In 2021, Ukrainian pharmacies to sell antibiotics only by electronic prescription. The corresponding system is already being developed, and it should be launched on April 1. First, they will issue prescriptions for insulin, immunosuppressive drugs, and narcotic drugs. Antibiotics are already the second phase of the program.
Healthcare minister Stepanov gives three arguments in favor. First, the Ministry of Health will strengthen control over the issuance of prescriptions and the sale of drugs in pharmacies.
The second – for pharmacists less bureaucratic red tape and paperwork. After all, now pharmacies must keep paper prescriptions for a year after they are used for inspections by the State Medicines Service.
Third, this will allow forming a clearer idea of what medicines Ukrainians need, in what quantities, and exactly what types of medicines Ukraine should buy abroad (if imported) or produce locally (if they are domestic).
The fourth argument in favor of this program is that Ukrainians will stop self-medicating. This problem has become especially relevant during the coronavirus pandemic, when the use of antibiotics, according to the Ministry of Health, has increased by 5-6 times in some population groups. Ukrainians are increasingly taking antibiotics not as prescribed by a doctor, but on their own, without any reason for this, although this group of drugs does not even work against viral diseases, which include Covid-19. All this creates an artificial shortage of this group of drugs.
Such irresponsibility negatively affects the health of not only an individual but the entire nation. It has been proven that the use of antibiotics leads to the development of antibiotic resistance in bacteria.
Therefore, for example, patients with a bacterial sore throat will spread the disease against which there will be no effective drugs. After all, causative agents of the disease will have time to "get used" to the drugs that neutralize them, provided that these drugs are widely used.
But bacterial sore throat is not yet the worst disease. The Public Health Center of Ukraine warns: the formation of antibiotic resistance among the population will lead to the fact that we will lose the ability to treat simple diseases that have long been defeated. Possible consequences include the following:
- bacterial pneumonia will become a fatal disease;
- women will die more often during childbirth;
- cancer treatment will become more complicated, because often during chemotherapy, patients are given prophylactic antibiotics;
- many sexually transmitted diseases will become incurable again;
- people will die more often from complications after surgery;
- tuberculosis will be a sentence again
The scheme by which it is proposed to dispense prescription drugs in the future is not completely clear. Obviously, it will look like this: the patient first gets an appointment with the family doctor, who, if necessary, refers him to a narrow specialist (if we are talking, for example, about dispensing insulin), then the patient's name is entered into the general e-base, which they have access to. all pharmacies.
But the fact not all Ukrainians signed the declaration with the family doctor. This means that not everyone will be able to get a prescription. And this is the main argument against it.
The Ministry of Health informs that today 26% of Ukrainians do not have a family doctor. At the same time, the lowest indicator of the number of submitted declarations, and, consequently, the choice of your family doctor is in Luhansk (23%), Donetsk regions (33%), and Kyiv (72%). The likely reason for this delay is the low confidence in domestic medicine in general. According to the "Health Index. Ukraine", almost every fifth Ukrainian will not go to the doctor, because he does not trust doctors.
And, according to the sociological group "Rating", the Ministry of Health of Ukraine is trusted by 33%, and not trusted by 54% of respondents.
In general, there are many complaints against the Institute of Family Physicians. Citizens note that the system works poorly and in case of dismissal or even death of a doctor, no one informs patients about it. This means that an unpleasant "surprise" is the situation when you find out, retroactively, that you were left without your doctor, and therefore without consultations, referrals, or prescriptions.
Antibiotic prescriptions will only be issued online. However, the digitalization of the population is sinking: not all Ukrainians have access to the Internet. Electronic databases are not perfect. Parents of preschoolers know this well. Electronic queues for kindergarten did not justify themselves, and quite often a child whose turn was about to come up suddenly ended up at the end of the list.
It doesn't have to be the same with e-prescriptions. However, it is obvious that some time will pass until the work of prescription e-bases will get better. And the terms announced by the Ministry of Health (transition from April 1, 2021) look too optimistic. At the same time, the ministry does not report that software development is still ongoing.
The third argument "against" as of now can be considered unfounded. But there are fears that the issuance of prescriptions will turn into a profitable business for Aesculapian. As we understand, in conditions of high corruption of Ukrainian officials, such fears are not unfounded.
In any case, reports of bribes demanded by doctors for assigning a disability group to ATO fighters are received regularly. From the latest news - the detention on December 17 by investigators of the State Bureau of Investigation of a military doctor of the National Military Medical Clinical Center "Main Military Clinical Hospital:" a woman demanded from a combatant an "unlawful reward" in the amount of 6,300 USD.
With the transition to prescription dispensing for some drugs, with a high probability, a black market will simply form, which, in fact, is taking place now. From time to time, investigative journalists write essays on the topic "How we ordered prohibited drugs to the editorial office," which is really easy to do.
On a Google search, the first site that came across offers to buy over-the-counter narcotic analgesics tramadol and methadone, which are "popular" in certain circles. It is not difficult to predict that the site will expand its assortment with antibiotics if they are included in the list of prohibited drugs.
The Ministry of Internal Affairs, unfortunately, does not keep statistics on drugs banned for free sale, seized on the black pharmaceutical market, and therefore it is difficult to say which segment of it. However, the messages of the security department are full of information about uncovered illegal transactions. For example, in the Donetsk region, the police, together with the regional prosecutor's office, documented the sale of drugs without a prescription - almost 60 thousand doses of codeine-containing drugs worth 1,200 USD at black market prices. And there are plenty of such cases.
The work of online pharmacies is especially chaotic. In the EU, the online sale of medicines is regulated by Directive 2001/83/EC. But each country has national legislation providing for the classification and differentiation of prescription / non-prescription drugs. In Ukraine, this is a complete mess, says Oleg Klimov, chairman of the board of the All-Ukrainian Pharmaceutical Chamber. It is necessary for the Ministry of Health of Ukraine to prepare a list of medicines that the patient is allowed to order online. At the same time, it is necessary to provide the doctor with the opportunity to control the use of prescription drugs, he says. It is important, Klimov adds, that online pharmacies have mandatory labeling of websites with a special logo, which is entered into a single register.
But all this has not been done in Ukraine.
The expert community is inclined to believe that prescription antibiotics are necessary. Only first, it is necessary to strengthen control over the pharmaceutical market, streamline and license the activities of pharmacies, and only after that form a list of prescription / non-prescription drugs. In addition, before the introduction of changes in antibiotic circulation, it is necessary that the e-bases of the Ministry of Health work "perfectly, and the number of Ukrainians who have a family doctor should approach 100%. Otherwise, the government's plans will look at least irresponsible.