2021 № 8 Ways of optimizing the organization of providing ambulatory coloproctological assistance to the population
The article substantiates the priority directions of optimization of the organization of outpatient coloproctological care to the population of the Perm Region.
The purpose of the study is to substantiate the priority directions for optimizing the organization of outpatient coloproctological care to the population.
Materials and methods. The data on the reasons for 4822 calls to outpatient polyclinic offices for specialized medical care in the profile of «Coloproctology» in the Perm Region in 2018, as well as about 2222 calls to the Center of Coloproctology with a day-long hospital stay were analyzed.
Results. It is shown that the frequency of detection of DND in the center of coloproctology was 22.50%, with the frequency at polyclinic appointments‑11,83%, p<0,001. At polyclinic appointments, the frequency of detection of ZNO was 5,96%, in the center of coloproctology – 12,15%. The results obtained can be explained by the number and quality of diagnostic measures performed at the Coloproctology Center, which allows for almost complete coverage of all patients of the center with rigid rectoscopy – 98,38%, with 33,80% (at outpatient appointments (p<0,001). Sigmoscopy, which is not available in the coloproctologist’s offices at the Coloproctology Center, was performed in 7,02% of patients, FCS was performed in 34,29% of cases, compared to 9.49% in the polyclinic (p<0,001).
The presence of an emergency appointment in the Center of Coloproctology explains the higher frequency of detection of acute hemorrhoids – 7,06%, versus 3,2% in polyclinics; acute paraproctitis – 2,29% and 0,62%, respectively; ECC – 1,53% and 0,5%, respectively; anal itching – 1,44% and 0,64%, respectively; proctitis – 0,99% and 0,16%, respectively; rectocele – 0,99% and 0,18%, respectively; injuries of the colon and rectum – 0,72% and 0,16%, respectively; anal insufficiency – 0,72% and 0,37%, respectively; p<0,005.
Conclusions. The traditional model of providing outpatient coloproctological care (offices in polyclinics) is not effective even in diagnostics, since it does not have its own endoscopic and anesthesiological service, which significantly affects the volume and quality of the necessary studies. It is proposed to reorganize the service in order to organize a primary link on the basis of an outpatient coloproctology center with a day-long hospital, separate or at the coloproctology department of the State Clinical Hospital.
2022 № 2 Rationale for optimizing the organization of providing coloproctological assistance to the population by assessing the quality of different approaches of its providing
In this article, in order to justify the optimization of the organization of providing coloproctological care to the population, the results of assessing the quality of various approaches to its provision are presented.
Materials and methods. A comparative analysis of the coefficients of medical efficiency for the traditional coloproctological profile service system and the proposed system is carried out. The quality of coloproctological care was assessed using efficiency coefficients and an integrated quality indicator.
Results. As a result, a higher level of medical, social and economic efficiency is shown in the conditions of the developed
system. The data are reliable, differences are noted both for individual coloproctological pathologies and in general. An integral quantitative assessment of the quality of coloproctological care also showed a higher efficiency of the developed system (p<0.05), which reflects its medical, social and economic effectiveness.
Conclusions. The creation of regional coloproctology centers combining inpatient treatment and outpatient care; provided with highly qualified personnel with sufficient experience in this specialty; equipped with modern equipment, including video endoscopic equipment for performing diagnostic procedures; introducing new high-tech operations, will further improve the timely diagnosis of coloproctological diseases and provide highly qualified specialized care to patients.