120
POSSIBILITIES OF CLINICAL AND ECONOMIC ANALYSIS
IN OPTIMIZING THE CHOICE OF DRUGS
Nozima Tokhirzhonovna Mavlyanova,
Assistant of the Department of Family Medicine №2, Clinical Pharmacology
Associate professor of the Department of Family Medicine №2, Clinical
Pharmacology. Tashkent Pediatric Medical Institute, Uzbekistan
nozimaxonmavlyanova@gmail.com
Nazifa Valievna Agzamova,
Assistant of the Department of Family Medicine №2, Clinical Pharmacology
Associate professor of the Department of Family Medicine №2, Clinical
Pharmacology. Tashkent Pediatric Medical Institute, Uzbekistan
lolaisroilova486@gmail.com
Annotation:
A comprehensive clinical and economic analysis of drugs usually
includes frequency analysis, ABC and DDD methodologies. The clinical and economic
analysis allows to prioritize among purchased drugs and limits the possibility of
uncontrolled use of drugs that do not belong to the category of vital importance. It
also contributes to improving the quality of medical care, and the main task of
clinical and economic analysis is the optimization of technologies for the acquisition
and use of drugs.
Key words:
clinical economic analysis, antibacterial drugs, treatment of
bronchopulmonary diseases in children.
ВОЗМОЖНОСТИ КЛИНИКО
-
ЭКОНОМИЧЕСКОГО АНАЛИЗА
В ОПТИМИЗАЦИИ ВЫБОРА ЛЕКАРСТВЕННЫХ ПРЕПАРАТОВ
Нозима Тохиржоновна Мавлянова
Ассистент кафедры Семейного врачевания №2, клинической фармакологии
Ташкентский педиатрический медицинский институт, Узбекистан.
Назифа Валиевна Агзамова
К.м.н., доцент кафедры Семейного врачевания №2, клинической
фармакологии
.
Ташкентский педиатрический
медицинский институт, Узбекистан.
Аннотация:
Комплексный клинико
-
экономический анализ препаратов
обычно включает частотный анализ, АВС и DDD методологии. Клинико
-
экономический анализ позволяет определить приоритеты среди
закупаемых препаратов, ограничивает возможности бесконтрольного
применения лекарственных средств, не относящихся к категории
121
жизненной важности. Он также способствует повышению качества
медицинской помощи и главной задачей клинико
-
экономического анализа
является
оптимизация технологий приобретения и применения
лекарственных препаратов.
Ключевые слова:
клинико
-
экономический анализ, антибактериальные
препараты, лечение бронхолегочных заболеваний у детей.
DORILARNI TANLASHNI OPTIMALLASHTIRISHDA KLINIK-
IQTISODIY TAHLIL IMKONIYATLARI
Nozima Toxirjonovna Mavlyanova
Oilaviy shifokorlik №2, klinik farmakologiya kafedrasi assistenti
Toshkent pediatriya tibbiyot instituti, O‘zbekiston.
Nazifa Valievna Agzamova
Oilaviy shifokorlik №2, klinik
farmakologiya kafedrasi dotsenti, t.f.n.
Toshkent pediatriya tibbiyot instituti, O‘zbekiston.
Annotatsiya.
Dori vositalarining keng qamrovli klinik va iqtisodiy tahlili
odatda chastota tahlili, ABC va DDD metodologiyalarini o
‘
z ichiga oladi. Klinik
va iqtisodiy tahlil sotib olingan dori vositalari orasida ustuvorlikni belgilash
imkonini berib, hayotiy ahamiyatga ega bo
‘
lgan toifaga kirmaydigan dori
vositalarini nazoratsiz qo
‘
llash imkoniyatini cheklaydi. Shuningdek, u tibbiy yordam
sifatini oshirishga yordam beradi va klinik va iqtisodiy tahlilning asosiy vazifasi dori
vositalarini sotib olish va ulardan foydalanish texnologiyalarini optimallashtirishda
keng ishlatiladi.
Kalit so
‘
zlar:
klinik ekonomik tahlil, antibakterial dori vositalari, bolalarda
nafas yo
‘
llari kasalliklarni davolash.
The purpose of the research is to analyze data on the use of clinical and
economic analysis of antibacterial drugs in children with respiratory diseases.
Materials and methods:
Materials and methods for studying this type of
analysis were by studying the literature data, and research data of foreign
scientists and determining the prospects for the development of the application
of this analysis in the future in domestic clinics using advanced knowledge in
practice.
Results:
Currently, the problems associated with the use of antibacterial
drugs in healthcare are considered taking into account the professional,
epidemiological, and economic components of the pharmacotherapy section. In
their daily practice, doctors of various specialties regularly prescribe antibiotics
to their patients, and the need for the rational use of drugs in this group is very
relevant to this day. According to world experts, in almost 50% of cases,
122
antibiotics are used unreasonably. Examples of unjustified cases of antibiotic use
are the use of antibacterial drugs without indications, including for prophylactic
purposes; the appointment of antibiotics without taking into account the
sensitivity of the microflora; the appointment of antimicrobial drugs for viral
infections and in a number of other cases. The result of the irrational use of
antibacterial drugs is antibiotic resistance. In recent years, there has been a
significant increase in the resistance of pathogens to antibacterial drugs. The
etiological structure of nosocomial infections is determined by the microbial flora
of the specialized hospital, and gram-negative rod pathogens are prevalent here.
There is also the problem of structural diversity of resistant community-acquired
and nosocomial infections. Accordingly, it is very important to have a
“
susceptibility passport
”
of hospital strains, according to which the choice of
antibiotic should be made at the empirical stage. The presence of clear criteria for
the use of medicines, programs for monitoring the effectiveness of treatment, and
monitoring side effects contribute to improving the quality and safety of
treatment. The cost of antibiotic therapy is 30% of the budget of medical
institutions. In many countries around the world, research is underway to
optimize the use of antibacterial drugs and reduce their ongoing costs. For
example, in the UK, a randomized controlled trial focused on the strategy of using
antibacterial drugs for the most common pathology, lower respiratory infections.
In the course of a prospective pharmacoeconomic study, the effectiveness of the
implementation of the program was evaluated to reduce the consumption of
antibacterial drugs and the cost of antibiotic therapy in medical institutions.
In response to the observed significant increase in microbial resistance to
penicillin and sulfonamides, Canada is developing a national action plan to
regulate the use of antibiotics in the country.
Some types of clinical and economic analysis, such as ABC, VEN and DDD,
are the most popular and have not only a restrictive function, but can also improve
the quality of pharmacotherapy. ABC
–
analysis, as a variant of clinical and
economic analysis, was one of the basic technologies in rationalizing the purchase
of drugs in a medical institution. Despite the fact that antibiotics receive great
attention from scientists and public health officials, there is no optimal method
for monitoring the consumption of antibiotics, and therefore there is a need for
further research in this direction.
In many medical institutions, in matters of drug provision, a significant role
belongs to the section of antibacterial drugs. Keeping records of purchased
antibiotics is the most common way to estimate antibiotic consumption. But this
type of monitoring of drug movement is highly dependent on the stability of
facility purchases, manufacturer prices, supplier discounts, and such drug supply
estimates are not stable enough to compare antibiotic consumption within and
between facilities. The quality and safety of therapeutic measures are determined
by: the presence of clear criteria for the use of medicines, the creation of programs
123
for monitoring the effectiveness of treatment, and monitoring side effects.
The cost of antimicrobial therapy is 30% of the budget of medical institutions.
The most important section of the rational use of drugs is the introduction of
guidelines, protocols, and standards for the diagnosis and treatment of diseases.
Protocols and standards are not a complete technological form, they should be
considered as a dynamic methodological system that requires constant revision
and change. This provision is especially relevant in relation to antibacterial drugs
since their use is associated with antibiotic resistance, the formularies of this
group of drugs should be regularly reviewed in accordance with the infection
monitoring data of a particular medical institution. The development and
application of accurate diagnostic schemes and approaches to the treatment of
patients will make it possible to carry out diagnostics, including differential, in the
shortest possible time, and to choose a plan for managing a particular patient.
Starting points should be the clinical presentation, the spectrum of suspected
infectious agents, and the antibiotic resistance profile of the particular hospital.
A comprehensive clinical and economic analysis of drugs usually includes
frequency analysis, ABC and DDD methodologies. The clinical and economic
analysis allows you to prioritize among purchased drugs, and limits the possibility
of uncontrolled use of drugs that do not belong to the category of vital importance.
It also contributes to improving the quality of medical care, and the main task of
clinical and economic analysis is to optimize the technologies for the acquisition
and use of drugs, and expand their range and quality, which in general will
improve the level of medical care for the population. The most accessible way to
assess the consumption of drugs, in particular antibiotics, is to record the
purchases of drugs, but it largely depends on the stability of the institution
’
s
purchases, manufacturer
’
s prices, and supplier discounts. This form of economic
analysis is not perfect for comparing antibiotic consumption within and between
facilities. The summation of the number of grams of antibiotics dispensed or
prescribed can be used to estimate consumption. This method has advantages
over procurement accounting in that it does not depend on the price of the drug,
but it does not allow comparison of consumption of antibiotics with different
potency. Sections of clinical and economic analysis for wide practical application
include the most popular and well-mastered methods of ABC, VEN and DDD.
To conduct these types of analysis, objects are selected
–
medical services,
medicines, diseases, and organizational technologies. For each position in the
selected nomenclature, its characteristics are given
–
numerical, descriptive.
Range optimization in accordance with the Pareto rule, as a modification of the
ABC analysis, immediately affects the increase in sales, which is especially
noticeable if the priorities of the distributor's purchasing policy are aimed at
ensuring an uninterrupted supply of the right amount of products. Thus, the main
conclusion from the Pareto rule is a real opportunity to save time and own
resources. This is quite achievable, but with the right choice of target settings and
the observance of a number of simple technological methods. The essence of the
124
ABC analysis itself is that it is in ranking the selected positions according to the
level of costs from the highest to the lowest. It is used to estimate costs and plan
costs in any organization, even those not related to healthcare. At the same time,
the application of this method deserves close attention not only of businessmen,
but also of heads of healthcare institutions, as it allows you to quickly and visually
study the distribution of costs, to identify the most costly technologies. ABC
analysis: class A drugs have the highest cost per year. In the general list, they are
presented in the amount of 20%, and the costs are 70-80%. Class C drugs usually
account for up to 80% of the total list of drugs consumed, and their costs
–
up to
5% of total costs. Class B drugs in terms of the cost of annual consumption occupy
an intermediate position between classes A and C and account for 15%.
An increase in the duration of antimicrobial therapy increases the cost of
treatment and is not justified, except in selected cases. It is considered cost-
effective to switch from intravenous administration in a hospital to taking oral
forms of antibiotics on an outpatient basis.
Conclusions:
Despite the wide possibilities of clinical and economic
analysis, and pharmacoeconomic methods of analysis, a number of scientists
believe that there is no optimal method for monitoring the consumption of
antibiotics. Further research is required in this direction.
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