Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.081-089 meta

Аннотация

Diabetes – a disease in which the effect of the treatment substantially depends on the patient. Known a study showed that the use of glucometers with the technology of three-color display of test results facilitates self-monitoring of blood sugar and leads to a decrease in glycated hemoglobin (HbAlc).

Purpose of the study: to modeling the impact of using of a glucometer with a color-coded display on the clinical outcomes of diabetes mellitus and calculating, the potential economic benefits of reducing the hospitalization rate of patients with diabetes.

Material and methods. Based on data from two studies (O. Schnell et al. and M. Baxter et al.) simulation of the reduction in the number of complications with the use of a glucometer with a color indication. In a study by O. Schnell et al. a decrease of HbA1c by 0.69 percent is shown when using the considered type of glucometers, which was the basis of the model.

Results. In the model, the use of a glucometer with a color-coded display for type 1 diabetes led to a decrease in the total number of complications by 9.2 thousand over 5 years per a cohort of 40 thousand patients with different initial levels of HbA1c. In a cohort of 40 thousand patients with type 2 diabetes, the simulated number of prevented complications was 1.7 thousand over 5 years. When extrapolating these data to all patients with diabetes included in the federal register of diabetes mellitus (FRD), the number of prevented complications was 55.4 thousand cases for type 1 diabetes and 67.1 thousand cases for type 2 diabetes. The possible economic effect from the use of the device by all patients with a diagnosis of diabetes, which are included in the FRD, estimated at 1.5 billion rubles for a cohort of patients with type 1 diabetes and 5.3 billion rubles for patients with type 2 diabetes.

Conclusion. Improving the effectiveness of self-monitoring, which is the result of the use of glucometers with color indicators, can potentially significantly reduce the incidence of complications in diabetes and thereby provide significant economic benefits to society.

Keywords

diabetes, complication of diabetes, self-control, colorimeters with color indication of test results, economic effect.

For citations

Popovich L.D., Svetlichnaya S.V., Moiseev A.A. Model estimates of the results of diabetes patients using modern glucometers with tri-color technology for displaying test results. Medical Technologies. Assessment and Choice. 2019;(3):81–89. DOI: 10.31556/2219-0678.2019.37.3.081-089

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.071-080 meta

Аннотация

Objective: budget impact assessment on the healthcare system use of teriparatide in the treatment of severe osteoporosis in comparison with antiresorptive drugs.

Material and methods. Study Design – retrospective literature analysis. Methods of pharmacoeconomic analysis: cost analysis, the “budget impact” analysis, sensitivity analysis. In the study, patients were considered as a target group for prescribing the drug teriparatide or antiresorptive therapy with severe postmenopausal osteoporosis with the presumed development of two compression fractures requiring surgical reconstruction.

Results. The use of teriparatide in patients with two low-traumatic vertebral fractures will require a cost 1.4% less than treatment with zoledronic acid and 33.07% less than the treatment with alendronic acid and 13.6% less in comparison with the use of denosumab. At a weighted average frequency of 3 clinically significant fractures per year, the use of teriparatide will require 15.0%, 42.9% and 24.7% less cost, respectively. For a group of 1000 patients with 2 fractures per year, the savings over 4 years will amount to 13.7 million rubles, 483.0 million rubles, respectively and 154.1 million rubles. With a more severe course, expressed in an increase in the number of fractures to 3 per year, budget savings over 4 years per 1000 patients will amount to 219.0 million rubles, 930.9 million rubles and 406.0 million rubles, respectively. A sensitivity analysis showed that on a 4-year horizon, the use of teriparatide remains economically feasible with a decrease in the frequency of fractures to 1.95 per year compared to zoledronic acid, to 1.4 per year compared to denosumab and to 0.95 per year compared alendronic acid.

Conclusion. Teriparatide is more cost effective than antiresorptive drugs for severe osteoporosis, when an average of 2 clinically significant vertebral fractures per year can be expected in untreated patients requiring surgical reconstruction. In this way, the appointment of teriparatide as the first line of therapy for osteoporosis in patients at high risk of fractures, having more than one clinically significant fracture of the vertebral body in a history is justified from a pharmacoeconomic point of view.

Keywords

severe osteoporosis, vertebral fracture, antiresorptive therapy, bone-anabolitic therapy, budget impact, teriparatide, zoledronic acid, alendronic acid, denosumab.

For citations

Diakov I.N., Belaia ZH.E., Zyrianov S.K., Mazurov V.I. Budget impact analysis of teriparatide in comparison with antiresorptive drugs in severe osteoporotic patients. Medical technologies. Assessment and Choice. 2019;(3):71–80. DOI: 10.31556/2219-0678.2019.37.3.071-080

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.062-070 meta

Abstract

Objective. To evaluate comprehensively the websites of health facilities (HFs) of various forms of ownership that provide information for consumers of medical services, and develop recommendations for optimizing the placement of this information on HFs websites.

Material and methods. The list containing 417 unique HFs websites records were received from Moscow City Compulsory Medical Insurance Fund register. Based on the requirements of regulatory enactments of the Russian Federation for the content of HF websites, 9 categories were formulated, including 43 conformity assessment criteria. The overall content of HFs websites evaluated as ratio of compliant criteria to total number of criteria. We used IBM SPSS Statistics 24 and Microsoft Excel 2016 for the comparison of two groups of HFs.

Results. The overall fulfillment of HFs websites was 95% with interquartile range (IQR) from 91% to 98%. The fulfillment of public and private HFs websites was 95% with IQR 92.5%–98% and 91% with IQR 56%–95%, respectively. Only 18.5% of Moscow HFs websites fully met the requirements of regulatory legal acts (24.0% of public and 5.6% of private HFs). Compared with the websites of private HFs, those of public HFs were more likely to comply with each criterion.

Conclusions. One fifth of HFs websites fully meet the basic requirements of regulatory legal acts. The problem of patients’ awareness about HF services require organizational actions. Those may include stimulation of integrative processes of information exchange between different departments and sufficient theoretical training of HFs managers about regulatory legal acts requirements for HFs websites.

Keywords

website, health facility, Internet, marketing, marketing communications, regulatory legal acts.

For citations

Ekkert N.V., Polukhin N.V. Presentation of information for consumers of medical services on the websites of health facilities: problems and solutions. 2019;(3):62–70. DOI: 10.31556/2219-0678.2019.37.3.062-070

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.053-061 meta

Abstract

Purpose of the study. Healthcare budget impact analysis in the Russian Federation of providing adult patients with chronic obstructive pulmonary disease (COPD) with basic therapy for outpatient treatment.

Material and methods. The hypothesis of reducing costs for the treatment of exacerbations of COPD was tested while providing all patients with basic therapy on an outpatient basis. The model calculates the direct medical costs of drug provision and treatment of exacerbations in patients with COPD in the current situation and when all patients with COPD are covered with basic therapy as part of a program of preferential drug provision. The simulation period is 1 year. The analysis does not take into account social losses associated with disability, payment of disability certificates, reduced labor productivity and mortality.

Results. The cost of providing all patients with COPD with the recommended basic drug therapy on an outpatient basis is substantially offset by a decrease in the cost of treating exacerbations: drug costs should increase by 14.1 billion rubles compared with the current situation, while the cost of providing medical care to patients with exacerbations is reduced by 9.7 billion rubles. As a result, the difference in direct medical costs, or the necessary additional investments, is 4.4 billion rubles. The price of drugs used for basic therapy has the greatest impact on the size of the required additional investments.

Conclusion. Providing all patients with COPD with the recommended basic drug therapy on an outpatient basis, we can expect a decrease in the number of moderate exacerbations per year by 14.7% and severe exacerbations by 31.2%. Taking into account not only medical, but also socio-economic costs can not only offset additional investments, but also demonstrate significant savings. When implementing a pilot project of preferential drug provision for patients with COPD in a specific region of the Russian Federation, it is possible to reduce the cost of purchasing medicines when forming a municipal order.

Keywords

chronic obstructive pulmonary disease (COPD), budget impact analysis, drug provision, basic therapy.

For citations

Maliavin A.G., Dzanaeva A.V., Avxentyeva M.V., Babak S.L. Medical and economic analysis of the consequences of expanding the drug supply program for patients with chronic obstructive pulmonary disease in the Russian Federation. Medical technologies. Assessment and Choice. 2019;(3):53–61. DOI: 10.31556/2219-0678.2019.37.3.053-061

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.046-052 meta

Abstract

Application of simulation techniques in modern educational process associated with the use of virtual simulators in medical education is topical issue in article examined. Literary review of using simulations in medical education was purpose of this article.

Material and methods. Keywords used in search simulation technologies, simulators, medical education (in Russian and English), using Google Scholar search system, search range from 2009 to 2019. More than 19 000 articles is founded, using sorting by date and exact matches, and we narrowed down the search result to 98 articles that we analyzed, selected 32 of them, taking into account the purpose of the article.

Results. It has identified the main advantages of using simulators, which allow the medical student to present the object of study and perform practical actions with it. Simulators independently set the initial parameters of the conducted research and register the corresponding changes in the experimental results, analyze, identify patterns and draw conclusions, if necessary, repeatedly repeating attempts. It also shows the difficulties associated with significant initial costs for teacher’s training, and the lack of current educational modeling programs.

Conclusion. The use of computer simulation technology in the educational process increases the objectivity and quality of the verification and assessment of knowledge, skills and possessions of practical skills of students, and in clinical practice can improve the skill level of practitioners.

Keywords

simulation’s technology, simulators, medical education.

For citations

Kamyshnikova L.A., Efremova O.A., Ivakhno E.N., Dubrova V.A. Opportunities of using simulators in medical education. Medical Technologies. Assessment and Choice. 2019;(3):46–52. DOI: 10.31556/2219-0678.2019.37.3.046-052

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.032-045 meta

Abstract

It has been globally recognized that effective management of human resources for health HRH is a key element in ensuring the quality of care. Health workforce planning (WFP) plays an important role in achieving the Millennium Development Goals in the field of health. Global communities and international organizations, such as the UN and WHO, have been developing various tools and programs to support the implementation processes of joint WFP to be adopted and used by governments around the globe. The main tool of WFP is modeling. A number of models have been developed to support WFP decision making. Such projects as The National Health Workforce Accounts (NHWA) and the European Joint Action Health Workforce Planning and Forecasting (JAHWPF and SEPEN) serve primarily to obtain reliable and comprehensive data for WFP and involve countries in joint activities in this direction, as well as to form homogeneous terminology and methodological approaches. This review describes a theoretical approach to the WFP and offers the implementation path based on the international practice.

Keywords

human resources for health, health workforce planning.

For citations

Omelyanovskiy V.V., Bezdenezhnykh T.P., Alkhasov T.G., Lukyantseva D.V. International experience in health workforce planning. Medical Technologies. Assessment and Choice. 2019;(3):32–45. DOI: 10.31556/2219-0678.2019.37.3.032-045

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.022-031 meta

Abstract

This article describes the rationale for methodology of comprehensive assessment of drug consumption in real clinical practice. The proposed methodology includes three stages: 1) epidemiological monitoring – disease epidemiology assessment; assessment of the role of factors leading to the disease; 2) pharmacoepidemiological monitoring – assessment of pharmacotherapy in real clinical practice; clinical efficacy analysis of drugs; cost-effectiveness analysis; 3) long-term clinical and economical evaluation of various treatment options. Comprehensive assessment of drug consumption should result in optimal pharmacotherapy regimens, decrease of the drug load, increasing of the therapy effectiveness and cost reduction. The scheme of comprehensive assessment of drug consumption is universal and can be used for clinical guidelines development, treatment standards, for the optimal formation of drugs lists at the federal level. Separate stages and sub-steps of an integrated assessment also can be used at the territorial and local levels, medical institution, to optimize pharmacotherapy.

Keywords

comprehensive assessment of drug consumption, epidemiological monitoring, pharmacoepidemiological monitoring, optimal pharmacotherapy regimens, drugs prescription and consumption audit.

For citations

Zhukova O.V. Comprehensive assessment of drug consumption as a basis for pharmacotherapy optimization. 2019;(3):22–31. DOI: 10.31556/2219-0678.2019.37.3.022-031

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.016-021 meta

Abstract

The aim of the study is to develop the assessment technology and forecasting heterogeneity of regional incidence for differentiated healthcare management.

Material and methods. The incidence of skin and subcutaneous tissue diseases in children aged 0–14 years in 2009–2017 in Russia was used as a material. The sources of information were the data of state statistics. Generally accepted statistical methods were used for the analysis.

Results. The expressed heterogeneity of regions of the Russian Federation on children’s dermatological morbidity with a coefficient of variation of 28% is revealed. The marked size of heterogeneity steadily persisted in the 8-year follow-up. The stable predisposition of subjects to a certain rank place is proved. The territories were ranked according to the total 9-year rank. The classification of territories into types of low, medium and high risk of morbidity is carried out. Long-term stability of regional trajectories allows extrapolating them for prediction.

Conclusion. The complex of statistical calculations forming the standard “forecast of regional heterogeneity technology assessment” is carried out. Used methods is universal and it could be used in assessment of any sign heterogeneity: morbidity, mortality, fertility, crime, unemployment, etc.

Keywords

heterogeneity of morbidity, regions of Russia, differentiated approach, standard technology, assessment and prognosis, population health, ranking of territories.

For citations

Gundarov I.A., Pilguy E.I. Heterogeneity of regional population morbidity in Russia – assessment and prognosis principals. Medical Technologies. Assessment and Choice. 2019;(3):16–21. DOI: 10.31556/2219-0678.2019.37.3.016-021

Issue № 3 | 2019 (37)

DOI: https://doi.org/10.31556/2219-0678.2019.37.3.008-015 meta

Abstract

The article describes the methodology for the standardized modules (SM) of healthcare development, which are functional elements of standards of healthcare allowing to increase the functionality of the development and updating of the diagnosis related groups model and objectifying the process of its development. The methodology for the development of SM allows taking into account medical services, drugs, implantable medical devices and medical nutrition, including specialized medical nutritional products necessary for the provision of medical care using a specific treatment method. A distinctive feature of the methodology is the use of not only actual data on the costs of medical organizations, but also expert estimates and regulatory documents existing in the healthcare system.

Keywords

diagnosis related groups, healthcare payment, standardized modules of healthcare, clinical guidelines.

For citations

Ledovskikh Y.A., Semakova E.V., Omelyanovskiy V.V. Methodology for the development of diagnosis related groups based on clinical guidelines using standardized modules of healthcare. Medical Technologies. Assessment and Choice. 2019;(3):8–15. DOI: 10.31556/2219-0678.2019.37.3.008-015

Issue № 2 | 2019 (36)

DOI: https://doi.org/10.31556/2219-0678.2019.36.2.069-074 meta

Abstract

The article tells about the transplantology birth, about the first organ transplants, about Alexis Carrel and Vladimir Demikhov pioneering works and about the first heart transplant from person to person the famous surgery made in 1967 in Cape Town by Christiaan Barnard and forever in the medicine history.

Keywords

transplantology, first heart transplant, Alexis Carrel, Vladimir Demikhov, Christiaan Barnard, transplant rejection, ciclosporin.

For citations

I.V. Opimakh One life – two hearts Medical Technologies. Assessment and Choice. 2019; 2 (36) 69–74.