Real clinical practice
Authors: Lurie L. 
Published: July 2021

Background. Real clinical practice (RCP) exists in an evidence-based and regulatory framework, taking into account the social, political and economic situation in the country. Coronavirus pandemic (COVID-19) is the main challenge of modern RCP.
Objective. To describe the modern features of the RCP.
Materials and methods. Analysis of literature sources on this issue.
Results and discussion. On December 31, 2019, WHO was informed about 27 cases of pneumonia of unknown origin. On January 1, 2020, the first WHO guidelines were issued. The COVID-19 outbreak was declared a health emergency on January 30 and a pandemic – on March 11. Experience with COVID-19 varies from country to country. In Germany, for example, pharmacies were allowed to produce disinfectants on their own, in Australia the telemedicine system was expanded, and in Poland a law was issued that provided the regulation of remote work, simplification of public procurement, and emergency pharmacy prescriptions. In Ukraine, the first information from the Ministry of Health on coronavirus was published on January 21. On February 19, a decision was made to procure medicines to combat COVID-19. On March 11, the export of personal protective equipment was banned, and on March 12, quarantine was imposed throughout Ukraine. On March 17, the first laws of Ukraine on combating the coronavirus were adopted. One in four patients who fell ill at the beginning of the outbreak was a health worker, which reduced the availability of medical care. The imposition of a pandemic on phase 2 of health care reform has limited health care and patients’ access to clinics and hospitals, and suspended planned hospitalizations and surgeries. Medicines without evidence were included in the COVID-19 National Treatment Protocol. An analysis of drug sales in pharmacies showed that quarantine had decreased the sales of cough and cold remedies, nasal irrigation solutions (due to a reduction in the number of socially transmitted diseases), and antidiarrheal drugs. Instead, sales of laxatives have increased (presumably due to changes in diet and limited physical activity). Sales of drugs for the treatment of sexually transmitted diseases also decreased. Quarantine in combination with the restriction of the availability of infusion therapy in the practice of the family doctor has led to a reduction in the appointment of parenteral drugs by half. In the absence of planned hospitalizations and surgeries, the volume of prescriptions for infusion drugs decreased by 13 %. There was a redistribution of drug consumption in favor of domestic drugs. “Yuria-Pharm” was in the top 3 among Ukrainian drug manufacturers. 6 out of 10 general leaders are domestic companies. “Yuria-Pharm” is a leader in blood substitutes and perfusion solutions prescribed by doctors of 16 specialties. The solutions were most often prescribed for pneumonia, mental and behavioral disorders caused by alcohol abuse, acute pancreatitis, cerebrovascular diseases, delivery, acute appendicitis, malignant tumors, insulin-dependent diabetes mellitus, chronic ischemic heart disease. For example, Tivortin (“Yuria-Pharm”) is most often prescribed by gynecologists, less often – by physicians / family doctors, neurologists, surgeons, cardiologists, anesthesiologists. In turn, Reosorbilact (“Yuria-Pharm”) is among the top 3 drugs administered by hospital doctors for the period 2014-2020. Repeated prescriptions for reimbursement were issued remotely, however, despite government programs, treatment in Ukraine still depends on the patient’s money. The National Health Service of Ukraine for 2021 proposed to increase the salaries of health care workers and reduce the catastrophic costs of medicines paid by patient on its own. At present, there is a need to transfer the results of clinical trials to the RCP, as the studies are conducted in specialized strictly controlled conditions, and the RCP allows to obtain more real results. There are several types of RCP studies: non-interventional, post-registration, marketing, pharmacoeconomic, and patient database and registry studies.
Conclusions. 1. COVID-19 pandemic is the main challenge of modern RCP. 2. The imposition of a pandemic onto phase 2 of health care reform has limited health care and patients’ access to clinics and hospitals, and suspended planned hospitalizations and surgeries. 3. In the conditions of pandemic and quarantine there was a redistribution of drug consumption in favor of domestic drugs. 4. Reosorbilact (“Yuria-Pharm”) is among the top 3 drugs administered by hospital doctors for the period 2014-2020.