THE PROBLEMS OF THE IMPLEMENTATION OF PRESCRIPTION INSTITUTION IN THE INSTITUTIONAL DEVELOPMENT OF HEALTH CARE IN GEORGIA

Abstract

Ministry of Labour, Health and Social Affairs realized reform from 1th february till 1th september in 2014 for prescription system implementation. According to these changes pharmaceutical products of second group becamethe prescription medicines. In Georgia, access to and supply Rx medicines is governed by a regulatory framework. Second group drugs are only available to the public when prescribed by doctors on new prescription form N 3. The aim of research is to reveal and evaluate positive and negative sides of new prescription system; to study it, sinfluence on achievement process to drugs. As part of the quantitative research, doctors and pharmacists of the medical institution were interviewed. As part of the qualitative research, in-depth interviews with healthcare experts were conducted. The special questionnaire was designed for each aimed group. The questionnaires consist of open and closed questions. The results of the study revealed the positive aspects of the Prescription Institute: with this reform, the system returned to the logic of normal clinical medicine; The role of the doctor in relation to the patient's pharmacotherapy has been strengthened; The competence of the pharmacist was included in the appropriate framework and the specific skills of selling medicinal products by prescription were developed; The culture of purchasing medicines with prescriptions has been established among the population; At the same time, the results of the research revealed such actual problems that are an obstacle to the introduction of the prescription institute: prescription drugs are sold without a prescription; In the doctor's offices opened next to the pharmacies, the doctor is limited to prescribing only prescriptions; In case of chronic or long-term diseases, patients' access to prescription drugs is complicated; Doctors do not have complete information about the dispensing mode of this or that pharmaceutical product from the pharmacy. Pharmacists talk about the lack of specific skills in prescribing prescriptions: in the case of more than one medicine prescribed on one prescription form, the prescription is cancelled; Prescriptions not certified with a seal are invalid; Incorrectly indicated generic name, inconsistency between generic and trade names, prescription of a combined pharmaceutical product with a generic name prolongs the service of the user; Incorrectly indicated course of treatment, drug release forms, medicinal dose are the cause of misunderstanding; e.g. A pharmacist is prohibited from selling a 10 mg tablet of the same name medicine instead of a specified 5 mg tablet. One of the goals of the reform planned by the Ministry of Health is the correct treatment, the reduction of the share of expenses on medicine and the harm caused by self-medication. It is too early to talk about these achievements within the framework of the conducted research, however, one of the details was revealed that will contribute to the reduction of expenses on medicines, namely: it is necessary to indicate the diagnosis in the prescription according to ACD-10; The doctor's prescription should always be consistent with the diagnosis; The institute of prescriptions should reveal the rationality of the prescription issued by the doctor, compliance with the guidelines, which will partially reduce the costs of medicines. The reform implemented in connection with the restoration and establishment of the Institute of Recipes in Georgia is a step forward. The medical community unequivocally welcomes this change. The competence and authority of the doctor increased; the specific rules for prescribing by a doctor and issuing prescription medication by a pharmacist are gradually being established. Along with the highlighted positive aspects, significant systemic errors and technical flaws are visible. The sale of drugs of the second group without a prescription is an obstacle to the introduction of the Institute of Prescriptions. At this stage, fining the pharmacy cannot solve the problem. The Ministry of Health considers the establishment of an electronic prescription system to eliminate this problem. The current activity of the "pharmacy" doctor also hinders the reform. Access to medicines for patients with chronic diseases is complicated. The existing classification of medicines has flaws. Recommendations Based on the conducted research, the following recommendations were developed: • Improving the administration of the prescription institute implementation process; • Study of the activities of "pharmacy" doctors by the Agency for the Regulation of Medical Activities; • Refinement of regulatory normative base, administration tools; • Revision of the classification of pharmaceutical products and periodically making rational changes taking into account the data of AMEA, WHO, PSUR; • In order to use medicines rationally, it is advisable to introduce a system of electronic prescriptions.