pharmacoepidemiological research:

1. Pharmacoepidemiological research: Estimation of use of the medical products which are released under recipes of the doctor (medical assistant) when providing additional free-of-charge medical aid (DLO) to separate categories of citizens who are having the right of reception of the state social help at a regional level Kulikov A.J. senior scientific employee at a lab of farmacoeconomics of MMA named after Sechenov Safiullin R.S. professor, managing faculty of management and economy of pharmacy Yarkaeva F.F. The State Medical University of Kazan

3. The purpose of this research Estimation of use and the subsequent definition of the need for medical products when providing additional free-of-charge medical aid to separate categories of citizens who are having the right of reception of the state social help in Republic Tatarstan

4. The tasks that are being worked To estimate volumes and structure of consumption of medical products (MP), received by separate categories of citizens under reembersment system (RS) in 2005 To allocate nosologic forms having the greatest prevalence and/or the greatest financial load The expert estimation of use of medical products under standards of rational application of MP by the people with diabetes, coronary heart disease (CHD) , hypertonic illness and breast cancer .

5. Further development of research To estimate expenses for medicinal maintenance under program RS, under condition of rational prescription of medicine To construct the forecast of MP consumption in RS program on 2008

6. Additional tasks To study dynamics of volumes and structures of consumption MP in 2004-2005 by the citizens who received MP under RS program in 2005 To study the possibility of use of data from personified registers of written out and paid medical services and medicines as indicators of conformity of medicinal therapy received by citizens to existing standards of rational therapy

7. The results RS received on all data file for 2005 in Republic Tatarstan

8. Scale of RS program 2005 in Republic Tatarstan Total of participants RS 216722 patients Total sum of the paid recipes 896 520 300 roubles Total of the paid recipes 2 543 599 pieces

9. The dynamics of growth of expenses for a year (million rbl.)

10. The dynamics of amount of the paid recipes (thousand)

11. The dynamics of the cost of recipes

12. Average recipe cost Average cost of the recipe has made 355, 59 rbl.

13. Quantity of recipes by age groups

14. Distribution of expenses on age groups (in rbl.)

15. Average of recipes one patient receives in a month 0,98

16. Average cost for 1 patient a year

17. Preliminary results RS program received during profound research for 2005 in Republic Tatarstan

18. Selection of diseases for the profound research for this purpose data given by FOMC RT have been analysed

19. Pharmacoepidemiological research Definition of sample of patients Gathering of the information from out-patient cards of patients for 2004-2005 Generalization and statistical data processing of questionnaires The analysis of MP�s consumption dynamics MP and medical services according to the profound research for 2004-2005

20. Distribution of expenses to medicinal maintenance under RS program in Republic Tatarstan

21. Nosologic groups�s distribution of number of the recipes which have been written out under RS program in Republic Tatarstan

23. Chosen nosologics for study by means of the basic questionnaire The arterial hypertensia Coronary heart disease, CHD Diabetes Breast cancer

24. Main questions in the poll-questionnaire Sex Age The basic diagnosis The accompanying diagnosis Aftereffects of illness

25. Main questions in the poll-questionnaire,therapy Regular therapy: prescription of MP in 2004 prescription of MP in 2005 the reason of change of therapy if it was observed Other therapy: in any other occasions (influenza , an otitis, etc.) prescription of MP in 2005

26. The analysis of information databases in RS and cards The analysis of structure and completeness of filling of databases Definition of prevalence of diseases among preferential categories of citizens RT (both chronic, and acute) Compatibility diseases�s definition Definition of a share of the citizens, really using preferential medicinal maintenance Definition of frequencies of MP�s prescription, original, generical medicinal forms Definition of frequency of MP�s prescription in relation to the most widespread nosologic units

27. Algorithm of work with cards Gathering of the information, entering of data Formation of an electronic database Formation of a pool of regional and federal experts Carrying out of the preliminary analysis Writing of the conclusion regional experts Preparation of preliminary results of research Report on research and the publication of results

28. Preliminary results The statistical analysis of prescription of medicinal therapy now proceeds During the analysis of a part of questionnaires on cardiovascular therapy within the limits of RS program in RT, preliminary results are received

29. Using inhibitor APF

30. Using a, �-adrenoblocker

31. Using calcium channel�s blockers

32. Using diuretics

33. The coordinated criteria of antihypertention therapy�s efficiency On a degree of the control the blood pressure: Therapy is inefficient - target levels of blood pressure are not achieved or achieved, but an achievement is kept no longer than two months in a row. Therapy is partially effective - target levels of blood pressure are achieved, but kept no more than 3 months. Therapy is effective - target levels are achieved and kept during all time of supervision, probably incidental (no more than 2 times a year and not successively) excess of target levels of blood pressure. As a whole 140/90 (blood pressure), for patients with a diabetes, diseases of kidneys - 130/80 (blood pressure).

34. Effectiveness of arterial hypertensia therapy

35. Outpatient reduction of hypertensic crisis

36. Outpatient visits

37. Number of hospitalizations

38. Estimation of rationality of MP�s use The analysis of conformity of therapy to existing standards Further steps: Definition of need and volume of expenses on MP Construction of the forecast of MP�s consumption on 2008 Development of the plan on monitoring and the further optimization of medicinal maintenance in RS system

39. 73 subgroups of patients Criteria: the Arterial hypertensia, CHD, chronic insufficiency of blood circulation, a heart attack of a myocardium in the anamnesis, a diabetes (I or II type), presence of complications of a diabetes, acute stroke of cerebral circulation (on ischemic, to the mixed type, passing), type arrhythmia, presence of accompanying diseases

40. Federal experts Will define the rational scheme of introduction of patients for each of 73 subgroups Considering frequency of prevalence of each group the forecast of MP�s consumption will be constructed in RS - 2008 in Republic Tatarstan