Manager Zdravoochranenia 2023 #9

Published: 2023-09-22

138

CONTENT OF THE ISSUE

    Management in healthcare
  • Results of medical support of citizens’ preparation for military service in the Subject of the Russian Federation.

    The armed forces of the Russian Federation are the guarantor of ensuring the national security of our state. The importance of strengthening
    the health of citizens of military age is increasing, which are viewed from the perspective of a human resource responsible for the country’s defense capability.
    Purpose of the study is to analyze the results of medical support for the preparation of citizens for military service in the Orenburg region for the period from 2000 to 2022.
    M a t e r i a l s a n d m e t h o d s . Statistical and analytical methods were used in the study. The data of statistical collections of the Territorial Body of the Federal State Statistics Service for the Orenburg region, accounting and reporting documents of the Center for military medical expertise of the Federal State Institution «Military Commissariat of the Orenburg Region» were used.
    R e s u l t s . Over the years of the study, there has been a gradual decrease in the conscription resource (the number of young men put on military registration) by 49,2% – from 19,504 in 2000 to 9598 young men in 2022. In 2000, the fitness for military service for health reasons was 60,2%. The current situation required the adoption of managerial decisions aimed at compensating the conscription resource needed to recruit the Armed Forces of the Russian Federation in sufficient quantity by increasing the fitness of conscripts for military service.
    The promotion of a healthy lifestyle by young people, regular physical education and sports has become widespread. The result of the work done is a gradual increase in the fitness for military service, which in 2022 amounted to 76,3%.
    F i n d i n g s . The organization of medical support required interdepartmental interaction in the work of state and public organizations for timely management decisions on problematic issues. The improvement of health indicators and, as a result, an increase in the number of citizens fit for military service, contributed to the stable fulfillment of the state task of conscription of citizens for military service.

    Authors: Kalinina E. A. [5] Kuzmin S. A. [1] Izbagambetova K. A. [1] Grigorieva L. K. [1]

    Tags: conscript1 fitness for military service1 medical support2 military service1 state of health1

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  • The need to observe an individual approach when routing patients with atherosclerosis of the brachiocephalic arteries in the framework of the «Healthy Moscow» project.

    During the implementation of the program, up-to-date data were obtained on the state of the cardiovascular system, the main risk factors for stroke, especially among middle-aged able-bodied people who had a new coronavirus infection COVID‑19. An assessment was made of the dynamics of populations undergoing preventive examinations in the format of field medical care, the most common diseases, including pathologies of the BCA. A database has been created for long-term monitoring of the incidence of cardiovascular diseases in the population and the prevention of BCA pathologies and stroke.
    The routing of patients with BCA pathologies was developed based on the analysis of many years of practical experience in providing specialized medical care to patients with pathology of the precerebral arteries in medical organizations of the Moscow public health system. Routing of patients within the framework of this project, based on a specially developed methodology, an integrated approach to treatment with preliminary training of medical personnel in the ultrasound technique for measuring carotid artery stenosis according to the European ECST scale, a clear algorithm and mechanisms for working with patients within the framework of intersectoral activities, allows to reduce the incidence of stroke and mortality. Successful strategies to expand screening of patients with BCA pathology implemented in the «Healthy Moscow» project require further study to evaluate the effectiveness of specific stroke prevention mechanisms.

    Authors: Mingazova E. N. [34] Bezymyanny A. S. [4] Grinin V. M. [3] Starshinin A. V. [1]

    Tags: atherosclerosis of brachiocephalic arteries1 cancer screening1 check-up1 emias1 routing of patients1 the «healthy moscow» project1

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  • The issue of biocompatibility of ceramic implants in the provision of orthopedic care.

    When organizing orthopedic care, specialists should be aware of scientific data regarding the ability of the zirconia implant system used to osseointegrate. The biocompatibility of implants depends on various parameters such as the nature of the material, chemical composition, surface topography, chemical composition and loading, surface treatment, physical and mechanical properties. Zirconium has a high biocompatibility with soft tissues, resistance to bacterial biofilms. Zirconia implants are a promising alternative to titanium, especially for titanium allergic patients.

    Authors: Mingazova E. N. [34] Ulyanov Yu. A. [1] Zaripova E. M. [1]

    Tags: ceramic implants1 dental implantology1 orthopedic care1 zirconium dioxide1

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  • Study of emphysematous changes in the population of Moscow using automated evaluation of radiological examinations.

    Background. Emphysema, commonly seen in patients with chronic obstructive pulmonary disease (COPD), worsens the course of chronic cardiovascular and endocrine diseases and is also associated with an increased risk of lung cancer. Although the evaluation of COPD incidence is applied systematically, the prevalence of emphysema is often not known. One of the ways to offset that is automated analysis of chest CT scans using artificial intelligence technologies.
    Goal. To study the prevalence of emphysema in the population of Moscow using automated analysis of radiological examinations.
    Methods. The results of the chest CT scan of 116,216 patients were analyzed. All studies were performed between October 2022 and June 2023 in Moscow medical facilities. The Emphysema-IRA AI service (Intelligent Radiology Assistance Laboratories (AIRA Labs) LLC) used an automated mode to determine the presence of emphysematous changes in the lungs (binary classification – yes/no) and the percentage of emphysematous lesions in both lungs and each lung separately.
    Results. The prevalence of pulmonary emphysema among the Moscow population was 0.614 per 1,000 people; the prevalence of clinically significant emphysema was 0.173 per 1,000 people. The majority of individuals presented with either pulmonary or clinically significant emphysema in CT belong to the elderly group (47.0% and 55.0%, respectively); the proportion of young people is also significant (9.0% and 5.0%). Men of all age groups have a significantly higher chance to get diagnosed with emphysema which suggests a higher incidence compared to the female population (Chi-square = 1000.0; p<0.001). Regardless of gender, a 5-year increase in age elevates the likelihood of both emphysema and clinically significant emphysema by 1.1 times.
    Conclusions. Automated detection of signs of pulmonary emphysema on CT allows for a quick, population-wide, and objective assessment of the COPD prevalence. Thanks to the development of AI-based medical software, it has become possible to develop and implement ground-breaking digital technologies for healthcare management and public health studies.

    Authors: Vladzymyrskyy A. V. [4] Vasilev Y. A. [3] Arzamasov K. M. [4] Goncharova I. V. [1] Pestrenin L. D. [1]

    Tags: artificial intelligence8 computed tomography3 emphysema1 opportunistic screening1

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  • Analysis of architectural and planning solutions of polyclinics as a management tool in the implementation of lean manufacturing.

    In the clinics of the Moscow region, within the framework of the project «A new model of a medical organization providing primary medical care», there is difficulty in achieving the target indicators of the project criteria. The analysis of the architectural and planning characteristics of polyclinics that affect the achievement of the criteria of this project was carried out.
    Purpose: analysis and evaluation of the architectural and planning capabilities of polyclinics in the Moscow region for the successful implementation of lean production technologies.
    Materials and methods: 224 polyclinics of the Moscow region were included in the project, statistical reporting forms were evaluated:
    Analysis of data from the federal register of medical organizations, forms of federal statistical observation No. 30, No. 47. shortage of polyclinic capacity), depreciation of polyclinic buildings. Research methods – analytical, observation, expert, mathematical, statistical.
    Results. In the clinics of the Moscow region, there is an imbalance between the attached population and the design capacity of the clinics.
    Also, a pronounced variability in the area of polyclinics in the Moscow region was revealed, 34% of polyclinics have a shortage of space.
    The physical deterioration of buildings leads to a limitation in their operation.
    Conclusions. Polyclinics of the Moscow region differ in variability in terms of capacity, shortage or redundancy of the area of polyclinics, wear and tear of the building, architectural and planning features of polyclinics. These criteria must be taken into account when choosing projects for the most effective achievement of results.

    Authors: Aleksandrova O. Yu. [5] Orlov S. A. [5] Gorenkov R. V. [5] Kurmangulov A. A. [2] Shinkareva N. V. [1] Shinkarev S. V. [1]

    Tags: architectural planning1 polyclinics1 tools and methods of lean manufacturing in healthcare1

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  • Strategic management
  • Analysis of the effectiveness of healthcare organizations implementing the development strategy.

    The development strategy is the most well-known model implemented in various industries, including healthcare. It allows managers to make decisions and focus the efforts of employees on processes that contribute to the achievement of the long-term goals of the organization.
    However, when conducting a study of management models that affect the sustainable development of healthcare organizations, we received conflicting results. On the one hand, some healthcare organizations implementing the development strategy achieved their results within 3 years or more. On the other hand, 24,6% of healthcare organizations using this concept participated in the study, which did not achieve sustainable growth in indicators. This was the basis for the present study
    Purpose of the study is to determine and the analysis of the effectiveness of the activities of healthcare organizations implementing a development strategy.
    Materials and methods. The study of management models for the development of healthcare organizations was carried out in the period from 2012 to 2023 at the Novosibirsk State Medical University. Sociological (n=625) and expert survey (n=286) of heads of healthcare organizations was conducted in the period from 2012 to 2018.
    Results. 625 heads of healthcare organizations participated in the sociological study. Only 43,4% of respondents used a development strategy in their work.
    According to the results of the study, healthcare organizations that implement a development strategy in 100% of cases pay special attention to the implementation of an effective strategy. Plan processes in line with the organization’s strategy 34,6% more often than the average of all organizations surveyed. 1,7 times more likely to cooperate with government and scientific organizations to achieve their strategic goals. In the internal policy of the organization, they emphasize the implementation of corrective and preventive measures, and also evaluate mutual cooperation between departments.
    Findings. The results of the study show that in order to achieve strategic goals, it is necessary to involve all the main activities of a healthcare organization, which gives reason to believe that the development strategy has a positive impact on the effectiveness of the organization as a whole. However, the method under study contributes to increasing the potential for sustainable development of a healthcare organization by only 39%. And a quarter of all the studied organizations that implement a development strategy do not achieve a stable growth of indicators within 3 years. This means that the studied management model can improve the efficiency of the organization only in combination with other approaches.

    Authors: Son I. M. [41] Latukha O. A. [3] Tolstova K. S. [3] Bravve Y. I. [2]

    Tags: development of the healthcare system1 development strategy2 efficiency of healthcare organizations2 healthcare organization8 sustainable development4

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  • Population and health
  • Psoriasis: disease burden in current environment.

    Psoriasis currently is considered to be beyond the list of socially significant diseases; however, a pilot study shows that the medical, social and economic burden of the disease can be significant. The pilot study made it possible to identify the most actual research areas for assessing of disease burden indicators what is necessary for development of comprehensive multidisciplinary interdepartmental programs aimed at improving population health and reducing the medical, social and economic consequences of psoriasis.

    Authors: Kadyrov F. N. [122] Meshkov D. O. [4] Zolotarev P. N. [3] Bezmelnitsyna L. Yu. [2] Besstrashnova Y. K. [2] Lobanov A. V. [2] Cherkasov S. N. [3] Shoshmin A. V. [2] Feduaeva A. V. [1]

    Tags: chronic skin diseases1 clci1 comorbidity2 cumulative life course impairment2 disease burden2 economic disease burden1 morbidity14 prevalence7 psoriasis2 social disease burden1

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  • Assessment of the quality of life of women of different age groups according to the level of physical and functional state after surgical treatment of breast cancer.

    Purpose of the study: to assess the quality of life in terms of the level of physical and functional condition in women of different age groups who underwent radical surgery for breast cancer.
    Materials and methods. A survey was conducted using the international questionnaire FACT-G and the FACT-B module among women who underwent radical surgery for breast cancer (I–II stages). The study included women (186 people) who underwent a full course of treatment in a hospital, including chemotherapy and radiation therapy. The respondents were divided into age groups. The share of urban residents was 69,0%, rural – 31,0%. Statistical processing of the obtained data was carried out on a personal computer using the STATISTIKA.
    Results. The study of the quality of life of patients after surgical treatment for breast cancer on a scale of physical well-being revealed features in different age groups. Significant differences were noted on physical scales. With increasing age, there is a significant deterioration in the general physical status and its components. The most pronounced symptoms of negative physical well-being are typical for the age group of 41–50 years. With age (61–70 years and older), symptoms such as weakness began to appear (in 58,3% of respondents).
    More than 90% of women in this age group indicated that, due to their physical condition, it is difficult for them to help their family. With increasing age, the functional state of the organism of the respondents is characterized by a pronounced negative attitude towards life’s pleasures. The symmetrical distribution of positive and negative answers among middle-aged respondents indicates the functional instability of women. There were no significant differences in the physical and functional state of respondents from urban and rural residents.
    Conclusion. The complex of medical, social and psychological problems that lead to a deterioration in the quality of life of women who have undergone surgical treatment for breast cancer requires a comprehensive medical and social approach to the rehabilitation of this contingent, involving the participation of various specialists from medical organizations, as well as society and, of course, the family.
    Conclusions. It is necessary to monitor the quality of life of women who have undergone radical surgical treatment, not only at the stage of early rehabilitation, but also in subsequent years of life, as well as to dynamically monitor the progress and effectiveness of dispensary observation and rehabilitation of this contingent.

    Authors: Alikova Z. R. [2] Dzhioeva I. A. [2] Mamieva A. E. [1] Kozyreva F. U. [1]

    Tags: breast cancer1 physical and functional condition1 quality of life8 questionnaire2

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  • Sociology of healthcare
  • The referral of children to medical organizations as a criterion for the medical activity of parents.

    An important component of the lifestyle of the population is medical activity, which plays a significant role in maintaining and strengthening the health of not only the adult population, but also children.
    Purpose of the study: evaluation of the influence of the social characteristics of families in the Chechen Republic on the appeal of children to medical organizations.
    Materials and methods. The collections “The incidence of the Russian child population (0–14 years old) with a diagnosis established for the first time in life” of the Federal State Budgetary Educational Institution of Central Research Institute of Health and Human Health for 2017–2021 were analyzed. A subjective assessment of children’s referral to medical organizations was carried out on the basis of the results of a survey of 536 parents, which was carried out using the «Questionnaire of the parents of a child under the age of 7 years»
    in 2021 in 9 districts of the Chechen Republic. Mathematical data processing was carried out using spreadsheets of the MS Office‑2016 software package (Word, Excel) and the StatSoft-Statistica 10.0 statistical software package.
    Results. Primary morbidity, according to the data on the appealability of the children’s population of the Chechen Republic, is 3.7 times lower than the national average. The number of children in the family, the education of the parents and the financial situation of the family influence the number of children in the family. In families with 5 or more children, parents are less medically active in terms of seeking medical care than in families with 1–2 children and 3–4 children (p<0.05). Families where the mother or father have an incomplete secondary education compared to families where the father or mother has a complete secondary or higher education, including incomplete higher education, parents are significantly more likely to show less medical activity (p<0.01). Families where the funds for the normal
    material support of the child are not fully enough or not enough at all, more often do not seek medical help or seek medical help only in case of a serious illness of the child, compared with financially secure families (p <0.01). The medical activity of parents is not affected by the age of the parents, family residence in the city or countryside, whether the child is organized or not, and he is also brought up in a family where mothers work or are housewives (p> 0.05).
    Conclusion. One of the most significant subjective reasons for low attendance to medical organizations in the event of a child’s illness is the low medical activity of parents, which largely depends on the social characteristics of the family. Families with 5 children or more, families where one of the parents has an incomplete secondary education, and families with a low financial situation are more likely to show poor medical care.
    Scope of the results. Development of organizational measures aimed at improving the quality and availability of medical care in organizations of the children’s healthcare system.

    Authors: Moiseeva K.  E. [2] Yuriev V. K. [1] Mezhidov K. S. [1]

    Tags: attendance at medical organizations1 chechen republic1 children under the age of 71 medical activity of parents1 social factors2

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  • Algorithm for working with citizens’ appeals: the experience of a regional ophthalmological center.

    Relevance. At present, the institution of citizens’ appeals is a dynamically developing model of interaction between the population and state and municipal authorities, including medical organizations. In the legislation of the Russian Federation, for the purpose of a comprehensive, timely and objective procedure for considering citizens’ appeals related to receiving medical care, a three-level hierarchy of regulatory legal regulation has been formed. Determination of the officials of the organization, forms and methods of working with appeals, analysis of the results of consideration of citizens’ appeals and the introduction of measures that correct the activities of employees of a medical organization (medical and non-medical personnel), the implementation of organizational and legal changes are an indispensable element of an effective management system of a modern healthcare institution.
    The purpose of the study: аnalysis of the organization and conduct of work with citizens’ appeals related to obtaining medical care for the adult population in the field of «ophthalmology» in the regional center of the Republic of Tatarstan – the state autonomous healthcare institution «Republican Clinical Ophthalmological Hospital of the Ministry of Health of the Republic of Tatarstan named after Professor E. V. Adamyuk» (GAUZ “RKOB MH RT named after prof. E. V. Adamyuk”), and the development of measures to improve the
    efficiency of the ophthalmological clinic.
    Materials and methods. The analysis of modern requirements of normative legal acts of quality control and safety of medical activity has been carried out, the main tools used in conducting external audits in the system of compulsory medical insurance have been systematized. We used mathematical and statistical analytical methods (quantitative, comparative, structural, expert).
    Results. A routing scheme for citizens’ appeals is presented, taking into account the channels of their receipt, and an algorithm for working with written appeals sent to the regional ophthalmological center of the Republic of Tatarstan. The trend of modern feedback services with applicants is noted, characterized by the active use of new Internet resources, social networks and instant messengers, various mobile applications for registering citizens’ appeals, and «fan» distribution of complaints about the activities of a medical organization.
    According to the statistics for 2021–2022 in the structure of the reasons for written appeals of the GAUZ “RKOB MH RT named after prof.
    E. V. Adamyuk” were in the lead in requests for the provision of medical documentation, which amounted to 2021. 45,4%, 2022 – 55,9% of all received applications. In second place were issues related to the organization of medical care, the share of which amounted to 2021 in 2021. 32,5%, in 2022 – 26,3%. Requests for assistance in the provision of medical care were made in 2021. 12,1%, in 2022 – 8,4% of the total considered appeals.
    Conclusions. Based on the results of consideration of citizens’ appeals by officials of the GAUZ “RKOB MH RT named after prof.
    E. V. Adamyuka, managerial decisions are made to increase the satisfaction of the adult population of the Republic of Tatarstan with the quality and availability of medical care in the field of ophthalmology, including changes in the organization of the clinic, the implementation of measures that correct the activities of medical and non-medical personnel.

    Authors: Khusainova D. K. [4] Zigangareeva G. G. [4] Koroleva O. I. [3]

    Tags: algorithm for working with appeals1 appeals of citizens1 internal quality control and safety of medical activities2 management of a medical organization2

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  • Self-assessment of reproductive health by future doctors.

    The reproductive health of the younger generation is of particular medical and social importance. The state of health of today’s youth, their reproductive potential and attitudes will be reflected in the demographic situation of Russia’s future. To maintain and improve the reproductive health of young people, a whole range of medical measures is being implemented. Of interest is the state of reproductive health of future doctors who receive a comprehensive education in the field of health care and have the highest level of knowledge about risk factors and health-saving technologies.
    T h e p u r p o s e o f t h e s t u d y : to analyze the responses of medical students to assess their reproductive health and commitment to maintaining it.
    M a t e r i a l s a n d m e t h o d s . An anonymous survey of 460 medical students studying at medical universities in St. Petersburg was conducted (September-October 2022). Methods of analytical and descriptive statistics were used.
    R e s u l t s . There is a low effectiveness of activities to inform adolescents about sexual education and reproductive health. Most students do not consider their own health as a priority for the coming years, give a low assessment of their physical condition, rarely go in for sports or do not do it at all, every second eats irregularly. A third of young people suffer from acute and chronic extragenital diseases, and every fifth has a pathology of the reproductive system. 72.6% of girls and only 21.4% of boys visit a gynecologist/urologist/andrologist at least once a year, more often for preventive purposes. During sexual intercourse, respondents prefer barrier contraceptives that meet the requirements of availability, reliability and ease of use.
    C o n c l u s i o n s . When developing strategies for improving and maintaining reproductive health, gender differences, medical and social characteristics and motivation of young people should be taken into account. To improve reproductive health-saving behavior, it is necessary to increase the availability of preventive measures, incl. anonymous counseling.

    Authors: Sokolova V. V. [3] Kokushin D. N. [1] Kirilenko V. V. [1] Zhgulyova A. A. [1] Kuzmin A. N. [2]

    Tags: factors4 generations2 nurses8 prevention24 professional burnout3

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  • Digital healthcare
  • Digital transformation in primary health care and data-driven management.

    In the contemporary healthcare context, there exists a necessity to optimize the organization and management of patient diagnosis, routing, and treatment, especially within the primary care sector. Within this scope, digital transformation assumes a pivotal role, offering novel avenues for enhancing the quality of medical assistance.
    Research Objective: This study aims to identify the fundamental issues pertaining to the organization and management of patient diagnosis, routing, and treatment within the primary care sector. Furthermore, the study seeks to formulate recommendations for addressing these challenges through the avenue of digital transformation.
    Materials and methods. The study was conducted through the utilization of comparative analysis employing synthesis, analysis, modeling, and specialization methodologies. Data were acquired through a specially developed questionnaire encompassing inquiries regarding healthcare process organization and management.
    Discussion and results. The outcomes of the investigation elucidate notable disparities between the organization and management of healthcare processes within the primary care sector and the inpatient setting. Notably, the application of digital technologies is underscored for its capacity to enhance patient-physician communication, reduce transactional overheads, and facilitate the effective collection and analysis of health-related data.
    Conclusion. The significance of digital transformation is underscored in enhancing patient satisfaction with medical care, optimizing processes, and elevating the quality of medical assistance within the primary care domain.

    Authors: Tyurganov A. G. [2] Khanov A. M. [2]

    Tags: diagnosis3 digital transformation3 healthcare management6 medical care quality2 primary care2 process organization2 routing3 treatment4

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  • Digital transformation in primary health care and data-driven management.

    In the contemporary healthcare context, there exists a necessity to optimize the organization and management of patient diagnosis, routing, and treatment, especially within the primary care sector. Within this scope, digital transformation assumes a pivotal role, offering novel avenues for enhancing the quality of medical assistance.
    Research Objective: This study aims to identify the fundamental issues pertaining to the organization and management of patient diagnosis, routing, and treatment within the primary care sector. Furthermore, the study seeks to formulate recommendations for addressing these challenges through the avenue of digital transformation.
    Materials and methods. The study was conducted through the utilization of comparative analysis employing synthesis, analysis, modeling, and specialization methodologies. Data were acquired through a specially developed questionnaire encompassing inquiries regarding healthcare process organization and management.
    Discussion and results. The outcomes of the investigation elucidate notable disparities between the organization and management of healthcare processes within the primary care sector and the inpatient setting. Notably, the application of digital technologies is underscored for its capacity to enhance patient-physician communication, reduce transactional overheads, and facilitate the effective collection and analysis of health-related data.
    Conclusion. The significance of digital transformation is underscored in enhancing patient satisfaction with medical care, optimizing processes, and elevating the quality of medical assistance within the primary care domain.

    Authors: Tyurganov A. G. [2] Khanov A. M. [2]

    Tags: diagnosis3 digital transformation3 healthcare management6 medical care quality2 primary care2 process organization2 routing3 treatment4

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