Hormonal battle: why did diabetic patients storm the chief physician's office
In the Central City Hospital of Kamyshin (Volgograd region), diabetic patients, without waiting for admission coupons, broke into the office of the chief physician and demanded prescriptions for insulin. There are no problems with its availability in the city, but it is not so easy to get a vital drug. Throughout Russia, people with diabetes regularly face the inability to receive insulin due to mistakes in the organization of medical care. Izvestia figured out why this is happening and how to deal with it.
What happened in Kamyshin
The incident with the "storming" of the chief physician's office in Kamyshin occurred on Tuesday. A group of insulin-dependent residents of the city came to the Central City Hospital at four in the morning to take a queue and get coupons for a therapist: only diabetic patients can take prescriptions for free insulin from this doctor. However, after opening the record, only four coupons were issued. After that, the rest of the patients decided to go to the waiting room of the acting chief physician Alexei Marchishin.
They tried to stop them there — the chief doctor was having a meeting, but people were already tired of fighting for prescriptions for the drug, which they should receive for free, and entered without an invitation.
In a video posted on social media, elderly patients with insulin dependence discuss their problems in the waiting room before a "breakthrough." One of the visitors, in particular, says that he allegedly has not been able to get a referral for a year. The meeting with the head of the hospital itself was not included in the frame — the head doctor agreed to talk to people only with the camera turned off.
Later it became known that prescriptions for medicines were given to everyone who found themselves in the chief physician's waiting room.
Is there any insulin in Kamyshin
Margarita Konstantinova, Deputy Chairman of the Health Committee of the Volgograd Region, told Izvestia that upon the incident, the Regional Health Authority initiated a comprehensive audit of the Central City Hospital of Kamyshin. The acting chief physician has already been brought to disciplinary responsibility.
— Today, the insulin supply in the region is sufficient to meet the demand until the end of this year, — Margarita Konstantinova assured. — The heads of medical organizations were instructed to organize control over the provision of patients with diabetes mellitus, as well as to organize control over the effective use of medicines purchased for privileged categories of citizens.
At the same time, in Kamyshin, the deputy chairman of the Regional Health Department emphasizes, there are no technical problems for making an appointment with a doctor.
— The issues of rational organization of patient care, including coordination of staff actions when prescribing prescriptions for patients with diabetes, will be further resolved during the inspection, — said Konstantinova.
Is there enough insulin in Russia
Yan Vlasov, co-chairman of the All-Russian Union of Patients, said in a comment to Izvestia that there is currently "no shortage of any specific insulins on the market." There are no recorded patient complaints in this regard. Purchases and deliveries are carried out on time, medicines are available in pharmacies.
— If patients are faced with the inability to obtain a prescription for the purchase of medicines, it is most likely due to the organization of management in a particular medical institution, — he noted. — People who need insulin are not the primary patients who came to the doctor during the pandemic. These are chronic patients who have been coming to the doctor for years, and everyone knows them by sight. Accordingly, there should be therapy planning. A disrupted process indicates a loss of communication between the doctor and the patient and indicates organizational problems of the medical institution.
Andrey Konoval, co-chairman of the Action Healthcare workers' union, notes that the current situation in Kamyshin could be related to a shortage of personnel.
"According to the results of 2024, the Ministry of Health reported an increase in the number of outpatient doctors, but it is not so significant as to cover the acute personnel shortage in the industry as a whole," the source said. — Many district doctors work above the rate and receive the population assigned to another area where there is no doctor. At the same time, in order to save money, employers try not to arrange for doctors to work overtime, which is paid in double the amount.
For what reason can there be no insulin
Nevertheless, there are periodic problems with the lack of drugs, experts say. But this is also usually associated with organizational problems. As, for example, it recently happened in the Kursk region, where diabetic patients could not receive insulin promptly due to its absence in pharmacies.
"This was caused by an untimely procurement procedure," Andrei Kovalev, head of the Diabetes Life patient organization, explained to Izvestia. — The problem was solved thanks to the active intervention of our organization and the personal participation of the governor of the Kursk region. Currently, there are no problems with the provision of insulin in the region.
The experience of the patient organization shows that most often the reasons for the lack of insulin in pharmacies are related to logistics, a shortage of specialists or failures in prescribing. The Popular Front expert. Analitika, head of the Diaresurs project at the Moscow City Association of Parents of Disabled Children, Yulia Pankova, also emphasizes that there is insulin itself in the country: there are enough drugs from both Russian and foreign, localized in the Russian Federation. Nevertheless, problems with patient care are observed in many regions. In some regions of the Russian Federation, it even went so far as to initiate criminal cases, as officials did not take measures to promptly purchase drugs.
"There are a number of problems in the regions," the Izvestia interlocutor continues. — Firstly, procurement procedures carried out by regional authorities in the field of health protection may be untimely. The problem with the availability of insulins is particularly acute at the beginning and end of the year, when new supplies have not yet been made, and the old drugs have already run out.
The second problem is the failed auctions for the purchase of insulins, due to the low price offered by the customer or the inability to fulfill the terms of the contract for other reasons, says Yulia Pankova.
The third difficulty typical for many regions is the "chaotic replacement of insulins based solely on procurement procedures," says the expert. In this situation, it is not the doctor or the regional Ministry of Health, but the supplier who decides which insulins he will supply as part of the purchase.
— As a result, the patient cannot receive the insulin on which the therapy is selected, — Yulia Pankova explained. — We have also identified cases of an undesirable reaction or lack of therapeutic effect when using insulin. These incidents are not always recorded by doctors as part of Pharmacovigilance (a system for detecting and preventing undesirable effects of drug use. — Ed.), there are no medical commissions for prescribing insulins by trade names in accordance with current legislation.
The expert calls stories like the one that happened in Kamyshin a fourth frequent problem, when patients simply cannot make an appointment with a doctor to get a prescription. Moreover, in some regions, only an endocrinologist prescribes a prescription, which also needs to be recorded through a referral from a therapist or pediatrician.
"Prescriptions can only be issued for one month of treatment, whereas the law provides for preferential prescriptions for up to 180 days of treatment,— Yulia Pankova notes. — For children with disabilities, preferential prescriptions should, in principle, be valid for 90 days from the date of registration, but they are often issued with a validity period of only 30 days.
Andrey Kovalev is convinced that access to insulin for diabetic patients should be simplified as much as possible. The limited number of vouchers for therapists and the lack of a flexible electronic prescription system are bureaucratic barriers that can lead to real threats to patients' health.
Yulia Pankova believes that the development of telemedicine technologies can be a solution to the problem of insulin availability. Another effective mechanism is the introduction of a simplified procedure for processing preferential prescriptions when therapy has already been prescribed. In addition, it is necessary to extend the validity period of these prescriptions for the course of treatment to 180 days, as well as strengthen supervision of preferential drug provision by regulatory authorities.
Переведено сервисом «Яндекс Переводчик»
