All articles by Shlyafer S. I.
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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. -
2018 № 1 The Department of Medical and Social Assistance to the Adult Population and the Department of Nursing: the concept and principles of organization
The concept of the organization of medical and social assistance to the most socially vulnerable population contingents (people in the residential and senile age, the disabled and citizens with a temporary restriction of the ability to move and self-care after the transferred diseases and injuries) is proposed. This includes the creation departments of medical and social assistance in medical organizations that provide assistance to the adult population on an outpatient basis
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2016 № 7 The activities of day hospitals in the Russian Federation in 2000–2014
The article analyzes legal documents, which that regulate the work of day hospitals in the Russian Federation since the late 90-ies of XX century to the present. Presents an analysis of the performance of activities of day hospitals in health institutions providing medical care in ambulatory and stationary conditions in the country in 2000–2014. Marked increase in the number of beds in day hospitals 2,3 times, which is mainly due to the increase of beds in day hospitals in health institutions providing medical care in ambulatory conditions. Spend the evaluation of use of hospital beds hospitals for 15 years. During the study period the number of beds in hospitals has decreased by 27,7%, the number of discharged patients has almost not changed, which is associated with the intensity of the work beds. Shows the comparison of the number of persons treated in day hospitals and hospitals round-the-clock stay. The total number of patients treated in day hospitals and round hospitals, the proportion of patients treated at a convenience care hospitals declined from 92,5 to 80,3%, the proportion of patients treated in day hospitals increased from 7,5 to 19,7%.
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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. -
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