STUDY OF CONSUMPTION OF DRUGS FOR THE TREATMENT OF SOLDIERS AS SURGICAL PATIENTS IN A MILITARY MOBILE HOSPITAL

Мета – провести аналіз споживання лікарських засобів для лікування військовослужбовців хірургічного профілю в умовах військового мобільного госпіталю (ВМГ). Методи. З використанням кількісно-вартісного методу АВС-аналізу досліджено структуру споживання лікарських засобів (ЛЗ) хворими хірургічного профілю військового мобільного госпіталю. Матеріалами дослідження слугували звітні дані показників лікувальної роботи ВМГ за 2014-2016 рр., звіт-заявки наявності і потреби в медичному майні (ф.8/мед), статистичні та аналітичні показники захворюваності військовослужбовців (ф.3/мед), стандарти медичної допомоги , клінічні протоколи надання медичної допомоги з актуальних і найбільш значущих захворювань військовослужбовців в умовах ВМГ. Результати. Аналіз споживання лікарських засобів для лікування військовослужбовців хірургічного профілю у військових мобільних госпіталях визначив прямо пропорційну залежність з величиною і структурою госпітальної захворюваності. Лідерами споживання в грошовому вираженні стали представники групи протимікробних засобів, в кількісному ЛЗ, що впливають на нервову систему. Висновки. Отримані дані свідчать про раціональність витрачання грошових коштів на медикаментозне забезпечення досліджуваного контингенту і можуть бути використані для прогнозування потреби ЛЗ на наступний рік при плануванні медичного постачання. Також інформація про перелік ЛЗ, затребуваних у лікуванні хірургічних хворих в умовах військового мобільного госпіталю може стати основою для включення до складу клінічних протоколів надання медичної допомоги та розробки вартісних нормативів за відповідними нозологічними формами Ключові слова: військовий мобільний госпіталь, аналіз споживання лікарських засобів, АВС-аналіз, фармакотерапевтична група


Introduction
Preservation of life and health of soldiers of the Armed Forces of Ukraine is the most important task of the medical service of the Armed Forces of Ukraine. A number of reforms in the medical care system of the Armed Forces of Ukraine are aimed at creating wellequipped, highly mobile field medical institutions that are able to effectively solve the tasks set for rendering medical assistance to wounded and sick soldiers.
One of the main factors that determine the high level of medical care is the state of logistical support. The effectiveness of medical care is directly related to the completeness and timeliness of medical supplies [1,2].
The presence of a sufficiently wide range of medical property on the domestic pharmaceutical market requires the conduct of a relevant clinical and economic analysis for a justified choice of medical property, in particular medicines for use in the military medical service [3].

Formulation of the problem in a general way, the relevance of the theme and its connection with important scientific and practical issues
One of the most urgent scientific and practical tasks at the present time is to determine the list and volumes of medical supplies and equipment to deliver it in military mobile hospitals. Certain lists and volumes of medical stock and equipment for supplying military mobile hospitals will provide an opportunity to provide effective medical care and support the fighting ability of military personnel. All of the above was the reason for prompt viewing of the forms and methods of managing the medical supply system in order to bring the equipment of the medical service in reasonable quantitative indicators and the corresponding qualitative condition.

Analysis of recent studies and publications in which a solution of the problem are described and to which the author refers
After the start of military operations in the East of Ukraine, the medical supply system has raised questions of improving the supply of medical equipment to military mobile hospitals. Researches to determine the need for medical property are constantly taking place in the military medical service. In particular, were carried out studies on the problems of improving the drug supply of military personnel during polytrauma in peacetime and the rationing of medical equipment to meet the needs of medical care of military personnel in the field [4,5]. However, there was no attention paid to the issue of a comprehensive study of the lists and quantitative indicators of medicines in the treatment of surgical patients in military mobile hospitals. In this regard, the study of the consumption of medicines for the treatment of the studied patient population is extremely important and necessary question.

The field of research considering the general problem, which is described in the article
Against the background of the reform of the military medicine system, noticeable advances are also taking place in military medical supplies. In particular, there is a positive trend in the formation of the regulatory and legal framework for the organization of medical supplies in the Armed Forces of Ukraine.
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In Table 1 was shown the distribution of the categories of hospitalized military personnel in the MMH for the first half of 2017 (in relative terms).
Thus, in the structure of the incoming flow of sanitary losses in the MMH, the prevalence of noncombat sanitary losses (traumatized and sick) was observed. In Table 2 was shown the quantitative indicators of the contingent of treated patients in MMH.
It should be noted that against the background of the increasing total number of treated patients from 2014 to 2016, the number of surgical profiles treated also increased. Surgical interventions were performed on urgent indications (46 %). Taking into account these indicators, the subject of our research was the study of the state of drug consumption in the provision of skilled surgical care to military personnel in the conditions of military mobile hospitals. Taking into account the dynamics of the indicators of the level and structure of the incidence of military personnel, the nosologic composition of surgical profile soldiers, the implementation of new methods of treatment, the level of drug supply, individual choice by physicians of individual drugs or their groups, the main factors influencing the needs of this category of patients in drug therapy, allocating financial-economic, organizational, regulatory, pharmaceutical, technological and situational factors.
Qualitative and clinically effective drug therapy includes three elements: a range of drugs, quantitative indicators of drug costs in kind and cash costs for the acquisition of drugs.
First of all, the entire range of medicines was analyzed, which the MMH was provided during 2015-2016. Analysis of the structure of drug consumption showed growth over a certain period of the drug consumption volume, that affect the digestive system and metabolism (A) in accordance from 23.6 % to 32.7 %, antimicrobial agents for systemic use (J) -from 6.9 % up to 17.41 %, drugs affecting the musculoskeletal system (M) -from 4.6 % to 7.6 %, medicines affecting the nervous system (N) -from 16.2 % to 18.3 %. The volume of prescriptions of dermatological agents (D), drugs affecting the genitourinary system and sex steroids (G), drugs affect-ing the sense organs (S) and various agents (V) in 2016 increased and amounted to 4.1 % of the total number of drugs. In general, the structure of prescribed and consumed drugs corresponds to the structure of hospital morbidity described above. Detailed information on the changes in the drug consumption patterns of the various pharmacotherapeutic groups according to the ATC classification in the MMH is given in Table 3.
Obvious is the fact that in compare to 2015, a qualitative (57 new names instead of 27 seized) and quantitative (116 drugs were significantly increased in volume of consumption, in contrast to 34, which decreased), modification of the assortment of medicines. This indicates that the domestic military medical service uses modern medicines in the treatment of military personnel in parallel with the development of the commodity assortment of the pharmaceutical market in Ukraine.
In Fig. 2 is shown the dynamics in the drug consumption pattern in the MMH in the period 2015-2016. Simultaneously with the trend towards an increase in the total number of medicines consumed in MMH from 230 to 259 trade names, the total number of consumed medicines by international nonproprietary names in the MMH increased from 187 to 213 INN, which is reflected in Fig. 3. The uniform nature of the increase in drug use is characteristic for all pharmacotherapeutic groups.
Analysis of the provision of medicines to surgical patients of MMH for the first half of 2017 showed that the available assortment consists of 189 trade names of medicines at 133 INN (Fig. 4). С -drugs that affect the cardiovascular system Determination of the approximate amount of money for the half-year for the provision of medical support for military personnel of the surgical profile of the military mobile hospital in the total amount is 226 990.09 UAH (Table 4). After the analysis of the expenditure of funds for medicines MMH using ABC-analysis allowed to determine the group of the most expensive drugs. For 32 drugs included in group A (16.93 % of the total nomenclature), 79.75 % of funds were spent; for 49 preparations of group B -15 % of funds; for 108 preparations of group C -5 % of total costs. The major part of the funds in the structure of drug therapy expenditures was spent on antimicrobial agents (27.2 %), a significant proportion was made up of drugs affecting the blood system (17 %) and the musculoskeletal system (14 %). In class A antimicrobial agents remain in the leader, in class B -drugs affecting the musculoskeletal system, in the class C -drugs affecting the cardiovascular system. In the structure of the total number of medicinal products (189), the most specific weight belongs to groups of drugs that affect the nervous system, hematopoietic and digestive systems (33, 29 and 28 drug positions, respectively). In class A, a group of drugs af-fecting the nervous system predominates in the B-drug class, affecting the digestive system, in the C-drug class, which affect the cardiovascular system.

Conclusions from the conducted research and prospects for further development of this field
1. The structure of the incoming flow of sanitary losses in the MMH during the ATO period has a reliable tendency to reduce the share of combat sanitary losses and increase the share of non-combat sanitary losses. The main nosological forms of diseases among military servicemen are diseases of the respiratory system, cardiovascular system and neurological diseases.
2. The dynamics of drug consumption, used in the treatment regimens of surgical patients of MMH was established. The most popular are groups of drugs that affect the digestive tract and metabolism, the nervous system, the blood system and hematopoiesis, the cardiovascular system and antimicrobial agents. A progressive tendency to increase the use of modern drugs of this group was determined. 3. The results of the ABC-analysis made it possible to approve the rationalization of costs in the treatment of surgical patients of MMH, the adequacy of the cost of drug therapy for a nosological unit of the disease. The leaders of consumption in money terms were representatives of a group of antimicrobial agents, in quantitative terms -drugs that affect the nervous system.