Ministry of Health of Ukraine approved Procedure for choosing primary care doctor

The Ukrainian government is carrying out an initiative that aims to improve urgent cardiology quality and develop regional reperfusion networks to provide free stenting in emergency cases of acute myocardial infarction. The co-financing model will provide for the state procurement of the necessary angiography equipment and free-of-charge urgent stenting to patients with symptoms of acute myocardial infarction.

‘SAVING THE HEARTS OF UKRAINE’ INITIATIVE

For years, Ukraine has been 'the leader' among all European countries in terms of mortality rates from cardiovascular diseases. Over 40,000 people in Ukraine suffer from heart attacks each year and about 14% of heart attack patients die. Meanwhile, urgent stenting can prevent 21% of such deaths.

The European Society of Cardiology (ESC) estimated that in 2017 about 16,000 acute myocardial infarction patients in Ukraine needed emergency stenting. To put this in perspective, only 6,800 stent placement procedures were performed in 2016.

For the first time in the country's history, an international organization controlled the centralized procurement of stent systems and medical supplies to ensure that every patient who needs urgent angiography / stenting will receive such services FREE-OF-CHARGE.

The Government approved Resolution of the Cabinet of Ministers of Ukraine No.185 dated February 21, 2017 ‘On Approval of the Procedure and Conditions for the Provision of Subventions from the State Budget to Local Budgets for the Purchase of Angiography Equipment’ that provides for the purchase of stationary angiography equipment under the terms of co-financing from local budgets.

Our aim is to develop a network of regional reperfusion centers, which shall fundamentally change the system of urgent care for patients with acute myocardial infarction symptoms. However, the effective network functioning does not only depend on the availability of angiography equipment, but more importantly on the efficient coordinated work of all units – emergency first aid, reperfusion centers and cardiac care departments that ensure postoperative rehabilitation of patients.

THE REGIONAL REPERFUSION NETWORK IN UKRAINE

Each reperfusion center should ensure 24/7/365 care delivery (i.e. operate 24 hours a day, 7 days a week, 365 days a year). All patients who need urgent stenting should be provided with timely diagnosis, and free-of-charge effective treatment. According to the European clinical practice guidelines, to maximize the effect of the procedure and subsequent effective rehabilitation, urgent stenting should be performed within the first 2 hours from the initial patient contact with medical staff (or within 12 hours after the onset of symptoms).

As of mid-2017, there were 22 reperfusion centers in 18 oblasts of Ukraine. Regional reperfusion centers are located on the territory of the country so that it is possible to deliver a patient in time by an ambulance (or by car) during the first 2 hours. To ensure a full load and timely assistance, each reperfusion center should work for 0.3-1 million people in the 24/7/365 mode.

Reperfusion centers constitute only one component of the entire system. Therefore, it is important to regulate and coordinate work of all urgent care delivery services and ensure that all units have enough ECG systems and defibrillators, permanent telephone connection with reperfusion centers and cardiac care departments, and that healthcare professionals are trained in full compliance with modern clinical practice guidelines and treatment protocols.

The activities of reperfusion centers are aimed at, among other, reducing the mortality rates in patients with acute coronary syndrome. Today, in-hospital mortality rates from myocardial infarction in clinics that are already functioning as reperfusion centers decreased to 3-6%.

HOW TO GET FREE STENTING

Patients with signs and symptoms of acute myocardial infarction (AMI is the initial stage; the sharpest phase of AMI is called acute coronary syndrome with ST-segment elevation or STEMI) should seek treatment by calling 103 emergency number, especially in cases when types of transportation other than an ambulance are unavailable.

If AMI is confirmed in the first hours after the initial onset of symptoms, it is important to provide assistance within the first 12 hours (in some cases 24 hours) after the onset of symptoms – the sooner, the better. To maximize the effect of the procedure and to ensure subsequent effective rehabilitation, a patient has to be delivered to the RC within the first 2 hours from the initial contact with medical staff.

Then, a team of interventional cardiologists shall carry out a stenting procedure.

Stent placement (stenting) is a procedure for the placement of a small wire mesh tube (stent) within the blood vessel to help keep it open (mechanical removal of thrombus or atherosclerotic plaque) and restore blood flow.

A timely and effective reperfusion procedure usually ensures quick patient recovery, and,  depending on the severity of one's condition, patients can be discharged from the RC in a few days and continue rehabilitation on an outpatient basis.

The approved procedure defines for the Ukrainian citizens the rules for choosing a primary care doctor: general practitioner, pediatrician or family physician. This procedure is mandatory for all primary care providers in Ukraine.

Starting April 2, 2018, all citizens of Ukraine can freely choose a primary care doctor: a general practitioner for adults, pediatrician for kids or family physician for the entire family, provided that the healthcare facility where the chosen doctor works is already connected to the e-Health system (the unified electronic healthcare system in Ukraine).

By signing a New Patient Declaration Form or, in other words, contracting with the chosen doctor, patients report to the state through the National Health Service of Ukraine (NHSU) that the money for their healthcare services should go to this particular primary care provider (according to the ‘money follows the patient’ principle). Therefore, the patient-doctor contract is actually an application form. There is no need to re-sign this contract, as it is valid until a patient decides to change the chosen doctor. When this is the case, a contract with a new doctor automatically terminates the previous one.

The Procedure also stipulates that patients can now choose any primary care doctor they want, regardless of the place of residence or registration. But it is important to check whether the chosen primary care provider has already been connected to the eHealth system, because patients’ data and medical records will be stored in an electronic system instead of countless folders or cardboard boxes. Just look for the sign "Here you can choose your doctor".