Pharmacists’ attitudes and preparedness prior to introducing the system of electronic prescriptions in Bulgaria

The common border between Bulgaria and North Macedonia, alongside the regulatory requirements stemming from Bulgaria’s membership in the European Union, provide grounds for comparing the legislative environment in both countries. This article presents a comparative case study of the regulatory frameworks governing community pharmacies in Bulgaria and North Macedonia. The aim of this study is to examine the specific features of current legislation related to the operation of community pharmacies, and to identify similarities, differences, and gaps in the organizational structure of pharmacy services, the population’s access to pharmaceutical care, and the qualification requirements for personnel working in community pharmacies. Bulgaria has been a member of the European Union since 2007, while the Republic of North Macedonia has had official EU candidate status since 2005. This provides a basis for comparing the regulatory frameworks of an EU and a non-EU system within the same regional context. In both countries, the overall pharmacy-to-population ratio exceeds the European average (3.3 pharmacies per 10,000 inhabitants), indicating sufficient availability. However, pharmacies are predominantly concentrated in major urban areas. In Bulgaria, challenges remain in ensuring access to pharmaceutical services in smaller and rural settlements, while in North Macedonia, the provision of such services is better ensured. The findings of this case study may be particularly relevant for countries undergoing health system reforms or EU harmonization processes.

Background and Aim : Telepharmacy has emerged as a transformative model for delivering pharmaceutical services remotely through digital and telecommunication technologies. In Bulgaria, persistent regional disparities in pharmacy distribution, a growing elderly population, and advancing digital infrastructure create both the need and the conditions for telepharmacy implementation. This narrative review aims to analyze the conceptual framework, technological prerequisites, regulatory landscape, and practical opportunities for telepharmacy within the Bulgarian healthcare system. Methods : A structured literature search was conducted between December 2025 and March 2026 across PubMed, Scopus, and Google Scholar, supplemented by national regulatory documents and reports from international organizations. A total of 362 records were identified, of which 67 met the inclusion criteria. A thematic synthesis approach was applied to organize findings into major categories: conceptual frameworks, technological infrastructure, regulatory aspects, and practical applications. Results : Telepharmacy encompasses four core components—remote pharmacist-patient communication, electronic prescribing and digital health records, therapy monitoring systems, and digital health promotion—applicable across community, hospital, and consultative domains. Bulgaria demonstrates favorable prerequisites for implementation, including 83% digital connectivity and an operational National Health Information System since 2020. However, significant barriers persist: telepharmacy lacks an explicit definition in national legislation, remote dispensing of prescription medicines is prohibited, and regional disparities in pharmacy coverage remain pronounced. Conclusion : Telepharmacy represents a viable and promising strategy for improving equitable access to pharmaceutical care in Bulgaria, particularly in rural and underserved areas. Its full integration into the healthcare system requires the development of a clear regulatory framework, sustained investment in digital infrastructure, and coordinated collaboration among public authorities, academic institutions, and the pharmaceutical profession.

Introduction: The community pharmacy is the most accessible medical facility in the current healthcare system. Therefore, the expectations from pharmacists as the most accessible healthcare professionals are constantly rising. However, various studies indicate that pharmacists are subject to very high levels of occupational stress and professional burnout is common. The COVID-19 pandemic has posed new challenges to the work organisation in pharmacies and demand for an adequate reorganisation. In addition, it forced pharmacists to quickly adapt to the new circumstances and requirements and further increased occupational stress. Objective: To establish the level of occupational burnout among community pharmacists during COVID-19. Materials and Methods: An anonymous questionnaire survey was conducted among 127 pharmacists working in community pharmacies in Varna, Bulgaria. The study period was from March 2021 to October 2021. The questionnaire consisted of two parts; the first one was based on the specialised Maslach Burnout Inventory (MBI-HSS) tool, assessing professional burnout in terms of emotional exhaustion, depersonalisation, and personal accomplishment; the second one collected data about the demographic characteristics of the respondents, including their job position, pharmacy type (an independent pharmacy or a pharmacy chain) and information on specific problems during COVID-19. Results: The identified mean values in the group of respondents were as follows: emotional exhaustion M=23.39 (SD 9,298), depersonalisation M=12.37 (SD 6,426), professional achievements M=31.25 (SD 7,531). The sample mean values that stood out were in the depersonalisation scale М=12.37, which is considered a high value. A statistically significant difference was found in the different age groups on the depersonalisation scale (F=3,957, p=0,022). There was a statistically significant difference between the arithmetic mean values for the age groups 25-40 years (M=13.75) and over 55 years (M=9.86). Conclusion: Based on the statistical differences for depersonalisation among pharmacists in different age groups, it can be concluded that young pharmacists do not express empathy while providing pharmaceutical care services.

Obstructive sleep apnea (OSA) as the most common sleep disorder, is associated with increased morbidity and mortality from cardiovascular diseases and traffic injuries. Sleep disorders, particularly those resulting from sleep apnea, despite their significant health and financial burden, are poorly recognized, often underdiagnosed, and ineffectively managed. Screening, diagnosing, and adequately treating OSA requires multidisciplinary teamwork and an individualized approach to patients with sleep disorders. Pharmacists, as some of the most accessible health professionals integrated into interdisciplinary teams, can provide complementary clinical (pharmacy) services for screening, health education, monitoring, and management of sleep disorders and OSA.