2018 № 9 Comparative analysis and assessment of polyclinic work at the second level of urological care to the population in the region within the framework of the developed three-level system
The system of urological care in the region is an integral component of effective health care. The regional system of urological care, implemented in the form of the so-called “traditional approach” is not optimal. The article provides an analysis of the three-level system of restructuring of urological care in the Voronezh region in terms of the polyclinic activity of medical organizations of the second level of urological care on the example of urolithiasis, benign prostatic hyperplasia and prostate cancer. The study included two time stages: the traditional system of urological care before the introduction of the restructuring system and after the introduction of a three-level system of care for patients with urological pathology. The results demonstrate a strong statistically significant objective increase in outpatient activity and the level of medical examination for the vast majority of patients in all three diseases considered in this study reflect the ultimate performance of the regional urological service (on the example of Voronezh region), in terms of its functioning in the format developed a three-tiered system of medical care in comparison with the traditional approach.
2018 № 2 Analysis of CT utilization for primary care clinics of the large city
We studied the use of CT scans in forty-five polyclinics in a large city. The maximum load per unit was 657 exams per month. The average load was 220 exams per month (CI 95% 208–231). No direct correlation was found between the exam volume and the size of the population served by the polyclinic (r = 0.47). The average CT utiliza- tion was 14.4 exams per 1000 adults inhabitants (CI 95% 12.4–16.5). The age-specific patterns of CT usage were revealed. For population within the age group of 18 to 45 years the frequency of CT usage gradually increased from 4.24 to 5.94 per 1000 people. Most often CT was used within the age group of 70-year-olds. Within this group, the number of tests reached 30.6 per 1000 adults inhabitants. In the older age groups, the number of exams was lower. In polyclinics without an MRI scanner, the structure of CT exams differed. The share of brain exams among all CT exams was 18% (compared to 10.8% in MRI equiped polyclinics), the share of spine exams was 17.7% (compared to 9.5% in MRI equiped polyclinics). Evidence is obtained of a multiple increase in the frequency of use of contrast media for CT in response to a complex of educational, control and economic interventions