In the framework of the IV all-Russian meeting of specialists in botulinum toxin therapy in Suzdal held a panel discussion of experts on the treatment and rehabilitation of patients with spastic paresis. Due to the lack of routing systems of patients and insufficient financing of pharmaceutical care, only 2% of those in need receive botulinum toxin therapy, the experts said.
The route is not built
The lack of systemic approach due to a number of factors — from routing the patient to the limited rates of clinical-statistical groups (CSG) to therapy with botulinum toxin. “The low level of availability of effective rehabilitation for patients with spasticity is a social problem that leads to direct economic losses of the state. In light of the fact that the duration and quality of life are strategic priorities of the state, requires full access for patients with spasticity to effective methods of medical and rehabilitative care, including the use of botulinum toxin therapy”, — said the Director of the division of specialized areas of the company Ipsen in Russia, Ivan Titov.
What was the reason for the low supply of patients with spasticity with botulinum toxin type a injections? Assist To identify difficulties and learn from the doctors, was conducted the online survey on the organization of medical aid and provision of medicines. Most of the respondents noted that the necessary range of measures. In second place was 30% of respondents that identified in the priority system the routing of patients.
Moderator — Director of the Center for social economy Ruslan Dreval noted that to build an effective health care system in this direction is necessary to solve problems in four areas: Finance, legal regulation, organization of medical care and its quality control. “It’s an interdisciplinary problem: it is obvious that the synchronization of activities between the professional community, healthcare managers and patient community,” said Mr. Dreval.
Co-chair of the all-Russian Union of patients Yuri Zhulev confirmed the problem: “When the doctor refuses a patient treatment, we understand that it’s not his fault, a lack of funds, the administrative burden. And here uniting the efforts of the patient community should help to overcome these difficulties.”
Patronage on their own
That today’s rates of KSG insufficient for full amount of botulinum toxin therapy, is known to every doctor. Physician-neurologist Department neurorehabilitation is nmhts them. N. And. Pirogov Eduard Novak admitted: “In the treatment of spastic paresis in KSG faced with the fact that for quality the treatment of spasticity and maintain a long-term effect required according to the instructions recommended dose. These volumes do not fit into the new tariff of KSG, which is obtained even with a correction factor in the area of 34 thousand RUB For example, with the current cost of any of the botulinum toxins, and even cost-effective Dysport for the treatment of arm spasticity after stroke, requires the expenditure of at least half of the fare. To achieve the goals of treatment should be two to three vials of BTA. Still need to add expenses for hospital and rehabilitation. Therefore it is necessary to invite the patient in a month for another re-introduction, however, the most difficult to reach regions. In the end, the botulinum toxin therapy loses its clinical effectiveness”.
A significant component of the successful treatment of spastic paresis is not only the introduction of BTA in the spastic muscle, but further rehabilitation program. To the solution of problems at the ambulatory stage are connected and private organizations. For example, Ipsen has developed a program of I-Can, allowing the home saturability.
A separate block of problems is the continuity of medical care. Shared their experiences of the home D. a neurologist yuao of Moscow Rafis of Shikhkerimov. “Problems arise including because of the lack of a unified electronic database for hospitals and clinics. When the patient is discharged from the hospital, the doctor has this information as long as the patient will not seek medical help. This was the reason for the introduction of a uniform system for obtaining patient data via secured communication channels from the hospitals and distribute them across locations in the clinic. The neurology clinics hold the patronage, the patients are entered in the register and in the identification of spasticity is directed to a botulinum toxin therapy”, — said the expert.
But he admits that the disadvantage of this system is the need for constant control, and for that she should not be local manual control, and Autonomous. Need domestic economic, legal frameworks, the interest of the doctors. “If today 2% of those in need receive botulinum toxin therapy, then increase to 4-5%, would require a dramatic increase in the resources of medical care,” said Mr. Shikhkerimov. A key aspect for the development of infrastructure remains the case. But there is no legal framework, a unified information platform for all regions. Namely, the register allows you to make an evaluation of the effectiveness and planning of therapy.
Resolution as a revolution
In its resolution the participants of the forum drew the attention of the relevant medical community and regulators on the need to adopt the following measures. The MoH — approved clinical guidelines medical and rehabilitation care of patients with spastic syndrome. Specialized medical communities — to develop and submit proposals to the Ministry of health to change the existing order and standards of care, given the characteristics of the routing of patients, and to develop an optimal model of the register of patients with spastic syndrome for subsequent implementation at the regional and Federal levels.
The heads of health authorities of constituent entities of the Russian Federation proposed to develop and adopt at the level of each of the subject orders “On the routing of patients with spastic syndrome.”