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Manager Zdravoochranenia 2019 #1
Published: 2019-01-25
1222
CONTENT OF THE ISSUE
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«Manager of Health Care»
There are defined winners in nominees of Publishing House
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About inadmissibility of transfer of all chief physicians and their deputies to the status of non-medical workers and the admission to management of the medical organizations as the first heads of persons without medical education
In the article, the authors show in detail and justify the very dramatic consequences that the country's health care will receive if the planned changes to the Regulation on the licensing of medical care are adopted the activities assuming exception of works (services) on "the organization of health care and public health" from the List of the works (services) making medical activity, and also the admission to the management of the medical organization as the first leaders of persons without higher medical education. The authors emphasize that the implementation of the planned changes will lead to the fact that the chief physicians and their deputies will cease to be medical workers, the manageability of medical organizations and the quality of medical care will decrease, the system of training of managers will degrade. This is totally unacceptable.
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Methodological approaches to the assessment of compliance of activity of medical organizations order of rendering of medical care
The article presents the results of the development, implementation and experimental testing of the conformity assessment system based on order of medical care, which can be used by any medical organization in order to improve the planning and management of its activities.
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Analysis of hemoblastosis morbidity rate of saint petersburg population for 1990–2016 period and forecast till 2026
Level and dynamics of hematological malignancies morbidity of Saint Petersburg population were analyzed for 1990–2016 period and forecast till 2026 was given. It was found that in 2016 Saint Petersburg held the 1st place in hemoblastosis incidence among territories of the Russian Federation. Morbidity of men increased morbidity of women. The highest morbidity levels were detected in 70–79 age group. The increase of hemoblastosis incidence was followed up, the highest increase rate was noticed among people of working age. The increase of hemoblastosis prevalence (general morbidity) was observed. According to the forecast if the detected tendency towards the increase remains in 2026 the incidence rate will increase by 8.6% if compared with 2016 and will make 21.4 morbid events per 100 thousand of population; the general morbidity rate will increase by 44.4% and will make 130.4 morbid events per 100 thousand of population. The data received give evidence of the increase of the population’s need in expert oncohaematological treatment, necessity in the increase of its availability to the population and more efficient use of existing resources.
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To the question of volume reducing of dispansserization and preventive examinations
The beginning of mass prophylactic medical examination in Russia was accompanied by an excessive inclusion of screening methods and additional diagnostic interventions. Such tactic was not justified from the financial, economic and organizational point of view. Although in 2017 the volume of medical examination was significantly reduced, analysis of official documentation and reporting forms shows that imbalance in its structure is still preserved, and some methodic, used for screening and additional diagnostic, are not justified from position of evidence-based medicine. In 2015, only due to optimization of clinical examination structure on the first stage it would possible to reduce costs by more than 10 billion rubles, increasing the effectiveness of preventive interventions through rational reallocation of funds.
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Organization of specific prevention of infectious diseases to ensure sanitary and epidemiological welfare of the population
The achievement of high coverage of preventive vaccinations of participants of mass events is an important link in ensuring epidemiological well-being in the territory. Aim: to analyze vaccination coverage in the framework of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications among the personnel involved in the maintenance of the 2018 FIFA world Cup in Kazan (world Cup). Materials and methods. The analysis of coverage of preventive vaccinations against diphtheria, measles, rubella, influenza, viral hepatitis A, dysentery 8 food facilities of the world Cup, 7 objects of placement of the main client groups, 2 training bases, 27 food facilities and accommodation of the given forces and 1 object of water and sewage facilities, 43 other food facilities and accommodation of guests of the world Cup; against diphtheria, measles, rubella, flu-among volunteers, medical workers, employees of the attached forces involved in the maintenance of the world Cup. Results and discussion. According to the results of the analysis of immunization status within the national calendar of preventive vaccinations of public catering workers, hotel institutions involved in the maintenance of the world Cup, vaccination coverage against diphtheria and tetanus was 98.3%, against measles – 97.9%, against influenza – 45.7%, against rubella – 90.2%. Vaccination coverage of health workers against diphtheria and tetanus was 97.8%, against measles – 97%, against influenza – 92.2%, against rubella – 98.5%. Among the personnel of the forces attached to the world Cup, vaccination coverage against diphtheria and tetanus was 95.1%, against measles – 94.8%, against influenza – 76.9%, against rubella – 92.7%. Immunization coverage of volunteers against diphtheria and tetanus was 94.0%, against measles – 93.8%, against rubella –94.4%, against influenza – 49.8%. According to epidemic indications, 94.9% of the staff were vaccinated against hepatitis A, 94.3% against dysentery
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The main trends in the incidence of injuries, poisoning and some other effects of external causes in the constituent entities of the Russian Federation
Injuries, poisonings and some other causes of external causes make an indisputable significant contribution to the morbidity structure of the population of the Russian Federation. Despite the decline in the share of morbidity from external causes for 2005–2016, this cause still consistently occupies the second ranking position, causing enormous economic, and knowing a high level of violent mortality, and medico-demographic damage. Despite the positive trend of reducing the incidence of external causes, a number of subjects of the Russian Federation with extremely high values, as well as negative growth dynamics, were identified. For 2005–2016, the most negative trend in the increase in incidence from external causes was found in the Moscow Region, the Kurgan Region, the Altai Territory, the Bryansk Region, the Republic of Sakha. Of particular interest to the organizers of health care should be those areas of the Russian Federation in which low incidence rates are registered, and a positive trend of decline. It is necessary to analyze the systems of organization of medical care and medical prophylaxis, and to use subjects with the lowest incidence rates from external causes as an example in order to improve measures aimed at reducing morbidity.
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Methodology for estimating the costs of identifying, diagnosing and treating tuberculosis with multiple and extensive drug resistance
Estimating the cost of treating patients with extensive drug-resistant Mycobacterium tuberculosis is useful both in planning financial resources for anti-tuberculosis activities and in determining the economic burden of this phenomenon. The article proposed the author’s methodology for estimating the costs of identifying, diagnosing and treating tuberculosis with multiple and extensive drug resistance, calculated estimates of the cost of combating the general drug resistance of mycobacteria tuberculosis.
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An integrated approach to determining the need for medical personnel on the model of the Tomsk region
The recent history of modernization of the national health care system is characterized by the improvement of the health care system, including in the staff aspect. However, the opinion of the population and experts shows that it was not possible to completely solve the problem of shortage of doctors. This article presents the experience of the Tomsk region in terms of approaches to determining the deficit and imbalance of medical staff. This analysis formed the basis for further actions on staff policy in the health care system of the region.
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Financing health care in 2019: new priorities and channels for the movement of funds
Analysis of the future financing of health care shows that in 2019–2021, despite the difficult financial situation, the volume of financial support for the industry will continue to grow. Thus, the size of health care spending from the Federal budget is growing not only in absolute terms, but also occupies all a large share in the structure of Federal budget expenditures. The increase in expenses in the system of compulsory health insurance (CHI) in absolute terms is still quite large. Among the priorities of 2019 are the increase in funding for cancer care, as well as high-tech medical care, which directly follows from the provisions of the Decree of the President of the Russian Federation May 7, 2018 № 204 "The national goals and strategic objectives of the Russian Federation for the period up to 2024" (presidential Decree № 204). The distribution of funds to the compulsory medical insurance system is based on these priorities, and based on the results of implementation of decrees of the President 2012 for leveling a series of problems, such as unreasonable reductions in personnel. All this should have a positive impact on the further development of health care.
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Application of clinical guidelines
