Study of preferences of patients with diabetes regard to pharmaceutical services

Pharmacies are a component of the healthcare. Pharmaceutical care and pharmaceutical services improve disease control, quality of patients life and reduce of the burden on healthcare. The implementation of pharmaceutical care and pharmaceutical services for patients with diabetes according to the standards of the GPP is relevant for the domestic pharmacy. Therefore, it is advisable to determine the preferences of patients with diabetes because they have their own needs for treatment and control. The purpose of the study was to study the views of patients with diabetes regarding to function of pharmacies, pharmaceutical services and determine their preferences. The survey of patients with diabetes by the questionnaire method was carried out. Relevant questionnaires of 510 patients with type 1 and type 2 diabetes were included in the study. The results of the survey showed that the majority of patients with diabetes would like to be served in a specialized pharmacy that specializes in drugs and medical products for diabetes. On the basis of the study, the preferences of patients with diabetes regarding to the activities of pharmacies were determined: availability of a wide rang of product; loyalty program for special products related to diabetes, additional services and pharmaceutical consultations. The majority of those interviewed noted that they need a pharmacist's consultation on taking medications. This type of service requires training of pharmacists in diabetes in order to provide pharmaceutical care at an appropriate level. Pharmaceutical services which patients with diabetes need were identificated. There are: testing of blood glucose, cholesterol, blood pressure, weight check, calculation of body mass index and interpretation of results. The creation of a «diabetes self-management school» based on pharmacies will improve the availability of education for patients with diabetes. It is necessary to study the demand directly in the area of the pharmacy before introduction this type of service. It is important to implement systematic special events in pharmacies for the World Diabetes Day. Thes is appropriated for the general population, but also for patients with diabetes. From the point of view of patients with diabetes during this event, they are interested in: consultation of an endocrinologist and nutritionist; blood glucose test; test of diabetes risk; information materials about diabetes. The results of the survey can be prospectively used to improve the service of patients with diabetes and provide for their needs

Analysis of oral hypoglycemic drugs that are subject to reimbursement in Ukraine

Increasing the affordability of pharmaceutical provision to the population is the most important task of the governments, especially in the context of health care reform. Therefore, considering that reimbursement of the cost of drugs increases their affordability, it is relevant to analyze the updated list of GLDs that are subject to reimbursement. The purpose of the work is to conduct an audit of oral GLDs for the treatment of type 2 diabetes, which are subject to reimbursement under the state program in Ukraine, and to study their affordability. The objects of the research were the State Register of Medicinal Products, the Register of Maximum Wholesale and Retail Prices for Drugs, which are subject to reimbursement under the program of state guarantees of medical care for the population. Bibliosemantic, marketing, analytical, graphical, generalizing analyzes and mathematical calculations were used. An audit was conducted of GLDs, except of insulin, for the treatment of patients with type 2 diabetes, the cost of which is subject to reimbursement under the program under the state guarantee program. Only three drugs under the INN are subject to reimbursement: metformin, glibenclamide, and gliclazide. The number of TNs is 51 Ukrainian-made and foreign-made GLDs, and the majority (76.9%) are domestic products. Metformin, gliclazide, and glibenclamide tablets are available in a sufficient assortment of 40 TN, 8 TN, and 3 TN tablets, respectively, in different dosages and packaging (No 30, No 60, No 90, No 120). There are no prolonged forms of metformin, although they are available on the pharmaceutical market of Ukraine. 3 glibenclamide drugs, 1 drug out of 8 – gliclazide, and 13 out of 40 drugs – metformin are subject to full reimbursement. Others require co-payments from the patient. Calculations of co-payments DDD of GLDs that are partially reimbursable, taking into account dosage and packaging, have been carried out. The co-payments for DDD ranges from UAH 0.111 to UAH 2.510 for gliclazide, and from UAH 0.105 to UAH 1.576 for metformin. The co-payments for foreign-made drugs is more than that of the domestic one. To increase the affordability of GLDs and the introduction of modern treatment schemes, it is necessary to expand the list of reimbursable GLDs, including prolonged forms of metformin and innovative drugs. Innovative drugs such as GLP1 and SGLT2 are recommended to be used at the beginning of treatment to prevent the development of DM complications

Study of physicians' preferences for optimizing the pharmacy assortment of glocose-lowering drugs

For the stable operation of the pharmacy and the proper support of patients with diabetes, it is necessary to optimize the assortment of glucose-lowering drugs (GLD), taking into account the significant prevalence of this disease. The demand for prescription drugs is formed by doctors who choose therapy and prescribe drugs. The purpose of this study was to determine the factors that influence of choosing GLD for the treatment of type 2 diabetes and the preferences of doctors when choosing GLD for therapy. They used a remote questionnaire form using Google forms. 732 doctor questionnaires were processed. Statistical processing was carried out using structural, comparative and graphic analysis. A survey of doctors established the factors that influence the prescription of drugs for the treatment of type 2 diabetes: high effectiveness and inclusion of drugs in treatment standards, their safety, and their own positive experience in prescribing drugs. It was also found that when choosing a GLD type, almost half of doctors take into account the patient's purchasing power and the presence of a GLD in the reimbursement program. The survey showed that a third of doctors prefer domestic GLD, and half of the respondents do so sometimes. When choosing foreign medical medications, doctors prefer German, French, and Swiss-made medical drugs. A significant part of doctors do not have preferences when choosing trade name (TN), but the majority of doctors who have preferences prefer TN mainly of foreign production and prolonged forms. It was found that about 10% of the responding doctors do not prescribe combined GLD. The majority of respondent doctors have preferences for combinations: metformin/glimepiride, dapagliflozin propanediol/metformin and sitagliptin/metformin. Problems have been identified at the stage of pharmacological supervision of GLD. Despite the fact that doctors noted in their practice the side effects of drugs in patients, only a fourth (22.7%) of respondents recorded these effects in accordance with the current legislation and made reports. It is advisable to use the results of the questionnaire to improve the care of patients with diabetes and to meet their needs by optimizing the pharmacy assortment. It is advisable to increase the list of International Nonproprietary Name of GLDs for reimbursement, which will contribute to the availability of modern treatment regimens, because the price of medicines limits the quality of modern treatment regimens for type 2 diabetes

Biosimilar insulins in international and domestic practice of pharmacist

In Ukraine, people with diabetes receive insulin, including insulin biosimilars in pharmacies, so pharmacists should increase their knowledge about biosimilar because they become more available in the coming years. The aim of the work was to summarize current information on insulin biosimilars. Research materials ‒ regulatory database information and scientific publications on biosimilars. Content analysis, bibliosemantic, analytical, generalizing analyzes were used. The terminology related to reproducible biological drugs (biosimilars) is difference and it depend on the regulatory agency or the country that controls the approve of drugs. Insulin was the first biopharmaceutical drug which was developed. For approving biosimilars, it is necessary to establish similarity with the reference drug in terms of safety, purity and efficacy. Regulatory of biosimilars and requirements for demonstration the biosimilarity are specified in regulatory of the EMA and WHO. The regulatory of the approving of biosimilar in Ukraine is harmonized with European regulatory. The rules on interchangeability are not determined by all regulatory agency. The International Diabetes Federation emphasizes the role of the pharmacist, stating that they should be well informed about the forms of insulin, includes biosimilars. In Ukraine, pharmacists must dispense insulin, including biosimilars, exactly in accordance to the prescription in which the trade name of insulin (or biosimilars) is indicated. Insulin biosimilars can be an alternative to original insulins that have lost patent protection by increasing the availability of drugs, which can lead to increased market competition and access insulin for patients. Based on the analysis of current information on biosimilars, generalizations about their terminology, aspects of manufecture, regulatory, interchangeability, prospects in the treatment of diabetes and their replacement of referens insulins are presented. The potential impact of biosimilar insulins to patients and the health care system was determinated. The importance of awareness of these drugs by pharmacists as part of the diabetic team are highlighted

Coverage of influenza vaccination of patients with diabetes and determination of barriers for implementation of vaccination

People with diabetes (PWD) are considered to be at high risk of developing severe influenza complications that can lead to hospitalization and sometimes death. It is because of the high risk of developing severe complications that WHO recommends seasonal influenza vaccination (SIV) for PWD. The purpose of the work is to establish the level of coverage of vaccination in PWD and to identify barriers to vaccination in this group in order to overcome obstacles. We analyzed data on the coverage of SIV in PWD and studied the problems of low adherence to vaccination in PWD. We used content analysis, bibliosemantic, analytical, generalizing analyses. An insufficient level of vaccination coverage of PWD has been established. Barriers to vaccination in PWD have been identified. Barriers can be: age, health status, allergic reactions and chronic diseases of people, lower level of education, gender and their employment in economic activities. At the same time, gaps in the knowledge of health care provider, insufficient involvement of endocrinologists and diabetologists in informing PWD about vaccination, a limited number of imported vaccines, and low physical and economic accessibility of vaccines negatively affect the coverage of SIV. A significant factor influencing the level of vaccination coverage of people is their vaccination hesitation. Pharmacists should actively participate in the vaccination campaign by raising public awareness and providing advice to PWD who regularly visit pharmacies. To increase the vaccination coverage of PWD, it is necessary to introduce training programs for doctors and pharmacists to attract them to influenza vaccination companies. Simultaneously conduct educational campaigns and education of PWD. It is advisable to organize a free flu vaccination in medical and diagnostic diabetic hospital (institutions) to increase the physical and economic accessibility of vaccination for PWD. A large number of studies showing the cost-effectiveness of SIV in PWD should be a significant factor for health authorities to improve measures to increase the level of coverage of SIV in patients in this risk group

Analysis of Terminology Used to Categorize Power Uprates of Nuclear Power Plants

Terms used for categorization of power uprates of nuclear power plants (NPPs) are analyzed in the paper. The power uprate program adopted in Ukraine is briefly described to emphasize importance of this area and need to use the appropriate terms. The categories of power uprates adopted by the U.S. NRC and applied by the IAEA are described. They include measurement uncertainty recapture, stretch, and extended power uprates. Translation of these terms into the Ukrainian language based on the analysis is proposed.Аналізуються терміни, що використовуються для визначення категорій підвищення потужності атомних електростанцій (АЕС). Наведено стислий опис програми підвищення потужності АЕС в Україні, яка підкреслює важливість цього напрямку та необхідність використання відповідних термінів. Описуються категорії підвищення потужності, прийняті Комісією ядерного регулювання США, а також використовувані МАГАТЕ. Вони охоплюють підвищення потужності за рахунок вищої точності вимірювань, підвищення потужності в рамках проектних можливостей та розширене підвищення потужності. На основі проведеного аналізу запропоновано переклад цих термінів українською мовою.Выполнен анализ терминов, применяемых для определения категорий повышения мощности АЭС. Приводится краткое описание программы повышения мощности АЭС в Украине, которое подчеркивает важность данного направления и необходимость использования соответствующих терминов. Описаны категории повышения мощности, принятые Комиссией ядерного регулирования США, а также применяемые МАГАТЭ. Они включают в себя повышение мощности за счет более высокой точности измерений, повышение мощности в рамках проектных возможностей энергоблока и расширенное повышение мощности. На основании выполненного анализа предложен перевод этих терминов на украинский язы

Active pharmaceutical ingredients in dermatological medicines of Ukrainian pharmaceutical market

The problem of the diabetic foot is one of the most serious complications of diabetes mellitus. There is still an active search for medicines (drugs) that could be used in the complex treatment of trophic lesions in diabetic foot. The period before the development and launch of the drug into the pharmaceutical market need to make marketing research aimed at ensuring that the future drug is competitive. The purpose of the work was to analyze the market of dermatological drugs for the treatment of trophic ulcers in order to determine the marketing opportunities for domestic producers. The research objects were active pharmaceutical ingredients (APIs), which are part of the dermatological registered drugs in Ukraine. Materials for research were official sources of information about drugs registered in Ukraine. Marketing analytical methods were used. To determine the level of tension between manufacturers and the same product, the coefficient of tension. Number of D preparations registered in Ukraine ‒ 452 trade names (January 2018) was established. Medicines wich prodused by Ukraine are slightly higher (55.3%). In groups D01, D03, D06, D07 and D08 the highest number of APIs is determined, which is 25, 36, 33, 29 and 30, respectively. Part API is contained in the drug in combination with other API. In the D01 group, only a small amount of API ‒ 7 is present in combination with other substances, and in group D02 ‒ 6, certain APIs are part of the combined drug. In preparations of D03 4 API are in combination. In group D06, 12 APIs are contained in combination drugs. Most of the established API groups D07 (13) are found in the drug in combination. In the D08 group, part of the API (8) is part of a combined drug. There is a combination of APIs antiseptic or antimicrobial activity, anti-inflammatory effect, local anesthetic and wound healing effect. According to the results of the calculation of the tension indices between the manufacturers of analogues of drugs in group D, the highest competition (Kvi ≥ 0.800) was observed in the groups D01 and D03 (for 4 drugs with Kvi ≥ 0.800), D06 (3 drugs), D07 (8 drugs), D08 (7 drugs). An analysis of the competitiveness of analogue manufacturers has shown that Ukrainian manufacturers are not sufficiently competing in the production of modern analogues of dermatological drugs

Attributes of pharmacy's educational activities according to good pharmacy practice standards from the perspective of patients with diabetes

According to the Good Pharmaceutical Practice (GPP) Standards of Quality of Pharmacy Services, pharmacists should participate in preventive measures to improve the health of the population and prevent disease. The problem of diabetes is becoming increasingly relevant due to its prevalence and a significant number of undiagnosed cases. Patients with diabetes are frequent visitors to pharmacies and have specific needs for treatment. The purpose of the study was to determine the attributes of pharmaceutical educational activities in pharmacies according to the standards of GPP from the perspective of patients with diabetes, as well as to compare the obtained results with similar ones in other countries. The objects of the study were information sources regarding the involvement of pharmacists in the strategy of preventing diabetes in other countries, using literature review and analytical methods. To study the perspective of patients with diabetes, a semi-structured in-depth interview of patients with diabetes who use insulin therapy was applied. Based on research using the semi-structured in-depth interview method, attributes of educational activities were identified in providing pharmaceutical care to patients with diabetes according to GPP standards: identifying individuals with risk factor of diabetes and people with undiagnosed diabetes; group training of diabetes patients in self-management control; and recommendations flu vaccination in the pre-epidemic period. The availability of diabetes risk factor detection and blood glucose testing in pharmacies contributes to early diagnosis and motivates patients to change their lifestyles. Training people with diabetes by qualified specialists are important for diabetes patients. The organasing of the «diabetes self management school» in pharmacies will increase the accessibility of training for diabetes patients and at the same time enhance the role of pharmacists in clinical practice and the social image of the pharmacy. To promote flu vaccination among patients with diabetes, pharmacists should be actively involved in providing information and promoting vaccination. The identified attributes of educational activities in providing pharmaceutical care according to GPP standards have already been implemented in many countries of the world and have demonstrated their high efficiency for the health care system

ВИЗНАЧЕННЯ ПРОДУКТИВНОСТІ КОРІВ ПРИ КЕТОЗІ ЗА ВИКОРИСТАННЯ ПРОБІОТИКА

High-yielding cows are prone to negative energy balance due to high lactation and insufficient dry matter intake after calving. This leads to the mobilization of fat and protein in the body to meet the nutrient needs of the lactating cow. High levels of nonesterified fatty acids are maintained by fat and protein mobilization, leading to ketosis due to incomplete oxidation of ketone bodies. The purpose of the research was to investigate the effect of probiotics on the productivity of cows and the quality of milk in ketosis. Research was conducted in the period from October to November 2021 on Holstein cows in the limited liability company "Lan" Agricultural Company of the North-Eastern region of Ukraine. It was found that in cows in the post-calving group, seven days after calving, the level of ketone bodies in the blood of the cows ranged from 1.0 to 2.1 mmol/l, which is higher than in the control by 71.42–185.71%. Two weeks after probiotic administration, ketone levels were between 0.5 and 1.2 mmol/L, 16.65–100% higher than controls. On the 28th day of the study, the content of ketone bodies in cows was within the physiological norm. In cows suffering from ketosis, productivity was reduced on the seventh day of research by 22.42–336.4%, on the 14th day by 11.6–29.35%. During the study of productivity, its restoration to the indicators of healthy animals on the 28th day after calving was established at the level of 28-29 kg/day. At the same time, the content of microorganisms and somatic cells had a direct correlation with productivity, and on the 28th day, the milk of all experimental cows was suitable for consumption and corresponded to the "extra" variety. In the first week after calving, the ratio of milk fat and protein in the milk of cows with ketosis was slightly imbalanced, which is a sign of ketosis. On the seventh day of the study, the milk fat level exceeded the protein content in cow 6905 by 32%, in cow 6852 by 39.25%, in cow 6916 by 30.34%, in cow 7642 by 41.17%, in cow 6187 – by 33.62%, in cow 2563 – by 36.40%, in cow 3891 – by 41.63%. At the end of the study on the 28th day, the fat/protein ratio approached the reference level of 1:1 in all experimental animals.Високопродуктивні корови мають схильність до негативного енергетичного балансу через високий рівень лактації та недостатнє споживання сухої речовини після отелення. Це призводить до мобілізації жиру та білка в організмі для задоволення потреб у поживних речовинах лактуючої корови. Високий рівень неетерифікованих жирних кислот підтримується шляхом мобілізації жиру та білка, що призводить до кетозу через неповне окиснення кетонових тіл. Метою досліджень було дослідження впливу пробіотика на продуктивність корів та якість молока при кетозі. Дослідження були проведені в період із жовтня по листопад 2021 року на коровах породи голштин у товаристві з обмеженою відповідальністю агрофірми «Лан» Північно-східного регіону України. Встановлено, що у корів у групі роздою після отелення через сім діб рівень кетонових тіл коливався від 1,0 до 2,1 ммоль/л, що вище, ніж у контролі на 71,42–185,71 %. Через два тижні після застосування пробіотика рівень кетонів був у межах 0,5 до 1,2 ммоль/л, на 16,65 –100 %, що більше порівняно з контролем. На 28 добу дослідження вміст кетонових тіл у корів був у фізіологічних межах. У хворих на кетоз корів продуктивність була знижена на сьому добу досліджень на 22,42–336,4 %, на 14 добу – на 11,6–29,35 %. При дослідження продуктивності встановлено її відновлення до показників здорових тварин на 28 добу після отелення на рівні 28-29 кг/добу. При цьому вміст мікроорганізмів та соматичних клітин мали пряму кореляцію з продуктивністю і на 28 добу молоко всіх дослідних корів було придатне до вживання та відповідало гатунку «екстра». У перший тиждень після отелення співвідношення молочного жиру та білка в молоці хворих на кетоз корів мало дисбаланс, що є ознакою кетозу. На сьому добу дослідження рівень молочного жиру перевищував вміст білка у корови 6905 на 32 %, у корови 6852 – на 39,25 %, у корови 6916 – на 30,34 %, у корови 7642 – на 41,17 %, у корови 6187 – на 33,62 %, у корови 2563 – на 36,40 %, у корови 3891 – на 41,63 %. По завершенню дослідження на 28 добу співвідношення жир/білок наблизилося до референтного рівня 1:1 у всіх дослідних тварин

Study of the needs and pharmaceutical provision of patients with diabetes during time of state of martial law

Military action is a global health problem. Disruption of health care and inadequate pharmaceutical provision can lead to serious complications and even death of the patient, making the population particularly vulnerable. Emergency care always focuses on injuries, infectious diseases and other acute conditions, and chronic diseases, including diabetes, have historically been a low priority. The aim of the work was to study the needs and problems of patients with diabetes, which arose during the martial law in the dynamics and to outline the main aspects of recommendations for improving the treatment of patients with diabetes in humanitarian crisis. Materials and methods. The analysis of the needs and problems of patients with diabetes was studied by a questionnaire (February‒May 2022). People with diabetes and members of their families took part in the study. Relevant official documents and international recommendations about providing diabetic care to the population during crisis situations are analyzed. Content analysis, bibliosemantic, analytical, generalizing analyzes were used. The studied needs and problems of patients with diabetes during martial law and their dynamics depending on time. Restrictions on medical care and rapid resumption of the pharmacy, which released, including insulin, have been established. The dynamics of actions on medical and pharmaceutical provision of patients with diabetes were analyzed, which showed that the health care system was not ready for martial law, but the Government took urgent appropriate actions on medical and pharmaceutical provision of patients with diabetes, which allowed to provide continuous treatment of patients with diabetes. The acute problem of not being able to supply the necessary drugs, including insulin, clean water, food to the occupied territories, creates a critical situation for the population in these regions, including those with diabetes, which can be fatal. Based on the elaboration of international documents, the main aspects of recommendations for improving the medical and pharmaceutical provision of patients with diabetes in emergencies are outlined