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58PHARMACEUTICS
QUESTIONNAIRE ANALYSIS OF PHARMACIST TO IMPROVE GOVERNMENT PROGRAMS OF
AVAILABLE MEDICINES
Nemchenko A.
Doctor of Pharmaceutical Sciences, Professor National university of pharmacy, Kharkiv, Ukraine
Nazarkina V.
Candidate of Pharmaceutical Sciences, Associate Professor National university of pharmacy, Kharkiv, Ukraine
Kurylenko Yu. Phd student
National university of pharmacy, Kharkiv, Ukraine
Lebed S. Postgraduate student National university of pharmacy, Kharkiv, Ukraine
Abstract
A survey of pharmaceutical workers in Ukraine was conducted. It is established that there are problems in the process of participation of pharmacies and their employees in government reimbursement programs. Suggested approaches to solving problems, according to the results of a survey.
Keywords: questionnaire, pharmacist, reimbursement, goverment program
Introduction. Reforming the national health care system is currently an urgent and necessary step in the development of the healthcare system and pharmaceutical supply of the population.Information technology is a critical lever in decision making in the healthcare industry. At the present stage, there is no socially effective policy for the development of the national health care system, first of all in the process of implementation of Government programs on pharmaceutical provision of affordable medicines for patients with socially important pathologies, in particular cardiovascular dis-eases(CVD). [1,2].
Thus, in recent years, deaths from CVDs in middle- and low-income countries ranged from 38% to 89%, and in high-income countries more than 8% of the total number of causes of death. In this regard, the leading countries of the world are taking measures to provide all segments of the population with timely, high-quality and affordable medical and pharmaceutical assistance, in particular the introduction of programs to reimburse the cost (reimbursement) of medicines to patients.
From 04/04/2017 in Ukraine, the Government's program «Available medicines» has started, which includes the most common nosologies: CVD, type II diabetes, and bronchial asthma. The purpose of the program is to provide patients with affordable, effective drugs and prevent their premature death. The drugs included in the program are listed under the International Non-proprietary Names (INN). As part of the program, reference prices for the drugs included in the List of drugs for which the cost is reimbursed were calculated. The state compensates for the cost of the cheapest drugs that participate in the program.
Other drugs, the price of which does not exceed the reference, the patient can get, having paid the difference in the cost of the selected drug. To obtain the
drug you must have a prescription written by your doctor. From 01.04.2019 The National Health Service administers the government's Affordable Care Drug Reimbursement Program. 7761 pharmacies and pharmacies in Ukraine have now joined the program. Primary care doctors have prescribed more than 9 million e-pre-scriptions. In the last 7 days (31.01.2020-02.02.2020) 5264 were dispensed. The largest number of prescriptions was released from Dnipropetrovsk region (431 prescriptions) and the lowest number was in Lugansk region (147 recipes) [3].
In the process of implementing Government programs, pharmacy institutions, which should provide the population with affordable, effective and high-quality drugs, play a key role [4,5]. Therefore, the aim of our study was to analyze questionnaire pharmaceutical professionals to improve the work of the Government program «Availablemedicines».
Material and research results.For the study, we used materials from the Ministry of Health of Ukraine, the World Health Organization, the National Health Service of Ukraine and the results of a questionnaire survey [6,7,8].
We, together with the Health Department of Kharkiv Regional State Administration and the State DrugsControl Service in Kharkiv region, developed a questionnaire for pharmaceutical workers.
The total number of respondents who took part in the survey was 447 pharmaceutical.
In total, 20 oblasts and regions of Ukraine were involved without taking into account the Kharkiv region and Kharkiv in the questionnaire of pharmaceutical workers.
The calculation for the Kharkiv region and Kharkiv was separate and were compared with the total number of questionnaires in other regions of the country.
- The results of a survey on the ownership forms of pharmacy establishments in which re-respondents work showed that:
- - 197 specialists from other regions of Ukraine and 224 respondents from Kharkiv region (92,49% and 95,43%) work in pharmacy establishments of private ownership;
- - Communal property pharmacy employs 10 specialists, both from other regions of the country and 10 from Kharkiv region (4,69% and 4,67%);
- - only 6 respondents (2,82%) work in state-owned pharmacies only in other regions of the country.
According to the results of the survey, it was found that the majority of pharmaceutical workers are prescription drugs sold without prescriptions - 213 respondents from Kharkiv region and 160 specialists from other regions of the country (91,03% and 75,12% of respondents). The remaining answers are presented in Figure 1.
never
4,23% 2,14%
M pharmaceutical workers (Kharkov and Kharkov region)
0 pharmaceutical workers (regions of Ukraine excluding Kharkov and the region)
Figure 1. Answers to the question about prescription drugs
It should be noted that the prescription is a doctor's recommendation and should fulfill its basic functions: medical, technological, social, economic and legal [9,10].
The questions included in the questionnaire regarding increasing responsibility for illegal prescription drug delivery allowed to establish the respondents' attitude to this problem.
Thus, 191 respondents from Kharkiv Oblast (81, 62%) and 194 specialists from other Oblasts of Ukraine (91, 08%) are in favor of increased responsibility, while 41 and 20 respondents (17, 52% and 9, 39%) - against.
When analyzing the answers to the questions regarding the implementation of Good Prescribing Practice in Ukraine, it was found that the overwhelming majority of respondents, both from Kharkiv and other regions of Ukraine, were 189 and 208 (80,77% and
97,00% respectively). 65,0%% of respondents) believe that this practice is needed in Ukraine, and 44 and 5 specialists (18,80% and 2,35%) believe that it is not [10].
At the next stage, we analyzed the responses of pharmacists about the participation of their pharmacy institution in the Government program for providing CVD patients with affordable medicines (it was possible to choose up to three answer options). The results of the survey showed that one of the main factors due to which the respondent's pharmacy took part in the government's «Available medicines» program is the approximation of pharmaceutical assistance to consumers - 179 specialists from Kharkov region and 125 specialists from other regions of the country (76,50% and 58 , 69%), other factors are presented in Figure 2.
72,65%
increase in pharmacy turnover
V 45,54%
appeals of district administrations
22,65%
il IJ
32,86%
bring pharmaceutical assistance closer to the consumer
76,50%
I
58,69%
m pharmaceutical workers (Kharkov and Kharkov region)
□ pharmaceutical workers (regions of Ukraine excluding Kharkov and the region)
Figure 2 Assessment of the main factors for the participation ofpharmacy establishments in the Government's
program «Available medicines»(respondents' opinion)
An analysis of the experts' answers to the ques- state programs for ensuring the vailability of medicines tions regarding the problems that most often arise in (up to three options could be chosen) is presented in pharmacy establishments in the case of participation in Figure 3.
low public awareness of information 99,57%
programs
79,34%
imperfection of legal regulation
53,42%
39,91%
failure to meet financial obligations to pharmacies
50,00%
30,52%
lack or lack of communication in the pharmacist-physician system
45,30%
30,99%
0 pharmaceutical workers (Kharkov and Kharkov region)
□ pharmaceutical workers (regions of Ukraine excluding Kharkov and the region)
Figure 3 Structure of responses ofpharmacists to problems encountered in pharmacy facilities when participating in government programs regarding the availability of medicines
According to Figure 3 most respondents from Kharkiv Oblast 233 (99, 7% of respondents) and 169 (79, 34% of respondents) from other regions of the country consider the low awareness of the population among the key problems most often encountered by pharmacists regarding participation in Government programs.
One of the most urgent problems that a pharmacy faces when participating in the Dose-blueprint program is the reduction of the retail mark-up for drugs included in the reimbursement system from 25% and 15%, according to the CMU resolution of 17.10.2008. No. 955. That is, the income of pharmacies from the sale of drugs included in the list "Available medicines" is much lower and the response rate is much higher. The pharmacy institution purchases the necessary medicines at its own expense, and the state reimburses their cost upon the report to the fund manager - the hospital. In addition, each pharmacy staff is subjected to an additional burden in connection with the processing of prescriptions and the adaptation of already available computer programs to the Government's program «Available medicines» [11,12].
It should be noted that medical information systems for pharmacies are currently expensive and, due to poor Internet coverage in Ukraine, often slows down the speed of prescription processing, which means that the pharmacy is losing time and money participating in the program.
In order to evaluate the views of pharmaceutical workers on the economic viability of reducing the retail mark-up from 25% to 15%, we included an additional question for pharmacy managers only within the state Government's program«Available medicines».
From 59 experts Kharkiv region and 39 other regions of the country participated in the study. Thus, in the opinion of 58 and 19 respondents (59,18% and 19,39%) this step is not clear and economically unreasonable, and for 6 and 15 specialists (6,12% and 15,31%) this step is quite acceptable [13,14].
Conclusions. In general, the results of the questionnaire of pharmaceutical workers allowed us to say that a necessary step is to improve the regulatory legal acts on prescription leave and mechanisms of state regulation of prices and reimbursement of drugs in Government programs.Also, research in this direction should be carried out constantly, introducing the experience of the leading countries of the world and WHO reports on the functioning of such programs.Systematic monitoring and rapid response to the transformations of the healthcare industry will help increase the adaptation and accessibility of government programs for the population.
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1. WHO Official Website URL: https://www.who.int/en
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