Chronic patients take medicine twice a month, is it a win-win situation?

Patients get medicine with health insurance at District 1 Hospital, Ho Chi Minh City - Photo: DUYEN PHAN

This proposal is supported by public opinion because it is beneficial for both sides: reducing the burden on the health system and making it convenient for people (especially people in remote provinces).

Tuoi Tre quoted the opinions of patients and the medical industry on this issue:

- Mr. NGUYEN DUC HOA (Deputy Director of Vietnam Social Security):

Recommendations based on expert opinion

Mr. Nguyen Duc Hoa

This proposal is based on expert opinion, for patients with chronic diseases that are usually stable, changing medication is not necessary every month. During the COVID-19 epidemic prevention period, the Ministry of Health has also implemented prescriptions every 3 months for some chronic diseases that have not developed complications.

Therefore, Vietnam Social Security proposes to prescribe outpatient medication for this group of patients for a minimum of 60 days, and a maximum of 90 days, instead of 30 days as currently prescribed.

Increasing prescription time is beneficial for both patients and hospitals. Patients have more time for follow-up visits, patients do not have to spend time, money, etc. Besides, it reduces the burden on hospitals in health insurance examination and treatment for chronic patients who have been treated stably.

Since 2023, we have sent two documents to the Minister of Health to propose recommendations on prescription time. I hope the Ministry of Health will study the proposal and apply it as soon as possible.

- Mr. NVD (55 years old, Ho Chi Minh City, has had diabetes for many years):

Reduce stress for patients

I have been sick for many years and have been treated stably, but every month I have to put my work aside to go to the hospital for a check-up to get a prescription. Meanwhile, most of the drugs prescribed every month are the same, in case of 3-6 months, I have to re-test to adjust the medication.

I suggest giving chronic patients a 60-day supply of medication, which would help relieve the stress.

- Mr. PHAM VAN NHAN (65 years old, Ninh Binh province):

Flexible for patients who cannot travel far

I just discovered that I have diabetes and high blood pressure about 3 years ago. Every month I have to go to the hospital for a check-up and prescription refill. However, because I am old and my children do not live nearby, I often have to walk and take a bus to the provincial hospital 40km from home to get a prescription.

The hospital is crowded with patients, jostling each other, it is very difficult for elderly and weak patients like us. I really wish we could extend the time for prescribing medicine to make it less difficult for patients.

- Mr. NGUYEN THANH TAM (Director of District 1 Hospital, Ho Chi Minh City):

Depending on each chronic disease, consider adjusting.

Mr. Nguyen Thanh Tam

Depending on the type of chronic disease, doctors can be flexible in changing the prescription time for patients. For newly diagnosed patients, the prescription time should be a maximum of 30 days so that doctors can grasp the situation, do additional tests, etc.

For cases of long-term, stable treatment, the prescription time for patients can be increased to more than 30 days, especially in cases such as: living far away, traveling, unable to have regular check-ups at the hospital...

However, some chronic diseases have many risk factors that can easily cause complications and worsen, so do not be subjective but go to the hospital for a doctor's re-evaluation.

For example, for some chronic diseases such as blood lipids, the follow-up visit should be every 1-2 weeks or every month for testing, doctors to evaluate, and prescribe more or less medication for the patient.

- Dr. TRAN THANH TUNG (Deputy Head of Pharmacology Department, Hanoi Medical University):

Can be done soon

Dr. Tran Thanh Tung

Chronic diseases require long-term medication treatment. After an initial prescription phase to find the right medication and dosage for 15-30 days, the doctor will re-evaluate and may prescribe the patient a 60-day supply.

Doing this will save medical staff, reduce the burden on hospitals, and also save time and money for people with chronic diseases. The Ministry of Health should soon agree to implement the regulation of prescribing drugs for chronic diseases for up to 60 days.

- Ms. TRAN THI OANH (Deputy Director of Duc Giang General Hospital, Hanoi):

Hospitals reduce revenue, but need to look further

Mrs. Tran Thi Oanh

I support the prescription of 2 months/time for patients with stable chronic diseases instead of 1 month/time as currently. The proposal of 3 months/time is too long, I think it is not advisable.

For patients with chronic diseases such as high blood pressure, diabetes, the doctor will decide to prescribe medication every 2 months or once a month depending on the individual condition of each patient. The prescription must ensure the health and create favorable conditions for the patient.

Many hospitals are concerned that increasing the time to provide medicine to 2 months will reduce revenue from visits and examinations. I think that this reduction in revenue will not affect the hospitals too much, and in the long run, the hospitals will benefit from good disease management, creating prestige with patients.

If the medicine is given every 2 months, the number of doctor visits will be reduced by half, so the doctor will have more time to consult, screen more carefully, and interact more with the patient.

In addition, the revenue from the number of visits is reduced, but this money is still in the health insurance fund and can be used for other purposes. The hospital can use the fund more effectively, such as doing more in-depth tests for progressive patients instead of normal tests for monthly disease management.

- Mr. NGUYEN TRONG KHOA (Deputy Director of the Department of Medical Examination and Treatment Management - Ministry of Health):

Need to consider carefully

Mr. Nguyen Trong Khoa

During the COVID-19 pandemic due to social distancing and disease prevention, the Ministry of Health has implemented outpatient medication delivery every 3 months. However, to fully adjust, it is necessary to consider the benefits and risks. The benefits are that people reduce travel time and hospitals reduce the burden.

Extending the prescription period may also lead to the risk of the patient not being examined for a long time, not being able to closely monitor the disease progression, which may affect the treatment. We are considering studying this proposal and will have adjustments to the documents and circulars guiding the prescription period.

Prescription times for chronic medications in different countries

In most countries around the world, prescription periods for chronic medications range from 28 to 30 days. However, in recent years, an increasing number of countries have considered extending prescription periods.

In Australia, in April 2023, the country's relevant authorities approved prescriptions for up to 60 days for 320 different drugs. The drugs are mainly used to treat heart disease, high blood pressure, obesity, etc.

With this change, the Australian Government estimates that each patient will save up to 180 AUD/year (2,900,000 VND). Within four years, the country could save up to 1.6 billion AUD.

In Thailand, since 2016, Phramongkutklao Military Hospital has been piloting a 3-month (90-day) prescription for all patients.

Research published in May 2023 by a team of scientists at this hospital and Chulalongkorn University showed that giving all patients a 90-day prescription contributed to increasing the rate of patients' compliance with prescriptions.

In the UK, the Department of Health does not set any hard limits, but only regulates the duration of each prescription to "balance patient convenience and clinical condition, cost savings and patient safety".

Source: https://tuoitre.vn/nguoi-benh-man-tinh-lay-thuoc-2-thang-lan-co-phai-loi-doi-duong-20240420232047824.htm