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6SCIENTIFIC JUSTIFICATION OF IMPROVEMENT MANAGEMENTS OF PROVIDING WITH MEDICINES PATIENTS IN THE HOSPITAL
1M. D. Alekceeva N. U., 2Candidate of Medical Science Lomakina E. A.
1Russia, Irkutsk, Irkutsk State Medical University, 2Russia, Irkutsk, Clinic of Irkutsk State Medical University
Abstract. In the article the need of monitoring improvement of providing with medicines for treatment-and-prophylactic is scientifically based. Data of the pharmaceutical economic analysis and sociological research are submitted.
In modern conditions of reforming of domestic health care in connection with change of organizational and legal forms of healthcare institutions, changes in a control system and formation of new system of the economic relations, the former system of financing of medical care in combination with low efficiency of use of resources, including on medicamentous providing a hospital, can't continue to exist in an invariable look.
Now the questions connected with monitoring of providing with medicines at the level of the patient that doesn't give the chance in full to satisfy requirements of a hospital in the conditions of tough regulations of an expenditure of medicines within medico-economic standards of treatment are a little studied. It isn't possible to solve these and other topical issues concerning rational and adequate provision of medicines of versatile LPU without the strict personified accounting of medicines. Actually only possible option of implementation of this account is use of the corresponding software allowing to exempt the medical personnel from routine information processing on papers.
All above defined high relevance of complex studying of a problem of monitoring of providing with medicines at the level of a hospital and need of improvement of its organization.
Studying of standard legal support showed that the main document concerning the accounting of medicines in a hospital is the Instruction on the accounting of medicines, dressing means and products of medical appointment in the treatment-and-prophylactic healthcare institutions consisting on the state budget approved by the order of Ministry of Health of the USSR No. 747 of June 2, 1987 and existing to the present. The order of the accounting of medicines presented in the Instruction and created even at strictly budgetary financing doesn't provide a number of important sections in modern conditions, such as: the separate accounting of medicines on financing sources; the subject and quantitative accounting of preparations of the general list and the means acquired by the patient. In this regard there is a difficulty at an assessment of level of real costs of the medicines used for delivery of health care to patients that is the raising risk factor of decline in quality of delivery of health care.
Besides, during research the contradiction of some points of the Instruction each other was revealed. Therefore there is an obstacle for formation of uninterrupted high-quality providing with medicines in a hospital.
Implementation of monitoring of medicines on papers is very labor-intensive process demanding special attention from the personnel involved in it, and a large number of time for its implementation. For the purpose of decrease in labor costs of the medical personnel we developed information and analytical system.
Introduction of the information and analytical system of monitoring of providing with medicines developed by us included the following stages:
1. development of local standard and legal documents;
2. development of new registration forms of account of the movement of medicines in a hospital;
3. use of the offered registration forms of account in work of LPU, their adjustment;
4. development and deployment of the software of the automated workplaces;
5. training of the personnel in work on the automated workplaces;
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6. transition from papers to information and analytical system;
7. use only of information and analytical system;
8. an assessment of efficiency of the developed system.
As a result of introduction of the information and analytical system developed by us the scheme of the organization of providing patients with medicines in a hospital changed.
Before introduction, at implementation of providing with medicines according to official standard and legal documents their account and control upon transition from the senior nurse to the patient was absent. This fact promoted formation of unaccounted stocks on a post of offices and possibility of use of medicines by the medical personnel for personal reasons, but not for needs of the patient.
At improvement of management of providing with medicines the account and control of their use are carried out in full - from the receipt moment in LPU drugstore before performance of the appointments ordered to patients. Besides there is also a feedback which wasn't earlier. It promotes rationalization of an expense of financial means on providing patients with medicines in a hospital. Gives a clear idea to administration of LPU of the volume of medicinal stocks in each office. Excludes unaccounted stocks. All listed above renders assistance in considerable reduction of number of cases of co-payments from patients, providing thereby high social satisfaction of patients with medicamentous providing at stay on hospitalization.
The high extent of economy of financial means became result of improvement of management of providing patients with medicines in a hospital. It made more than 24%. The greatest economy -19,2% was brought by introduction of subject and quantitative monitoring of all medicines including brought in a hospital by the patient. The automated control of the movement of medicines promoted economy for 1,3%.
We conducted sociological research of opinion of patients and the medical personnel about provision of medicines and monitoring of medicines in a hospital. Its results testify that inopportuneness of supply of medicines was reduced by 2014 to 4,05%.
In general at a comparative assessment of results of two sociological researches of satisfaction of patients of Clinics of IGMU with the medical care provided to them the tendency to its increase in 2014 in comparison with 2008 was revealed. In particular, the increase in specific weight of the respondents who are completely satisfied with provision of medicines in Clinics of IGMU and ready repeatedly to ask in this LPU for medical care was noted. 91,2% in 2014 against 62% in 2008.
The research conducted by us showed that use of the information and analytical system of monitoring developed and offered by us medicines promoted improvement of management of providing patients with medicines in a hospital and allowed to provide not only rational use of financial resources of a hospital, but also increase of satisfaction of patients with the medical care provided to them. And also to increase efficiency of use of working hours of the medical personnel involved in monitoring of medicines the economy of working hours made 62,5%.
REFERENCES
1. The instruction on the accounting of medicines, dressing means and products of medical appointment in the treatment-and-prophylactic healthcare institutions consisting on the state budget approved by the order of Ministry of Health of the USSR No. 747 of June 2, 1987.
Article was received 2015-09-16 © Alekceeva N. U., © Lomakina E. A.
46 № 2(2), Vol.2, October 2015
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