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Manager Zdravoochranenia 2023 #2
Published: 2023-07-26
272
CONTENT OF THE ISSUE
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Periodic accreditation by order of the Ministry of Health of Russia dated 10.28.2022 No. 709n: which option of professional development is more preferable for a doctor
The article analyzes in detail the possible options for training a doctor, offered by order of the Ministry of Health of Russia dated October 28, 2022 No. 709n in order to prepare for periodic accreditation. The authors substantiate in detail that in order to pass periodic accreditation, the most high-quality, reliable, safe and least expensive training option for a doctor is the development of advanced training programs, the total development period of which is at least 144 hours over 5 years. The following are named as the main reasons for this: in the domestic legislation, advanced training of a doctor is understood exclusively as the development of relevant educational programs; due to the numerous requirements of the legislation for the content and development of educational programs, the requirements for
scientific and pedagogical personnel and for educational organizations implementing these programs, it is the development of advanced training programs that ensures the training of a specialist of the proper quality, which determines his admission to the profession; in accordance with the Labor Code of the Russian Federation, the employer is obliged to conduct additional professional education for a doctor, i. e. including to promote the training of a doctor specifically for advanced training programs. -
A new methodology of medical and legal aspects of compensation for moral damage in disputes with patients.
The authors consider the explanations of the Supreme Court of the Russian Federation contained in the new Resolution on compensation for moral damage, including items affecting compensatory aspects in the provision of medical care and harm to the health of patients.
Changes in the policy of the Supreme Court of the Russian Federation on the problem under consideration are shown.
An assessment of the possible consequences of the explanations of the Supreme Court of the Russian Federation in relation to citizens (patients) and medical organizations, prospects of law enforcement practice based on the provisions of the new Resolution is given. -
Analysis of drug supply for patients with malignant neoplasms at the inpatient stage of treatment.
Drug provision of patients with malignant neoplasms in a hospital and day hospital in the constituent entities and Federal districts of the Russian Federation has not been studied enough. Meanwhile, hundreds of billions of rubles are annually spent on the purchase of drugs for these patients. The aim of the study is to analyze the drug supply of patients with malignant neoplasms at the inpatient stage of treatment. We analyzed the purchase of medicines at the expense of compulsory medical insurance in the subjects and federal districts of the Russian Federation according to the website zakupki.gov.ru. To compare federal districts and constituent entities with each other, we compared the amounts spent on the purchase of medicines at the expense of compulsory medical insurance, in terms of 1 patient with a newly diagnosed cancer in each federal district and constituent entity, respectively. We found significant differences
in the drug treatment of patients with MN not only between the Federal Districts, but also within the Federal District. Moreover, the difference in drug provision of patients with specific drugs in the subjects reaches multiple values. Oral drugs are also used differently, with a mixed trend in the Federal Districts of their use over the past two years. Drug provision of patients with malignant neoplasms in the constituent entities of the Russian Federation at the inpatient stage of treatment varies significantly, patients have different access to drugs with oral administration. -
Actual problems of management of the radiology diagnostics service of the primary level of health care.
The main problems of the organization of the work of the radiation diagnostics service and the possibilities for their solution provided by the tools of information systems are considered. The organizational tasks that need to be provided for in the digitalization of healthcare are formulated. The analysis of changes in the organizational and managerial approach to ensuring the work of the diagnostic department is carried out. A decisive role in the development of modern healthcare is played by a systematic approach to the digitalization of the industry and the creation of digital infrastructure in accordance with current requests for operational management.
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Subsidized Pharmaceutical Provision for patients in the Federal Districts and subjects of the Russian Federation using the example of the most common diseases.
In the Russian Federation, the obligations of federal and regional authorities for Subsidized Pharmaceutical Provisionfor patients are legally defined, the issues of providing patients with drugs for the treatment of a particular nosology are analyzed with varying degree of detail, however, a comprehensive assessment of Subsidized Pharmaceutical Provision for patients with the most common diseases in the Federal Districts and federal subjects was not carried out. This was the aim of this study. We analyzed the purchase of medicines for the treatment of patients with cancer, broncho-obstructive diseases (bronchial asthma and chronic obstructive pulmonary disease) and diabetes in the Federal Districts and federal subjects of Russia though regional and federal budgeting and recalculated the total spendings per 1 patient living in the Federal District or federal subject.
We found that both the federal districts and the constituent entities differed in the budget spendings for purchase of medicines for the treatment of the analyzed nosologies. In addition, we found inconsistency in the sum of funds spent on the subsidized Pharmaceutical Provision from year to year.
The availability of medicines at the outpatient stage of treatment of cancer, broncho-obstructive diseases and diabetes mellitus differs greatly between the different Federal Districts and on the federal subject level. This creates unequal access to drug treatment for patients at the outpatient stage of treatment. Health authorities do not use a unified methodology for planning the demand of medicines at the outpatient stage of treatment, nor a unified strategy for Subsidized Pharmaceutical Provision xecution. -
Analysis of the incidence of the population older than working age in the Russian Federation and its regional features.
Objective assessment of the health status and medical care of the elderly in the context of progressive aging of the population is one of the leading health problems.
Purpose of the study. Based on the analysis of the medical and demographic situation and the incidence of the population, as well as the results of our own research, to give recommendations on the health protection of the population older than working age.
Research methods: statistical, sociological, expert assessments, direct observation. The forms of federal and sectoral statistical observation for 2018–2021 were analyzed. Results of sociological surveys of patients older than working age.
Results. Over the 10 years of analysis (2012–2021), the overall incidence rate of the entire population in Russia increased by 4,5%, the adult population – by 8,2% and the working-age population – by 1.3%, in children and adolescents the indicators decreased by 8,8 and 4,7%. The overall incidence of the population older than working age in 2021 in the Russian Federation was 209164‰00, which is 1.2 times higher than the total population (167714‰00). The difference in the general morbidity rates of the population older than working age in the federal districts of the Russian Federation was 1.3 times, in the constituent entities of the Russian Federation 2.3 times. 2020, there is a significant decline in the overall incidence rate in all age groups, which is associated with the COVID‑19 pandemic. The first detected incidence of the population older than working age (in 2021) amounted to 66183,5 per 100 thousand of the corresponding population, which is lower than the total population by 22,6% (85531,6‰00). The population older than working age has significantly higher rates of newly diagnosed morbidity than the entire population in the classes: diseases of the circulatory system by 103%, the indicators were 6191,7‰00, 3048,3‰00, respectively; neoplasms (by 66%), musculoskeletal and connective tissue (by 16%) and diseases of the endocrine system, eating disorders and metabolic disorders (by 15,6%). The results of the study should be taken into account for planning the volume
of preventive and dispensary work for people of older age groups. The article gives recommendations on the health protection of the population of pre-retirement and older working age using hospital-replacing technologies. -
Features of the structure and dynamics of morbidity rates in children and adolescents in the Republic of Azerbaijan.
Analysis of the incidence of children and adolescents in the Republic of Azerbaijan for 2014–2019 showed that the largest share in the structure of the general morbidity of children was occupied by respiratory diseases – 47,5%, certain conditions that occur in the perinatal period – 18,1%, some infectious and parasitic diseases – 9,1%, diseases of the digestive system – 8,5%, The largest increase in the level of primary morbidity in children in 2019 compared to 2014 was observed in mental and behavioral disorders – by 370,1% in the age group 0–5 years and by 208,4% in the age group 14–17 years, by 49,7% in the age group of 6–13 years; diseases of the eye and its accessory apparatus – by 41,5% in the age group of 0–5 years, by 15,2% in the age group of 14–17 years and by 13,4% in the age group of 6–13 years; neoplasms – by 28,4% in the age group of 0–5 years and 26% in the age group of 6–13 years.
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Epidemiology of tuberculosis in Russia and Rno-Alania during the COVID-19 pandemic
The study of the combination of diseases at the present stage of development of medicine is extremely relevant. Among the combined effect of various pathologies on humans and populations, two main concepts are distinguished: comorbidity (the combined effect of diseases on a patient or group), including the underlying and concomitant diseases, and syndemia (the combined effect of diseases at the population level).
P u r p o s e : to analyze the epidemiology of tuberculosis during the COVID‑19 pandemic to identify trends in Russia as a whole and in North Ossetia-Alania.
M e t h o d s : a theoretical analysis of the current research situation in Russia in relation to the tuberculosis and COVID‑19 syndemics was carried out. The data sources were annual forms of federal statistical observation.
R e s u l t s : Significant factors that slow down the dynamics of improving the epidemic situation for tuberculosis in Russia and North Ossetia-Alania are the reduction in the coverage of the population with preventive examinations for tuberculosis. In general, a clear syndemic between the epidemiology of TB and the COVID19 pandemic has not been identified both for Russia and according to the results of the analysis of statistics in RNO Alania. There are social trends to reduce the coverage of the population and belated primary treatment of patients with a general practitioner and phthisiatrician, as well as persons removed from the dispensary, so there is an increase in the proportion of severe forms of TB (with lung tissue destruction, fibrous-cavernous type).
C o n c l u s i o n s : The identified trends indicate a later appeal of patients during the pandemic and a decrease in population coverage in Russia and in the analysis of data for North Ossetia-Alania. The increase in the proportion of severe forms of tuberculosis is more likely to be associated with the above trends, and not with syndemic. Trends in the dynamics of TB indicators in Russia and North Ossetia-Alania are similar in terms of comparing negative or positive increases in indicators. -
Influence of exclavity and income level of the population on consumer preferences of patients in the market of medical services.
The article presents the results of a qualitative analysis of the influence of exclavity and the level of income of the population on the consumer preferences of patients in the medical services market using the Kaliningrad region as an example. Economic disparity in access to healthcare services contributes to the psychographic stratification of healthcare consumer preferences. Territorial isolation from the country and the proximity of foreign countries leave an imprint on the social and economic life of the population of an exclave subject and commitment to medical tourism.
M a t e r i a l s a n d m e t h o d s . In the period from September to November 2022, a one-time comparative study of consumer preferences for choosing a country and a medical organization in the medical services market of 773 working-age residents of the Russian Federation was planned and conducted. All respondents were stratified into two groups according to their place of residence: residents of the Central Federal District and the Kaliningrad Region. The groups were comparable in terms of gender and age. Methods used: open online survey, qualitative analysis, statistical. The significance of differences in the percentages of the trait was estimated by the Fisher angular transformation coefficient (φ) with a given confidence level of 95%.
R e s u l t s . The influence of exclavity and income level on consumer preferences for choosing a medical organization has been established. The features of the priority motivators for the choice of public, private or foreign medical services of the respondents of the Kaliningrad region are revealed. The comfort of receiving medical services (“lack of queues”) was 1,4 times more likely to motivate the choice of private medicine among respondents in the Kaliningrad region compared to respondents in other regions. The demand for the services of private and foreign clinics in the exclave territory is proportional to the level of income. Medical tourism services were used by 28,7% of respondents from the exclave territory who prefer private medicine.
C o n c l u s i o n . A distinctive feature of consumers of medical services in the exclave Kaliningrad region is the increase in demand for private medicine and treatment abroad in proportion to the increase in income levels. Respondents from the exclave territory are 1,4 times more likely to choose private clinics and 23,9 times more likely to use medical tourism services compared to residents of the Central Federal District. Every fourth respondent in the Kaliningrad region does not trust the quality of training of doctors in the Russian Federation. Transport accessibility of the EU countries, dissatisfaction with the level of training of medical personnel, the lack of a number of medical services in the Russian Federation, the ability to realize the desire to combine treatment with a trip abroad with a sufficient level of income of the population in the exclave region, along with a shortage of medical personnel in the subject, contribute to increasing the attractiveness of private medical organizations, import of medical services and outflow of patients abroad. Recommendations are given to increase the attractiveness of state medicine in the exclave territory. -
Issues of implementation of new special social payments to medical workers, including those working on an outpatient basis, from January 1, 2023
The article examines the mechanism of implementation of new special social benefits, which are introduced for a number of categories of medical workers from January 1, 2023.
These payments, as well as the previously existing special social benefits paid to persons providing medical care to patients with COVID‑19, will be carried out through a social fund – in this case, through the Pension and Social Insurance Fund. Such a mechanism, despite the long chain of financial flows, has its advantages, primarily concerning the possibility of personalized accounting of payments and minimizing the risks of misuse of funds.
At the same time, the implementation of special social benefits raises a number of questions concerning the payment of insurance premiums, etc., the answers to which are not always obvious, but can be obtained on the basis of consideration of the provisions of the current legislation.
