{"id":19911,"date":"2023-01-12T18:37:46","date_gmt":"2023-01-12T16:37:46","guid":{"rendered":"https:\/\/zurnalsiepirkumi.lv\/?p=19911"},"modified":"2023-01-16T12:38:38","modified_gmt":"2023-01-16T10:38:38","slug":"labaka-eiropas-prakse-ka-vertiba-balstiti-iepirkumi-palidz-arstiem","status":"publish","type":"post","link":"https:\/\/zurnalsiepirkumi.lv\/?p=19911","title":{"rendered":"LAB\u0100K\u0100 EIROPAS PRAKSE: K\u0101 v\u0113rt\u012bb\u0101 balst\u012bti iepirkumi pal\u012bdz \u0101rstiem?"},"content":{"rendered":"\n<div class=\"wp-block-group has-global-padding is-layout-constrained wp-block-group-is-layout-constrained\">\n<p>Katr\u012bne P\u013cavi\u0146a-Mika, Sorainen zv\u0113rin\u0101ta advok\u0101te<br>Paula \u0160\u016btava, jurista pal\u012bdze<\/p>\n\n\n\n<p>&nbsp;<\/p>\n\n\n\n<p> <\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>\u0100rstiem ir ties\u012bbas iesaist\u012bties medic\u012bnas pre\u010du un pakalpojumu iepirkumos, lai nodro\u0161in\u0101tu sava darba efektivit\u0101tes un kvalit\u0101tes uzlabo\u0161anu, k\u0101 ar\u012b vislab\u0101k\u0101s pacientu apr\u016bpes iesp\u0113jas. <\/p>\n\n\n\n<p>Ir j\u0101nosaka priorit\u0101te vesel\u012bbas apr\u016bpes m\u0113r\u0137u sasnieg\u0161anai, nevis naudas taup\u012b\u0161anai uz pacientu dz\u012bv\u012bb\u0101m un \u0101rstu labkl\u0101j\u012bbu.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p><strong>Kas ir v\u0113rt\u012bb\u0101s balst\u012bta vesel\u012bbas apr\u016bpe?<\/strong><strong><\/strong><\/p>\n\n\n\n<p>V\u0113rt\u012bb\u0101s balst\u012bta vesel\u012bbas apr\u016bpe jeb VBVA ir pieeja vesel\u012bbas apr\u016bpes p\u0101rveidei, balstoties uz pacientu vesel\u012bbas apr\u016bpes rezult\u0101tu un vesel\u012bbas apr\u016bpes sist\u0113mas snieguma uzlabo\u0161anu. <\/p>\n\n\n\n<p>VBVA atsl\u0113ga liel\u0101kaj\u0101 da\u013c\u0101 Latvijas slimn\u012bcu ir ar\u012b pla\u0161\u0101ka v\u0113rt\u012bb\u0101s balst\u012btu iepirkumu ievie\u0161ana. Praks\u0113 tas noz\u012bm\u0113 iepirkt preces un pakalpojumus, balstoties uz pacientu, \u0101rstu un sabiedr\u012bbas vesel\u012bbas interes\u0113m.<\/p>\n\n\n\n<p><\/p>\n\n\n\n<p>&nbsp;<\/p>\n\n\n\n<p>\u0160\u0101da pieeja paredz v\u0113rt\u0113t kvalit\u0101tes krit\u0113rijus:<\/p>\n\n\n\n<p><\/p>\n\n\n\n<ul>\n<li>cenas un kvalit\u0101tes attiec\u012bba,<\/li>\n\n\n\n<li>inovat\u012bvi risin\u0101jumi,<\/li>\n\n\n\n<li>energoefektivit\u0101te,<\/li>\n\n\n\n<li>soci\u0101lie aspekti,<\/li>\n\n\n\n<li>person\u0101la kvalifik\u0101cija,<\/li>\n\n\n\n<li>profesion\u0101l\u0101 r\u016bp\u012bba,<\/li>\n\n\n\n<li>reput\u0101cija.<\/li>\n<\/ul>\n\n\n\n<p>V\u0113rt\u012bb\u0101 balst\u012bti iepirkumi pal\u012bdz sasniegt vesel\u012bbas apr\u016bpes uzlabojumus un sasniegt sabiedr\u012bbas vesel\u012bbas m\u0113r\u0137us.<sup><a href=\"#fn1\" id=\"ref1\">1<\/a><\/sup> Tiem ir strat\u0113\u0123iska noz\u012bme, lai nodro\u0161in\u0101tu uz pacientu orient\u0113tu, dro\u0161u, pieejamu un augstas kvalit\u0101tes vesel\u012bbas apr\u016bpi.<sup><a href=\"#fn1\" id=\"ref1\">2<\/a><\/sup><\/p>\n\n\n\n<p>V\u0113rt\u012bbas, k\u0101d\u0101s balst\u012bt medic\u012bnas pre\u010du un pakalpojumu iepirkumus, var dal\u012bt tr\u012bs grup\u0101s \u2013pacientu ieguvumi, \u0101rstu un \u0101rstniec\u012bbas person\u0101la ieguvumi un sabiedr\u012bbas vesel\u012bbas m\u0113r\u0137i. Krit\u0113rijus var formul\u0113t da\u017e\u0101di \u2013 gan kvalitat\u012bvi, gan kvantitat\u012bvi. \u0160ie krit\u0113riji var b\u016bt samazin\u0101ts mirst\u012bbas l\u012bmenis slimn\u012bc\u0101, risin\u0101jumus tele-medic\u012bnai, konkr\u0113ts medm\u0101su skaits uz vienu \u0101rstu vai pacientu vai konkr\u0113ts \u0101rstniec\u012bbas personu darba stundu skaits uz vienu pacientu slimn\u012bcas noda\u013c\u0101. \u0160\u0101da prakse ir izplat\u012bta citur Eirop\u0101 un to ir iesp\u0113jams ieviest ar\u012b Latvij\u0101.<\/p>\n\n\n\n<p><strong>Zviedrijas pieredze<\/strong><strong><\/strong><\/p>\n\n\n\n<p>Pirmaj\u0101 piem\u0113r\u0101 v\u0113lamies apskat\u012bt br\u016b\u010du kop\u0161anas l\u012bdzek\u013cu iepirkums Stokholm\u0101.<sup><a href=\"#fn1\" id=\"ref1\">3<\/a><\/sup> \u0160aj\u0101 iepirkum\u0101 pas\u016bt\u012bt\u0101js prioritiz\u0113ja:<\/p>\n<\/div>\n\n\n\n<ul>\n<li>br\u016b\u010du apr\u016bpes \u0101trumu,<\/li>\n\n\n\n<li>atk\u0101rtotas apr\u016bpes bie\u017eumu,<\/li>\n\n\n\n<li>&nbsp;preces dz\u012bvescikla izmaksas.<\/li>\n<\/ul>\n\n\n\n<p>T\u0101tad iepirkum\u0101 nosegtas visu tr\u012bs grupu v\u0113rt\u012bbas.<\/p>\n\n\n\n<p>Pas\u016bt\u012bt\u0101js iepirkuma pretendentiem pied\u0101v\u0101ja 3 hipot\u0113tisku br\u016b\u010du apr\u016bpes pacientu anamn\u0113zes, un tika l\u016bgts apr\u0113\u0137in\u0101t katra pacienta kop\u0113j\u0101s \u0101rst\u0113\u0161anas izmaksas, izmantojot pas\u016bt\u012bt\u0101ja sniegto apr\u0113\u0137inu modeli. \u0160aj\u0101 model\u012b bija iek\u013cautas:<\/p>\n\n\n\n<ul>\n<li>p\u0101rs\u0113ju vien\u012bbas izmaksas,<\/li>\n\n\n\n<li>p\u0101rs\u0113ju mai\u0146as rei\u017eu skaits,<\/li>\n\n\n\n<li>person\u0101la izmaksas par p\u0101rs\u0113ju nomai\u0146ai pavad\u012bto laiku,<\/li>\n\n\n\n<li>transport\u0113\u0161anas izmaksas uz un no pacientu m\u0101j\u0101m,<\/li>\n\n\n\n<li>sagaid\u0101mais atkl\u0101tais vai nov\u0113rstais komplik\u0101ciju l\u012bmenis un bie\u017eums.<\/li>\n<\/ul>\n\n\n\n<p>Pas\u016bt\u012bt\u0101js l\u012bguma sl\u0113g\u0161anas ties\u012bbas pie\u0161\u0137\u012bra pied\u0101v\u0101jumam, kuram bija zem\u0101k\u0101s kop\u0113j\u0101s apr\u016bpes izmaksas un kura br\u016b\u010du apr\u016bpes metodes bija pier\u0101d\u012btas ar kl\u012bniskiem p\u0113t\u012bjumiem. Rezult\u0101t\u0101 pas\u016bt\u012bt\u0101js ietaup\u012bts medm\u0101su un \u0101rstu laiku br\u016b\u010du apr\u016bp\u0113, jo izmantoja to apr\u016bpes l\u012bdzekli, kas j\u0101lieto vai j\u0101atjauno ret\u0101k un kas izraisa maz\u0101k komplik\u0101ciju.<\/p>\n\n\n\n<p><strong>Igaunijas pieredze<\/strong><strong><\/strong><\/p>\n\n\n\n<p>Iepriek\u0161\u0113j\u0101 m\u016bsu rakst\u0101 apl\u016bkotaj\u0101 Igaunijas kardiostimulatoru iepirkuma (<a href=\"https:\/\/www.iepirkumi.lv\/lv\/akademija\/aktualitates\/19291\/ka-nodrosinat-modernakas-iekartas-latvijas-slimnicas\">https:\/\/www.iepirkumi.lv\/lv\/akademija\/aktualitates\/19291\/ka-nodrosinat-modernakas-iekartas-latvijas-slimnicas<\/a>) piem\u0113r\u0101 v\u0113lamies apskat\u012bt kvalit\u0101tes elementu v\u0113rt\u0113\u0161anas krit\u0113rijus. \u0160aj\u0101 gad\u012bjum\u0101 pas\u016bt\u012bt\u0101js kombin\u0113 Latvij\u0101 ierasto pieeju \u2013 pie\u0161\u0137irt v\u0113rt\u0113jumu par iek\u0101rtu parametriem, kas p\u0101rsniedz minim\u0101l\u0101s pras\u012bbas, ar v\u0113rt\u012bb\u0101s balst\u012btiem krit\u0113rijiem.<\/p>\n\n\n\n<p>Pas\u016bt\u012bt\u0101js kardiostimulatoru iepirkum\u0101 noteica \u0161\u0101dus krit\u0113rijus:<\/p>\n\n\n\n<p>1.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Tehnisk\u0101 atbalsta un implant\u0101cijas atbalsta reakcijas laiks (50%)<\/p>\n\n\n\n<p>a)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; reakcijas laiks (kas noz\u012bm\u0113 laiku, kas nepiecie\u0161ams, lai ra\u017eot\u0101ja apm\u0101c\u012bts speci\u0101lists p\u0113c izsaukuma sa\u0146em\u0161anas non\u0101k slimn\u012bc\u0101) darba dien\u0101s no plkst. 8 l\u012bdz 16 nep\u0101rsniedz 4 stundas<\/p>\n\n\n\n<p>b)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; elektrodu esam\u012bba ar 2 mm att\u0101lumu starp galu un \u0137\u0113des kontaktu, lai nov\u0113rstu att\u0101lin\u0101ti dzirdamo sign\u0101lu no kambara (10%)<\/p>\n\n\n\n<p>c)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Implant\u0113t\u0101 defibrilatora pievad\u012bt\u0101 \u0161oka ener\u0123ija vismaz 40 d\u017eoulu (10%).<\/p>\n\n\n\n<p>d)&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; zemsprieguma un augstsprieguma ier\u012b\u010du telemetrisk\u0101s kontroles br\u012bdin\u0101jumi tiek nos\u016bt\u012bti piln\u012bgi autom\u0101tiski un bez pacienta iejauk\u0161an\u0101s (10%)<\/p>\n\n\n\n<p>2.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Iesp\u0113ja ieprogramm\u0113t citu b\u0101zes frekvenci un citu AMS frekvenci vai t\u0101 saukto kambara pulsa frekvenci, kas ir atsevi\u0161\u0137a programm\u0113\u0161anas iesp\u0113ja autom\u0101tisk\u0101 re\u017e\u012bma p\u0101rsl\u0113g\u0161anas laik\u0101 (7%)<\/p>\n\n\n\n<p>3.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Asinsvadu slim\u012bbu diagnostika un tendences slimn\u012bc\u0101s (7%)<\/p>\n\n\n\n<p>4.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Zemsprieguma ier\u012bces intrakardi\u0101l\u0101s elektrogrammas ieraksta vismaz 9 min\u016btes un augstsprieguma ier\u012bces t\u0101s ieraksta vismaz 35 min\u016btes (3%)<\/p>\n\n\n\n<p>5.&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Augstsprieguma vads, kas ievietots caur 7F vai maz\u0101ku ievieto\u0161anas ier\u012bci (3%)<\/p>\n\n\n\n<p>Ar\u012b \u0161is piem\u0113rs atkl\u0101j nepiecie\u0161am\u012bbu tehniskos parametrus kontrol\u0113t ar pier\u0101d\u012bjumiem ar medic\u012bnas ier\u012b\u010du efektivit\u0101ti. No k\u0101 ir secin\u0101ms, ka medic\u012bnas ier\u012bces kvalit\u0101ti ir b\u016btiski p\u0101rbaud\u012bt ar pier\u0101d\u012bjumiem par to darb\u012bbas un terapijas efektivit\u0101ti.<\/p>\n\n\n\n<p><strong>N\u012bderlandes pieredze<\/strong><strong><\/strong><\/p>\n\n\n\n<p>Erasmus Universit\u0101tes medic\u012bnas centrs slimn\u012bcu gultu iepirkum\u0101 v\u0113l\u0113j\u0101s koncentr\u0113ties uz viedu un visaptvero\u0161u risin\u0101jumu, t\u0101 viet\u0101, lai balst\u012btu savu izv\u0113li uz pirkuma cenu. Tika apzin\u0101tas kritisk\u0101s probl\u0113mas apr\u016bpes snieg\u0161an\u0101. Piem\u0113ram, \u0161aj\u0101 centr\u0101 durv\u012bm nebija logu, t\u0101d\u0113\u013c medm\u0101si\u0146\u0101m n\u0101c\u0101s t\u0101s v\u0113rt va\u013c\u0101 katru reizi, lai p\u0101rliecin\u0101tos, ka pacienti atrodas gult\u0101. L\u012bdz ar to rad\u0101s secin\u0101jums, ka ir nepiecie\u0161amas digit\u0101li savienotas gultas, kas br\u012bdin\u0101tu medm\u0101sas, ja pacients, kuram ir j\u0101b\u016bt gultas re\u017e\u012bm\u0101, to pamet. \u0160\u012bs gultas vair\u0101kos aspektos uzlaboja darba pl\u016bsmu, piem\u0113ram, autom\u0101tiski sverot pacientu, lai tas neb\u016btu j\u0101dara manu\u0101li medm\u0101si\u0146\u0101m. K\u0101 ar\u012b, t\u0101s samazina izgul\u0113jumu un infekciju risku. Izv\u0113rt\u0113jot visus min\u0113tos ieguvumus, tika veikts \u0161is v\u0113rt\u012bb\u0101 balst\u012btais iepirkums.<\/p>\n\n\n\n<p><strong>Francijas pieredze<\/strong><strong><\/strong><\/p>\n\n\n\n<p>Francijas Slimn\u012bcu apvien\u012bba iepirkumu veik\u0161anai (Union des H\u00f4pitaux pour les Achats &#8211; UniHA), kas apvieno 870 slimn\u012bcas, iepirka pacientu sild\u012b\u0161anas sist\u0113mas. Francij\u0101 90% pacientu \u0137irur\u0123isko proced\u016bru laik\u0101 tika nodro\u0161in\u0101ta sild\u012b\u0161ana, tom\u0113r 60% no vi\u0146iem cieta no hipotermijas, k\u0101 rezult\u0101t\u0101 palielin\u0101j\u0101s asinsreces trauc\u0113jumi, diskomforts, infekciju gad\u012bjumi un ilgsto\u0161a \u200b\u200b uztur\u0113\u0161an\u0101s stacion\u0101ra. UniHA izveidota daudznozaru komandu no \u0101rstiem, \u0101rstniec\u012bbas person\u0101la, biomedic\u012bnas in\u017eenieriem un pirc\u0113jiem. Galveno krit\u0113riju attiec\u012bba tika izvirz\u012bta k\u0101 25% pieg\u0101d\u0101t\u0101ja iesaiste (rezult\u0101ti, iztur\u012bba, elast\u012bba), 35% preces kvalit\u0101te un t\u0101 atbilst\u012bba slimn\u012bcas vajadz\u012bb\u0101m un 40% izmaksas. Komanda secin\u0101ja, ka pacientu uztur\u0113\u0161ana normotermisk\u0101 st\u0101vokl\u012b ir v\u0113rt\u012bg\u0101ka, sal\u012bdzinot ar izmaks\u0101m, kas saist\u012btas ar komplik\u0101ciju nov\u0113r\u0161anu. T\u0101d\u0113\u013c iepirkum\u0101 t\u0101 izv\u0113l\u0113j\u0101 pied\u0101v\u0101jumu ar vislab\u0101ko risin\u0101jumu situ\u0101cij\u0101m, kad pacientu temperat\u016bra kr\u012btas.<sup><a href=\"#fn1\" id=\"ref1\">4<\/a><\/sup><\/p>\n\n\n\n<p>\u0160ie un l\u012bdz\u012bgi gad\u012bjumi var kalpot par piem\u0113ru, lai ar\u012b Latvij\u0101 ieviestu v\u0113rt\u012bb\u0101 balst\u012btus medic\u012bnas pre\u010du iepirkumus. \u0160\u0101d\u0101 sist\u0113m\u0101 iepirkums k\u013c\u016bst par b\u016btisku instrumentu \u0101rstu arsen\u0101l\u0101, lai nodro\u0161in\u0101tu terapeitisko m\u0113r\u0137u sasnieg\u0161anu. K\u0101 zin\u0101ms, publisko iepirkumu regul\u0113jums tikai da\u013c\u0101 gad\u012bjumu pie\u013cauj bez vair\u0101ku pieg\u0101d\u0101t\u0101ju pied\u0101v\u0101jumiem izv\u0113l\u0113ties \u0101rstniec\u012bbas person\u0101lam v\u0113lam\u0101k\u0101s medic\u012bnas ier\u012bces. Tom\u0113r tie\u0161i v\u0113rt\u012bb\u0101 balst\u012bts iepirkums pal\u012bdz paskaidrot \u0101rstu izv\u0113\u013cu mot\u012bvus un \u0146emt v\u0113r\u0101 to v\u0113rt\u0113jumu iepirkuma uzvar\u0113t\u0101ja izv\u0113les proces\u0101.<\/p>\n\n\n\n<p><sup id=\"fn1\">1. <a href=\"https:\/\/www.iknz.cz\/knihovna\/c46c78c9-962c-475b-a437-f788033f1488\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.iknz.cz\/knihovna\/c46c78c9-962c-475b-a437-f788033f1488<\/a><a title=\"Jump back to footnote 1 in the text.\" href=\"#ref1\">\u21a9<\/a><\/sup><\/p>\n\n\n\n<p><sup id=\"fn1\">2. <a href=\"https:\/\/www.vbpcommunity.eu\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.vbpcommunity.eu\/<\/a><a title=\"Jump back to footnote 2 in the text.\" href=\"#ref1\">\u21a9<\/a><\/sup><\/p>\n\n\n\n<p><sup id=\"fn1\">3. <a href=\"https:\/\/www.medtecheurope.org\/wp-content\/uploads\/2016\/06\/Value-based-procurement-report_0.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.medtecheurope.org\/wp-content\/uploads\/2016\/06\/Value-based-procurement-report_0.pdf<\/a><a title=\"Jump back to footnote 3 in the text.\" href=\"#ref1\">\u21a9<\/a><\/sup><\/p>\n\n\n\n<p><sup id=\"fn1\">4. <a href=\"https:\/\/www.medtecheurope.org\/wp-content\/uploads\/2020\/09\/2020_mte_vbp-journey.pdf\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.medtecheurope.org\/wp-content\/uploads\/2020\/09\/2020_mte_vbp-journey.pdf <\/a><\/sup><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>\u0100rstiem ir ties\u012bbas iesaist\u012bties medic\u012bnas pre\u010du un pakalpojumu iepirkumos, lai nodro\u0161in\u0101tu sava darba efektivit\u0101tes un kvalit\u0101tes uzlabo\u0161anu, k\u0101 ar\u012b vislab\u0101k\u0101s pacientu apr\u016bpes iesp\u0113jas. <\/p>\n","protected":false},"author":1938,"featured_media":19922,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[120,33,1],"tags":[],"_links":{"self":[{"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/posts\/19911"}],"collection":[{"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/users\/1938"}],"replies":[{"embeddable":true,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19911"}],"version-history":[{"count":28,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/posts\/19911\/revisions"}],"predecessor-version":[{"id":19963,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/posts\/19911\/revisions\/19963"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=\/wp\/v2\/media\/19922"}],"wp:attachment":[{"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19911"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19911"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/zurnalsiepirkumi.lv\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19911"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}