All articles by Zolotareva L. S.
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2019 № 7 Improving the system of organizing the psychiatric aid of the megapolis
Abstract. Currently, a restructuring of the psychiatric service is carried out in Moscow. The changes are implemented accordingto the concept of socially-oriented psychiatry based on a biopsychosocial approach. Reforms include the reductionof inpatient and the development of an outpatient unit of the psychiatric service. Psychiatric hospitals were merged with outpatient units on a territorial basis.
The aim of the study was a comprehensive analysis of the psychiatric service functioning in Moscow during the period of
its restructuring.
A retrospective analysis of the demographic characteristics of the Moscow population and clinical and epidemiological
indicators characterizing the incidence of mental disorders, as well as an analysis of the functioning of inpatient and
outpatient units of the Moscow psychiatric service and its staff, was made. The evaluation of the conversion efficiency
indicators was made. A sociological survey about the reforms (questionnaire) of specialists and relatives of persons with mental disorders being carried out through questionnaires was also conducted.
During the transformation of the psychiatric service, the incidence of mental disorders, hospital mortality and the number of cases of disability decreased. The provision of the population with places in day hospitals, the number of places in day hospitals and patients who received assistance in day hospitals, the staffing level of outpatient rates, and the number of visits to district psychiatrists increased. The share of persons involuntarily examined and recognized as in need of inpatient treatment increased from 70% to 100%. According to a sociological survey, most of the heads of structural units of the psychiatric service, psychiatrists, and users of the service positively assess the reforms that have been carried out.
For a large city, the cluster-modular system of psychiatric service, currently organized in Moscow, is a priority.
Results of this work have found application in the organization of psychiatric care in Moscow, Vladimir, and Tula regions
and the city of Sevastopol, and can be put into practice in other major cities of the Russian Federation. -
2023 № 12 Asessment of healthcare workers’ perceptions on the effectiveness of medical care in the profile of psychiatry in the Moscow region.
Relevance. The reorganization and modernization of the psychiatric service in Moscow (from 2010) and in Moscow region (from 2021) was carried out. The reforms were carried out in accordance with WHO regulations and consisted in reducing the medical care provided in a hospital setting and expanding the outpatient link.
Aim. Asessing the perceptions of employees on the effectiveness of providing assistance in the profile of “psychiatry” in the Moscow region after its restructuring.
Methods. An anonymous survey of employees of the psychiatric service in the Moscow region was conducted regarding the transformations carried out (N=236).
Results and discussions. The reforms have been positively assessed by the healthcare workers interviewed. According to them, the provision and equipment of clinics with modern examination methods and equipment has improved. The reorganization has led to a better quality of medical care and accessibility at the local level, the number of beds in day hospitals has increased and the conditions of patients’ stay in medical organizations improved. Existing protocols for the provision of mental health services to the public need to be regularly updated, as most respondents indicated. Also, as mentioned by interviewees, both the psychiatric care service as a whole and psychiatric care in a hospital separately needed an increase in funding. In the course of the study, respondents noted that further modernization of the psychiatric service should primarily be carried out in the following areas: unification into a single complex of a psychoneurological dispensary and a psychiatric hospital, expansion of the volume of outpatient care, development and improvement of coordination between general somatic care and help in the “psychiatry” profile, development of medical care based on general somatic hospitals.
Conclusion. The majority of respondents positively assessed the reforms carried out in the Moscow region in the field of assistance in the profile of “psychiatry”. Further modernization of the psychiatric service should include the development and improvement of coordination between general somatic care and assistance in the “psychiatry” profile, the expansion of the volume of outpatient care, the best use of resources based on the needs of the population.