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Monday, February 19, 2018

Palliative care is not developed out of fear of addiction


The practice of pain management of non-oncological patients in our country just emerging, and that palliative care at home, it is still not possible to include in the OMS system in full. At the same time, oddly enough, the request of patients to pain relief is quite low. Doctors argue whether this is a General patience of the Russians or concerns “get hooked” on drugs.

About 3.5 thousand children in Moscow need palliative care, said in the beginning of the week children’s specialist of the Department of health of Moscow, chief physician of the children’s hospice “the House with the lighthouse” Natalia Savva.

“The pain is eliminated, not only drugs. Should be the study of pain. The need to properly diagnose, and for this a doctor needs to be certain knowledge”

“Of all the children who need palliative care, only 7% suffer from cancer, 93% have a non-cancer pathology, – quotes the Sava, the Agency “Moscow”. – Of non-oncological pathologies, 42% are congenital malformations and genetic diseases, 23% for diseases of the cardiovascular system, and 12% to disease of the neonatal period.”

Other regions are looking for ways to provide such assistance as quickly as possible. In early January in Khanty-Mansiysk Autonomous district have announced plans to create in the Nizhnevartovsk and Surgut mobile teams for palliative care for children. As explained in the Department of public and foreign relations of Ugra, such teams will become an alternative to hospice. According to experts of the regional clinical children’s hospital in Nizhnevartovsk, 95% of parents want their children in the most difficult period were at home.

Recall that palliative care is a system of measures aimed at maintaining the quality of life of patients with incurable, life-threatening and severe disease occurring at the greatest possible with this condition the patient comfortable level. In particular, palliative care aims to alleviate pain and deliver other anxiety symptoms.

“Monstrous bureaucratization home” drugs

At the end of last year the charity Fund “Children’s palliative” and Association of private clinics and experts of the Moscow headquarters of the popular front carried out a study on how the capital is palliative care. It surveyed 400 officials from health, representatives of relevant NGOs, doctors and patients in Moscow. The final report the weakest in this area mentioned quality of analgesia in clinics. This is due to lack of knowledge of physicians about existing medications, the algorithm of diagnostics and treatment of palliative patients. There are still problems with the discharge of narcotic drugs, in particular the reluctance of hospitals to dispense to the patient on hands medications for five days, although technically it is their duty.

The onf focus on the issue drew almost two years ago – after in Moscow, a wave of suicides of cancer patients who are unable to receive necessary pain medications.

In October, the newspaper VIEW published post of neurosurgeon, candidate of medical Sciences Alexey Kashcheev (Yekaterinburg) about why in the country “so poorly treated pain.” On the surface based on the answers regarding the actual health, he writes: the monstrous bureaucratization leave hard drugs, brutal sanctions against physicians for violations of formal rules, the existence of harmful and useless drug control mechanisms, the lack of registration at a clinically effective painkillers that only “small public procurement” on drugs. This blogger adds a low professional level of a huge number of their colleagues.

However, the background of all these problems Kashcheev sees outside of medicine – in the collective psychology. “The lack of a coherent supply on the market of anesthesia, economically speaking, due to low demand,” – said Kascheev, saying that many Russians do not even try to reduce the degree of his suffering and the suffering of their loved ones, because historically accustomed to suffer.

“Not all pain syndromes are eliminated drugs”

Chief freelance specialist of health Committee of St. Petersburg, the head physician of the hospice № 2 Zoe sofieva sure that the low demand caused not by the mythical habit to endure the pain and fears of many Russians become drug addicts. “This is a multifaceted situation. It is necessary to give information to the public. Here is more evident and insufficient knowledge of doctors about the drugs and the fear of the patient before the drug, says Zoya sofieva the newspaper VIEW. – The pain is eliminated, not only drugs. Should be the study of pain. The need to properly diagnose, and for this, a doctor must be certain knowledge.”

According to her, the townsfolk frightened by the publications on drugs, and it is “very difficult to reverse”. “There is fear of addiction. Relatives are afraid, say, “not drugs.” Scaring our patients, they say, drug planting… We, too, suffer from this information. We need to help. Now it is proven that narcotic analgesics lengthen the lives of our patients. The pain goes away, starts a quiet life without pain,” she said.

“We are now much easier than 25 years ago”

What she agreed with Kaseeva is that the skill level of many physicians remains low. Sofieva laments: the medical school do not teach palliative medicine, it is still not included in the basic education. “The practitioner is very difficult to get decent information. Worldwide being taught palliative medicine. Along with the diagnosis, prevention and treatment is a priority. Students from the first year know that they will treat a person with the first day of its birth till the last breath. And in Russia there is no specialty in palliative medicine, she said. – We are currently working with the Ministry of health to the profession.”

But in General, palliative care is actively growing – and the state has “great interest”, says Sofiev. “We feel it. We are now a lot easier than 25 years ago. The public is not only a medical, but officials also understand the problem. As the year comes complaints of refusal of assistance? Isolated cases in our million city. Society has developed so that demands for better conditions of life, especially in medical care,” says Sofiev.

Kashcheev also called “harmful and useless” many of the mechanisms of drug control. He suggested that the transfer of functions of Federal drug control service of the interior Ministry “had only worsened the situation.” Sofieva argues: the transfer of functions from the Federal drug control service of the Ministry of interior no problems arose – “we have a very fruitful work”. “We have not noticed this transition. This is a very good people, they really help us. The case established. Over the years all worked out quite clearly. With drugs no problem at all, there is a problem in that the drug is prescribed to patients too late,” said sofieva.

We will remind, in April 2015, the Ministry of health issued the order “On approval of the procedure for the provision of palliative medical care of adult population”, according to which the number of palliative beds in hospitals is expected to grow to a hundred for every million inhabitants of the region – this will create 1,400 jobs. It should be twice as better. According to Ministry of health, palliative care requires about 300 thousand Russians. By the end of 2015, the number of palliative care beds has increased compared to the 2014 year in 1,5 times and amounted to 7930 pieces.

“A prolonged form of drugs”

The report also lamented the fact that the clinics doctors substitute the most effective drugs their analogs – generic. For this reason the expert working group of the Russian popular front (onf) “Social justice”, Director of the Higher school of organization and management of health care Guzel Ulumbekova recalls that in Russia a lot of generics because they are cheaper.

“Around the world at public expense are paid mostly generics, with the exception of rare diseases against which analogs yet. Sometimes generics for quality and efficiency are not inferior to the original drug,” explained Ulumbekova the newspaper VIEW.

The market is seeing new products, and their need to explore, says Zoe sofieva. “Basically, it’s the perfect imported drugs. But we’re good with what we have. We have no bases, where they could see drugs. It’s the drugs. Our industry is not ready. But we already have the raw material used to make the pills, the patches. I would like to have more drugs for children with the appropriate dosage. This problem is solved,” she stresses.

“25 years ago, when I started palliative medicine, was the problem, but now drugs enough. Now we are facing problem that not able to prescribe the drug,” said sofieva, adding that it considers sufficient and the state order for such drugs.

To give patients a supply of “five days”

Experts have prepared recommendations for the relevant departments of the government of Moscow. In particular, to regularly inform the doctors of children’s polyclinics about new narcotic painkillers and their children’s forms clearly require hospitals to give patients a supply of medications for five days.

The authors of the report, which quoted the website of the popular front, has also proposed to include palliative home care in full volume in the system of mandatory health insurance (MHI), however, the government must increase funding. As explained Ulumbekova, today palliative care is paid for by the region. “Where can I get extra money?! Grants, which come from mandatory health insurance Fund territorial funds, in current prices grew by only one to two percent. And thanks to inflation, declined by four percent. That is, in real terms subsidy fall” – rhetorically asks Ulumbekova.

“If there is no money, then palliative care will be provided at the expense of other types of assistance that are paid by the OMS. Such a rich region as Moscow, instead of endlessly jump over sidewalks, let find the money for palliative medicine encourages the expert. – Moscow is one of the richest actors. Let not the greedy for it!”

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