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Manager Zdravoochranenia 2023 #12
Published: 2023-01-16
341
CONTENT OF THE ISSUE
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Project management in medicine on the experience of the program "Face Clinic" implementation.
A new management method in the public health care system is project management.
A i m . Improving the quality of medical care in a public health care institution for patients with neurological disorders of the face through organizational measures using project management.
M a t e r i a l s a n d m e t h o d s . The state medical organization has implemented an original program of assistance to patients with neurological disorders in the face in several stages. Used project management. There was no restructuring of medical departments or hiring of new employees.
R e s u l t s . At the Sklifosovsky Research Institute, in total for the period 2021–2022, 865 offline (over the year, the growth rate of consultations increased by 2.5) and 48 online consultations with neurologists were conducted, there were 139 MRIs, 180 electrodiagnostic procedures, surgical treatment was performed on 101 patients, and 161 botulinum therapy procedures were performed. Scientific research included the development of protocols for magnetic resonance imaging and electrodiagnostics, an algorithm for making decisions about surgical care was described, and new methods of physical rehabilitation were proposed. 28 scientific articles were published, the results were reported at scientific and practical conferences and congresses. A team of specialists has developed a postgraduate educational
program. Provided patient education. The Face Clinic project is recognized as socially important.
C o n c l u s i o n s . For a specific group of patients, in order to quickly achieve results, it is better to organize work through project management. It is necessary to teach doctors management tools. -
Main indicators of obstetric care in the region of Central Russia.
The article presents an analysis of the main indicators of obstetric care in the region of the Central Federal District – Kostroma Region.
Despite the identified positive trends in the reproductive and demographic process in the Kostroma region, a number of significant problems remain (exceeding the Russian average for the number of complications in labor, termination of pregnancy, infant mortality, etc.) that require management decisions in improving the obstetric care system and ensuring the proper level of medical care mother and child. This direction of improving the activities of the healthcare system of the Kostroma region is of paramount importance in conditions of reduced population reproduction. -
Indicators and directions for optimizing primary health care in the Southern Federal District.
The study of indicators and directions for optimizing primary health care in the regions of the Russian Federation allows us to assess the effectiveness of the functioning of the first and basic level of contact of patients with the health care system. The purpose of the work is to study indicators and directions for optimizing primary health care in the Southern Federal District. Materials and methods: A theoretical analysis of literature, statistical information and documents related to indicators and optimization of primary health care in the Southern Federal District was performed. For a comparative assessment of the dynamics of indicators, the growth (%) was calculated. Results. The supply of local therapists in the Southern Federal District is lower than the national average. It was revealed that the Republic of Kalmykia, Astrakhan region and Rostov region have a negative increase in the provision of local therapists for 2016 and 2021: –6.1; –20.9 and –22.2% respectively. In terms of the number of local pediatricians, a negative increase (9.0%) is observed only for the Rostov region. An analysis of directions for optimizing primary health care showed that in the regions of the Southern Federal District programs are being implemented to improve the infrastructural organization and equipment of primary health care, as well as to eliminate the personnel shortage of medical personnel. However, the reports indicate only indicators of the number of doctors per 10 thousand population without highlighting primary health care workers. Conclusion. The key problem of the Southern Federal District is the shortage of doctors in the
field of primary health care. The dynamics of the health care situation in the Southern Federal District have not been sufficiently studied.
It is necessary to continue: improving the material and technical equipment of the industry, including in hard-to-reach areas, carrying out preparatory work with students in medical institutions, improving working conditions and offering attractive labor financing for workers and organizing social assistance. -
Statistical analysis of the medical and social causes of the formation of benign men prostatic hyperplasia.
With the world’s population growing and aging, one of the challenges facing physicians and primary care professionals as the population ages is the management of lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH). It is known from the literature that 18% of men at the age of 40 report anxiety due to an enlarged prostate, but this figure rises sharply at the age of 50, when already 50% of men complain of unpleasant symptoms associated with an enlarged prostate, and at the age of 90 years of such men becomes 90%. In our study, we analyzed numerous works (articles) that studied the prevalence of benign prostatic hyperplasia in different population groups and at different times. In addition to analyzing the prevalence of benign prostatic hyperplasia, the article presents statistical data on the main causes of the formation of benign prostatic hyperplasia in men.
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Regional model for organizing telemedicine consultations in ophthalmology: problems and prospects.
Relevance. In modern healthcare, there is an increasing role of information and telecommunication technologies. Digital transformation of the medical industry makes it possible to ensure continuity of patient monitoring, optimize the diagnostic stage, and improve the quality of medical prevention. Today, teleconsultations are widely implemented in the activities of national medical research centers. This article presents a regional model for organizing and conducting telemedicine consultations in the 3rd level ophthalmological center of the Republic of Tatarstan – State Autonomous Institution «RKOB MZ RT named after Prof. E. V. Adamyuk» for the period 2019–2022, an analysis of problems and prospects for improving interaction Level 3 medical organizations with National Medical Research Center when
carrying out remote consultations (consiliums).
The purpose of the study studying the results of introducing telemedicine consultations (hereinafter referred to as TMC) into the activities of a regional ophthalmological center providing primary specialized health care and specialized (including high-tech medical care), in 2019–2022. and development of proposals to improve the efficiency of the use of telemedicine technologies in the provision of medical care.
Materials and methods. An analysis of the legal regulation of telemedicine technologies in healthcare was carried out, an assessment was made of the number and structure of telemedicine consultations with the National Medical Research Center using information from the unified state information system of the regional ophthalmological center for the period 2019–2022.
Results. When organizing telemedicine in the clinic, local regulatory documents were developed, the main processes of teleconsultations were identified, and responsible persons were appointed. Since the introduction of telemedicine technologies in the State Autonomous Institution “RKOB MZ RT named after Prof. E. V. Adamyuk”, 130 telemedicine consultations with the National Medical Research Center have been carried out. The structure of nosological forms during TMC is dominated by inflammatory diseases of the eye (49,5%), degenerative diseases of the retina (13%), and glaucoma (8,4%). Most often, specialists at the National Medical Research Center for TMC recommended face-to-face consultation or surgical treatment of the patient in the conditions of the National Medical Research Center (46,6%), correction of the ongoing conservative therapy (24,8%).
Conclusions. The work carried out indicates the demand for remote consultations with the National Medical Research Center when providing medical care in the field of ophthalmology. The more active introduction of telecommunication technologies into the activities of regional specialized centers in interaction with medical organizations of the second and first levels is becoming relevant. -
Using MVP in the development of a software product for an infectious disease monitoring information system.
In world practice, the effectiveness of management decisions taken to organize medical care for the population in the context of the COVID‑19 pandemic is associated with the construction of mathematical models based on statistical data implemented in the software of medical information systems and the development of digital technologies that allow remote observation and interaction with the patient.
As information about COVID‑19 accumulates, the issue of automating the processes of collecting, accumulating, storing, analyzing and visualizing medical data has become relevant for executive authorities in the field of protecting the health of citizens in the Russian Federation.
Purpose of study. To develop and to implement a software module for monitoring infectious diseases to automate basic business processes related to the provision of medical care to patients with COVID‑19.
Methods. The basis for the development of MVP was the e-document flow system (EDF) «Bureaucrat». The main tool was the CUBA platform, and the following technologies were used: Spring, Groovy, YARG, HL7, SOAP, REST API, Tomcat, Vaadin, Activiti.
Results. At the first five stages of creating an MVP information system for monitoring infectious diseases, the “Questionnaire” and “Observation Sheet” forms were introduced, and also integration with the Federal Register of COVID‑19 Patients was carried out, functionality for creating emergency notifications about infectious diseases was introduced, and integration with the regional information system was partially implemented. The sixth and seventh stages provided for the separation of MVP based on the Bureaucrat EDF into an independent software product with expanded functionality.
Conclusions. As a result of the work, a software product was obtained, first as a module within the Bureaucrat EDF, and then as an independent information system “Infections.Net”, which was able to quickly act as an addition to RMIS in the Tyumen region and automate all necessary business processes at the regional level related to work on COVID‑19 patients in a short time frame. -
Online training for doctors of non-oncology specialties on the prevention and early diagnosis of malignant skin tumors.
One of the reasons for the late diagnosis of malignant skin neoplasms (hereinafter referred to as MNS) is the insufficient knowledge of doctors in non-oncology specialties [1], [2]. The sensitivity for recognizing cutaneous melanoma (hereinafter referred to as MNS) during a visual examination by primary care physicians is 40,2% [3]. The sensitivity of recognizing MNS for an inexperienced dermatologist is 69%, compared to the sensitivity of diagnosing MNS by an experienced dermatologist is 92% [4].
Also, the reason for the late diagnosis of MNS is an insufficiently complete examination of patients. Evidence suggests that doctors do not routinely offer full body mole screening. Up to 63% of patients diagnosed with MK visited their GP in the year before diagnosis. Only 30% of dermatologists perform a full body skin examination on all of their patients [5].
Thus, an important method is the education of doctors of non-oncology specialties in the form of training programs in the principles of early diagnosis of cancer, which in turn can help improve the oncological epidemiological situation [9].
The purpose of this study is to study the effectiveness of organizing an 8-hour online training aimed at raising the awareness of nononcology doctors on the prevention and early diagnosis of cancer.
Material and methods. An 8-hour online course «Early diagnosis of skin tumors» was conducted for doctors, created by a group of authors on the platform «Personal Account of a Doctor at the Volga Research Medical University.» The training course included the following issues: risk factors for MK and other cancers, a description of the diagnostic algorithm using the ABCDE method with an illustration of each sign on photographic images, differential diagnosis of skin tumors, prevention with an emphasis on protection from ultraviolet radiation. The course used 82 photographs of MNS. The illustrated material consisted of 30 images of MK, 25 images of basal cell skin cancer (BCSC), 15 images of seborrheic keratoma of the skin, 12 images of skin hemangiomas.
Conclusion. As a result of online training, one can note an improvement in the level of knowledge of doctors after completing an online course aimed at the prevention and early diagnosis of cervical cancer.
Increasing the specificity of diagnosing nevi (0,846, 0,953) before and after, respectively, can help reduce costs in the “secondary level” of healthcare. The topic of prevention presented in the course also contributes to conducting preventive conversations with patients and correct patient routing.
Thus, conducting online training has a number of advantages and shows good learning results. The diagnostic methods discussed in the course, aimed at clarifying the diagnosis of cancer, especially in the early stages of the disease, predetermine the choice of optimal treatment tactics and are the key to ensuring the best prognosis of the disease. -
Asessment of healthcare workers’ perceptions on the effectiveness of medical care in the profile of psychiatry in the Moscow region.
Relevance. The reorganization and modernization of the psychiatric service in Moscow (from 2010) and in Moscow region (from 2021) was carried out. The reforms were carried out in accordance with WHO regulations and consisted in reducing the medical care provided in a hospital setting and expanding the outpatient link.
Aim. Asessing the perceptions of employees on the effectiveness of providing assistance in the profile of “psychiatry” in the Moscow region after its restructuring.
Methods. An anonymous survey of employees of the psychiatric service in the Moscow region was conducted regarding the transformations carried out (N=236).
Results and discussions. The reforms have been positively assessed by the healthcare workers interviewed. According to them, the provision and equipment of clinics with modern examination methods and equipment has improved. The reorganization has led to a better quality of medical care and accessibility at the local level, the number of beds in day hospitals has increased and the conditions of patients’ stay in medical organizations improved. Existing protocols for the provision of mental health services to the public need to be regularly updated, as most respondents indicated. Also, as mentioned by interviewees, both the psychiatric care service as a whole and psychiatric care in a hospital separately needed an increase in funding. In the course of the study, respondents noted that further modernization of the psychiatric service should primarily be carried out in the following areas: unification into a single complex of a psychoneurological dispensary and a psychiatric hospital, expansion of the volume of outpatient care, development and improvement of coordination between general somatic care and help in the “psychiatry” profile, development of medical care based on general somatic hospitals.
Conclusion. The majority of respondents positively assessed the reforms carried out in the Moscow region in the field of assistance in the profile of “psychiatry”. Further modernization of the psychiatric service should include the development and improvement of coordination between general somatic care and assistance in the “psychiatry” profile, the expansion of the volume of outpatient care, the best use of resources based on the needs of the population. -
Opinion of the parent community on the availability of pediatric otorhinolaryngological care.
The prevalence of ENT diseases in the pediatric population remains an urgent problem in practical pediatrics, otorhinolaryngology and healthcare, which is associated with their high level of occurrence in all age groups of children and the frequent development of various complications. One of the prerequisites for solving this problem is to ensure the availability of otorhinolaryngological care for children in primary health care.
The purpose of the study was to study the opinion of the parent community on the availability of otorhinolaryngological care for children aged 0 to 14 years.
Materials and methods. The study was conducted on the basis of state children’s clinics and private children’s ENT offices in the city of Ramenskoye, Moscow region in 2023; A survey of parents of children aged 0–14 years was conducted (1200 respondents). Statistical processing of the material involved processing and creating a database in electronic tables.
The results and conclusions of the analysis of a survey of the parent community showed that the general priority areas for increasing the availability of care for children for public and private health care systems are improving the organization of care, overcoming the obstacles of geographic remoteness of health care facilities, improving the level of medical information for patients, developing telemedicine technologies and the availability of allied health care specialists. -
On the Formation of Innovative lean Competence of nursing staff providing assistance to the population in the PSMP System.
Introduction. The article proposes and proves the effectiveness of a model for the formation of innovative lean competencies among nursing staff operating in an optimized healthcare environment.
Goal: to determine the effectiveness of the implementation within the framework of postgraduate training of an educational module on the formation of innovative lean competence in the professional activities of practicing nursing specialists.
Methods. The study was conducted according to a specially developed questionnaire in two stages: the first – in 2019 (before the implementation of the educational module); the second – in 2022 (evaluation of the implementation results). The analysis of the results provided for the calculation of relative values (P) and their errors (± m). The same indicators were compared in dynamics, the Student’s coefficient (t) was used to assess the reliability of the differences. The differences were considered statistically significant at p<0,05. Microsoft Office Excel and Statistica 5,0 programs were used to create an electronic database and calculate indicators.
Results. At the first stage, a high readiness of the majority of nurses for innovation was revealed, but a number of limitations for innovation were recorded: low level of computer skills, lack of necessary competencies for implementing innovations, lack of leadership qualities, search for personal gain. A strong inverse correlation was found between age and the desire to introduce innovations. The results of the second stage showed a 1,4-fold increase in the share of nursing staff who want to introduce innovations in their workplace; a 1,8-fold decrease in the proportion of people who are wary of changes in their professional activities; reducing the time spent on processing
medical documentation and increasing the amount of time allocated to working with patients. The proportion of nursing specialists using an electronic document management system in their professional activities has also increased – from 1,6% to 41,6%.
Conclusion. The effectiveness of the proposed educational module for the formation of innovative lean competence in the professional activities of nurses providing assistance to the population in the primary health care system is confirmed by the achieved positive results of its testing in healthcare institutions. -
Basic indicators of population morbidity, including prognostic ones, in assessing the reproductive potential of the region.
The article presents the results of a study conducted to study the main indicators of population morbidity from the perspective of assessing the reproductive potential of the region. Statistical, analytical, and graphological methods were used in the work. A key factor in the reproductive potential of a region is the level of health of its population, including morbidity rates. When developing measures to stimulate the birth rate, which is especially necessary for territories with the lowest rates of population reproduction, such as the Central Federal District and, in particular, the Kostroma Region, a detailed study of the regional characteristics of the health status of the population is necessary. It was determined that, according to predictive models, the incidence rate in the Kostroma region will increase from 701.1 per 1000 population in 2020 to 768.8 per 1000 population in 2025. To identify the relationship between indicators of the birth rate and morbidity in the Kostroma region for period 2010–2020 A cross-correlation analysis was carried out to reveal not only the degree and direction of the relationship between the analyzed indicators, but also the time lag. For the Kostroma region, according to the time series under consideration, no statistically significant relationship
was found between the level of fertility and morbidity. There is a slight correlation (–0.3) between the analyzed indicators for the Kostroma region with a time lag of 6 periods, but it is not statistically significant and does not allow us to draw clear conclusions. -
Incidence of acute coronary syndrome in the Russian Federation and in the Republic of Bashkortostan.
Purpose of the study. Based on an analysis of the medical and demographic situation and the incidence of acute coronary syndrome in the Russian Federation, in the federal districts and constituent entities of the Russian Federation, as well as in the pilot territory of the Republic of Bashkortostan, proposals are given for the development of management decisions at the regional and federal levels.
Materials and methods: statistical, analytical. We used statistical materials of the Federal State Statistics Service (2014–2021), statistical materials: M., TsNIIOIZ of the Ministry of Health of the Russian Federation (2023) and the Republic of Bashkortostan MIAC, Ufa (2022).
Results. The leading cause of mortality in the Republic of Belarus, as well as in the Russian Federation as a whole, is diseases of the circulatory system (CVD). In 2022, the mortality rate of the population from CVD in the Republic of Belarus was 459,5 per 100 thousand population, in the Russian Federation the figure was higher – 560,8‰oo. Fluctuations in indicators in the constituent entities of the Russian Federation are 7,6 times. The primary morbidity rate of the adult population in the Republic of Bashkortostan was BSK (2022) 4948,6‰oo.
Acute coronary syndrome (ACS) is a group of clinical symptoms or signs suggestive of acute myocardial infarction (MI) or unstable angina (UA). The primary incidence rate of the adult population of the Republic of Belarus with unstable angina pectoris was (2022) 113,8‰oo, acute myocardial infarction – 97,7‰oo, in the Russian Federation the figures are higher – 106,7 and 140,8‰oo, respectively. The difference in the incidence of myocardial infarction among the adult population in the constituent entities of the Russian Federation is 9,3 times; the difference in unstable angina is huge – 54 times, which to a certain extent indicates the ambiguity of the coding of unstable angina. The study indicates the need for an in-depth analysis of the incidence of acute coronary syndrome in the constituent entities of the Russian Federation.
Conclusions. It is necessary to develop management decisions, including improving the accessibility and quality of cardiac care to the population, including patients with acute coronary syndrome, at the regional and federal levels.
