Selekoksib Kodein Tramadol
MALİYET
1. Basamak Sağlık Hizmetleri İçin Akılcı İlaç Kullanımı İlkeleri Doğrultusunda Bireysel Formüler Oluşturma Rehberi ve Kaynak Kitap
Doğru hastaya doğru ilaç/ ların doğru doz, dozlam ve süre ile uygulanacak şekilde ve kabul edilebilir en düşük maliyetle seçilmesi ve reçete edilmesi hekimlik uygulamalarının en önemli becerilerinden birisidir. Akılcı İlaç Kullanımı (AİK) olarak 1985 yılında Dünya Sağlık Örgütü (DSÖ)’nün Nairobi toplantısında tanımlanan bu eylem eğitim bilimi açısından hem bilişsel hem psikomotor hem de tutum becerisi içeren karmaşık bir eylemdir ve ülkelerin sağlık harcamalarını belirleyen doğrudan bir etkiye sahiptir. Gerek gelişmiş ülkelerde gerek gelişmekte olan ülkelerde farklı nedenlerle deyimlenen akılcı olmayan ilaç kullanımının önlenmesi amacına yönelik DSÖ’nün çözüm önerileri, 30 yılı aşkın bir öyküye rağmen, DSÖ’nün kendi değerlendirme raporlarında hala kendine yer bulmakta ve AİK’in hekimlik uygulamalarına etkili bir şekilde yerleştirilmediği ifade edilmektedir. Ülkemizde de ilki 2014-2017, ikincisi 2018-2022 yıllarını kapsamış/ kapsayacak AİK Ulusal Eylem Planı çalışmalarına rağmen sağlık harcamalarında ilaca ayrılan pay hala kabul edilebilir düzeyin çok üzerinde seyretmektedir. Gerek DSÖ’nün gerekse ülkemizdeki AİK Eylem Planlarının temel çözüm önerisi “eğitim” dir ve ülkemizde tıp fakültelerinin büyük çoğunluğunda AİK ilkeleri eğitimi verilmektedir. Problemin hala gündemde olması, bir-iki örnek üzerinden verilen ilkeler eğitiminin, farklı nedenlerle de olsa, AİK ilkeleri bilgisinin “transfer” edilemediğini göstermektedir. İşte tam bu noktadan hareket edilerek, bu tez çalışması kapsamında, AİK ilkeleri bilgi/ becerisinin transfer edilebilmesini kolaylaştırmak, sürekli tekrar ile özümsenmesini sağlamak için, çalışma kitabı (study guide) niteliğinde bir kaynak kitap oluşturulmuştur. Kitap içeriği için ülkemiz Mezuniyet Öncesi Tıp Eğitimi Ulusal Çekirdek Eğitim Programı temel alınmış ve mezun hekimlerin birinci basamak sağlık hizmetlerinde tanı ve tedaviden bizzat sorumlu oldukları enfeksiyon hastalıkları için ilaç listeleri oluşturmakla sınırlandırılmıştır. Kullanıcı dostu olması için görsel niteliğine ağırlık verilmiş, kuramsal bilgi yüklemesinden kaçınılmış, kendi kendine öğrenmeyi tetikleyici olmasına özen gösterilmiş ve çalışma kitabının tamamlanmış son şeklinin “bireysel” ve “formüler” özelliklerine sahip olması sağlanmıştır. Uygulamalar için DSÖ’nün altı adım modeli kullanılmış olmakla birlikte alanyazında ilaç önceliklendirme için kullanılan tüm yöntemler tartışılmıştır. Kitabın işlerliği açısından alınacak geri bildirimlerden sonra, iyi planlanmış multidisipliner bir AİK Eğitim programı ile Mezuniyet Öncesi Tıp Eğitimi Dönem IV-VI süresince çalışma kitabının tamamlanmasının ve öğrencilerin mezun olurken, birinci basamak sağlık hizmetlerinde tanı ve tedaviden sorumlu oldukları enfeksiyon hastalıkları için reçete yazabilecek tüm özellikleri içeren ilaç listelerinin ve bireysel formülerlerinin hazırlanmasının sağlanması amaçlanmaktadır.
138 Anahtar Kelimeler: Akılcı İlaç Kullanımı, Bireysel Formüler, Birinci Basamak Sağlık
139
SUMMARY
Guidance and Resource Book For Personal Formulary In The Context Of Rational Drug Use For Primary Health Care Services
The selection and prescription of the right drug/drugs for the right patient in the right dose and dose intervals for the right with the lowest acceptable cost is one of the most important medical skills. It has been defined as Rational Drug Therapy (RDT) by World Health Organisation (WHO) at its Nairobi meeting in 1985. From an educational point of view, it is a complex skill involving all the three basic skills namely cognitive, psychomotor and attitude. Moreover, it has a direct effect on the health expenditure of countries. Despite its 30 years background, the solution proposals of WHO for the prevention of irrational drug use experienced both in well developed and developing countries, although with different reasons, they are still on the agenda of WHO evaluation reports which pass the opinion that RDT has not been effectively imbedded in medical practices. Moreover, despite the efforts and decisions undertaken in line with the first (2014-2017) and second (2018-2022) National Action Plan for RDT, the quota allocated to drug use within the total health expenditure is highly over an acceptable level. Education is in the centre of both WHO Reports and National Action Plan for RDT in Turkey. And, it is known that education directly related to RDT is given in most of the medical schools in Turkey. But, it is clear that “transfer effect” expected from RDT education relying on jest one-two examples has been inefficient. Thus, the present study has been undertaken to create a reference study guide to fascilitate the transfer of RDT principles knowledge and skills and assimilate by continuous repetition. National core curriculum for medical education has been used for the content of the guide book and drug lists creation has been limited to enfectious diseases which have to be diagnosed and treated within primary health services. Special attention was given to visual quality and avoidance of theoretical information overload to make it user-friendly and fascilitating self-learning. Moreover, care was taken to create a systematic design, to qualify as “personal” and “formulary “ when completed. Although WHO six-step model was used for the practices, all drug prioritization methods described in the literature where discussed. It is planned to take feedback for its interoperability and following feedback, with a well organized multidisciplinary RDT curriculum for years IV-VI medical education, it is planned to have the students complete the guidebook and thus, have their drug lists and personal formulary, with all the necessary details of drugs for prescription, ready until graduation.
Keywords: Rational Drug Use, Primary Health Care, Personal Formulary, Study
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