All articles by Nemkov A. G.
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2023 № 4 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. -
2023 № 4 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. -
2017 № 3 The analysis of prevalence of mental disturbances and socially dangerous actions mentally sick with intellectual backwardness and obtained organic damage of a brain (according to data from Tyumen region)
Socially dangerous actions mentally sick are an important performance indicator of work of mental health service, and the analysis of number of criminal delicts at mentally sick in the conditions of the proceeding epidemic of mental diseases is an urgent task. In work prevalence of organic damages of a brain and socially dangerous actions of patients with organic damage of a brain in the Tyumen region are analysed. As a source of information annual statements in a form No. 10, and also annual databases of the conclusions of the out-patient forensic-psychiatric commission of the Tyumen region are used. For handling of the SPEK databases the automated information system «SPEK-analytics» is used. In Russia decrease in prevalence of mental diseases is noted. The same tendency is noted also in the Tyumen region. The powerful share among all diseases is constituted by organic damages of a brain, including intellectual backwardness. At the same time this contingent of patients makes considerable amount of socially dangerous actions – annually more than 60% of their total number. It is noted that against the background of decrease in prevalence of mental diseases in the Tyumen region more, than for 35% for all researched period, the number of socially dangerous actions by 2,7 times increased, the share of the persons committing crimes more, than twice grew. By results of the obtained data measures for decrease in number of socially dangerous actions are proposed. In particular, it is about need of application of measures of primary prevention taking into account the revealed risk groups on the basis of the factors influencing making socially dangerous actions mentally sick.