Management in health care
  • 2020 № 2 Evaluation of the organization and transport accessibility of medical care to rural residents

    The basis of the study was the Orenburg region. According to the MIAC health care in the Orenburg region
    in 2015, the number of rural settlements was 1036, and the number of FAPs was 945. Sociological studies were conducted
    in three pilot rural areas with different populations and distances from the regional center: Abdulinsky, Orenburg, Svetlinsky.
    The total number of adults in the three districts is 19,356. The results of a sociological survey indicate a low availability of medical assistance to rural residents, the lack of a preventive focus among doctors on the prevention of exacerbations of chronic pathology, primarily of villagers living in localities attached to FAP. The need to improve the organizational forms of the work of medical organizations in the countryside, the development of mobile field complexes and general medical (family) practices, the development of medical and social assistance in rural areas is determined.

    Authors: Kalininskaya A. A. [15] Sulkina F. A. [3] Muftakhova A. V. [2] Bayanova N. A. [4] Kizeev M. V. [6]

    Tags: access to medical care1 first-aid station (fap)1 medical organization (md)1 regional hospital (rb)1 rural medical ambulance station (ias)1 rural residents2

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  • Management in healthcare
  • 2023 № 3 Scientific substantiation of proposals for improving medical care for villagers.

    P u r p o s e o f t h e s t u d y : based on the analysis of the medical and demographic situation and the staffing of the rural population, develop proposals for improving medical care for the villagers.
    M a t e r i a l s a n d m e t h o d s : statistical, analytical, direct observation. The article used the forms of state statistical observation of the Ministry of Health of the Russian Federation. The results of the actual research.
    Materials and methods: statistical, analytical, direct observation, the forms of state statistical observation of the Ministry of Health of the Russian Federation were used.
    R e s u l t s . The rural population in the Russian Federation (2021) is 36,9 million people (25,2% of the country’s population). The proportion of the rural population of working age was 53,8%, which is lower than in Russia as a whole – 56%. A 21-year analysis showed that the birth rate of the rural population increased until 2012, while mortality rates decreased, in 2013 the mortality and birth rates became equal and amounted to 14,5‰ each, in 2020 the death rate increased to 15,4‰ due to the COVID‑19 pandemic. The average (expected) life expectancy of the rural population (70,7 years) is lower than that of the urban population (71,8 years); the indicator for rural men is extremely low (66 years). The
    overall incidence of the rural population is 1,4 times lower than that of the urban population, 117993,2 and 166901,5‰oo respectively. Primary morbidity is also 1,5 times lower (55082,4 and 83002,2‰oo, respectively). The difference in primary morbidity rates of the rural population in the federal districts (2020) was 1,3 times, in the constituent entities – 8,3 times. The incidence of COVID‑19 in the rural adult population (2020) was 1986,0‰oo, which is 2 times lower than in the Russian Federation as a whole (3913.9‰oo). There was a significant difference in these indicators (by 59 times) in the subjects of the Russian Federation, which can be associated with a lower density of the rural population,
    low availability of medical care in the countryside, as well as the ambiguity of COVID‑19 coding. For 6 years (2016–2021), the provision of doctors in medical organizations in rural areas in the Russian Federation decreased from 14,8 to 13,6‰o, and of nurses – from 54,6 to 49,3‰o. The number of nursing staff individuals working for feldsher-obstetric station decreased by 12,5%, paramedics – by 9,4%. Given the special importance of paramedical assistance in the countryside, the reduction in the number of paramedics should be considered a negative.
    C o n c l u s i o n . The unfavorable medical and demographic situation in the countryside requires the development of organizational and managerial decisions aimed at increasing the availability of medical care to the villagers.
    C o n c l u s i o n s . Proposals have been developed to improve the provision of medical care to the population of rural areas.

    Authors: Kalininskaya A. A. [15] Lazarev A. V. [6] Shlyafer S. I. [5] Kizeev M. V. [6] Bakirova E. A. [5] Balzamova L. A. [3]

    Tags: covid-1928 doctors7 medical and demographic situation4 medical organizations23 medical personnel7 morbidity (general2 mortality21 paramedic3 primary health care21 primary pre-medical health care1 primary)2 rural population5

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  • 2023 № 2 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.

    Authors: Kalininskaya A. A. [15] Lazarev A. V. [6] Kizeev M. V. [6] Vasiliev M. D. [3] Smirnov A. A. [1]

    Tags: day hospital (ds)3 general morbidity4 health protection4 people older than working age2 primary morbidity5 regional peculiarities1 round-the clock stay hospital (skp)1

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  • POPULATION HEALTH
  • 2023 № 1 Medical and demographic indicators of the population older than working age in the conditions of pension reform in the Russian Federation

    Purpose of the study. Based on the study of medical and demographic indicators and analysis of the incidence of the population, develop recommendations for the health protection of the population older than working age in the context of the transition to pension reform.
    Materials and methods: sociological, statistical, direct observation. The materials of the Federal State Statistics Service and statistical materials of the TsNIIOIZ of the Ministry of Health of Russia for 2012–2021 were used.
    Results. The mortality rate of the population older than working age in the Russian Federation (2020) amounted to 4408,1‰oo, the total population – 1460,2‰oo, in the federal districts of the Russian Federation the indicators fluctuated 1,2 times: from 3818,7‰oo in the North- Caucasian Federal District to 4638,6‰oo in the Volga Federal District, in the subjects of the Russian Federation the difference is 3 times. The indicator of primary morbidity of the studied contingent in the Russian Federation (2020) was 57041,4‰oo, in the Federal District the difference in indicators is 1,25 times, in the constituent entities of the Russian Federation – 3,9 times. The incidence of COVID‑19 in 2020 was 4373,9‰oo, in the Federal District the difference in indicators is 2,2 times, in the subjects of the Russian Federation it is large – 10,6 times, which allows us to conclude that the coding of COVID‑19 is ambiguous. Comparative analysis of the primary incidence of the study population by disease classes in 2019 and 2020 showed an increase in the indicator by 8,9% due to respiratory diseases by 40,8%, the incidence of COVID‑19 in 2020 was 4357,6‰oo. In all other classes, the indicators decreased as a result of a decrease in dispensary and preventive work. During the period of analysis in people older than working age, the increase in the primary morbidity rate is higher – 8,9% than in the total population – 5,7%, which indicates the need to strengthen dispensary and preventive work with the older population. The article gives recommendations on the health protection of the population older than working age.

    Authors: Kalininskaya A. A. [15] Lazarev A. V. [6] Kizeev M. V. [6] Vasiliev M. D. [3]

    Tags: age groups1 constituent entities of the russian federation (rf)1 federal districts (fd)1 health protection4 medical and demographic situation4 mortality21 population older than working age1 primary morbidity5 ranking1

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  • 2022 № 7 Analysis of morbidity and staffing of the population of rural areas in the Russian Federation

    Rural health care is the most important socio-economic resource in the system of the agrarian economy.
    Purpose of the study. Based on medical and demographic indicators and analysis of morbidity and staffing of the rural population, develop proposals for improving the organization of medical care for rural residents.
    M a t e r i a l s a n d m e t h o d s : analytical, statistical, direct observation. The article used the forms of federal statistical observation of the Ministry of Health of the Russian Federation.
    R e s u l t s . The mortality rate of the rural population over the 20 years of analysis for all the years has been and remains higher than that of the urban population. In 2020, there was a sharp increase in the mortality of the population: urban – from 11,9 to 14,3‰, rural – from 13,3 to 15,4‰, which is associated with the COVID‑19 pandemic. The indicators of the general and newly diagnosed morbidity of the rural population are lower than those of the urban population, which is associated with the low availability of medical care to the rural population.
    The ranking of indicators of the general incidence of the rural population in the federal districts of the Russian Federation (2020) showed that the difference in indicators was 1,5 times. The highest indicator was noted in the Volga Federal District – 142220,6‰00, the lowest in the Far Eastern Federal District – 96922,8‰00. In the subjects of the Russian Federation, the difference in indicators is 8 times. Lower rates of primary morbidity in the rural population than in the urban population were noted for all classes of diseases. The incidence of COVID‑19 among rural residents was 2151,9‰00, lower than in urban areas – 4539,5‰00, in the Russian Federation the figure was 3384,5‰00. In 2020, the primary morbidity rate of the rural population decreased for all classes of diseases, except for respiratory diseases. In dynamics (2014–2020), the provision of medical organizations located in rural areas increased with doctors from 12,1 to 14,0‰0, with nurses from 44,4 to 50,3‰0, the number of physical EMS persons decreased by 14,8%, paramedics – by 11,6%, the number of FAPs and AFs decreased by 8,9%. The analysis shows that the Decree of the Government of the Russian Federation dated 02.02.2015 No. 151-r “Target indicators of the strategy for sustainable development of rural areas of the Russian Federation for the period up to 2030” is not being implemented.
    C o n c l u s i o n . Proposals for providing medical care to the population of rural areas are presented

    Authors: Kalininskaya A. A. [15] Lazarev A. V. [6] Shlyafer S. I. [5] Kizeev M. V. [6] Bakirova E. A. [5]

    Tags: covid-1928 doctors7 medical and demographic situation4 morbidity (general2 mortality21 paramedic3 primary health care (phc)2 primary premedical health care (pfmsp)1 primary)2 rural population5 staffing11

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  • Public health
  • 2022 № 3 Assessment of preventable health losses in the rural population

    Relevance. The protection of the health of the rural population is especially significant due to the fact that medical and social health problems are maximally concentrated in rural areas. The priorities in the organization of medical care for rural residents are currently the effective use of available health care resources, as well as increasing the availability and quality of medical care. The tasks of the federal and municipal authorities should be to provide software support, resources, as well as the practical solution of strategic problems in rural areas.
    The purpose of the study: development and testing of an automated system of information support for managerial decision-making using estimates of preventable losses in the health of the population of rural areas.
    The base of the study was the Orenburg region. The share of the rural population in the region is 40.1%, there are 35 rural territories (districts) in the region.
    Methodology. The following research methods were used: statistical, analytical, expert assessments.
    The preventable loss of health of the population of rural areas in the Orenburg region was assessed by experts according to the methodology developed by us. Four indicators of the likely preventability of health losses in the rural population were identified: health indicators; territorial availability of medical care; personnel; social well-being of the population.
    The results of the study were used as the basis for the methodological support of an automated information system for supporting managerial decision-making in the organization of primary health care in rural areas of the Orenburg region.
    The use of a software product of information support for managerial decision-making makes it possible to determine priorities for making strategic decisions at the level of heads of medical organizations, health authorities and institutions, as well as heads of administration in a constituent entity of the Russian Federation. The information is presented on the web page of the administrative territory and the administrative apparatus.

    Authors: Kalininskaya A. A. [15] Bayanova N. A. [4] Kizeev M. V. [6] Balzamova L. A. [3]

    Tags: health4 information system3 management decisions1 personnel4 rural population5 rural territories1 territorial accessibility of medical care1

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