Georgia’s Healthcare and Medical Staff Need Continuous Development
According to recent studies of the Georgian healthcare sector, there are a number of shortcomings in the primary healthcare field and their eradication is one of the main challenges facing the Georgian Health Ministry.
‘The Health Field Barometer- 6th Wave,’ a study by the Curatio foundation, reads that the quality of health services and problems with continuous education programs are considered one of the main problems in the Health System.
Representatives of the medical sector and doctors agree that doctors should not be motivated to or interested in prescribing inappropriate or excessive medications to patients. There are companies in Georgia that own both pharmaceutical companies and clinics whose doctors frequently prescribe medications manufactured by the same company. We spoke to Rusudan Jashi, Head of the Association for Development of Clinic Pharmacology and Rational Pharmacotherapy, about these issues.
How does the risk of polypragmasy increase in the above cases?
This problem does not exist only in Georgia. Many countries face the same issues. When talking about clinic management, we should also remember that it is not created here. Our associations take samples from Europe and those practices are tailored to the Georgian reality. Doctors follow the clinic management protocols regardless of who owns the clinic. When this practice is established, polypragmasy will be also reduced.
No owner or manager will tell a doctor to prescribe inappropriate medication to a patient that does not fit the protocol. We should assist doctors by supplying more literature to them and by involving them in the professional education system.
The Georgian Health Ministry plans to carry out reforms in the primary healthcare chain. Do you cooperate with the Ministry and do you have any recommendations to eliminate the polypragmasy problem?
Research shows that the primary healthcare chain contains a number of problems. Polypragmasy is met in the hospital sector, too, but protocols and guidelines regulate these issues somehow. In this respect the role of clinical pharmacology is decisive. Regretfully, these days clinical pharmacology is not taught at medical institutions here. I taught clinical pharmacology at the medical institution from 1987 but over the course of time, the academic hours decreased and, finally, the subject was fully removed. Therefore, this problem is of a failing in the education system. It is easier to teach students than to make a doctor give up habits.
What is the international practice in this respect?
In most countries clinics cannot receive licenses if they do not have clinical pharmacologists. In some cases patients may have more than one illness. A patient may be ill through diabetes plus cardiovascular disease and so on. This signifies, under the protocol, that medication should be prescribed for each illness and finally, the doctor may end up prescribing more than 10 medications. In this case, clinics need clinical pharmacologists to control the whole process.
What is happening in the regions and mountain villages?
Right now I’m working in Batumi as the Chief Pediatrician of the Adjara Autonomous Republic. Therefore, I have to frequently visit highland districts of Adjara. I would not say urban doctors have more information than doctors elsewhere. When pharmaceutical companies want to spread information about their own medications, they often bring doctors in minibuses in order to inform them about their products. In this way they manage to cover almost all regions of Georgia as it is in their own interest to do so. However, this does not signify the information is sufficient.
We often hear that doctors have certain motivation to prescribe this or that medication. Should we consider low salaries the main reason for this practice?
When working in the Pediatric Institute, my salary was frozen for several years. We have also lived through the period of Coupons. Despite these factors, we have never prescribed medications for personal benefit. This is an issue of ethics and it derives from the human mindset. I think a lack of information is one of the main causes of this problem.
How can this problem be resolved? What can the Health Ministry do to protect doctors from accusations?
The authorities should develop a continuous medical education program. The Union of Medical Associations has recently proposed the issue of undertaking such a program. The Association of Clinical Pharmacology is ready to join this process to upgrade the existing knowledge in the clinical pharmacology field. We expect the program details and the participant parties to be released in early May.
Keti Didebulidze