title: Ongoing initiatives in the Republic of Srpska to enhance prescribing efficiency: influence and future directions.
abstract: BACKGROUND
  Multiple reforms have been introduced in the Republic of Srpska to enhance prescribing efficiency.
  
  
  OBJECTIVE
  First, assess their influence on utilization and expenditure on proton-pump inhibitors, statins and renin-angiotensin inhibitor drugs. Second, assess whether the Republic can obtain low prices for generics. Third, suggest additional reforms that could be introduced.
  
  
  METHODS
  Observational study of all ambulatory care patients between 2003 and 2010. Defined daily doses (DDDs) and DDDs per 1000 inhabitants per day used for measuring changes in utilization. Reimbursed expenditure used as health insurance perspective.
  
  
  RESULTS
  Increasing utilization in all three classes. Utilization of angiotensin-receptor blockers principally limited by prescribing restrictions. Reimbursed expenditure/DDD in all three classes decreased by up to 82% in 2010 versus 2004, appreciably improving prescribing efficiency for the statins. Increased utilization of esomeprazole at higher reimbursed expenditure/DDD, and similarly angiotensin-converting enzyme-inhibitor combinations at higher expenditure versus single drugs, limited the ability to fully capitalise on these reductions.
  
  
  CONCLUSIONS
  Multiple measures helped lower expenditure/ DDD, providing hope to countries with small populations. Additional measures are planned to further improve prescribing efficiency in the Republic of Srpska.
authors.affiliation: Faculty of Medicine, University of Banja Luka, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
authors.forename: Vanda
authors.initials: V
authors.lastname: Markovic-Pekovic
authors.forename: Ranko
authors.initials: R
authors.lastname: Skrbić
authors.forename: Brian
authors.initials: B
authors.lastname: Godman
authors.forename: Lars L
authors.initials: LL
authors.lastname: Gustafsson
mesh_terms: D000553:Ambulatory Care / Q000191:economics / Q000592:standards* / Q000639:trends; D057911:Angiotensin Receptor Antagonists / Q000191:economics / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D017522:Bosnia and Herzegovina; D016568:Drugs, Generic / Q000191:economics / Q000627:therapeutic use*; D018166:Health Care Reform / Q000379:methods*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use; D007349:Insurance, Health, Reimbursement / Q000191:economics; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data / Q000639:trends; D054328:Proton Pump Inhibitors / Q000191:economics / Q000627:therapeutic use
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D054328:Proton Pump Inhibitors