Social Pharmacy in Health Care

The substantiation of the role of a clinical pharmacist in preventing antibiotic resistance

I. V. Kireyev — 2023-11-17

Aim. To study the role of a clinical pharmacist in overcoming antibiotic resistance in healthcare institutions that provide both primary (outpatient) and specialized (inpatient) medical care.

Materials and methods. The research materials were the Order of the Ministry of Health of Ukraine No. 1513 of 23.08.2023 “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”. Such methods as analysis, synthesis, grouping, formal-dogmatic, logical-semantic, ascent from abstract to concrete, historical, comparative, systematic, graphic ones were used.

Results. According to the results of the analysis of the new standard of medical care “The rational use of antibacterial and antifungal drugs for therapeutic and preventive purposes”, it can be noted that clinical pharmacists are responsible for promoting, managing and optimizing the use of antimicrobial drugs. It is the level of professional training, qualification and experience in working with infectious diseases that allow clinical pharmacists to be leaders of programs to combat antibiotic resistance.

Conclusions. According to the provisions of the Standard, the clinical pharmacist should be in close cooperation with the doctor through counseling. An important aspect of preventing complications of antibacterial pharmacotherapy and developing antibiotic resistance is a retrospective audit of antibacterial drug prescriptions performed by a clinical pharmacist. Taking into account the above, in our opinion, it will be rational to include the elements of practical training on prospective counseling and retrospective audit of the use of antibacterial agents in the working program of “Clinical Pharmacy and Pharmaceutical Care” for applicants of higher education of the educational and professional program “Clinical Pharmacy”.

Analysis of the range, economic availability and volume of consumption of antiestrogens for the hormone therapy of ER(+) HER2(−) breast cancer

O. Ya. Mishchenko — 2023-11-17

Aim. To study the range, economic availability and consumption volumes of antiestrogens for the hormone therapy of ER(+) HER2(−) breast cancer.

Materials and methods. The retrospective analysis of the range, as well as the analysis of changes in average retail prices, economic availability and consumption volumes of hormone therapy for ER(+) HER2(−) breast cancer presented at the pharmaceutical market of Ukraine in 2017-2022 were performed.

Results. At the pharmaceutical market of Ukraine in 2017-2022, 3 INNs of anti-estrogens were presented during the entire period under study: tamoxifen (L02B A01), toremifene (L02B A02) and fulvestrant (L02B A03). The value of the solvency adequacy ratio (Ca.s.) of the population for each drug under research decreased at the end of the study period. For almost every trade name (TN) of the drugs studied during individual years, the Ca.s. indicator was slightly higher than in the previous period, but this was not systemic in nature and did not affect the general trend of decreasing Ca.s., which, in turn, indicated an increase in the affordability of all TN of antiestrogens studied for an average citizen of Ukraine. There is an overall clear trend towards a year-on-year decrease in the consumption of anti-estrogens mainly due to a decrease in the consumption of tamoxifen drugs, but there is a steady trend towards an increase in the consumption of fulvestrant.

Conclusions. At the pharmaceutical market of Ukraine within 2017-2022, anti-estrogens for the hormone therapy of ER(+) HER2(–) breast cancer were presented by 3 INNs: tamoxifen, toremifene and fulvestrant. It has been found that for almost all drugs studied there is a steady trend towards increasing economic availability due to an increase in average wages, despite an increase in average retail prices. A trend towards a decrease in the consumption of drugs from the group of anti-estrogens has been determined mainly due to a decrease in the consumption of tamoxifen drugs.

Development of a target quality profile for capsules containing a dry extract of salvia sclarea l. grown in tajikistan

S. B. Kholov — 2023-11-17

Aim. To work out the concept of scientific research on the pharmaceutical development of capsules based on the substance of a dry extract of Salvia sclarea L. (clary sage) grown in Tajikistan by developing a target drug quality profile.

Materials and methods. During the research, methods of a systematic approach, scientific analysis, comparison, analogy, and generalization of information on the pharmaceutical development of herbal medicines were used. Tabular and schematic tools for visual presentation of the data obtained were also applied.

Results. The pharmacological studies of a dry extract of Salvia sclarea L. grown in Tajikistan using the “elevated plus maze” test indicate the prospects of its use as an active substance of a moderate anxiolytic action in the dose of 300 mg/kg. The results obtained served as the basis for developing a target quality profile for capsules containing a dry extract as the first stage of the pharmaceutical development, implementing the programmable quality concept “Quality by Design”. When developing the target quality profile for capsules, a set of complementary provisions, recommendations, and methods of the State Pharmacopoeia of Ukraine and the Eurasian Economic Union concerning the issues of technological, chemical, and microbiological requirements for the development of pharmaceutical products was analyzed.

Conclusions. Thus, the development of a target quality profile for capsules containing a dry extract of Salvia sclarea L. will make it possible to rationally use material resources and implement the programmable quality concept.

The study of current functional responsibilities of pharmaceutical workers and their acquisition of soft and hard skills adapted to modern conditions

M. V. Zarichkova — 2023-11-17

Aim. To study trends and changes in the list of functional responsibilities of pharmaceutical workers (PW) and their acquisition of soft and hard skills adapted to modern conditions taking into account the professional opinion of PW.

Materials and methods. For our study, information on the state regulation of healthcare institutions (HCIs) in the conditions of military aggression and the current state of crisis, a review of scientific literature, and the results of personal research were used. Such scientific methods as analysis, comparison, comparison, questionnaires and direct observations were applied. The results were processed and verified using licensed Microsoft Office Excel software products.

Results. The study involved 212 respondents in such positions as the head of a pharmacy, pharmacist, assistant pharmacist, clinical pharmacist (CP). The research has shown that employers need to update job descriptions and balance them with job cards to better understand the employees’ responsibilities and achievements and analyze the employer’s key performance indicators (KPIs) that show how a particular employee or an entire department is moving toward the achievement of the goal set during the daily work.

Conclusions. A sociological study has been conducted among the employees of HCIs, such as pharmacies, pharmacy branches, hospitals, and treatment and prevention institutions. For each position, the most significant functional responsibilities and desired KRI have been determined. It has been found that for the further effective development of pharmaceutical support for the population it is necessary to update the job descriptions and balance them with job cards to better understand employees’ responsibilities and achievements and analyze the employer’s KPIs.

The role of a clinical pharmacist in implementing modern guidelines for the pharmacotherapy of arterial hypertension

I. V. Kireyev — 2023-11-17

Aim. To study the possibilities of participation of a clinical pharmacist in complying with modern guidelines for antihypertensive pharmacotherapy using fixed combinations of drugs in the conditions of a pharmacy and determine the directions for improving the work of a clinical pharmacist to improve the quality of hypertension control.

Materials and methods. The analysis of reports on the sale of antihypertensive drugs containing one active substance and fixed combinations of two or three active substances was carried out in a pharmacy at a healthcare institution.

Results. Sales volumes of combined drugs prevailed over sales volumes of drugs that contained one active substance, and fixed combinations of two active substances prevailed over triple combinations. However, the frequency of selling two drugs of different groups as separate drugs was higher than the sale of drugs of two or three pharmacological groups as fixed combinations. At the same time, sales of fixed combinations prevailed for individual active substances among the angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers.

Conclusions. Data on the sale of fixed combinations of two or three active substances in the pharmacy have demonstrated insufficient compliance with current guidelines for antihypertensive pharmacotherapy. One of the ways to improve compliance with modern guidelines for the use of fixed combinations is the active participation of the clinical pharmacist in the selection of drugs for a particular patient, actively interacting with the doctor. Thus, a clinical pharmacist can be an important link in the control of arterial hypertension and the implementation of modern guidelines for the pharmacotherapy of arterial hypertension.

Assessment of the quality and effectiveness of the work of regulatory authorities in the field of drug circulation

A. A. Kotvitska — 2023-11-17

Aim. To assess the quality and effectiveness of the work of regulatory authorities in the field of drug circulation.

Materials and methods. The study was based on data from scientific publications, statistical reports, results of our own research, including a survey of representatives of senior management positions of business entities in the pharmaceutical sector of the healthcare sector. The methods used were a sociological survey, descriptive statistics, graphical analysis, and data generalization.

Results. Based on the results of the analysis of international and domestic experience in assessing the activities of state regulatory authorities, a system of qualitative indicators for assessing the effectiveness of their work was proposed. According to the questionnaire developed, an anonymous survey was conducted among representatives of the management level with at least 5 years of experience in organizations and enterprises engaged in a certain area of pharmaceutical activity. It was found that according to the indicators of assessing the general principles of providing regulatory services in the field of circulation of medicines, quality and availability of regulatory services, the activities of public authorities were assessed at a satisfactory level. It was determined that the work of regulatory authorities with complaints from consumers of their services needed to be improved, and the level of performance of regulatory functions in controlling the promotion of medicines and their advertising was also necessary to be improved.

Conclusions. Thus, based on the results obtained at this stage of the study, it can be stated that the level of activity of regulatory authorities in the field of circulation of medicinal products is satisfactory from the point of view of the recipients of their services. At the same time, taking into account the world experience of using approaches to assess state bodies in providing services to individuals and legal entities, we consider it necessary to develop a unified procedure for conducting a comprehensive assessment of the effectiveness of regulatory authorities by self-assessment and stakeholder assessment of regulatory services using the same performance indicators.

Legal and ethical dilemmas in the process of providing information to users of hormonal contraceptives

I. V. Pestun — 2023-11-17

Aim. To elucidate legal and ethical dilemmas in the process of providing information to consumers of hormonal contraceptives (HC) at the pharmaceutical market of Ukraine and search for ways to solve them.

Materials and methods. The method of logical and content formulation of the problem, systematic and statistical methods, desk and field methods of marketing research, such as analysis of patient information leaflets for HC, the content analysis of publications in scientific and practically-oriented medical and pharmaceutical publications, the questionnaire survey method, tabular and graphic means of visual presentation of the data obtained were used in the work.

Results. The problem of preserving the reproductive health of women using hormonal agents associated with the possible abortive effect of modern HC has been highlighted. The role of pharmacists in providing consultations when dispensing prescription medicines, in particular HC, has been determined. According to the results of the research, it has been found that there are gaps in the assessment of the quality of information work of pharmacists when dispensing HC from pharmacies. Directions for improving the information support of HC consumers taking into account regulatory and ethical aspects have been proposed. The expediency of expanding the data in patient information leaflets regarding the pharmacodynamics of drugs has been substantiated; it will minimize the psychological consequences of the use of contraceptives under the condition of a non-exclusive abortive effect.

Conclusions. The paper highlights the legal and ethical dilemmas associated with dispensing modern HC without a doctor’s prescription and the possible abortive effect of the study group of drugs. Taking into account the social significance of regulating the information support of HC consumers, as well as legal and ethical norms, there is a need to develop and implement additional instructional and informational materials on the rational purpose and application of HC.

Optimization methods for multi-criteria decisions in pharmacy

О. V. Kutova — 2023-11-17

Optimization methods for multi-criteria decisions in pharmacy

In pharmaceutical technological research, the determination of the quantitative composition of granules is considered as a task of multi-criteria selection. Today, to solve this problem, the regression analysis and multi-criteria optimization methods are widely used; they are based on mathematical models obtained for the object under study.

Aim. To identify a decision-making method in a multi-criteria space that is effective for use in pharmaceutical technology research with quantitative factors.

Materials and methods. The study uses tools of the popular computer mathematics system Mathcad (MathSoft Ins., USA) to automate the solution of mathematical problems. To automatically search for the type and coefficients of regression equations, the MS Excel application was used, namely: the data analysis package (regression analysis). The MS Word processor was used to edit the code.

Results. A variety of approaches to the formalization of the multi-criteria optimization task have been studied. The optimal quantitative content of excipients when developing the granule technology has been found using two different optimization criteria, which are formed according to different methodical approaches. The method proposed does not provide for the mandatory introduction of gradation of individual criteria or their weighting factors.

Conclusions. As a result of the comparison of multi-criteria optimization methods, the effectiveness of the decision-making method in the multi-criteria space has been shown; it synthesizes a mathematical procedure related to the vector of criteria and is based on determining the ideal point and introducing the concept of a norm into the space of functionals; it has not been mathematically proven, but it is practically useful decision-making algorithm compared to the mathematical method of convolution of criteria. The optimization method proposed has advantages that are manifested in the possibility of using a relatively simple mathematical apparatus and simplified logic of obtaining a solution.