Manager Zdravoochranenia 2023 #11

Published: 2023-11-14



    Management in healthcare
  • On the organization of internal quality control and safety of medical activities in a multidisciplinary hospital: practical experience and problems.

    The article presents the features of the implementation of the Regulations on internal quality control and safety of medical activities in the Clinical Hospital of the Federal Medical Institution «Medical and Sanitary Unit of the Ministry of Internal Affairs of the Russian Federation in Moscow». To implement this line of activity, a person responsible for this type of control was appointed, medical workers improved their qualifications on the issues of examination of the quality of medical care and quality control and safety of medical activities. The peculiarity of the implementation and implementation of internal control was associated with a large number of structural units and a bed fund. A regulation on interaction with the medical commission of a medical organization has been created. The general functions of the internal control system, the medical commission and the examination of the quality of medical care are defined.

    Authors: Kalinina E. A. [5] Mendel S. A. [1] Kuzmina T. S. [1]

    Tags: examination of the quality of medical care4 medical commission6 quality control and safety of medical activity3

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  • Indicators of Primary Medical and Sanitary Assistance to the Population Considering Medicodemographic Characteristics of the Region.

    One of the pertinent issues in practical healthcare is the enhancement of the organization of primary medical and sanitary assistance (PMSA) to the population. The evaluation of the quality, completeness, and adequacy of PMSA is inherently linked to medicodemographic indicators such as population size, age structure, and life expectancy. Additionally, issues related to the accessibility of PMSA for the population are of considerable importance. This study aims to conduct a statistical analysis of indicators of primary medical and sanitary assistance, including consideration of the medicodemographic characteristics of the region. This involves the analysis of specific demographic indicators in the Republic of Tatarstan over the past decade, an examination of the number of outpatient clinic visits in the regions and cities of the Republic of Tatarstan during the period 2018–2022, an assessment of the population’s provision with outpatient and polyclinic institutions (OPI) in Kazan and the regions of the Republic of Tatarstan during the period 2018–2022, and an analysis of the number of paramedical obstetric points in the Republic of Tatarstan during the period 2018–2022. It was observed that in the Republic of Tatarstan, there is an increase in population size and life expectancy during the studied period. The dynamics of the number of visits to OPI during the period from 2018–2022 revealed a pattern of reduced attendance during the COVID‑19 pandemic, followed by an increase in the indicator to levels comparable to the pre-COVID era. It was also noted that in the Republic of Tatarstan as a whole, there is an overall increase in the provision of OPI by 3.4% during the period from 2018 to 2022, and in Kazan, the increase is 8.6%. Intra-regional differentiation of the regions of the Republic of Tatarstan was identified, with areas exhibiting positive and negative trends in attendance and provision indicators for OPI.

    Authors: Mingazova E. N. [34] Krasnov A. E. [1]

    Tags: attendance of medical organizations1 medical statistics3 paramedical obstetric point1 primary medical and sanitary assistance1 provision of outpatient and polyclinic institutions1

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  • Modeling and forecasting
  • A mathematical model for assessing the contribution of viral hepatitis to the formation of infectious penitentiary syndrome.

    P u r p o s e : to study the role of viral hepatitis in the development and course of comorbid infection (disease caused by HIV, tuberculosis and parenteral viral hepatitis) in persons serving the penalty of deprivation of liberty.
    M e t h o d s . The indicators reflecting the epidemic situation of tuberculosis, HIV infection and parenteral viral hepatitis in institutions of the Russian penal system were analyzed. Correlation analysis and multiple regression analysis were conducted, followed by an analysis of the quality of the obtained regression models (calculation of the coefficient of determination).
    R e s u l t s . The following parameters have the maximum correlation between the predictors and the response function in this group of observations, with the subsequent exclusion of factors whose correlation with the variables involved in the calculations was higher than the correlation of these indicators with the response function: the incidence of hepatitis B per 100 thousand people (r = 0,86) [X1], the number of newly diagnosed hepatitis C patients in 2021 (r = 0,85) [X2], the proportion of newly diagnosed HIV-infected people in combination with tuberculosis and viral hepatitis (B, C, B+D), % (r = 0,85) [X3], the number of HIV patients receiving ART (r = 0,85) [X4], the incidence of tuberculosis in Pre-trial detention center (PTDC), per 100 thousand people (r=0,41) [X5], the number of newly arrested tuberculosis patients identified during the initial examination (r = 0,41) [X6]. The model was obtained: simulated mortality from HIV = –6,7 + 0,48 * X1 + 0,39 * X3 – 0,07 * X5 (R2 = 0,86). A similar model was obtained for the absolute values of the number of deaths; it involved the following parameters: the number of newly diagnosed patients with viral hepatitis B [X1], the
    number of newly diagnosed patients with viral hepatitis C [X2], the number of newly diagnosed HIV patients in combination with tuberculosis [X3], the number of patients burdened by premorbid background (injecting drug users) [X4]: The number of deaths from HIV= –0,36 + 0,06 * X1 + 0.02 * X2 + 0.36 * X3 + 0,03 * X4 (R2 = 0.91).
    C o n c l u s i o n . The association of HIV mortality rate with viral hepatitis and tuberculosis incidence is shown and estimated. HIV mortality can be considered as a function of the following factors: 1) the incidence of hepatitis B, 2) the proportion of first-time detected persons with HIV-tuberculosis-viral hepatitis coinfection, and 3) the incidence of tuberculosis in pre-trial detention centers.

    Authors: Sterlikov S. A. [8] Popova N. M. [2] Ponomarev S. B. [3] Mikhaylova Yu. V. [2] Mikhaylov A. Yu. [2] Averyanova E. L. [1] Pankova Ya. Yu. [1]

    Tags: hiv mortality1 infectious prison syndrome1 mathematical modeling1 viral hepatitis2

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  • Methodological principles of determining the directions of development of primary healthcare in the Russian Federation based on the cognitive matrix.

    The main approaches to assessing the level of development of primary health care (PHC) in the Russian Federation generally correspond to global trends, however, to a greater extent it is still concentrated on individual areas and not fully systematized. To solve this problem and create a common methodological basis for determining the most acceptable classification features for the Russian Federation, allowing to verify the current state of PHC, identify problem areas and gaps in its development, as well as to form priorities for scientific and practical research and public policy, it seems appropriate to develop a unified cognitive matrix of taxonomic features for the analysis and evaluation
    of PHC based on at the country level.
    O b j e c t i v e . To develop a cognitive matrix of taxonomic features for the analysis and evaluation of PHC in the Russian Federation based on international approaches to assessing the level of PHC development, the conceptual structural hierarchy and concrete steps to achieve the targets laid down in the strategic documents of the Russian Federation and elements of the healthcare system studied in scientific researches.
    M a t e r i a l s a n d m e t h o d s . Based on the previously prepared analytical review of WHO strategic documents, scientific research and publications [1, 2] by correlating with them on the principles of semantic or logical identity attributes, indicators, criteria or measures that determine the directions for research and evaluation of the current level of PHC development and directions of its prospective development, a content analysis of domestic publications (n = 41,824) with subsequent terminological adaptation.
    R e s u l t s . A cognitive matrix of taxonomic features has been developed to analyze and assess the current level of PHC development in the Russian Federation, as well as to search for existing gaps for concentrating the efforts of health policy makers and the scientific community in solving the problems of its long-term development.
    C o n c l u s i o n . The cognitive matrix of taxonomic features for the analysis and evaluation of PHC in the Russian Federation is a working tool for researchers, specialists of executive and legislative authorities in the field of health protection, experts in the field of health care and public health, allowing to determine the degree of study of certain areas of PHC, to identify gaps and unresolved legal provisions that create obstacles to its effective functioning and long-term development, directions for new fundamental and applied research, to unify approaches to determining priorities in the implementation of public policy.

    Authors: Orlov S. A. [5] Shepel R. N. [1] Kontsevaya A. V. [1] Drapkina O. M. [1]

    Tags: directions of development1 primary healthcare2

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  • Prediction of the risk of an unfavorable outcome in COVID‑19 using the classification tree method, taking into account the age and number of comorbid pathology according to the infectious hospital.

    Objective: to determine the probability of the risk of an unfavorable outcome using the classification tree method in patients with COVID‑19 who were treated in an infectious hospital based on the analysis of the contribution of such predictors as age and the amount of comorbid pathology.
    Materials and methods. The data of outpatient records of 5304 patients who were treated in an infectious diseases hospital with a diagnosis of COVID‑19 from January 1, 2021 to January 1, 2022 were analyzed. The age of the examined patients was 62 [56–66] years. Among 5,304 patients, there were 2,891 males (54,5%) and 2,413 females (45,5%). The patients were divided into age groups according to the WHO classification. The frequency of comorbid pathology was analyzed taking into account the nosological unit of the disease registered in at least 1% of the patients included in the study.
    Results. In the studied sample, the elderly prevailed in a larger percentage – 46.8%. The presence of one or more comorbid pathology was revealed in the prevailing number of hospitalized – in 5,244 people (98,9%). The most common comorbid pathology in the examined patients was arterial hypertension in 2038 people (38,4%), coronary heart disease in 1997 people (37,7%) and type 2 diabetes mellitus in 1629 people (30,7%). A classification tree was constructed to predict the risk of the probability of an unfavorable outcome in patients with COVID‑19.The minimum number of observations in the parent node in the classification tree was 400 people, in the child node – 200 people. In the resulting classification tree, 8 terminal nodes were observed.
    Conclusion. The probability of the risk of an unfavorable outcome in the analyzed sample of patients increases with an increase in the number of comorbid pathology and the age of patients. According to the forecast using the classification tree method, the greatest probability of risk (3,2 times) of an unfavorable outcome in relation to the general sample was among elderly persons+centenarians with more than three comorbid pathology. The developed classification tree showed a high probability of correct predictions (80%). The sensitivity of the resulting model was 77,9%, the specificity was 64,2%.

    Authors: Kalashnikov E. S. [1] Shapovalova M. A. [1] Polunina E. A. [1]

    Tags: classification trees1 comorbid pathology1 covid-1928 prognosis3 unfavorable outcome1

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  • Impact of the recreation and sports environment of the city on health of its residents.

    Recreation and sports environment is an essential part of the urban space, which is the most important factor in improving and maintaining health of the citizens, contributing to better mental health, cognitive functions, lower overall mortality, higher life expectancy, lower morbidity and mortality from cardiovascular diseases, prevalence of obesity and type 2 diabetes, better pregnancy and birth outcomes.
    Recreation and sports environment of the urban space includes the city’s greenery, recreational areas, areas for physical activities and sports, and waterfront areas. This study uses a correlation analysis to analyze impact of the recreation and sports environment of cities on health of the population of working and post-working ages. The study was conducted in 2019 on the example of large and huge urban cities of the Moscow region populated with more than 125,000 people. Based on the correlation analysis results, the authors have demonstrated the impact of the overall set of all sports facilities, sports structures, flat sports structures, swimming pools, sports halls, and public green spaces in cities on health of the post-working age. The study has also shown the impact of swimming pools, the overall set of
    all types of sports facilities, sports structures, flat sports structures, sports halls, and public green spaces in cities on health of the workingage population. The development and constant support of the city’s fitness and sports environment in a functional state is an important task of city administrations, the result of which is able to increase the physical activity of citizens and lead to a decrease in the morbidity of the urban population.

    Authors: Gorenkov R. V. [5] Rotov V. M. [2] Vasilieva T. P. [1]

    Tags: green spaces1 public health9 sports facilities1 urban environment2

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  • Morbidity of adolescents and some aspects of the relevance of medical and professional consultation of adolescents aged 15–17 years.

    Currently, conducting medical and professional consultations and medical professional orientation remains relevant against the background of the current situation of high morbidity of adolescents, inadequate choice of the direction of vocational training and uncontrolled employment, which requires the development and implementation of effective methodological approaches to the organization of professional orientation, taking into account the modern requirements of the labor market.
    The aim of the study is to assess the health status of adolescents, the professional orientation of adolescents and the leading occupational health risk factors.
    Research methods. On the example of Orenburg, an analysis of the morbidity of adolescents aged 15–17 years according to official statistics was carried out; a characteristic of the safety of workplaces at industrial enterprises of the Orenburg region was given; an assessment of the professional preferences of adolescents according to the method of I. L. Solomin was carried out in conjunction with the performance indicators determined by the method of «Landolt Rings».
    The results of the study. It is shown that adolescents aged 15–17 years have higher morbidity rates compared to the adult population of the Orenburg region by 8–29.1%, while every second teenager has a disease for the first time. The leading nosological forms in the structure of morbidity of adolescents were diseases of the musculoskeletal system and connective tissue, diseases of the organ of vision and its accessory apparatus and diseases of the genitourinary system. Common inconsistencies with sanitary standards in the workplaces of industrial enterprises of the region were indicators of vibration, microclimate and illumination. Every third teenager had professional preferences in the field of «man-man», which actualizes the problems of professional orientation, taking into account psychophysiological
    features, which have significant differences depending on the inclination to a particular profession.
    Conclusion. Medical professional orientation and medical and professional consultation for adolescents are an important area of work in the structure of primary health care for the adolescent population, contributing to the prevention of the progression of pathologies as a result of the adverse effects of production factors, the prevention of disability and increased productivity.

    Authors: Bulycheva E. V. [1]

    Tags: adolescents and youth1 medical professional counseling1 medical professional orientation1 morbidity14

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  • Digital healthcare
  • Digital evolution in Healthcare: Trends and legal regulation of Digitalization of primary Health Care in the Russian Federation (analytical review).

    Relevance. Digital evolution in the field of healthcare brings significant changes to the provision of primary health care in the Russian Federation. This process requires a comprehensive analysis and adequate legal regulation in order to ensure the effective implementation of innovative technologies, protection of the rights of patients and medical workers.
    The purpose of the study: is to analyze the current trends in the digitalization of primary health care in the Russian Federation and the existing legal regulation of the digitalization process in the field of primary health care in the Russian Federation.
    Materials and methods: the review is based on publications on the selected topic in the PubMed and eLibrary databases (n = 56), consideration of Russian regulatory legal acts related to digitalization in healthcare, including PHC, as well as the study of domestic and international experience in this field.
    Results. The study revealed the main trends and prospects for the development of digitalization of primary health care in the Russian Federation. The analysis of publicly available publications made it possible to identify the main regulatory legal acts that regulate the process of digital transformation in the Russian Federation, including the PHC area. The technologies and services actively implemented in the state healthcare system were studied, and it was revealed that the active dissemination of information via the Internet creates the need to improve the mechanisms for protecting the confidentiality of patients’ medical data. It was also found that in the context of the rapid development of digital technologies in healthcare, various aspects of legal regulation need to be reviewed, including organization, liability
    measures, guarantees and control. These conclusions emphasize the need for further analysis and improvement of legal regulation in this area to ensure effective and secure digital transformation in the field of primary health care in Russia.
    Conclusion. Digital transformation of healthcare is an integral part of the modernization of the Russian healthcare system and requires a comprehensive and balanced approach, taking into account all possible risks and benefits. It is worth emphasizing the need to work out effective legal regulation mechanisms to minimize possible risks and ensure maximum safety and efficiency of the digital transformation process in the Russian healthcare sector.
    The scope of the results. The results of the study can be used to improve legislation in the Russian Federation in the field of digitalization of healthcare, including primary health care, as well as to develop strategies and mechanisms for effective implementation of digital technologies in this area.

    Authors: Voshev D. V. [2]

    Tags: digital health literacy2 digital transformation3 digitalization of primary health care1 primary health care23 regulatory legal acts1

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  • Digital information support of patients in medical organizations.

    Today, digital transformation in the communication of an organization with its customers is more a necessity than a trend. It has penetrated into all spheres of life of modern society, including medical.
    However, only a small proportion of medical organizations (MO) understand this and are ready to switch their organizational systems and processes of communicating with patients to «digital».
    Based on the low level of awareness about digital information support tools and the willingness to allocate the organization’s budget for this, it is advisable at the beginning to focus on optimizing those tools that the Ministry already has and can improve. Thus, an effectively implemented strategy of using digital communication tools will allow the Ministry of Health to attract the attention of potential patients and significantly reduce the cost of existing tools, as well as increasing the effect of it.
    T h e p u r p o s e o f t h e s t u d y : to study the use of modern digital technologies for patient information support and develop proposals for their implementation and improvement in medical organizations
    M e t h o d s . The study used a descriptive method, questionnaire, analysis, comparison. Based on the results of the survey, a SWOT analysis was compiled.
    R e s u l t s . A survey was conducted among 100 patients of two medical organizations, which showed that digital information support for patients is poorly developed. Attention should be paid to the development and improvement of existing tools such as the website, messengers, social networks and chatbots of medical organizations.
    C o n c l u s i o n s . The introduction by medical organizations of new and improvement of old tools for digital information support of patients has a positive effect on the exchange of information with them. However, there is a clear link between the patient’s age and his desire to use digital means of communication. Based on this, the heads of the Ministry of Health should regularly conduct research on the quantitative and qualitative composition of their patients and, based on them, develop the necessary tools for digital information support.

    Authors: Ganeev K. A. [2]

    Tags: communication management2 communication networks2 communication security2 communication system3 healthcare informatization3 healthcare organization8 improving the efficiency of a medical organization2 information space2 management16 quality management system9

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  • Sociology of healthcare
  • Socio-hygienic parameters, lifestyle and medical activity of the elderly according to the results of the survey (on the example of the Tambov region).

    The purpose of our study was to study the lifestyle and medical activity of elderly people in the Tambov region in order to form a scientific understanding of the possibilities of a comprehensive medical and social corrective effect on this contingent. Materials and methods. The observation unit of our study is an elderly person who has reached the age of 60 years. A total of 412 people took part in the survey. The study was conducted from September 2022 to January 2023. The average age of respondents is 68.9 years. Among the respondents – 53.2% (219 people) are women, 46.8% (193 people) are men. Results and conclusion. One of the leading socio-hygienic factors affecting the health of the elderly
    and lifestyle should be considered the low-income level of a large number of respondents. 22% live close to poverty, 16% of the elderly people in the sample live below the poverty line (10% qualify as «Poverty», and 6% as «super-poverty»). The conducted research allows you to see the rea.

    Authors: Kalugina M. G. [2] Nassif U. [1] Polukhin К. I. [1] Rogachev D. Y. [1]

    Tags: lifestyle3 medical activity of the elderly1 social and hygienic factors1

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  • Personnel management
  • Factors affecting the shortage of nursing staff in medical institutions.

    The article presents the literature data on the shortage of nursing staff in medical institutions. The characteristic of the base on which the research was conducted is given. The analysis of completing of the nursing staff of the SAHI «Center for the Protection of Motherhood and Childhood» was carried out. It was found that during the three years of the Center’s existence, there was a shortage of secondary medical personnel from 50.0% to 65.0%. The study identified factors affecting the formation of a personnel shortage. The main ones were: dissatisfaction with the management style of the Center (57.2%), a high risk of overstrain and stress when performing functional duties, dissatisfaction with wages that do not correspond to professional loads. The insufficient involvement of young personnel under the age of 30 and the lack of motivation to obtain qualification categories when working in this medical institution had a negative impact on the replenishment and preservation of personnel potential. Based on the results of this study, ways to solve the problem of shortage of nursing staff in the Center have been developed.

    Authors: Krylova N. Yu. [1] Katsova G. B. [1]

    Tags: factors contributing to staff shortage1 nurses8 staff shortage1

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