All articles by Balzamova L. A.
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2022 № 6 Staffing of primary health care in the Russian Federation
The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support.
Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care.
P u r p o s e o f t h e s t u d y . Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices.
M a t e r i a l s a n d m e t h o d s : content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular.
R e s u l t s . The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016–2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from 3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which determines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated.
F i n d i n g s . The introduction of promising general medical practice models in the urban environment implies a complete transition
of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2.
It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure. -
2023 № 3 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. -
2022 № 3 Assessment of preventable health losses in the rural population
Relevance. The protection of the health of the rural population is especially significant due to the fact that medical and social health problems are maximally concentrated in rural areas. The priorities in the organization of medical care for rural residents are currently the effective use of available health care resources, as well as increasing the availability and quality of medical care. The tasks of the federal and municipal authorities should be to provide software support, resources, as well as the practical solution of strategic problems in rural areas.
The purpose of the study: development and testing of an automated system of information support for managerial decision-making using estimates of preventable losses in the health of the population of rural areas.
The base of the study was the Orenburg region. The share of the rural population in the region is 40.1%, there are 35 rural territories (districts) in the region.
Methodology. The following research methods were used: statistical, analytical, expert assessments.
The preventable loss of health of the population of rural areas in the Orenburg region was assessed by experts according to the methodology developed by us. Four indicators of the likely preventability of health losses in the rural population were identified: health indicators; territorial availability of medical care; personnel; social well-being of the population.
The results of the study were used as the basis for the methodological support of an automated information system for supporting managerial decision-making in the organization of primary health care in rural areas of the Orenburg region.
The use of a software product of information support for managerial decision-making makes it possible to determine priorities for making strategic decisions at the level of heads of medical organizations, health authorities and institutions, as well as heads of administration in a constituent entity of the Russian Federation. The information is presented on the web page of the administrative territory and the administrative apparatus.