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Ministry of Health (SAM) as of October 1. is preparing to introduce a radically modified procedure for the prescription of drugs for hypertensive diseases, which, according to doctors, will affect 730 thousand in one way or another. Lithuanian population. However, to the project, which was blessed with the signature of Minister Aurelius Veryga, but postponed several times, both doctors and those who suffer from these diseases oppose the project.
According to doctors and representatives of the affected communities, the new procedure promised by A. Veryga is common sense and suspicious: the project prepared in the working group is complemented by amendments prepared by an unknown person, and hypertensive patients will not receive treatment but experiments with the cheapest drugs. . Not only that, when the doctors expressed their dissatisfaction, SAM took a smart action: a few days ago an offer was made to prescribe family doctors with financial bonuses for prescribing the cheapest drugs.
Instead of good medicines, the cheapest ones.
The dissatisfaction of doctors and patients with the new procedure blessed by A. Veryga is so great that it was decided to speak in public: at a press conference held on Tuesday, several authorized doctors revealed a new procedure for prescribing drugs for high blood pressure and its shortcomings: the president of the Lithuanian Heart Association, doc. Sigita Glaveckaitė, Professor at the Lithuanian University of Health Sciences (LSMU), Head of the Department of Heart Failure and Defects at the Kaunas Cardiology Clinic, Gintarė Šakalytė and Gediminas Urbonas, Associate Professor of Family Medicine Clinics, LSMU MA . Along with them, Gediminas Augustaitis, a member of the Lithuanian Heart Association, who is treating hypertension, also participated.
According to the doctors, the order, that as of October 1. intends to present SAM, it goes against all the experience that they and their colleagues have been able to gain.
“All global recommendations state that the easiest and most effective way to improve drug use is to combine several active ingredients in one tablet, the so-called fixed drug combinations or polyhabs. This improves drug use almost twice, “said G. Šakalytė.
According to the professor, efforts are being made to treat the patient with as few tablets as possible, which should be reflected in current and future treatment regimens. However, A. Veryga’s own procedure will tie the hands of doctors: instead of drugs containing various active ingredients, they will have to receive the cheapest ones, regardless of how they affect a particular patient.
“The complications of hypertension depend not only on a healthy lifestyle, but also on medication. All the current guidelines in Europe do not speak of treatment with the cheapest drugs, but of individualized treatment, the most suitable drugs for a particular patient.
Let’s take medicines that lower blood pressure but at the same time lower heart rate, called beta blockers. Their duration of action is not the same, they are eliminated differently, the interaction with other drugs is also the same. If a doctor wants to prescribe a new treatment, he simply will not be able to take all these aspects into account; you will have to write the cheapest drug, which is currently on the VLK website, ”said G. Urbonas.
Gediminas Urbonas© Dominykas Griežė
“If the description goes into effect with nightly corrections from SAM staff that have not yet been submitted, there will be no more interest from patients or the role of a physician in treating high blood pressure, and there will be no more individualized treatments.”
In principle, neither the patients nor the doctors are satisfied with it, and no one seems to have calculated or intends to count how much will be saved ”, added the doctor.
Amendments by unknown who
Doctors are concerned not only about the new procedure for prescribing antihypertensive drugs, but also about the way it was adopted; According to the doctors, the new procedure was coordinated in the working group for almost a year, but finally Balažin whose additions and modifications are proposed for which no one assumes responsibility.
“That description was developed by the task force throughout 2019, approved by a vote of the task force, and presented to the minister for signature. The description was due to take effect on January 1, with so-called nightly changes, changes made by unknown SAM personnel, for which the minister apologized and said the description would be postponed and effective at a later date in accordance with the work group and the academy.
Since May 17. that the description was postponed until October 1, it should now come into effect exactly the same: no changes, with nightly changes that say that when prescribing compensatory drugs for high blood pressure, the family doctor should choose not the drug that is most suitable for a particular person, but the one that is the cheapest at that moment ”, said G. Urbonas.
Doctors who spoke in public also revealed one of the reasons that led them to speak: according to G. Šakalytė, although medical representatives participated in the working group that developed a new prescribing procedure, the scientific evidence was finally handed over to the scientific evidence .
“Naturally, each disease has its own rules and methods of treatment. It is logical that they are elaborated by specialists, as was the case in the working group. We worked there, we went to the ministry more than 10 times and the meetings lasted from 3 to 4 hours The discussions were intense enough, we showed scientific articles.
Where now we have some dissatisfaction about whether we distrust ourselves as professionals, it is because the changes have not been coordinated. If the changes have any logic or meaning, we understand the need to save money: we only prescribe the treatment we need, we do not prescribe all the pills. We thought we had reached a compromise: we prepared a document that complies with European guidelines, convenient for family doctors, we try to make the document acceptable to everyone and we cannot comment on the changes because we do not know how or when they occurred, “he said. G. Šakalytė.
Gintarė Šakalytė© Dominykas Griežė
Proposal for doctors: close your eyes and take the money
Doctors who attended the conference also revealed the SAM maneuvers taken when discontent with the new order in the medical community emerged.
“It just came to our attention then. Last week instead of an imperative required It is planned that recommended locate. But along with this initiative, the SAM Chancellor circulated a document to the medical societies and the academy that had to be agreed within three days, until yesterday.
The associations had to consider the issue of the so-called good work results: additional payments to family doctors are encouraged for good results, the project foresees that a good result of the work of a family doctor will not be a reduction in blood pressure , not an improvement in the quality of life, but the prescription of the cheapest medicine “, said G. Urbonas.
G. Augustinaitis, a member of the Lithuanian Heart Association, which treats hypertension, did not hide his emotions during the conference; according to him, the new procedure for prescribing drugs is ahead of humanity.
“It absolutely does not occur to me where these people come from. They seem to be from a test tube, kind of artificial, don’t they have grandparents or parents? It is a kind of humanization ”, commented G. Augustaitis.
Sigita Glaveckaitė, Gediminas Augustaitis© Dominykas Griežė
Sick every third
According to G. Šakalytė, the new procedure for prescribing antihypertensive drugs may be relevant for about one in three Lithuanians. Impaired cardiovascular function remains one of the leading causes of mortality in Lithuania.
“Every year in Lithuania about 21 thousand. Cardiovascular disease, which accounts for 55% of life. Of all deaths,” said S. Glaveckaitė. According to the doctor, we are strongly “leaders” in Europe in this field.
“Unfortunately, the situation in Lithuania is not improving, which is also reflected in the EU statistics. The number of deaths from cardiovascular diseases in Lithuania is 2.5 times higher than the EU average, and the number of deaths for ischemic disease is almost 7 times higher than the EU average, ”said S. Glaveckaitė.
