Objective: The objective of this research was to formulate the theoretical approaches to the improvement of pharmaceutical care considering the modern requirements of the public health system in Ukraine.Methods: The analysis of pharmaceutical care has been performed using “policy triangle” model. The pharmaceutical care policy model has been developed by applying the process approach.Results: The model of pharmaceutical care as a structural element of the national health policy has been developed. This model describes mechanisms by which the content, context, and process of the pharmaceutical care policy are influenced by the content, context, and process of the national health policy. Furthermore, we have defined the actors of the pharmaceutical care policy which are groups and organizations of various levels involved in the formation and development of the pharmaceutical care policy. Then, the structure of the pharmaceutical care policy has been elaborated. This policy is integrated into the national health-care system and is adapted to the good pharmacy practice requirements. The center of the policy is a process of pharmaceutical care delivering. The inputs, outcomes, management, and resources that are required for the pharmaceutical care process and provided by the actors have been identified. The data streams within this structure demonstrate implementation of the key elements of the pharmaceutical care process: Patient involvement, patient counseling and education, interprofessional collaboration, documentation of interaction, and follow-up. Furthermore, the mechanism of continual education and increasing of the professional level has been described in this structure.Conclusion: Proposed framework provides a comprehensive view of pharmaceutical care as a structural element of the national health policy considering new trends of the Ukrainian health system. The proposed model of the pharmaceutical care policy allows policy-makers to address all critical-to-quality aspects and stakeholders’ needs.
were questioned/ Most of them 188 (80%) live in Moscow, 47 (20%) -in the Moscow region. The average term of labor was 39 ± 2 weeks. 99 (42%) had first pregnancy, 82 (35%) -the second, 31 (13%) -the third, in 24 (20%) -4 or more pregnancies. 160 patients (68%) had no problems with movements, moderate difficulties were noted in the remaining 75 (32%) of the respondents. Also, the majority -193 (82%) didn't experience difficulties with self-service, 42 (18%) experienced moderate difficulties. Daily activity wasn't impaired in 153 (65%) patients, and 82 (35%) had some problems with the daily routine. 60 respondents (25.5%) didn't complain about pain and discomfort during pregnancy, more than half: 155 (66%) experienced moderate pain and discomfort. 20 (8%) of the women surveyed experienced severe pain and discomfort. Only 49 respondents (20%) didn't experience anxiety and depression, 136 (57%) noted a slight anxiety, in 30 women (13%) these feelings were strongly pronounced. The average score of QOL measured with the visual analogue scale (VAS) was 0.76 ± 0.15. Data of QOLwere higher in patients attened special group for physical exercices during pregnancy (p<0,05). ConClusions: in most cases there were no changes in physical activity of patients, psycho-emotional changes, such as anxiety and depression, pain and discomfort were noted. It can be improved by physical activity.
convergent validity). In EFA/CFA, discriminant validity was assessed by comparing the variance extracted estimates (AVE) to the squared correlation (Corr2). Convergent validity using EFA/CFA was evaluated by the extent to which one instrument's dimension and summary/utility scores loaded onto the same factors as the scores of other instruments. RESULTS: Tests of difference showed that all three instruments discriminated between respondent characteristics in the same direction. The AVE (range: 0.4122-0.5991) from EFA/CFA was greater than Corr2 (range: 0.0001-0.00245) also suggesting good discriminant validity. In terms of convergent validity, weak to moderate convergence was observed using tests of association with correlation higher between the WHQ-23 and SF6D (correlation range: 0.19-0.77 and Krippendorff's' alpha range: 0.17-0.69). Similarly, in EFA/CFA, the WHQ-23 and SF6D were found to load onto more common factors than the WHQ-23 and EQ-5D-5L. All factor loadings were 0.59 suggesting moderate convergence. CONCLUSIONS: These results suggest that EFA/CFA yields similar results as tests of difference/association and may therefore offer an appropriate alternative approach for the validation of QoL instruments.
trials' data were retrieved from the Haute Autorité de Santé (HAS) website and the Number Needed to Treat (NNT) to prevent one event (progression, death) was estimated. An Absolute Loss of Chance (ALOC) index was calculated over the time-lag period and per time unit combining NNT and HAS target population size. Drugs with level 5 Added Medical Value (ASMR, Amélioration du Service Médical Rendu) were excluded. Results: Twelve drugs were granted a EUMA for solid tumours in 2012 and 2013 with level 2-4 Added Medical Value: one drug of level 2-important (trastuzumab emtansine), five drugs of level 3-moderate (cabazitaxel, vemurafenib, critzotinib, pertuzumab, and enzalutamide), and six drugs of level 4-minor (eribuline, ipilimumab, abiraterone, vandetanib, axitinib, and vismodegib). The time-lags between EUMA and FPRD ranged from 7.4 months (enzatulamide) to 29.9 months (cabazitaxel). Concurrently, the overall ALOC ranged from 9 to 799 medical events which might have not been prevented unless alternative access (Compassionate, Clinical Trials), depending on drug, indication and time-lag. ConClusions: Early patient access for innovative drugs in oncology might help preventing a substantial number of progressions and deaths. ALOC might support patient access decision making process.
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