All articles by Kalininskaya A. A.
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2022 № 6 Staffing of primary health care in the Russian Federation
The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support.
Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care.
P u r p o s e o f t h e s t u d y . Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices.
M a t e r i a l s a n d m e t h o d s : content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular.
R e s u l t s . The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016–2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from 3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which determines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated.
F i n d i n g s . The introduction of promising general medical practice models in the urban environment implies a complete transition
of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2.
It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure. -
2020 № 2 Evaluation of the organization and transport accessibility of medical care to rural residents
The basis of the study was the Orenburg region. According to the MIAC health care in the Orenburg region
in 2015, the number of rural settlements was 1036, and the number of FAPs was 945. Sociological studies were conducted
in three pilot rural areas with different populations and distances from the regional center: Abdulinsky, Orenburg, Svetlinsky.
The total number of adults in the three districts is 19,356. The results of a sociological survey indicate a low availability of medical assistance to rural residents, the lack of a preventive focus among doctors on the prevention of exacerbations of chronic pathology, primarily of villagers living in localities attached to FAP. The need to improve the organizational forms of the work of medical organizations in the countryside, the development of mobile field complexes and general medical (family) practices, the development of medical and social assistance in rural areas is determined. -
2020 № 1 The effectiveness of the reorganization of dermatovenerological care in the Samara region in terms of “lean production”
By implementing “lean manufacturing”, medical organizations can save on all costs, while improving acces¬sibility and improving the quality of care.
The roadmap “Changes in social sectors aimed at improving the efficiency of health care” set the task of increasing the share of outpatient care costs in the total costs of the “Program of state guarantees of free medical care” from 25.3% in 2013 to 31.7% in 2018. the Share of inpatient care costs should be reduced from 60.3% to 50.3%. In providing effective treatment of patients with dermatovenerological pathology of great importance is the use of the necessary amount of der¬matological care, as well as therapeutic methods of diagnosis and treatment, which determines the need for continuity in the work of PHC and PHC. In 2010. in the Samara region the restructuring of the bed Fund and partial reduction of der-matovenerological beds, improvement of selection of patients for inpatient treatment according to the developed criteria of hospitalization in hospitals of round-the-clock stay and day hospitals on the profile of dermatovenerology were carried out, clinical protocols were introduced at the outpatient stage – all of the above contributed to the efficiency of the use of the bed Fund in dermatovenerology. The reorganization of dermatovenerological care improved the quality of medical care for patients with dermatovenerological diseases and clinical and organizational indicators of dermatovenerological care. -
2017 № 1 The incidence of malignant neoplasms
The article provides an analysis of the incidence of malignant neoplasms in Russia in dynamics for 10 years. The main feature of formation and development of cancer care in Russia is its preventive orientation. The experience of early diagnostics of malignant neoplasms expedient from the economic point of view a long-term strategy for the fight against cancer.
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2016 № 5 Performance analysis and ways of reforming the health village
Annotation. The analysis of the incidence of the rural population in the Russian Federation and the Federal District. Based on the results of the study developed proposals to reform the health of the village.
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2016 № 3 Analysis of the efficiency of the use of hospital beds in the hospital urology department
Annotation. The article presents the results of the examination of the validity of hospitalization in the urology department of City Clinical Hospital (CCH) in Zhukovsky, Moscow region. Carrying out of examination the validity of hospitalization in the urology department of the hospital showed that there had been excessive periods of treatment in 22% of patients. Share unreasonably executed patient days was 15.8%. Of the total number of bed days saved the largest part of the final period of treatment (37.3%), almost the same amount for an initial period (41.7%) and 21.0% – for the period of active treatment of the patient. Calculate the economic effect of follow-up care of patients in day hospital (DS).
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2016 № 2 Needs of the population Nizhny Novgorod region in cardiac surgery procedures
The article presents the analysis of security of the population of Nizhny Novgorod region with medical staff and bed capacity cardiology; analyzed actually existing cardiac surgery volumes in the Nizhny Novgorod region; designed neediness of the adult population of the Nizhny Novgorod region in cardiac surgery based on data from a multicenter epidemiological study СТЕРХ.
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2023 № 3 Scientific substantiation of proposals for improving medical care for villagers.
P u r p o s e o f t h e s t u d y : based on the analysis of the medical and demographic situation and the staffing of the rural population, develop proposals for improving medical care for the villagers.
M a t e r i a l s a n d m e t h o d s : statistical, analytical, direct observation. The article used the forms of state statistical observation of the Ministry of Health of the Russian Federation. The results of the actual research.
Materials and methods: statistical, analytical, direct observation, the forms of state statistical observation of the Ministry of Health of the Russian Federation were used.
R e s u l t s . The rural population in the Russian Federation (2021) is 36,9 million people (25,2% of the country’s population). The proportion of the rural population of working age was 53,8%, which is lower than in Russia as a whole – 56%. A 21-year analysis showed that the birth rate of the rural population increased until 2012, while mortality rates decreased, in 2013 the mortality and birth rates became equal and amounted to 14,5‰ each, in 2020 the death rate increased to 15,4‰ due to the COVID‑19 pandemic. The average (expected) life expectancy of the rural population (70,7 years) is lower than that of the urban population (71,8 years); the indicator for rural men is extremely low (66 years). The
overall incidence of the rural population is 1,4 times lower than that of the urban population, 117993,2 and 166901,5‰oo respectively. Primary morbidity is also 1,5 times lower (55082,4 and 83002,2‰oo, respectively). The difference in primary morbidity rates of the rural population in the federal districts (2020) was 1,3 times, in the constituent entities – 8,3 times. The incidence of COVID‑19 in the rural adult population (2020) was 1986,0‰oo, which is 2 times lower than in the Russian Federation as a whole (3913.9‰oo). There was a significant difference in these indicators (by 59 times) in the subjects of the Russian Federation, which can be associated with a lower density of the rural population,
low availability of medical care in the countryside, as well as the ambiguity of COVID‑19 coding. For 6 years (2016–2021), the provision of doctors in medical organizations in rural areas in the Russian Federation decreased from 14,8 to 13,6‰o, and of nurses – from 54,6 to 49,3‰o. The number of nursing staff individuals working for feldsher-obstetric station decreased by 12,5%, paramedics – by 9,4%. Given the special importance of paramedical assistance in the countryside, the reduction in the number of paramedics should be considered a negative.
C o n c l u s i o n . The unfavorable medical and demographic situation in the countryside requires the development of organizational and managerial decisions aimed at increasing the availability of medical care to the villagers.
C o n c l u s i o n s . Proposals have been developed to improve the provision of medical care to the population of rural areas. -
2023 № 2 Analysis of the incidence of the population older than working age in the Russian Federation and its regional features.
Objective assessment of the health status and medical care of the elderly in the context of progressive aging of the population is one of the leading health problems.
Purpose of the study. Based on the analysis of the medical and demographic situation and the incidence of the population, as well as the results of our own research, to give recommendations on the health protection of the population older than working age.
Research methods: statistical, sociological, expert assessments, direct observation. The forms of federal and sectoral statistical observation for 2018–2021 were analyzed. Results of sociological surveys of patients older than working age.
Results. Over the 10 years of analysis (2012–2021), the overall incidence rate of the entire population in Russia increased by 4,5%, the adult population – by 8,2% and the working-age population – by 1.3%, in children and adolescents the indicators decreased by 8,8 and 4,7%. The overall incidence of the population older than working age in 2021 in the Russian Federation was 209164‰00, which is 1.2 times higher than the total population (167714‰00). The difference in the general morbidity rates of the population older than working age in the federal districts of the Russian Federation was 1.3 times, in the constituent entities of the Russian Federation 2.3 times. 2020, there is a significant decline in the overall incidence rate in all age groups, which is associated with the COVID‑19 pandemic. The first detected incidence of the population older than working age (in 2021) amounted to 66183,5 per 100 thousand of the corresponding population, which is lower than the total population by 22,6% (85531,6‰00). The population older than working age has significantly higher rates of newly diagnosed morbidity than the entire population in the classes: diseases of the circulatory system by 103%, the indicators were 6191,7‰00, 3048,3‰00, respectively; neoplasms (by 66%), musculoskeletal and connective tissue (by 16%) and diseases of the endocrine system, eating disorders and metabolic disorders (by 15,6%). The results of the study should be taken into account for planning the volume
of preventive and dispensary work for people of older age groups. The article gives recommendations on the health protection of the population of pre-retirement and older working age using hospital-replacing technologies. -
2019 № 6 Perfection of organizational forms of work in dermatovenerology in conditions of “lean production”
An important part of the activity in dermatovenerological care in the conditions of “lean production” is the improvement of organizational forms of work of medical organizations (MO), providing medical care to patients with dermatovenerological pathology at all stages of its provision.The survey was conducted at the Samara oblast, the dermatovenerologic dispensary (SACVD). Based on the diagnosis of “zones of inefficiency” in the provision of medical care to patients with dermatovenerological pathology, the reorganization of dermatovenerological care was carried out, including: restructuring of the MO network, the creation of mo areas of responsibility for the provision of dermatovenerological care; the organization of an interdistrict center; the reorganization of three city CVD departments; the opening of CVC; the development of regulations for intradepartmental interaction of dermatovenerologists with doctors of other specialties; the organization on the basis of THE; information support of participants of interaction; increase of professional level of medical personnel. The economic effect due to the elimination of duplication of laboratory and diagnostic studies in the medical examination of patients with dermatovenerological pathology was in 2015 1190266,7 rubles. Sociological surveys of patients who applied to the CSQ, showed that the majority of respondents were satisfied with the medical care, positively assessed its availability (90,3%) and quality (96,1%).
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2023 № 1 Medical and demographic indicators of the population older than working age in the conditions of pension reform in the Russian Federation
Purpose of the study. Based on the study of medical and demographic indicators and analysis of the incidence of the population, develop recommendations for the health protection of the population older than working age in the context of the transition to pension reform.
Materials and methods: sociological, statistical, direct observation. The materials of the Federal State Statistics Service and statistical materials of the TsNIIOIZ of the Ministry of Health of Russia for 2012–2021 were used.
Results. The mortality rate of the population older than working age in the Russian Federation (2020) amounted to 4408,1‰oo, the total population – 1460,2‰oo, in the federal districts of the Russian Federation the indicators fluctuated 1,2 times: from 3818,7‰oo in the North- Caucasian Federal District to 4638,6‰oo in the Volga Federal District, in the subjects of the Russian Federation the difference is 3 times. The indicator of primary morbidity of the studied contingent in the Russian Federation (2020) was 57041,4‰oo, in the Federal District the difference in indicators is 1,25 times, in the constituent entities of the Russian Federation – 3,9 times. The incidence of COVID‑19 in 2020 was 4373,9‰oo, in the Federal District the difference in indicators is 2,2 times, in the subjects of the Russian Federation it is large – 10,6 times, which allows us to conclude that the coding of COVID‑19 is ambiguous. Comparative analysis of the primary incidence of the study population by disease classes in 2019 and 2020 showed an increase in the indicator by 8,9% due to respiratory diseases by 40,8%, the incidence of COVID‑19 in 2020 was 4357,6‰oo. In all other classes, the indicators decreased as a result of a decrease in dispensary and preventive work. During the period of analysis in people older than working age, the increase in the primary morbidity rate is higher – 8,9% than in the total population – 5,7%, which indicates the need to strengthen dispensary and preventive work with the older population. The article gives recommendations on the health protection of the population older than working age. -
2022 № 7 Analysis of morbidity and staffing of the population of rural areas in the Russian Federation
Rural health care is the most important socio-economic resource in the system of the agrarian economy.
Purpose of the study. Based on medical and demographic indicators and analysis of morbidity and staffing of the rural population, develop proposals for improving the organization of medical care for rural residents.
M a t e r i a l s a n d m e t h o d s : analytical, statistical, direct observation. The article used the forms of federal statistical observation of the Ministry of Health of the Russian Federation.
R e s u l t s . The mortality rate of the rural population over the 20 years of analysis for all the years has been and remains higher than that of the urban population. In 2020, there was a sharp increase in the mortality of the population: urban – from 11,9 to 14,3‰, rural – from 13,3 to 15,4‰, which is associated with the COVID‑19 pandemic. The indicators of the general and newly diagnosed morbidity of the rural population are lower than those of the urban population, which is associated with the low availability of medical care to the rural population.
The ranking of indicators of the general incidence of the rural population in the federal districts of the Russian Federation (2020) showed that the difference in indicators was 1,5 times. The highest indicator was noted in the Volga Federal District – 142220,6‰00, the lowest in the Far Eastern Federal District – 96922,8‰00. In the subjects of the Russian Federation, the difference in indicators is 8 times. Lower rates of primary morbidity in the rural population than in the urban population were noted for all classes of diseases. The incidence of COVID‑19 among rural residents was 2151,9‰00, lower than in urban areas – 4539,5‰00, in the Russian Federation the figure was 3384,5‰00. In 2020, the primary morbidity rate of the rural population decreased for all classes of diseases, except for respiratory diseases. In dynamics (2014–2020), the provision of medical organizations located in rural areas increased with doctors from 12,1 to 14,0‰0, with nurses from 44,4 to 50,3‰0, the number of physical EMS persons decreased by 14,8%, paramedics – by 11,6%, the number of FAPs and AFs decreased by 8,9%. The analysis shows that the Decree of the Government of the Russian Federation dated 02.02.2015 No. 151-r “Target indicators of the strategy for sustainable development of rural areas of the Russian Federation for the period up to 2030” is not being implemented.
C o n c l u s i o n . Proposals for providing medical care to the population of rural areas are presented -
2021 № 1 Emotional burnout of a district doctor
Based on the results of assessments of the dependences of the level of psychoemotional load of a primary care
physician (PHC) (district physician) on medical and social problems related to the conditions of his activity, measures have been developed for stress resistance and health saving of a district physician (VTU). The Orenburg region with a population of almost 2 million people was the pilot territory (base) for the study. The region has 12 cities and 35 rural districts, the share of the rural population is 40.1%.
Research materials und methods: sociological, direct observation, statistical: 1014 questionnaires of survey of district
physicians (93% of the total number of VTU) were subjected to statistical processing. The study included 4 stages. At the first stage, sociological surveys of district physicians working in medical organizations located in urban and rural settlements were carried out (568 and 446 VTU, respectively). At the second stage of the study, the level of psychoemotional burnout was assessed using the modified method of V. V. Boyko (2010) “Diagnostics of the level of emotional burnout”. At the third stage of the study, we calculated the statistically significant correlation of the symptom of professional burnout (SPEV) with factors related to medical and social problems of the professional activity of the local GP. At the fourth stage of the study, a set of measures has been developed and is being implemented to increase emotional stability in the professional activity of the local GP.
Relevance. WHO classifies occupational stress as a disease of the twentieth century, which can manifest itself in any
profession and can reach the size of a “global epidemic”. The accumulation of negative emotions in the profession of a
doctor can lead to psycho-emotional exhaustion and the formation of the syndrome of “emotional burnout”. A necessary quality of a primary care physician is emotional stability. This is the ability to overcome a state of excessive emotional arousal. Of particular importance is the development of professional burnout and the assessment of professional stability for district physicians who make first contact with the patient.
Results. Measures have been developed to increase the effectiveness of emotional (professional) stability in the activities of VTU.
Conclusion: Emotional stability in the doctor’s work allows you to maintain and further increase the effectiveness of professional activities. The obtained research results were used for the development of the “program for the modernization of health care in the Orenburg region”. They were used in the development of the Software product of the Ministry of health of the Orenburg region. -
2019 № 8 Health condition of a rural population living in different areas of medical aid accessibility
The problem of preserving the health of the rural population is key in the concept of the development of
rural society. Health issues of rural residents are of great social, political and economic importance. Promising areas for
preserving and improving the health of the rural population are raising the level and quality of life of the rural population.
Research methods: statistical, direct observation, sociological. In the course of the study, the analysis of the reporting data of the Ministry of Health of the Russian Federation (Form No. 47) was conducted, as well as the results of copying information from primary medical documentation in the pilot territory of the Orenburg Region.The results of the study indicate the need to improve the improvement of organizational forms of providing medical care to rural residents, intensify preventive and dispensary work in the village, and involve medical and social services in the village. The determining factors of public health are the lifestyle of the rural population, the financing of health care and the system of social protection of the population, the development of the agro-industrial complex that provides employment to the population. The analysis shows the need to improve the availability of care, medical activity, valeological literacy of the rural population and commitment to a healthy lifestyle, especially for residents living in the service area of the FAP. -
2022 № 3 Assessment of preventable health losses in the rural population
Relevance. The protection of the health of the rural population is especially significant due to the fact that medical and social health problems are maximally concentrated in rural areas. The priorities in the organization of medical care for rural residents are currently the effective use of available health care resources, as well as increasing the availability and quality of medical care. The tasks of the federal and municipal authorities should be to provide software support, resources, as well as the practical solution of strategic problems in rural areas.
The purpose of the study: development and testing of an automated system of information support for managerial decision-making using estimates of preventable losses in the health of the population of rural areas.
The base of the study was the Orenburg region. The share of the rural population in the region is 40.1%, there are 35 rural territories (districts) in the region.
Methodology. The following research methods were used: statistical, analytical, expert assessments.
The preventable loss of health of the population of rural areas in the Orenburg region was assessed by experts according to the methodology developed by us. Four indicators of the likely preventability of health losses in the rural population were identified: health indicators; territorial availability of medical care; personnel; social well-being of the population.
The results of the study were used as the basis for the methodological support of an automated information system for supporting managerial decision-making in the organization of primary health care in rural areas of the Orenburg region.
The use of a software product of information support for managerial decision-making makes it possible to determine priorities for making strategic decisions at the level of heads of medical organizations, health authorities and institutions, as well as heads of administration in a constituent entity of the Russian Federation. The information is presented on the web page of the administrative territory and the administrative apparatus.