EVIDENCE-BASED MEDICINE AS A CLINICAL-PHARMACEUTICAL ASPECT OF THE TRAINING OF PHARMACEUTICAL WORKERS

Drachuk V.; Goroshko О.; Kopchuk T.; Shchudrova T.; Dikal M.

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EVIDENCE-BASED MEDICINE AS A CLINICAL-PHARMACEUTICAL ASPECT OF THE TRAINING OF PHARMACEUTICAL WORKERS

Drachuk V.

PhD, associate professor Department of Pharmacology Bukovinian State Medical University Goroshko O. PhD, associate professor Department of Pharmaceutical Botany and Pharmacognosy Bukovinian State Medical University Kopchuk T. PhD, associate professor Department of Pharmacology Bukovinian State Medical University Shchudrova T. PhD, associate professor Department of Pharmacology Bukovinian State Medical University

Dikal M. PhD, associate professor Department of Bioorganic and Biological Chemistry and Clinical Biochemistry Bukovinian State Medical University

Abstract

The core principles of evidence-based medicine are to combine individual clinical practice with the best available independent clinical evidence from systematic studies. The globalization of information resources and processes in the medical and pharmaceutical fields makes it possible to ensure the choice of the most effective, safe and rational pharmacotherapy based on the reliable available evidence. The article discusses the main aspects of the integration of evidence-based medicine into the educational process and the need for its use in practice by pharmacists at different levels of the pharmaceutical industry, and as a result, solving the main task of the pharmaceutical industry - providing the population with highly effective, safe and affordable medicines.

Keywords: pharmacists, evidence-based medicine, rational pharmacotherapy, level of evidence.

The growing incidence of the population, the emergence and spread of new nosological categories of diseases requires the medical and pharmaceutical community to form well-developed schemes of drug supply to the population on the basis of evidence-based medicine [1]. Evidence-based medicine is a type of medical and pharmaceutical practice that involves daily use in the diagnosis, treatment and prevention of the disease only those medical interventions and the use of drugs whose effectiveness and safety have been proven in high-quality clinical trials [2]. On the other hand, evidence-based medicine can be seen as the latest technology for the systematic collection, analysis, synthesis and application of quality scientific medical information, which allows you to make optimal clinical decisions in favor of the patient.

The main position of evidence-based medicine is the integration of the most reliable evidence obtained during experimental research into practice, improving pharmacotherapy, optimizing the range of drugs and the formation of unified clinical protocols for medical

care. Therefore, the goal of evidence-based medicine on a global scale is to cleanse medical practice of ineffective and dangerous treatments and to promote the use of highly effective and safe drugs. The main objectives of evidence-based medicine are: to increase the effectiveness of treatment, namely to reduce mortality and improve the quality of life of patients; increase the safety of treatment, ie reduce the risk of complications when using the applied methods of treatment and optimize the economic aspects of treatment by choosing the most effective and cost-effective treatment approach. Practitioners face many challenges in terms of treatment ineffectiveness, and approval and mandatory clinical care protocols do not always yield the expected results. And it is in this aspect that the close interaction and cooperation of the doctor and the pharmacist should be actively involved. Pharmacy and pharmacotherapy are areas of rapid change, with the latest technologies, new products and new information about known drugs.

All health care workers are faced with an ever-increasing amount of information - its assimilation and application in order to improve their own practice requires a certain "filter" [3]. However, the marketing system of many pharmaceutical companies creates significant obstacles to identifying truly outstanding improvements among medicines. Pharmacists must clearly understand this and be prepared for a qualitative assessment of the significant amounts of information that comes to them, namely, be able to provide a critical assessment of the research tools and conduct an analysis of effectiveness. At the same time, they should share the critical assessment with other health professionals, especially doctors. The way to achieve this is to study a discipline that has emerged relatively recently - evidence-based medicine / pharmacotherapy (evidence-based medicine / pharmacotherapy) [4].

Students of pharmaceutical faculties of higher educational institutions, in the last courses of study, which is extremely important for understanding and forming a "quality picture" of the pharmaceutical industry and providing medicines to the population, after studying many related disciplines, have the opportunity to generalize their knowledge and better understand the basic principles. proving the effectiveness of drugs on the pharmaceutical market.

The purpose of teaching the subject "Evidence-Based Medicine" (EBM) is to train professionals who would have sufficient theoretical knowledge of the principles of evidence-based medicine and practical skills in finding, obtaining, evaluating the quality and interpretation of scientifically proven information on drugs needed to ensure rational pharmacotherapy and, in general, improve the quality of medical care for specific patients and optimize the health care system. The subject of the discipline "Evidence-Based Medicine" are the principles of evidence-based medicine, sources of evidence-based information on the effectiveness and safety of drugs, the practical implementation of the principles of evidence-based medicine in the health care system [2].

Curricula for master's degrees in "Pharmacy, Industrial Pharmacy" are aimed at developing in the future specialists in practical skills in finding, evaluating and interpreting scientific medical information in order to standardize medical care and implement a formulary system. So let's consider the main topic of software in the study of the discipline "Evidence-Based Medicine".

After getting acquainted with the basic concepts, principles, objectives of evidence-based medicine, students need to learn to properly formulate the "clinical issue" of a particular medical problem on the basis of evidence-based medicine. It is extremely important to understand that the pharmaceutical industry is the only world system that cannot exist only within a single state. The cooperation of the world's pharmaceutical giants creates an opportunity, through competition, through the desire to be leaders in the pharmaceutical market, to optimize the supply of drugs, search and implementation of highly effective and safe drugs. Therefore, for the qualitative formation of the clinical issue, students must master the principles of the

international system RICO, which reflects the key elements of the search, which should focus on: P -population - the studied population; And - intervention - the studied technology; C - comparator - alternative technology; O - outcomes - treatment results [5]. Important during the search are a clear documentation of the databases, time and period, strategies and sources used, the total number of results obtained after each search in each database, export, download the relevant data and save them. The algorithm of adaptation of a clinical question to practical activity is formed on the following principle: search - an estimation - selection.

In addition, it should be understood that the practitioner should be required to seek, evaluate and summarize the necessary information on the results of research on the effectiveness of pharmacotherapy, which is contained in 2-3 million articles published annually in more than 40-50 thousand biomedical journals, impossible. The solution is to involve experts, most of whom are pharmaceutical specialists, who summarize the results of clinical observations in the form of recommendations, systematic reviews and abstract analytical publications on current medical issues [6]. This is the function of evidence-based medicine. The task of the higher school is to acquaint students with the current world databases of scientific and medical data, to evaluate scientific and medical information on a specific clinical issue, to determine the level of evidence of clinical research results and to be able to compare levels of evidence.

In practical classes, much attention is paid to the study of information and communication activities in the modern library environment, which is the most important component and foundation of globalization of information. The formation of a single information space, ensuring equal access to information provided by modern technologies in medicine and pharmacy, make it possible to quickly obtain the necessary information from large and complex data sets that reflect the rapid development of world medicine and pharmacy. It is important in the learning process to coordinate and focus students on the proper use of these resources. When searching for information, the student must, first of all, clearly distinguish between sources of information, which are divided into primary, secondary and tertiary. From the point of view of evidence-based medicine, of course, the most effective and informative will be the use of primary and secondary sources, which include: systematic reviews, meta-analyzes and clinical trials. However, the use of tertiary sources (clinical reports, evidence reports, technology assessments) will not always allow experts to give an objective assessment.

It is important to focus the student on the probative value of the information found in order to optimize the work and "not get lost" in the information space. That is why the scientific community has adopted the division of information according to the level of evidence. From the highest to the lowest levels of evidence, information sources can be placed as follows:

1. Systematic reviews and meta-analyzes;

2. Randomized controlled trials with definite results;

3. Randomized controlled trials with uncertain results;

4. Cohort studies;

5. Case-control study;

6. Transverse (cross-sectional) studies;

7. Description of individual cases (case study).

An equally important aspect in evidence-based

medicine is the choice of scientometric databases, which should be based on qualitative and quantitative indicators of publications used around the world to evaluate the work of researchers. These include the number of publications, analysis of the frequency of their citation. The most popular today are the citation index, the worst index, the impact factor. World scientific information resources are widely demanded in scientific institutions and universities are divided into mass-oriented (consumer online) and professional (databases for professionals) consumers. The most universal for the medical and pharmaceutical community among them are: Web of Science, Scopus, Web of Knowledge, PubMed, Medline, Cochrane Library, Best Evidence, UpToDate, Clinical Evidence and Chemical Abstracts, Springer, and others.

The next stage of preparation of a pharmacist in the course of evidence-based medicine is to evaluate scientific and medical information obtained with the help of electronic medical databases; determining the level of evidence of the results, the degree of their persuasiveness, comparing the level of evidence and the provability of the results of clinical trials.

However, the question arises as to why a pharmacist needs this knowledge, if for each medical specialty there are medical protocols approved by the Ministry of Health, lists of over-the-counter drugs that a pharmacist can sell in pharmacies based on pharmaceutical care? The answer is very simple and logical. Unfortunately, in practice we often encounter the irrational use of drugs, and therefore international experts have identified the main prerequisites for irrational pharmacotherapy:

• low level of drug selection without taking into account their effectiveness, price / quality ratio or availability at the local level;

• inefficient procurement practices, which result in the unavailability or use of unnecessary expensive drugs;

• appointments that do not comply with standard treatment protocols developed in accordance with the principles of evidence-based medicine (or current instructions for medical use);

• incorrect dosing practice as a result of an error in prescribing drugs, as well as patients' lack of knowledge about the dosing regimen;

• the patient has no commitment to the treatment plan [7].

The solution to the problem of irrational pharmacotherapy is possible through the introduction of the Formulary System, should be constantly developed and improved, and requires regular review of existing lists based on new objective clinical evidence, data obtained from the analysis of adverse reactions and evaluation of drug use [8].

Objective use of the formulary system will make it possible to: identify the actual practice of prescribing drugs and the possibility of adequate influence on it; determining the objective needs of the industry in medicines; reducing the number of medical errors through the analysis of existing pharmacotherapy practices and proper informing of medical professionals about modern approaches to prescribing drugs; identification of the real situation regarding adverse reactions; optimization of drug prescriptions by quantity - counteraction to polypragmatism.

To date, the form is defined as one of the industry standards in the field of health care and is part of the standardization of health care, which also includes clinical guidelines developed on the basis of international clinical guidelines on evidence-based medicine, health care standards (set of norms presented in the form of relevant indicators (indicators)) and clinical protocols (regulations of the state level that determine the process of providing medical care, its scope and results in a particular disease; developed on the basis of clinical guidelines taking into account the capabilities of the health care system). The form is a detailed explanation of which drugs should be used in the clinical protocol [9].

Conclusion. Referring to the above, we can conclude that the main skills that a student must master in the process of studying the course are: formulating conclusions about the level of effectiveness and safety of treatment based on the results of clinical trials, handbooks of evidence-based medicine; determine the clinical and statistical significance of clinical trial results; formulate a clinical question; to search for scientific and medical data in the sources of evidence and summarize them for clinical decision-making; to carry out selection of scientific articles which are devoted to medical and preventive, diagnostic methods; determine the level of evidence of the results of clinical trials of pharmacotherapy and the degree of their persuasiveness (level of evidence); compare the levels of evidence and evidence of the results of clinical trials of drugs. Therefore, the study by students of pharmacy of the discipline "Evidence-Based Medicine" is essential for the formation of a highly qualified, competitive, educated, comprehensively developed specialist capable of information retrieval, analysis and implementation in medical and pharmaceutical practice of new treatment technologies based on in-depth analysis of effectiveness and safety of pharmacotherapy, through the use and implementation of the principles of evidence-based medicine.

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