REMEDIUM

The article is devoted to the analysis of socio-economic aspects of functioning of night pharmacies. There is a contradiction between the needs of the population for pharmaceutical care around the clock and the economic problems of the activities of pharmacy organizations associated with the specifics of the work of night shifts. The purpose of the study is to analyze the demand and necessity of functioning of round-the-clock pharmacies. Materials and methods. A chronometric observation of the activities of night shift workers was conducted by the method of self-photography of the working day using a specially designed card; 120 cards were filled out. Using the author's questionnaires, the opinion of pharmaceutical workers (No. = 126) on the peculiarities of functioning of pharmacies with night shifts and the opinion of consumers of pharmacy organizations (No. = 130) on the availability and use of round-the-clock pharmacies were studied. Results. In the structure of the work shift of night pharmacists, the share of lost working time is significant (23.8%), with a relatively high assessment of the need for the operation of night pharmacies by pharmaceutical workers (3.79 ± 0.08 points on a 5-point scale), none of them considers the round-the-clock mode optimal for a pharmacy organization. According to pharmaceutical workers, the round-the-clock mode of operation contributes to increased customer loyalty (26.2% of respondents), forms a positive image of the pharmacy organization (16.7%), but they doubt that such a mode of operation increases the availability of drug care to the population and brings benefits to customers. The role of night pharmacies in ensuring the availability and continuity of pharmaceutical care to the population is determined: consumers rated the need for the operation of night pharmacies significantly higher than pharmaceutical workers (4.27 ± 0.08 points on a 5-point scale), 63.1% of respondents in total assess the possibility of visiting a night pharmacy as important. Conclusion. Social factors determining consumer preferences when choosing the location and operating hours of pharmacies, as well as economic problems faced by 24-hour pharmacies, have been identified. It is necessary to find a balance between the economic interests of pharmacies and ensuring the availability of pharmaceutical care.

The article discusses the key organizational mechanisms aimed at improving the efficiency of the primary health care system in municipal healthcare. Special attention is paid to the issues of adaptation of management models, restructuring of resource provision, improvement of personnel policy and introduction of modern management technologies. The barriers and factors influencing the effectiveness of organizational transformations are identified, and the directions for further optimization of primary health care in municipalities are substantiated.

The article discusses the issues of increasing the financial stability and competitiveness of import substitution projects in the medical industry using the example of a domestic high-field magnetic resonance imaging device developed by Rosatom Corporation. An analysis of the state of the Russian magnetic resonance imaging market has been carried out, and key problems related to high dependence on imports and a shortage of modern equipment have been identified. Based on a comprehensive comparison of the technical and economic characteristics of domestic developments with leading foreign analogues, an integral indicator of competitiveness has been calculated. The Monte Carlo method was used to assess the investment risks and effectiveness of the project, which made it possible to quantify the likelihood of achieving positive financial results. The data obtained indicate the high sustainability and attractiveness of the project for investors, as well as confirm its potential for import substitution and increasing the technological sovereignty of the country.

Glaucoma is one of the leading chronic ophthalmological diseases characterized by progressive damage to the optic nerve and a high proportion of irreversible blindness. Given the latent course in the early stages, glaucoma screening and prevention are becoming particularly important in the context of public health. The article discusses the modern possibilities of digital technologies and telemedicine in the organization of an effective system for early detection of glaucoma. The role of artificial intelligence algorithms, remote monitoring of intraocular pressure, mobile ophthalmological platforms and integrated digital routes in the prevention and reduction of disability is substantiated. Special attention is paid to the legal and organizational aspects of the introduction of digital instruments into ophthalmological practice.

In recent years, the pharmaceutical industry has been facing a shortage of qualified staff in a pharmacy organization. Staff shortage can limit the population's access to preventive medical services, which can lead to improper treatment, deterioration of health, increased risk of side effects and decreased level of healthcare in society as a whole, exacerbating existing social and economic problems. In July — September 2024, a remote survey of pharmacy employees was conducted. A total of 385 respondents, employees of pharmacy institutions from 31 regions of the Russian Federation engaged in the commercial distribution of medicines, took part in the survey. 63.6% of them have higher pharmaceutical education, 34.6% have secondary pharmaceutical education. The average work experience of the study participants is 23 years, while 32% have more than 30 years of professional experience. The purpose of the study is to find out which aspects of the activity are attractive to pharmacists, what motivates the specialists to stay in the profession, and also to identify the factors that cause the greatest dissatisfaction. The main values of a first—year student's professional activity is of a humanistic nature — they are «the opportunity to help people» (80%) and «the opportunity to constantly learn new things and expand their knowledge» (72%). Among the key factors that can increase job satisfaction with significant excellence, «Recognition/respect for the profession at the state level» leads, 75% of respondents noted its need. «Salary independent of sales volume» was named by 50% of the study participants as a measure that they would like to bring into the profession. 36% of respondents believe that reducing commercial tasks can be an effective way to increase satisfaction. An important motivational component in the activity of a pharmaceutical worker, confirmed by the results of the study, is the constant development and improvement of knowledge and skills, 72% of respondents indicated it as attractive in the profession. The conducted research has confirmed that the solution in the current situation is not only to increase wages and create favorable working conditions.

This article analyzes the legal and ethical issues of disposal of medicines that are no longer needed: the instructions for use contain a direct reference of the patient to the pharmacist with the question of what to do with such remnants. The legal status of medicines purchased by end users but unused remains uncertain, which complicates the process of their disposal. In this context, the study includes the results of a survey of pharmacy professionals showing that most of them, like ordinary consumers, throw away medicines with household waste without taking measures to prevent their unauthorized use. The author proposes new terms for medicines in the hands of end-users intended for “throwing away” and emphasizes the need for pharmacy organizations to be actively involved in promoting safe disposal. Special emphasis is placed on the potential and competencies of pharmaceutical workers and pharmacy chains in ensuring the environmental safety of such medicines; the legal status of medicines unclaimed by the patient is analyzed; legal issues of the practice of their destruction are considered. There is a lack of programs at the federal level for the collection and disposal of drug waste in the form of unclaimed medicines from the population, as well as the lack of a legal framework regulating the participation of pharmacies and pharmaceutical workers in this process. There is a lack of awareness of citizens about the rules of safe disposal of unneeded medicines, as well as the lack of effective mechanisms for the collection and recycling of such waste. It is shown that most people are not aware of existing recycling programs, although many are willing to use them if the conditions are convenient. The importance of involving the public — both patients and pharmaceutical industry specialists — in environmental responsibility issues related to the handling of unclaimed drug waste is emphasized: the participation of pharmacy chains in such initiatives can not only enhance their image, but also contribute to the socio-economic development of the region. It is necessary to develop comprehensive approaches to solving the problem, including improvement of legislation, formation of appropriate competence among pharmaceutical workers, raising public awareness about the handling of unclaimed medicines, and introduction of special collection points from the public.

Recently, there has been an increase in cases of so-called «quiet dismissal» among medical workers in various countries, which is manifested in a deliberate decrease in work activity, distancing from work processes and a lack of desire for initiative in professional activities. Professional burnout and «quiet dismissal» are determined not only by a set of personal factors reflected in job dissatisfaction and the desire to quit, but also by objective systemic problems, including imperfect work organization, lack of qualified personnel and insufficient attention of the management of the medical organization to the psychological well-being of employees. An effective solution to these problems is based on an integrated approach combining traditional methods of improving working conditions and organizing the activities of a medical organization, as well as extensive use of the latest achievements in the field of high technology and artificial intelligence. The introduction of intelligent workflow management systems, automation of routine tasks, the development of personalized training and professional development programs, as well as monitoring the psycho-emotional state of employees can significantly reduce the burden on medical personnel and improve the quality of medical care. Modern technologies make it possible to create adaptive personnel management models that take into account the individual characteristics of each employee, which helps reduce the risk of developing burnout syndrome, the phenomenon of «quiet dismissal» and increase motivation to work.

The aim of this study was to prepare proposals to improve the production of standard ABO isohemagglutinin serum kits based on an assessment of the phenotypic, temporal, and gender characteristics of the prevalence of high-titer regular antibodies of the ABO system. Materials and methods. In 2021—2023, the Republican Blood Center of the Ministry of Health of the Republic of Tatarstan conducted a study of the titer of natural group antibodies in blood samples of all donors, except for group AB, in order to detect high (1:256 and higher) titers necessary for the production of standard ABO isohemagglutinin serum. A total of 38,795 donors were examined, high-titer regular antibodies of the ABO system were detected in 58 (15.0 ‰O). The phenotypic, temporal, and gender characteristics of the occurrence of high-titer regular antibodies of the ABO system were assessed. Results. The proportion of women among donors was 29.8%. Over the entire observation period, high-titer regular antibodies of the ABO system were found in women by 19.3 ‰O more often than in men (p<0.001). The frequency of occurrence of high-titer regular antibodies of the ABO system has no gender differences in the O and A phenotypes and is significantly higher in female donors of the B phenotype by 51.0 ‰O (p<0.001). Anti-B are less common than anti-A by 11.8 ‰O (p<0.03). Conclusion. The revealed increased frequency of anti-A in female donors of the Republic of Tatarstan allows us to recommend examining no more than 50% of female donors for high-titer regular antibodies and completely abandoning the search for these antibodies in men of group B. Based on the experience of 2021—2023 such a reduction would amount to 8662 out of 38795 studies or a reduction in material and labor costs by 22.3%.

Currently, 86,208 people live in rural areas of the republic, which is 6.2% of the total number of residents in the region. Strategic inventory planning and the formation of a stable supply are an integral part of the work of pharmacy organizations in rural areas due to the special logistics conditions. Materials and methods. Comparative, marketing, pharmacoeconomic, and content analysis were used in the analysis. The study was conducted in rural areas of the republic with a total population of 8,943 people. The materials for the study were data on the sale of medicinal products from the group of oral hypoglycemic drugs for 2022—2024, obtained from pharmacy retail applications (Algorithm — C). Two analysis methods were used to study consumption: ABC analysis with further representation in the form of a Lorentz curve and nDDD methodology. Results. The coefficients of the breadth and depth of the rural market assortment were 0.53 and 0.56, respectively, in comparison with the market of the republic as a whole. Over the three years studied, the majority of medicines in the general range belong to the group of up to 250 rubles (23 out of 40 items, 63%). The undisputed leaders in the number of doses consumed during the study period are metformin, glimepiride and gliclazide (group A), with more than 5,000 doses consumed per year. The structure of the sales leaders in terms of turnover is somewhat different: while maintaining the leadership positions of metformin and glimepiride, dapagliflozin drugs are the third largest in the group's turnover due to the high cost of packaging. The ratio of consumption in physical and monetary terms has shown that consumption groups do not always correspond to each other. Conclusion. The study showed that the local pharmaceutical market in rural areas had a number of key features: low breadth and depth of assortment in comparison with the market of the republic, the vast majority of drugs are monocomponent — 36 out of 40 trend names (90%), the predominance of goods in the low price category (up to 250 rubles). The sales leaders were monocomponent drugs. The structure of consumption leaders in physical and monetary terms had significant differences.

The aim of this study was to analyze the parameters of the temporary availability of medical care using radionuclide diagnostic methods within the framework of the treatment and diagnostic process in a medical organization against the background of the introduction of a new organizational technology for patient routing. The study was conducted using management accounting data from a private medical organization participating in the territorial program of state guarantees for the free provision of medical care to citizens of the city of Moscow, as well as a number of other constituent entities of the Russian Federation. The analysis was conducted using data on the waiting period for PET-CT from the moment the patient received a referral to the day of the PET-CT study itself with diagnosis. It was found that the average waiting period in Moscow in 2023 was 5.316 days, while for patients from other regions this parameter was 8.508 days, which is a statistically significant difference (p = 0.0374). A reliable increase in the time availability of medical care (from 7.388 days to 4.573 days) using PET-CT in the described medical organization can be established due to the introduction of a new organizational technology for routing patients, that is, a conclusion can be made about the significant social effectiveness of this organizational technology.

The article examines the problems of legal regulation of pharmacy chains. The article presents an analysis of sources that consider the definition and classification of pharmacy chains, and notes the problem of the lack of uniform approaches to their definition in the legal and expert sphere to date. The risks of introducing restrictive regulation in the absence of a clear understanding of the legal and economic features of the functioning of network structures, the degree of influence on the development of the pharmaceutical market, the need for and consequences of restrictive measures are outlined.