Manager Zdravoochranenia 2023 #5

Published: 2023-07-27

252

CONTENT OF THE ISSUE

    Focus of problem
  • New rules for the provision of paid medical services: review and evaluation of the main innovations

    The article discusses the change in the regulatory framework for the provision of paid medical services in connection with the adoption of the decree of the Government of the Russian Federation, which approved new rules for the provision of paid medical services. The reason for the adoption of the new rules is analyzed, as well as the content of its individual provisions. An assessment is given of how the new legal framework for the provision of paid medical services will affect the activities of medical organizations and how they will affect the interests of patients.
    Special attention is paid to the emergence of a new – remote form of contract conclusion.

    Authors: Kadyrov F. N. [122] Starodubov V. I. [40] Kobyakova O. S. [16] Chililov A. M. [24]

    Tags: acceptance1 consumer1 contract for the provision of paid medical services1 offer1 paid medical services19 patient13 remote method of concluding a contract1

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  • Risks of advanced training of doctors in private educational institutions: causes, consequences, what to do

    The article discusses in detail the reasons for the low quality of training of doctors in private educational institutions. Among them, the absence of the necessary personnel and material and technical base for training, the implementation of activities with gross violations of the law, the imperfection of legal regulation in the field of education, etc. of which today additional professional medical education programs are being implemented with gross violations of the requirements established by the legislation on education, creates significant legal risks for doctors in terms of the validity of their admission to professional activities. The article emphasizes that the low quality of medical training
    provided by a significant number of private educational organizations that implement additional professional medical education programs inevitably leads to a decrease in the quality of medical care provided, which today must be considered as one of the factors that threaten the national country’s security. Measures are proposed to correct the current situation.

    Authors: Piven D. V. [56] Kitsul I. S. [56]

    Tags: additional professional medical education programs1 distance learning3 licensing of educational activities2 national security1 private educational organizations1 professional development of doctors1 professional standards7

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  • Management in healthcare
  • Results of the quality control of the work in the regional vascular center of the Orenburg region (by the example of providing medical care to patients with acute myocardial infarction)

    Diseases of the circulatory system are an urgent medical and social problem. Cardiovascular disease is a common cause of death among more than half of all deaths in the Russian Federation, from 54,7 to 58,1 thousand people died from myocardial infarction every year in the last years.
    The regional vascular centers’ work is aimed at reducing the death rate of Russians from vascular accidents and improving their quality of life.
    The purpose of the study is the quality control of specialized medical care for patients with a acute myocardial infarction in Regional Vascular Center of the Orenburg region.
    Materials and methods. The study was conducted on the basis of the Orenburg Regional Clinical Hospital “Voynov”, where the Regional Vascular Center exists for 10 ten years. The assessment presents bed performance indicators and special indicators of the quality of work of vascular centers for the period 2018–2022. The work uses statistical and search methods of research.
    Results. It has been established that due to the pandemic of the new coronavirus infection Covid‑19, such an indicator of the activity of the Regional Vascular Center of the Orenburg Region as the work of a bed was found in the intensive care unit in 2021, is up to 285.8 days, in the cardiology department in 2020 is 253,6 days. The lethality rate of the arbitration department was maximum in 2018 and 2020, the composition of 9,9% each, storage – in 2021 (7,2%). At the same time, this indicator was lower than the target mortality rate from the acute infantry department in the Orenburg region, equal to 12,4%. With the exception of a period of decreasing coverage of patients with thrombolytic therapy, which is associated with an increase in percutaneous coronary lesions performed on an emergency basis, the maximum number of exercising cases was performed 862 patients in 2021. Among patients with coronary syndrome, an
    increase in the coverage of medical rehabilitation was revealed, so in 2022 the proportion of such cases reached 28,2%.
    Conclusions. Thus, the period of pandemic of a new coronavirus infection Covid‑19 seriously influenced the indicators of the Regional Vascular Orenburg Region, but at the same time, we can see the improvement in the quality of the work of the consumption center to global control.

    Authors: Borshchuk E. L. [4] Redyukov A. V. [1] Bortsov N. A. [1] Perepelkina N. Yu. [1]

    Tags: organization of specialized medical care1 precise coronary syndrome1

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  • Problems of providing endocrinological care to the elderly in the Russian Federation.

    The main goal of the modern organization of medical care to the population with diseases of the endocrine system is to improve the quality, efficiency and accessibility of medical care to persons suffering from diseases of the endocrine system. For many years now, the problem of the dynamics of the prevalence of diseases of the endocrine system reflects frightening figures. At the same time, the group of the most common diseases is still diabetes mellitus (DM), obesity and thyroid diseases. Diseases of the endocrine system significantly reduce the quality of life of the elderly. The health status of elderly people is most often characterized by the comorbidity of chronic diseases, which
    in turn leads to a deterioration in the prognosis regarding life and health, and also makes necessary forced polyprogmasia. Identification of the problems of providing endocrinological care to the elderly will improve the quality and effectiveness of medical care at all stages of its provision.
    The purpose of the study: to analyze the organization of medical care in the development of endocrine diseases in the elderly population of the Russian Federation.
    Materials and methods. A content analysis of regulatory and legal documents on the provision of medical care to elderly patients in the field of Endocrinology in the Russian Federation, an analysis of Rosstat data on the main health indicators of the elderly population of the Russian Federation over the past 10 years was carried out.

    Authors: Dzhopua I. D. [1]

    Tags: diabetes mellitus6 dyslipidemia1 endocrine diseases1 endocrinological care1 old age.3

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  • On certain topical issues of development of preventive activities of centers of public health and medical prevention.

    In actual conditions, increasing of health risks for population determines actuality of exploration of organization of preventive activities of centers of public health and medical prevention.
    Objective: to analyze particular actual issues of development of preventive activity of centers of public health and medical prevention in Russia.
    Material and methods. The topical selection of publications, analytical method, comparative analysis and systemic approach were applied.
    Results. The key measures required for effective preventive activity in centers of public health and medical prevention were established and aggregated. Within the framework of task of active involvement of population into unified preventive environment the implementation of new health care mobile technologies into activities of medical personnel of centers of public health and medical prevention is claimed to monitor patients with the purpose of treatment of various chronic non-communicable diseases and elimination of risk factors of their development.
    Conclusion. The provision of medical and preventive services to population on a free-of-charge basis is among advantages of preventive activities of centers of public health and medical prevention. The development of unified preventive environment in centers of public health and medical prevention applying mobile health care technologies permits to increase interest of population in health self-control and conscious implementation of medical recommendations about healthy life-style. The implementation of marketing measures can promote
    increasing of organizational and reputation status of “health center” among population.

    Authors: Zagoruychenko A. A. [7] Nechaev V. S. [1]

    Tags: center of public health and medical prevention1 healthy life-style1 non-communicable diseases1 preventive activity1 risk factor1

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  • Personnel management
  • Provision of the medical statistics service with qualified personnel.

    The implementation of the tasks of the medical statistics service is an integral part of the health care management process, as well as methodological support of the management vertical in the system [2, 3]. The quality of medical statistical and analytical data depends primarily on the personnel component of the medical statistics service. Currently, medical statistics are developing in the context of significant organizational changes in the healthcare system [1], which determines the priority of providing the service with qualified personnel [5].
    The purpose of the study: to study the availability of qualified personnel engaged in professional activities in medical statistics.
    Materials and methods. The data of the Federal statistical observation form No. 30 “Information about a medical organization” were used for the study.
    Statistical and analytical methods were used in the study.
    Results. The Medical Statistics Service performs one of the key roles in the management of a medical organization and the healthcare industry as a whole. In medical organizations, statistical document management is carried out by specialists of departments (offices) of medical statistics, which make up the medical statistics service as a whole. The key specialists of the service are statisticians and medical statisticians.
    The analysis of the indicator of the availability of qualified personnel of the medical statistics service shows its stable decline. Thus, in the dynamics of the total indicator of the provision of statisticians and medical statisticians per 10 000 population in the Russian Federation from 2015 to 2021, there is a decrease in its level by 18,6% or from 0,86 0/000 to 0,700/000, including in outpatient settings by 24,4% or from 0,450/000 to 0,34 0/000, in stationary by 11,8% or from 0,34 0/000 to 0,30 0/000. By the end of 2021, the shortage of qualified specialists of the medical statistics service amounted to 44,3% of their total needs. A similar situation is observed in medical organizations for outpatient and inpatient medical care (45% and 42,6%, respectively). Simultaneously with the decrease in the staffing of the medical statistics service, an increase in the load on the specialist was revealed. Thus, in medical organizations providing medical care in outpatient and inpatient settings, the average load on a statistician and medical statistician is almost 1,5–2 times higher than the average standard.
    Conclusions. The analysis of personnel changes in the medical statistics service indicates the need to improve approaches to the training and use of qualified personnel engaged in professional activities in medical statistics.

    Authors: Latyshova A. A. [1] Nesvetailo N. Ya. [1]

    Tags: medical statistician1 medical statistics2 medical statistics service1 staffing11 statistician1

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  • POPULATION HEALTH
  • Arterial hypertension among children and adolescents as a prognostic risk factor. Problems of diagnosis.

    An analysis of modern studies has shown that arterial hypertension, detected in childhood, is one of the main risk factors for both cardiovascular diseases and the progression of renal failure in subsequent age periods, which indicates the importance of early diagnosis, treatment and prevention of this condition among children and children. teenagers. The increase in the prevalence of hypertension among children and the associated health risks actualize the issues of the level, methods, techniques and frequency of blood pressure screening, differentiation of primary and secondary hypertension for successful treatment and control of the disease, as well as the development of
    methods for analyzing multiple factors for accurate diagnosis and prediction of spread. arterial hypertension. Of greatest research interest are the issues of accurate measurement of blood pressure during routine medical examinations of children, including invasive or noninvasive methods for measuring blood pressure in newborns, the availability of proven equipment and specialists in pediatric hypertension, and the interpretation of blood pressure measurements.

    Authors: Mingazova E. N. [24] Valeev V. V. [4] Bezymyanny A. S. [1] Traskovetskaya I. G. [1]

    Tags: adolescents3 arterial hypertension2 children12 hypertension2 prevalence6

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  • Evaluation of commitment to a healthy lifestyle among the students of a medical university as the basis for the formation of preventive programs.

    A student’s commitment to a healthy lifestyle (HLS) is determined by their values, worldview, level of awareness about the risk factors and knowledge of the measures to reduce them, where the result of programs for the formation of health skills depends, in turn, on the commitment of a particular person to the implementation of certain recommendations. To manage healthy lifestyle programs, sertain tools are needed to assess the level of knowledge and readiness to comply with health-preserving guidelines.
    Objective of the study: to study the informational and behavioral component of the commitment to a healthy lifestyle of medical students.
    Methods and materials. 686 students of the first (368 people) and third (320 people) courses were selected for the study of commitment to a healthy lifestyle. With the help of the questionnaire “Awareness of the main parameters of a healthy lifestyle” and the questionnaire “Study of a healthy lifestyle”, according to a specially developed methodology, the awareness of the main parameters of a healthy lifestyle, the degree of their implementation by the respondent and the opinion about the factors influencing the formation of a healthy lifestyle were studied. Statistical processing of the results was carried out using the programs Statistica 5.0 and Microsoft Office Excel.
    Results. The main factors influencing the commitment to a healthy lifestyle among medical students are low levels of awareness of the theoretical foundations of a healthy lifestyle and motivation to maintain it. Negative trends in commitment to a healthy lifestyle are more clearly manifested by the third year: students’ self-evaluation of their own health is falling, the proportion of respondents who assess their health as “mediocre” and “bad” is growing, the proportion of students with optimal physical activity and normal body weight is decreasing.
    Gender differences were found: young men are less committed to taking care of their own health.
    The ranking of risk factors according to the degree of influence on health showed that, according to the students, the leading factors are those directly related to their lifestyle: systematic lack of sleep and study overload. Opposite opinions of students on the influence of certain factors on their health were found, which may be due to both the lack of information and its incorrect interpretation. Objectivity of the assessment of students’ awareness of the main parameters of a healthy lifestyle using an individual scoring showed that the average score of “awareness” of the first year is 3.8, the third – 8.2 points. The point expression of awareness can be used in assessing the effectiveness
    of the theoretical part of the programs for the formation of a healthy lifestyle.
    Scope of the results. The results of the study can serve as an information stage in the development of healthy lifestyle programs for students, as well as for the formation of approaches to the development of an evaluation scale for the effectiveness of such programs.

    Authors: Pozdeeva A. N. [1] Guryanov M. S. [1]

    Tags: awareness2 commitment to healthy lifestyles1 criteria for healthy lifestyles1 factors affecting healthy lifestyles1 healthy lifestyle (hls)1 medical students3

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  • Medical and social problems of the prevalence of ENT diseases and the availability of otorhinolaryngological care to the population, including children (review of foreign literature)

    An analysis of foreign scientific sources suggests that the prevalence of otorhinolaryngological diseases in the world is high and affects the increase in disability and mortality rates. The most common pediatric otorhinolaryngological disease worldwide is otitis media. Low availability of specialized otorhinolaryngologist care and socioeconomic disadvantage are associated with earlier, more frequent and severe ENT disease in children. The most vulnerable to otitis media leading to hearing loss are children of low socioeconomic status (even in developed countries) and indigenous children in all countries of the world. In low- and middle-income countries, pediatric
    otorhinolaryngology faces challenges associated with a lack of infrastructure and equipment, a relatively small health care budget, a shortage of medical staff, and a lack of political will. In multicultural developed countries, the lack of understanding in medical institutions of the need to take into account ethno-cultural characteristics, as well as a decrease in confidence in medical institutions, creates constant barriers to access to medical services.

    Authors: Mingazova E. N. [24] Mingazov R. N. [11] Oleinik A. V. [2]

    Tags: accessibility3 children12 ent diseases3 medical and social problems1 otorhinolaryngological care2 prevalence6

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  • Informatization of healthcare
  • Development of the telemedicine services market in the form of remote consultations during the COVID‑19 pandemic

    During the COVID‑19 pandemic, there was an ever-increasing demand for telemedicine services in remote consultation format. This review analyzed 24 scientific publications, literary data in PubMed, eLibrary, «Guarantor», «Consultant» and WHO databases on this issue.
    The purpose of the study. The purpose of the review is to assess the current state and possible ways to address problematic issues in the development of the market for telemedicine services.
    Materials and methods. The research method was systematic review. As a result of the work carried out, it was revealed that the development of the market of telemedicine services in the form of remote consultations in the Russian Federation is much slower than abroad, due to the presence of certain provisions in the legislative framework, making it difficult to expand the horizons of telemedicine applications.
    Results. The most important issues are ensuring the adaptation of the legal framework, technical security of confidentiality of information, insurance of the risk of professional responsibility of medical workers and guarantees of patient rights. It was concluded that the development of the market for telemedicine services in the form of remote consultations was expected in connection with the pilot legal regime submitted for consideration in the Russian Federation.
    Findings. This trend will contribute to improving the availability and quality of health care.

    Authors: Prokhorova N. D. [1]

    Tags: covid‑19 pandemy1 experimental1 legal regime1 telemedicine services1

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  • Soft-technologies in medical rehabilitation after reconstruction of the anterior cruciate ligament of the knee joint.

    The use of soft-technologies in medical rehabilitation is a highly relevant and promising direction of the remote method of restoring the health of patients. The authors have developed a program for an electronic computer «Medical rehabilitation (therapeutic gymnastics after reconstruction of the anterior cruciate ligament of the knee joint)». It is designed for patients to independently perform a set of exercises of therapeutic gymnastics at home. Based on the results of the lesson, the patient fills out a report, on the basis of which the attending physician makes adjustments to the individual medical rehabilitation plan. The analysis of the results of the approbation based on an anonymous survey
    indicates high patient satisfaction when using a mobile application and an increase in commitment to the implementation of recommendations.

    Authors: Prikhodko A. N. [2] Suin P. A. [1] Nayda D. A. [1] Prikhodko N. A. [1]

    Tags: anterior cruciate ligament1 medical rehabilitation9 mobile application1 soft-technologies1 therapeutic gymnastics complex1

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Articles
11

Authors
29

Pages
80

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