Научно-практический журнал Медицинские технологии. Оценка и выбор
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Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.056-062 meta

Abstract

To improve the management of patients with diabetes mellitus (DM), a change to the current system of reimbursement for completed case treatment of this group of patients, followed-up in the outpatient departments of the hospitals, based upon obligatory health insurance fund was introduced. A new Diagnosis-Related Group (DRG) «Follow-up of patients» was proposed and proved to be listed in the medical register. Calculations based on the model of a patient with DM, who needs to be followed up and potentially has been diagnosed with complications of the disease. The model includes a patient’s stay in an outpatient department of the hospital for three days to be diagnosed and treated.

Keywords

diabetes mellitus, management and follow-up of patients, medical register, reimbursement for completed case treatment, diagnosis-related group.

For citations

Shestakova M. V., Zelenova O. V., Yarek-Martynova I. Ya., Abramov S. I., Vikulova O. K., Karpov O. I. Modelling of Healthcare Expenditures on Management of Patients with Diabetes Mellitus for Reimbursement under Diagnosis-Related Groups. Medical Technologies. Assessment and Choice. 2018; 4(34): 56–62.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.047-055 meta

Abstract

The article is devoted to the search for the fundamental bases for the effective solution of the problem of the safety of surgical patients (SSP), which becomes a key direction in improving the surgical services of each medical organization. The definition of SSP is proposed as a complex concept combining progressive educational, clinical and managerial technologies aimed at preventing the negative consequences of surgical treatment, based on their internal connections and general development prospects. This allowed to justify the implementation of an integrated approach to its solution in practice.
Obligatory components of the organizational structure of such an approach are: informational-legal, educational-motivational, surgical (perioperative), control-administrative and organizational. The necessary technological processes for this are considered by the authors: standardization, creation of a single legal and educational platform for all subjects of medical law, personnel management, the process principle of technology implementation, risk management, improvement of information support. The unity of the components and elements of the SSP program is harmonized with the principle of mutual potentiation of their specific requirements, which are consistent with the main goal – the restoration of the patient’s health.

Keywords

patient safety, surgery, conceptual framework, integrated approach, system organization, program.

For citations

Karsanov A. M., Polunina N. V., Gogichaev T. K. The Safety of Patients in Surgery. Part 1: Conceptual Basis of the Problem. Medical Technologies. Assessment and Choice. 2018; 4(34): 47–55.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.039-046 meta

Abstract

Aim. To measure comprehensive indicators of consumption in order to assess their correlation with the level of resistance of S. aureus, K. pneumoniae, E. coli in multidisciplinary hospitals of St. Petersburg in 2014–2016.

Materials and methods. We extracted data on the public procurement of antimicrobial drugs for systemic use (ATC code J01) in multidisciplinary hospitals of St.-Petersburg in 2014–2015 from IMS Health database. Prevalence of resistant strains was assessed based on the results of bacteriological surveys, St. Petersburg Medical Information-analytical Center (MIAC). The indicators of antimicrobial drugs consumption, drug resistance, drug resistance index were calculated.

Results. The structure of public procurement of antimicrobial drugs does not correlate with the the prevalence of multi-resistant infections in St. Petersburg hospitals as a result of out-dated standards for specialized medical care. Current epidemiological situation requires purchasing of the the expensive antimicrobial drugs of limited access and performing epidemiological control measures that demand additional investments.

Conclusion. The existing standards for specialized medical care should be timely updated with regard to recommendations on antibacterial treatment in accordance with the current epidemiological situation.

Keywords

antimicrobial drug, bacterial resistance, drug resistance index.

For citations

Gomon Y. M., Kolbin A. S., Svetlichnaya Y. S., Proskurin M. A. Comprehensive Assessment of Antimicrobial Drug Consumption at the St. Petersburg Hospitals in 2014-2016. Medical Technologies. Assessment and Choice. 2018; 4(34): 39–46.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.025-038 meta

Abstract

Objective. Cost-effectiveness analysis (CEA) of elbasvir in combination with grazoprevir (EBR/GZR) for the treatment of patients with chronic hepatitis C (CHC), infected with genotype 1 subtype b, who previously did not receive antiviral therapy (AVT), without cirrhosis or with compensated cirrhosis, from a Russian healthcare system perspective.

Methods. In a model, developed in MS Office (Microsoft Excel® package), the differences in direct medical costs were determined (using cost minimization analysis) by comparing EBR/GZR and 3D (the combination of ombitasvir, paritaprevir, ritonavir, and dasabuvir), which have comparable effectiveness in patients with chronic hepatitis C (genotype 1b). Besides, changes in costs for the treatment of patients with CHC (genotype 1b), if EBR/GZR are reimbursed, are analysed under the State-guaranteed benefit package (SGBP) for free medical care for the citizens of the Russian Federation (budget impact analysis). Frequencies of long-term consequences of CHC (number of cases of decompensated cirrhosis and hepatocellular carcinoma) were projected in the long run depending on whether AVT is administered or not, for 20 years or lifetime time horizon. For calculations, data from literature and standard financial expenditures in Russian healthcare system in 2018 were used. Univariate (one-way) sensitivity analysis was conducted to assess the impact in the price change of EBR/GZR package on the results of the analysis.

Results. Average cost per patient for therapy with EBR/GZR was 510 142 rubles, or 21% less than for therapy with 3D that was 645 614 rubles. If EBR/GZR are included in Vital and Essential Drugs List (VED), expenditures under SGBP for treatment of CHC (genotype 1b) are expected to decrease by 16,1% in three years: by 9,4% in the first year, 15,7% in the second year and by 21% in the third year.

Conclusions: Using EBR/GZR in clinical practice is efficient and leads to an improvement in the competitiveness in the field. It also allows reducing the additional healthcare system expenditures on direct-acting antiviral agents (DAAA) in AVT of CHC, and provides highly-effective therapeutic regimes under SGBP for patients without increasing the budget. Greater accessibility of DAAA (EBR/GZR and 3D) within the Russian healthcare system and increased availability of these drugs for the patients will lead to a significant decrease in incidence of such severe and costly consequences of hepatitis as decompensated cirrhosis and hepatocellular carcinoma in comparison with no treatment in the long run.

Keywords

chronic hepatitis C, antiviral therapy, direct-acting antiviral agents, elbasvir, grazoprevir, ombitasvir, paritaprevir, ritonavir, dasabuvir, cost-effectiveness analysis.

For citations

Pyadushkina E. A., Derkach E. V., Boyarskaya T. V., Zhdanov K. V., Kozlov K. V. Cost-effectiveness analysis of elbasvir and grazoprevir for treatment of adult patients with chronic hepatitis C (genotype 1b) from Russian Healthcare system perspective. Medical Technologies. Assessment and Choice. 2018; 4(34): 25–38.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.019-024 meta

Abstract

Taking into consideration growing attention to oncological problems in Russia concerns about statistical recording of malignant neoplasms are becoming important. The main sources of information on prevalence and morbidity of malignant neoplasms are discussed in the article. They are cancer registries, forms of federal statistical monitoring and registers of medical bills of medical care provided. The exhaustiveness of the data collection for specified sources are evaluated. Assessment is done to estimate the compliance of the data collected in Russia with recommendations of the International Agency for Research on Cancer. Improvements in statistical recording of malignant neoplasms were proposed including use of modern information technologies.

Keywords

oncology, malignant neoplasms, statistical recording, morbidity, cancer registry.

For citations

Semakova E. V., Ledovskikh Y. A., Tishkina S. N., Zheleznyakova I. A., Gerasimova K. V. Statistical Recording of Malignant Neoplasms in Russian Federation: Current Situation and Main Areas for Improvement. Medical Technologies. Assessment and Choice. 2018; 4(34): 19–24.

Issue № 4 | 2018 (34)

DOI: https://doi.org/10.31556/2219-0678.2018.34.4.011-018 meta

Abstract

The article provides the results of the assessment of methodological quality of budget impact analysis (BIA) submitted as a justification for the inclusion/exclusion of drugs into the drugs lists for medical use (Vital and Essential Drug list, List of Drugs for Certain Categories of Citizens, List of High-Cost Drugs) in 2018.The assessment was performed by the Center of Healthcare Quality Assessment and Control of the Ministry of Health of the Russian Federation according to the requirements, described in the Order of the Government of the Russian Federation, № 871 (version from 29.10.2018), which consist of 11 criteria. The information on distribution of BIA studies in regards to the number of criteria not meeting the requirements and proportion of mistakes on every criterion is presented. Besides, the authors analyzed main causes of non-meeting the requirements for methodological quality of BIA studies described in the Order of the Government of the Russian Federation, № 871.

Keywords

comprehensive assessment, Order of the Government of the Russian Federation № 871, drug list, budget impact analysis, methodological quality.

For citations

Ivakhnenko O. I., Khachatryan G. R., Sura M. V., Avxentyeva M. V., Omelyanovskiy V. V. Results of Methodological Quality Assessment of Budget Impact Analysis: Main Mistakes. Medical Technologies. Assessment and Choice. 2018; 4(34): 11–18.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.009-017 meta

Abstract

The paper discusses the issues of normative and legal regulation for creation of drug lists (List of Vital and Essential Medicines, List of Medical Drugs for Certain Categories of Citizens, List of High-Cost Medical Drugs (Seven Nosologies list). It also considers historical aspects, current state and planned changes of these rules. The stages of expertise, evaluation criteria, and rules of decision making in the process of inclusion of medical drugs (MD) into the lists according to the RF Government Decree no. 871 on 28 August 2014 and the project on the amendment of this decree are thoroughly considered. The proposed changes address the terms of submission of proposals for the inclusion and exclusion of MDs into the lists, and the terms of expert procedures. Changes in expert procedures (complex evaluation) of MD are proposed; a new stage (analysis of methodological quality of pharmacoeconomic studies and budget impact analysis) is introduced. Integral scales of clinical and pharmacoeconomic evaluation of MD are substituted with complex evaluation scales. The requirements for methodological quality of pharmacoeconomic studies and budget impact analysis are created. A further stage of the development of the rules for creating the lists can be the performance of complex evaluation within a single expert body with the participation of expert organizations and leading specialists.

Keywords

drug list, FR Government Decree no. 871 on 28 August 2014, complex evaluation, complex evaluation scale.

For citations

Omelyanovskiy V. V., Sura M. V., Avxentyeva M. V., Khachatryan G. R. The Rules for Creation of Federal Drug Lists: Current State and
Development Prospects. Medical Technologies. Assessment and Choice. 2018; 2(32): 9–17.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.018-027 meta

Abstract

The application of the nomenclature of medical services in the Russian Federation revealed limitations of its structure and content. The analysis of international experience in the classification of medical interventions can help to improve this nomenclature. World Health Organization has prepared a draft of the International Classification of Health Interventions (ICHI), which should be a part of a family of health-related international classifications. It is not yet finished and cannot be used for the classification of medical services on a national level; however, its main principles have already been formulated. All interventions are classified according to three levels (axes): target of intervention; action (the essence of intervention), and means. Lists of types of targets, actions and means have been developed, and recommendations on the classification and coding of medical interventions have been proposed for various situations. There are significant differences in the approach to the classification of medical interventions between ICHI and the Russian nomenclature of medical services. A detailed comparative analysis of the classification principles in ICHI and in the nomenclature is needed.

Keywords

nomenclature of medical services, classification, coding, World Health Organization, International Classification of Health Interventions.

For citations

Tyurina I. V. The Principles of International Classification of Health Interventions of World Health Organization. Medical Technologies. Assessment and Choice. 2018; 3(33): 18–27.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.028-035 meta

Abstract

The paper considers the issues of funding of medical organizations rendering outpatient primary medical care, and the assessment of availability of medical care for population depending on the financial resources of medical organizations.

Keywords

performance audit, medical organization, signed population, unique patients, compulsory medical insurance, capitation fee.

For citations

Budarin S. S., Elbek Yu. V. The Analysis of the Resources Used for the Activities of Outpatient Medical Organizations at the Level of Primary Medical Care. Medical Technologies. Assessment and Choice. 2018; 3(33): 28–35.

Issue № 33 | 2018 (3)

DOI: https://doi.org/10.31556/2219-0678.2018.33.3.036-041 meta

Abstract

The article highlights the history and stages of the formation of the «maxillofacial surgery» profile in the Moscow region. The structure of the service is currently examined in detail according to the new distribution of interterritorial municipal associations. This structure includes 5 specialized highgrade profile hospitals in 8 interterritorial municipal unions. The data on the hospital fund of hospital beds are given. According to the latest statistical data, resources indicators of the doctors of medical department maxillofacial surgeons are presented in comparison with other regions of the Russian Federation. Also in the article the scheme of routing of patients from the dentist of an out-patient reception of a medical institution to the maxillofacial surgeon MONIKI is indicated. The issue of interaction between treatment and prophylactic institutions of the dental profile with in-patient hospitals in the field of maxillofacial surgery is considered. In conclusion, priority directions for the improvement of the profile service in maxillofacial surgery in the Moscow region are formulated.

Keywords

maxillofacial surgery, the medical aid organization, routing patients, the rate of availability of maxillofacial surgeons.

For citations

Sipkin A. M., Kryazhinova I. A., Lapshin V. P. Priorities for Maxillofacial Surgery Improvement in the Moscow Region. Medical Technologies. Assessment and Choice. 2018; 3(33): 36–41.