Manager Zdravoochranenia 2023 #1
CONTENT OF THE ISSUE
The state and prospects of the hematological service of the subjects Central Federal District of the Russian Federation
Improving the quality of medical care is one of the priority objectives of the state policy, for the solution of which the resources of the national project «Healthcare» and its constituent federal projects are used.
Purpose of the study is the development of high-cost, resource-intensive and socially significant healthcare industry, such as the Hematology service. The aim of this study was to assess the organization and state of the Hematology service in the Central Federal District (CFD) of Russia – the leader both in terms of population and in terms of the number of subjects included in it – which is necessary to develop organizational and methodological measures aimed at its improvement.
Materials and methods. Official statistical data and analytical materials of Federal State Statistics Service, the Cancer Registry, open sources of information, data from check-out work of the National Medical Research Center for Hematology in СFD. Statistical data analyzed with the Excel‑2007 package. The main research methods: study and generalization of the available information, informationanalytical, statistical, bibliographic.
Results. The analysis of the performance indicators of Hematology in the CFD identified its main components, taken together of which it is possible to assess the quality of the organization of the provision of specialized medical care with subsequent rating, and made it possible to identify key points for further improvement of the hematological service. Conclusions. The results of the study indicate the need for constant monitoring of the main indicators of the Hematology service (staffing, bed fund, availability of specialized high-tech research methods for the blood system diseases), taking into account certain directions and the course of the state policy pursued in this direction.
Review of the work of the state dental service of the Tver region in 2021
Taking care of the health of the population of the Tver region is an important direction of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of the citizens of the Tver region, to increase the role of preventive care of dental diseases, to form a model of organization of the dental industry that ensures the availability and quality of dental care, to increase the efficiency of dental services, the volume, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science. The aim of the research is the analysis of the statistical data of the stomatological service of the state public health institutions of the Tver region.
Materials and methods. Analysis of the statistical data reflecting demographic indexes, statistics of the stomatological service structure, staffing, distribution of dentists among the institutions of the Tver region, quality of dental care, the main indexes of the stomatological service of the Tver region, indexes of treatment and preventive work.
Results. The present study is devoted to the analysis of the activity of state medical institutions of health care of the Tver region that provide dental care to the population of the Tver region. The indices of the provision of dentists in this region (not taking into account orthopedists and orthodontists) makes 3,82 posts for 10 thousand population (426,25 rates in total). Indicators of provision of the region’s population with dentists are 4,3 positions per adult population of the region. The deficit specialties have been revealed: pediatric dentists, orthodontists, in the regional institutions there is a shortage of orthopedists. The share of occupied staff positions in the specialty of pediatric dentistry was 49%, which reflects the need for training in this area. The difficulties in the organization of preventive examinations of the
children’s population were revealed, and the low percentage of the examined persons.
Conclusions. The municipal, district and regional medical institutions of health care rendering dental treatment to the population are functioning on the territory of the city of Tver and the Tver region in general. The statistical analysis has revealed a number of difficulties that require further action on the part of the medical community and public organizations. It is necessary to develop comprehensive measures to solve the shortage of pediatric dentists at the level of the Ministry of Health and educational institutions. The difficulties of preventive examinations among the population of different groups are highlighted. It is important to strengthen the preventive profile in order to reduce the cases of complicated caries, tooth extraction. Development of hygienic direction will increase awareness of the population
about the peculiarities of dental and oral hygiene, methods of prevention and treatment of dental diseases.
Awareness of the population about primary prevention of cervical cancer
A proven effective preventive measure against cervical cancer is a full-fledged HPV vaccination course conducted before the start of the patient’s sexual life. Its cost is essential for the realization of the possibility of using the vaccine on a voluntary basis. However, the most important argument for making a decision about vaccination is the awareness of patients about its expediency, effectiveness and safety.
P u r p o s e : to identify the level of awareness of the population about the primary prevention of cervical cancer by vaccination against HPV.
M a t e r i a l s a n d m e t h o d s . According to a specially developed questionnaire, an anonymous survey of adolescents and their parents (legal representatives) on the organization of HPV vaccination was conducted. The quota sample for the survey included 723 respondents who applied to women’s consultations and children’s polyclinics in St. Petersburg (a total of 19 medical organizations).
R e s u l t s . In fact, only 59,7% of respondents are informed about diseases caused by HPV, and another 5,1% of those who took part in the survey are mistaken about this. Only one in three (36,4%) respondents know about the safety of currently used vaccines, and the majority of respondents – 50,8% noted that they do not know anything about this issue.
Among the respondents, 87,8% indicated that given the high importance of vaccination to prevent the development of oncological diseases of the female genital area, HPV vaccinations should be carried out free of charge to citizens within the framework of the National Vaccination Calendar and the calendar of preventive vaccinations for epidemic indications.
F i n d i n g s . A sociological study showed an unsatisfactory level of knowledge of the population on the issues of primary prevention of malignant neoplasms of the female genital organs.
Problems of organization of outpatient care for patients with carpal tunnel syndrome
Peripheral nerve diseases occupy an important place in the structure of morbidity, accompanied by temporary disability and invalidation of the population. In addition, these diseases lead to an increase in the citizens’ and state’s expenditure for maintaining health and active lifestyle.
P u r p o s e of the study is to analyze and evaluate the routing of patients with carpal tunnel syndrome, formulate proposals for its improvement.
M a t e r i a l s a n d m e t h o d s . The study used the following methods: analytical, expert assessments of medical organization employees who provide care to patients with diseases of the peripheral nervous system. The analysis of medical documentation of S. P. Botkin City Clinical Hospital have been carried out. The object of the study were patients treated in this hospital from 2007 to 2021.
R e s u l t s . Analyzing the routing stages of a patient with carpal tunnel syndrome, attention is drawn to the violation of the priority of the patient’s interests not only within the rational use of his time, but also the duration of neuropathic pain syndrome. The timeframes of medical care are violated. In addition, in conditions of limited resources and lean production, budgetary funds are unreasonably spent on the examination of the patient.
F i n d i n g s . Optimization of routing of patients with this pathology will contribute to the timely provision of high-quality medical care, which will reduce the time of temporary disability and avoid invalidation of population.
Economic effect of vaccination as an argument in explanatory work on vaccine prevention
There is no doubt about the economic effect of vaccination. However, the relevant assessments have not yet become a convincing argument for the need for vaccination.
P u r p o s e o f t h e s t u d y . Based on the results of the inventory of the existing domestic and foreign experience in determining the economic effect of vaccination, identifying management problems in the relevant explanatory work, propose other approaches on how to calculate the economic effect of vaccination and how to use this argument in explanatory work on vaccination.
M a t e r i a l s a n d m e t h o d s . A comparative analytical assessment of domestic and foreign experience in the field of calculating the economic effect of vaccination has been carried out. It is analyzed what place the economic effect of vaccination has in explanatory work of state bodies on vaccination.
R e s u l t s . It has been established that the insufficient effectiveness of explanatory work on vaccination is largely the result of an incorrect delineation of functions at different levels of government (municipal, regional, federal). Unreasonably large tasks in this area are assigned to the municipal level, while the federal level, on the contrary, turned out to be actually unreasonably exempted from solving the substantive tasks in the field of explanatory work on vaccine prevention. The analysis of foreign and domestic experience in determining the economic effect of vaccination confirmed the significance of the results, calculations, and estimates. The necessity of presenting the results of the
assessment of the economic effect of vaccination in a simpler and more understandable form is substantiated. For this purpose, an assessment was made of what can give the economy in value terms 25 years of additional human life, which he received in the 20th century thanks, according to experts, to vaccination. The calculation of GDP per capita (according to Rosstat for 2021, in purchasing power parity) for 25 years of extra human life due to vaccination was carried out. The need to consider the issue of the advisability of paying people for vaccination is substantiated.
F i n d i n g s . It is necessary to reconsider the traditional approaches to assessing the economic effect of vaccination. State and municipal authorities should update the tasks in the field of vaccination in order to increase its effectiveness.
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.
Planning medical care for patients with cancer in the constituent entities of the Russian Federation.
National project “Fight against oncological diseases 2019 - 2024” implemented for the fourth year. During this time, experience has been gained in planning the volume of medical care, including diagnostic tests, and financial support in the system of compulsory medical insurance, but there is no systematic analysis of planning problems. The purpose of this study was to study the planning by the subjects of the volume of medical care and their implementation of the target indicators of the territorial programs of state guarantees of free medical care (TPGG) and to identify planning problems. We analyzed the territorial programs of state guarantees of some subjects of the Russian Federation. Also, from the territorial CHI Funds (TFOMS) we received information on the performance of TPSG indicators: the
volume of care in round-the-clock and day hospitals, planned and actually performed molecular genetic studies and cases of positron emission tomography combined with computed tomography in 2021 and the first half of 2022 of the year. We found significant problems, some of which have causes at the federal level, others are purely regional in nature, which lead to significant differences in planning the volume of medical care between the subjects of the Russian Federation. Conclusion. Planning the volume of medical care in the field of “Oncology” varies significantly between the subjects of the Russian Federation and has systemic difficulties, control over the effective use of funds is insufficient. We consider it necessary when planning medical care for the oncology profile in the Program of State Guarantees of
Free Medical Care to take into account the standardized incidence rate per 100,000 population, and not the number of insured persons in the subject.
Bronchitis in children’s populations of different countries, risk factors
The issues of etiology, clinical presentation, distribution, diagnosis and treatment of bronchitis, as one of the most common respiratory diseases among children, are of considerable research interest. Risk factors for bronchitis are considered meteorological indicators (wind speed and direction, anomalies in relative humidity and atmospheric pressure, a decrease or increase in temperature), environmental pollution (tobacco smoke, NO2 and PM10), immune dysfunctions, preterm birth, exclusive breastfeeding for ≤ 4 months of life. Currently, a significant place in the research literature is occupied by the issues of acute, protracted bacterial and plastic bronchitis in children. Acute bronchitis is mainly caused by a viral infection, mainly rhinovirus, enterovirus, influenza A and B viruses, parainfluenza, coronavirus, human metapneumovirus and respiratory syncytial virus, with bacteria detected in 1–10% of cases. Protracted bacterial bronchitis, isolated as a clinical diagnosis since 2006, can occur in up to 88,5% of cases in children with chronic wet cough, wheezing and airway deformities, more often in children under 6 years of age and males. Prolonged bacterial bronchitis is mainly caused by the bacteria Haemophilus influenzae, Streptococcus pneumoniae and Moraxella catarrhalis. It is believed that recurrent bronchitis (>3 episodes/year) and the presence of H. influenzae infection in the lower respiratory tract may be significant risk factors for bronchiectasis Plastic bronchitis, a rare disease, in the
pediatric population is associated with cardiothoracic surgery (Fontaine operation), infections (viruses influenza, Mycoplasma pneumoniae, tuberculosis, adenoviruses, in particular serotype 7), inflammatory and allergic diseases, acute chest syndrome and iatrogenic processes.
Socio-hygienic and clinical-microbiological features of the formation of reproductive health disorders in adolescent girls
Studies show that inflammatory diseases of the small pelvis and inflammatory diseases of the external genital organs are risk factors for the formation of reproductive health disorders in adolescent girls, the reason for seeking advice and treatment in outpatient and inpatient medical organizations. It is generally believed that pelvic inflammatory disease, as a consequence of the activity of a polymicrobial infection, usually occurs in sexually active women and is rare in young women and adolescent girls who are not sexually active. However, worldwide the prevalence of pelvic inflammatory disease remains quite high among children and adolescent girls of prepubertal and sexually inactive age. In contrast, inflammatory gynecological diseases of the external genital organs are considered a common pathology in girls of early and prepubertal age, however, studies show that they are common among adolescent girls due to the high prevalence
of risk factors. Early diagnosis and treatment of pelvic inflammatory disease (PID) in adolescent girls is essential to ensure fertility and reproductive health in this population.
Clivelend clinic case study on pateint experience inprovement and workplace empathy development
The article presents a case-study of the patient experience improvement strategy and empathy development among healthcare professionals in Cleveland Clinic, USA. Key activities of the Patient Experience Department and the main components of the corporate program for empathy development “Communicate with H.E.A.R.T.” are also described, as well as the effectiveness of these programs.
Management in healthcare