Сучасний стан пенсійного забезпечення в Україні

У статті розглянуто сучасний стан солідарної системи загальнообов'язкового державного пенсійного страхування та проаналізовано основні показники функціонування недержавних пенсійних фондів.In the article the current state of solidarity system of obligatory slate pension insurance is considered. The basic indicators of functioning of non-stale pension funds are analyzed

No difference in between-country variability in use of newly approved orphan and non- orphan medicinal products - a pilot study

<p>Abstract</p> <p>Background</p> <p>Regulators and payers have to strike a balance between the needs of the patient and the optimal allocation of resources. Drugs indicated for rare diseases (orphan medicines) are a special group in this context because of their often high per unit costs. Our objective in this pilot study was to determine, for drugs used in an outpatient setting, how utilisation of centrally authorised drugs varies between countries across a selection of EU member states.</p> <p>Methods</p> <p>We randomly selected five orphan medicines and nine other drugs that were centrally authorised in the European Union between January 2000 and November 2006. We compared utilisation of these drugs in six European Union member states: Austria, Denmark, Finland, Portugal, The Netherlands, and Sweden. Utilisation data were expressed as Defined Daily Doses per 1000 persons per year. Variability in use across countries was determined by calculating the relative standard deviation for the utilisation rates of individual drugs across countries.</p> <p>Results</p> <p>No association between orphan medicine status and variability in use across countries was found (P = 0.52). Drugs with an orphan medicine status were more expensive and had a higher innovation score than drugs without an orphan medicine status.</p> <p>Conclusions</p> <p>The results show that the variability in use of orphan medicines in the different health care systems of the European Union appears to be comparable to the other newly authorised drugs that were included in the analysis. This means that, although strong heterogeneity in access may exist, this heterogeneity is not specific for drugs with an orphan status.</p

Ю.О. Митропольський — вчений та вихователь молоді

Висвітлено наукову діяльність та роботу з підготовки наукових кадрів академіка Ю.О. Митропольського. Змальовано його риси як вченого та вихователя молоді.Освещены научная деятельность и работа по подготовке научных кадров академика Ю.А.Митропольского. Обрисованы его черты как ученого и воспитателя молодежи.The paper highlights research and tutorial activities by Academician Yu.O. Mitropolsky. His qualities as a scientist and a tutor of youth are outlined

Guidance by physicians and pharmacists during antidepressant therapy: patients' needs and suggestions for improvement

OBJECTIVE Guidance of patients treated with antidepressants is paramount for successful therapy. The aim was to assess patients' needs and suggestions for improvement of guidance by physicians and pharmacists during second generation antidepressant (SGA) therapy. DESIGN Five focus group discussions were held with a total of 34 patients using an SGA. METHODS The discussions were conducted flexibly and responsrvely using a semistructured topic list. All focus group discussions were video-recorded and transcripts were analysed using ATLAS.ti for coding, thematic and open analysis. RESULTS Participants stated they were in need of better guidance. They suggested improving content of information during decisional moments, patient-health care professional communication and communication in-between health care professionals, and finally, organisation of guidance. Barriers to achieving improved guidance were cited. CONCLUSION Content, communication and organisation of guidance are pivotal for achieving optimal guidance. Participants mentioned that their current experienced guidance had limitations and brought up solutions for improvement. A next step would be to discuss the suggested solutions with health care professionals to assess their views and to discuss the possibility for implementation. After implementation, future studies could be aimed at determination of its impact on patients' treatment efficacy, quality of life, treatment satisfaction and healthcare costs

Medication self-management: Considerations and decisions by older people living at home

Background: Medication self-management is complicated for older people. Little is known about older persons’ considerations and decisions concerning medication therapy at home. Objective: (s): To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior. Methods: Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation). Results: Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after reading the patient information leaflets for fear of side effects. In the execution phase, participants had various methods for integrating the use of new and chronic medication in daily life. Usage problems were discussed with healthcare professionals, but side effects were not discussed, since the participants were not aware that the signs and symptoms of side effects could be medication-related. Furthermore, participants stored medication in various (sometimes incorrect) ways and devised their own systems for ordering and filling repeat prescriptions. In the discontinuation phase, some participants decided to stop or change doses by themselves (because of side effects, therapeutic effects, or a lack of effect). They also mentioned different considerations regarding medication disposal and disposed their medication (in)correctly, stored it for future use, or distributed it to others. Conclusions: Participants’ considerations and decisions led to the following: problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals

Proposal of standardization to assess adherence with medication records: methodology matters

Medication adherence is the process by which patients take their medication as prescribed and is an umbrella term that encompasses all aspects of medication use patterns. Ambiguous terminology has emerged to describe a deviation from prescribed regimen, forcing the European ABC Project to define 3 phases of medication use: initiation, implementation, and discontinuation. However, different measures of medication adherence using medication records are currently available that do not always distinguish between these phases. The literature is lacking standardization and operationalization of the assessment methods.; To propose a harmonization of standards as well as definitions of distinct measures and their operationalization to quantify adherence to medication from medication records.; Group discussions and consensus process among all coauthors. The propositions were generated using the authors' experiences and views in the field of adherence, informed by theory.; The concepts of adherence measures within the new taxonomy were harmonized, and the standards necessary for the operationalization of adherence measures from medication records are proposed. Besides percentages and time-to values, the addition of a dichotomous value for the reinitiation of treatment is proposed. Methodological issues are listed that should be disclosed in studies on adherence.; The possible impact of the measures in adherence research is discussed. By doing this, the results of future adherence research should gain in accuracy. Finally, studies will become more transparent, enabling comparison between studies

Home care nurses’ perceptions about their role in interprofessional collaborative practice in clinical medication reviews

Regular clinical medication reviews (CMRs) are recommended for monitoring and addressing potential drug-related problems, especially in elderly people. Interprofessional collaborative practice (ICP) by general practitioners, community pharmacists, and nurses in a CMR is recommended and expected to produce more efficient CMRs. Involving home care nurses in ICP is not yet well implemented, and their perspectives are unclear. This study explores how they perceive their role in ICP in CMRs and the requirements to assume that role. Structured interviews were performed, using case-vignettes; data were analyzed with a thematic analysis approach. Twelve home care nurses were interviewed. Three themes regarding the nurses' role were identified: (1) observing, recognizing, and communicating information for a CMR to prescribers and community pharmacists (2); helping to provide patient information and education about implemented changes in the pharmaceutical care plan; and (3) the nurses’ level of involvement in ICP. Three themes regarding requirements were identified: (1) nursing competences, (2) periodic interprofessional consultation and ad hoc interprofessional communication, and (3) guidelines describing the role of nurses. Home care nurses could provide additional support in a CMR. Nursing competences, periodic interprofessional consultation and ad hoc interprofessional communication, and guidelines describing the role of home care nurses are required

Key factors underlying the willingness of patients with cancer to participate in medication redispensing

BACKGROUND: Redispensing medication unused by patients to other patients could reduce the environmental burden of medication waste. Simultaneously, associated financial loss could be reduced, particularly for expensive medication such as oral anticancer drugs. An important determinant for successful medication redispensing is patient participation. OBJECTIVE(S): To identify key factors underlying the willingness of patients with cancer to participate in the redispensing of unused oral anticancer drugs. METHODS: Semi-structured interviews via telephone or video call were conducted with adult patients diagnosed with cancer from two Dutch hospitals. The interview guide was framed using the COM-B model for behavioural change, to elicit patients' capability, opportunity and motivation to participate in medication redispensing. Questions were related to patients' willingness to accept redispensed medication, reasons thereof, perceived concerns and needs. Inductive thematic analysis was applied. RESULTS: Seventeen patients (aged 38-82 years, 71% female), with nine different types of cancer participated. The majority of participants supported medication redispensing. Four categories of key factors underlying the willingness of patients with cancer to participate in medication redispensing were identified. First, the driver for participation was having positive societal impact, relating to affordability and sustainability of healthcare. Second, having trust in product quality was a requirement, influenced by preconceived beliefs, quality assurance and patients' knowledge of this process. Third, a facilitator for participating in medication redispensing was adequate provision of information. This concerned awareness of medication waste, information about medication redispensing, support from healthcare providers and other patients, and insight into medication dispensing history. Last, a convenient process for returning unused medication to pharmacies would facilitate participation in medication redispensing. CONCLUSIONS: The willingness of patients with cancer to participate in medication redispensing relates to a drive for achieving positive societal impact, provided that medication is of high quality, there is adequate information provision and a convenient process

Quantifying antibiotic use in paediatrics: a proposal for neonatal DDDs

The defined daily dose (DDD) as defined by the World Health Organization (WHO) has been the most frequently used unit of measurement to measure antibiotic use. However, measuring antibiotic use in paediatrics is a problem as the WHO DDD methodology is not applicable in children (aged >1 month) due to the large variation in body weight within this population. Based on the narrow range of body weights in the neonatal population, we therefore aimed to develop a set of neonatal DDDs for antibiotics. Eight well-respected (inter)national sources for dosage recommendations of antibiotics in children and neonates were consulted for the assumed maintenance dose of the ten most frequently used antibiotics in neonatal intensive care units in its main indication for neonates. A set of neonatal DDDs for ten commonly used antibiotics in neonates based on an assumed neonatal weight of 2 kg was proposed. Primarily in children DDDs are not applicable to quantify antibiotic use since there is large variation in body weight. In the neonatal population, however, based on its narrow range of body weights and when access to patient level data is not available, neonatal DDDs can be used as a unit of measurement