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Manager Zdravoochranenia 2022 #7
Published: 2022-07-28
648
CONTENT OF THE ISSUE
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Prospects and possible options for the development of continuing medical education in Russia
The article analyzes the prospects and possible options for the development of continuous medical education (CME) in Russia. Currently, the most realistic and preferable option is the development of CME based on improving the quality and increasing the volume of implementation of additional professional medical education programs. It is noted that one of the most important factors of national security is the constant maintenance of a high professional level of medical workers, which can be ensured within the framework of the CME, first of all, by implementing additional professional programs of appropriate quality and the necessary volumes.
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Topical issues of organization and financial support of high-tech medical care
The article provides a historical overview of changes in approaches to the financial provision of high-tech assistance, analyzes the causes of these changes, shows the system that has developed at the moment.
Comments are given on the most relevant changes concerning the financial provision of high-tech medical care. -
Dynamics of patient loyalty before and during the COVID-19 epidemic on the example of Children’s Polyclinic
The COVID-19 has had an enormous impact on the entire Russian health care system, including a significant impact on both the provision of medical services and the relationship between the doctor, the patient, and patient’s legal representatives. On this basis, the research is interested in issues related to the adaptation of medical organizations to the new working conditions with patients and their legal representatives. Aim of the study: to test long-term monitoring of the NPS Loyalty Index by a simplified methodology in patient’s legal representatives of pediatric polyclinic patients before and during the COVID-19 epidemic. Materials and Methods. The empirical material based on patient legal representative scores (n=22098) collected using the simplified NPS (Net Promoter Score) methodology during the two periods: 14.05.2019 -13.06.2020 and 18.06.2021 – 23.08.2021, as well as comments and predictions from lead outpatient clinic staff (n=19) collected by brainstorming to obtain additional interpretations of dynamics of patient legal representative loyalty index during the periods. The Results. According to the results of the study, the NPS patient legal representatives in pediatric polyclinics has increased significantly since the beginning of the coronavirus
epidemic and after a year was fixed at a level almost one and a half times higher than the values from the first measurement.
According to the initiative group, this growth was due not only to measures taken by the management of polyclinics, but also to cultural and psychological characteristics of the population; when the epidemic is over, the loyalty index of legal representatives of pediatric polyclinic patients is likely to return to its initial values. Conclusions. The use of a simplified method to measure the loyalty level (NPS) of patients and their legal representatives is a rather effective tool. An important condition in this case is to provide feedback to dissatisfied patients and their legal representatives. The professionalism and dedication of the medical staff play and will play a role in ensuring a high level of loyalty regardless of the epidemiological situation. -
Features of national account of donor platelets collection
Based on the analysis of the practice of donor platelet concentrates collection in 16 Russian blood service organizations, it was
established that:
- the term “unit” is used in relation to 4 concepts, which leads to a misreporting of the blood component “Platelet concentrate
from a blood unit”,
- the blood component “Leuco-reduced platelet concentrate from a blood unit” is not produced at all due to the lack of clinical need and excessively high cost,
- ANOVA analysis of variance revealed significant differences in the volumes of both therapeutic doses (p=0,038) and units of platelet concentrates (p<0,001) prepared by eight studied methods,
- indicators of the volume of pooled platelet concentrates are higher than similar indicators of apheresis products: a) treatment dose – by 36,1% (p=0,001), b) unit – by 35,5% (t-test – 4,771, p<0,001),
- the current system for accounting for the volume of collection of 11 types of donor platelet concentrates does not allow assessing either the number of prepared therapeutic doses or the degree of implementation of technologies for their additional processing,
- a form of the blood establishment report on the collection of platelets was proposed, which characterizes: a) the number of received therapeutic doses, b) the use of the processes for preparing these doses. -
On the issue of the current state of the medical and demographic situation in Russia
At the present stage in Russia, the main strategic initiatives aimed at improving medical and demographic processes are set out in a number of regulatory documents presented in the form of national projects, concepts, strategies and other federal projects, while special attention is required to study and monitor these indicators of public health of the population.
Purpose of the study is analysis of the medical and demographic situation in Russia and in individual subjects in recent years, making proposals to improve the processes of fertility and mortality, migration growth.
Materials and methods. Scientific publications, official statistical data and analytical materials of Rosstat, data from the
statistical collection of the SFO were used as research materials. Statistical data processing was carried out using SPSS, Excel‑2007 packages. The main research methods were: the study and generalization of experience, information-analytical, statistical, bibliographic.
Results. The analysis of the dynamics of indicators of the demographic situation in the Russian Federation determined a low degree of compliance with the priorities of the state policy; there was a negative dynamics and a discrepancy between the actual value of the planned target indicators, therefore, in order to eliminate the existing problems, it is necessary to take into account the specifics of individual territories when setting and formulating strategic directions and initiatives on this problem.
Findings. The results of the study indicate the need for constant monitoring of the main demographic indicators, considering certain directions and the course of the state policy pursued in this direction. -
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 -
The disease burden of atopic dermatitis in current conditions
The prevalence and increase in morbidity of the atopic dermatitis make possible to consider it to become actual and relevant in nearest future. The pilot study analyzed using the Delphi method allowed identifying the most significant areas for further detailed research and development of programs reducing the disease burden of atopic dermatitis in the country. The study showed that the Cumulative Life Course Impairment associated with this disease is mediated by its systemic nature and a complex of concomitant diseases. The social burden of the disease is primarily associated with missed opportunities of patients even after the onset of spontaneous remission due to education and socialization issues from the period of schooling. Almost all adult patients report a decrease in the quality of life and experiencing problems with communication and sports. The economic burden of the disease is associated with household spending on medicines and a decrease in income as a result of changing or losing work, primarily in families with sick children in addition to healthcare system expenditures. The COVID‑19 pandemic has led to a decrease in the volume of medical care for atopic dermatitis adult patients and also there is a possibility of developing previously unknown complications in patients with atopic dermatitis.
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Data-based management in imaging: evaluation of the performance of a unified radiological information service model
The development and availability of information technologies covers all spheres of society, providing ever newer and more advanced means of automating processes and structuring data, primarily in order to improve management efficiency.
Radiation diagnostics, due to its clinical significance, is one of the key areas of modern healthcare. At the same time, it is distinguished by an extremely high degree of digitalization, which creates extensive opportunities for the development and improvement of organizational and managerial aspects. An analytical study was carried out on the principles of a systematic approach, consisting of three stages.
First stage. The main phases and indicators of the development of a single digital circuit for radiodiagnosis in Moscow are characterized: the dynamics of the integration of diagnostic equipment, the structure of medical organizations, the rate of accumulation of the results of radiological examinations by modality.
Second phase. The analysis of the influence of a single digital circuit of radiodiagnosis on the level of informatization of medical organizations and informatization of the health care system of a constituent entity of the Russian Federation was carried out, its compliance with the requirements of the Ministry of Health of Russia was assessed.
Third stage. The analysis of the influence of a single digital circuit of radiodiagnosis on the level of digital maturity of the health care system of a constituent entity of the Russian Federation was carried out.
The practical implementation of the model of a single digital circuit for radiation diagnostics of an administrative-territorial unit was carried out in the period 2015–2020 in Moscow.
The Unified Radiological Information Service (UIS) of Moscow was created – an information system in the field of healthcare that combines the workplaces of radiologists, radiologists and diagnostic equipment, accumulates information about each study or a series of studies conducted on devices connected to it, is equipped with additional tools for solving analytical, managerial and organizational tasks.
The analysis of the significance of ERIS EMIAS as an implemented single digital circuit for radiodiagnosis of a subject of the Russian Federation was carried out.
The development of URIS EMIAS ensured a steady increase in the level of informatization coverage of medical organizations that have radiation diagnostics units in their composition. -
Issues related to the replacement of special social payments for work with COVID-19 with compensation payments
The article discusses issues related to the suspension of special social payments for work with COVID‑19 and their replacement with compensation payments. Problems such as the procedure for completing existing payments, lists of employees who are subject to compensation payments, measures that need to be taken by medical organizations in a new situation are considered.
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Issues related to changing the procedure for providing state guarantees to employees of medical organizations working with COVID-19
Emergency and rather extraordinary measures aimed at increasing the degree of social protection of medical workers in connection with the spread of COVID‑19 have been repeatedly changed. At the current stage, characterized by a decrease in the spread of coronavirus infection, these measures have undergone quite drastic changes, the essence of which is discussed in this article.
