Current approaches to medical care optimization for patients with multimorbidity. Diachuk D.D., Hidzynska I.M., Moroz G.Z., Tkachuk I.M. Scientific interest to the problem of multimorbidity is increasing due to the increase of the number of such patients. The aim of this work was to analyze and summarize current approaches to optimizing care for patients with multimorbidity and the results of their implementation in clinical practice. Since the beginning of this century, a number of documents have been created by WHO, government agencies and professional medical societies to improve medical care to patients with multimorbidity. The evidential basis of the effectiveness of the majority of the proposed measures based primarily on expert consensus. In 2016 NICE has published a clinical guideline NG56 «Multimorbidity: clinical assessment and management», WHO -a monograph «Multimorbidity: Technical Series on Safer Primary Care». In 2017 NICE has published a quality standard -Quality Standard №153 «Multimorbidity». The strategy of improvement of medical care for patients with multimorbidity is directly related to the patient-centered approach formation, which includes comprehensive assessment of the patient's condition. The main component of medical care is the definition of a realistic goal of medical intervention according to patient`s preferences, and making the choice of the optimal amount of diagnostic, treatment, and preventive measures, which can lead to the desired goal. A number of studies (the 3D randomized controlled trial, the MultiCare AGENDA, the SPPiRE study, the WestGem study etc.) have being conducted to evaluate the effectiveness of implementing proposed approaches in clinical practice. The results of the studies and meta-analysis do not provide conclusive evidence of the medical and economic effectiveness of their implementation at the presentstage. Improving the outcomes of medical care to patients with multimorbidity involves conducting further clinical trials that can provide evidence to determine the list of most effective interventions for clinical practice. Реферат. Сучасні підходи до оптимізації медичної допомоги пацієнтам з мультиморбідністю. Дячук Д.Д., Гідзинська І.М., Мороз Г.З., Ткачук І.М. Науковий інтерес до проблеми мультиморбідності зростає через збільшення кількості таких пацієнтів. Метою цього дослідження було проведення аналізу й узагальнення сучасних підходів до оптимізації медичної допомоги хворим з мультиморбідністю та результатів їх впровадження у клінічну практику. З початку цього століття ВООЗ, державні установи та професійні медичні товариства створили ряд документів для вдосконалення медичної допомоги пацієнтам з мультиморбідністю. Доказова база ефективності більшості запропонованих заходів в основному ґрунтується на консенсусі експертів. У 2016 році NICE опублікував клінічні настанови NG56 «Мультиморбідність: клінічна оцінка та управління», ВООЗ -монографію «Мультиморбідність: Технічна серія щодо безпечної первинної допомоги». У 2017 році NICE опублікував стандарт якості -...

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Abstract. In light of the coronavirus pandemic (COVID-19), we carried out a regular review of the information resources of international organizations specializing in combating infectious diseases, as well as governmental and intergovernmental organizations of the world's leading countries with strong economies and stringent regulatory systems in January-December 2020.          The analysis of the materials accumulated on the monitoring results revealed some differences in the legislation and practice of health care organization in Ukraine. First of all, this is a small number of registered clinical trials on COVID-19 prevention and treatment, as well as the lack of permit to use medicines for the indications which are not in basic prescribing information, in particular, "compassionate treatment" programs or emergency access to medicines, which are in clinical trials.          In the absence of traditional evidence of the health interventions effectiveness, it is necessary to emphasize the importance of identifying reliable information sources, transparency, quick and widespread information disclosure and experience exchange on challenging issues of resource and risk management, communication and public health activities, discussion of organizational forms and clinical activities in public health in the vast majority of countries. The establishment of independent monitoring and analytical centers, the participation of professional communities in various studies is an example of the rapid scientific data acquisition and supporting recommendations on various aspects of countering the pandemic. Based on the analysis of international data published in reliable sources, the legislation has been changed in Ukraine, the approaches to planning the transformation of the health care system have been identified to increase its resistance to the infectious diseases epidemic, the quarantine measures and other restrictions have been justified, the standards of medical and pharmaceutical care have been presented, the measures to ensure the availability of medical care for patients with health disorders of other etiologies and priority areas for the development of health care facilities to protect medical staff and patients have been identified.

The aim: Тo assess the current approaches to training doctors to manage patients with multimorbidity or comorbidity and the awareness of physicians of the State Institution of Science “Research and Practical Center of Preventive and Clinical Medicine” State Administrative Department (SIS “RPC PCM” SAD) of this problem. Materials and methods: 88 medical doctors of SIS “RPC PCM” SAD were interviewed anonymously, using the specially designed questionnaire. The age of respondents varied from 32 to 72 years; the average age was 53,1±1,2 year; the average length of service was 27,8±1,4 years. The doctors were divided into two groups: the 1st one included 56general practitioners, the 2nd group – 32 doctors – consisted of cardiologists, rheumatologists, neurologists and endocrinologists. Results: The results of the sociological survey showed that 94,3±2,5% of SIS “RPC PCM” SAD medical doctors pay attention to the presence of comorbid pathology in patients with coronary artery disease (CAD) during the appointment of examination and treatment. Іntroduction of the module «Comorbidity in patients with coronary artery disease: current requirements for treatment» into the postgraduate medical education curriculum is considered necessary by 95,5 ± 2,2% of the interviewees. No statistical difference was found betweenthe 1st and the 2ndrespondent groups (р=0,55). Conclusions: The results of the study substantiate the necessity of implementation of continuing medical education of doctors (general practitioners, cardiologists, rheumatologists, neurologists, endocrinologists) on management of patients with multimorbidity and comorbidityusing interactive live workshops and online case studies.

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