.2% for intervention and control, respectively ; P < 0.001). The proportion of patients with TTR ≥ 65% was also significantly higher in the intervention group (86.2 vs. 7.6% for intervention and control, respectively ; P < 0.001). Factors independently associated with TTR ≥ 65% were intervention (P < 0.001), less frequent dose change (P = 0.005), better adherence (P < 0.001) and less variable vitamin K intake (P = 0.010).

The aim of the present study was to explore impact of endurance exercise on urinary level of minerals and trace elements as well as on some oxidative stress and biochemical parameters. Urine samples were collected from participants (n = 21) of mountain ultra-marathon race (53 km ; Medvednica, Zagreb, Croatia), before (baseline value), immediately after, 12 h and 24 h after the race. In urine samples level of minerals (Ca, P, K and Na) and trace elements (Se, Zn, Mn, Cu, Fe and Co) were assessed using the bench top Total reflection X-ray Fluorescence (TXRF) spectrometer. Oxidative stress was determined as level of malondialdehyde (MDA). Immediately after the race level of minerals, trace elements, MDA, creatinine, ketones, erythrocytes and specific gravity increased compared to their baseline value. In 24 h follow-up trace elements involved in antioxidant defence, MDA and biochemical parameters returned to their baseline values, Cu and Co remained increased as after the race, Fe and K tended to return to baseline values while Ca, P and Na continued to increase. Mountain ultra-marathon resulted in alteration of physiologically important minerals and trace elements that for some minerals and trace elements persist, indicating their involvement in recovery processes. However, due to their loss in urine, level of minerals and trace elements in athletes participating in endurance exercise should be monitored.

The global workforce needs to be competent, flexible, adaptable, sustainable, and patient-focused. A competency approach towards education, development, and professional practice strengthens services and increases better health outcomes. This paper will provide a global perspective on competency approaches from different health care professions. It will focus on two case reports, describing the use of competency methodologies at an undergraduate and postgraduate level, as well as supporting the internship and/or pre-registration training. Challenges and opportunities will be highlighted by addressing some of the key questions posed for this special edition.

Abstract. This work aimed to evaluate and compare the benefits of the energy restricted Mediterranean diet (MD) and Standard hypolipemic diet (SHD) accompanied by exercise on metabolic syndrome parameters. A 12-month, randomized, single-blinded, diet-controlled study was conducted on 124 obese participants in the University Hospital Dubrava. Participants were assigned to the MD (n = 63) or the SHD (n = 61) and received the same amount of nutritional education and guidance on physical activity. The completion rate was 67.7 %. Both diets produced significant beneficial changes in body weight and waist circumference (P

Background Competency frameworks that prompt personal and professional development have become an important component of lifelong learning; they are driven by healthcare professionals’ need for development and professional recognition. This study aimed to evaluate the self-assessed competencies of community pharmacist-preceptors by using Croatian Competency Framework (CCF) and to identify competencies to be improved. The secondary aim was to explore the association between community pharmacists’ characteristics (i.e. age, education etc.) and self-assessed competency performance. Methods The study subjects were community pharmacist-preceptors who provide support to and mentor student trainees enrolled in pre-registration training for pharmacy students. At the beginning of their mentorship, the pharmacist-preceptors assessed their competencies on a four-point Likert scale by using the Croatian Competency Framework (CCF), a validated tool for assessment and self-assessment of community and hospital pharmacists. Data were collected via e-mail in the period from October 2015 to April 2016. Results Of the 260 community pharmacists approached, final analysis included 223 respondents. The response rate was 85.8%. Community pharmacist-preceptors assessed themselves as the most competent in competencies pertaining to the cluster “Organization and management competencies” (M = 3.64, SD = 0.34), while they considered themselves as the least competent in the competencies pertaining to the cluster “Pharmaceutical public health competencies” (M = 2.75, SD = 0.77). Younger pharmacists with a postgraduate qualification who worked for large pharmacy chains in the capital city area and who had been in their current posts for a shorter period perceived themselves to be more competent. Conclusion This research represents the first analysis of the CCF in practice and identifies community pharmacist-preceptor competencies that require improvement. Consequently, areas for additional professional education were defined. Implementing modalities to measure and support development of preceptors’ competences is essential for improvement of student training programmes.

The aim of this study was to measure the prevalence of potentially inappropriate medications (PIMs) by using the EU(7)-PIM list, STOPP (Screening Tool of Older Persons’ potentially inappropriate Prescriptions) version 2 criteria and the new comprehensive protocol. This prospective study involved a sample of 276 consecutive elderly patients discharged from the university teaching hospital. Age, gender, diagnoses, medication history and medicines at discharge were recorded. The main outcome measure was the prevalence of PIMs according to each set of criteria: EU(7)-PIM list, STOPP version 2 criteria and comprehensive protocol. The median patient age (range) was 74 (65–92) years. The median number of prescribed medications was 7 (1–17). STOPP identified 393 PIMs affecting 190 patients (69%), EU(7)-PIM list identified 330 PIMs in 184 patients (66.7%) whilst the comprehensive protocol identified 134 PIMs in 102 patients (37%). STOPP version 2 criteria identified significantly more PIMs per patient than the other two protocols (p

The aim of the study was to adjust and validate the Global Competency Framework (GbCF) to be relevant for Croatian community and hospital pharmacists. A descriptive study was conducted in three consecutive steps: translation, consensus development and validation by an expert panel and public consultation. Panel members were representatives from community pharmacies, hospital pharmacies, regulatory and professional bodies, academia, and industry. The adapted framework consists of 96 behavioural statements organised in four clusters: ‘Pharmaceutical Public Health’, ‘Pharmaceutical Care’, ‘Organisation and Management’, and ‘Personal and Professional’ competencies. When mapped against the 100 statements listed in the GbCF, 27 matched, 39 were revised, 30 were newly introduced and 24 were excluded from the original framework. The adaptation and validation proved that GbCF can be adaptable to local needs, thus the Croatian Competency Framework emerged from it. Key amendments were conducted within ‘Organisation and Management’ and ‘Pharmaceutical care’ clusters demonstrating that these issues can be country-specific.

The aim of this work was to evaluate the combined effect of physical activity and 1 and 12 months’ adherence to Mediterranean diet (MD) on serum total antioxidant capacity (TAC) in obese patients, as well as factors contributing to TAC. One hundred twenty-four patients were randomly assigned to either MD combined with physical activity or standard hypolypemic diet (SHD) with physical activity. Both groups received counseling and education during the initial week and were invited for the follow-up visits, where data on body weight and blood samples were collected. TAC was determined by Trolox equivalent antioxidant capacity and urate was determined using a uricase spectrophotometric method at the initial visit and after 1 and 12 months. Eighty-four patients finished the 12- month program and were analyzed. The baseline and 1- and 12- month mean ( §SD) TAC values in the MD group (n D 40) were 2.38 § 0.48, 2.51 § 0.47, and 2.47 § 0.45 mmol Trolox equivalent (TE)/L, respectively. In the SHD group (n D 44), TAC values were 2.37 § 0.49, 2.48 § 0.49, and 2.31 § 0.51 mmol TE/L, respectively. There was a statistically significant main effect for time (p < 0.001), as well as statistically significant time–diet interaction effect (p D 0.009). There was no statistically significant correlation between TAC and uric acid after 1 month (p D 0.733) or 12 months (p D 0.844) of the intervention. Based on the regression model, which included gender, diet, physical activity level, and percentage body weight change, the type of diet was the only significantly contributing factor to TAC change after the 12-month period, F D 3.867, df D 3, p D 0.012, R D 0.358, R2 D 0.128. This randomized controlled trial with diet and physical activity intervention and TAC as a primary outcome demonstrated initial antioxidant improvement in both MD and SHD groups and a long- term beneficial effect of MD. The results imply that diet composition—olive oil, nuts, and fish in particular—combined with physical activity modify antioxidant capacity.

Metabolički sindrom (MetS) podrazumijeva skup metaboličkih poremećaja koji povećavaju rizik od šećerne bolesti tipa 2, srčanožilnih bolesti, moždanog udara, masne jetre, određenih malignih i nekih drugih bolesti. U ovome preglednom radu raspravljeni su koncept, definicija i terapija MetS pri čemu su uzete u obzir trenutačne smjernice i dostupni dokazi u liječenju stanja povezanih s MetS. U liječenju MetS ključno je rano prepoznavanje osoba s MetS i poduzimanje mjera koje će smanjiti prisutnost rizičnih čimbenika. Najvažnija terapijska intervencija je promjena životnih navika (zdrava prehrana i povećanje tjelesne aktivnosti), dok je terapiju lijekovima (primjerice antihipertenzivima, antidijabeticima, hipolipemicima) potrebno uvesti tek ako nefarmakološkim mjerama nisu postignute ciljne vrijednosti individualnih komponenata MetS., Metabolic syndrome (MetS) is a cluster of metabolic abnormalities that confer an increased risk for type 2 diabetes mellitus, cardiovascular diseases, stroke, fatty liver, certain cancers, etc. This article reviews the concept, definition and treatment of MetS taking into consideration current guidelines and available evidence for treatment of conditions associated with MetS. Management of MetS focuses on recognizing patients with MetS and introducing measures to decrease their risk factors. Primary recommendations are lifestyle changes (healthy diet and physical activity), while pharmacologic treatment (e.g. antihypertensive, antidiabetic, antihyperlipidemic) is indicated only if lifestyle changes were not effective and did not result in the achivement of recommended goals.

Pretilost je kronični poremećaj visoke učestalosti te složene etiologije, koji uključuje ozbiljne zdravstvene posljedice kao što su šećerna bolest, povišen krvni tlak te bolesti srca i krvožilnog sustava. Pretilost je danas globalni javnozdravstveni problem, a u Hrvatskoj je njena učestalost dosegla 20.34% (2), što našu zemlju smješta na peto mjesto po učestalosti pretilosti u Europi (3). Promjene životnih navika, koje uključuju dijetu i fizičku aktivnost, smatraju se najjačim oružjem u borbi protiv pretilosti te su i dalje glavne preporuke suvremenih smjernica za mršavljenje (4 ; 5). Danas na tržištu postoji velik broj dijeta, a mali broj dokaza o njihovoj dugoročnoj učinkovitosti i sigurnosti za pacijenta. Tijekom predavanja bit će prikazan rad kliničkog farmaceuta uključenog u multidisciplinarni tim za liječenje pretilosti na Odjelu za endokrinologiju, dijabetes i bolesti metabolizma Kliničke bolnice Dubrava u Zagrebu. U program su bili uključeni pacijenti s indeksom tjelesne mase većim od 30kg/m2. Uključeni pacijenti u sklopu dnevne bolnice prolaze petodnevni program čiji je cilj edukacija o pravilnoj prehrani i mijenjanju životnih navika te ih se prati tijekom perioda od godinu dana.

Recent meta analysis shows that adherence to a mediterranean diet can significantly decrease the risk of overall mortality, mortality from cardiovascular diseases, as well as incidence of moratlity from cancer and incidence of Parkinson s and Alzheimers diseases. All of these diseases could be linked to axidative stress as antioxidative effect of MD is getting more attention nowaday. Although a lot of research has been done in this area and it suggests antioxidative protective role of MD, the presented evidence is still inconclusive. The aim of this paper is to review studies investigating the effect of MD on OS , as well as to identify the areas for further research

Objectives. To measure Croatian community pharmacists’ progress in competency development using the General Level Framework (GLF) as an educational tool in a longitudinal study. Methods. Patient care competencies of 100 community pharmacists were evaluated twice, in 2009 and in 2010 in a prospective cohort study. During this 12-month period, tailored educational programs based on the GLF were organized and conducted, new services and standard operating procedures were implemented, and documentation of contributions to patient care in the pharmacist’s portfolio became mandatory. Results. Pharmacists’ development of all GLF patient care competencies was significant with the greatest improvements seen in the following competencies: patient consultation, monitoring drug therapy, medicine information and patient education, and evaluation of outcomes. Conclusions. This study, which retested the effectiveness of an evidence-based competency framework, confirmed that GLF is a valid educational tool for pharmacist development.

Objectives. To assess Croatian community pharmacists’ patient care competencies using the General Level Framework (GLF). Methods. The competencies of 100 community pharmacists working in 38 community pharmacies were evaluated using an adapted version of the GLF. Results. Pharmacists demonstrated the best performance in the competency areas drug specific issues and provision of drug products ; the poorest performance was in the competency areas evaluation of outcomes and monitoring drug therapy. Pharmacists’ behavior varied the most in the following areas: ensuring that the prescription is legal, prioritization of medication management problems, and identification of drug-drug interactions. Conclusions. Competencies were identified that need to be developed to improve pharmacist interventions in community settings. This study provides the first data on pharmacists’ performance in Croatia and serves as a starting point for future studies and actions.

Uvod Pretilost je danas jedan od vodećih javnozdravstvenih problema hrvatskog društva koji zahtijeva multidisciplinarni pristup u prevenciji i liječenju. Svrha rada Svrha rada je ispitati stavove studenata sestrinstva o uzrocima, načinima prevencije i mogućnostima liječenja pretilosti te ulozi ljekarnika i ostalih zdravstvenih radnika u suzbijanju epidemijskih razmjera ovog javnozdravstvenog problema. Ispitanici i metode Ispitanici su bili studenti sestrinstva Medicinskog fakulteta u Puli. Anonimnim upitnikom analizirani su znanje i stavovi studenata o uzrocima i posljedicama pretilosti, načinima prevencije i mogućnostima liječenja. Dobiveni podaci obrađeni su metodama deskriptivne statistike i rezultati prikazani grafički. Rezultati Anketiran je 101 student, 80 ženskog i 21 muškog spola. Pretilost smatra javno zdravstvenim problemom 95% anketiranih, a da je pretilost bolest i smanjuje kvalitetu života njih 99%. Prosvjetni radnici i roditelji nisu dovoljno educirani na temu pretilosti misli 81%, te da im je potrebna dodatna edukacija u cilju prevencije čak 97% ispitanih. Također, 78% ispitanih studenata smatra da je dodatna edukacija neophodna i za zdravstvene radnike. 95% studenta odgovorilo je da je zdravstveni odgoj i obrazovanje neophodan u svim vrtićima i školama. Ljekarnike je kao ključne dionike u prevenciji i liječenju pretilosti naveo zanemariv broj studenata sestrinstva. Zaključak Studenti su dobro upoznati s javnozdravstvenim značajem pretilosti u društvu, imaju dostatno znanje o pretilosti, ali prehrambene i životne navike studenata nisu na zadovoljavajućoj razini. Odgoj i obrazovanje za zdravlje i podizanje zdravstvene pismenosti od vrtićke dobi na dalje preduvjet je uspješne prevencije bolesti i promocije zdravlja pri čemu zanemarivi broj studenata vidi ulogu ljekarnika u tom procesu, pa je potrebno uložiti dodatne napore u cilju povećanja povjerenja javnosti u kompetencije ljekarnika za prevenciju i liječenje pretilosti. Kompleksnost pretilosti zahtijeva multidisciplinarni pristup i u prevenciji i liječenju, a dostupnost i kompetencije ljekarnika predstavljaju značajan preduvjet koji ljekarnike čini važnim dionikom u sveobuhvatnim programima prevencije i liječenja pretilosti.