CONTENT OF THE ISSUE
Portrait of regional health authority manager – 2022
The heads of regional executive authorities in the sphere of health protection are key figures in the realization of the Russian Federation’s healthcare development strategy. Without qualified managers, it is difficult to achieve national goals and objectives of federal projects. The study of the qualifications, professional experience, and skills of the high leaders of regional health systems allows the evaluation of top personnel’s human potential and the successful implementation of steps to increase the efficiency of its administration.
T h e a i m o f t h e s t u d y was to give a detailed information about regional health authorities managers in Russian Federation.
M a t e r i a l s a n d m e t h o d s . A single-stage, continuous sociological study was planned and carried out using a specially developed questionnaire, which included a characterization of the accounting characteristics of participants’ age and demographic characteristic, level of basic and additional education, availability of professional competencies, and work experience in managerial positions.
R e s u l t s . We achieved a response from 85 respondents. It was found that, as compared to 2021, there was a slowdown inside the process of rotation of regional ministers’ personnel and an increase in the degree of professional qualifications of managers in 2022.
These trends were reflected in the increase in the average length of service in the position of regional minister (2021 2,1±1,9 years; 2022 2,6±2,5 years), the doubling of the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21), and the decrease in the number of managers with work experience of up to one year (2021 n = 42; 2022 n = 21).
C o n c l u s i o n . The research allows for an assessment of the dynamics of changes in regional health care systems in terms of managerial human resources from 2021 to 2022. Positive declining trends in 2022 have been identified. The pace of rotation of regional ministers’ staff adds to the development of leaders’ professional abilities and experience and, eventually, will be the key to accomplishing strategic goals in health care.
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.
Analysis of the average duration of treatment of victims of various forms of poisoning with drugs and psychodisleptics (hallucinogens) for 2015–2021
Relevance. One of the indicators that allows you to comprehensively assess the level of organization of specialized medical care in a hospital, the quality of medical services, the use of modern medical technologies, continuity in the work of the pre-hospital stage, is the indicator of the average length of a patient’s stay in a hospital.
The purpose of the study. To study the average duration of treatment of victims of drug poisoning and psychodisleptics (hallucinogens) of varying severity for 2015–2021.
Materials and methods. The analysis of the average length of stay of patients with acute drug poisoning and psychodisleptics (hallucinogens) of varying severity in the process of standardization of toxicological care for the period from 2015 to 2021 was carried out.
The study was conducted in four groups of victims: mild forms, moderate forms, severe forms, severe complicated forms with fatal outcome.
Results. For the period from 2015 to 2021, the average duration of treatment of victims of acute poisoning with drugs and psychodisleptics (hallucinogens) was undulating and did not exceed 2.4 days. A statistically confirmed decrease in the average duration of treatment of victims during the study period was observed in the group of moderate forms of poisoning with drugs and psychodisleptics (hallucinogens), which indicates the controllability of the course of chemical trauma, providing a prognosis. The study of the average terms of medical care for victims of poisoning with drugs and psychodisleptics (hallucinogens) allows us to evaluate clinical measures of an urgent nature, formulate a prognosis of a pathological condition.
The wage system as an instrument of influence on the quality of primary health care.
Qualified and motivated employees of a medical organization are a necessary component that ensures the provision of medical care of appropriate quality One of the motivating factors of medical workers for high-quality and efficient work is wages.
The purpose of the study. To analyze and evaluate the impact of the remuneration system of medical workers based on labor rationing on the quality of primary health care (PHC) on the example of the state district polyclinics of St. Petersburg. Materials and methods. Based on the reporting data of polyclinics selected by the research bases, the following were studied: the dynamics of the number and staffing of medical workers from 2018 to 2021; the percentage and structure of reasons for refusal to pay for cases of medical care in 2010–2018 and 2020–2021; the dynamics of the detection of malignant neoplasms in the early stages. The results of the patient survey were analyzed in order to assess changes in the quality of primary health care for the adult population after the introduction of a system of remuneration for medical workers based on labor rationing.
Results. After the introduction of a new wage system based on its rationing, a number of general positive trends were identified for the studied polyclinics, such as: an increase in staffing of medical personnel in general by 3.5%–8.7%, district internists by 4.6%–42.7%, specialist doctors by 2.8%–12.4%, average medical personnel by 4.5%–17.7%; increase in the proportion of oncological pathology detected at early stages by 13.5%–20.1%; decrease in the share of refusals to pay for medical care cases by 9.3%–32.9%; a decrease in the total number of citizens’ complaints in the form of complaints by 6.0–58.0%, including justified ones.
Findings. The introduction of a wage system based on labor rationing has increased the economic and medico-social efficiency of the polyclinics under study, as well as the motivation of medical workers to provide medical care of appropriate quality.
Retrospective analysis of the form of industry statistical observation №131/o regarding the registration of risk factors for development chronic non-communicable diseases
To monitor, assess, analyze and register the prevalence of behavioral and biological risk factors, the form of industry statistical reporting No. 131/o “Information on preventive medical examination and medical examination of certain groups of the adult population” is used.
The quality and reliability of the primary statistical data presented in Form No. 131/o determines the further planning and implementation of preventive measures within the framework of interdepartmental interaction and cooperation with broad segments of the population.
The reliability and quality of statistical materials collected during the medical examination of certain groups of the adult population should guarantee the adoption of adequate management decisions on the development of preventive medicine and the basis for improving the effectiveness of the public health system.
Purpose: to conduct a retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o “Information on preventive medical examination and medical examination of certain groups of the adult population” for the period from 2013 to 2021, in terms of providing primary data on the registered risk factors.
Material and methods. Content analysis of orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o for 2013, 2015, 2020; reporting forms № 131/o; orders regulating the procedure for preventive medical examination and medical examination of certain groups of the adult population for the period from 2012 to 2021.
Results. A retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting № 131/o for the period from 2013 to 2021, in terms of providing primary data on the registration of risk factors, showed that, despite the shortcomings, only this form allows you to study and analyze information on the prevalence of risk factors and on this basis to identify priority areas for the prevention of chronic non-communicable diseases. That is, the analysis of form № 131/o allowed us to conclude that it is necessary not only to reconsider approaches to the organization of medical examinations and the collection of primary data, but also to modernize the concept of the largest preventive measure carried out within
the framework of the state health system.
Conclusions. A retrospective analysis of the orders of the Ministry of Health of the Russian Federation regulating the procedure for filling out and submitting the form of industry statistical reporting No.131/o for the period from 2013 to 2021, in terms of providing primary data on the registration of risk factors, showed that, despite the shortcomings, only this form allows you to study and analyze information on the prevalence of risk factors and on this basis identify priority areas for the prevention of chronic non-communicable diseases. The analysis of form No. 131/o allowed us to conclude that it is necessary not only to reconsider approaches to the organization of medical examinations and the collection of primary data, but also to modernize the concept of the largest preventive measure carried out within the framework of the state health system.
Lifestyles of students, including with disturbances in physical development during the COVID‑19 pandemic
The article deals with issues that characterize the lifestyle of students in the context of the COVID‑19 pandemic. A number of researchers found that during this period, cases of physical and mental health disorders, non-compliance with the norms of good nutrition, a significant decrease in physical activity, changes in the physical parameters of the body, weight gain, etc. became more frequent among students.
Materials and methods. An international methodology was applied to assess the structure of the students’ lifestyle – the Health-Promoting
Lifestyle Profile Questionnaire (HLPP-II). The methodology takes into account the characteristic features of 6 integral components (responsibility for health, physical activity, nutrition, spiritual growth, interpersonal relationships and stress management). For the purpose of comparative analysis, 505 students surveyed were divided into 3 groups depending on the body mass index: those with underweight, with normal body weight, and those with excess body weight.
Findings. The results obtained made it possible to establish that among those with a deficiency or excess of body weight compared with those with normal body weight, there were significantly more students with a low level of severity of all 6 considered components of the overall level of health.
Analysis of the morbidity of a separate medical university students before and during the pandemic of the new coronavirus infection COVID-19
The study of the health of modern students is an urgent problem that requires a comprehensive and comprehensive analysis. With the beginning of the COVID-19 coronarovirus pandemic, isolated works devoted to the study of the morbidity of students have been published.
In this regard, the study of the morbidity of medical students during the pandemic of a new coronavirus infection is of great practical interest.
Purpose. To analyze the morbidity and structure in medical university students before and during the pandemic of a new coronavirus infection COVID-19.
Materials and methods. Students of the Smolensk State Medical University of the Ministry of Health of the Russian Federation (SSMU) took part in a comprehensive study. Research bases -polyclinic, health center, serving university students. Sources of information in the study: reporting and accounting forms of a medical institution, a statistical coupon for registering final diagnoses and reporting documentation of healthcare organizations providing medical care to students. The analysis of morbidity was carried out according to the nomenclature, according to the “International Classification of Diseases, Injuries and Causes of Death X revision”.
Results. The analysis of the overall incidence showed its increase in the pre-pandemic period of the new coronavirus infection COVID-19, and in the first year of the pandemic - a significant decrease with a distinct increase in 2021. The level of primary morbidity in the first year of the pandemic decreased significantly, and in the second year it exceeded the values of primary morbidity, both before the pandemic and the first year of the pandemic. Analysis of the structure of morbidity by incidence, by classes of diseases showed that respiratory diseases were the most frequent among students both in the pre-pandemic and pandemic periods.
Conclusions. Thus, in the pre-pandemic period, there was an increase in both general and primary morbidity, as well as in all classes of diseases. Respiratory diseases were in the leading ranking place. In the first year of the pandemic, there was a decrease in the level of general, primary morbidity and the level of morbidity in almost all classes of diseases. In the second year of the pandemic, there was a significant increase in these indicators.
Issues of payments for medicines in the provision of specialized medical care for compulsory medical insurance
In the article, on the basis of regulatory legal acts, the issues of the legality of the use of co-financing mechanisms (co-payments) in the system of compulsory medical insurance are considered.
The situations and conditions in which co-payments are legitimate are analyzed.
It is concluded that it is necessary not to combat this phenomenon, but to regulate cases of co-payments on the part of insured citizens.
Management in healthcare
Questions and answers