The outpatient medical care in patients with chronic diseases under dispensary supervision in the conditions of the COVID19 pandemic. Temporary guidelines. Version 2

The aim of these guidelines is to provide primary care physicians with scientifically based algorithms for the implementation of dispensary monitoring in patients with chronic noncommunicable diseases in the conditions of the new coronavirus infection (COVID19) pandemic, including the use of telemedicine technologies. The organization and conduct of highquality medical followup are the most important tasks aimed at both reducing the risks of developing complications of chronic noncommunicable diseases and reducing overall mortality, especially in the current conditions of the COVID19 pandemic. The guidelines contain clinical aspects of dispensary followup, general principles of tactics for managing patients with various chronic noncommunicable diseases in COVID19 conditions, in addition, brief checklists with options for interviewing patients with various chronic noncommunicable diseases are presented, topical aspects of the interaction of drugs used in the treatment of chronic noncommunicable diseases with antiviral drugs are considered. The guidelines are intended for general practitioners, district therapists, general practitioners (family doctors), as well as doctors of other specialties providing primary health care. © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

Assessment of Awareness and Experience of Using off-label Drugs by Doctors of Clinical Specialties.

Aim      To evaluate the frequency of off-label prescription of medicines in practice of clinical specialists and the awareness of respondents of the procedure of justified off-label prescription.Material and methods  The sample included 542 clinical specialists who worked in definite medical organizations in 26 entities of the Russian Federation. The respondents were proposed to fill in remotely an anonymous questionnaire to evaluate the experience of prescribing medicines off-label to adult patients.Results Prescribing medicines not in consistence with the officially approved instruction for medical use (off-label or "outside instruction") is a relevant issue of global medical care since convincing scientific evidence for safety of such use is scarce. Analysis of information about off-label prescription is one of current tasks of national medical research centers according to the Federal Project "Development of a network of national medical research centers and implementation of innovative medical technologies". According to the responses about the frequency of off-label prescriptions 67.5 % of respondents reported of no experience of off-label prescription, 27.7 % said "rarely" or "sometimes", and 4.8 % said "frequently" and "very frequently". Specialties of physicians who have more often used medicines off-label (50% and more) included obstetrics and gynecology, pediatrics, rheumatology, hematology, and pulmonology. Cardiologists, neurologists and clinical pharmacologists use medicines off-label relatively rarely (19.6%, 28.6 %, and 22.2 %, respectively). 40 % of medicines used off-label were those designed for the treatment of coronavirus infection SARS-CoV-2. The medicines most frequently used off-label included metformin, rituximab, and thioctic acid. 65 % of respondents assessed their knowledge of off-label prescription as insufficient. In addition, 75 % of respondents consider it useful to receive additional information about risks and benefits of off-label prescription in clinical practice.Conclusion      The survey revealed the need of physicians for information about risks of the off-label use of medicines in clinical practice.

Interim guidelines: "Outpatient care for patients with chronic diseases subject to outpatient care in the context of the COVID-19 pandemic"

Consensus of experts of the Russian Society for Prevention of Noncommunicable Diseases, S.P. Botkin National Society for Advanced Medical Training, Profile Commission on Therapy and General Medical Practice of the Ministry of Health of Russia and Profile Commission on Medical Prevention of the Ministry of Health of Russia. Консенсус экспертов Российского общества профилактики неинфекционных заболеваний, Национального общества усовершенствования врачей имени С.П. Боткина, Профильной комиссии по терапии и общей врачебной практике Минздрава России и Профильной комиссии по медицинской профилактике Минздрава России.