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Manager Zdravoochranenia 2020 #9
Published: 2020-08-03
1385
CONTENT OF THE ISSUE
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On the implementation of certain “medical” amendments to the constitution of the Russian Federation
The article suggests legislative implementation of certain “medical” amendments to the Constitution of the
Russian Federation. The authors propose to add two articles to the Federal law “on the basics of public health protection in the Russian Federation” dated 21.11.2011 N323-FZ. In one article, it is proposed to reveal and specify the
content of the newly introduced in the Constitution of the Russian Federation concept “unified legal bases of the health
care system”. Another proposed article reveals the forms and content of work on the coordination of health issues,
again referred by the Constitution of the Russian Federation to the joint responsibility of the Russian Federation and the
subjects of the Russian Federation. According to the authors, the proposed changes in legislation will allow to ensure
in practice the proper implementation of “medical” amendments to the Constitution of the Russian Federation, which in
turn will ensure the improvement of legal regulation of the organization and activities of health care, and strengthen its
material and technical base. -
Improving the technology of work of heads of therapeutic departments of Central district hospitals
The article presents the results of studying the organization of work of heads of departments of central district hospitals (CRH) and the quality of therapeutic care for the rural population. The study was conducted in 2017–2019. on the basis of
26 Central District Hospital of the Republic of Dagestan. The quality of therapeutic care was studied through an expert assessment
of 1,085 inpatient and 748 outpatient patient records. The timing of the working time spent by the heads of the departments of
the Central District Hospital for 845 hours. It was found that under the current conditions the heads of departments devote up to
50.7% of their working time to the fulfillment of the main duties. Waste of time is 15.1%.
In the therapeutic departments of the Central District Hospital, an untimely and complete examination of a significant part of the
patients took place; treatment is not always complete and complete, there is no continuity in the examination and treatment of
the patient between the clinic and the hospital.
On the basis of the research materials, a set of recommendations was developed to improve the technology of work of heads of
departments of the Central District Hospital and improve the quality of medical care. Experimental verification of the recommendations confirmed their effectiveness: the time spent on the main work increased from 51.2% to 72.4%, the share of time spent on organizing and managing the treatment and diagnostic process increased by 15.5%. Improving the organization of work of heads of departments during the experiment had a positive effect on the quality of medical care: the proportion of patients examined at the prehospital stage increased by 25.4%; the number of those fully surveyed increased from 58.4% to 90.3%; the number of patients who received full treatment increased by 14.7%. -
A technique of the analysis of subjective and objective characteristics of medical services for design of quality of medical services
In a control system of quality of medical services the important part is assigned to estimates of results of activity of the medical organization, in particular degree of satisfaction of patients with quality of the received services. Now
the question of quality of medical services is extremely relevant, a need for development of instruments of improvement
of quality of services is had.
Methods: The technique of measurement of satisfaction with quality of SERVQUAL provided to medical care based on
provisions of GOST “Quality Management …” and a technique of expansion of functions of quality of QFD which elements
are defined in GOST “Quantitative methods of improvement of processes “Six sigma are used”.
Results: Approach on the basis of integration of techniques of measurement of satisfaction of consumers of medical services of SERVQUAL and expansion of function of quality of QFD which realization allows to build the House of quality is
stated and to create data for carrying out design of quality of medical services.
Conclusion: The conducted research allowed to create tools for elaboration of the adjusting and warning operating influences directed to demanded change of quality of medical services and, as a result, the recipients of services increasing
satisfaction. -
From patient-centered medicine to 4p-medicine: the semantic aspect of the trend
The step-by-step guidelines for the formation, development and implementation of the direction defined as “patient-oriented medicine” in the scientific and practical segments of healthcare are presented. It reflects not only the historical aspect of
this semantic plot, but also gives a characteristic of the diverse models of interaction between subjects – a doctor and a patient.
The analysis of definitions of “patient-oriented medicine” in the framework of foreign and domestic scientific schools, as well as
the analysis of the relationship of the pattern with the new concept of health care development – 4P-medicine is given. The structure of the 4R-medicine concept is characterized, the ideological implications of the prospects for its development are given. The legislative and organizational initiatives for the development of patient-oriented medicine are outlined. -
Organization, current state and immediate prospects of the problem «bloodless surgery»
The research focus of the publication is the problem of preserving the blood of the operated patient. The variety
of blood preservation methods shows the multidisciplinary nature of the problem and the importance of well-coordinated
teamwork of busy doctors. For more than 20 years, surgical, anesthetic, transfusion technologies of blood saving have
been used mainly in cardiac surgery patients. The use of a complex of blood-saving technologies allows you to reduce
the amount of blood loss and the consumption of donor blood components. Over 7 years in cardiac surgery, the number
of recipients of donor hemocomponents decreased by 41% (erythrovesue) and 61% (FFP). Autologous plasma is 68-78%
of the total volume transfused to cardiac patients. 50% of patients operated on the ascending aorta do not need a blood
transfusion. Blood loss during extensive liver resections has decreased three times in 10 years and does not require allogeneic blood transfusions. An adequate multidisciplinary approach to solving the problem of blood conservation can improve
the results of surgical treatment of patients. -
Organization of the orthopedic and neurological service in the practice of a gerontologist
Integrating neurological services into primary health care should be an important policy goal in both developing
and developed countries. Providing neurological care through primary health care requires significant investment in training
primary health care professionals to identify and treat neurological disorders. Such training should meet the specific practical needs of different groups of primary health care professionals, such as doctors, nurses, and community health workers.
Preferably, continuous training is necessary to provide follow-up support to strengthen new skills. In many countries, this is
not possible, and therefore suboptimal assistance is provided.
Purpose: to analyze the organization of orthopedic and neurological services in the practice of a gerontologist.
Methods: General clinical, neurological examination using diagnostic criteria of the DISEASE, PKP syndrome, 3-stage
scale of global Deterioration (Global Determination Scale – GDS) and Clinical Dementia Rating scale (clinical Dementia
Rating – CDR); neuroimaging methods – MRI/CT of the brain; quantitative EEG; experimental psychological examination:
MMSE test, coding subtest, special experimental psychological study using Schulte tables, tests for memorizing 10 words
and 8 numbers, Wechsler Memory Scale – Revised – WMS-R, spielberger-Hanin anxiety scale, geriatric Depression Scale;
discriminant analysis was used to predict the development of dementia.
Results: As a result of repeated studies, it was found that after three years in the group of patients with ART. II with PKP syndrome in 35.3%, dementia syndrome was diagnosed. Depending on the subtype of the PKP syndrome, dementia syndrome
was detected in 55% of patients with the amnesic subtype, in 34.8% – with multi – domain, in 15.8% – with non-amnesic.
The most vulnerable to the development of dementia were patients with the amnesic subtype of PKP syndrome.
Conclusion: Using discriminant analysis of testing data of patients WITH stage II diabetes with advanced age PKP syndrome, informative and independent predictors of dementia development were established, which were included in the
prognostic formula, namely, indicators of maximum reproduction of 10 words, coding subtest, complex verbal paired associations (short-term memory), visual reproduction (short-term memory), light verbal paired associations (long-term memory).
There was a significant increase in pronounced correlations between various cognitive indicators in the group of patients
with art. II WITH PKP syndrome in comparison with the groups of patients with ART. II without PKP syndrome, practically
healthy elderly and young people, which indicates the formation of a stable pathological state in the cognitive sphere in
patients with PKP syndrome.
As we can see, the activity of a gerontologist is often closely related to neurology, so we consider it necessary to point
out in conclusion the high efficiency of the neurology service based on a gerontologist. -
Donor platelets collection in a pandemic of COVID‑19 infection
The work of the Samara Regional Clinical Blood Transfusion Station, the collection and delivery of platelet concentrates in
2018, 2019 and in the first 6 months of 2020 was assessed. The annual demand for platelet concentrates in 2019 increased by 22.9%, and in the first half of 2020 the issue of platelet concentrate decreased by 12.1%, which is associated with a change in treatment work during the period of infection COVID‑19. The proportion of platelets isolated from whole blood in the first half of 2020 decreased from 24.7% (the end of 2019) to 17.4%, (p <0.001). This maneuver made it possible to accept all donors wishing to donate apheresis platelets. -
Distributed ledger technology in patient experience management
Actuality. The role of “patient experience” in assessing quality of medical services is growing as a global trend to value-based healthcare. Currently, only 11% of the Russian population positively assess the quality of medical services. Federal law
No. 256-FZ requires all public healthcare providers to conduct an independent assessment of the provision of services, but 44% of
organizations do not have such assessment, that can be caused by methodological and organizational reasons.
Purpose of the study to evaluate the prospects for digital improvement of measuring patient satisfaction using distributed ledger
technology. To analyze the literature on the topic of independent assessment of the quality of services provided by medical organizations; to analyze modern approaches to assessing patient satisfaction with healthcare providers; to assess the opportunities of improving the processes and results of satisfaction assessment using distributed ledger technology.
Materials and methods. To achieve the purpose, the authors analyzed numerous relevant Russian and foreign sources of literature. Literature review was carried out across scientific libraries as eLIBRARY, PubMed by key words. The search in open sources in
Google and Yandex was used.
Results. The complexity of “patient experience” measurement, biased assessment, ambiguity of the results obtained and the difficulty of correct interpretation require more transparent methods of measuring the value of healthcare. A decentralized platform based on distributed ledge technology may become one of the possible solutions to the problem of objective assessment of patients ‘ satisfaction with the quality of medical services. Such approach allows to form an objective dynamic multi-factor rating of processes and all other components of healthcare services.
Conclusion. The existing mechanisms for independent assessment of the quality of medical services need to be improved. Confidence in the results of the patient satisfaction measurement is one of core requirement. To make managerial decision evidence-based, it is important to evaluate the processes and patient experience along with results of healthcare services. Distributed ledger technology implemented as a dynamic multi-factor rating platform can be a logical solution for improving the quality of services and could become a part of a comprehensive IT ecosystem based on value-based approach. -
Regional medical information systems in the field of healthcare: directions of development and legal problems
The article analyzes the development trends of regional medical information systems in the field of health care.
The authors pay special attention to the peculiarities of the development of regional medical systems, identify individual
and general problems of these systems, and finally draw conclusions about the ongoing development of the legal framework of the Russian Federation in the field of e-health, and as a solution to the identified problems, they propose to form
unified rules at the federal level containing general principles and provisions on regional medical information systems,
including the electronic health records. -
Value orientations of the doctor as predictor of efficiency of activity of the medical organization
The article presents the results of an empirical study of the value orientations of dental clinic employees. It is
suggested that gaps in human values are factors that influence professional activities in terms of communication (in the
production team) and ultimately the profitability of the individual in the teams. The initial data is obtained from the reports
of the clinic’s medical information system and the Schwartz’s Value Survey (SVS) and Portrait Values Questionnaire (PVQ).
In addition, we used a retrospective analysis and a questionnaire survey. Doctors were divided into two groups based on
the impact of value gaps on the share of revenue plan fulfillment (type one and type two groups). Attention is drawn to the
direction of relationships in the group of the first type, all correlations of average strength are direct, in the group of type
2 – reverse. In the structure of the profile of value orientations, there are differences between the groups on the second
place in importance for the respondents in the group of the first type are the value orientation (VO) “Achievement” and
secondly, “Self-Direction”, third place in the group of the first type is “Benevolence”, whereas in the group of the second
type of “Benevolence” in 4th place. To increase economic efficiency, managers of medical institutions need to organize
activities to create cultural artifacts about the normative ideals of those values that affect the workflow, take into account
the data of the employee’s value profile for optimal selection of the team composition (work shift). -
Forecasting of labor resources in the system of primary health care in Kazakhstan
Primary health care is a highly effective and efficient way to tackle the root causes and risks of poor health
status, and to address emerging problems that threaten future health and well-being.
Goal: Develop a model for predicting the need for general practitioners (GPs) until 2030, taking into account various
input data in the equations describing the movement of labor resources in the form of “flows” and “ stocks “ using the
method of system dynamics.
Methods: The model was built using the Any Logic program, based on information about the availability of primary
health care doctors, demographic data and the general prevalence of diseases in the population. Three scenarios were
considered to predict the need for general practitioners. The base year was 2018, the forecast was carried out until 2030.
Results: All of three scenarios indicate that with the current number of graduated GPs, the shortage of primary care
physicians will be exacerbated. In general, the shortage can reach more than two thousand.
Conclusion: Government and medical universities need to take measures to correct the number of students in the specialty of “General Practitioner” in order to avoid a growing shortage of primary care physicians in the future until 2030. -
COVID-19 with fatal outcome: methodology, formulations and reasonings of quality defects
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State measures to support the budget and budget institutions at the current stage of the spread of coronavirus infection
Despite the fact that the main source of financial support for health care is currently the means of compulsory
medical insurance, the importance of the Federal budget and the budget system as a whole for the functioning of the
industry cannot be overestimated. In the context of the spread of coronavirus infection, budget legislation is undergoing major changes, with many changes being temporary and aimed at ensuring the budget process in specific conditions related to the fight against COVID‑19. -
Issues of using resources purchased from other sources to provide paid medical services
