Manager Zdravoochranenia 2017 #4
CONTENT OF THE ISSUE
Mortality rate in the Russian Federation in 2006-2015
Aim-сomparative analyses of age peculiarities and nosological structure in mortality causes in 2006 and in 2015 in the Russian Federation. Rosstat’s data of male and female population size and the number of dead as well in 5-years age groups for the years 2006 and 2015 were used. Standardised all-causes mortality coefficients were calculated using Kitagava’s formulae, comparison in 5yaers age groups was conducted. Nosological mortality structure based on Rosstat’s mortality causes nomenclature analyses was made. Percentage of each mortality cause was assessed; level of increase/ decrease was calculated for the completely identical groups. The mortality rate decreased by 13,6% in 9 years, the standardized rate dropped by 25,9%. The main decline was at the age of 25-29 (by 46,6%) and an the age of 1-4 (by 45,7%). The less change was an the age 90-94 (by 9,5%). More intensive dynamics in male was determined by the initial male «overmortality». The percentage of diseases of the circulatory system in all death’ cases was 48,7% in 2015 comparing to 56,9% in 2006; external causes had 7,7% and 9,9%; Neoplasms - 15,7% and 13,1%; diseases of the respiratory system - 3,97% and 3,8%; diseases of the digestive system - 5,3% and 4,1% respectively. The percentage of the mortality causes as «Senility» increased in 2,7 times. The highest percentage in the mortality causes in 2006 as well in 2015 falls on «Atherosclerotical heart disease» (12,5%). Mortality rate decline was determined, among others, by the realization of the state demographic policy and the task programs in health care. The mortality causes structure has changed because of the significant decline in the portion of diseases of the circulatory system and of external causes. Rosstat’s additional list of mortality causes which had no defined clinical criteria for the diagnosis had a certain influence, and MoH RF recommendations to use the «Senility» code as a cause of death since 2014, as well.
Operational parameters and characteristics of MRI workflow in outpatient clinics of Moscow
We present continuous data of outpatient MRI units in Moscow, 2016. Unit uniformity, identical working conditions, compensation schemes, study justification, process monitoring and result analysis as well as first-time adoption of newest information technologies in Moscow allowed for process characterization and advanced result analysis of 28 outpatient MRI units. Presented data encompasses operational parameters of 64326 MRI examinations with results being evaluated on-line. Yearly median number of examinations for one MRI unit was 2076, with first and third quartile being 1830 and 2836. Reasons of low workload were analyzed. For instance, average number of work shifts in a month varied from 24 (95% CI 18-30) to 49 (95% CI 43-52). Workload during the day also varied. In first four hours of work shift up to 40% of all examinations were performed (95%; CI 40.5-41.2). In last four hours of work shift only 20% of all examinations were performed (95% CI 19.7-20.2). Additionally, the interval between sequential studies was 38 minutes, with first quartile being 29 minutes, and third quartile being 55 minutes. The delay was observed in 50.7 cases (95% CI 50.3-51.4). Every fifth delay was longer than 60 minutes, and in 7.4% of cases - longer than 90 minutes (95% CI 7.2-7.6). In best outpatient clinics, the prevalence of these intervals was only 4.8%. Average waiting interval in outpatient clinics was 7.8 days (95% CI 7.7-7.9). In 44.9% of cases, it was shorter than 6 days (95% CI 39.6-47.5) and in 8.2% of cases examination was performed on the day of study reservation. In several clinics waiting interval did not exceed one day without any detrimental effect on overall workload. The results highlight the need to improve operational processes and overall quality of diagnostic services.
Functional features of the system of ultrasound examination of patients with urinary malignant neoplasms
The incidence of the urinary malignant neoplasms has been steadily growing in Russia. However, in the Russian Federation there is no document, approving the standard of primary health care in this pathology. In practice, the burden of primary and specialized ultrasound of the urinary malignant neoplasms rests on the shoulders of Oncology Center doctors. Purpose - analysis of the effectiveness of the ultrasound diagnostic services in Kursk and the Kursk region at the urinary malignant neoplasms examination of patients at primary inspection, the specialized treatment, dispensary observation, uptake of this population in commercial structures. The study includes 309 patients assigned to Cancer registration in Kursk Regional Clinical Oncology Center from 2012 to 2015 diagnosed with kidney cancer and bladder cancer. Statistical analysis of the data is performed using SPSS «STATISTICS20.0». Our study shows that the majority of patients with primary urinary malignant neoplasms holds ultrasound examination in primary health care facilities. Often, however, the survey volume is carried out incomplete. The main factor determining the effectiveness of the primary ultrasound is an establishment of the meeting (p < 0,01). The greatest problems encounter in the study of retroperitoneal lymph nodes and the inferior vena cava, and the detection of tumors of small dimensions (T1). The ways of elimination of shortcomings of the ultrasound system and direction of further scientific research are proposed in this article.
The load on the blood service of medical establishments depending on the volume of platelet transfusions per days of week
Rate of the frequency of transfusions, goal-setting, and the stratification of 1519 doses of donor platelets on different days of the week have been evaluated in 16 clinics in the Republic of Bashkortostan. The proportion of transfused platelets in the different days of the week has been different at 5.1 times. The needs of clinics, from Sunday to Tuesday inclusive in platelets make up 17.2% of the total consumption and at 61,3% (p < 0,01) more often than on other days of the week are met by apheresis platelets. Maximum uniformity of platelet transfusion dates identified in Children Republic Clinical Hospital, which from Wednesday to Friday inclusive, transfuses 51.2% of platelets, whereas in other hospitals – 76,8% (p < 0,01). Increased frequency of platelet therapy beginning on Friday in small clinics can cause compliance audit for transfusion rules. The results may be useful for evaluating workflow of blood service clinics, improve the efficiency of clinical work.
SWOT-analysis in the practice of forming the main directions of counteraction to the spread of HIV infection
The paper presents the results of a strategic analysis of the system of medical care for HIV-infected patients at the regional level. The data of the analysis on the basis of expert assessments made it possible to identify the key areas for counteracting the spread of HIV infection in the region. The results of the research show the priority of the program activities to improve the material and technical and personnel support of medical organizations that provide medical and social assistance to patients with HIV infection, as well as activities aimed at raising awareness and attracting the population of the region to HIV testing
Human resources as the main resource for ensuring access to health care
The calculation of the ratio of the population to one medical worker by federal districts and Russian regions is presented. This criterion provides visibility and relevance in assessing the accessibility of health care and social status of regions. The ranking method was used for typification of territories and regional ratings were determined
Implementation of the recommendations of the Committee on social policy of Council of Federation on control over activity of the insurance medical organizations
Paradoxes of law: the guarantee of free medical aid often limit the rights of patients to improve quality
The legislation of the Russian Federation, recognizing the rights of citizens on free medical aid and paid medical services, however, makes clear the roll the side free of charge. At the same time guarantee free of charge formulated in such a way that often limit the rights of citizens to receive medical care with the use of drugs, medical devices, etc., not provided for in the programme of state guarantees of free rendering to citizens of medical aid. Moreover, if the rights of citizens to receive paid medical services directly spelled out in the law, the right of citizens to self-purchase of medicines, medical devices, etc. did not say anything. There is no outright bans, which in practice leads to numerous conflict situations. The article provides specific suggestions for improving the legislation in this field.
Focus of the problem
Management in health care
Manager of health care consults