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Manager Zdravoochranenia 2021 #4
Published: 2021-05-19
917
CONTENT OF THE ISSUE
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ABOUT ENSURING STABILITY OF FUNCTIONING OF HEALTH CARE IN EMERGENCY SITUATIONS
The pandemic of COVID‑19 put before society new unique, economic and ethical dilemmas as it imposed increased requirements to health care systems, both on national, and at the global level. One of these problems – ensuring stability of functioning of a health care system in emergency situations.
Research objective – the analysis of the current trends defining ability of health care to satisfy sharply increasing needs of people for medical care at emergence of emergency situation.
Materials and methods. Methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, statistical materials of the Russian Ministry of Health and Federal State Budgetary Institution TSNIIOIZ of the Russian Ministry of Health [1], a form of the state statistical observation No. 62, summary across Russia, “Data on resource providing and on delivery of health care to the population”, methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, expert estimates, analytical materials and statistical data of World Health Organization, statistical data and metadata over the countries of the Organization for Economic Cooperation and Development (OECD) and the certain countries which are not members and also the materials of monographic researches and periodicals including placed on the Internet are used.
Results. At the level of the state, resistance of a national health care system to emergency situations is defined by a condition of infrastructure of the industry, the mechanism and the amount of financing and also scales of attraction of the private medical sector to work for the benefit of society. For 2011–2019 the number of the hospitals of the state form of ownership participating in implementation of the Program was reduced from 4542 in 2011 to 2896 in 2019, or for 37%, and the number of the group hospitals participating in implementation of the Program increased almost by 1.5 times – from 163 organizations in 2011 to 235 in 2019. The number of the medical organizations of emergency medical service of the state form of ownership was reduced from 235 in 2011 to 169 in 2019, and the number of the private medical organizations of emergency medical service participating in implementation of the Program increased from only one organization in 2012 to 28 organizations in 2019. The number of the out-patient and polyclinic institutions of the state form of ownership participating in implementation of the Program was reduced since 2581 in 2011 to 1419 in 2019, or twice, and the number of private out-patient and polyclinic medical institutions increased from 485 organizations in 2012 to 2160 organizations in 2019, or by 4,5 times. At the level of the population stability of health care is affected by social and economic structure of society, ability and readiness of people to pay and be assessed with a tax for payment of medical care. At the same time, the solvency of the population of Russia remains low, and the insufficient amount of financing of health care leads to the accruing substitution guaranteed to medical
care by paid medical services.
Conclusions. In modern Russia there was a trend of increase in number of the private medical organizations which are carrying out activity in the sphere of compulsory health insurance in a combination to decrease in number of the public medical institutions that demonstrates gradual strengthening of a role of private business in questions of providing the population with medical care. It is necessary to guarantee that financing of the private sector at the expense of treasury will be carried out not to the detriment of the state medical organizations and will not undermine the processes which began in the country on system strengthening of health care, first of all – its primary link. For this purpose it is necessary to increase significantly a share of the public expenditures by health care in gross domestic product of Russia. -
QUALIMETRIC ASSESSMENT OF THE EFFECTIVENESS OF IMPLEMENTING THE RESULTS OF PROJECT ACTIVITIES IN THE WORK OF MEDICAL ORGANIZATIONS AND HEALTH MANAGEMENT BODIES
In addition to the economic assessment of the effectiveness of the implementation of the results of project activities in the practice of medical organizations and health management bodies, for a qualitative assessment of the implementation results, a qualimetric analysis of the implementation effectiveness can be carried out. A complex qualimetric indicator in a dimensionless form from 0 to 1,0 or as a percentage from 0 to 100% can be reflected by color symbols and at the same time has a certain logical meaning. It shows the degree of deviation of the value of the estimated indicator before and after the implementation of the project results from the original (normative or standard).
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PROFESSIONAL BURNOUT OF NURSES: FEATURES OF GENERATIONS
Professional burnout among nurses is an urgent public health problem, which negatively affects the quality of medical care. A specialist’s belonging to a certain generation determines its own characteristics of the response to stress factors and the development of professional burnout.
Purpose of the study is to determine the main patterns of occurrence of professional burnout among nurses depending on the generation for development and implementation of targeted prevention methods.
Materials and methods. A one-stage comparative study was planned and conducted using a specially designed questionnaire, including a burnout questionnaire MBI (Maslach Burnout Inventory) and questions assessing professional performance and socioeconomic status to determine the factors of professional burnout. All nurses were stratified into three generational groups.
Results. The study involved 2486 nurses. It was found that respondents of all generations were prone to professional burnout, with a high and extremely high degree. At the same time, the third generation was most susceptible to the development of professional burnout, the first was the least. The main predictors of the development of professional burnout in the third generation were: lack of sleep and rest, low salary and large loan payments, excessive work load; in the first – the presence of chronic diseases. The second generation had a smaller percentage of respondents with an extremely high degree of professional burnout, because they were characterized by lower labor intensity, lack of sleep deficit and the highest salary.
Findings. Thus, prevention measures can be individual for each generation, with considering the differences in predictive and protective factors. While, it is necessary to focus on the youngest, third generation, reinforcing factors preventing the development of professional burnout. -
COST-EFFECTIVENESS ANALYSIS OF MODERN MEDICAL TECHNOLOGIES MALDI-TOF MS FOR RAPID DIAGNOSTICS OF BACTERIAL INFECTIONS
The principle of rational antibiotic therapy can only be realized in the case of accurate and rapid identification of the pathogen. The spread of antibiotic resistance limits the choice of antimicrobial drugs and worsens the clinical prognosis for patients, so new strategies are needed to improve patient outcomes. The article presents a clinical and economic analysis of innovative technologies MALDI-TOF MS for the rapid diagnosis of microorganisms. Mass spectrometric identification of bacterial pathogens helps to reduce the time required for the issuance of the results of bacteriological analysis and an economically viable technology for use in routine practice of microbiological laboratories in Russia.
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REMOTE EFFECT OF IMMUNOPROPHYLATICS OF INFECTIOUS DISEASES ON THE APPEALS OF CHILDREN TO THE POLYCLINIC
The structure of complaints about diseases of 28,432 children aged 0 to 14 years was studied, for the period from 2006 to 2019 to a medical organization against the background of vaccination. The data of the medical information system were used. To compare the distributions of values in vaccinated and unvaccinated children, the “copy-pairs” method and the nonparametric Mann-Whitney test were used. It was found that the analysis of data over a long period of time, allows you to identify special effects. Thus, the vaccinations given to children do not lead to a decrease in the number of visits for diseases, but lead to changes in the structure of visits by children in ICD‑10 classes. In unvaccinated children, the proportion of requests for diseases of the genitourinary system, infectious and parasitic diseases is significantly higher than in vaccinated children. Starting from the age of 4 years, the proportion of vaccinated children with diseases of the digestive system is higher than that of unvaccinated children.
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DYNAMICS OF THE INCIDENCE OF DIABETES MELLITUS AMONG CHILDREN IN THE RUSSIAN FEDERATION FOR 2014–2018 YEARS
Diabetes mellitus among children is one of the urgent health problems due to high morbidity and disability.
Objective – establishing the main trends in the incidence of children.
Materials and methods. A statistical analysis of the data of reporting forms of federal statistical observation No. 12 “Information on the number of diseases registered in patients living in the service area of a medical organization” for the period from 2014 to 2018 was carried out.
Results. During the analyzed period, the incidence of diabetes mellitus in the Russian Federation among children aged 0–17 years increased by 28,1%. In dynamics for 2014–2018 the primary incidence of diabetes among children aged 0–17 years in the Russian Federation increased by 15,5%. In 94,9% of cases of diabetes in children account for type I diabetes. In dynamics for 2014–2018 it grew by 26,2%.
Conclusion. The results of the analysis of diabetes mellitus among children indicate the need for the development of primary prevention of type I in children and raising public awareness of a healthy lifestyle in children -
STUDY OF THE INFLUENCE OF TECHNOLOGIES OF ACTIVE LONGEVITY ON THE SOCIAL ADAPTATION OF ELDERLY AGED PERSONS FOR PREVENTIVE PREVENTION OF AGE-ASSOCIATED DISEASES
In the context of demographic problems of population aging the prevention of age-related diseases is becoming increasingly important in the activities of practical health care workers, geriatricians, social workers, which indicates the relevance of researching technologies for extending a healthy period of life, increasing the adaptive capabilities of older people in the formation of a health-oriented urban space, comfortable and a complementary environment the influence of which on the state of health does not provoke the development of pathological changes, but on the contrary, ensures the improvement of the human body, maintains and restores its reserve functionality.
The present study has shown that the use of technologies for active aging is an important medico-social factor contributing to the strengthening and restoration of health. During the experiment there was a positive dynamics of the influence of active aging technologies on the preservation and prolongation of social activity of elderly people in terms of preventing the risks of chronic non-communicable diseases on the example of a group of elderly muscovites aged 55–85 years and older, participants of the Moscow longevity project at the research base of the City club space «My social center» (Moscow city). -
THE SYSTEM FOR ASSESSING THE DYNAMICS OF THE PATIENT'S CONDITION IN THE PROCESS OF REMOTE NEUROREHABILITATION THROUGH THE PORTAL “NEURODOM”
Progress in the field of information technology has made it possible to successfully apply modern computer technology for various tasks in medicine. This article presents the capabilities of the NeuroDom information system for assessing changes in the condition of a patient undergoing rehabilitation after suffering neurological diseases. The main feature of the described approach is that the patient’s rehabilitation was carried out remotely, through the NeuroDom portal.
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NEW SYSTEM OF CONTRACTS WITHIN THE FRAMEWORK OF COMPULSORY HEALTH INSURANCE
The system of compulsory health insurance is regulated by a large number of regulatory legal acts. Nevertheless, many issues related to the relationship between the participants of the MHI system, and above all – financial, are determined by the content of the contracts concluded between them. This article analyzes the new system of contracts that has developed in the system of compulsory medical insurance in connection with the adoption of Federal Law No. 430-FZ of December 8, 2020 “On Amendments to the Federal Law “On Compulsory Medical Insurance in the Russian Federation”, as well as other related regulatory legal acts. There have been changes not only in the content of the contracts, but also in the composition of their participants. In addition, there is a new, previously absent type of contract. The purpose of the work is to analyze changes in contracts in the MHI system and their possible consequences.
