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Manager Zdravoochranenia 2023 #4
Published: 2023-07-27
257
CONTENT OF THE ISSUE
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Problematic issues of contractual relations between a medical worker and a medical organization: what needs to be paid attention to the head of a medical organization and a medical worker
The “Guidelines for Compliance with Mandatory Requirements in Carrying Out Medical Activities” approved by Roszdravnadzor on November 11, 2022, noted that the most common violations include the licensee’s lack of employment contracts with employees performing work (services) permitted by the license. In this regard, the article substantiates in detail the need to conclude an employment contract with every medical worker working in a medical organization, regardless of whether this organization is his main place of work or not.
The authors show that when a medical organization engages a medical worker from another medical organization to consult patients on a regular basis, it is also necessary to conclude an employment contract with him. At the same time, when a medical organization engages a medical worker of another medical organization on a paid basis for one-time/separate consultations, a civil law contract can be concluded with him. The article emphasizes that the concepts of “consultant” and “medical consultation” require their disclosure in the legislation, which determine the legal status of specialists involved in consultations and give a detailed description of medical consultations. -
Normative support and assessment of the availability of otorhinolaryngological care for children and adolescents.
Diseases of the ear, throat, nose in children and adolescents are one of the most pressing public health problems due to their high prevalence and medical and social significance, both in our country and abroad. The condition for increasing the effectiveness of otolaryngological care for children and adolescents is to ensure its accessibility.
P u r p o s e : analysis of regulatory support and assessment of the availability of medical care for children and adolescents in the field of otorhinolaryngology.
M a t e r i a l s a n d m e t h o d s . Methods of legal analysis, expert assessments, as well as expert, mathematical-statistical and analytical methods were applied.
F i n d i n g s . Studies conducted in 2022 on the basis of children’s polyclinics in the city of Ramenskoye, Moscow Region, revealed “bottlenecks” in the legal regulation of the issues of access to medical care for children and adolescents in children’s polyclinics. A methodology for an integral assessment of the availability of otorhinolaryngological care for children and adolescents in the conditions of children’s polyclinics has been developed. The deviation of the integral evaluation index according to the proposed method by 18,0% relative to the optimal level was revealed, which requires involvement of local authorities in solving problems. -
Approaches to the integral efficiency assessment of primary prevention measures in management decision-making
Standard indicators currently used to evaluate efficiency of various prevention measures do not determine the impact of these measures on public health indicators and achievement of target results.
P u r p o s e of this study is to develop approaches of integral assessment efficiency evaluation of public health system primary prevention measures.
M a t e r i a l s a n d m e t h o d s . The analysis was conducted in Omsk region municipal districts during the period from 2018 to 2022. The materials for this research were data from reporting forms of federal sectoral monitoring, morbidity of the population data, information about prevention measures volume and quality. The method of integral efficiency assessment was used. This method is based on arithmetic mean of the selected general indices of measures that include individual indices of public health measures efficiency. Efficiency assessment of measures aimed at population alcohol consumption reduction is used as an example.
R e s u l t s . Individual indices that evaluate retail alcohol sales rate, the proportion of persons with risk factors, their involvement in dispensary supervision, involvement of the population in preventive measures, were created to assess the overall index of measures aimed at alcohol consumption reduction. Individual indices are presented with baseline and target values. The analysis of the dynamics of actual indicators of the volume of alcohol consumption reduction measures is given. Integral index of prevention measures efficiency is the arithmetic mean of the general indices, including six components of primary prevention of chronic non-communicable diseases that have a significant impact
on public health indicators, including: tobacco consumption reduction, obesity prevalence, proportion of the population with physical activity increase, rational nutrition, healthy lifestyle. The closer the integral index is to the value of 1, the more effective preventive measures are. The integral index of primary prevention measures efficiency in Omsk in 2022 is at 0,46 points.
C o n c l u s i o n . Implementing the integral efficiency assessment method allowed to use unified approach in evaluation of the current primary prevention of chronic non-communicable diseases measures model, to conduct a comparative evaluation of measures aimed at strengthening public health in Omsk region municipal districts, showed the direction of additional measures to improve the efficiency of the process as a whole. -
Medical datasets for machine learning: fundamental principles of standartization and systematization.
Backgraund: Active implementation of artificial intelligence technologies in the healthcare in recent years promotes increasing amount of medical data for the development of machine learning models, including radiology and instrumental diagnostics data. To solve various problems of digital medical technologies, new datasets are being created through machine learning algorithms, therefore, the problems of their systematization and standardization, storage, access, rational and safe use become actual.
A i m : development of an approach to systematization and standardization of information about datasets to represent, store, apply and optimize the use of datasets and ensure the safety and transparency of the development and testing of medical devices using artificial intelligence.
M a t e r i a l s a n d m e t h o d s : analysis of own and international experience in the creation and use of medical datasets, medical reference books searching and analysis, registry structure development and justification, scientific publications search with the keywords “datasets”, “registry of medical data”, placed in the databases of the RSCI, Scopus, Web of Science.
R e s u l t s . The register of medical instrumental diagnostics datasets structure has been developed in accordance with stages of datasets lifecycle: 7 parameters at the initiation stage, 8 – at the planning stage, 70 – dataset card, 1 – version change, 14 – at the use stage, total – 100 parameters. We propose datasets classification according to the purpose of their creation, a classification of data verification methods, as well as the principles of forming names for standardization and datasets presentation clarity. In addition, the main features of the organization of maintaining this registry are highlighted: management, data quality, confidentiality and security.
C o n c l u s i o n s . For the first time, an original technology of medical datasets for instrumental diagnostics structuring and systematization is proposed. It is based on the developed terminology and principles of information classification. This makes it possible to standardize the structure of information about datasets for machine learning, and ensures the storage centralization. It also allows to get quick access to all information about the dataset, and ensure transparency, reliability and reproducibility of artificial intelligence developments. Creating a registry makes it possible to quickly form visual data libraries. This allows a wide range of researchers, developers and companies to choose data sets for their tasks. This approach ensures their widespread use, resource optimization and contributes to the rapid
development and implementation of artificial intelligence. -
Medical datasets for machine learning: fundamental principles of standartization and systematization.
Backgraund: Active implementation of artificial intelligence technologies in the healthcare in recent years promotes increasing amount of medical data for the development of machine learning models, including radiology and instrumental diagnostics data. To solve various problems of digital medical technologies, new datasets are being created through machine learning algorithms, therefore, the problems of their systematization and standardization, storage, access, rational and safe use become actual.
A i m : development of an approach to systematization and standardization of information about datasets to represent, store, apply and optimize the use of datasets and ensure the safety and transparency of the development and testing of medical devices using artificial intelligence.
M a t e r i a l s a n d m e t h o d s : analysis of own and international experience in the creation and use of medical datasets, medical reference books searching and analysis, registry structure development and justification, scientific publications search with the keywords “datasets”, “registry of medical data”, placed in the databases of the RSCI, Scopus, Web of Science.
R e s u l t s . The register of medical instrumental diagnostics datasets structure has been developed in accordance with stages of datasets lifecycle: 7 parameters at the initiation stage, 8 – at the planning stage, 70 – dataset card, 1 – version change, 14 – at the use stage, total – 100 parameters. We propose datasets classification according to the purpose of their creation, a classification of data verification methods, as well as the principles of forming names for standardization and datasets presentation clarity. In addition, the main features of the organization of maintaining this registry are highlighted: management, data quality, confidentiality and security.
C o n c l u s i o n s . For the first time, an original technology of medical datasets for instrumental diagnostics structuring and systematization is proposed. It is based on the developed terminology and principles of information classification. This makes it possible to standardize the structure of information about datasets for machine learning, and ensures the storage centralization. It also allows to get quick access to all information about the dataset, and ensure transparency, reliability and reproducibility of artificial intelligence developments. Creating a registry makes it possible to quickly form visual data libraries. This allows a wide range of researchers, developers and companies to choose data sets for their tasks. This approach ensures their widespread use, resource optimization and contributes to the rapid
development and implementation of artificial intelligence. -
Determinants of the use of telemedicine in pediatric dentistry.
Currently, favorable conditions are being created in the Russian Federation for the development and effective use of telemedicine in healthcare. Options for the use of information and communication technologies in pediatric dentistry are: telemedicine consultations, consultations, distance education of medical workers, medical education and preventive activities among the child population.
The aim of the research as part of the dissertation work, the research was aimed at studying the attitude of dentists to the use of telemedicine technologies in pediatric dentistry.
Materials and methods. The process of studying the attitude and readiness of pediatric dentists to use telemedicine technologies was aimed at identifying individual (micro) and conceptual (meso- and macro) factors affecting the use of medicine in pediatric dentistry. The study included a semi-formal interview and questionnaire.
Results. As a result of the research on the sections: Telemonitoring – remote monitoring of patients, including outpatient management of patients; storage and transmission of medical data; interactive telemedicine, it was found that doctors in Tver and the Tver region have both positive and negative beliefs and opinions that can promote or hinder their use of telemedicine in their professional practice.
Conclusions. Research with the participation of pediatric dentists will help both developers and managers of medical institutions to understand the limitations and advantages of technologies from the point of view of practicing pediatric dentists, will allow predicting its development.
The results of this study will contribute to solving the problems of implementing telemedicine services, contribute to the rational development of telemedicine platforms in pediatric dentistry in Tver and the Tver region. -
Evaluation of the effectiveness of using remote monitoring of blood pressure in the dispensary observation of patients with arterial hypertension
Arterial hypertension (AH) is by far the most important risk factor for cardiovascular disease. An effective method of dealing with high blood pressure (BP) is dispensary observation. Of particular relevance is the search for new tools to improve the dispensary observation of patients with hypertension, one of which may be remote monitoring of blood pressure, as an option for providing medical care using telemedicine technologies.
Purpose of study – Analysis of the effectiveness of using remote monitoring of blood pressure in the dispensary observation of patients with hypertension.
Methods. A non-randomised, open-label, generalized, single-centre, retrospective, longitudinal, parallel, applied study included 78 patients who completed a remote blood pressure monitoring program who were subsequently divided into 2 groups depending on the degree of achievement of target values of blood pressure (<135/85 mm Hg).
Results. During the observation period, all patients (n=78) experienced a decrease in SBP by 8.2 mmHg, DBP at 3.8 mmHg. Group 1 consisted of 35 patients who reached target levels of blood pressure, group 2 included 43 patients who did not reach target levels of blood pressure. Initially, the groups did not differ in sex and age, while in the second group, the initial values of SBP and DBP were higher. The study found that the degree of achievement of target levels of blood pressure is influenced by the following factors: the level of SBP and DBP at the beginning of observation, the proportion of extraordinary measurements with blood pressure levels above 135/85 mmHg during the observation period, the proportion of missed blood pressure measurements during the observation period, as well as the duration of remote monitoring.
Conclusions. Remote monitoring of blood pressure is an effective tool for improving the dispensary observation of patients with arterial hypertension and can improve the availability and quality of medical care. -
The possibilities of redistributing the functions of the city clinic at the opening of the Distant consultation center unit.
Goal. To evaluate the interim results of a pilot project on the organization of an independent unit of a city clinic that provides remote support to citizens – the Distant Consultation Center of the Government Autonomous Organization Healthcare “City Clinic No. 8” (hereinafter referred to as the DCC).
M e t h o d s o f w o r k . To assess the effectiveness of the pilot project, a number of indicators of the work of the medical organization were analyzed before the start of the project and 12 months after the start of its implementation. The analysis was carried out in two way of work of the Distant Consultation Center: 1. the process of providing medical care to patients with acute respiratory viral infections / Influenza / COVID‑19; 2. the process of providing medicines to the Subsidized category of citizens. The volumes of work that can be transferred to the Distant Consultation Center
from the department of primary care physicians care and from the emergency medical care are analyzed.
The source of the data was the medical information system of the medical organization “URMO TO” (modules Registry, Control of realization, doctor’s ARM, Disability sheets, Additional processing). The period of work of the medical organization from 01.01.2022 to 31.12.2022 is analyzed.
Statistical processing of the results was carried out using the Statistica 6.0 application software package.
Distance consultation was carried out via IP telephony, as well as using specialized Telemedicine software.
R e s u l t s o f t h e w o r k . Before the organization of the DCC, the median indicator of the actual workload per hour of the covid team was 2,5 [2,3–2,7] patients, p<0,07. While the doctor of DCC carried out an average of 56,9 [44–68] remote consultations, which is an average of 8,8 patients per hour, p< 0,07.
The median value of patients for prescriptions for Subsidized medicines before the start of the project was 4 [3–6] patients per day (p<0,07), on average 22.2% time of the initial consultation falls on patients requiring a Subsidized medicine. The median value of applications for the purpose of providing Subsidized categories of citizens with medicines when discharged by a medical assistant at the DCC was 1 [0–3] (p<0,08). Thus, this section began to occupy 0,06% in the structure of reasons for the initial appointment to the primary care physician.
C o n c l u s i o n s . The organization of the work of the DCC allowed us to develop approaches, approve and adapt them to the processes of filling out the schedule of primary care doctors in order to increase accessibility to the primary consultations of the primary care physician’s department.
Scaling up the organizational model and processes of the Distance consultation center of the Municipal Polyclinic No. 8 can serve as an effective tool in achieving the goals announced within the framework of the pilot project of the Ministry of Health of the Russian Federation “Incident 38” launched in 2022.
T h e s c o p e o f t h e r e s u l t s . The presented experience shows the possibility of managing patients with respiratory viral diseases in outpatient polyclinic conditions on an ongoing basis, as well as the telemedicine format of care can be extended and adapted to non-infectious nosologies. -
The use of information technologies in assessing the quality of medical care
The currently relevant value-based healthcare model (Value-Based Healthcare) is more focused on ensuring long-term effectiveness and patient satisfaction, which is directly related to the implementation of the principles of patient-oriented and patient-centered activities [1].
In accordance with the Proposals (practical recommendations) on the organization of internal quality control and safety of medical activities in a medical organization (hospital) of the Federal State Budgetary Institution “National Institute of Quality” of Roszdravnadzor, compliance with the principles of patient-centered medical care provides for the development and implementation at the level of a medical organization of a patient safety strategy, including compliance with ethical standards and rules in the implementation of medical care activities. This also includes the procedure for organizing feedback with patients [15].
The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing most aspects of hospital activities from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components.
The purpose of the study is to provide the results of the implementation of the author’s information and analytical system for collecting and processing information about patient satisfaction through an electronic web questionnaire and providing the calculation of satisfaction indicators in a multidisciplinary hospital.
M a t e r i a l s a n d m e t h o d s . The basis of the study was a multidisciplinary hospital of the state budgetary healthcare institution “Regional Clinical Hospital No. 2” in Vladivostok. Within the framework of the study, the inpatient patients were surveyed using questionnaires in electronic form prepared by a medical organization, an information and analytical system was developed to conduct a mathematical analysis of the results of the survey according to five criteria for assessing the quality of medical care conditions.
The study used a questionnaire including 20 questions, the answers to which express the opinion of patients about the quality of work of doctors and nursing staff, the comfort of the conditions of stay in the emergency department, as well as in the hospital during hospitalization.
The questionnaire was developed in 2015, and for many years the survey was conducted using paper and manual calculations. But since 2021, patient questionnaires and analysis of the collected data have been transferred to an electronic format.
In this article we present the results obtained with the help of an information system for collecting and analyzing questionnaires, in which adult patients of a round-the-clock hospital participated.
R e s u l t s . The use of information technologies in patient questionnaires and analysis of results allows for operational monitoring of patient satisfaction indicators and to create a basis for assessing a number of aspects of hospital activity from the perspective of patients: the quality of medical services and their results, interaction with staff, infrastructure and service components make it possible to evaluate the effectiveness of measures to ensure comfortable conditions for the patient’s stay and can be used in practical healthcare to organize measures to eliminate defects and make decisions on the management of a medical organization.
C o n c l u s i o n s . The introduction of additional methods for studying patient satisfaction using electronic forms, taking into account the specifics of the work of a medical organization to the requirements established by the Ministry of Health of the Russian Federation, makes it possible to increase the effectiveness of interaction with patients and can be one of the tools for assessing the social effectiveness of a medical organization (hospital). -
Aspects of the quality of the life of persons of working age with chronic noncommunicable diseases of the respiratory organs
Chronic noncommunicable diseases (NCD) are widespread and affect people of different age groups in all countries. The fight against this group of diseases is one of the priorities of the modern health care. Non-infectious diseases of the respiratory system as well as other diseases, affect social, physical and mental components of well-being. The qualitative assessment of their influence helps to assess the study of the quality of life.
P u r p o s e : to assess the quality of life of the working-age population of the Nizhny Novgorod region and to develop measures to reduce the risk factors for chronic non-infectious diseases of the respiratory system in these cohorts.
M a t e r i a l s a n d m e t h o d s . A one-stage comparative study was carried out using the method of standardized interviewing using the SF‑36 questionnaire. The quality of life of people of various age-gender groups with chronic non-infectious diseases of the respiratory system was assessed. All respondents were stratified into groups by pathology and age.
R e s u l t s . The scientific article reflects the results of the study of assessing the quality of life of working-age patients with the chronic respiratory system pathology. The analysis of the data revealed statistically significant differences in age, gender and groups of pathologies among the respondents. Differences in indicators reflecting emotional states were revealed among men and women of the working age. Age-related changes in indicators of physical and psychological components of health and on all scales of the quality of life were presented. The obtained values of patient indicators show the need to develop specific measures to reduce behavioral risk factors for chronic non-infectious respiratory diseases of the population of the Nizhny Novgorod region.
Findings. The comparative analysis of the results of the scales of the quality of life and health components reflects the age-related changes in indicators. The people of the older age group of the working age demonstrate significantly low results. The indicators of physical functioning are statistically significantly different in different pathologies of the respiratory system. Chronic obstructive pulmonary disease (COPD) restricts the physical activity of patients more strongly than other pathologies. Low values of the quality of life reflect the need to develop the measures to reduce the risk factors for chronic non-infectious diseases for the population of the Nizhny Novgorod region.
