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Manager Zdravoochranenia 2023 #10
Published: 2023-10-08
281
CONTENT OF THE ISSUE
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Legal regulation of test purchases in the provision of paid medical services: relevance of the issue for medical organizations.
The article presents a detailed analysis of the Federal Law of July 31, 2020 № 248-FZ “On State Control (Supervision) and Municipal Control in the Russian Federation” in the context of such a control (supervisory) event as a test purchase in the provision of paid medical services. Heads of medical organizations need to know and take into account in their activities that grounds for conducting a control purchase of paid medical services may arise, including when supervisory authorities carry out control measures without interaction with controlled persons, and as a result of a preventive visit. Legislative consolidation of test purchases as a method of control (supervision) over the provision of paid medical services requires medical organizations to ensure their constant readiness in terms of knowledge
by employees of the medical organization of the established procedure and mechanisms for its implementation. The implementation by Roszdravnadzor bodies of a test purchase within the framework of federal state control (supervision) of the quality and safety of medical activities once again confirms that the issues of providing paid medical services should be constantly in the spotlight when medical organizations conduct internal control of the quality and safety of medical activities. The authors substantiate that organizing and conducting control purchases of paid medical services is a very promising control (supervisory) measure for its active use by supervisory authorities. -
Integrated approach to the implementation of strategy in a sustainable developing healthcare organization.
Currently, strategic planning is the basis of the activities of many healthcare organizations. Building strategic goals and objectives structures the action plan and allows you to determine the degree of importance of the work being carried out relative to the organization’s policies.
However, not all management methods and techniques lead to sustainable development of healthcare organizations. To achieve the strategic goals of an organization, an integrated approach is needed, which determined the relevance of this study.
Purpose of the study is to determine and the description of an integrated approach to the implementation of strategic objectives in a sustainably developing healthcare organization providing primary health care to the urban population.
Materials and methods. The study of the sustainable development of healthcare organizations was carried out from 2012 to 2023, and a sociological study of the opinions of the heads of healthcare organizations implementing a development strategy was carried out from 2012 to 2018.
Results. A sociological survey of managers showed that 24,6% of healthcare organizations applying a development strategy do not achieve their indicators within 3 years. To increase the sustainability of the development of healthcare organizations, an integrated approach is required in combination with such management methods as: implementation of a quality management system; implementation of a sustainable development model; implementation of improvements; training staff on a long-term development strategy; analysis of process effectiveness, etc.
To implement a sustainable development strategy in the healthcare organization, the following activities were developed and implemented: determining the long-term goals of the healthcare organization; determination of key performance indicators of the organization; identifying key processes to achieve long-term goals of the clinic; identification of key performance indicators for each process; determining the quality and quantity of resources that support key processes; on-the-job training of personnel; monitoring and analysis of key performance indicators; identifying departmental best practices; implementing organizational improvements and innovations; changing long-term goals and key performance indicators based on the internal needs of the organization.
In general, over 6 years, the effectiveness of the organization’s strategy and policies increased by 5,9 times.
Findings. Thus, to achieve sustainable growth in long-term development indicators, it is necessary not only to formulate strategic performance indicators, but also to ensure their implementation in all divisions of the healthcare organization, including administrative, economic and support services. To this end, it is necessary to involve staff in improving work efficiency through on-the-job training in the best practices for implementing project work to improve the activities of a healthcare organization. This integrated approach increases employee engagement and allows for sustainable development of the organization as a whole. -
Development of standards for the provision of children’s population with ultrasound examinations.
Ultrasound examination is the most popular among other diagnostic methods. In pediatrics, ultrasound diagnostics has additional advantages due to its painlessness and lack of radiation exposure. However, there are a number of problems in regulating the activities of ultrasound diagnostics offices and departments, namely the standards for providing the children’s population with ultrasound examinations both for children’s city clinics and for children’s hospitals. These indicators are necessary for planning ultrasound activities in pediatrics and monitoring the availability of ultrasound in pediatric medical organizations. To calculate the indicator of the provision of ultrasound services to the child population, annual reports of ultrasound examination rooms and departments in 13 pediatric medical organizations in Kazan and Naberezhnye Chelny, including 10 clinics and 3 hospitals, were analyzed. The annual number of ultrasound scans was compared to the size of the attached child population (for clinics) and the number of hospitalized patients (for hospitals). It turned out that the number of ultrasound scans varies significantly in different clinics. The average number of ultrasound scans per year in the clinic was calculated – the coverage of the child population in ultrasound, which amounted to 918 ultrasound scans per 1000 children’s population in the clinic, and in the hospital there are 114–390 ultrasound scans per 100 hospitalized patients. Using the presented algorithm for calculating the need for ultrasound in a children’s hospital and in a children’s clinic, it becomes possible to plan the activities of ultrasound diagnostic rooms and departments in pediatrics, and the ability to control the availability of ultrasound examinations for children.
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Semantic analysis of the development of the topic of management and management of hospitals from 1945 to 2021.
The results of the study showed that the subject area on the topic of «Management» and «Hospital Management» has been developing since 1945, but it becomes wider from 1982 to 2021 and acquires clear boundaries of the object of research.
The analysis of verbs allowed us to come to the conclusion that their number remains approximately at the same level. However, there are differences in the verbs used, so on the topic of «Management», first of all, actions related to the evaluation of the object of study are used, then actions related to the basis of management and then the impact on the object in order to change its state. While researchers on the topic of «Hospital management» are primarily interested in the impact on the object in order to change its condition, then an assessment of the condition of the object, at what stage this object of research is located and then its processing.
Today, there is a growing interest not only in the general processes of hospital management and management, the stages of its implementation, but also in knowledge in narrow subject areas: cardiology, emergency medical care, medical technologies. It also highlights the continuous evolution of management practices in healthcare, exploring new ideas, strategies and practices to improve the efficiency and quality of «hospital management».
P u r p o s e o f t h e s t u d y is to study the subject area on the topic of management and management of hospitals using semantic analysis.
M a t e r i a l s a n d m e t h o d s . The works in which the application of semantic analysis, classification of verbs and nouns is directly reflected are studied. Articles were selected based on the presence of terms related to the subject of the study, keywords in the most cited articles were selected. The lexico-semantic analysis of L. M. Vasiliev was used for the analysis of keywords. 10 groups of verbs are defined.
R e s u l t s . It was found that initially such areas as «Demography», «Gender Sociology», «Obstetrics», «Journalism» were leading in the topic of «Hospital Management». However, by the third period, the leading positions are occupied by «Cardiology», «Emergency medical care», «Medical Technologies». This dynamic indicates a growing interest in both general management processes and specialized knowledge in this area. Also, when analyzing verbs, it was revealed that in the topic «Management» and «Hospital Management» attention is differently focused on their categories. The field of research on the topics of «Management» and «Hospital Management» was divided into health sciences, sociology and business.
F i n d i n g s . Thus, the results of the study led to the conclusion that today there is a growing interest not only in general management processes, but also in knowledge about management, narrow specialties and features of gender management. -
Medical and social problems of geriatrics patients.
Introduction. Currently, the demographic situation is characterized by a serious increase in the aging of the population. Life expectancy is an important indicator that determines the level of public health and socio-economic development of the country, which depends on a number of biological and social factors. Geriatric patients are a category of people in need of medical and social assistance. Much has been done in the Russian Federation to improve the quality of life of older people in order to increase life expectancy. Active longevity is an important aspect of the health and social services system.
The aim is to study the medical and social problems of geriatric patients in the historical aspect.
Materials and methods. The analysis of Russian-language and English-language literature of domestic and foreign authors was carried out in order to verify the medical and social problems of the elderly and determine methods for helping this category of patients. PRISMA data was used to compile the review.
Results. Based on the analysis of scientific literature materials, 3 categories of problems in geriatric patients were identified: decreased mental and physical abilities; geriatric syndromes; support for caregivers. Based on these categories, the following subcategories were identified: Decreased mental and physical abilities (loss of mobility; malnutrition; visual impairment; hearing impairment; cognitive impairment; symptoms of depression); geriatric syndromes: (urinary incontinence; risk of falls); support for caregivers.
Discussions. The main goal of public health according to the WHO concept of healthy aging is to maintain functioning throughout the life cycle. Taking measures at an early stage plays a crucial role, since the process of senile decrepitude or dependence on outside help can be delayed, slowed down or even partially reversed if appropriate measures are taken at an early stage of reduced functionality.
Conclusions. Geriatric patients are a serious medical and social problem that should be solved by: medical workers, government officials, psychologists, social services, volunteers, scientists, relatives of patients. -
Analysis of practical experience in the development and implementation of standard operating procedures in the activities of nursing medical staff.
The article addresses issues of quality of care and the implementation of standard operating protocols (SOPs) to improve patient safety. As part of the “High 5’s” project, WHO developed SOPs to address 5 priority patient safety issues, which were implemented in 5 countries around the world. In Russia, the implementation of SOPs is closely related to the performance of functional responsibilities of nursing specialists, who play an important role in improving the quality of medical care, including patient care. The main functions of SOPs for nurses are training medical personnel, conducting examinations and assessing the quality of care provided, planning measures to improve the provision of medical care, protecting the rights of patients and staff when resolving controversial and conflict situations. The article also
discusses the implementation of standard operating procedures (SOPs) to improve patient safety and analyzes the experience of developing and implementing SOPs for nurses in public medical organizations in Tambov. The introduction of standard operating procedures (SOPs) into the work of nursing staff can improve the quality of work and reduce the risk of errors. A survey of nurse practitioners found that the most requested SOPs were the prevention of healthcare-associated infections and nursing procedures. The main requirements for the drafters of SOPs are a deep understanding of processes and manipulations, the ability to analyze risks and knowledge of the regulatory
framework and reference literature. In general, the implementation of SOPs is an effective tool for improving the quality of work of medical personnel and ensuring patient safety. In general, the implementation of SOPs is an effective tool for improving the quality of work of medical personnel and ensuring patient safety. The results obtained can be used to develop new SOPs and improve existing ones, as well as to train medical personnel and improve their skills. -
Assessment of the impact of the implementation of telemedicine in the sphere of health care.
It has been revealed that telemedicine significantly improves the availability of medical care, especially in remote and sparsely populated regions. It has been determined that the integration of telemedicine can improve the quality of medical care due to prompt consultation of specialists and reduction of time for diagnosis. A direct relationship has been found between the use of telemedicine and patient satisfaction. The key factors influencing the effectiveness of telemedicine are identified: the quality of the Internet connection, the training of medical personnel, and the level of patient awareness. It has been established that the use of the DEMATEL method allows one to deeply
penetrate the structure of relationships in the telemedicine system and identify potential growth points.
Purpose of the study is to determine the complex relationships and interactions within the telemedicine system in the context of healthcare.
Materials and methods. The study is based on the application of the DEMATEL method for analyzing cause-and-effect relationships in a telemedicine system. This method allows you to penetrate deeply into the structure of relationships, identify key factors, and highlight causes and consequences.
Results. The study results confirm that the integration of telemedicine improves the availability and quality of medical care. The main cause-and-effect relationships influencing the effectiveness of telemedicine in the healthcare context were identified. It has been revealed that telemedicine significantly improves the availability of medical care, especially in remote and sparsely populated regions. It has been determined that the integration of telemedicine can improve the quality of medical care due to prompt consultation of specialists and reduction of time for diagnosis. A direct relationship has been found between the use of telemedicine and patient satisfaction. The key factors influencing the effectiveness of telemedicine are identified: the quality of the Internet connection, the training of medical personnel,
and the level of patient awareness. It has been established that the use of the DEMATEL method allows one to deeply penetrate the structure of relationships in the telemedicine system and identify potential growth points.
Findings. The importance of using analytical methods such as DEMATEL in the healthcare system has been confirmed. The use of such methods may be the key to optimization and further development of telemedicine in the digital economy. -
Chatgpt as one of the elements of digital health literacy: the transformation of healthcare and primary health care.
Artificial intelligence (AI) plays an important role in digital healthcare, including primary health care, and large language models make a significant contribution to this progress. ChatGPT, the newest language model, has aroused interest in the global community, including in the healthcare sector, and attracted attention to the study of large language models in terms of their usefulness and safety of practical use. This article explores the role of ChatGPT as a tool for improving digital health literacy, assessing its benefits and potential risks in the context of modern healthcare and primary health care.
Purpose of the study is to еvaluate the potential benefits and challenges of integrating ChatGPT into the healthcare system, including primary health care, as an element of digital health literacy.
Materials and methods. A systematic search was conducted in PubMed/MEDLINE and Google Scholar.
Results. In the course of this study, concerns were found about the use of ChatGPT. These concerns include ethical issues, transparency and legal aspects, the risk of bias, misquotes, and information security.
Findings. ChatGPT is a valuable tool for improving digital health literacy and its implementation can lead to drastic changes in medical education, research and practical healthcare, but its use should be carried out with caution: the cooperation of regulatory authorities of all countries of the world is required. This approach will make it possible to develop legal norms regulating the code of ethics, which will become the basis for the «responsible» use of ChatGPT and other AI-based models in the field of medical education, scientific research and practical healthcare. -
Actual issues of the organization of professional retraining of physical rehabilitation specialists (kinesiospecialists) in the context of a new model of medical rehabilitation.
The system of medical rehabilitation in Russia undergoes significant transformation which is reflected in the Federal Program «Optimal for health restoration medical rehabilitation in the Russian Federation». In such situation the issues of personnel training in the field of medical rehabilitation are becoming extremely relevant. The difficulties that arise along this path are associated with the interdisciplinarity of medical rehabilitation and the necessity to train specialists with medical education (doctors and nurses) as well as with higher non-medical education: physical therapists, ergotherapists, medical psychologists and medical speech therapists (according to the Order No. 788n of 31.07.2020).
These allied health specialties are new for Russia but they are responsible for the main practical activity in the implementation of an individual medical rehabilitation plan. The difficulties in training non-medical personnel in rehabilitation largely arise from the requirement for them to have both medical and pedagogical competencies and to have the ability to work independently as well as in a rehabilitation team.
This article summarizes the three-year experience of training specialists in medical rehabilitation with higher non-medical education at the National Research Nizhny Novgorod State University named after N. I. Lobachevsky. The article presents the main issues of the professional retraining program «Physical rehabilitation (physical therapy)» with a duration of 1020 hours, defines professional competencies, difficult issues of training, formation of practical skills and assessment of professional competencies in this category of students. -
Incidence of reproductive system diseases in St. Petersburg women.
The study showed a high level of incidence of reproductive system diseases in women in St. Petersburg. Most of the nosological forms considered for 2017–2021. had a decreasing trend, except for menstrual disorders and female infertility. The dynamics of the level of primary and general incidence of inflammatory diseases of the female pelvic organs, menstruation disorders and benign breast dysplasia in St. Petersburg was significantly higher than the national average. Against the background of the COVID‑19 pandemic, in contrast to the regions of the Russian Federation as a whole, in St. Petersburg there was an increase in cases of primary and general incidence of female infertility and a decrease in primary cases of menstrual disorders. The results of the comparative analysis indicate the presence
of territorial features in the prevalence of diseases of the reproductive system in St. Petersburg, which must be taken into account when planning government programs for the development of the healthcare system at the regional and federal levels.
Objective: to assess the characteristics of the incidence of diseases of the reproductive system of women in a metropolis using the example of St. Petersburg.
Materials and methods: An assessment and analysis of indicators of primary and general morbidity of women from 18 to 55 years of age with diseases of the reproductive system was carried out according to official statistical reports and publications of the Federal State Statistics Service and the Ministry of Health of Russia in St. Petersburg and in the Russian Federation as a whole in dynamics over 2017–2021. -
Development of prognostic matrices for assessing the degree of risk of physical development disorders of students of higher educational institutions.
The most significant medical and social factors served as the basis for the development of appropriate prognostic matrices in order to obtain objective and comparable indicators of the prevalence of signs, in this case, the development of deficiency or excess body weight among students. The presented tables indicate risk factors that may affect the level of a quantitatively predicted phenomenon, through the gradation of the significance of relative risk factors. These prognostic matrices allow us to assess the impact of biomedical, socio-hygienic, behavioral factors on the formation of disorders in the health of students, including physical development in a pandemic, provide an individual approach, are the basis for a program of medical and social prevention of violations in the physical development of students
at the personal and collective levels. -
Medical and social significance of diseases of the peripheral nervous system on the example of carpal tunnel syndrome.
Peripheral nerve diseases are one of the socially significant problems in the healthcare system of the Russian Federation. Effective care for patients suffering from these diseases is an important task for healthcare, as so as they are accompanied by prolonged disability.
However, at present we do not have data that could fully demonstrate the medico-social and medico-economic aspects of carpal tunnel syndrome (CTS) and other peripheral nerve diseases in the Russian Federation.
The aim of the study is to improve the quality of medical care for patients with carpal tunnel syndrome based on the analysis of statistical data of patients operated on for this pathology in the S. P. Botkin City Clinical Hospital.
Material and methods. The patients in the study were all adult men and women who underwent surgical treatment of CTS at S. P. Botkin City Clinical Hospital in the period from 2016 to 2022. The sources of information about the treated patients were the information of medical information systems used in the hospital in different years. Statistical and visualization tools of the Microsoft® Excel® spreadsheet were used to obtain descriptive statistics and present data graphically.
Results. In the S. P. Botkin City Clinical Hospital, which is the clinical base of the Department of neurosurgery of the Russian Medical Academy of Continuous Professional Education, in the period from 2016 to 2022, 692 surgical interventions were performed for patients with CTS. The analysis of statistical data has shown results comparable with the available literature data, however, a distinctive feature is an extremely long history of the disease before surgical treatment.
Conclusions. Currently, in our country, there is an underestimation of the importance of peripheral nerve diseases, therefore, their separate statistical accounting in the structure of neurological morbidity is extremely important. Another important task is a multidisciplinary approach that provides high-quality medical care to patients with this pathology.
