subscribe
Manager Zdravoochranenia 2023 #7
Published: 2023-12-14
616
CONTENT OF THE ISSUE
-
New rules of paid medical services: is a medical organization required to have an official website.
The Rules for the provision of paid medical services by medical organizations, approved by Government Decree No. 736 dated May 11, 2023, significantly expand the requirements that provide for an increase in the amount of information about the contractor and the paid medical services provided by him, which the medical provider must provide to the consumer. organization. Taking into account these requirements, the article considers in detail the question of whether medical organizations providing paid medical services are required to have their own official website. The authors substantiate that all medical organizations providing paid medical services, but not participating in the implementation of the State Guarantees Program, are required to post the information provided by law about themselves and about
the paid medical services they provide on the Internet. At the same time, the specified information may be posted on the official website on the Internet and (or) in other information systems on the Internet. At the same time, all medical organizations providing paid medical services must take into account the risks associated with the use of information systems owned by foreign legal entities and citizens, the use of which is subject to the prohibitions established by Part 8 of Art. 10 of the Federal Law “On Information, Information Technologies and Information Protection”. One way to account for these risks is to create or develop your own official sites on the Internet. -
On the issue of the effectiveness of the maintenance of insurance medical organizations in the healthcare system of the Russian Federation.
The problems of domestic healthcare are associated with a number of factors that are influenced by the indicators of the economic state of the country, while the main problem is insufficient funding, largely related to the participation of insurance medical organizations in healthcare. A comparison of the cost of maintaining the CFR and the Pension Fund of Russia over a long period of time clearly shows that the effectiveness of the healthcare system with the participation of the CFR is significantly less than the effectiveness of the Pension Fund.
-
The current state and prospects for the development of rural health care.
The article discusses current trends in the development of primary health care in the Russian Federation. The reasons that caused in the 90s. of the last century, the destruction of rural health care, as well as the effectiveness of restorative measures. A comparative description of the main indicators of the health of rural and urban residents is given. The mortality rate for rural residents is much higher than for urban residents with a steady upward trend. There is a disproportion between the relatively low morbidity rates of the rural population with cardiovascular and oncological pathologies and mortality from the same diseases, which may be due to insufficiently effective detection
of these categories of diseases. The concept of a geriatric contact center is proposed, aimed at eliminating the shortage of personnel and resource support for rural healthcare. -
On the issue of peculiarities of organization of preventive measures for patients with cardiovascular diseases.
The problem of prevention of chronic non-communicable diseases in Russia is particularly acute, among which diseases of the circulatory system occupy the first place, becoming widespread.
O b j e c t i v e : to analyze and study the features of the organization of preventive measures for patients with cardiovascular diseases, especially the elderly population.
M a t e r i a l s a n d m e t h o d s . For the analysis were literary sources, statistical reporting data, regulatory documents, and electronic resources. In the context of this study, such methods as: studying and generalizing experience, content analysis, a systematic approach, and statistical analysis were used.
R e s u l t s . In the framework of the study revealed a high overall and primary morbidity of BSK in older age groups, so you need to increase the interest of the population in activities of preventive medicine, in which medical services are provided free of charge; analyzed the main preventive measures in the world and the example of some of the subjects of the Russian Federation; the main role of physical activity of the population in the fight against CVD is determined; the main problems in the framework of prevention at the regional level are identified: low interest of the population in health care and low the problem of distribution of preventive measures in the framework of VHI programs is studied.
C o n c l u s i o n . Higher common and primary morbidity of CVD in elderly age groups of population requires as priority-driven active enhancement of commitment of population in effective medical prevention on the basis of free-of-charge medical care and services. The key role of physical activity of population in prevention of CVD is approved. Among regional problems of CVD prevention of priority importance are critically low commitment of population in one’s own health care and inadequate exploration of prevalence of preventive activities within the framework of implementation of VMI programs. -
Theoretical substantiation of the organization of detection of cases of tb and hiv infection in temporary issuers of territories with low population density.
Detection of cases of tuberculosis in temporary detention facilities (TDF) and police reception centers (PR) makes it possible to identify TB patients among socially vulnerable segments of the population with high efficiency; a similar result is expected for HIV infection. This is especially true for low-density entities where the population is exposed to specific risk factors. However, at present there are no calculations showing the potential effectiveness of implementing the method in them.
T h e p u r p o s e o f t h e s t u d y : to develop theoretical prerequisites for the introduction of a survey of detainees, suspects and accused in order to detect tuberculosis and HIV infection in PR and TDF.
M a t e r i a l s a n d m e t h o d s . We used information from official statistical observation to analyze the detection rate of tuberculosis and HIV in pre-trial detention centers. Information about the number of offenders according to the Ministry of Internal Affairs, and estimates of the detection of tuberculosis patients according to statistical materials. 95% confidence limits (95% CI) were used as limits for the 95% uncertainty interval.
R e s u l t s . From 2018 to 2022 2,512 newly arrested people passed through the pre-trial detention center in Petropavlovsk-Kamchatsky, among whom 94 people living with HIV were identified for the first time (detection rate is 37,4 per 1,000 examined; for comparison, in public health care – 2,1 per 1,000 examined) and 54 patients tuberculosis (detection rate is 21,5 per 1000 examined; for comparison, in public health care – 0,29 per 1000 examined). During this time, the police detained 16,282 people who, one way or another, went through the PR and IVS. Their examination would make it possible to additionally identify from 80 to 108 PLHIV and from 34 to 71 TB patients annually.
C o n c l u s i o n . Screening for the detection of tuberculosis and HIV infection in TDFs and PRs is a potentially extremely effective tool that can lead to a significant improvement in the detection of patients with socially significant infectious diseases with the potential to interrupt the infection chain among socially vulnerable part of the population. -
Organization of the educational process in improving the primary prevention of non-medical consumption of psychoactive substances by minors.
The article presents the results of an experiment conducted in teaching teenagers from among healthy individuals and at-risk groups to prevent the use of psychoactive and other non-drug drugs using a differentiated approach taking into account their metacognitive styles and information coding styles. The main goal of teaching teenagers children was to instill motivation for health-saving behavior as the main meaning of life. After the classes conducted by specially trained personnel from among teachers, narcologists, medical psychologists, nurses with specialized teenagers, positive results were noted in increasing the assessments of hygienic competence of teenagers, their
medical activity and motivation to preserve. -
Organization of preventive examinations of the adult population in the Healthy Moscow pavilions.
The value and originality of the new organizational approach implemented in the Healthy Moscow program lies in the fact that mobile pavilions have been set up as part of a large-scale preventive examination of the population in convenient location accessibility – park areas, squares and recreation areas, which makes it possible to identify not only diseases at an early stages, but also risk factors among population groups who consider themselves healthy, as well as organize targeted promotion of a healthy lifestyle. During the period of the Healthy Moscow program, more than a million citizens underwent preventive examinations in the pavilions, and to a greater extent the population that, for a number of reasons, rarely visits polyclinics and who do not have pronounced symptoms of diseases. However,
according to the results of the surveys, it was revealed that approximately 12% of the so-called healthy people have diseases. -
Organization of preventive examinations of the adult population in the Healthy Moscow pavilions.
The value and originality of the new organizational approach implemented in the Healthy Moscow program lies in the fact that mobile pavilions have been set up as part of a large-scale preventive examination of the population in convenient location accessibility – park areas, squares and recreation areas, which makes it possible to identify not only diseases at an early stages, but also risk factors among population groups who consider themselves healthy, as well as organize targeted promotion of a healthy lifestyle. During the period of the Healthy Moscow program, more than a million citizens underwent preventive examinations in the pavilions, and to a greater extent the population that, for a number of reasons, rarely visits polyclinics and who do not have pronounced symptoms of diseases. However,
according to the results of the surveys, it was revealed that approximately 12% of the so-called healthy people have diseases. -
Comparative analysis of the standards of medical care for adults in the oncology profile approved before and after 2019 for the possibility of planning a program of state guarantees.
In the healthcare system in Russian Federation, in recent decades, standards of medical care have been formed, which are tabular forms indicating medical services, medicines, medical devices implanted in the human body, blood components and clinical nutrition (components), indicating average frequency indicators.
P u r p o s e – a comparative analysis of the standards of medical care for adults in the oncology profile, approved by orders of the Ministry of Health of Russia in the period from 2012 to 2018, and the standards developed on the basis of clinical guidelines and approved in the period from 2019 to 2022, with a view to the possibility of planning a state guarantee program based on them.
M a t e r i a l s a n d m e t h o d s . The comparison was performed by comparing the standards of medical care in the context of types of medical care, the conditions for providing medical care, localizations and nosological forms according to ICD‑10 blocks, types of medical interventions and assessing consistency with planning units of the state guarantees program.
R e s u l t s . The standards of medical care in the oncology profile, approved in the period from 2012 to 2018, were developed in the context of the types of medical interventions and were not coordinated either with the planning units of the state guarantees program or with the methods of payment by diagnosis-related group. The introduction of a methodology for the formation of standards of medical care based on clinical guidelines using standardized modules of medical care made it possible to revise the principle of the formation of standards for the oncology profile and harmonize them with the planning units of the state guarantees program and methods of payment
by diagnosis-related group.
F i n d i n g s . Structuring the process of developing medical care standards based on clinical guidelines and developing a methodology for their formation makes it possible to realize the economic function of medical care standards. -
The economic effect of providing medical care using simultaneous dental implantation by one specialist.
The economic effect of the introduction of a new organizational model “dentist-implantologist-orthopedist” is considered. Optimization of work, cost savings of the Ministry of Defense and an increase in the responsibility of a dentist who owns related specialties “Orthopedic Dentistry” and “Surgical Dentistry” were obtained.
Purpose: assessment of the economic effect in the provision of medical care using simultaneous dental implantation.
Materials and methods. The study was conducted in the dental polyclinic of the AUZ UR “RSP MZ UR” of Izhevsk, Udmurt Republic.
The economic effect was assessed by comparing two models of providing medical care in orthopedic dentistry using dental implantation: the first – medical service was provided by two separate teams (1 – surgical care; 2 – orthopedic care); the second – medical service was provided by one team entitled to provide this type of care.
Results. The economic effect of providing medical care using simultaneous dental implantation by one specialist allowed to reduce the use of the area of the medical organization, the number of full-time positions of nurses and reduced the costs of the medical organization for consultation.
Conclusion. With the introduction of a new organizational model “dentist-implantologist-orthopedist”, an economic effect was obtained by reducing staff positions, reducing wage costs and rational use of MO areas. All this contributes to the optimization of the work of a medical organization, saving the Ministry of Health without reducing the quality of services provided and increasing the responsibility of one specialist for the final result of the treatment at the moment and in the future, which is one of the main factors of a value-based approach in healthcare. -
Rehabilitation and preventive measures for infectious and inflammatory diseases of the urinary system in children, considering the risk factors.
The article presents an analysis of the materials of domestic and foreign scientific articles on the issues of modern features of the prevalence of infectious and inflammatory diseases of the genitourinary system among children and rehabilitation and preventive measures, taking into account risk factors. Information on the so-called internal risk factors, such as congenital malformations of the genitourinary system and disorders of the immunological state of the body, leading to infectious and inflammatory diseases (pyelonephritis, urinary tract infections, cystitis, urethritis, asymptomatic bacteriuria, etc.) is considered in detail. The emergence, in particular, of pyelonephritis can be facilitated by late breastfeeding, early transfer to mixed and artificial feeding. The risk group also includes children born to mothers with pyelonephritis, which is associated with heredity and perinatal risk factors (complicated pregnancy in the mother, chronic intrauterine fetal hypoxia, intrauterine growth retardation). Taking into account the whole variety of risk factors will make it possible to build programs for medical and social prevention and rehabilitation for infectious and inflammatory diseases of the genitourinary system in children.
-
Review of the regulatory framework regarding the use of multifocal IOLs for cataract surgery.
Considering the increasing requirements for the quality of postoperative vision, the number of requests from patients for the implantation of a multifocal IOL is increasing, which makes it relevant to analyze the existing regulatory framework for the possibility and obligation to use this medical device in the provision of specialized medical care – surgical treatment of cataract within the framework of the state guarantees program. An analysis of the current regulatory framework showed that the existing regulatory framework allows the use of multifocal IOLs in the provision of medical services under the state guarantees program, however, it does not give the patient the right to choose, and makes considering the patient’s desire to implant this particular type of medical device is not mandatory when planning
surgery. Considering the requirements of mandatory informed voluntary consent when receiving a medical service, the patient must be informed about the implantation or refusal to implant this type of medical device when providing him with specialized medical care. Most of the analyzed medical devices – IOLs with multifocal properties – are registered in the Russian Federation as “Intraocular lens for the posterior chamber of the eye, pseudophakic”, and not “Intraocular lens for the posterior chamber of the eye, pseudophakic, with increased depth of focus”. There is both a clinical need for changes (Clinical guidelines), and an organizational need to identify a group of operations, including with the application of additional coefficients to the tariff as part of the payment for medical services included in the program of state guarantees. -
The use of artificial intelligence technologies as a way to ensure the quality of chest radiography.
When performing radiographic studies, errors may occur that reduce the diagnostic value of the radiographs and complicate their interpretation by radiologists and diagnostic software based on artificial intelligence technology. The creation of automated quality assessment systems will optimize this process, especially in conditions of increased workload of medical personnel.
Purpose: development of an automated quality control tool for chest radiographs, which allows for quality control of the patient’s positioning and the correctness of filling in meta-information about the study.
Material and methods. To train and test automated quality control models, were used 61505 chest radiographs, obtained from open datasets and the Unified Radiological Information Service of the Unified Medical Information Analysis System of the City of Moscow. To create models we used transfer training of deep neural network architectures VGG19 and ResNet152V2.
Results. 7 models were created: a model for determining the anatomical area of study, a model for determining projection, a model for determining photometric interpretation, models for determining incomplete visualization of the anatomical area on the frontal and lateral projections of the chest radiographs, a model for determining rotation on the lateral projection of the chest radiographs. All created models have diagnostic accuracy metrics above 95%, which allows them to be used in clinical practice. Based on the developed models, a web-based quality control tool of the chest radiographs was created, which allows analyzing the quality of X-ray datasets.
Conclusion. The active use of this quality control tool will optimize the process of assessing the quality of diagnostic studies and facilitate the processes of classification of studies and the formation of datasets. Also, this tool can be used to support the decision-making of an X-ray technician and assess the quality of the study before sending the study for processing to artificial intelligence-based services. -
Urban infrastructure design as a significant means of shaping public health.
The article discusses the importance of urban infrastructure design in ensuring public health.
Relevance. The growing level of urbanization of territories, the growth of cities and the formation of the urban environment currently provide relevance in the search for means to strengthen and maintain the health of the population at the proper level. One of the ways to achieve this goal is to form an eco-friendly, health-saving space that will have all the necessary resources to achieve comfort in the lives of urban residents.
The purpose of the study is to analysis of the directions and methods of creating urban infrastructure design that have an impact on environmental and health-oriented characteristics of the external environment.
The subject of the study is a health-oriented urban space.
Research methods. The analysis of scientific information on this topic, the synthesis of opinions, statistical analysis, the method of graphical data transmission is carried out.
Results. Thus, the conducted research has shown the importance of ensuring a safe urban space, eco-friendly and practical infrastructure design in ensuring public health.
Conclusions. The health-oriented characteristics of urban space are the key to the successful development of sustainable urban indicators and the full socio-economic development of our country.
The scope of the results. The results of the conducted research will be reflected in the development of such topics in the scientific healthcare system.
