Read 619_8111_887824_Paliativi-geo.pdf text version

saangariSo moxseneba

ian stjernsvordi

paliatiuri mzrunvelobis erovnuli programa saqarTveloSi

Tbilisi 2005 w.

saangariSo moxseneba ian stjernsvordi

paliatiuri mzrunvelobis erovnuli programa saqarTveloSi

Sinaarsi: 1. miznebi 2. arsebuli viTarebis analizi 2.1 arsebuli viTareba, problemebi, moTxovnilebebi 2.2 saxelmwifo politika 2.3 wamalTa nebadarTuloba (xelmisawvdomoba) 2.4 ganaTleba da swavleba 3. Sexvedrebi xelisuflebis warmomadgenlebTan da dargis liderebTan 3.1 saqarTvelos pirveli ledi, saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministri da ministris moadgile 3.2 wamlebis maregulirebeli sistemis warmomadgenlebi da farmakologebi 3.3 dekanebi da direqtorebi 3.4 axalgazrda iuristTa asociacia 3.5 saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komiteti 3.6 fondi "Ria sazogadoeba-saqarTvelo" (OSGF) da jandacvis msoflio organizaciis (WHO) warmomadgenloba saqarTveloSi 3.7 onkologiis nacionaluri centri 4. erovnuli politikis SemuSavebisadmi miZRvnili seminari, paliatiuri mzrunvelobis erovnuli programa (pmep) 5. rekomendaciebi: 5.1 monawileebisaTvis

6. 7.

8.

5.2 "strategiis dokumenti" saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetisaTvis 5.3 "strategiis dokumentis" pirveli rekomendaciebi saswavlo kursi samoqmedo gegma da masze meTvalyureoba 7.1 adgilobrivi pasuxismgebeli pirebi 7.2 erovnuli koordinatoris Tanamdeboba 7.3 prioritetuli rekomendaciebi 7.4 drois aTvla 7.5 monitoringisa da Sefasebis kriteriumebi 7.6 dafinanseba da resursebis mobilizacia literatura

danarTebi: 1. jandacvis msoflio organizaciis (WHO) midgomebi 2. jandacvis msoflio organizaciis rekomendaciebi qveynebis mTavrobebisaTvis 3. paliatiuri mzrunvelobis CarTva kibos marTvis zogad (rutinul) sistemaSi 4. kibos kontrolis erovnuli programa 5. ratom aris tableturi morfinis sulfatis generiuli forma tkivilis kontrolis saukeTeso saSualeba da rogor unda ganisazRvros masze samomavlo moTxovnileba 6. moTxovna morfinis sulfatze 7. mxardaWera (lobireba) 8. erovnuli politikis SemuSavebisadmi miZRvnili seminaris dRis wesrigi, paliatiuri mzrunvelobis erovnuli programa 9. erovnuli politikis SemuSavebisadmi miZRvnili seminaris da saswavlo kursebis monawileebi 10. pirveladi (ZiriTadi) da meoradi (damatebiTi) rekomendaciebi monawileTaTvis 11. "strategiis dokumenti" saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetisaTvis.

12. "strategiis dokumentis" pirveli rekomendaciebi 13. paliatiuri mzrunvelobis sistemis sayovelTaobis uzrunvelsayofad aucilebelia mTeli sazogadoebis Zalisxmeva 1. miznebi 1.1 paliatiuri mzrunvelobis erovnuli programis Seqmna, romelic xelmisawvdomi iqneba am mzrunvelobis saWiroebis mqone yvela adamianisTvis. 1.2 saqarTveloSi efeqturi paliatiuri mzrunvelobis sistemis Camoyalibeba, romelic SeiZleba modelad (nimuSad) gamodges kavkasiis qveynebisaTvis. 2. arsebuli viTarebis analizi paliatiuri mzrunveloba amsubuqebs momakvdavi adamianis tanjvas da aumjobesebs sicocxlis xarisxs. sasicocxlo mniSvneloba eniWeba paliatiuri mzrunvelobis wyalobiT socialur-ekonomikuri da sulieri tanjvis Semsubuqebas ukurnebeli seniT Sebyrobili da momakvdavi avadmyofisa da misi ojaxis wevrebisaTvis. daavadebis terminalur stadiaSi erT-erTi umTavresi simptomia tkivili (1). arsebobs tkivilis kontrolis mecnierulad dasabuTebuli da martivi meTodi, romlis Rirebuleba ar aris maRali da SesaZlebelia mosaxleobis didi nawilis daxmareba (1,2,3). paliatiuri mzrunveloba yvela adamianis uflebaa. paliatiuri mzrunvelobis saWiroebis mqone pacientebisaTvis am mzrunvelobaze uaris Tqma ara marto samedicino da iuridiuli, aramed eTikuri "danaSaulicaa" (4). dReisaTvis msoflioSi tkivilis marTvisa da paliatiuri mzrunvelobis saqmeSi dagrovili uzarmazari codnis gamoyeneba saSualebas iZleva swrafad da mniSvnelovnad gaumjobesdes rogorc kiboTi Sebyrobili adamianebis, ise qronikuli daavadebebis mqone terminalur stadiaSi myofi pacientebis sicocxlis xarisxi (4 da danarTi 1,2,3,4).

amasTanave,saWiroa sworad gaazreba,rom sikvdili sicocxlis bunebrivi gagrZelebaa, xolo am fenomenTan dakavSirebuli sazogadoebis erovnuli, kulturuli, socialur-ekonomikuri da religiuri tradiciebi iseve mniSvnelovania, rogorc samedicino daxmareba (4). qveynis politikuri neba, samedicino personalis profesiuli momzadeba, sazogadoebis ganaTleba, saWiro medikamentebis xelmisawvdomoba (nebadarTuloba), kulturuli, religiuri da socialur-ekonomikuri daxmarebis sistemebis uzrunvelyofa es is sakiTxebia, romelTa mogvarebac naklebad mtanjvels gaxdis sikvdils. 2.1 arsebuli viTareba, problemebi, moTxovnilebebi saqarTveloSi, romlis mosaxleobac 4,7 milionia, sikvdilobis sixSiris maCvenebeli aris 9,09/1000 (5), rac Seadgens 42 000 sikvdilis SemTxvevas weliwadSi. saerTaSoriso gamocdilebiT gardacvlilTa daaxloebiT 60%, anu 25 000 adamiani ama Tu im xangrZlivobiT saWiroebs paliatiur mzrunvelobas da tkivilis Semsubuqebas, maT Soris iseTi opioidebis gamoyenebiT, rogoricaa morfini. Tu gaviTvaliswinebT, rom terminalur stadiaSi myof pacients mzrunvelobas uwevs ojaxis minimum ori wevri,yovelwliurad paliatiuri mzrunvelobis daxmarebiT SesaZlebeli gaxdeba daaxloebiT 75 000 adamianis sicocxlis xarisxis mniSvnelovnad gaumjobeseba. saqarTveloSi adamianTa umetesoba upiratesobas aniWebs ojaxSi sikvdils da es misi ufleba da nebaa. saqarTvelos mosaxleobis asakobrivi struqturis gaTvaliswinebiT mosalodnelia kibos daaxloebiT 8 500 axali SemTxveva weliwadSi. 2004 wlis ianvridan onkologiis nacionalur centrSi registrirebulia 5 700 axali pacienti, maTgan 4 300 ukve gardacvlilia, maT Soris 2 177- pirveli wlis ganmavlobaSi. kiboTi daavadebuli pacientebis umravlesoba miekuTvneba ukurnebel kategorias

(7). amrigad, kiboTi Sebyrobili avadmyofebis umetesobisTvis tkivilis Semsubuqeba da paliatiuri mzrunveloba warmoadgens yvelaze humanur Carevas. 2005 wlis bolosTvis kiboTi daavadebulma daaxloebiT 350 pacientma ukve gaiara paliatiuri daxmarebis kursi (7). saqarTveloSi sicocxlis saSualo xangrZlivoba 74 welia. paliatiuri mzrunvelobis kategoriaSi Semavali pacientebis umravlesoba moxucia. Sidsis/aiv gavrcelebis sixSire 0,1%-ia, xolo sikvdiloba weliwadSi 200-ze naklebia. paliatiuri mzrunvelobis ganyofileba, romelic gaSlilia 15 sawolze, ganTavsebulia onkologiis nacionaluri centris teritoriaze calke SenobaSi. misi funqcionireba daiwyo 2004 wlis noemberSi da moicavda rogorc stacionarSi myof, ise ambulatorul pacientebs. paliatiuri mzrunvelobis ganyofilebis StatSi Sedis: koordinatori, asistenti, 6 eqimi, 4 eqTani,4 mkurnali eqimi,diasaxlisi,buRalteri da Tbilisis saxelmwifo samedicino universitetis IV-V kursis moxalise studentebisagan Semdgari jgufi. 2005 wlis ganmavlobaSi paliatiuri mzrunvelobis ganyofilebaSi daxmareba gaewia daaxloebiT 250 pacients. binaze paliatiuri mzrunvelobis pirveli mobiluri gundi dafinansebuli iqna 2004 wels saqvelmoqmedo-fumanitarul fond "SOCO"-s mier, saqarTvelos pirveli ledis uSualo patronaJiT. 2.2 saxelmwifo politika paliatiuri mzrunveloba warmoadgens "onkologiaSi saxelmwifo politikis" Semadgenel nawils. evropis sabWos rekomendaciebi, romelic exeba paliatiur mzrunvelobas, aseve janmos rekomendaciebi ukve Targmnilia qarTul enaze, Tumca mas ar mohyolia Sesabamisi ganxilva. kibos marTvas unda mieniWos prioritetuli adgili jandacvis erovnul gegmaSi, romelic amJamad muSavdeba. dRes arsebuli gegma ki, samwuxarod ar moicavs arc kibos kontrolis

erovnul programas, arc paliatiur mzrunvelobas. tkivilis Semsubuqeba da paliatiuri mzrunveloba ar aris Setanili eqimebis, eqTanebis, farmacevtebisa Tu socialuri muSakebis di plomamdeli ganaTlebis programebSi. ar arsebobs erTiani politika aucilebeli medikamentebis nebadarTulobis (xelmisawvdomobis) TvalsazrisiT. opioidebis racionalur daniSvnas ewinaaRmdegeba ararealuri, sruliad arapraqtikuli da Zvel, sabWour mentalitetze dafuZnebuli kanonebi. opioidebis daniSvnas aregulirebs saqarTvelos janmrTelobisa da socialuri dacvis ministris 1999 w. 29 noembris #465/o brZaneba da saqarTvelos janmrTelobisa da socialuri dacvis da Sinagan saqmeTa ministrebis 2000 wlis 13 da 15 martis #32/o da #102 erToblivi brZaneba. 2.3 wamalTa nebadarTuloba (xelmisawvdomoba) ambulatoruli avadmyofebisTvis: opioidebis daniSvna SesaZlebelia mxolod kibos IV stadiis avadmyofebisaTvis, upiratesad histologiurad dadasturebuli diagnoziT. ambulatoriaSi, specialurad am mizniT Seqmnili komisiis wevrebi (pacientis eqimi (Terapevti, ojaxis eqimi), onkologi da samedicino samsaxuris ufrosi) aucilebeli gasinjvis Semdeg adgenen opioidebis sawyis dozas. amis Semdeg aucilebelia ramdenime savaldebulo dokumentis Sevseba. opioidebis SeZena SesaZlebelia kviraSi 2jer,mkacrad gansazRvrul dReebSi,specialuri dokumentaciis SevsebiT,mxolod mkacrad gansazRvrul afTiaqebSi,romlebic ganTavsebulia policiaSi da masze monitorings axorcielebs Sinagan saqmeTa saministro. Tu pacienti saWiroebs dozis koreqcias (momatebas), zemoaRniSnuli komisia ganmeorebiT ikribeba da adgens axal dozas. stacionarSi myofi pacientebisTvis: opioidebis daniSvna evaleba mkurnal eqims. avadmyofis binaze gaweris Semdeg es prerogativa gadaecema ambulatorias

zemoaRniSnuli sqemis mixedviT. dResdReobiT xelmisawvdomia nela xsnadi (neli moqmedebis SR) morfinis tabletebi. arsebobs swrafad xsnadi (swrafi moqmedebis IR) morfinis tabletebic, romelic saqarTveloSi ar aris registrirebuli. (amasTanave aRniSnul formaTa fasi gansxvavdeba. wamlis Rirebuleba ki Zalze mniSvnelovania im mosazrebidan gamomdinare, rom saqarTvelos mosaxleobis 54% siRaribis zRvarzea,xolo mosaxleobis 17% umuSevaria. eqTanis saSualo Tviuri xelfasi 100 amerikul dolarze naklebia). gasul wels morfinis yvela ti pis moxmarebam Seadgina 13 kg; umetesad es exeboda sainieqcio formebs. aRsaniSnavia, rom morfinis gamoyeneba naklebad iyo gapirobebuli paliatiuri mzrunvelobiT/tkivilis SemsubuqebiT. 2.4 ganaTleba da swavleba Zlieri e.w. "opioiduri fobiis" gamo da maTze sisxlis samarTlis pasuxisgebis aRZvris Tavidan acilebis mizniT eqimebi xSirad eridebian pacientebisTvis morfinis daniSvnas. narkologiis s/k institutis mesveurTa gancxadebiT dReisaTvis saqarTveloSi wamalze damokidebulTa ricxvi Seadgens 275 000, rac eqimebisaTvis morfinis daniSvnis "akrZalvis" ZiriTadi mizezia. es niSnavs, rom saqarTvelos populaciis 5,85%, anu 1/20 aris narkotikuli saSualebebis momxmarebeli?, rac savaraudod ar unda Seesabamebodes simarTles. Sinagan saqmeTa saministroSi SemuSavebulia akrZaluli medikamentebis mTeli nusxa, romelic, samwuxarod, Sedgenilia samedicino moTxovnaTa naklebi gaTvaliswinebiT. dReisaTvis saqarTveloSi ar arsebobs paliatiuri mzrunvelobis kvalificiuri eqimi. Tumca onkologiis nacionaluri centris eqimebi warmatebiT axorcieleben paliatiur mzrunvelobas da axerxeben mis integracias kibos yoveldRiur mkurnalobaSi. ukanaskneli ori wlis ganmavlobaSi saerTaSoriso eqspertebis monawileobiT Catarda saswavlo kursebi, romelic dafinansebuli

iyo fond "Ria sazogadoeba - saqarTvelos" (OSGF), Ria sazogadoebis institutis (OSI), ungreTis hospisTa fondis (HHF), saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministrosa da saqvelmoqmedo-humanitaruli fondis "SOCO"-s mier. saxelmZRvaneloebi iTargmna qarTul enaze, momzadda saswavlo masala da SemuSavda paliatiur mzrunvelobaSi uwyveti samedicino ganaTlebis 10-saaTiani 2 kursi, romlis akreditacia ganxorcielda di plomisSemdgomi da uwyveti samedicino ganaTlebis sabWos mier. paliatiuri mzrunveloba/tkivilis Semsubuqeba ar aris Setanili eqimebis, eqTanebis, farmacevtebisa da socialuri muSakebis di plomamdeli swavlebis programebSi. saqarTveloSi aseve daarsda paliatiuri mzrunvelobis asociacia "humanistTa kavSiri"(HU). saqarTveloSi di plomamdeli samedicino ganaTleba 7 wliania. samedicino profilis saxelmwifo da kerZo umaRles saswavleblebSi erTad swavlobs daaxloebiT 5 000 studenti. paliatiuri mzrunvelobis pirveli kursis dawyeba navaraudevia 2006 wlis gazafxulis semestridan. kursi iTvaliswinebs leqciebsa da praqtikas. studentebs eqnebaT praqtikuli gamocdilebis miRebis saSualeba onkologiis nacionaluri centris hospissa da binaze paliatiuri mzrunvelobis mobilur gundTan muSaobis dros. tkivilisa da sxva simptomebis marTvas warmarTaven eqimi-onkologebi. eTikur da organizaciul sakiTxebs gaaSuqebs profesori dimitri korZaia (asociacia "humanistTa kavSiris" damfuZnebeli). seminarebSi monawileobas aseve miiReben farmakologebi. 2005 wlis dekembris bolos igegmeba 2 wignis gamocema samedicino universitetis studentebisTvis (300 gverdi) da saeqTno saswavleblebis studentebisTvis (150 gverdi). es iqneba saerTaSorisod aRiarebuli masalis Targmnili da Sejamebuli varianti. 2006 wels jandacvis saministro

10

SeimuSavebs da daamtkicebs specialobebisa da subspecialobebis axal nusxas. navaraudevia, paliatiur mzrunvelobas mieniWos sub-specialobis kategoria. 2006 wels onkologiis nacionalur centrSi degegmilia 6Tviani specialuri momzadebis kursis Catareba. dReisaTvis saqarTveloSi ar arsebobs eqTanebis di plomisSemdgomi ganaTlebis sistema. Tumca jandacvis saministros gamocxadebuli aqvs tenderi eqTanebis di plomisSemdgomi ganaTlebis sistemis sakanonmdeblo bazis SemuSavebisaTvis. navaraudevia "paliatiuri mzrunvelobis" CarTva eqTanTa di plomisSemdgomi daxelovnebis programebSi. 2006 wels, zemoaRniSnuli saxelmZRvaneloebis gamocemis Semdeg saeqTno saswavleblebis xelmZRvanelebi (mag. prof. mamuka goleTiani) gegmaven "paliatiuri mzrunvelobis", rogorc damoukidebeli disci plinis Setanas di plomamdeli ganaTlebis programebSi. saqarTveloSi ukve gamocemulia paliatiuri mzrunvelobis sainformacio da meToduri literatura, xolo pacientis ojaxis wevrebisa da moxaliseebisTvis darigebulia sainformacio broSurebi. 2000 wlidan (6) Catarda sami saerTaSoriso seminari. 3. Sexvedrebi xelisuflebis warmomadgenlebTan da dargis liderebTan 3.1 Sexvedra saqarTvelos pirvel ledisTan, saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministrTan da ministris moadgilesTan, saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetis wevrTan. saqarTvelos pirveli ledi sandra rulovsi, saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministri l.Wi paSvili, ministris moadgile l. juReli, saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetis wevri o. ToiZe Sexvdnen saerTaSoriso eqspertebs eqimebs ian stjernsvords, frank ferissa da maria daniliCevs. SexvedraSi monawileobdnen dimitri korZaia da rema RvamiCava

11

("binaze paliatiuri mzrunvelobis" da "hospisis" programis xelmZRvanelebi). udaod konstruqciul Sexvedraze SemuSavda rekomendaciebi da ganxiluli iqna mosalodneli Sedegebi. gadawyda, rom SemuSavebul iqnes paliatiuri mzrunvelobis erovnuli programa, romelic saboloo jamSi iqneba sayovelTao, Tumca sawyis etapze gaiTvaliswinebs mxolod kiboTi daavadebuli pacientebis daxmarebas. jandacvis ministrma daadastura, rom paliatiuri mzrunveloba unda iqnes Setanili jandacvis erovnul strategiul gegmaSi da xazi gausva imas, rom kibos marTva yovelTvis warmoadgenda prioritets. ministrma gamoTqva imedi, rom kibos kontrolis erovnuli programis SemuSaveba SesaZlebeli gaxdeba uaxloes momavalSi. paliatiuri mzrunveloba warmoadgens kibos kontrolis farTomasStabiani programis erT-erT umniSvnelovanes nawils. SeTanxmeba miRweul iqna im sakiTxze, rom momavali paliatiuri mzrunvelobis erovnuli programa moeqces saqarTvelos pirveli ledis uSualo patronaJis qveS. saqarTvelos paliatiuri mzrunvelobis erovnuli programa aseve unda gaxdes sademonstracio proeqti mTel kavkasiaSi paliatiuri mzrunvelobis programebis ganxorcielebisas. aseTi Txovna saqarTvelom ukve miiRo somxeTidan. 3.2 wamlebis maregulirebeli sistemis warmomadgenlebi da farmakologebi ori seminarisa da Semdgomi Sexvedrebis dros wamoWrili da ganxiluli iqna sxvadasxva sakiTxebi. SexvedrebSi monawileobdnen: ian stjernsvordi, dimitri korZaia, profesori niko gongaZe, romelic warmoadgens jandacvis saministros wamlis saagentos pasuxismgebel pirs, farmakologiis profesori neli anTelava, farmakologiis profesori Tamar kezeli, wamlis saagentos mTavari konsultanti qveynisaTvis opioidebis kvotis gansazRvris sakiTxebSi- Tamaz kvirkvelia. niko gongaZem Camoayaliba

1

arsebuli problemebi da gadawyvetilebis miRebis gzebi, romlebic miRebul iqna rekomendaciis saxiT. SeTanxmeba iqna miRweuli masze, rom SemuSavebuli iqnes narkotikuli saSualebebis daniSvnis ufro racionaluri wesebi, swrafad xsnadi da nela xsnadi morfinis generiuli formebi gaxdes ufro advilad xelmisawvdomi (danarTi 5) da Seadginos moTxovnili Zliermoqmedi opioidebis 90% (danarTi 6), mas Semdeg rac narkotikebze kontrolis saerTaSoriso biuroSi (INCB) miRebul iqneba gadawyvetileba saqarTvelosTvis kvotis gazrdis Sesaxeb (3; gv. 46-58). mniSvnelovani roli eniWeba politikosebis (8), jandacvis sferoSi momuSave personalisa da sazogadoebis informirebas (danarTi 7). tkivilis Semsubuqeba da paliatiuri mzrunveloba unda iqnes Setanili klinikuri farmakologiis sauniversiteto saswavlo kursSi. mniSvnelovania aseve klinikuri farmacevtebis CarTva eqTanebis momaval praqtikul momzadebaSi. profesorma gela leJavam, romelic xelmZRvanelobs narkologiis s/k instituts daadastura faqti, rom saqarTveloSi sadReisod arsebobs wamalze damokidebulebis mqone 275 000 adamiani, rac misi azriT gaxda paliatiur mzrunvelobaSi opioidebis racionaluri gamoyenebis akrZalvis ZiriTadi mizezi. 3.3 dekanebi da direqtorebi profesori ramaz Sengelia, samedicino fakultetis dekani, profesori mamuka goleTiani, saeqTno saswavleblis xelmZRvaneli (daaxloebiT 900 studenti/weliwadSi) da profesori niko gongaZe SeTanxmdnen, rom tkivilis Semsubuqeba da paliatiuri mzrunveloba, mniSvnelovania, rom Setanili iqnes eqimebisa da eqTanebis di plomamdeli swavlebis programebSi, xolo sakiTxebi am Temebis garSemo Setanil iqnes sagamocdo bileTebSi (magaliTad, klinikur farmakologiaSi,onkologiaSi). sakiTxis ganxilva daniSnulia 2006 wlis SemodgomisTvis. am droisTvis mniSvnelovania

1

maswavleblebisa da instruqtorebis kadris SerCeva da momzadeba. 3.4 saqarTvelos axalgazrda iuristTa asociacia aRniSnul asociacias gaaCnia maRali avtoriteti adamianis uflebebis dacvis efeqtur lobirebasa da propagandaSi erovnuli televiziisa da presis saSualebiT. dimitri korZaia da ian stjernsvordi Sexvdnen axalgazrda iuristTa asociaciis Tavmjdomares ana doliZesa da programis koordinators lali Cxetias. isini dadebiTad gamoexmaurnen Cvens Txovnas da gamoTqves mzadyofna daxmareba gawion paliatiuri mzrunvelobis TvalsazrisiT sakanonmdeblonormatiuli bazis cvlilebaTa proeqtis momzadebaSi. 3.5 saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komiteti saqarTvelos parlamentSi gamarTul SexvedraSi monawileobdnen: komitetis Tavmjdomare batoni gigi wereTeli, komitetis 7 wevri, komitetis aparati, eqimebi: dimitri korZaia,Tamar ruxaZe,ian stjernsvordi,frank ferisi da maria daniliCevi. komitetis Tavmjdomarem mimoixila komitetis muSaoba da misi samomavlo gegmebi. eqimebma dimitri korZaiam da ian stjernsvordma daasabuTes paliatiuri mzrunvelobis saWiroeba da paliatiuri mzrunvelobis erovnuli programis ganxorcielebisaTvis Sesabamisi kanonis miRebis aucilebloba. Sexvedraze miRebul iqna dasturi, rom Semdgomi 10 wlis ganmavlobaSi SesaZlebeli gaxdeba paliatiuri mzrunvelobis saWiroebis mqone pacientebis 80%-is daxmareba (momakvdavi moxucebi, kiboTi daavadebulebi, sxva ukurnebeli daavadebebiTa da aiv/SidsiT Sebyrobilebi). komitetma gansazRvra, rom kibos kontroli warmoadgens erTerT umniSvnelovanes prioritets da xazi gausva aqtiuri qmedebis aucileblobas. Cveni rCevis Tanaxmad, pirveladi prevenciis,adreuli aRmoCenisa da diagnostikis,mkurnalobisa

1

da paliatiuri mzrunvelobis paraleluri ganviTareba unda warmoadgendes sakiTxisadmi yvelaze racionalur midgomas. komitetis Tavmjdomarem aRniSna, rom jandacvis axali strategiuli gegma muSavdeba da gamoTqva mzadyofna am gegmaSi CaerTos paliatiuri mzrunveloba, Tu uaxloes dReebSi warmodgenili iqneba: 1) strategiuli gegmis mokle varianti da 2) rekomendaciebi misi ganxorcielebisaTvis. zemoaRniSnuli pirobebis dakmayofilebis Semdeg (danarTi 11 da 12) miRebul iqna gadawyvetileba, rom paliatiuri mzrunveloba da paliatiuri mzrunvelobis erovnuli programa gaxdes jandacvis erovnuli strategiisa da gegmis Semadgeneli nawili. 3.6 fondi "Ria sazogadoeba-saqarTvelo" da jandacvis msoflio organizaciis warmomadgenloba saqarTveloSi seminarebis iniciatorad da Cveni delegaciis Camosvlis damfinanseblad mogvevlina fondi "Ria sazogadoebasaqarTvelo"/Ria sazogadoebis instituti (OSGF/OSI). ori sakoordinacio Sexvedra Catarda fondis aRmasrulebel direqtorTan baton daviT darCiaSvilTan da programis koordinatorTan baton laSa zaaliSvilTan. SexvedraSi monawileobdnen: dimitri korZaia, rema RvamiCava, ian stjernsvordi, frank ferisi da maria daniliCevi. Cveni misiis warmatebisaTvis mniSvnelovani iyo fondis dinamikuri daxmareba da rekomendaciebi. fondis warmomadgenlebi kvlavac mzad arian gauwion daxmareba saqarTveloSi paliatiuri mzrunvelobis erovnuli programis dafuZnebas. ian stjernsvordis winadadebiT prioritetuli iqneba fondis mier 2-wliani vadiT gamoyofili dafinanseba programis koordinatorisTvis, romelic xels Seuwyobs paliatiuri mzrunvelobis erovnuli programis danergvisaTvis aucilebeli rekomendaciebis realizacias. fondma mxari dauWira mocemul winadadebas da gamoTqva mzadyofna moiZios Sesabamisi dafinanseba.

1

jandacvis msoflio organizaciis warmomadgenloba saqarTveloSi: SexvedraSi monawileobdnen eq. rusudan klimiaSvili, jandacvis msoflio organizaciis saqarTvelos ofisis xelmZRvaneli, eqimebi dimitri korZaia da ian stjernsvordi. jandacvis msoflio organizaciis evropis biuros 2006-2007 wlebis programaSi tkivilis Semsubuqebasa da paliatiur mzrunvelobas ar eniWeba prioritetuli adgili, ris gamoc am periodisaTvis ver moxerxdeba dafinansebis moZieba, Tumca 2008-2009 wlebSi SesaZlebelia am mosazrebis gadaxedva. Sexvedraze gamoiTqva imedi, rom rusudan klimiaSvili jandacvis saministrosTan da kolegebTan erTad ganixilavs sakiTxs 2008-2009 wlebSi jandacvis msoflio organizaciis gegmaSi tkivilis Semsubuqebisa da paliatiuri mzrunvelobis CarTvis winadadebis wardgenis Sesaxeb. CvenTvis sasiamovno iyo eq. amiran gamyreliZesTan Sexvedra, romelic amJamad warmoadgens janmos aiv/Sidsis programis koordinators saqarTveloSi. warsulSi igi muSaobda SvedeTSi, sadac dResac kargi kavSirebi gaaCnia. misi azriT upriania dakavSireba SvedeTSi saerTaSoriso ganviTarebis saagentosTan (SIDA), romelsac SeuZlia daxmareba gauwios paliatiuri mzrunvelobis erovnuli programisa da SemdgomSi kibos kontrolis erovnuli programis ganxorcielebas. 3.7 didi Semovla onkologiis nacionalur centrSi onkologiis nacionaluri centris prezidenti, profesori revaz gagua xelmZRvanelobda did Semovlas, sadac ian stjernsvordma da frank ferisma xazi gausves paliatiuri mzrunvelobis mniSvnelobas da yuradReba gaamaxviles, rom aucilebelia paliatiuri mzrunvelobis integracia onkoloogiis nacionaluri centrisa da saqarTveloSi moqmedi sxva ori onkologiis centris muSaobaSi. eq. rema RvamiCava erT-erTi pirvelTagania, romelmac moaxerxa

1

paliatiuri mzrunvelobis danergva onkocentrSi (danarTebi 3 da 4). gamoiTqva imedi, rom momavalSi is gaxdeba warmatebuli centri paliatiuri mzrunvelobis sferoSi kadrebis Teoriuli da praqtikuli momzadebisaTvis, aseve am mimarTulebis mTel saqarTveloSi propagandisaTvis. 3.8 fsiqosocialuri daxmareba da gamokvleva profesorma ramaz sayvareliZem, fsiqologma da fsiqoTerapevtma, fsiqosomaturi medicinis ganyofilebis xelmZRvanelma, monawileoba miiRo erovnuli politikis SemuSavebisadmi miZRvnil seminarebSi, sadac gamoTqva mosazreba, rom momakvdavi adamianis daxmarebasTan erTad Zalze mniSvnelovania misi ojaxis wevrebis daxmarebac. onkologma irina maliniZem Seiswavla kiboTi daavadebuli 40 pacienti, romlebmac miiRes religiuri daxmareba sasuliero pirisagan. Sedegma aCvena, rom tkivilis skaliT Sefasebisas aRniSnuli pacientebis umravlesobaSi aRiniSneboda SesamCnevi dadebiTi Zvrebi. 4. erovnuli politikis SemuSavebisadmi miZRvnili seminari; paliatiuri mzrunvelobis erovnuli programa saqarTvelos pirveli ledis uSualo patronaJiTa da jandacvis saministros, fondebis SOCO-s, "Ria sazogadoebasaqarTvelos" da asociacia "humanistTa kavSiris" sponsorobiT saqarTveloSi Catarda seminari, romelic miznad isaxavda erovnuli samoqmedo gegmisa da programis SemuSavebas saqarTveloSi tkivilis Semsubuqebisa da paliatiuri mzrunvelobis ganxorcielebisaTvis. danarTebSi mocemulia dRis wesrigis detalebi (danarTi 8), monawileTa sia (danarTi 9) da rekomendaciebi monawileTaTvis (danarTi 10 A/B).

1

5. rekomendaciebi paliatiuri mzrunvelobis erovnuli programis SemuSavebisadmi miZRvnili Sexvedris rekomendaciebi mocemulia me-9 danarTSi, rekomendaciebi saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetisaTvis mocemulia me-11 da me-12 danarTebSi, xolo jamuri rekomendaciebi, romelic ZiriTadad exeba saqarTveloSi paliatiuri mzrunvelobis erovnuli programis ganxorcielebis samoqmedo gegmas - muxli 7.4 5.1 rekomendaciebi monawileebisaTvis (danarTi 9). 5.2 "strategiis dokumenti" saqarTvelos parlamentsaTvis (danarTi 11). 5.3 "strategiis dokumentis" pirveli rekomendaciebi (danarTi12) 5.4 prioritetuli rekomendaciebi. (danarTi 7); samoqmedo gegma (muxli 7.4) 6. saswavlo kursebi eq. frank ferisisa da eq. maria daniliCevis xelmZRvanelobiT Catarda intensiuri 6-dRiani saswavlo kursi eqimebis, eqTanebis, farmacevtebisa da studentebisaTvis, romelic aseve moicavda praqtikul muSaobas pacientebTan. leqciis Temebi SerCeuli iyo uSualod monawileebis mier, rogoricaa: tkivilis marTva, depresia, SiSi, fsiqologiuri simptomebi, deliriumi, Wrilobis movla, informaciis gacvla, usiamovno axali ambebis miwodeba. saswavlo kursi gamoirCeoda maRali aqtiurobiTa da azrTa kolegialuri urTierTgacvliT. gamocdilebam uCvena, rom avadmyofis sawolTan Catarebuli praqtikuli mecadineoba Zalze mniSvnelovania Zliermoqmedi opioidebis gamoyenebisas samedicino personalSi TviTdajerebulobisaTvis. upriania, rom msgavsi ti pis saswavlo kursebi gaimarTos momavalSic, rodesac uzrunvelyofili iqneba swrafad xsnadi (dauyovnebeli

1

moqmedebis) da nela xsnadi (neli moqmedebis) morfinis generiuli formebis xelmisawvdomoba (nebadarTuloba) da narkotikuli saSualebebis daniSvnis proceduris gamartiveba. aseve rekomendebulia paliatiuri mzrunvelobis momavali instruqtorebisa da ukve arsebuli maswavleblebisTvis sakvalifikacio-saswavlo kursis Catareba. mniSvnelovani sargeblobis motana SeuZlia imave saerTaSoriso maswavlebeleqspertTa ganmeorebiT Camosvlas saqarTveloSi. 7. samoqmedo gegma da masze meTvalyureoba arsebobs sami mTavari winaaRmdegoba, romelic xels uSlis paliatiuri mzrunvelobis msoflioSi arsebuli gamocdilebis danergvas da imsaxurebs gansakuTrebul yuradRebas. esenia: arasakmarisi adamianuri resursebi, instituciuri infrastruqturis nakleboba da arasakmarisi dafinanseba (14). warmatebuli samoqmedo gegmis SemuSavebisTvis mniSvnelovnad gvesaxeba paliatiuri mzrunvelobis erovnuli programis koordinatoris Tanamdebobis SemoReba. 7.1 adgilobrivi pasuxismgebeli pirebi tkivilis marTvisa da paliatiuri mzrunvelobis saqarTvelos programa: programa xorcieldeba saqarTvelos pirveli qalbatonis, sandra elizabet rulovsis patronaJiT ([email protected]);

Tavmjdomare: l. Wi paSvili ­ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministri sabWos wevrebi: l. juReli ­ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris moadgile ( [email protected]);

1

g. wereTeli ­ saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetis Tavmjdomare; o. ToiZe ­ saqarTvelos parlamentis jandacvisa da socialur sakiTxTa komitetis wevri; politikis SemuSavebaze d.korZaia ­ ([email protected] ) pasuxismgebelni r. RvamiCava ([email protected]) T. turZelaZe ([email protected]) wamalTa regulaciaze pasuxismgebelni n. gongaZe ([email protected]) r. RvamiCava ([email protected]) m. Savdia ([email protected]) i. abesaZe ([email protected]) eqimTa da eqTanTa ganaTlebaze d. korZaia ([email protected]) pasuxismgebelni T. kezeli ([email protected]) T. ruxaZe ([email protected]) n. gongaZe ([email protected]) - farmacevtTa ganaTlebaze pasuxismgebeli eq. ian stjernsvordi ([email protected]) saerTaSoriso eq. frank ferisi ([email protected]) eqspertebi meri kalavei ([email protected]) katalin muzbeki ([email protected]) paliatiuri mzrunvelobis erovnuli programa G-NPCP warmoadgens samuSao dasaxelebas qvesaTauriT: "jandacvis saministros/Ria sazogadoebis institutis (OSI) sademonstracio proeqti kavkasiisTvis". "yvela erTisaTvis da erTi yvelasaTvis" princi pidan gamomdinare, mizanSewonilia, rom proeqtis yvela monawilis mier paliatiuri mzrunvelobis Taobaze gamoqveynebuli nebismieri publikacia an Tezisi gamoices avtorTa koleqtivis saxeliT. yvela aseTi moxseneba, prezentacia Tu publikacia unda Semowmdes koordinatoris mier.

0

7.2 erovnuli koordinatoris Tanamdeboba mocemul moxsenebaSi gaSuqebulia sazogadoebriv jandacvaze dafuZnebuli paliatiuri mzrunvelobis erovnuli programis gegmebi da misi realizaciisaTvis aucilebeli pirobebi. paliatiuri mzrunvelobis erovnuli programis warmatebiT ganxorcielebisaTvis, aseve moqmedebis zusti koordinaciisa da saerTaSoriso rekomendaciebis SesrulebisaTvis, mniSvnelovania erovnuli koordinatoris samuSao adgilis uzrunvelyofa uaxloesi ori wlisaTvis. am samuSaos Sesasruleblad SemoTavazebuli da Semdeg miRebuli iqna eq. dimitri korZaias kandidatura. koordinatoris dafinansebas uzrunvelyofs OSGF/OSI 2006 wlis ianvridan. misi ofisi Seiqmneba saqarTvelos parlamentTan. koordinatoris muSaobis uSualo patronaJs uzrunvelyofs saqarTvelos pirveli ledi, xelSewyobas ganaxorcielebs saqarTvelos parlamenti, jandacvis saministro da paliatiuri mzrunvelobis kuTxiT momuSave arasamTavrobo organizaciebi. 7.3 prioritetuli rekomendaciebi (ix. aseve rekomendaciebi saqarTvelos parlaments) - "paliatiuri mzrunvelobis" Setana jandacvis erovnul gegmaSi da misi integracia jandacvis sistemaSi yvela doneze; - paliatiuri mzrunvelobis dafinansebis Setana saxelmwifos biujetSi yvela doneze (federaluri, munici paluri da regionaluri); - "tkivilis Semsubuqebisa" da "paliatiuri mzrunvelobis" CarTva saqarTvelos kanonebSi, "samedicino saqmianobis Sesaxeb" da "janmrTelobis dacvis Sesaxeb". - paliatiuri mzrunvelobis sistematuri propaganda sazogadoebaSi, jandacvis sferos muSakebSi, politikis SemmuSaveblebSi; - opioidebis xelmisawvdomobis (nebadarTulobis)

1

-

-

-

-

-

-

-

-

-

sakanonmdeblo uzrunvelyofa; ori ministris (jandacvisa da Sinagan saqmeTa) brZanebaSi cvlilebebis Setana opioidebis daniSvnis, dozis gansazRvris, Senaxvisa da ganawilebis proceduris gamartivebis mizniT; morfinze samomavlo moTxovnilebis zrdis gansazRvra da narkotikebze kontrolis saerTaSoriso biuroSi (INCB) saqarTvelosTvis kvotis gazrdis Sesaxeb gadawyvetilebis miRebisaTvis Txovnis momzadeba; swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) morfinis generiuli formebis xelmisawvdomobis (nebadarTulobis) uzrunvelyofa; eqimebis praqtikuli da Teoriuli codnis gaRrmaveba mTeli qveynis masStabiT Catarebuli saswavlo kursebis daxmarebiT, romelSic gamoyenebuli iqneba Tanamedrove video da multi-mediuri saswavlo masalebi; paliatiuri mzrunvelobis mniSvnelobis Sesaxeb sazogadoebis codnisa da informaciulobis xarisxis amaRleba; binaze paliatiuri mzrunvelobis uzrunvelyofa da masTan dakavSirebuli aucilebeli RonisZiebebis ganxorcieleba; paliatiuri mzrunvelobis integracia saqarTveloSi arsebul samive onkologiur centrSi (Tbilisi, baTumi, quTaisi); paliatiuri mzrunvelobis swavlebisa da treningisTvis centris dafuZneba (erovnul da kavkasiis regionis moTxovnaTa Sesabamisad); eqimebis, eqTanebis, farmacevtebisa da socialuri muSakebis di plomamdeli ganaTlebis programebSi "tkivilis marTvisa" da "paliatiuri mzrunvelobis" kursebis CarTva.

7.4 drois aTvla aRniSnul rekomendaciaTa ganxorcielebisaTvis saWiro vadebis gansazRvra da Sejereba moxdeba erovnuli koordinatoris mier mas Semdeg, rac pasuxismgebeli pirebi gansaxilvelad warmoadgenen TavianT samoqmedo gegmebs. 7.5 monitoringisa da Sefasebis kriteriumebi _ cvlilebebi erovnul politikaSi (normatiul da sakanonmdeblo bazaSi) paliatiuri mzrunvelobis saWiroebis mqone da aseTi mzrunvelobis mimRebi pacientebis raodenoba _ morfinis moxmarebis maCvenebeli _ treningze momzadebul pirTa raodenoba _ paliatiuri mzrunvelobis samsaxurSi srul samuSao droze myof pirTa raodenoba _ paliatiur mzrunvelobaSi momzadebuli eqimebisa da eqTanebis raodenoba axali samuSao adgilebi _ paliatiuri mzrunvelobis propaganda da misi Sefaseba 7.6 dafinanseba da resursebis mobilizacia 7.6.1 dafinansebis erT-erT prioritetad miCneulia erovnuli koordinatoris samuSao drois anazRaureba 1-2 wlis ganmavlobaSi. 7.6.2 saWiroa saxelmwifo biujetis gazrda 2-wliani programisaTvis, romelic iTvaliswinebs binaze myofi inkurabeluri pacientebis moTxovnilebaTa da saWiroebaTa Seswavlas (gamokvlevas), specialuri testebiT informirebulobis xarisxis, propagandisa da swavlebis efeqturobis dadgenas, saswavlo masalebis da TvalsaCinoebebis Seqmnas. 7.6.3 jandacvis axal erovnul strategiul gegmaSi paliatiuri mzrunvelobis CarTvis Semdeg saxelmwifos biujetSi misi Setanis sakiTxis ganxilva. 7.6.4 molaparakebis dawyeba imis Taobaze, rom jandacvis

msoflio organizaciam saqarTvelosTvis momaval 2008-2009 wlebSi gaTvaliswinebul biujetSi gamoyos garkveuli Tanxebi paliatiuri mzrunvelobisaTvis. 7.6.5 paliatiuri mzrunvelobis CarTva jandacvis ganviTarebis erovnul strategiul gegmaSi, raTa gaimarTos molaparakeba fondebis mozidvaze paliatiuri mzrunvelobis erovnuli programis dafinansebisaTvis; amisaTvis SeiZleba imave resursebis gamoyeneba, riTac finansdeba (unda dafinansdes) kibos kontrolis erovnuli programa. (paliatiuri mzrunveloba am globaluri programis erT-erTi ganuyofeli da mniSvnelovani Semadgenelia). 7.6.6 paliatiuri mzrunvelobis CarTva qveynis jandacvis erovnul strategiul gegmaSi qmnis oficialur safuZvels, raTa misi dafinansebisaTvis xelSewyoba eTxovos iseT ucxour warmomadgenlebs saqarTveloSi, rogoricaa: DANIDA, NORAD, SIDA, USAID, msoflio banki da sxva. 8. literatura 1. WHO: "Cancer pain Relief", WHO, Geneva 1986 2. WHO: "Cancer Pain Relief and Palliative Care". WHO Technical Report Series 804, 1990 3. WHO: "Cancer Pain Relief. With a guide to opioid availability", Second Edition, WHO, Geneva 1996 4. Stjernsward J and Clark D: "Palliative Medicine- a Global Perspective" in Oxford Textbook of Palliative Medicine, 3 Edition Eds. Doyle D, Hanks G at al Oxford University Press, Oxford. Chapter 21,2003 4b. Stjernsward J: Uganda: Establishing a Goverment Public Health Approach to Pain Relief and Palliative Care" J. Pain and Symptom Management, Vol 3, August 2002 4c. Foley K., Aulino F., Stjernsward J: "Palliative Care in Resource Poor Settings" in "Clinical Guidelanes to Supportive and Palliative Care for HIV/ AIDS" pp 387-407, Eds O'Neil JF., Selwyn P., Schielinger H., Washington DC, Health Resources and Services Administration, 2004

5. 6.

World Fact Book www.odci.gov/cia/publications/factbook/mg.html WHO: "National Cancer Control Guidelines: Polices and Managerial Guidelines". WHO, Geneva 1995 7. Gvamichava R "Georgia Cancer Prevention Center", Report 1-6, Tbilisi, 2005 8. WHO "Achieving Balance in National opioids Control Policy: Guidelines for assessment" Geneva, WHO 2000 9a Gomez Batiste X, Borras J M, Fontanals M D, Stjernsward J, Trias X.: "Palliative care in Catalonia 1990-95". Palliative Medicine, 1992; 6:321-79b Gomez-Batiste X, Porta J, Tuca A, Carrales E, Madrid F, trails J, Fontanals D, Borras J, Stjernsward J, Salva A, Ruis E. "Spain: The WHO Demonstration Project of Palliative Care Implementation in Catalonia. Results at 10 years (1991-2001). "Journal of Pain and Symptom Management, 2002; 24 (2): 239-44 10. "Distress: Treatment Guidelines for Patients" National Comprehensive Network, NCCN, www.nccn.org and Jacobsen P, Donovan K., Trask P., Fleishman S., Zabota J., Baker F., Holland J. "Screening for Psychological Distress an Ambulatory Cancer Patients" www.interscience.wiley.com 11. NNPC: "Work Book: International Workshop on Community Participation in Palliative Care" Manjeri, Mallapuram Distint, Kerala 26-28 Nov.2004 by NNPC groups, Department of Community Medicine and Institute of Palliative Medicine, Medical College, Calicut, Kerala, 673008 India. [email protected] 12. Stjernsward J "Community participation in Palliative Care" Indian Journal of Palliative Care, June 2005, vol.11, issue 2, and December 2005, vol. 11, issue 2:52-58 13. Callaway M., Foley K: "Educational Resources: Palliative Care in Cancer", Palliative Care Program, OSI, New York, 2005 14. WHO: "Bridging the Know-Do Gap in Global Health", Special Issue, Bulletin WHO, 2004,82 (10)

danarTebi: danarTi 1: jandacvis msoflio organizaciis ZiriTadi midgomebi

danarTi 2: jandacvis msoflio organizaciis rekomendaciebi qveynebis mTavrobebisaTvis mTavrobam unda: 1. SeimuSaos paliatiuri mzrunvelobis erovnuli politika da programa 2. uzrunvelyos paliatiuri mzrunvelobis CarTva jandacvis erTian sistemaSi. calke mofunqcie paliatiuri mzrunvelobis sistema araefeqturia. 3. uzrunvelyos jandacvis sferoSi momuSave personalis (eqimebi, eqTanebi, farmacevtebi, agreTve adgilobrivi moTxovnebis Sesabamisad sxva kategoriis pirebi) adekvaturi momzadeba paliatiur mzrunvelobaSi. 4. gadaxedos jandacvis erovnul politikas, raTa

ganaxorcielos binaze paliatiuri mzrunvelobis programis adekvaturi xelSewyoba. 5. izrunos kompensaciis sistemis SemoRebaze kiboTi daavadebuli pacientebis ojaxis wevrebisaTvis ­ aseTi pacientis movliT gamowveuli mZime emociuri, fizikuri da socialuri problemebis Sesamsubuqeblad. 6. gaiTvaliswinos kibos Sorswasuli formebiT daavadebulTa binaze movlis prioritetuli mniSvneloba da Seqmnas msgavsi pirobebi stacionarSi maTi gadayvanis (moxvedris) SemTxvevebisaTvis. 7. uzrunvelyos rogorc ara-opioiduri, ise opioiduri analgetikebis, gansakuTrebiT morfinis generiuli formebis xelmisawvdomoba. unda ganisazRvros opioidebze pacientebis samomavlo realuri moTxovnileba. 8. uzrunvelyos,rom wamlebTan dakavSirebuli kanonmdebloba qmnides Semdegi punqtebis adeqvaturi Sesrulebis pirobas: a. mudmivi zedamxedveloba, romelic miznad isaxavs samedicino moTxovnilebisaTvis opioidebis importis, warmoebis, daniSvnis, gamoweris, momaragebisa da ganawilebis regulacias; b. samedicino personalisTvis opioidebis daniSvnis, momaragebisa da ganawilebis legaluri Zalauflebis miniWeba; g. opioidebis gamoyenebis makontrolebeli sistemebis zedamxedveloba, raTa gamartivdes wamlebis saWiro raodenobiT legaluri miwodeba. (WHO: "Cancer pain Relief and Palliative Care" WHO Technical Report Series # 804, WHO, Geneva 1990

danarTi 3: paliatiuri mzrunvelobis CarTva kibos marTvis 24 danarTi 3: paliatiuri mzrunvelobis CarTva kibos marTvis zogad zogad (rutinul) sistemaSi

(rutinul) sistemaSi

paliatiuri mzrunvelobis tradiciuli (Zveli) gaazreba: paliatiuri mzrunvelobis tradiciuli (Zveli) gaazreba:

(rutinul) sistemaSi

danarTi 3: paliatiuri mzrunvelobis CarTva kibos marTvis zogad

24

paliatiuri mzrunvelobis tradiciuli (Zveli) gaazreba:

mkurnaloba

hospisi

paliatiuri mzrunvelobis CarTva mkurnalobis procesSi diagnozis dasmisTanave

mkurnaloba

paliatiuri mzrunvelobis CarTva mkurnalobis mkurnaloba procesSi diagnozis dasmisTanave paliatiuri mzrunvelobis CarTva mkurnalobis procesSi diagnozis

dasmisTanave

hospisi

pm

pm

o sT pa pm

binaze

mkurnaloba

q,o + sT p + pm

pm

pm

q binaze

q o sT = sxivuri Terapevti pa = paTologanatomi pm = paliatiuri p WHO: "Cancer pain Relief and Palliative Care" WHO TRS 804, 1995 + pm Modified from mzrunveloba pme = paliatiuri mzrunvelobis eqimi

q,o + sT

qirurgi onkologi sxivuri Terapevti paTologanatomi paliatiuri mzrunveloba pmeqirurgi = paliatiuri = mzrunvelobis eqimi = onkologi

= = = = =

Modified from WHO: "Cancer pain Relief and Palliative Care" 1995 Modified from WHO: "Cancer pain Relief and Palliative Care" WHO TRS 804,WHO TRS 804, 1995

25

danarTi danarTi 4: rekomendaciebi kibos kontrolis erovnuli 4: rekomendaciebi kibos kontrolis erovnuli programisaTvis:

programisaTvis: jandacvis jandacvis msoflio rekomendaciebi kibos kontrolis msoflio organizaciis organizaciis rekomendaciebi kibos kontrolis erovnuli erovnuli programisaTvis programisaTvis

ep

ep pp = erovnuli politika = pirveladi prevencia = adreuli diagnostika = mkurnaloba = paliatiuri mzrunveloba

ad

pp

pm

ad m pm

m

Stjernsward: "National Cancer Control Programmes: Policies and Managerial Guidelines Stjernsward: "National Cancer Control Programmes: Policies and Managerial "WHO, Geneva 1995

Guidelines "WHO, Geneva 1995

danarTi 5: ratom aris tableturi morfinis sulfatis generiuli forma tkivilis kontrolis saukeTeso saSualeba da rogor unda ganisazRvros masze samomavlo moTxovnileba 1. optimaluri efeqtis, gverdiTi movlenebis ganviTarebis minimaluri riskis, amasTanave, yvelaze misaRebi Rirebulebis mqone tkivilgamayuCebeli saSualeba. mecnierulad dadasturebulia, rom morfini, rogorc peroraluri, ise parenteraluri saxiT, warmoadgens yvelaze efeqtur damoukidebel tkivilgamayuCebel saSualebas. is erTnairi warmatebiT gamoiyeneba xanmokle, xangrZlivi, SeteviTi, Tu procedurebTan dakavSirebuli tkivilis marTvisTvis. mas gaaCnia minimaluri gverdiTi moqmedeba. morfinis tkivilis mosaxsnelad moxmarebis SemTxvevaSi pacientTa mxolod 0,1%-ze naklebs uviTardeba misi borotad gamoyenebis tendencia.

per-oraluri morfinis saSualebiT SesaZlebelia pacientTa umravlesobaSi qronikuli tkivilis marTva. parenteraluri morfinis inieqciebi da infuziebi saWiroa mxolod pacientTa 3-5%-Si - Znelad marTvadi qronikuli tkivilis sindromebis dros. SedarebisaTvis: sxva ufro ZviradRirebuli opioidebidan kargi tkivilgamayuCebeli efeqtiT xasiaTdeba magaliTad, transdermuli fentanili. mas ar gaaCnia mniSvnelovani upiratesobani sargeblianobis (efeqturobis) mxriv,amasTanave Seicavs gacilebiT did risks wamaldamokidebulebis ganviTarebisa da e.w. "Savi bazris" TvalsazrisiT. amasTanave, misi efeqturi gamoyeneba gacilebiT Znelia uxvTmiani kanis mqone pirebSi, gansakuTrebiT cxeli havis da Sesabamisad, maRali oflianobis pirobebSi, rac arTulebs efeqturi dozebis miRebas (Sewovas). rac Seexeba aseve xSirad gamoyenebul narkotikul saSualebas- petidins, (fiqrobdnen, rom is warmoadgens me-3 safexuris opioids), is mxolod me-2 safexuris analgeziuri saSualebaa, romelic susti efeqtiT xasiaTdeba. amasTanave, toqsikuri metabolitebis akumulaciis gamo misi gamoyeneba dakavSirebulia seriozul gverdiT movlenebTan da amdenad ar aris gamarTlebuli qronikuli tkivilis marTvisaTvis. xarjTefeqturoba: rogorc swrafad xsnadi (dauyovnebeli moqmedebis), ise nela xsnadi (neli moqmedebis) morfinis generiuli formebis Rirebuleba sazogadod, SesaZlebelia gautoldes acetilsalicilis mJavas (aspirinis) tabletebis Rirebulebas, maSin rodesac transdermuli fentanilis ekvivalenturi dozis Rirebuleba gacilebiT ufro metia. opioiduri preparatebis SedarebiTi Rirebuleba Semdegia:

0

SesaZlebelia SesaZlebelia

gautoldes gautoldes

acetilsalicilis acetilsalicilis

mJavas mJavas

(aspirinis) (aspirinis)

tabletebis Rirebulebas, maSin rodesac transdermuli fentanilis tabletebis Rirebulebas, maSin rodesac transdermuli fentanilis ekvivalenturi dozis Rirebuleba gacilebiT ufro metia (ix. cxrili). ekvivalenturi dozis Rirebuleba gacilebiT ufro metia (ix. cxrili). opioiduri preparatebis SedarebiTi Rirebuleba Semdegia: opioiduri preparatebis SedarebiTi Rirebuleba Semdegia: medikamenti medikamenti gamoSvebis gamoSvebis forma forma SedarebiTi SedarebiTi Rirebuleba Rirebuleba morfini morfini peroraluri peroraluri parentera peroraluri parentera peroraluri (neli luri (dauyovnebeli (neli luri (dauyovnebeli moqmedebis) moqmedebis) moqmedebis) moqmedebis) (IRM) (SRM) (IRM) (SRM) 1x 3x 5x 1x 3x 5x fentanili fentanili transdermuli transdermuli

>20x >20x

wamlebis xelmisawvdomoba (nebadarTuloba): wamlebis xelmisawvdomoba (nebadarTuloba): wamlebis xelmisawvdomoba (nebadarTuloba): am am peroraluri peroraluri dauyovnebeli dauyovnebeli moqmedebis moqmedebis morfini (IRM) morfini (IRM) 30% 30% 10 mg 10 mg 20 mg 20 mg peroraluri Pparenteraluri sxva opioidebi Pparenteraluri sxva opioidebi peroraluri neli morfini neli morfini moqmedebis moqmedebis morfini (SRM) morfini (SRM) 60% 5% 5% 60% 5% 5% 30 mg 2mg /ml 30 mg 2mg /ml 60 mg 10mg/ml 60 mg 10mg/ml (100 mg) 50mg/ml (100 mg) 50mg/ml

TvalsazrisiT SemuSavdes aseTi politika: mniSvnelovania, narkotikebis amTvalsazrisiT SemuSavdes aseTi politika: politika: mniSvnelovania, TvalsazrisiT SemuSavdes aseTi mniSvnelovania, narkotikebis kontrolis saerTaSoriso biuroSi opioidebis kontrolis saerTaSoriso biuroSi opioidebis kvotis 90%-s Seadgendes narkotikebis kontrolis saerTaSoriso kvotis 90%-s opioidebis biuroSi Seadgendes swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) kvotis 90%-s Seadgendes swrafad xsnadi (dauyovnebeli morfinis tabletirebuli gamocdilebam morfinis tabletirebuli formebi. samwuxarod, gamocdilebam aCvena, rom moqmedebis) da nela formebi. samwuxarod, moqmedebis) aCvena, rom xsnadi (neli morfinis didi farmacevtuli kompaniebi awarmoeben ufro ZviradRirebul, magram farmacevtuli kompaniebi awarmoeben ufro ZviradRirebul, magram didi tabletirebuli formebi. samwuxarod, gamocdilebam aCvena, mkveTr SezRudvebs SezRudvebs daqvemdebarebul daqvemdebarebul wamlebs, wamlebs, romlebic romlebic tkivilis tkivilis mkveTr rom didi farmacevtuli kompaniebi awarmoeben ufro kontrolis TvalsazrisiT saukeTesod ver miiCneva kontrolis TvalsazrisiT saukeTesod ver miiCneva . . ZviradRirebul, magram mkveTr SezRudvebs daqvemdebarebul wamlebs, romlebic tkivilis kontrolis TvalsazrisiT praqtikuli rCeva: praqtikuli rCeva: saukeTesod ver erovnuli politikis/strategiis principebisa da miiCneva. politikis/strategiis principebisa da jandacvis erovnuli - - jandacvis praqtikuli rCeva:samkurnalo aucilebeli saSualebebis nusxis (EDL) aucilebeli samkurnalo saSualebebis nusxis (EDL) - urTierTSesabamisobaSi moyvana; jandacvis erovnuli politikis/strategiis princi pebisa urTierTSesabamisobaSi moyvana; da aucilebeli samkurnalo saSualebebis nusxis (EDL) urTierTSesabamisobaSi moyvana; - swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) morfinis tabletirebuli formebis mwarmoebel kompaniebTan dakavSireba da qveynis momaragebisaTvis maT Soris tenderis gamocxadeba; narkotikuli saSualebebis daniSvnis proceduris gamartivebisa da ukeTesi xelmisawvdomobis uzrunvelyofa; - swrafad xsnadi (dauyovnebeli moqmedebis) da nela

1

xsnadi (neli moqmedebis) morfinis generiuli formebiT qveynis adekvaturi uzrunvelyofis Semdeg, paliatiuri mzrunvelobis sistemaSi CarTuli yvela piris (eqimi,eqTani, farmacevti, socialuri muSaki) uSualod "sawolTan" swavlebisa da treningebis organizeba; morfinis moxmarebisa da momxmarebel pacientTa raodenobis monitoringi da dokumentacia. SegaxsenebT: generiuli morfinis Rirebuleba utoldeba an naklebia aspirinis Rirebulebaze. magaliTad, keralaSi (indoeTi) 10 mg swrafad xsnadi morfinis Rirebuleba Seadgens 2 amerikul cents. ugandaSi per-oraluri morfinis erTi TvisaTvis saWiro raodenobis Rirebuleba Seesabameba puris 2 kviris maragis Rirebulebas. amdenad, swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) morfinis tabletirebul formebze gadasvla efeqturia, rogorc samedicino, ise socialuri da finansuri TvalsazrisiT. danarTi 6: moTxovna morfinis sulfatze narkotikebis kontrolis saerTaSoriso biuroSi qveynis kvotis moTxovnisas morfinis saWiro raodenoba ganisazRvreba (iTvleba) imis gaTvaliswinebiT, rom kiboTi gamowveuli tkivilis marTvisaTvis saSualod saWiroa dReSi morfinis 100mg, saSualod 100 dRis ganmavlobaSi. amdenad, erTi pacienti saSualod moixmars morfinis 10000 mg-s, e.i. 1 kg morfini sakmarisia 100 pacientisaTvis. kibos ti pis, daavadebis stadiisa da mkurnalobis vadebis gaTvaliswinebiT morfinis saerTo raodenoba SeiZleba icvlebodes. morfinis Senaxvis oficialuri vada 2 welia, Tumca biologiurad is aqtiuria gacilebiT meti xnis manZilze. dawyebuli tkivilis sawinaaRmdego Terapiis Sewyveta arahumanuri qmedebaa pacientis mimarT, amdenad, morfinis maragis "amowurva"- miuRebelia. mas Semdeg rac moxdeba qveynis uzrunvelyofa swrafad xsnadi

(dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) tabletirebuli morfinis saWiro raodenobiT, aucilebelia eqimebisa da eqTanebisaTvis saswavlo kursebis Catareba, romelic moicavs 1-kvirian interaqtiul Teoriul, da minimum, 2-kvirian praqtikul mecadineobebs. saswavlo kursis dawyeba mizanSewonilia mas Semdeg, rac narkotikebze kontrolis saerTaSoriso biuros (INCB) mier moxdeba saqarTvelosTvis kvotis gazrdis gadawyvetilebis miReba. Sinagan saqmeTa da jandacvis saministroSi unda ganisazRvros swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) morfinis tabletirebuli formebis axali (gazrdili) kvotebi. morfinis tabletebi unda iqnes Setanili aucilebeli medikamentebis nusxaSi (EDL) da gamoyenebuli standartuli mkurnalobis protokolebSi.

danarTi 7: mxardaWera (lobireba) 1) mniSvnelovania sazogadoebisa da jandacvis sferos muSakebis yuradRebis gamaxvileba Semdegze: · paliatiuri mzrunveloba aumjobesebs pacientis sicocxlis xarisxs miuxedavad imisa, rom daavadeba ganukurnelia. · mkurnalobiT SesaZlebelia tkivilisa da sxva simptomebis Semsubuqeba. · tkivilis sawinaaRmdego preparatebi ar unda iyos Zviri. · pacientis tanjva, tkivilisa da stresis momgvreli sxva simptomebis atana dauSvebelia. · tkivilis Sesamsubuqebeli preparatebis miReba SeiZleba ganusazRvrelad, rac gavlenas ar axdens maT efeqturobaze. · morfini, rogorc wesi, ar iwvevs "miCvevis" (fsiqologiuri damokidebulebis) ganviTarebas, Tu is gamoiyeneba

·

tkivilis kontrolisaTvis. ojaxis wevrebs, moxaliseebsa da sazogadoebis mxardaWeras eniWeba gadamwyveti roli inkurabeluri pacientis sicocxlis xarisxis gaumjobesebaSi.

2) mniSvnelovania, rom politikosebma da sazogado moRvaweebma yuradReba gaamaxvilon Semdeg debulebebebzec: · tkivilis dayuCeba aris princi puli sakiTxi, radganac, sazogadod tkivili dayuCebadia. tkivilisa da sxva simptomebis marTvis arsebuli efeqturi meTodebis gamoyeneba warmoadgens erT-erT umniSvnelovanes sakiTxs. · amrigad, paliatiuri mzrunvelobis uzrunvelyofaze pacientisaTvis uaris Tqma araeTikuria. paliatiuri mzrunvelobis miReba adamianis uflebaa. · yvelas unda axsovdes, rom erT dRes yoveli CvenTagani mokvdeba. · "Cven yuradRebiT veqceviT axalSobilebs, romlebic Semodian Cvens cxovrebaSi, aseTive yuradRebis Rirsia yvela mozrdili da momakvdavi adamiani, romelic tovebs cxovrebas" (ian stjernsvordi 1986).

danarTi 8: erovnuli politikis SemuSavebisadmi miZRvnili seminaris dRis wesrigi seminaris dRis wesrigi paliatiuri mzrunvelobis erovnuli programa paliatiuri mzrunvelobis erovnuli programa

danarTi 8: erovnuli politikis SemuSavebisadmi miZRvnili

31

tkivilis Semsubuqeba da paliatiuri mzrunveloba tkivilis Semsubuqeba da paliatiuri mzrunveloba (saqarTvelos iniciativa - saqarTvelos pirveli ledis (saqarTvelos iniciativa - saqarTvelos pirveli ledis patronaJiT) patronaJiT) erovnuli seminaris sponsorebi: saqarTvelos jandacvis saministro, erovnuli seminaris sponsorebi: Ria sazogadoebis instituti, saqarTvelos jandacvis saqvelmoqmedo humanitaruli fondi SOCO, saministro, sazogadoeba-saqarTvelo", paliatiuri fondi SOCO, saqvelmoqmedo humanitaruli fondi "Ria mzrunvelobis Ria sazogadoebis kavSiri", jandacvis msoflio organizacia, san fondi "Ria sazogadoebaasociacia "humanistTa instituti, saqarTvelo", paliatiuri mzrunvelobis asociacia diegos hospisi. "humanistTa kavSiri", tkivilis Semsubuqebisa organizacia, san jandacvis msoflio da paliatiuri miznebi: saqarTveloSi diegos hospisi. mzrunvelobis erovnuli samoqmedo gegmisa da programis ganviTarebis miznebi: saqarTveloSi tkivilis Semsubuqebisa da paliatiuri xelSewyoba. mzrunvelobis erovnuli samoqmedo gegmisa da programis dRis wesrigi misalmeba ganviTarebis xelSewyoba. monawileTa warmodgena (eq. dimitri korZaia) dRis wesrigi mimoxilva (eq. misalmeba ian stjernsvordi) ras warmoadgens kargi (adekvaturi) paliatiuri mzrunveloba (eq. frank monawileTa warmodgena (eq. dimitri korZaia) ferisi) mimoxilva (eq. ian stjernsvordi) seminaris amocanebi kargi (adekvaturi) paliatiuri mzrunveloba ras warmoadgens da strategia (eq. ian stjernsvordi) sauzme (eq. frank ferisi) problemaTa diskusiebi samuSao jgufebSi: seminaris amocanebi da strategia (eq. ian stjernsvordi) sauzme politika opioidebis xelmisawvdomoba (nabadarTuloba) problemaTa diskusiebi samuSao jgufebSi: ganaTleba ·politika rekomendaciebi samuSao jgufebisaTvis ·opioidebis xelmisawvdomoba (nabadarTuloba) reziume ·ganaTleba rekomendaciebi samuSao jgufebisaTvis reziume

danarTi 9: erovnuli politikis SemuSavebisadmi miZRvnili seminaris da saswavlo kursebis monawileebi saqarTvelos parlamenti 1. gigi wereTeli ­ saqarTvelos parlamentis jandacvisa socialur sakiTxTa komitetis Tavmjdomare 2. oTar ToiZe - saqarTvelos parlamentis jandacvisa socialur sakiTxTa komitetis wevri 3. nana jebaSvili - saqarTvelos parlamentis jandacvisa socialur sakiTxTa komitetis wevri 4. eka yorelaZe - saqarTvelos parlamentis jandacvisa socialur sakiTxTa komitetis wevri

da da da da

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministro 5. lado Wi paSvili ­ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministri 6. levan juReli - saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris moadgile 7. nikoloz fruiZe - saqarTvelos Sromis, janmrTelobisa da socialuri dacvis ministris moadgile 8. TinaTin turZelaZe ­ saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros wamlis saagentos ufrosi 9. nana gorgasliZe - saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros wamlis saagentos TanamSromeli 10. Tamaz kvirkvelia - saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros wamlis saagentos TanamSromeli 11. irina xavanskaia ­ jandacvis munici paluri samsaxuris TanamSromeli paliatiuri mzrunvelobis asociacia "humanistTa kavSiri" [proeqti "binaze paliatiuri mzrunveloba" (pbpm)] 12. Tamar alibegaSvili ­ asociacia "humanistTa kavSiris" prezidenti

13. dimitri korZaia - asociacia "humanistTa kavSiris" damfuZnebeli, proeqt "binaze paliatiuri mzrunvelobis" (pbpm) direqtori 14. ia axalaZe ­ pbpm eqimi 15. Tamar ruxaZe - pbpm eqimi 16. marine TurqaZe - pbpm eqimi 17. xaTuna doliZe - pbpm eqimi 18. Tea surmava - pbpm eqimi 19. Tea kakabaZe ­ pbpm eqimi 20. Suqia WinWarauli ­ pbpm eqTani 21. marina zarnaZe - pbpm eqTani 22. Tamar gogolaZe - pbpm eqTani 23. irma abulaZe - pbpm eqTani kavSiri "onkoprevenciis centri" [onkologiis erovnul centrTan (oec) arsebuli hospisi] 24. rema RvamiCava ­ oec hospisis eqimi onkologi 25. mixeil Savdia ­ oec hospisis eqimi onkologi 26. ioseb abesaZe ­ oec hospisis eqimi onkologi 27. Tengiz aroSiZe - oec hospisis eqimi onkologi 28. ludmila iarkina - oec hospisis eqimi onkologi 29. giorgi metiviSvili - oec hospisis eqimi onkologi 30. naTia vekua - oec hospisis eqimi onkologi 31. zurab TargamaZe - oec hospisis eqimi onkologi 32. Tamar jinjibuxaSvili - oec hospisis eqimi fsiqoTerapevti 33. marika giorgaZe - oec hospisis eqTani 34. maia gigineiSvili - oec hospisis eqTani 35. nana juSoSvili - oec hospisis eqTani onkologiis erovnuli centri (oec) 36. revaz gagua ­ onkologiis erovnuli centris (oec) prezidenti 37. zaza zarqua ­ oec eqimi onkologi 38. Tamar kapanaZe - oec eqimi onkologi 39. paata xorava - oec eqimi onkologi 40. ia mWedliSvili - oec eqimi onkologi 41. miranda gogiSvili - oec eqimi onkologi

42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53.

Temur qemokliZe - oec eqimi onkologi maia tatiSvili - oec eqimi onkologi giorgi kaWaxiZe - oec eqimi onkologi daviT kuWava - oec eqimi onkologi Tamaz focxveria - oec eqimi onkologi lela giorgobiani - oec eqimi onkologi dina qurdiani - oec eqimi onkologi nana ubilava - oec eqimi onkologi vaxtang SoSiaSvili - oec eqimi anesTeziologi arCil kapanaZe - oec eqimi radiologi memed jinWaraZe - oec eqimi onkologi (baTumi) maia aRniaSvili ­ oec eqTani

pirveladi jandacvis qselis eqimebi 54. nunu manjgalaZe ­ eqimi onkologi 55. manana jangulaSvili - eqimi onkologi 56. leila gevorqiani - eqimi onkologi 57. qeTevan gigilaSvili - eqimi onkologi 58. mila belqania - eqimi onkologi 59. nana qavTaraZe - eqimi onkologi 60. naTela asabaSvili - eqimi onkologi 61. inesa giorgobiani - eqimi onkologi 62. manana ramiSvili - eqimi onkologi 63. darejan Savdia - eqimi onkologi 64. qeTevan eremeiSvili - eqimi onkologi 65. marine yavelaSvili - eqimi onkologi 66. manana giorgobiani - eqimi onkologi 67. irina gubeliZe - eqimi onkologi 68. nino zenaZe - eqimi onkologi 69. irina maliniZe - eqimi onkologi 70. cicino gogvaZe - eqimi onkologi (baTumi) Sps "medula" 71. nino SariqaZe ­ eqimi onkologi 72. lia abSilava ­ eqimi onkologi

janmos saqarTvelos ofisi rusudan klimiaSvili - ofisis xelmZRvaneli saqarTvelos eqTanTa asociacia 73. marina saxvaZe ­asociaciis prezidenti saswavlo da samecniero centrebi 74. gela leJava ­ narkologiis s/k institutis direqtori 75. Tengiz cercvaZe ­ Sidsis centris xelmZRvaneli 76. ramaz sayvareliZe ­ Tssu fsiqo-somaturi medicinis fakultetis dekani 77. ramaz Sengelia ­ Tssu samkurnalo fakultetis dekani 78. nikoloz gongaZe ­ eqimi-farmakologi, Tssu farmacevtuli fakultetis dekani, farmkomitetis Tavmjdomare 79. nodar baqraZe ­ ojaxis eqimis institutis direqtori 80. gaioz vasaZe ­ informatikis erovnuli centris xelmZRvaneli 81. mamuka goleTiani ­ saSualo samedicino saswavleblis direqtori 82. irina qarosaniZe ­ eqimi ­ saojaxo medicinis centris xelmZRvaneli 83. revaz morgoSia ­ eqimi - saojaxo medicinis centris xelmZRvaneli 84. Tamar samxaraZe ­ Sidsis centris eqimi fsiqologi 85. Tamar kezeli ­ eqimi farmakologi 86. neli anTelava ­ eqimi farmakologi sxvadasxva specialobis eqimebi 87. mariam Jvania ­ eqimi 88. Tamar kiknaZe ­ eqimi 89. Tamar gvarjalaZe ­ eqimi 90. irina wirqvaZe - eqimi 91. nana TorTlaZe ­ eqimi 92. nino turabeliZe ­ eqimi 93. aleqsandre gvazava ­ eqimi 94. nukri siraZe - eqimi 95. marine abaSiZe ­ eqimi 97. nona odiSeliZe ­ eqimi

danarTi 10 A da B: rekomendaciebi monawileTaTvis erovnuli politikis SemuSavebisadmi miZRvnili seminari, 25 oqtomberi 2005 weli, Tbilisi, saqarTvelo 10 A : politika / rekomendaciebi samuSao jgufebisaTvis - saqarTveloSi paliatiuri mzrunvelobis institutis Seqmna; - saqarTveloSi paliatiuri mzrunvelobis pedagogiuri Semadgenlobis momzadeba; saqarTveloSi aucilebeli medikamentebis nusxis gamocema, romelic Seicavs per-oralur morfinis sulfats, tramadols da sainieqcio morfinis sulfats; - opioidebis gamoweris uflebis mqone eqimebis raodenobis gazrda; - opioidebis realizaciis nebarTvis mqone afTiaqebis (mag: I kategoriis afTiaqebi) TandaTanobiTi gansazRvra; -saqarTveloSi hospisebis qselis Seqmna da ganviTareba; -pacientebisa da maTi ojaxis wevrebisaTvis fsiqologiuri daxmarebis gawevis unaris mqone jgufis Seqmna da misi Semdgomi momzadeba-daxelovneba; - ojaxis wevrTa daxmareba (maTi gaTviTcnobiereba) e.w. "zedmeti movlisa da mkurnalobis" usargeblobaSi; -eqimebsa da pacientebs Soris urTierTgagebis gaumjobesebis xelSewyoba pacientebis survilebisa da moTxovnebis ukeT dakmayofilebis mizniT; - aucilebelia gaanalizdes: ra "unda" icodes pacientma da "surs" mas rom icodes; - mediis daxmarebiT sazogadoebisaTvis paliatiuri mzrunvelobis rolis gacnoba. kibos SiSis daZlevisa da paliatiuri mzrunvelobis Taobaze codnis gaRrmavebis xelSewyoba; - jandacvis erovnuli politikis gadaxedva- opioidebis garda sxva analgeziuri saSualebebis, aseve ZiriTadi simptomebis (mag: yabzoba, gulisreva) marTvis saSualebebis (mag: arasteroiduli anTebis sawinaaRmdego saSualebebi, steroidebi) momaragebis dafinansebis uzrunvelsayofad; - erTdroulad miwodebuli medikamentebis raodenobis da

0

maTi daniSvnis (gamoweris) an dozis Secvlis grafikis limitis minimalizacia; - narkotikebis zedamxedvelobis sistemis mimarT moTxovnaTa Secvla. 10 B: rekomendaciebi saswavlo jgufisaTvis - paliatiur mzrunvelobaSi CarTuli yvela rgolis-eqimebis, eqTanebis, farmacevtebis, moxaliseebis, sazogadoebis, socialuri muSakebis, fsiqologebisa da sasuliero pirebis codnis da saWiro unar-Cvevebis amaRleba da daxvewa; - yvela samedicino, saeqTno da farmacevtuli skolisa da universitetis saswavlo programebSi disci plinis "paliatiuri mzrunvelobis" CarTva; -eqimebis uwyveti samedicino ganaTlebis programebSi pacientis movlis Tanamedrove princi pebis, maT Soris fsoqologiuri da moraluri mxardaWeris sakiTxebis Setana; -opioidebis xangrZlivad zemoqmedebis farmakologiis sakiTxebSi eqimebis Teoriuli da praqtikuli codnis amaRleba, maTi Cvevebis daxvewa; -samedicino skolebisa da di plomisSemdgomi ganaTlebis sistemaSi paliatiuri mzrunvelobis damoukidebeli saswavlo kursis integracia; -di plomisSemdgomi specializacia "paliatiur mzrunvelobaSi"; - eqimebis, eqTanebisa da farmacevtebisaTvis tkivilis marTvis saswavlo kursis dafuZneba (procesSi monawile yvela rgolisaTvis); - eqimebis, eqTanebis, farmacevtebisa da fsiqologebis damatebiTi uwyveti ganaTlebis saswavlo kursebis uzrunvelyofa; moxaliseTa jgufSi samedicino saswavleblebis studentebis CarTva; - binaze paliatiuri mzrunvelobis ganmaxorcielebeli mobiluri jgufebis muSaobaSi fsiqologebis monawileoba, pacientis ojaxis wevrTa codnisa da Cvevebis amaRlebisa da gaumjobesebis mizniT;

1

- sasuliero ganaTlebis saswavlo programaSi paliatiuri mzrunvelobis zogierTi aspeqtis CarTva (gansakuTrebiT im SemTxvevebSi, Tu sasuliero pirebs gaaCniaT samedicino ganaTleba an sxva gamocdileba); - paliatiuri mzrunvelobis gundis TiToeuli wevri kargad unda flobdes pacientis ojaxis wevrebis codnis amaRlebis meTodebsa da Cvevebs; - saqarTveloSi ar arsebobs socialuri muSakis profesiuli momzadebis institucia, ris gamoc mravali problema rCeba gadauWreli. aucilebelia am xarvezis gamosworeba; - sazogadoebis codnis amaRleba mas mediisa da beWdviTi sityvis saSualebiT; - paliatiuri mzrunvelobis gundis wevrebisaTvis gadamzadebis iseTi kursebis organizacia, rom erTi da imave pirovnebas SeeZlos iyos paliatiuri mzrunvelobis gundis wevric da amasTanave, sxva gundis wevrebis maswavlebelic; - EPEC da ELNEC-is damateba paliatiuri mzrunvelobis Taobaze qarTulad Targmnil da gavrcelebul masalebze; - saWiroa paliatiuri mzrunvelobis ganviTarebis aucileblobis gansxvavebuli propaganda politikosTa Soris da sazogadoebaSi; - paliatiuri mzrunvelobis samsaxuris Taobaze sakontaqto informaciis gavrceleba yvelgan, sadac mosaxleoba iRebs informacias an daxmarebas.

danarTi 11: "strategiis dokumenti" saqarTvelos

parlamentis jandacvisa da socialur sakiTxTa komitetisaTvis tkivilis Semsubuqebisa da paliatiuri mzrunvelobis erovnuli programa saqarTveloSi "strategiis dokumenti" saqarTvelos parlamentisaTvis 30 oqtomberi, 2005 weli paliatiuri mzrunveloba miznad isaxavs ukurnebeli seniT Sebyrobili pacientis tanjvis Semsubuqebas, sicocxlis xarisxis gaumjobesebas da mis Rirseulad dasrulebis xelSewyobas (1). jandacvis msoflio organizaciis mier misi wevri qveynebisaTvis SemuSavebulia paliatiuri mzrunvelobis erovnuli programis dafuZnebis rekomendaciebi (2). evropis sabWoc Tavis rekomendaciebSi xazs usvams paliatiuri mzrunvelobis mniSvnelobasa da saWiroebas (3). tkivilis Semsubuqeba da paliatiuri mzrunveloba warmoadgens sazogadoebrivi jandacvis erT-erT yvelaze mniSvnelovan problemas saqarTveloSi. qveyanaSi wlis ganmavlobaSi aRiricxeba sikvdilis 43 000 SemTxveva. janmos rekomendaciiT momakvdavTa daaxloebiT 60 % saWiroebs paliatiur mzrunvelobas. saqarTvelosTvis es cifri uaxlovdeba 25 000. kibos SemTxvevaSi paliatiuri mzrunvelobis saWiroeba kidev ufro maRalia da misi maCvenebeli 2/3-s aRwevs. amdenad, saqarTveloSi kibos yovelwliuri daaxloebiT 7 000 axali SemTxvevidan, paliatiur mzrunvelobas saWiroebs 4 500-ze meti adamiani. dReisaTvis cnobilia tkivilis marTvisa da tanjvis Semsubuqebis mecnierulad dasabuTebuli efeqturi meTodebi ara marto kiboTi SebyrobilTaTvis, aramed sxva daavadebebis mqone (mag: gul-sisxlZarRvTa daavadebebi, insulti, Sidsi) pirTaTvis, maT Soris bavSvebisaTvis. amdenad, araeTikuria paliatiur mzrunvelobaze da sicocxlis xarisxis gaumjobesebaze uaris Tqma ukurnebeli seniT Sebyrobili adamianebisa da maTi ojaxis wevrebisaTvis. ukanaskneli 3 wlis ganmavlobaSi saqarTveloSi gadadgmulia mniSvnelovani nabijebi paliatiuri mzrunvelobis

sistemis Camoyalibebisa da damkvidrebis saqmeSi. Seqmnili da Targmnilia jandacvis erovnuli politikis SemuSavebis xelSemwyobi sxvadasxva normatiuli dokumentebi, agreTve saxelmZRvaneloebi jandacvis muSakebis, pacientebisa da maTi ojaxis wevrebisaTvis. 100-ze metma eqimma, eqTanma da moxalisem warmatebiT gaiara uwyveti profesiuli ganaTlebis sxvadasxva programebi rogorc saqarTveloSi, ise sazRvargareT. Seqmnilia di plomamdeli samedicino ganaTlebis programebi eqimebisa da eqTanebisaTvis. 2005 wlidan onkologiis nacionalur centrSi Seqmnil paliatiuri mzrunvelobis axal ganyofilebaSi daxmareba gaewia 200-mde pacients, xolo binaze paliatiuri mzrunvelobis mobilurma gundma ganaxorciela 100-ze met pacientTan 4 000-ze meti viziti. gamoikveTa dargis liderebic. aRniSnuli warmatebebis miuxedavad am sferoSi saqarTveloSi arsebuli problemis moculobis gaTvaliswinebiT saWiroa (aucilebelia) paliatiuri mzrunvelobis erovnuli programis SemuSaveba. amisaTvis rekomendebulia: - paliatiuri mzrunvelobis ganviTarebis samoqmedo gegmis SemuSaveba da misi integracia saqarTvelos jandacvis sistemaSi yvela doneze; - swrafad xsnadi da nela xsnadi morfinis generiuli formebis xelmisawvdomobis (nebadarTulobis) uzrunvelyofa da misi gamoweris (daniSvnis) racionaluri (gamartivebuli) politikis SemuSaveba; - paliatiuri mzrunvelobis sferoSi dasaqmebuli eqimebis, eqTanebis, farmacevtebis, fsiqologebisa da socialuri muSakebis codnis amaRleba. amasTanave, imis gaTvaliswinebiT, rom saqarTveloSi avadmyofTa umravlesoba amjobinebs saxlSi gardacvalebas, programam aucilebelia mimarTos sazogadoebrivi Zalisxmeva zedmeti (usargeblo) wamlebiT mkurnalobisa da sikvdilis institucionalizaciis Tavidan asacileblad. TbilisSi Cvens mier axlaxan Catarebuli "erovnuli politikis SemuSavebisadmi miZRvnili" seminaris

gaTvaliswinebiT, erovnuli samoqmedo gegma strategiiTa da prioritetebiT, ganxorcielebis etapebis detalizaciiT da pirveli xelSemwyobi (katalizuri) biujetiT momzadebuli iqneba 2005 wlis dekemberSi. Tbilisi, saqarTvelo 30 oqtomberi, 2005 weli eqimi dimitri korZaia

saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministro paliatiuri mzrunvelobis asociaciis "humanistTa kavSiris" damfuZnebeli binaze paliatiuri mzrunvelobis piloturi proeqtis direqtori

eqimi rema RvamiCava

onkologiis nacionaluri centri kavSiri "onkoprevenciis centris" direqtori paliatiuri mzrunvelobis pirveli ganyofilebis damfuZnebeli

eqimi frank ferisi

san diegos hospisisa da paliatiuri mzrunvelobis centris samedicino direqtori, Ria sazogadoebis institutis (niu-iorki) saerTaSoriso mrCeveli

eqimi ian stjernsvordi

jandacvis msoflio organizaciis (Jeneva) kibos ganyofilebis xelmZRvaneli (emeritusi) Ria sazogadoebis institutis (niu-iorki) saerTaSoriso mrCeveli

(1) WHO: Definition of palliative care, 1990, 2002 Canadian Hospice Palliative Care Association. A model to guide patient and family care. Based on nationally accepted principles and norms of practice. J Pain Symptom Manage. 2002 Aug; 24(2): 106-23. (2) WHO: Cancer Pain Relief and Palliative Care. WHO Technical Report Series, 804, WHO: Geneva, 1990. (3) European Council: Recommendation Rec (2003) 24 of the Committee of Ministers to member states on the organisation of palliative care.

danarTi 12: "strategiis dokumentis" pirveli rekomendaciebi tkivilis Semsubuqebisa da paliatiuri mzrunvelobis saqarTvelos erovnuli programa "strategiis dokumentis" pirveli rekomendaciebi 30 oqtomberi, 2005 weli I. politikis sakiTxebi: 1. paliatiuri mzrunvelobis CarTva saqarTvelos jandacvis momaval (misaReb) erovnul programaSi. 2. kibos kontrolis yovlismomcveli erovnuli programis SemuSaveba. 3. saqarTvelos parlamentTan, saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministrosTan da arasamTavrobo organizaciebTan SeTanxmebiT saqarTvelos parlamentTan sakoordinacio ofisis Seqmna, romelic iTvaliswinebs ukanaskneli erovnuli politikis seminaris (2005 wlis dekemberi) rekomendaciebis koordinaciasa da danergvis xelSewyobas saerTaSoriso eqspertebTan erTad. ofisis xelmZRvanelad rekomendebulia eq. dimitri korZaias kandidatura (saqarTvelos Sromis, janmrTelobisa da socialuri dacvis saministros TanamSromeli, paliatiuri mzrunvelobis asociaciis "humanistTa kavSiris" damfuZnebeli). 4. paliatiuri mzrunvelobis samsaxuris ganviTareba mTeli qveynis masStabiT (jandacvis sistemis yvela doneze). aRniSnuli saqmianobis koordinatorad rekomendebulia eq. Rema RvamiCavas kandidatura. (kavSiri" onkoprevenciis centri", onkologiis nacionaluri centris direqtorTa sabWos wevri, Tbilisis saxelmwifo samedicino universitetis asocirebuli profesori). 5. swrafad xsnadi (dauyovnebeli moqmedebis) da nela xsnadi (neli moqmedebis) morfinis generiuli formebis xelmisawvdomobis (nebadarTulobis) uzrunvelyofa, misi racionaluri daniSvnis da gamoweris wesebis gamartiveba.

II. ganaTleba 1. paliatiuri mzrunvelobis CarTva samedicino skolebis studentebisa da klinikuri farmacevtebis saswavlo programebSi; 2. paliatiuri mzrunvelobis (paliatiuri medicinis) subspecialobad gamoyofa da misi rezidenturis programis Seqmna; 3. kanonmdeblebis, samedicino personalis, socialuri muSakebis, moxaliseebis, pacientebisa da maTi ojaxis wevrebis uwyveti ganaTlebis sistemis uzrunvelyofa (seminarebi, treningebi, satelevizio programebi da publikaciebi). III. dafinanseba 1. uwyveti da mzardi sabiujeto (saxelmwifo) dafinanseba: - paliatiuri mzrunvelobis samsaxurebis biujetis gazrda (paliatiuri mzrunvelobis ganyofileba da binaze paliatiuri mzrunvelobis mobiluri jgufebi). - biujetis gamoyofa axali paliatiuri mzrunvelobis samsaxurebisaTvis saqarTvelos regionebSi. 2. saerTaSoriso donorebisagan xelSewyobis moZieba Ria sazogadoebis institutis mier ukve garantirebul dafinansebasTan erTad: - paliatiuri mzrunvelobis erovnuli programis dawyebisaTvis - kibos kontrolis momavali erovnuli programis ganviTarebis xelSewyobisaTvis. eqimi frank ferisi

san diegos hospisisa da paliatiuri mzrunvelobis centris samedicino direqtori, Ria sazogadoebis institutis (niu-iorki) saerTaSoriso mrCeveli

eqimi ian stjernsvordi

jandacvis msoflio organizaciis (Jeneva) kibos ganyofilebis xelmZRvaneli (emeritusi) Ria sazogadoebis institutis (niu-iorki) saerTaSoriso mrCeveli

danarTi 13: paliatiuri mzrunvelobis sistemis sayovelTaobis uzrunvelsayofad aucilebelia mTeli sazogadoebis Zalisxmeva

Stjernsward Jan: Ind.J.PallCare, 2005, December 2005 ,11,2:52-58, and June 2005

Information

48 pages

Report File (DMCA)

Our content is added by our users. We aim to remove reported files within 1 working day. Please use this link to notify us:

Report this file as copyright or inappropriate

517650


You might also be interested in

BETA