Medical news October 21: Consider extending prescription time for chronic patients
The Ministry of Health is considering a proposal from the Vietnam Social Security to adjust the provision of medication for chronic patients, such as diabetics, people with high blood pressure, etc. who have been treated stably, from 30 days to 90 days.
Consider proposal to extend prescription time for chronic patients
Based on the treatment regimen, the doctor will assess the patient's condition and decide on the appropriate time to prescribe and dispense medication for the patient.
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| The Ministry of Health is considering a proposal from the Vietnam Social Security to adjust the provision of medication for chronic patients, such as diabetics, people with high blood pressure, etc. who have been treated stably, from 30 days to 90 days. |
Extending the time to dispense medicine will reduce the burden on the hospital, because each examination session will reduce the number of people waiting for examination by half, or even two-thirds.
Recently, Vietnam Social Security proposed to increase the time for prescribing drugs to treat stable chronic diseases to 2-3 months, instead of 1 month as at present.
Chronic diseases including high blood pressure, diabetes, arthritis, asthma, etc. are long-term progressive diseases, lasting 3 months or more and cannot be cured. Therefore, patients need to have regular health check-ups and use medication as prescribed by their doctor.
Circular No. 52/2017/TT-BYT, dated December 29, 2017 of the Ministry of Health stipulates prescriptions and prescriptions of pharmaceuticals and biological products in outpatient treatment. Medical facilities are only allowed to prescribe drugs after receiving results of medical examination and diagnosis. The prescribed quantity of drugs is sufficient for use but not more than 30 days. Therefore, patients need to return for monthly check-ups to receive prescription drugs.
According to the reporter's records, at general hospitals, there are many patients with chronic diseases coming for regular check-ups and medication. For patients in big cities, re-examinations and medication collection are less difficult, but for patients in the provinces, this is not easy.
Faced with the above reality, Vietnam Social Security is proposing that the Ministry of Health study and consider changing regulations on prescription of drugs for chronic diseases.
Specifically, for patients with chronic diseases whose health is stable, HIV patients who have been treated with ARV drugs for 12 months or more, and whose health is stable, the prescribed amount of drugs must be sufficient for a minimum of 60 days, and a maximum of 90 days. For patients receiving chronic treatment at primary health care facilities, the medical facility shall provide treatment drugs for no more than 30 days.
According to Deputy General Director of Vietnam Social Security Nguyen Duc Hoa, the above proposal is based on scientific and practical grounds, and has received opinions from experts. Currently, many countries in the world have applied 60-day prescriptions.
“This does not affect the quality of medical examination and treatment but will contribute to reducing hospital overload and reducing costs for both patients and the Health Insurance Fund,” said Mr. Hoa.
Further analysis on this according to the leader of Vietnam Social Security, in our country, in the past, during the complicated development of the Covid-19 epidemic, elderly patients and patients with chronic diseases requiring long-term treatment were prescribed a minimum of 2 months of medication and a maximum of 3 months.
If unusual symptoms are detected, causing the patient to have to return for a check-up before the scheduled appointment and have to change the medication, the medical facility will instruct the patient to return any unused medication.
This temporary regulation helps patients limit the risk of Covid-19 infection without affecting the treatment of chronic diseases, thus bringing satisfaction to many patients as well as medical facilities.
Regarding the above proposal, the Principal of the University of Medicine and Pharmacy, Vietnam National University, Hanoi, Le Ngoc Thanh, assessed that all regulations aim at the highest goal of ensuring the health of patients.
With some common chronic diseases such as diabetes, high blood pressure, etc., there are now many tools and means for patients to monitor their condition at home.
Therefore, extending the duration of drug use for chronic diseases will contribute to reducing unnecessary overload in many medical facilities, reducing unnecessary costs for both patients and the Health Insurance Fund.
According to the Director of Hanoi Medical University Hospital, Nguyen Lan Hieu, if the prescribed medication for chronic diseases is working well and the patient's health is stable, they do not need monthly check-ups. In the context of a large number of patients with chronic diseases, and many people go to the doctor because of regulations, not because of their illness, it is a waste in many ways.
From another perspective, some doctors believe that the time to provide medication to patients for 30 days, 60 days or 90 days should be left to the doctor to decide for each individual patient, and should not be made into a regulation. Because if it is made into a regulation, it will lead to the patient not complying with treatment, easily increasing the risk of complications.
Accordingly, for patients with severe complications and many underlying diseases, a 60-day follow-up visit is quite long for the doctor to manage the disease or prevent acute diseases. For example, for diabetic patients, if blood sugar is well managed, it will prevent and prolong the time of complications later.
Therefore, it is suggested that this proposal should only be applied to a number of subjects with few underlying diseases, mild disease stages, few complications, good treatment compliance, good drug tolerance and no side effects of the drug.
Need to manage online drug market
In 2024, it is estimated that the Vietnamese online drug market will reach about 5-8% of the drug sales market share and is growing continuously.
Selling drugs on e-commerce platforms is posing many problems for state management agencies in tightening the management of online prescriptions and online drug stores.
In Vietnam, online drug sales started in 2017-2018 and have grown rapidly. However, pharmacies have many disguised forms of online drug sales to circumvent the law and erase traces.
For example, pharmacy chains are allowing people to choose drugs on their websites, and if a prescription is filled, they call the customer directly to make the transaction and deliver the product.
In some mobile applications, when customers choose medicine, the application will introduce the customer to a pharmacy and the pharmacy will call to consult by phone, then there are many forms of delivery such as through pharmacy staff or motorbike taxi.
By buying medicine online, people find it convenient to buy medicine delivered to their home, saving travel costs and time. This is also a habit when they are buying all the essentials for life online.
Up to now, the system has only connected nearly 170 million orders from more than 20,000 medical examination and treatment facilities and more than 100,000 doctors.
The software system for drug retail establishments has been operating since 2019 according to the provisions of Circular 02/2018/TT-BYT on 100% of retail establishments having computers, network connection and software. Therefore, these establishments can receive electronic prescriptions and sell drugs, and send reports on the status of prescription sales to the national prescription.
Therefore, the representative of the Vietnam Medical Informatics Association said that in order to sell medicine online accurately, safely and effectively, the Ministry of Health needs to include it in the law and coordinate with the Ministry of Industry and Trade to inspect, monitor and certify the announcement of applications and e-commerce platforms that meet management regulations.
Accordingly, e-commerce platforms with the function of selling drugs must ensure that all sales establishments on the platform meet GDP standards and have licenses from the Department of Health.
E-commerce platforms must prove that they accept and send orders for purchasing drugs from customers via electronic prescription codes. E-commerce platforms must ensure that they create a consulting environment for pharmacies and patients. E-commerce platforms must ensure that prescriptions are sent to pharmacies near patients within a distance of no more than 5km.
Rabies deaths on the rise
The recent series of deaths from rabies were all due to people who had not been vaccinated after being bitten by dogs or cats. The price of vaccines and anti-rabies serum is still a large sum of money for many poor people and people living in remote areas, so many people after being bitten by animals did not get vaccinated with vaccines and anti-rabies serum, or did not get enough doses.
According to the Ministry of Health, on average, the country records about 80 deaths from rabies each year. However, in the first 7 months of 2024, our country had 65 deaths from this disease, an increase of 50% compared to the same period in 2023.
The most recent death from rabies was recorded in Dong Nai province on October 14, the victim died 1 year after being bitten by a cat. The deceased was Mr. DTĐ (born in 1974, residing in Nam Cat Tien commune, Tan Phu district).
A year ago, Mr. D's family raised 2 dogs and 1 cat (a stray cat that came to live in the house on its own). In early November 2023, while the 2 dogs and the cat were playing and biting each other, Mr. D reached out to stop them and the cat bit his finger, causing bleeding. However, thinking the cat was healthy, Mr. D only washed the wound and did not get a rabies vaccination.
After recording the case, the health sector conducted an epidemiological investigation and discovered that around Mr. D's house there were 19 dogs and 6 cats that had not been vaccinated against rabies, and no abnormalities were recorded. Mr. D is the third death from rabies in Dong Nai province since the beginning of the year.
One day later, on October 15, Dak Lak also recorded the 6th death due to rabies since the beginning of the year in this province.
The deceased victim was Ms. CTL (born in 1971, residing in Hiep Nhat village, Quang Hiep commune, Cu Mgar district). 2 months ago, she was bitten on the leg by a dog kept in the house.
Because she subjectively thought that her dog was her pet, Ms. L did not get vaccinated against rabies. Two months later, Ms. L showed symptoms of convulsions. Her family took her to the District Health Center for examination, then transferred her to the Central Highlands General Hospital and diagnosed her with rabies. Due to her serious condition and the prognosis of death, the family asked for the patient to go home and die at home.
According to medical experts, rabies is an especially dangerous infectious disease because there is no cure. Only a vaccine can save patients from death when bitten, scratched, or licked on an open wound by a rabid dog or cat.
In particular, a very small number of cases where the patient did not receive the first 1-2 doses of vaccine in time died due to injuries in dangerous areas such as the head, face, neck, and the virus attacked the brain before the vaccine took effect. Therefore, people should absolutely not be subjective.
However, according to epidemiological investigations, the main reason people do not get vaccinated against rabies is because they think they are bitten by domestic dogs or cats and that dogs and cats do not have rabies, so they do not need to be vaccinated.
There have been some cases of unjust deaths due to believing and seeking out traditional healers to treat rabies instead of getting vaccinated. Especially young children, after being bitten by dogs or cats, many do not tell their families, missing the opportunity to get vaccinated, causing extremely tragic deaths.
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