Manager Zdravoochranenia 2021 #8
CONTENT OF THE ISSUE
Study of quality of life related to health in patients with COVID19 on the first day of admission to hospital
The COVID‑19 pandemic has resulted in exceptional social disruption and consequent changes in quality of life. Assessment of the health-related quality of life in patients infected with the SARS-CoV‑2 (2019-nCoV) virus in a covid hospital is an urgent public health issue that affects the organization of medical care processes and the planning of rehabilitation programs.
Purpose of the study is to determine the level of health-related quality of life in patients with COVID‑19 on the first day of inpatient treatment for comparison with pre-pandemic norms and planning targeted rehabilitation programs.
Materials and methods. A study of the quality of life was carried out using the EuroQol EQ‑5D‑5L questionnaire assessing the Index EQ and EQ VAS indicators. Using the method of simple random sampling, the data of patients were collected for three sets having following features: “Both sexes”, “Men”, “Women”. The analysis was carried out using descriptive statistics methods.
Results. The indicators of health-related quality of life in patients with COVID‑19 on the first day after admission are lower than the pre-pandemic population norms for Moscow residents according to Index EQ by 20%, according to EQ VAS by 29%, on average. Women have more health limitations than men in all EQ‑5D‑5L domains, which is proportionally lower than population norms. In 3,7% of patients on admission to the hospital, the type of quality of life corresponded to “a condition worse than death”, which was practically not observed in the pre-pandemic period in Moscow residents. The greatest losses are observed in the “Self-Care” and “Mobility” domains, both for men and women. On admission to the hospital, no differences were found in the pre-pandemic and pandemic levels of health limitations in the “Anxiety/Depression” domain.
Conclusions. The results of the study can be used by specialists from various branches to plan clinical, service, educational, economic, and other public health programs related to the rehabilitation of patients who have had COVID‑19. And it also represents an indispensable additional material for further sociological and clinical research.
Theoretical approaches to the effective interaction of the state and private medical institutions in the format of public-private partnerships
Expanding the sphere of interaction between the state and the medical business is one of the priorities for the development of the medical services market in the Russian Federation. The healthcare reform, based on the principles of evidence-based medicine, digital healthcare, and high medical technologies, is primarily aimed at improving the quality of medical services and the availability of highly qualified medical care for all segments of the population. Accessibility, quality and timeliness of medical care are the main postulates of the daily activities of a private medical institution. during the period of increasing crisis phenomena in the economy and social sphere, private medicine can provide significant assistance to the state health service, become the “lifesaver” for the domestic health protection system, which today is mostly represented by the public sector. One of the most effective mechanisms of interaction between the state and private business, adopted all over the world, is the system of public-private partnership.
The purpose of the study is to analyze possible forms and mechanisms of interaction between the medical business and the state within the framework of public-private partnership.
M a t e r i a l s a n d m e t h o d s . The assessment of the current regulatory framework was carried out, a significant volume of domestic and foreign literary publications was analyzed, the main theoretical hypothesis was formulated on the basis of the systematic scientific method and a research plan was built.
R e s u l t s . In the course of the conducted research, objective main cause-and-effect factors affecting the development of an adequate system of public-private partnership in the field of medicine and healthcare have been identified and analyzed, in terms of the distribution of benefits, costs and risks carried out on the principles of long-term, voluntary, manageability, legal validity between a private medical organization and federal and/or municipal executive authorities. The main causal factors include insufficient funding, an unfavorable demographic situation, low efficiency of using the resource base, a reduction in the bed fund under the guise of “optimization”, a decrease in the social level of the population and the redistribution of the medical and diagnostic structure due to the COVID‑19 infection pandemic.
It should be recognized that the state system of medical care is not always able to fully meet the needs of societies for high-quality qualified medical care. The analysis of foreign literature has shown that medical services abroad successfully use the principle of public-private partnership, redistributing efforts to form the necessary institutional environment in healthcare between private business and the state. Such a form of interaction as concession, leasing, franchise, outsourcing, aufstaffing allows us to optimally balance the interests of the medical business and public health, significantly optimize the budget costs for health protection, especially in a difficult epidemiological period.
The result of the research was the development of a conceptual and theoretical model of various forms of interaction between private medical business and government agencies within the framework of public-private partnership programs.
C o n c l u s i o n s . Thus, public-private partnership is an effective economic tool that ensures the coincidence of the interests of private medical business and the state, allowing to make a profit for both subjects of medical activity, with a reduction in state budget expenditures for healthcare purposes, but with the preservation of high quality medical services and resource provision.
A self-assessment methodology for improving the activity of a health resort based on the global model EFQM 2020
Improving the quality of health resort services through effective management is one of the key tools to increase their competitiveness, which increases the demand, ensures year-round occupancy and increases their financial results. An independent assessment of the management system in a health resort and the publication of the results build the trust of guests as well as authorities and investors, which contributes to attracting investment in the resort and its sustainable development.
Purpose of the study. This study develops a methodology for managing changes in accordance with standardized international criteria to improve the results and ensure the development of a health resort.
Materials and methods. An express self-assessment of the health resort's management system was carried out by means of a questionnaire, which reveals the development level according to the most effective approaches within each criterion of the global model EFQM 2020. These criteria emphasize consumer priorities, sustainable values, the satisfaction of stakeholder needs, and the environment. The approaches characterizing the health resort’s activity, help to estimate the level of its maturity in accordance with the principles of sustainable development. The results were used to plan improvements in the health resort's operations.
In comparison with the results of past self-assessments, these results record the current state of the management system and demonstrate the levels of development and tendencies in work practices, showing possibilities for the development of the resort. To assess the activities of the health resort organization for each element of the model, four options for assessing the levels of maturity were selected.
Conclusions. Express self-assessment gives a rapid assessment of the activities of health resorts based on the questionnaire and information supplied verbally. The results can be obtained within one day and can represent graphically the evaluation profile of the health resort. The method can be used in any health resort, regardless of its organization, ownership, or medical specialization. Indirectly, the methodology develops patient- and risk-oriented thinking among management, which forms a culture of quality and innovation in the health resort itself and in the professional community of organizations in order to contribute to the growth and prosperity of the spa industry in Russia as a whole. Improving the methodology of express self-assessment includes clarifying and adding statements to the questionnaire in relation to the best management practices of health resorts, new goals, objectives, and
business technologies, as well as challenges at the regional and global levels.
Assessment of the efficiency of leasing when operating a mobile medical clinic in russia (on the example of the Rostov region)
In recent years, especially during the COVID‑19 pandemic, the need for mobile medical clinics has increased. For the effective implementation of the project of mobile medical clinics in Russia (by the example of the Rostov region), it is necessary to purchase expensive medical equipment using leasing technologies.
P u r p o s e of the study was to assess the effectiveness of leasing when operating a mobile medical clinic in the Rostov region.
M a t e r i a l s a n d m e t h o d s . The article investigated the cost-effectiveness of operating leasing compared to the standard purchase of medical equipment. The amount of lease payments was calculated and compared with payments for the purchase of medical equipment. Payments were calculated for a standard set of medical equipment for a medical clinic, including 5 cars on KAMAZ chassis No. 1 with offices of a therapist, surgeon, otolaryngologist, endocrinologist and neurologist, dentist, gynecologist, urologist and ophthalmologist, laboratory and fluorographic, mammographic and CT complexes.
R e s u l t s . According to the results of the study, it was found that in the modern conditions of the spread of coronavirus infection, the need for mobile medical clinics has increased significantly. Effectiveness of medical equipment leasing technology: supplier (equipment manufacturer) – lessee (mobile medical clinic) with the assistance of a leasing company (lessor), lease payments for operating leasing have been estimated.
F i n d i n g s . The effectiveness of leasing in the Rostov region with full depreciation of medical equipment by 30–80% within 10 years of operation has been established.
Study of temporary losses of patients when receiving medical services in ambulatory-polyclinic conditions
The study of the patient’s temporary losses when receiving medical services in an outpatient clinic and their minimization contribute to an increase in patient satisfaction with the quality of medical care.
Objective of the stud y: to assess the temporary losses of patients when visiting outpatient clinics of the city municipality.
Methods and materials. The temporary losses of patients were studied by analyzing route maps compiled using a special technique. The analysis of the questionnaires made it possible to assess the patient’s satisfaction with the conditions of providing medical services, the information received in the healthcare institution and the attitude of the nursing staff to the visitor. Statistical processing of the results was carried out using the programs Statistica 5.0 and Microsoft Office Excel.
Results. As a result of the conducted research, significant time costs of patients were identified when receiving medical care in polyclinics of the district center: when visiting a district doctor, a registry, a treatment room and a laboratory, which directly affected the results of assessing their satisfaction with the temporary criteria for visiting a medical organization.
Scope of the results. The data obtained during the study can be used as basic information when developing measures to optimize key processes in outpatient health care institutions.
Ways of optimizing the organization of providing ambulatory coloproctological assistance to the population
The article substantiates the priority directions of optimization of the organization of outpatient coloproctological care to the population of the Perm Region.
The purpose of the study is to substantiate the priority directions for optimizing the organization of outpatient coloproctological care to the population.
Materials and methods. The data on the reasons for 4822 calls to outpatient polyclinic offices for specialized medical care in the profile of «Coloproctology» in the Perm Region in 2018, as well as about 2222 calls to the Center of Coloproctology with a day-long hospital stay were analyzed.
Results. It is shown that the frequency of detection of DND in the center of coloproctology was 22.50%, with the frequency at polyclinic appointments‑11,83%, p<0,001. At polyclinic appointments, the frequency of detection of ZNO was 5,96%, in the center of coloproctology – 12,15%. The results obtained can be explained by the number and quality of diagnostic measures performed at the Coloproctology Center, which allows for almost complete coverage of all patients of the center with rigid rectoscopy – 98,38%, with 33,80% (at outpatient appointments (p<0,001). Sigmoscopy, which is not available in the coloproctologist’s offices at the Coloproctology Center, was performed in 7,02% of patients, FCS was performed in 34,29% of cases, compared to 9.49% in the polyclinic (p<0,001).
The presence of an emergency appointment in the Center of Coloproctology explains the higher frequency of detection of acute hemorrhoids – 7,06%, versus 3,2% in polyclinics; acute paraproctitis – 2,29% and 0,62%, respectively; ECC – 1,53% and 0,5%, respectively; anal itching – 1,44% and 0,64%, respectively; proctitis – 0,99% and 0,16%, respectively; rectocele – 0,99% and 0,18%, respectively; injuries of the colon and rectum – 0,72% and 0,16%, respectively; anal insufficiency – 0,72% and 0,37%, respectively; p<0,005.
Conclusions. The traditional model of providing outpatient coloproctological care (offices in polyclinics) is not effective even in diagnostics, since it does not have its own endoscopic and anesthesiological service, which significantly affects the volume and quality of the necessary studies. It is proposed to reorganize the service in order to organize a primary link on the basis of an outpatient coloproctology center with a day-long hospital, separate or at the coloproctology department of the State Clinical Hospital.
Concerning the process of forming motivation to a healthy lifestyle
The components of the concept of a healthy lifestyle, starting with the provisions presented in early sources, are considered from the standpoint of management. It was found that it is difficult to achieve the increase of the number of citizens leading a healthy lifestyle in the absence of clear criteria for the healthy lifestyle, since there is an objective difficulty in assessing the lifestyle of people. It is definitely necessary to formulate the basic principles for creating lists of criteria for healthy lifestyle in order to effectively motivate citizens for health-preserving behavior.
The need was identified to update and expand a number of modern lists that are used to obtain information that serves as the basis for making managerial decisions in the field of public health protection at the strategic level based on the analysis of the main existing lists of criteria for a healthy lifestyle. It is proposed to create an individual list of criteria for a healthy lifestyle by forming a low-variability part using the traditional approach, and a high-variability part using the personalized approach.
The formulated principles of compiling lists of criteria for a healthy lifestyle can be used in the system of motivating and stimulating citizens to health-preserving behavior, aimed at reducing the prevalence of known behavioral risk factors for diseases.
Psychological aspects in the problems of infertility among the population of various countries.
The problem of infertility in the 21st century has become extremely important for public health in various countries, affecting the birth rate of the population and the number of humanity. Infertility, affecting approximately 8–12% of the world’s population, is associated with factors such as unwillingness to conceive, the age of the female partner, the number of diseases that affect fertility, etc. Questions of the influence of psychological problems, often regarded as the causes of idiopathic infertility, such as stress, depression, sleep disturbances, are of particular interest to researchers. A review of works on the potential impact of stress and depression on reproductive function showed not only a definite relationship, but also the difficulty of determining causal relationships due to the lack of a single assessment tool.
P u r p o s e o f t h e s t u d y : to review foreign scientific literature containing information on the role of psychological factors in the formation of reproductive health disorders of the population, including infertility.
M a t e r i a l s a n d m e t h o d s : bibliographic, information and analytical methods and the method of comparative analysis were used.
R e s u l t s . Mental health issues are often viewed as the causes of female and male infertility. To improve the quality of life of patients with infertility, it is necessary to address the issues of a causal relationship between psychological health and infertility, psychological health when using IVF and ways to solve the problem of psychologically induced infertility. The risk of developing depression and the relationship of a higher degree of anxiety with clinical pregnancy after IVF are shown. Due to the inaccurate data on the relationship between psychological stress and a decrease in male reproductive function, psychological stress is considered in studies as a risk factor for erectile function and ejaculation in men against the background of a high level of stressful life events, compared with women.
Findings. Research has proven the effectiveness of psychological support and cognitive-behavioral group therapy in fertility treatment programs, including interventions accompanying IVF. Studies of psychological ways of correcting depression and positive IVF results have shown the importance of programs for influencing the mental state of couples undergoing treatment for infertility reasons.
Evolution of information systems
In medical organizations, information systems solve the following tasks: the ability to receive and store information, quick access to it and its transmission, the ability to generate various reports, the availability of specialized workplaces of medical workers, etc. Information systems are gradually evolving, turning from a tool capable of solving the simplest management tasks into a tool capable of solving the entire range of management tasks encountered in the practice of a medical organization at all levels of management. The purpose of the study is to describe the four stages of creating information systems, highlight the characteristic features of the functioning of information systems at each stage, as well as highlight the list of the main management tasks that are being developed at the selected stage and ways to solve them. The main attention was paid to the development of information systems of medical organizations working with the children’s population.
Results. The first stage of the development of information systems began with the use of computer technology in the practice of medical organizations and was reduced to the fact that programmers of both medical and third-party organizations began to develop tasks, the totality of which later became known as “creating an information system” of a medical organization. The goal of the second stage is already the transformation of information systems of medical organizations in order to describe production processes in terms of a process approach and implement them in the form of software modules. The third stage of building information systems is the stage of describing the work of a medical organization based on mathematical models in order to justify the optimal solution of the production tasks available in it. The fourth stage of building information systems is the construction of an “information system that implements the functions of an intelligent management system of a medical organization”. The authors of the article give recommendations on the formalization of information available in a medical organization for the purpose of its
effective use by artificial intelligence.
Findings. Thus, an information system is a tool for solving management problems, its development as a tool for solving management problems requires knowledge of management theory, organization theory, process approach in management, methods of multidimensional statistical analysis and modeling methods, languages and modeling methods based on neural networks.
Regional features of the provision of medical personnel in Russia
The article analyzes the regional features of the provision of medical personnel in Russia in the context of various subjects and federal districts.
P u r p o s e of the study is to analyze the features of staffing of medical organizations in the constituent entities of the Russian Federation in modern conditions and the main directions of policy to improve the staffing situation at the regional level.
M a t e r i a l s a n d m e t h o d s . According to the official statistics, an analysis of the staffing of medical and paramedical personnel was carried out in the context of the constituent entities of the Russian Federation; in the course of the study, methods were used such as: analytical, statistical, study and generalization of experience.
R e s u l t s . The analysis showed that the provision of doctors and the provision of emergency medical services for different regions of the Russian Federation is different. The lowest values of the indicator of the provision of doctors in 2019 were recorded in the Ural FD, the Southern FD and the North Caucasian FD, while in the constituent entities of the Russian Federation the most pronounced tendency towards a decrease in the level of provision nursing staff was noted in Moscow, Tyumen region, Chukotka Autonomous Okrug, Republic of Kalmykia, Udmurt Republic, as well as in Yaroslavl, Murmansk, Novgorod and Kirov regions, which emphasizes the need to take appropriate management measures, both at the local and federal levels.
F i n d i n g s . The existing imbalance in the country between the provision of the population with doctors and nurses in various regions (the difference between low and high rates is more than 2.3 times), as well as between the provision of medical workers in the city and rural areas is the main problem of staffing the system. To overcome this situation, further implementation of new measures of social support and moral incentives for medical personnel in Russia is required.
The status of a geriatric nurse in the organization of medical and social assistance
The article attempts to consider understanding the role of a geriatric nurse in solving problems related to the aging of the
population and the expansion of the group of older people with increased requirements for social and medical care. The review includes materials published from 2015 to 2020.
Questions implementation of incentive payments to medical workers for vaccination against Covid -19
In order to financially support medical workers and further motivate them to increase the rate of vaccination against COVID‑19, the Russian Government has introduced special incentive payments for additional workload for medical workers. The established mechanism of financial support and the procedure for making payments is quite complex, since it is aimed at achieving specific practical vaccination indicators. This publication explains some of the issues that arise in connection with the implementation of these payments.
Focus of problem
Management in health care
Questions and answers