| Abstract: | Farmacinė rūpyba tai filosofija, kurios pagrindu buvo pradėtos plėtoti praktikoje taikomos farmacinės rūpybos paslaugos, padedančios išvengti neracionalaus vaistų vartojimo, užtikrinančios tinkamą ir efektyvų gydymo plano vykdymą bei prisidedančios prie pacientų sveikatos išsaugojimo. Kiekviena valstybė šias paslaugas reglamentuoja skirtingai, tačiau jas vienija bendras tikslas – paciento gerovės užtikrinimas. Neaiškus teisės aktų reglamentavimas nustatant farmacijos specialisto atsakomybę, teikiant farmacinės rūpybos paslaugas, sąlygojo šio magistro darbo temos pasirinkimą. Šiame magistro darbe siekiama nustatyti farmacijos specialisto atsakomybę tuo atveju, kai nesant teisės aktais nustatytų sąlygų, teikti farmacinę rūpybą, sukeliama žala paciento sveikatai dėl netinkamo vaistų paskyrimo ir parinkimo.
Pirmajame šio darbo skyriuje atskleista farmacinės rūpybos samprata, jos turinys bei svarba. Išanalizavus mokslinę literatūrą prieita prie išvados, jog farmacinė rūpyba yra itin svarbi šiuolaikinėje sveikatos priežiūros sistemoje. Nors farmacinės rūpybos apibrėžimai gali skirtis dėl lingvistinių priežasčių, tačiau juos visus vienija bendras tikslas – paciento gerovės užtikrinimas.
Antrajame skyriuje nagrinėti Lietuvos teisės aktai reglamentuojantys farmacinės rūpybos paslaugų teikimą ir nustatyta, jog šiuo metu galiojantis farmacinės rūpybos reglamentavimas yra netinkamas, o farmacijos specialistų atsakomybė, teikiant farmacinę rūpybą, įtvirtinta tik formaliai. Taip pat nustatyta, jog ne visos vaistinės gali užtikrinti teisės aktais nustatytų sąlygų laikymąsi, kadangi Elektronine sveikatos paslaugų ir bendradarbiavimo infrastruktūros informacine sistema (toliau – ESPBI IS) ir kitomis priemonėmis nėra užtikrinamas tinkamas sveikatos priežiūros ir farmacijos specialistų bendradarbiavimas, kuriuo būtent paremtas farmacinės rūpybos paslaugų teikimas.
Trečiajame skyriuje, pasinaudojus teisės aktų reglamentuojančių farmacijos ir sveikatos priežiūros specialistų bei pacientų teises ir pareigas, nustatyta, jog Lietuvoje farmacijos specialistai neprivalo atsakyti už žalą sukeltą netinkamu vaistų parinkimu ir paskyrimu. Farmacijos specialistų atsakomybė, teikiant farmacinės rūpybos paslaugas, apsiriboja pacientų tinkamu informavimu bei pastebėjus galimą vaistų sąveiką – konsultacijomis su vaistus paskyrusiu gydytoju, tačiau nesant teisės aktais nustatytų sąlygų farmacinės rūpybos paslaugų teikimui, farmacijos specialistai neprivalo atsakyti už žalą, sukeltą netinkamų vaistų paskyrimu ir parinkimu.
Nustačius farmacijos specialistų atsakomybės ribas, pasiektas magistrinio darbo tikslas ir pateiktos rekomendacijos dėl farmacinės rūpybos paslaugų teisinio reglamentavimo, bei šių paslaugų prieinamumo skatinimo.
A question analyzed in this master thesis is whether pharmacy specialists should be held liable for damages caused by dispensing and prescribing inappropriate medicines in the absence of conditions set by legislation to provide pharmaceutical care. First of all, it is important to mention that pharmaceutical care is a philosophy that laid down foundation for pharmaceutical care services, provided by pharmacist, which are now legally acknowledged. Pharmaceutical care is important not only for rational use of medicines and patients health preservation, but also it is inseparable from correct and efficient carrying out of treatment plan. Although there are differences in the way each country refers to pharmaceutical care, all definitions seek one goal – to ensure patients welfare. All of the definitions have patient’s welfare at the center, while pharmacy specialist and health care specialist, based on their obligations, manage the correct and efficient carrying out of the treatment plan. As the concept is based on strong connection between health care professionals, the conditions for their cooperation are essential for proper execution of pharmaceutical care services.
However, due to lack of clear regulations of pharmaceutical care, these services are now limited to a very small range of patients. With the current regulation it is almost impossible to provide services that would satisfy the concept. On the other hand, with just a few adjustments in legal system, the benefits of pharmaceutical care would be seen more clearly as it could be offered for a wider range of patients. Despite many advantages providing pharmaceutical care, there are also many obstacles which are also very important. While there are many different models of pharmaceutical care, when this concept is laid down into legislation, it is important to determine the liability of pharmacy specialist’s and set the limits of it. The question of pharmacy specialist’s liability has not been raised before. Therefore the purpose of this thesis is to ascertain liability of pharmacy specialists, when in the absence of conditions set by legislation to provide pharmaceutical care, damages are caused by inappropriate prescribing and dispensing of medicines.
The first chapter of this thesis defines the concept, content and importance of pharmaceutical care. By analyzing scientific literature, it was concluded that pharmaceutical care is extremely important. Although there are differences between what each country calls pharmaceutical care – they are all united by the goal of ensuring patient’s welfare. While European countries have a wide range of pharmaceutical care services, pharmacy specialists in Lithuania are able to provide services for only a very limited range of patients. Despite that, the importance of pharmaceutical care in Lithuania was proven by various studies.
Second chapter deals with analysis of Lithuania’s legislation of pharmaceutical care. The analysis showed that the current legislation is ineligible as pharmacist liability is only regulated formally. There are no provisions that would deliver the content of pharmacy specialist’s liability in case of providing pharmaceutical care. Contrary to European Union’s legislation, pharmacy specialists are not considered to be health care specialists. However, this problem will be solved by preparing concept of clinical pharmacists and by integrating them into health care system. It is also important to note that conditions set by legislation to provide pharmaceutical care are not fulfilled in reality. Analysis showed that many pharmacies cannot ensure proper cooperation between health and pharmacy specialists, which is the cornerstone of pharmaceutical care.
The Third chapter aims to define liability of pharmacy specialist in the course of providing pharmaceutical care. By analyzing rights and obligations of pharmacy specialists, health care specialists and patient, it was concluded that pharmacy specialists should not be held liable for damages caused by inappropriate prescribing and dispensing of medicines. Pharmacy specialist’s liability is restricted to appropriate informing of patient and in case of drug interaction – consulting with specialist who prescribed medicine. However, in the absence of conditions set by legislation to provide pharmaceutical care, pharmacy specialist should not be held liable for damages caused by inappropriate prescribing and dispensing of medicines. In each case pharmacist’s liability should be determined by obligations set in the legislation. Only when pharmacy specialist’s actions are determined as inappropriate, the scale and nature of damages for patient’s health are defined, causality between pharmacy specialist’s actions and damages is determined, and pharmacy specialists fault is proven – only then pharmacy specialist should be held liable.
In conclusion, all the goals set in this master thesis are achieved as well as the purpose of it. The purpose of this thesis is achieved by determining limits of pharmacy specialist’s liability and answering to the question – whether pharmacy specialists should be held liable for damages caused by dispensing and prescribing inappropriate medicines in the absence of conditions set by legislation to provide pharmaceutical care. In addition, recommendations for improvement of pharmaceutical care legislation are suggested as it is inevitable in order to establish proper execution of pharmaceutical care services. It is recommended to eliminate legal gaps, to promote patient education as well as pharmaceutical care services and also, to widen the range of these services. |
