CONTENT OF THE ISSUE
Patient support program as a part of value-based healthcare implementation
Patient support programs as a new institutional phenomenon take over part of the functions of the Institute of Healthcare in drug provision, diagnostics, clinicians and patients education, infrastructure support.
Purpose: to evaluate the role of patient support programs (PPMS) by describing the mechanisms of their implementation.
Materials and methods. On the basis of open sources of information and scientific literature data, the initiatives to launch PPP in Russia of medicines and medical devices were analyzed.
Results. The most common programs are that combine financial and information mechanisms. The key principle of the development of the PPP is orientation to the patient’s pathway. Typical tools for the implementation of PPP include the following: hotline, SMS-informing, patronage service, online monitoring, patient training, insurance. The effectiveness of the PPP is assessed by four groups of indicators: patient adherence, quality of life and patient experience, clinical outcome indicators, cost savings.
Conclusions. Health authorities and medical professionals should be aware of the possibilities of programs to achieve the goals of improving the quality and accessibility of medical care, and can also help to systematically assess the effectiveness of such programs from the perspective of public health.
Choosing optimal treatment organisation strategy for unresectable liver cancer: case of Moscow region
Introduction: despite quite low morbidity with up to 6 thousand cases per year in Russia, therapy for unresectable liver tumors is based on costly therapy with tyrosine kinase inhibitors or anti-PD‑1L agents thus leading to extremely high costs per life year saved. In the meantime, transaterial radioembolization (TARE)technique is reported to show better outcomes in this patient group compared to conservative treatment and transarterial chemotherapy (TACT). This article researches strategic options for regionwide treatment programs focused on involving TARE in unresectable liver tumors treatment.
Methodology. Epidemiological data provided by national cancer report. Systematic review of literature (not meeting PRISMA criteria) was done for TARE vs. TACT and TARE vs. conservative treatment overall survival. Treatment costs were based on current governmental treatment tariffs for Moscow region. Only direct oncology costs were included without possible complications analysis. The final analysis was done for optimistic, pessimistic and moderate expected numbers of patients eligble for TARE.
Results. Optimal treatment strategy implies maximum allowable rate of TARE with patients concentration in selected hospitals. For Moscow region (population of 7,6 million people) estimated yearly benefit of this strategy is 309,3 RUB (USD3,4 million USD) and 284 life years saved based on moderate prognosis.
Features of the formation of the labor rationing system in medical organizations providing primary health care
Labor rationing has a number of potential opportunities, with the competent implementation of which it is possible to solve many urgent management tasks, including stimulating employees.
The purpose of the study is to evaluate the principles of the formation of the remuneration system through the applied elements of labor rationing for various categories of medical workers providing primary health care, taking into account the specialty of the medical worker and his activities.
Materials and methods. A mechanism has been developed for the introduction of a remuneration system (an effective contract) through labor rationing in compliance with labor legislation and other regulatory documents based on the timing of the performance of the labor function (manipulation, procedure, examination, etc.), its quantitative and qualitative characteristics.
Results. During the development of the labor rationing system in the polyclinic, timekeeping tables for load accounting were developed for all departments. Based on these data, the optimal accounting unit of labor costs was established and the required number of points was determined, which guarantees the receipt of an official salary with a full worked rate of hours per month. For each employee, the form “Performance of the load per month” was filled out, where the indicators “Number of patients/days per month” and “Average load per day” were calculated. Summary evaluation data were entered into labor passports, which reflected the rate of points per day, the actual number of points scored, the difference between the actual number and the norm, the percentage of the surcharge. As an example, several developed methods are presented for the development of criteria and the establishment of additional payments to polyclinic medical workers within the framework of an effective contract.
Findings. Determining the workload of medical workers based on the study of labor processes and the cost of working time to perform various jobs, and then rationing their labor, in general, makes the requirements for the volume of work performed transparent, reasonable and understandable for the staff of medical organizations.
Opportunities for reducing mortality from prostate cancer in Russia: analysis of data from the state cancer registry for 2018–2020
The article provides an analysis of the data of the state cancer registry on the registration and treatment of patients with prostate cancer (PC) for the period 2009–2020. Based on the analysis of the registry data, a method was proposed to identify a subgroup of patients with indirect signs of non-metastatic castration-resistant prostate cancer (nmCRPC), for which the risk of developing distant metastases was analyzed. The article presents data on the prevalence of nmCRPC n 2018–2020 among the contingent of patients registered with prostate cancer in Russia, in comparison with global and Russian data on the study of the epidemiology and natural course of nmCRPC.
The relationship between the structure of nutrition and chronic non-communicable diseases
I n t r o d u c t i o n . The article analyzes modern literary sources and scientific ideas devoted to the study of the role of healthy
nutrition and the influence of nutrition factors on health. Proper and healthy nutrition is the basis of a high-quality human life,
affects health, longevity and performance. Modern nutrition should not only satisfy the physiological needs of a person for nutrients
and energy, but also perform preventive and therapeutic functions. Diets based entirely on the consumption of plant products are
becoming increasingly popular due to the many claimed health benefits. Numerous studies conducted in recent years indicate
that a plant-based diet with a restriction of animal products is accompanied by a lower risk of developing chronic diseases, and
in some nosologies contributes to disease control. The goals and objectives of the prevention of healthy eating are to preserve
and strengthen the health of the population, prevent diseases caused by inadequate and unbalanced nutrition. M a t e r i a l s a n d
m e t h o d s . A review of the literature on the control of food safety, the fullness and balance of nutrition, compliance with dietary
regimes. R e s u l t s . With eating disorders, the ability to withstand adverse environmental influences, stress, increased mental
and physical exertion sharply decreases. An imbalance of nutrients, vitamins and minerals in the composition of food leads to
metabolic disorders and subsequently to disease. D i s c u s s i o n . Rational nutrition is considered as one of the components of
“lifestyle medicine”. At the same time, most researchers emphasize the need for large-scale population-based research in this
area in accordance with modern principles of evidence-based medicine. C o n c l u s i o n . The results of numerous studies indicate
the significant role of nutrition in the development of various diseases, their prevention and treatment. Nutrition is the basis for all
metabolic processes of the human body, therefore, a violation of nutrition contributes to the occurrence of the disease. A healthy
diet and a healthy lifestyle are the basis of disease prevention.
Features of the main anthropometric indicators of physical development of students
P u r p o s e : to determine the features of the main anthropometric indicators of the physical development of students during their studies in the context of the COVID‑19 pandemic.
M a t e r i a l s a n d m e t h o d s . Medical and sociological research was conducted among students of one of the Institutes of the Russian State University named after A. N. Kosygin (Technology. Design. Art). The continuous sample of students was 505 people. During the study, clinical, socio-hygienic, statistical, analytical methods were used.
R e s u l t s . The proportion of persons from the continuous sample (n=505) with normal body mass index was 64.8%, the proportion with underweight indicators was 23.1%, with excess body weight indicators – 12.1%, respectively. The largest proportion of persons with indicators of body weight deficiency was observed in the age group of 18–19 years – 23.5%, the smallest – in the age group of 22–23 years – 12.1% (Р˂0.05). However, the reverse trend is observed in the number of overweight people – with age, their proportion in the respective groups increases: from 9.3% in the age group of 18–19 years old to 18.2% in the group of 22–23 years old (Р˂0.05).
F i n d i n g s . As a result of the study, it was found that the majority of students have normal body mass index, their share is 64.8%; the proportion of people with deviations in physical development is high – 35.2%, and almost every fourth student has a lack of body weight (their share in the sample is 23.1%,), one in eight is overweight (their share in the sample is 12, one%); the average value of BMI among the contingent of students (median) corresponding to the standard value was revealed, however, its high scatter was determined, amounting to 23.01, which indicates the need to use more accurate methods for analyzing the assessment of physical development indicators, for example, the method using regression scales.
Physical activity of students during the COVID‑19 pandemic as a health-saving perspective
According to the WHO, physical activity contributes to the prevention and treatment of noncommunicable diseases. Lack of fitness is considered an important cause of future lifestyle-related diseases, including metabolic syndrome, diabetes, hypertension, and cardiovascular disease. People with low levels of physical activity have higher body mass index, higher waist circumference and fat mass than those with high levels of physical activity. In recent decades, especially during the COVID‑19 pandemic, physical inactivity and sedentary lifestyles have become a major global public health problem, even among younger populations. All this suggests the special importance of the physical activity of students in difficult life situations, including the conditions of the COVID‑19 pandemic.
Purpose: to review foreign scientific literature containing information about the characteristics of physical activity of students during the COVID‑19 pandemic and their impact on health indicators, about risk factors and ways to level them.
Materials and methods: bibliographic, information-analytical and methods of comparative analysis.
Results: during the COVID‑19 lockdown, students, regardless of baseline fitness scores, reduced time spent in moderate to vigorous physical activity, increasing sedentary lifestyle and screen time. At the same time, first-year students turned out to be the most vulnerable to lifestyle changes due to isolation due to the difficulties of adapting to the conditions of study at the university and to the new realities during the COVID‑19 pandemic. During the lockdown, there has been an increase in the positive relationship observed before the pandemic between students’ physical activity indicators and gender, weight, psychological state and year of study. There is a greater adaptability of women to the conditions of isolation, women more often retained physical activity due to concern for health and shape. Women were more sociable, more often used social networks when doing physical exercises.
Findings: when developing strategies to stimulate physical activity and create a favorable environment for its implementation during isolation, one should take into account gender differences, socio-cultural factors, the role of the family and close circle, the role of educational organizations. Promoting physical activity among students during the COVID‑19 pandemic requires the joint efforts of the family, the public, the state, health organizations and educational institutions.
The concept of implementing a business plan for a mobile medical clinic
The article is devoted to the economic aspect of the concept of implementation and functioning of a mobile medical clinic (MMC).Despite the role of mobile medical clinics in providing medical assistance to the entire population, all social groups, the overall impact of mobile medical clinics has not often been the subject of research.
The purpose of the study is to analyze the project of implementing the business plan of a mobile (mobile) medical clinic.
Materials and methods. The presented business plan has a structure focused on the creation of mobile medical complexes on the territory of each subject of Russia. The introduction of such medical clinics is a necessary and important process within the framework of preserving the health and working capacity of the population. Important stages in the implementation of the business plan are: a legislative plan that includes the main regulations, a marketing plan that takes into account the segment of the services market and the demand for the planned price, and an organizational plan that includes an assessment of the total cost of the project and fixed costs.
Results. In the article, the results show that the introduction of mobile medical clinics on the territory of the subjects of Russia will not only improve the state of health and improve the quality of care for people, but also improve the health of the population while reducing the growth rate of costs (within the framework of the all-Russian national strategy). In this regard, an organizational plan was developed that takes into account the fixed costs of the mobile clinic.
Conclusion. The development of a business plan for the implementation of mobile medical clinics in the territory of each subject of Russia and the introduction of MMC programs into the healthcare system will increase the level of socio-economic well-being of the population.
Relevance of introducing remote surveillance technologies for high-risk patients suffering with cardiovascular diseases during a pandemic Professional burnout of medical nurses: features of generations
The organization of health support for people with cardiovascular diseases during a pandemic requires limiting direct contact with the patient. It is necessary to introduce/improve technologies for remote monitoring of the condition of high-risk patients with the possibility of prompt response in case of deterioration.
The purpose of the work – a detailed study of the possibilities of implementing remote technologies for analyzing the condition of high-risk patients with cardiovascular diseases.
Methods and materials: a detailed analysis of literature sources concerning remote monitoring of the condition of persons suffering from cardiovascular diseases and being at high risk was carried out. Particular attention is paid to studies conducted during the pandemic. The study of the state of the issue of interest was carried out by analyzing publications in the databases: Cyberleninka, PubMed, Elibrary, ScienceDirect, Springerlink.
Results: the trends in the development of modern technologies for remote analysis of the parameters of the functioning of the cardiovascular system, including pulse rate, blood pressure, and electrocardiographic studies, were determined. Particular attention is paid to assessing the possibilities of counseling the patient through remote communication, options for transmitting data on the patient’s condition, methods of emergency communication.
Marketing in health care