Social Medicine最新文献

{"title":"Improvement of Reimbursement Policies for Medical Products Through Health Technology Assessment","authors":"Iliyana Belichenova, Evgeniya Delcheva","doi":"10.14748/SM.V28I1.7849","DOIUrl":"https://doi.org/10.14748/SM.V28I1.7849","url":null,"abstract":"Reimbursement policies for medical devices in EU and health technology assessment (HTA) are at the heart of this article. Their development is the result of coordination of many institutions - the European Commission, the European Parliament, the government, agencies and their importance is key. The financial instruments in the reimbursement policies for medical devices in the EU are becoming more and more avant-garde, with the key importance of those from donations or crowdfunding, fundraising for patient organizations and others. The authors emphasize the role of public administration in the formation of effective reimbursement policies for medical devices in line with trends and good practices in the field of medical devices and active participation in the processes, together with European institutions and programs. The authors of the article discuss alternative and innovative approaches, budget impact assessment and reimbursement policies for medical devices in Europe and the EU based on HTA. The authors focus their research on the European experience, the synchronization with European regulations, the harmo-nization of management methods and the role of HTA in the field of management of public funds by institutions and public organizations in Bulgaria. The authors of the publication examine the experience of international institutes in the field of HTA-experience of Great Britain, Germany, France, given the benchmark they have and the need to educate health professionals, administrators, companies in Bulgaria.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"79 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84144087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transmission mechanism in COVID-19 and the management of the epidemic process","authors":"R. Konstantinov","doi":"10.14748/SM.V27I3.7568","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7568","url":null,"abstract":"The health significance, determined by the severity of the clinical course, the mass systemic nature of the epidemic process and the high intensity of coverage of the population worldwide, posed to epidemiological science the problem of studying and clarifying the peculiarities of the epidemic process in COVID-19 and its management. In this epidemiological study, we set out to examine the mechanisms and routes of transmission of SARS-CoV-2 in human society and the possibilities for managing the epidemic process. Theoretical and epidemiological methods, analysis and prognosis were used. A theoretical-epidemiological and applied analysis of the peculiarities of the process of the transmission mechanism in COVID-19 has been performed and the specific practical directions for the effective and rational anti-epidemic behavior are indicated.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"28 1","pages":"18-22"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82253559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing’s motives for work in pediatric care","authors":"A. Georgieva","doi":"10.14748/SM.V27I3.7572","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7572","url":null,"abstract":"The purpose of this study is to investigate the motives of the nurses for career choices in pediatric care. An analysis of literary sources, a documentary method and a questionnaire are attached. The opinion of 70 nurses working in children’s departments of Multiprofile Active Care Hospitals, Creches and Individual Practices for Primary Care in Varna in the period November 2017 - August 2018 was studied. The results prove that the selection of careers in the field of pediatric nursing for a significant part of the respondents is considerable and purposeful. The majority of the nurses confirm that if they had the opportunity to repeat their choice, they would once again turn to work in the field of pediatric care, driven by love for children and the belief that this is vocation. Leading factors that motivate them to continue to care for the children are the nature of the work and the favorable working environment.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87014488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nursing cares at fast - track (laparoscopic and robotic ) surgery","authors":"M. Nankova, S. Borisova","doi":"10.14748/SM.V27I3.7574","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7574","url":null,"abstract":"Introduction: The concept of accelerated surgical recovery after laparoscopic surgery, also called ERAS aims at faster discharge from the hospital and faster recovery of the body after various volumes of surgical interventions without increasing complications or mortality. The application of nursing care with the fast recovery method postoperatively can reduce postoperative complications and pain, shorten the hospital stay, so that the quality of rehabilitation is significantly improved. Aim: To study the application of rapid recovery syrgery (RRS) by surgical nurses (SN) and to reveal the possibilities for its optimization.. Material and methods: In nine large hospitals in Bulgaria the opinion of doctors and senior nurses (122) on the application of RRS by SN was studied; self-assessment of SN (147) who are working according to the rules of RRS. Applied methods - documentary analysis, structured interview and direct anonymous poll. Results: A high degree of knowledge of the rules and experience in practicing RRS from SN is established, as well as the need for additional nursing documentation related to postoperative care - algorithms for work and introduction of a checklist. Suggestions for improvement of the SN work protocol have been made.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82234512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacoeconomic analysis of medical abortion in Bulgaria","authors":"D. Marinov, E. Grigorov, V. Belcheva, S. Djambazov","doi":"10.14748/SM.V27I3.7570","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7570","url":null,"abstract":"The drug treatment for interrupting early pregnancy begins with the identification of prostaglandins. In the 1970s, many developed countries legalized abortion, which led to the development and active application of this healthcare technology worldwide. The cost-effectiveness method was used in the pharmacoeconomic analysis by comparing the costs of abortion of two of the most popular protocols and dosage regimens with the medicines available at the time of the study on the Bulgarian market and the costs of classic abortion. The eventual complications were also noted. With equivalent efficiency of the two procedures, the application of cost-minimum analysis (CMA) is an appropriate and logical choice. The analysis shows that the drug termination of pregnancy under the EMA protocol is (600 mg Mifepristone + 400 mcg Misoprostol) a slightly higher cost per patient compared to the surgical abortion if the procedure is performed during the first trimester of pregnancy (∆Costs = +10,61 BGN) and leads to cost savings for the patient during the second trimester of pregnancy (∆Costs = -90,96 BGN). Medication termination of pregnancy under WHO protocol results in a cost-saving per patient compared to surgical abortion, regardless of the period of pregnancy during which the procedure is performed (∆Cost = -50,43 BGN in the first trimester and ∆Cost = -156,60 BGN in the second trimester). Drug termination is non-invasive, highly effective, and safe, resembling the natural mechanism of spontaneous abortion. In most cases, medical abortion is cost-saving and can be considered as a reasonable alternative to surgical abortion.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74474391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aesthetic restoration of the front teeth (case of practice)","authors":"Izabela Oganesyan-Boeva","doi":"10.14748/SM.V27I3.7576","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7576","url":null,"abstract":"Ever since ancient times, the social nature of human existence had to look for ways and means of recovery, replacement and alignment of the frontal teeth, mainly for aesthetic reasons. Natural teeth have an anatomy and a certain position in accordance with principles, maintaining an excellent balance with the surrounding tissues. Emphasizing the beauty of the face is one of the basic requirements of patients who are looking for high quality dental services. The perfect smile is made up of natural-shaped teeth and colors, corresponding to face shape and natural skin pigments, eyes and hair. The teeth have different shapes and sizes, but in combination they create a sense of naturalness, harmony, beauty and health. To achieve successful results ,we must also consider all the factors - aesthetics, functionality, structural dynamics, biological and periodontal factors and last but not least our visual perception. The purpose of this article is to present two case studies, in which the treatment is with the help of dental technique laboratory and restoration materials. For this purpose, a team was formed to maximize aesthetic dental restoration.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"54 1","pages":"56-58"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86254282","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feldsher education and practice in Bulgaria","authors":"P. Tsonov","doi":"10.14748/SM.V27I3.7577","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7577","url":null,"abstract":"","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"16 1","pages":"59"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87281434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Study of the terms for performing procedures under the HTA of a medicinal product in Bulgaria for the period 04.2016-12.2018","authors":"Anelia Nikolova, E. Grigorov","doi":"10.14748/SM.V27I3.7573","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7573","url":null,"abstract":"Introduction: The Health technology assessment (HTA) is a multidisciplinary activity that systematically assesses the effects of technology on health, on the availability and allocation of resources and their effectiveness for the health system. It is a dynamic, rapidly evolving process that helps make informed decisions about the benefits, risks and costs of introducing new technologies. The administrative terms for the HTA vary in different European countries and depend on the type of evaluation that is performed - single, multiple, rapid assessments and more. For Bulgaria, the statutory deadline for carrying out the procedure under the HTA according to Ordinance № 9 of 01.12.2015 is 90 days from the date of submission of the application by the Marketing Authorization Holder (MAH). Objective: To monitor and analyze the average duration of HTA procedures and the factors that affect it in order to assess whether the normatively determined term of 90 days is sufficient. Methodology: Monitoring, analysis and synthesis are applied for data extraction and interpretation of information about the submitted applications for HTA in National Center of Public Health and Analyses (NCPHA), as well as the overall organization of the process. Criteria for completeness and duration of the procedure are analyzed. Results: In the general case of conducting HTA, the practice shows that the normatively determined term is extremely insufficient. The leading reason for going beyond the time frame is the interval for convening and holding regular meetings of the Heath Technology Assessment Committee (HTAC). Other factors are the incomplete information in the submitted documents or the need to revise the reports. The analysis of the deadlines shows that the share of procedures completed on time is very small and decreases over the years. The longest terms are for procedures in the field of oncology, urology and hematology, and the shortest - in the field of dermatology, rheumatology and endocrinology. Conclusion: The normatively set term is insufficient and regardless of the efforts made, it was not observed in 90% of the implemented procedures. The average duration of a HTA procedure in Bulgaria in the analyzed period is about 156 days. The established practice shows that in the country the duration of HTA is close to the group of EU countries with an established term of 90-220 days.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"283 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76837677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nurse and prophylactic care for children in their early age","authors":"G. Petrova, S. Dimitrova","doi":"10.14748/SM.V27I3.7571","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7571","url":null,"abstract":"Introduction: The prophylactic care for children in their early age, traditionally provided by Children consultations, today is delivered by the General practitioners and the role of the nurse was minimized if not missing. Aim: To analyze the relevant legislation concerning health and preventive care for children and the role of nurse and to point out the problems to be solved in order to improve quality of service. Methods: Document analysis, Inquiries of nurses (188) working at children healthcare facilities. Results: Document analysis show that there is no regulation that mandates nurse’s participation in the team that provides basic health care service including prophylactic care for children. There is no good definition or distinction for the functions of GPs and nurses in the terms of prophylactic care for children. There is contradiction in the established professional competencies for a nurse and the restrictions in the existing legislation towards healthcare for children. Inquired nurses find their role in improving the quality of the health care service in children consultations by helping doctors in the routine activities like immunizations and anthropometry and also in educating parents in terms of health culture and prevention. Home visits or patronage is suggested as appropriate action in this regard. Conclusion: Changes in the legislation and reorganization focused on the recipients may lead to better inclusion of the nurse with an increased capacity for improving the prophylactic care for children in their early age.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"163 1","pages":"33-36"},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83204811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prefered shannels for health information depending on health status","authors":"T. Karanesheva, N. Danova, I. Yaneva","doi":"10.14748/SM.V27I3.7567","DOIUrl":"https://doi.org/10.14748/SM.V27I3.7567","url":null,"abstract":"Background: In a rapidly changing communication environment study of the communication preferences of different audience segments allows the selection of channels for health information to be tailored to the needs and characteristics of the audience. The purpose of the study is research the channels preferred for health information depending on the health status. Material and methods: A direct individual anonymous questionnaire was used, with a questionnaire on paper. The preferred channels for health information among 2979 persons over 20 years of age, from the 28 districts of the country, depending on their health status, were studied. The main statistical methods are: descriptive analysis, graphical analysis; variation analysis, Z-test to establish a significant difference. The results show significant differences in the choice of sources of health information between people with disease and people without disease. Physicians are the most commonly preferred health information channel, with a statistically significant difference depending on the health status (p<0,001). The Internet is twice as often preferred for health information by healthy people than by people with a disease (p<0.001). Television is a major channel for health information for people with a specific disease or medical problem, while healthy respondents more frequently prefer the Internet.","PeriodicalId":38881,"journal":{"name":"Social Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91283180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}