MANAGEMENT OF RHEUMATOID ARTHRITIS PATIENTS IN ROMANIA

Abstract

Introduction . Rheumatoid Arthritis is a chronic disease with long evolution which produces important consequences at the level of patient and society, a disease with several available therapeutic options, but not all of them having the same effects. The therapeutic measures are applied on a long term basis and they are, in most of the time, the result of medical practice guidelines developed at local or international level. Methods . The authors made a revision of the local and international speciality literature regarding rheumatoid arthritis and studied the legal framework in Romania regarding the medical practice guidelines, therapeutic protocols and treatment reimbursement conditions. Results . In Romania the management of patient with rheumatoid arthritis is based on several clinical and administrative decisions, reflected into the medical practice guidelines and therapeutic protocols with normative value. Because of high costs, the availability of biologic therapies for the rheumatoid arthritis patients is restricted only to these patients with approved treatment by the public payer, according to specific therapeutic protocols developed by the Ministry of Health and National Health Insurance House. The limited available financial resources in the social health insurance system create the conditions for waiting lists of the patients with medical recommendation for expensive therapies. Conclusions . The management of patient with rheumatoid arthritis is a complex process related with patient factors, but also with the health system functionality. In Romania, the usage of newly and expensive treatments requires the utilization of some medical practice guidelines and therapeutic protocols which should rely more and more on the effectiveness rather than the efficacy of treatments, considering the fact that clinical data regarding effectiveness of drugs treatments started to be available. Key words : patient management, rheumatoid arthritis, efficacy, effectiveness therapeutic protocols, quality of life