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English Language Page Norms of clinical spending on medications can significantly differ depending on the region. For example, in the Komi Republic the daily norm of spending on medications is only 13.99 rubles per patient, in the Astrakhan region — 20 rubles per patient, while in Karelia it is 36 rubles per patient, in Arkhangelsk — 39 rubles, and in St. Petersburg — 45.12 rubles per patient. Hospitals that are able to independently enter agreements with foreign pharmaceutical companies and purchase the drugs they need directly from them are in a much better position than others. For example, the Kaliningrad regional psychiatric clinic #1 spends 32 rubles per day per patient to acquire a wide assortment of required pharmaceuticals, including a sufficient amount of new generation drugs (40%). The Tyumen regional hospital enters into agreements with companies producing pharmaceuticals in Belgium and Denmark which results in the fact that it also is well supplied with new generation drugs in sufficient quantities. Hospitals that are provisioned with medications centrally sometimes experience interruptions in supplies of pharmaceuticals. The Health Care Ministry of the Moscow Region has purchased a five-year supply of amitriptiline and sibazon which resulted in surpluses of these drugs in the Moscow regional psychiatric clinic #2 while other medications are in short supply. The principle of assigning concrete suppliers to a particular hospital sometimes impedes the acquisition of drugs required by this clinic. For example, the Krasnodar territorial psychiatric clinic, the Ukhta psychiatric clinic of the Komi Republic and some other hospitals are sometimes unable to spend the money they have because the drugstores assigned to them do not have the pharmaceuticals in stock that their patients require at that particular moment. Lack of sufficient and regular funding when the major portion of funds arrive at the hospital at the end of the year in fact creates a situation in which hospitals simply do not have enough time to spend the money they have received. If a hospital fails to spend the money before the end of the fiscal year it simply loses it. It was discovered in the course of the survey that a relatively large number of psychiatric institutions (36 or 39%) are not only unable to provide their patients with medical assistance at the level of modern standards, but some of them are also deprived even of a guaranteed minimum amount of psychotropic and anticonvulsant drugs of the old generation. The need of these hospitals in drugs is met by only 50% and they experience a severe shortage of new generation drugs. Usually it is patients themselves who buy them (see Appendix 4). Due to the high cost and lack of funding new generation drugs are practically never purchased. For example, the chief physician of the Perm regional psychiatric clinic admitted that they bought new drugs only to keep their doctors updated on the most recent developments in the pharmaceutical industry that caters to psychiatric clinics. Head of the psychiatric department of the Altai republican hospital said that they never bought new drugs that cost more than 1,000 rubles, especially considering that “old ones were more effective.” At the same time many psychiatric practitioners have a high opinion about new generation drugs and regret that their clinics cannot afford buying enough of them. Hospitals that are in a position to buy new generation drugs administer them first and foremost to children and patients who have fallen ill for the first time. Hospitals that experience a severe deficit of even basic psychotropic drugs, including neuroleptics and correctors, are in the worst position. Among them are the Republican neuro-psychiatric dispensary of Kalmykia, Kotelnicheskaya psychiatric clinic of the Kirov region, Kostroma regional psychiatric clinic, Nizhnii Novgorod city psychiatric clinic #1, the Republican psychiatric clinic of Mordovia, the Smolensk psychiatric clinic, the Chita regional psychiatric clinic #1 and the Ulyanovsk regional psychiatric clinic #1 named after Karamzin. Patients of these clinics have to buy the majority of their drugs themselves and if they are not in a position to do so — content themselves with most common and primitive drugs. In such cases one has to choose from among two or three available names. Sometimes drugs are not available at all and the only alternative is to apply restraint measures when the patient is agitated. The survey showed that the lack of disposable instruments remains to be a serious problem for some of the hospitals. Current supplies are not sufficient in the Prokhladnensk district psychiatric clinic of Kabardino-Balkaria, the Kotelnicheskaya psychiatric clinic of the Kirov region (15%), the Kostroma regional psychiatric clinic, the Smolensk regional psychiatric clinic and Smolensk city psychiatric clinic, Vladivostok city psychiatric clinic of the Primorsky territory, the Republican neuro-psychiatric dispensary of Kalmykia, the Ulyanovsk regional psychiatric clinic #1 named after Karamzin, Shadrinsk neuro-psychiatric dispensary of the Kurgan region, and the Kuznetsk psychiatric clinic of the Penza region. Patients of these institutions have to independently buy their disposable instruments. Sometimes a severe deficit of medecines is compensated by utilization of complex methods of therapy that are sometimes traumatic for patients. For example, the insulin-comatose therapy is administered in 11 clinics, while the electric-convulsive therapy — in 17 psychiatric institutions. Attitudes towards these methods differ: some practitioners are of the opinion that they have become obsolete, others think them very effective but too difficult to administer. In all the hospitals the above methods are used with consent of the patient (in some cases consent of patient’s relatives is also obtained) or based on the decision of psychiatric commission if the patient is unable to provide an informed consent, supported by a signature on a special form and a relevant entry in the patient’s records. |
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