Pharmacoeconomic Evaluation of Clinical Pharmacology Service Efficiency in Terms of Outpatient Drug Supply in Nur-Sultan Medical Organization (Kazakhstan)

Purpose of the study. Evaluate the clinical pharmacologist's contribution to the rational use of medications at the outpatient level.Methods. Clinical and economic analysis of budgetary expenditures on drugs purchased as part of the Guaranteed amount of free medical care and in the system of mandatory social health insurance (MSHI) for the period from 2019-2021. Assessment of the effectiveness of spending budgetary funds for drugs was conducted using data on the number and cost of drugs purchased to provide outpatient care in the medical organization of Nur-Sultan.Results. A three-year analysis showed a positive trend of a 7.1% decrease in the proportion of spending on unproven drugs (index N) by 2021 compared with the previous year 2020, which was 29.54% of spending on 13 drug items, despite the expansion of lists under insurance medicine. Before the introduction of mandatory social health insurance in 2019, this figure was 8.18% of all outpatient drug coverage costs in the Guaranteed amount of free medical care, indicating an average use of drugs not included in international clinical guidelines.Conclusions. The introduction of clinical pharmacology services into clinical practice has optimized the cost of drug therapy and promoted rational use of medications. The result is a 7.1% decrease in the share of spending on unproven drugs compared to the previous year 2020, which amounted to 29.54% of spending on 13 drugs (index N) not included in the Kazakhstan National Medical Formulary and the WHO Model List of Essential Medicines. However, due to the long-term training of clinical pharmacologists, including basic education in therapeutic medicine (6-7 years) and additional education at the level of residency or doctoral studies (2-3 years), there is decreased motivation of clinical pharmacologists to work in budget medical organizations due to the "low" level of wages. Abroad, in particular, this problem was solved by the introduction of clinical pharmacy, where training includes basic pharmaceutical education (4-5 years) with the possibility of additional training at the master's level (1-2 years) and doctoral studies (2-3 years)