Soloninina Anna Vladimirovna
Vice-Rector, Head of the Department of UEF FDPO and FZO, prof. Perm SFA, Doctor of Pharmacy
Medical and pharmaceutical workers are faced with the following questions:
Physician in the 21st century does not have time to follow the constantly updated range of drugs, data on pharmacotherapy, showing forced conservatism in prescribing drugs, uses an average of 20-30 drugs in daily practice, does not always write prescriptions.
The patient in the 21st century- Competent and exacting consumer. He is cautious about taking drugs. A healthy lifestyle, the rejection of bad habits are in fashion. Less turns to doctors, more often to a pharmacist, and more often resorts to self-medication.
Pharmacist (pharmacist) in the XXI century.- Consultant doctor and patient. His recommendations influence the choice of drugs. He assists in the choice of drugs for self-treatment, takes part in maintaining the health of the population and the rational use of drugs. He must be a diagnostician, and a psychologist, and a marketer, and a nutritionist, and a businessman, and a lawyer.
Why today the patient, bypassing the doctor, turns to the pharmacy for help?
Because it's more accessible. In addition, pharmacists know more about medicines, can identify problems related to medicines, make recommendations for solving problems, refer to a doctor when necessary, improve the knowledge of doctors and patients about medicines, advise them, monitor the use of medicines, therapeutic results and take responsible solutions.
The pharmacy is the most appropriate place to promote healthy lifestyles and inform about risk factors.
Guidance on the rules of Good Pharmacy Practice (GPR):
The goal of developing and implementing EAP guidelines is to change the place and role of the pharmacist in the health system, especially in relation to health promotion and disease prevention, safe, effective and economical self-medication, and identifying and solving problems related to the use of drugs.
On the role of the pharmacist in modern world- WHO meetings with the IFF and other events with the participation of WHO:
The role of the pharmacist:
A pharmaceutical worker is not a trader, but a carrier of specialized knowledge, an adviser to a doctor and a patient in matters of choosing drugs, key person in providing drugs.
The purpose of a pharmaceutical worker is to promote health, prevent diseases, and provide pharmaceutical assistance.
Changing the role of the pharmaceutical worker (the experience of some foreign countries):
Some duties of a doctor are transferred to a pharmacist (pharmacist):
Special services provided by pharmacies in EU countries:
As a result, starting in 1988, new goals were set for pharmacists. Pharmacy is recognized as a full-fledged medical profession in Europe. The importance of the role of the pharmacist (pharmacist) in the health care system has increased. The WHO Resolution on the role of the pharmacist was adopted. A course has been set for joint efforts with the IFF and other organizations for the development of NAP and pharmaceutical assistance.
Pharmaceutical care is:
The fundamental idea of the WHO pharmaceutical care concept is not only to provide drugs, TMN, medical services, but also to help people and society as a whole with the greatest efficiency through the implementation of activities aimed at:
Central to the concept is the acceptance by pharmacists of a share of responsibility for the outcome of treatment, along with other healthcare workers and patients.
The concept is particularly relevant to special population groups such as the elderly, pregnant women, children, the chronically ill, and society as a whole, as it helps to contain health care costs.
The rational use of medicines in pharmaceutical care is based on three elements:
Despite the fact that the basic concepts of pharmaceutical care and EAP are basically identical, it can be said that EAP is one of the ways to implement pharmaceutical care.
According to the materials of the round table "Pharmacy section" within the framework of "PharmMedAppeal-2008"
A pharmacist today is not just a seller, he is a bearer of knowledge. When prescribing a drug, the doctor should proceed from the ideas not only about the disease, but also about the pharmacokinetics, biochemistry, transformation, synergism, and antagonism of the drug. This is quite difficult for him to navigate. Therefore, in many developed countries, the primary responsibility for drug safety lies with the clinical pharmacist. It is he who is the link between the doctor and the patient, performs (in a sense) the function of a defender, giving objective reliable information about the drug, thus ensuring the patient's safety and rational pharmacotherapy.
According to analytical agencies, Russian retail is one of the fastest growing markets in Europe. Over the past four years, the annual growth of the market amounted to more than 9%, in 2004 - 10%.
All these economic indicators affect both the work of the pharmacy and the requirements for its employees. Any successful employee knows that effective work requires not only industry knowledge, but the skill of a psychologist and personal communication skills. One of the features of the work of a pharmacist is to overcome various psychological barriers that arise when communicating with pharmacy visitors. Often such qualities as the skill of communicating with a visitor, protection from customer aggression and stress are considered the main ones. After all, any big city is a source of stress, and we know that not every visitor is a buyer, and not every buyer is a patient. Many go to the pharmacy not for medicine, because. people now do not have enough spiritual comfort, they are oppressed by a sense of uncertainty, anxiety for tomorrow - and they go to communicate. People are also attracted by additional services - pressure measurement, doctor's consultations on the trading floor. Unfortunately, many patients come to conflict.
According to the results of Western research, friendly staff service and convenient location of goods are significant for 55% of visitors. Sometimes a large assortment provokes a choice problem, which creates new stress for the visitor. Technological progress has brought up a generation that is fluent in modern technologies, but, unfortunately, we are getting socially incompetent people. There is a problem of communication of young personnel. The issue that is acute in the work of a modern pharmacy is the dispensing of prescription drugs without a prescription. Often a patient comes at best with an oral prescription from a doctor, with an extract from the medical history and assurances that the drugs have already been taken. And in the pharmacy they release these drugs to him. The doctor is also to blame, who believes that it is enough to write the name of the drug on a piece of paper to the patient, and the pharmacist who dispenses the drug without a prescription and understands that his firm professional position will not prevent the patient from going to a nearby pharmacy and buying everything he needs. The patient is also to blame, who does not want to listen to anything and understand what irresponsible self-medication threatens him with.
There should always be a dialogue between doctor, patient and pharmacy. And we must, first of all, talk about the quality and safety of the treatment process, because. All work is aimed at the interest of the patient. The duty of the state is to carry out information and educational activities of the population. A prescription is an appeal from a doctor to a pharmacist; it is written in Latin. Of course, there is the concept of the human factor, everyone can make a mistake - both a doctor and a pharmacist. In the US, a special commission has been set up to collect data from pharmacies about incorrectly written prescriptions - they are systematized, and then a brochure is published annually so that doctors and pharmacists can familiarize themselves and take this factor into account in their work. The pharmacy also has such orders, but now they are often forgotten.
The pharmacy worker plays a significant role in antibiotic therapy - the pharmacist needs to prevent inadequate self-treatment, limit the uncontrolled use of antibiotics, because the responsibility is ultimately transferred to pharmacy workers. In addition to the information work carried out among doctors and pharmacy workers, it is necessary to cultivate a culture of prescribing, to achieve economic growth, but not in this way. This is the hallmark of high professionalism, pharmacy traditions and a sincere attitude towards their patients.
CHAPTER 9 THE ROLE OF THE PHARMACEUTICAL WORKER IN THE HEALTH CARE SYSTEM
The active interest of the world community in the role of the pharmacist in the health care system manifested itself in the second half of the 1980s. It was during this period that the narrowing of the traditional sphere of activity of pharmacists in many countries became especially noticeable - the manufacture of drugs according to extemporaneous recipes. In fact, by that time, the production of drugs had almost completely begun to be carried out under conditions industrial production. The scope of drug sales has undergone significant changes: in some countries (Japan, the USA), the practice of dispensing drugs by doctors has firmly established itself; increased sales in the general distribution network (for example, in supermarkets); more popular was the sale of drugs by mail, in last years- through the Internet. The wholesale distribution of drugs is increasingly being carried out by businessmen who do not have a pharmaceutical education. Using the imperfection of the legislation, in many countries numerous intermediaries without a pharmaceutical education have appeared between manufacturers and retail pharmacies.
At the same time, other areas of activity in the pharmaceutical sector became more complicated, such as the development and production of drugs, their quality control, supply, distribution, selection and rational use of drugs, state regulation of the pharmaceutical market, etc. There was a problem of counterfeit drugs, which required a certain reorientation of the quality control system. In those areas of activity where specialists with medical, chemical, economic education traditionally dominated, there was a need for workers with a pharmaceutical education. Thus, a situation arose when, on the one hand, the knowledge of pharmacists remained unclaimed, and on the other hand, pharmacists were not sufficiently involved in new areas of activity. Underestimating the importance of the work of pharmacists inevitably leads to underutilization
their potential capabilities and professional knowledge, and also forces these specialists to pursue only economic interests (sell more, sell the most expensive medicines, etc.).
It should be noted that by the mid-1980s, the need to revise the personnel structure was ripe in all areas of healthcare. In 1985, the WHO Expert Committee for Health for All by the Year 2000 called for a redefinition of the roles and functions of all categories of health workers.
Since the late 1980s, a number of meetings have been held with the support of WHO, as a result of which a new role for the pharmaceutical worker in the health system has been defined.
In 1988, in Madrid (Spain), the European Regional Meeting "The Role of the Pharmacist in Retail and Hospital Pharmacy" was held, the participants of which came to the following conclusions:
Physicians and pharmacists must work together; necessary general approaches to the choice of drugs; a pharmacist is a doctor's consultant, he takes part in the choice of drugs and gives recommendations on their rational use;
Pharmacists play a leading role in providing information and advice to the patient regarding the use of drugs; pharmacists should inform patients about the possible side effects of drugs;
Pharmacists should contribute to the promotion of a healthy lifestyle.
Also in 1988, in New Delhi (India), a meeting of the International Pharmaceutical Federation (IPF) "The content of pharmacy and the functions of pharmacists" was held. Participants reaffirmed the conclusions of the Madrid meeting regarding the role of the pharmacist in retail and hospital pharmacy and made recommendations regarding the scope of activities of pharmacists beyond pharmacy network. In their opinion:
The department of the Ministry of Health responsible for the pharmaceutical service should have the same importance as other departments;
Pharmacists with experience should be involved in the development of drug legislation;
Procurement, storage and distribution of medicines should be managed by pharmacists, not doctors. Pharmacists passing
relevant training should be headed by national control and analytical laboratories, they can be involved in the work on registration and post-registration quality control of drugs, to participate in clinical trials, etc.
Pharmacists should be members of the “team of health workers”, together with other specialists, participate in scientific research, training of medical personnel, dissemination of information, and the work of international organizations.
At the meeting of the IFF "Quality Pharmaceutical Services - Benefits for the State and Society" (Tokyo, 1993), the concept of pharmaceutical care was formulated, according to which the main thing in the work of a pharmacist should be the interests of the patient. The participants of the meeting proposed to provide pharmaceutical care both for each patient and for the entire population. This implies:
Providing patients with reliable and objective information about drugs;
Participation of pharmacists in the development of draft laws and regulations regarding the provision of drugs to the population;
Development guidelines and criteria for compiling forms;
Development of drug distribution systems.
The 47th World Health Assembly (WHA) in May 1994 adopted a resolution "The Role of the Pharmacist in Supporting the Revised WHO Medicines Strategy" (WHA 47.12), which contains the important conclusion that "the pharmacist can play a key role in the public health system." The WHA Resolution substantiates the need for the participation of pharmacists in the development of relevant regulations and rules governing work in the pharmaceutical field. Member countries were asked to define the role of pharmacists in the implementation of the National Drug Policy as part of the Health for All strategy; make full use of the knowledge of pharmacists at all levels of the health system, especially in the development of the National Drug Policy.
During the 3rd Annual Meeting of the European Forum of Pharmaceutical Associations and WHO, held in May 1994 in Copenhagen (Denmark), with the aim of improving the efficiency of health systems, the following principles were adopted:
Medicines cannot be considered solely as a commodity;
The supply of medicines to the population should be carried out only through pharmacies;
At all stages of drug distribution, it is necessary to exercise control by professionals;
The duty of the pharmacist is to be guided by strict ethical rules and standards of professional conduct and to exercise personal control over the distribution of medicines among the population;
The pharmacist must be free from economic influence on the conduct of his activities by non-pharmacists;
Special pharmaceutical education gives the pharmacist the exclusive right to:
Personally responsible for the sale of pharmaceutical products on the market;
The ability to guarantee, in the interests of maintaining the health and safety of the population, adequate control over the quality, storage, safety and supply of medicines to the population;
Manage a pharmacy.
These principles and modern views on the special responsibility of pharmacists for ensuring the quality of pharmaceutical products are reflected in the WHO Good Pharmacy Practices (GPP).
An important outcome of the third WHO consultative meeting “The role of pharmacists in the health system. Preparing Future Pharmacists: Curriculum Development (Vancouver, 1997) is the compilation of modern requirements for a pharmacist, called the “7-Star Pharmacist”:
1) healthcare worker, team member;
2) is able to make responsible decisions;
3) a communication specialist - an intermediary between a doctor and a patient;
4) ready for leadership in the interests of society;
5) a leader capable of managing resources and information;
6) ready to learn all his life;
7) a mentor involved in the training of young pharmacists. These requirements are aimed at improving personal qualities, which, along with the acquired professional
These skills will allow the specialist to take a worthy place among the workers of the public health system.
The key issue of the fourth WHO consultative meeting "The role of the pharmacist in self-treatment of the patient" (The Hague, 1998) was the provision by pharmacists of assistance to people who expressed a desire to self-medicate. It was noted that in many countries there has been a trend towards an increase in the number of patients who prefer self-medication. The duty of the pharmacist, according to the recommendations of this meeting, is to establish a trusting relationship with the patient and recommend high-quality drugs to him, as well as to interact with other healthcare professionals, government and public organizations, representatives of the pharmaceutical industry, etc.
The meeting participants considered the issue of self-medication as part of Good Pharmacy Practice (GPP).
The first guidelines for DAP were developed in 1992 by the International Pharmaceutical Federation under the title Good Pharmacy Practice in Community and Hospital Pharmacies. At the IFF Congress in Tokyo (1993), the text of the WCT / FFF was approved as part of the Tokyo Declaration on Pharmacy Quality Standards, which states: “Standards are an important component in assessing the quality of customer service. In adopting the Guidelines for Good Pharmacy Practice at the meeting of the Federation Council in Tokyo on September 5, 1993, the International Pharmaceutical Federation expresses its confidence that the standards based on this guideline will be used by national pharmaceutical organizations, governments and international pharmaceutical organizations in setting national standards for Good Pharmacy Practice . The Good Pharmacy Practice Guide covers and builds on the services provided by pharmacists. The guidelines recommend setting national standards for: promoting healthy lifestyles, supplying medicines and medical devices, self-management of patients, and improving prescribing and use of medicines through the activities of pharmacists. The IFF encourages pharmaceutical organizations and governments to work together to introduce or revise relevant standards in countries where national standards are already in place, in the light of the recommendations of the Goodwill
pharmacy practice. The IFF DAP document was submitted to the WHO Expert Committee and became the basis for the implementation of some of the principles embodied in resolution WHA 47.12. After the revision, the document was presented to WHO in 1996 - "Good pharmacy practice in community and hospital pharmacies."
Pharmaceutical group European Union in 1998 she developed a WCT document for Europe with a special focus on EU countries - Good Pharmacy Practice in Europe.
In 2001, WHO developed a guideline Good Pharmacy Practices in the Newly Independent States. Guidelines for the development and implementation of standards. The recommendations in the guidance are intended to assist regulators and pharmacy managers in their efforts to implement WCT standards at both the national and pharmacy levels.
The WHO/WAP Guidelines for Good Pharmacy Practice in Community and Hospital Pharmacies can be seen as a set of professional challenges for national pharmaceutical associations and governments.
According to the Guide the main task Pharmacy practice is to provide medicines, other medical products and health care services, and to help people and society make the best use of them.
Good Pharmacy Practices (GPP) The WHO requires that:
The first task facing the pharmacist was the well-being of the patient, regardless of his location;
The main activity of the pharmacy was to provide patients with medicines and other medical products, relevant information, advice, as well as to record side effects from the use of drugs;
An integral part of the pharmacist's activity was the promotion of rational and economical prescription and correct use LS;
Each element of the pharmacy service was focused on an individual, was clearly defined and effectively communicated to each participant.
The WCT guidance covers participation in health promotion and the prevention of ill health in the population. If treatment is necessary, then there must be a process for the correct use of drugs by a person in order to
to achieve the maximum therapeutic effect and avoid the adverse effects of the drug. This implies that pharmacists, together with other health care workers, as well as with patients, take collective responsibility for the outcome of treatment.
The concept of DAP promotes more intensive cooperation between the doctor, the patient and the pharmacist, which will optimize the use of drugs and help in the evaluation of treatment outcomes. The pharmacist should contribute to improving the quality of the drug use process. It is emphasized that the pharmacy is an important source of information on the consumption and use of medicines.
To meet the requirements of the WAP, it is necessary that:
The basis of the ideology of practice was professional factors, although the importance of economic factors is also recognized;
The pharmacist contributed to drug use decisions;
The pharmacist had the necessary medical and pharmaceutical information about each patient; obtaining such information is simplified if the patient prefers to constantly use the services of one pharmacy or a prescription card for the patient is available;
The pharmacist had independent, comprehensive, objective current information about the therapy and drugs used;
Pharmacists in all areas of pharmaceutical practice have taken personal responsibility for maintaining and evaluating their competence throughout their professional life;
National DAP standards have been established to be followed by practicing pharmacists.
The concept of WDA is a means to recognize and fulfill the obligations incumbent on all practicing pharmacists.
In the process of developing the guidelines for WAD, the desire was realized to change the place and role of the pharmacist in the health care system through their implementation, in particular in terms of:
Improving the health of the population and preventing diseases;
Safe, effective and economical self-treatment;
Identification and solution of problems related to the use of drugs.
For the implementation of the DAP in the country, national standards for the following activities should be established and implemented in professional activities:
Activities related to promoting health, avoiding ill health and achieving a healthy lifestyle;
Activities related to the release and use of drugs;
Activities related to self-medication, including advice on medicines and, where appropriate, the provision of medicines and other forms for the treatment of symptoms of ailments that are successfully managed by self-medication;
Activities related to influencing the prescription and use of drugs.
In each of the main elements of the WCT, there are types of activities; methods and requirements necessary for the implementation of these types of activities; equipment and premises for the implementation of this activity; qualification of employees; methods for evaluating these activities for which standards can be developed; education and prevention of ill health; educational activities related to the prevention of ill health, disease prevention and health promotion.
According to the Constitution of the Russian Federation, every citizen has the right to health care, therefore ensuring the safe use of drugs is one of the state's priorities. However, aggressive drug advertising and uncontrolled distribution of over-the-counter drugs from pharmacies do not allow the state to fully implement the obligations of the state for the safe use of medicines.
In addition, the absolute safety of any drug, including those that are subject to over-the-counter dispensing, has not been proven. This obliges a pharmaceutical worker, when dispensing over-the-counter drugs, to be more careful in choosing a drug by a pharmacy visitor and to give qualified advice.
In addition, the psychological impact of a doctor and a pharmacist on a patient when communicating with him is known, which is confirmed by the “placebo” effect, as well as diseases such as iatrogenic (disturbance of the patient’s psyche as a result of the wrong behavior of the doctor and pharmacist). This confirms the thesis about the importance of information received by visitors in a pharmacy and the role of a pharmacist, whose influence increases many times when OTC drugs are dispensed.
The issue of the role of pharmacists (pharmacists) has been repeatedly raised at meetings and congresses that have been held by the World Health Organization (WHO) and the International Pharmaceutical Federation (FIP) since 1988 at the regional and international levels. At the same time, all over the world, specialists with higher education called "pharmacist", and with a secondary education - "assistant (assistant) of a pharmacist".
WHO documents on the role of pharmacists include the reports of five WHO meetings, the 1994 Assembly Resolution (WHA 47.12) and guidelines regarding Good Pharmaceutical Practice (GPP). To date, five WHO meetings have been held on this issue: - European Regional Meeting, Madrid, 1988 "The Role of the Pharmacist in Retail and Hospital Pharmacy". - First (Global) Meeting, New Delhi, 1988 "Content of Pharmacy and Functions of Pharmacists". - Second meeting, Tokyo, 1993 "Quality pharmaceutical services - benefits for the state and society." - Third meeting, Vancouver, 1997 "Training future pharmacists: curriculum development". - Fourth meeting, The Hague, 1998 "The role of the pharmacist in self-medication and self-medication".
At a meeting in Vancouver, modern requirements for a pharmaceutical worker were formulated, called "Pharmacist 7 Stars", which should be considered as a mandatory minimum for a pharmacist around the world:
As can be seen from the above requirements, the emphasis is not on any special knowledge, but on personality traits, which, together with the skills of constantly mastering new knowledge, will allow a specialist to take a worthy place in the system of protecting the health of citizens.
Katkova A.D., Kirshchina I.A., Soloninina A.V.
UDC 614.2:615.1:613.6.01
Katkova Anastasia Davidovna, postgraduate student
Kirshchina Irina Anatolyevna, Ph.D. pharmaceutical Sciences
Soloninina Anna Vladimirovna, Doctor of Pharmacy. sciences, prof.
Perm State Pharmaceutical Academy of the Ministry of Health and Social Development of Russia
The expediency of including aspects of pharmaceutical care in government programs in the healthcare sector to address key public health issues.
Keywords: pharmaceutical assistance, public health care
The usefulness of the integration of pharmaceutical care in public programs in the health sector to address key issues of public health is substantiated in this article.
keywords: pharmaceutical care, health protection
One of the main conceptual tasks of the social policy of the state is the protection of the health of citizens. Modern healthcare is a system consisting of many links, the well-coordinated work of which ensures the preservation of the country's labor reserves, and also largely determines the quality and standard of living of the population. An important component of effective public policy in the healthcare sector is the use and coordination of possible resources, ensuring the consolidation of efforts of all sectors directly or indirectly related to the protection of public health. One of the leading industries in this area is pharmacy, the importance of which is often not properly assessed in the development of systems for the implementation of social guarantees for citizens.
This problem has been repeatedly discussed during meetings and congresses of the World Health Organization (WHO) and the International Pharmaceutical Federation (FIP). Since 1988, the lack of application of pharmaceutical science knowledge, skills and resources has been regularly raised at the regional and international levels. The result of numerous meetings dedicated to the formation of a new direction of practical pharmacy was the development and implementation of a guide to Good Pharmacy Practice, the purpose of which is to change the place and role of the pharmacist in the health care system, especially in relation to: health promotion and disease prevention; safe, effective and economical self-treatment; identifying and solving problems related to the use of medicines. Thus, based on the proven role of a pharmaceutical worker in the healthcare system, it follows that pharmaceutical specialists should be actively involved in solving key issues of public health, and the consolidation of the efforts of practical medicine and pharmacy can be quite productive.
However, the existing regulatory and legal regulation in the field of healthcare in Russian Federation does not establish in key documents the proper role of pharmaceutical specialists in the implementation of measures aimed at preserving the health of the nation. So, the federal law Russian Federation of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation", defines a pharmaceutical worker solely as " individual who has a pharmaceutical education, works in a pharmaceutical organization and whose labor duties include wholesale trade in medicines, their storage, transportation and (or) retail trade in medicines for medical use, their manufacture, dispensing, storage and transportation”, i.e. . limits the functions of pharmaceutical workers only to the area of drug circulation and does not define the role of the pharmacist in the implementation of programs to improve public health indicators.
In addition, the Federal Law of the Russian Federation of April 12, 2010 N 61-FZ "On the Circulation of Medicines" defines pharmaceutical activity as "... an activity that includes the wholesale trade in medicines, their storage, transportation and (or) retail trade in medicinal products, their dispensing, storage, transportation, manufacture of medicinal products", and a pharmacy organization - as an organization engaged only in "... retail trade in medicinal products, storage, manufacture and distribution of medicinal products for medical use". Thus, these documents limit pharmaceutical activity to the area of drug circulation, and a pharmaceutical worker - as a specialist in the sale of this product, while in the Educational standard of higher professional education in the field of training (specialty) PHARMACY (Order of the Ministry of Education and Science of the Russian Federation of January 17, 2011 N 38) in the description of the professional activity of specialists, among other things, the following shall be indicated: "carrying out activities for qualified informing the population about over-the-counter medicines, biologically active food supplements, medical products"; “providing advice to specialists of medical organizations, pharmaceutical enterprises and organizations and the public on the use of medicines”; "carrying out sanitary and educational work"; "formation of patients' motivation to maintain health".
Based on the foregoing, it follows that a pharmaceutical specialist who has graduated from higher educational institution in the specialty "Pharmacy", must be ready to provide pharmaceutical assistance in accordance with the rules of Good Pharmacy Practice, but modern Russian legislation does not provide for the implementation of its functions in this direction.
Currently, one of the key areas of modern health care in the Russian Federation is to reduce the incidence rate, as well as increase the average life expectancy of patients with socially significant diseases, the list of which is formed on the basis of an analysis of the structure of morbidity and causes of death in the population of the Russian Federation and approved by Government Decree No. 1706-r dated December 11, 2006. In this regard, Government Decree No. 280 dated May 10, 2007 defines the Federal Target Program for the Prevention and Control of Socially Significant Diseases in the context of specific nosologies. The purpose of this Program is to reduce the incidence, disability and mortality of the population in socially significant diseases, increase the duration and improve the quality of life of patients. One of the objectives of the Program is to improve the methods of prevention, diagnosis, treatment and rehabilitation for socially significant diseases, while the proposed measures for the implementation of this task did not reflect the issues of pharmaceutical management and pharmaceutical care.
Foreign practice shows that the consolidation of the efforts of medical and pharmaceutical workers in the field of personalized care for patients with chronic diseases has a positive effect on the course of the disease. Thus, in the UK, patients with diabetes mellitus, which is included in the List of Socially Significant Diseases in Russia, are provided with additional assistance, including an analysis of drug therapy based on laboratory parameters, as well as individual patient counseling on many issues related to this disease. An analysis of the effectiveness of the prescribed measures showed that none of the patients receiving these services was hospitalized as a result of the onset and/or exacerbation of complications of diabetes, while 25% of patients in the control group were hospitalized for these reasons.
Thus, the proven role of a pharmaceutical worker and positive foreign experience make it possible to speak about the expediency of including aspects of pharmaceutical care in order to achieve the goals and objectives set by the Program to combat socially significant diseases. In this regard, we have considered the subprogram "Diabetes mellitus" from the standpoint of the effective participation of pharmaceutical specialists in helping patients with this nosology. The designated subprogram highlights such a direction as “Improving the provision of specialized care for diabetes mellitus”, for the implementation of which, of course, the uninterrupted rational supply of drugs and diagnostics to such patients within the framework of the implementation of state guarantees is essential, which is an important component of maintaining the quality of life of patients and prevention of complications of diabetes. The solution of these tasks is within the competence of pharmaceutical specialists, which is enshrined in the relevant regulatory legal acts.
So, according to the "Educational standard of higher professional education in the field of training (specialty) pharmacy", "organization of activities to provide medicines to citizens eligible for social assistance", as well as "organization and procurement of medicines and other pharmaceutical products to ensure state and municipal needs” is one of the characteristics of the activities of pharmaceutical specialists. Obviously, the development of a modern effective mechanism for managing and controlling purchases, managing the movement of medicines and diagnostics, optimizing drug supply and informing consumers should be carried out with the active involvement of pharmaceutical specialists and use the resources of not only medical, but also pharmaceutical science.
The fundamental task of organizing a system for the implementation of state guarantees is to compile a list of drugs for procurement in order to effectively provide patients with timely drug care, the solution of which, in our opinion, should be carried out with the active participation of pharmaceutical specialists. Thus, pharmacoeconomic criteria for choosing drugs can be calculated using existing methods developed by scientists from the Perm State Pharmaceutical Academy, who are actively working in this direction at the present time.
It is known that adequate public awareness of the potential dangers of the disease, early diagnosis and high-quality monitoring of health status can significantly reduce human losses, costs for the healthcare system and the socio-economic burden on society from socially significant diseases, in particular diabetes mellitus. This aspect in the "Diabetes mellitus" subprogram is designated as "Implementation of educational programs for the population on issues of diabetes mellitus, including in schools for diabetics", but, unfortunately, only in the context of the event "Improving the provision of specialized medical care with diabetes." Based on the types of professional activities of specialists with pharmaceutical education, regulated by the international requirements of Good Pharmacy Practice and the Russian educational standard, focused on maintaining and strengthening the health of citizens, the implementation of this aspect should be carried out not only within the framework of medical care, but also by optimizing pharmaceutical services for patients with diabetes mellitus, which is also not provided for by this Program.
To improve pharmaceutical care for patients with diabetes mellitus
we propose to include in the program of measures to combat diabetes mellitus the development and implementation of certain preventive measures at the pharmacy organization level, as well as the involvement of pharmaceutical specialists in the creation and conduct of thematic seminars for diabetics (for example, on the use of drugs for the treatment of minor health disorders). Another aspect of improving pharmaceutical care is the optimization of information and consulting activities of employees of pharmacy organizations. But, as our analysis showed, the professional competence of pharmaceutical specialists in the selection of drugs for the treatment of mild health disorders against the background of diabetes mellitus is insufficient and requires additional training of specialists, which is successfully implemented in the pharmaceutical practice of some foreign countries. For example, in the UK, for counseling patients with diabetes mellitus in the presence of such conditions as allergic rhinitis, obstipation, earache, cystitis, special training programs have been created for pharmaceutical specialists, including theoretical and practical classes.
The next direction of optimizing pharmaceutical care for patients with diabetes mellitus may be the participation of a pharmaceutical worker in re-prescribing drugs within the framework of social guarantees. It is known that patients with insulin-dependent diabetes mellitus are forced to make daily injections of insulin for life, obtaining which, within the framework of exercising their rights to state guarantees, requires a monthly visit to the doctor in order to issue a prescription for this drug. In this regard, the creation of mechanisms that allow pharmaceutical workers to prescribe medicines (after special training, certification and legal consolidation of this right) can significantly facilitate the procedure for obtaining vital medicines, have a positive effect on the psycho-emotional state of patients with diabetes mellitus, and also significantly reduce burden on doctors. We note that this practice already exists in the UK, and, as found in the survey, the majority of patients preferred this system traditional.
In our opinion, the inclusion of pharmaceutical aspects in state programs in the field of healthcare and the implementation of planned activities will help improve the quality of pharmaceutical services for the most vulnerable segments of the population, increase the effectiveness of preventive measures, and optimize economic costs to solve the strategic tasks of the state in the field of protecting the health of citizens.
