Manager Zdravoochranenia 2022 #6

Published: 2022-08-03



    Focus of the problem
  • Features of inspection in 2022: what medical organizations need to be prepared for

    The article shows that the decisions adopted in March 2022 on a moratorium on scheduled inspections until the end of 2022 not only do not mean a complete stop of measures for monitoring (supervision) of medical activities carried out by medical organizations, but also actively stimulate the practical implementation of a number of basic provisions of the reform of control and supervisory activities. Medical organizations, despite the moratorium on scheduled inspections announced by the end of 2022, need to ensure strict compliance with the requirements of legislation to ensure and control the quality and safety of medical activities; constant readiness for the implementation by the supervisory authorities of new control (supervisory) measures without interaction with the controlled person, as well as professionallactic events.

    Authors: Piven D. V. [59] Kitsul I. S. [59] Ivanov I. V. [30]

    Tags: control (supervision) without interaction2 controlled person2 mandatory requirements3 moratorium on scheduled inspections1 on-site examination2 quality and safety of medical activity11 reform of control and supervisory activities1 safety monitoring2 unscheduled  inspections2

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  • Management in health care
  • Expert validation of the clinical laboratory service models’ standardized descriptors

    Introduction. The growing demand for the availability and quality of clinical laboratory tests has necessitated the search for new approaches to organizing and management of laboratory services. At the same time, needs a systematic description of the laboratory services organization models as a background for further improvement. Objective: to validate the description of the laboratory services organization models by standardized characteristics. Methods. A sociological study carried out on the principles of a systematic approach. Research methods: sociological (expert assessments), analytical, statistical. Results and discussion. The inter-expert agreement for the centralization (consolidation) model was 0,626 (95% CI 0,516–0,711), outsourcing (decentralization) – 0,747 (95% CI 0,672–0,804), horizontal integration – 0,784, 95% CI 0,720–0,833, mobile (pointto-care) model – 0,883 (95% CI 0,848–0,909). The first value interpreted as doubtful, significant adjustments made to the model characteristics. The second and third values – as sufficient, minimal adjustments made. Fourth – as good, the description was not changed. The final SWOT-analysis matrices for four models formed. Conclusions. Thanks to expert validation, a methodical change from an empirical to a scientifically based standardized description of the four basic laboratory services organization models made.

    Authors: Vavilova T. V. [2] Goldberg A.  S. [2] Chernish N. Yu. [1]

    Tags: clinical laboratory service1 laboratory diagnostics3 management17 model of organization1

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  • The impact of patient loyalty on the economic indicators of the activities of a medical organization providing paid medical services

    I n t r o d u c t i o n . In modern conditions of the paid medical services market, the vector of competition development is shifting from the concept of classical marketing to relationship marketing, and in these circumstances the issues of forming, retaining and managing patient loyalty come to the fore. The authors propose to consider a fundamentally different approach to measuring patient loyalty by a medical organization. In their opinion, the most effective method for studying the level of loyalty in combination with economic indicators is the consumer loyalty index (English Net Promoter Score, NPS), developed and first introduced in 2003 by Fred Reichheld.
    T h e p u r p o s e o f t h e r e s e a r c h is to study the impact of patient loyalty on improving the economic efficiency of a medical organization providing paid medical services.
    M a t e r i a l s a n d m e t h o d s . A study was planned and conducted using the NPS methodology to study patient loyalty. The survey of patients was carried out through SMS messages in automatic mode using a service integrated into the medical information system (MIS) of a medical organization. Previously, patients provided consent to the processing and transfer of their personal data.
    The results of the survey and data on the actual payment for paid medical services for each respondent were integrated into a consolidated database for further statistical processing.
    R e s u l t s . The study involved 39320 patients of the dental clinic. The results obtained during the study period coincided with the calculations of Fred Reichheld and confirmed the relevance of the application of this methodology in the current conditions of the paid medical services market. It has been established that the loyalty of patients to a medical organization affects the increase in economic indicators, and achieving a sustainable growth rate of a medical organization and predictable positive financial indicators is impossible without creating a base of loyal repeat patients. In addition, increasing the level of loyalty of repeat patients has a positive effect on NPS, which is directly related to an increase in the average cost of medical appointment and net sales.
    C o n c l u s i o n . Thus, the level of patient loyalty has a direct impact on the main economic indicators of the medical organization activity.

    Authors: Novikov M. S. [2] Solovieva Yu. A. [1]

    Tags: consumer loyalty index1 economic indicators1 paid medical services22 patient loyalty3 patient-in-focus approach1

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  • Population and health
  • Risk-Based Approaches to Endoscopic Diagnosis of Gastrointestinal tract сancer in the medical organizations of primary healthcare (on the example of GAUZ SO GB № 1, Nizhny Tagil)

    Early detection of gastrointestinal cancer is an actual public health problem. The implementation of the modern endoscopic diagnostic methods based on the progressive digital technologies significantly reduce the risks of diagnostic errors and contributes to the effective solution of that problem.
    P u r p o s e : to clarify the possibilities of the early detection of gastrointestinal cancer by equipping the endoscopy unit of the city district hospital with the modern digital endoscopes, including devices with zoom functions – ZOOM.
    M a t e r i a l s a n d m e t h o d s . The article analyzes the statistical data of the work of the endoscopy unit of Nizniy Tagil State city hospital № 1 from 2013 to 2022 (except 2020–21, when the hospital was completely redesigned as a COVID-hospital).
    R e s u l t s . A clear relationship between the increase in the number of detected oncopathologies of the gastrointestinal tract and the modern technical equipment of the endoscopic units under the modernization of primary health care program in the Sverdlovsk region in 2021 is presented. Based on risk-based approaches and evidence-based medicine data, the importance expert-class equipment in the routine endoscopic practice in the primary healthcare district hospital for diagnosing gastrointestinal cancer at an early stage is shown. Modern approaches to optical endoscopic diagnostics are analyzed, as well as the potential risks of diagnostic errors associated with technical equipment and possible measures to reduce these risks for further improvement of primary endoscopic diagnostics aimed at detecting gastrointestinal cancer in the early stages are determined, the expediency of equipping endoscopic units of primary care medical organizations with endoscopes inreached magnification functions – ZOOM, as well as photo and video
    recording of digital images with the possibility of archiving, color printing and further expert analysis of endoscopic images.
    C o n s e q u e n c e . From the presented statistical data, it is clearly seen how with the improvement of the equipment quality, the detection of gastrointestinal cancer of various localizations is growing.

    Authors: Starodubov V. I. [40] Ivantsova M. A. [1] Khain V. V. [1] Pavlovskikh A. Yu. [1]

    Tags: colonoscope1 colorectal cancer1 early cancer1 endoscopy2 esophageal cancer1 gastroscope1 oncopathology of the gastrointestinal tract1 stomach cancer1 zoom1

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  • Peculiarities of the quality of life of students, including with disturbances in physical development, under the conditions of the COVID‑19 pandemic

    In the context of the COVID‑19 pandemic, student youth are facing significant adverse impacts that affect the state of physical and mental health, as well as changes in quality of life indicators. Factors such as the sudden transition of students to online learning, the closure of hostels, limited access to public spaces, an increase in morbidity in the close environment, the manifestation of fears and phobias had a negative impact. Students have irregular meals, limited access to good nutrition, increased time spent in front of the monitor, less opportunities for physical activity and associated significant changes in physical parameters, namely obesity, an increase in body mass index weight.
    Materials and methods: bibliographic, socio-hygienic, sociological, statistical, analytical methods were used in the work.
    Findings. Analysis of the results of the study made it possible to establish: a) the average level of the physical component of students’ health is higher than the psychological one; the indicator of the physical component of health, corresponding to the norm, was observed in 70.7% of students; psychological – in 63.4% of students; no statistically significant relationship was found between the physical and psychological components of students’ health; b) in terms of the physical and psychological components of health, the largest percentage of respondents with a norm was noted among students with a lack of body weight; a low level of the physical component of health is much more common in the group of students with excess body weight, compared with the other studied groups

    Authors: Mingazova E. N. [30] Gureev S.  A. [8] Mingazov R. N. [12]

    Tags: deficiency and excess of body weight2 disorders in physical development1 quality of life8 students6

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  • Sociology of healthcare
  • Satisfaction of parents with the availability of preferential drug provision for minors

    The health and well-being of children is in the first place in the social policy of any state. In relation to children with chronic diseases, a lot of state support measures are being developed, including preferential drug provision. At the same time, the availability and volume of benefits for each particular child can affect the further prognosis of the disease, the social and economic efficiency of the measures taken. The purpose of the study was to identify the reasons for parents' dissatisfaction with the availability and quality of the organization of preferential drug provision for minors. The study was conducted by anonymous questioning of 455 parents of children admitted for inpatient treatment at the FSBEI HE SPb SPMU and the G.I. Turner in 2020, belonging to the preferential category. The study showed that there are restrictions at all stages of the provision of drug benefits. Most parents have low awareness of the child's right to benefits, as well as low legal activity in situations where the child's right is violated.
    A third of parents prefer not to use the benefit, fearing obstacles to its implementation. For children eligible for a federal benefit, the availability of drug coverage is significantly higher than for children with a regional benefit.

    Authors: Akulin I. M. [6] Sokolova V. V. [3]

    Tags: availability of medical care1 awareness of parents1 children13 legal activity of parents1 medical benefit1

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  • Features of relationships in the family among teenagers at risk group of using psychoactive substances and the role of their study in psychological and pedagogical prevention of the Udmurt Republic

    The article presents an analysis of the preventive medical examination of teenagers to identify risk factors for non-drug use of narcotic and psychotropic substances in educational institutions of the Udmurt Republic. Risk factors for a healthy lifestyle have been identified through a survey of teenagers and their parents, types of families and specifics of upbringing have been identified, groups for family psychological and pedagogical prevention have been formed. Training sessions were held with parents of teenagers and the data of the results are presented, allowing them to be used in the preventive work of health care institutions.

    Authors: Lukin A. Yu. [2] Beznosova M. G. [1] Tikhomirova G. I. [2]

    Tags: education1 family relationships1 methodology5 psychological and pedagogical prevention1 teenager population1 types of nurture1

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  • Hr management
  • Staffing of primary health care in the Russian Federation

    The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support.
    Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care.
    P u r p o s e o f t h e s t u d y . Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices.
    M a t e r i a l s a n d m e t h o d s : content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular.
    R e s u l t s . The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016–2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from 3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which determines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated.
    F i n d i n g s . The introduction of promising general medical practice models in the urban environment implies a complete transition
    of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2.
    It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure.

    Authors: Kalininskaya A. A. [15] Lazarev A. V. [6] Shlyafer S. I. [5] Balzamova L. A. [3]

    Tags: general medical practice1 general practitioner4 general practitioner’s nurse1 local therapist1 medical organization providing medical care on an outpatient basis – polyclinic1 primary health care21

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  • Digital healthcare
  • Experience and prospects of digital twins application in public healthcare

    Digitalization of healthcare opens up opportunities for applying new approaches to the organization of medical care, improving its quality, optimizing the use of healthcare resources. Digital twin is one of the new approaches, a virtual model of a physical object with dynamic bidirectional connections between a physical object and its corresponding twin in a digital environment.
    Digital twins allow to study, create and test new hypotheses, conduct experiments and research in silico. T h e a i m o f t h e s t u d y is to describe the existing Russian and foreign experience in the practical application of digital twins in the field of healthcare.
    M a t e r i a l s a n d m e t h o d s . The literature review was conducted in Pubmed and Elibrary databases. Publications describing ethical and regulatory aspects, industrial, engineering or logistics applications were excluded. The articles have passed two rounds of peer review. R e s u l t s . Digital twins are used in clinical medicine to test new methods of treatment and the body’s response to them, to simulate the work of organs and tissues. The application of the technology for the development of precision therapy in cardiology, oncology, endocrinology, gastroenterology, orthodontic treatment, rehabilitation, intensive care is described. The digital twin can be used by health authorities to model patient behavior, predict the spread of the infectious process, the work of a medical institution and its structural units in order to optimize resources. C o n c l u s i o n s . The article provides an overview of technology and the main areas of application of digital twins for personalized medicine, public health and smart healthy cities. The prospects for using digital twins lie in the field of creating smart “healthy” cities and regions.

    Authors: Zuenkova Yu. A. [4]

    Tags: big data2 digital healthcare2 digital twin1 imitation modelling1 precision medicine1

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  • Manager of health care consults
  • Changes in the procedure for carrying out control measures in the compulsory health insurance system in 2022

    One of the most important innovations in the system of compulsory medical insurance in 2021 was the change in the order of control measures. At the same time, both the participants of the MHI system, who have the authority to conduct control measures, and the procedure for conducting control have changed.
    This paper analyzes the next, rather voluminous changes in the system of control measures that occurred already in 2022. An assessment of the impact of these changes on the effectiveness of control and on the work of medical organizations is given.

    Authors: Kadyrov F. N. [123] Chililov A. M. [24] Mitroshin P. V. [3]

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  • Questions and answers
  • Issues of distribution of the cost of medicines and other consumables by sources of financing in the provision of paid medical services

    In the article, on the basis of regulatory legal acts and explanations of the Ministry of Finance of the Russian Federation, possible ways of distributing medicines by sources of financing are substantiated.

    Authors: Kadyrov F. N. [123] Chililov A. M. [24]

    Tags: accounting of medicines1 cost allocation1 indirect costs1 paid medical services22 sources of financing2

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