Articles from rubric: «Management in healthcare»

  • 2023 № 1 The state and prospects of the hematological service of the subjects Central Federal District of the Russian Federation

    Improving the quality of medical care is one of the priority objectives of the state policy, for the solution of which the resources of the national project «Healthcare» and its constituent federal projects are used.
    Purpose of the study is the development of high-cost, resource-intensive and socially significant healthcare industry, such as the Hematology service. The aim of this study was to assess the organization and state of the Hematology service in the Central Federal District (CFD) of Russia – the leader both in terms of population and in terms of the number of subjects included in it – which is necessary to develop organizational and methodological measures aimed at its improvement.
    Materials and methods. Official statistical data and analytical materials of Federal State Statistics Service, the Cancer Registry, open sources of information, data from check-out work of the National Medical Research Center for Hematology in СFD. Statistical data analyzed with the Excel‑2007 package. The main research methods: study and generalization of the available information, informationanalytical, statistical, bibliographic.
    Results. The analysis of the performance indicators of Hematology in the CFD identified its main components, taken together of which it is possible to assess the quality of the organization of the provision of specialized medical care with subsequent rating, and made it possible to identify key points for further improvement of the hematological service. Conclusions. The results of the study indicate the need for constant monitoring of the main indicators of the Hematology service (staffing, bed fund, availability of specialized high-tech research methods for the blood system diseases), taking into account certain directions and the course of the state policy pursued in this direction.

    Authors: Maloletkina E. S. [1] Lazareva O. V. [1] Tsyba N. N. [1] Shvets D. A. [1] Dvirnyk V. N. [1] Parovichnikova E. N. [1]

    Tags: assessment of the quality of hematological care1 check-out work1 hematological service infrastructure1 hematology1 the hematology service1

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  • 2023 № 1 Review of the work of the state dental service of the Tver region in 2021

    Taking care of the health of the population of the Tver region is an important direction of social regional policy. The main task of the dental service of the Tver region is to preserve and strengthen the health of the citizens of the Tver region, to increase the role of preventive care of dental diseases, to form a model of organization of the dental industry that ensures the availability and quality of dental care, to increase the efficiency of dental services, the volume, types and quality of which should correspond to the level of morbidity and the needs of the population, advanced achievements of medical science. The aim of the research is the analysis of the statistical data of the stomatological service of the state public health institutions of the Tver region.
    Materials and methods. Analysis of the statistical data reflecting demographic indexes, statistics of the stomatological service structure, staffing, distribution of dentists among the institutions of the Tver region, quality of dental care, the main indexes of the stomatological service of the Tver region, indexes of treatment and preventive work.
    Results. The present study is devoted to the analysis of the activity of state medical institutions of health care of the Tver region that provide dental care to the population of the Tver region. The indices of the provision of dentists in this region (not taking into account orthopedists and orthodontists) makes 3,82 posts for 10 thousand population (426,25 rates in total). Indicators of provision of the region’s population with dentists are 4,3 positions per adult population of the region. The deficit specialties have been revealed: pediatric dentists, orthodontists, in the regional institutions there is a shortage of orthopedists. The share of occupied staff positions in the specialty of pediatric dentistry was 49%, which reflects the need for training in this area. The difficulties in the organization of preventive examinations of the
    children’s population were revealed, and the low percentage of the examined persons.
    Conclusions. The municipal, district and regional medical institutions of health care rendering dental treatment to the population are functioning on the territory of the city of Tver and the Tver region in general. The statistical analysis has revealed a number of difficulties that require further action on the part of the medical community and public organizations. It is necessary to develop comprehensive measures to solve the shortage of pediatric dentists at the level of the Ministry of Health and educational institutions. The difficulties of preventive examinations among the population of different groups are highlighted. It is important to strengthen the preventive profile in order to reduce the cases of complicated caries, tooth extraction. Development of hygienic direction will increase awareness of the population
    about the peculiarities of dental and oral hygiene, methods of prevention and treatment of dental diseases.

    Authors: Konovalov O. E. [2] Morozov A. M. [4] Zhukov S. V. [4] Zhukova K. V. [1] Gavrilova O. A. [1]

    Tags: accessibility1 compulsory health insurance16 dental care1 dental diseases1 dental service1 health promotion2 qualification of doctors1 quality4 quality expertise1

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  • 2023 № 1 Awareness of the population about primary prevention of cervical cancer

    A proven effective preventive measure against cervical cancer is a full-fledged HPV vaccination course conducted before the start of the patient’s sexual life. Its cost is essential for the realization of the possibility of using the vaccine on a voluntary basis. However, the most important argument for making a decision about vaccination is the awareness of patients about its expediency, effectiveness and safety.
    P u r p o s e : to identify the level of awareness of the population about the primary prevention of cervical cancer by vaccination against HPV.
    M a t e r i a l s a n d m e t h o d s . According to a specially developed questionnaire, an anonymous survey of adolescents and their parents (legal representatives) on the organization of HPV vaccination was conducted. The quota sample for the survey included 723 respondents who applied to women’s consultations and children’s polyclinics in St. Petersburg (a total of 19 medical organizations).
    R e s u l t s . In fact, only 59,7% of respondents are informed about diseases caused by HPV, and another 5,1% of those who took part in the survey are mistaken about this. Only one in three (36,4%) respondents know about the safety of currently used vaccines, and the majority of respondents – 50,8% noted that they do not know anything about this issue.
    Among the respondents, 87,8% indicated that given the high importance of vaccination to prevent the development of oncological diseases of the female genital area, HPV vaccinations should be carried out free of charge to citizens within the framework of the National Vaccination Calendar and the calendar of preventive vaccinations for epidemic indications.
    F i n d i n g s . A sociological study showed an unsatisfactory level of knowledge of the population on the issues of primary prevention of malignant neoplasms of the female genital organs.

    Authors: Starodubov V. I. [36] Chernobrovkina A. E. [1] Belkina N. N. [1]

    Tags: cervical cancer1 malignant neoplasms of female genital organs1 public awareness2 vaccination against human papillomavirus1

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  • 2023 № 1 Problems of organization of outpatient care for patients with carpal tunnel syndrome

    Peripheral nerve diseases occupy an important place in the structure of morbidity, accompanied by temporary disability and invalidation of the population. In addition, these diseases lead to an increase in the citizens’ and state’s expenditure for maintaining health and active lifestyle.
    P u r p o s e of the study is to analyze and evaluate the routing of patients with carpal tunnel syndrome, formulate proposals for its improvement.
    M a t e r i a l s a n d m e t h o d s . The study used the following methods: analytical, expert assessments of medical organization employees who provide care to patients with diseases of the peripheral nervous system. The analysis of medical documentation of S. P. Botkin City Clinical Hospital have been carried out. The object of the study were patients treated in this hospital from 2007 to 2021.
    R e s u l t s . Analyzing the routing stages of a patient with carpal tunnel syndrome, attention is drawn to the violation of the priority of the patient’s interests not only within the rational use of his time, but also the duration of neuropathic pain syndrome. The timeframes of medical care are violated. In addition, in conditions of limited resources and lean production, budgetary funds are unreasonably spent on the examination of the patient.
    F i n d i n g s . Optimization of routing of patients with this pathology will contribute to the timely provision of high-quality medical care, which will reduce the time of temporary disability and avoid invalidation of population.

    Authors: Boyko Yu. P. [1] Fedyakov A. G. [1] Shcherbin A. V. [1] Razin M. A. [1]

    Tags: carpal tunnel syndrome1 outpatient care6 patient-oriented healthcare model1

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  • 2022
  • 2022 № 10 Features of the organization of work of paramedical personnel of emergency medical care in the conditions of COVID‑19

    In recent years, the ambulance service in our country has been undergoing changes in the direction of reducing the number of stations, medical personnel, as well as persons who have been assisted on trips, which has increased the burden on this healthcare sector in the context of the spread of a new coronavirus infection.
    The purpose of the study is to develop proposals to improve the organization of the work of the ЕMС in the conditions of the spread of a new coronavirus infection.
    Materials and methods. To study the organization of work, information was copied from call cards (n=134 before the
    pandemic, during the pandemic n=2058), the study of the frequency and validity of ЕMС calls was carried out using a developed questionnaire.
    Statistical processing of the material was carried out using the Statistika 10.0 software package. Statistical differences were considered significant at p<0.05.
    Results and discussions. It was found that in the conditions of the spread of a new coronavirus infection, the number of calls and the time spent on their full processing increased, and factors affecting the duration of the call were also identified. In addition, an increase in the number of unreasonable calls was detected and their causes were determined.
    Findings. The developed proposals for improving the work of the ЕMС will reduce time losses when making a call and increase public awareness of the reasons for calling an ambulance

    Authors: Noskova V.  A. [2] Snegireva A. S. [1] Pozdeyeva T. V. [1]

    Tags: ambulance2 call waiting time1 covid-1924 new coronavirus infection2 nursing  staff4 paramedic2 public awareness2 unreasonable call1

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  • 2022 № 9 The evaluation of the provision of specialized medical care to patients with COVID‑19 in the conditions of the central district hospital

    Planning and managing the activities of a medical organization in the context of a biological challenge associated with the spread of a new coronavirus infection (COVID‑19) is an urgent task for the healthcare system, determining the possibilities of its functioning in the conditions of transformation and re-profiling of the bed fund, mobilization of human, material and technical resources. Based on the results of assessing the parameters of the activities of a medical organization, it is possible to systematize and streamline the work of its structural divisions.
    P u r p o s e of the study is to determine the optimal burden on medical workers, to establish factors that affect the duration of hospitalization and determining the outcomes of the disease among patients with COVID‑19.
    M a t e r i a l s a n d m e t h o d s . The retrospective continuous study of hospitalizations of 7576 patients was planned and conducted with an analysis of the duration of hospitalization, the dependence of the results of hospitalization on gender and age, as well as the impact on this indicator of the severity of the disease (using Pearson’s linear correlation coefficient (r-Pearson)) and analysis of survival by evaluating Kaplan-Meier.
    R e s u l t s . The results of the analysis showed that the average number of patients per doctor per month was 28,23 ± 13,27 patients [IQR: 16,93; 41,25]. The dependence of the duration of hospitalization on sex and age showed the absence of statistical significance between these indicators (r-Pearson = 0,079; p < 0,001). The dependence of the duration of hospitalization on the severity of the course of the disease showed no statistical significance between these indicators (r-Pearson = 0,04; p < 0,001). The risk of death was increased with the length of hospitalization.
    C o n c l u s i o n . The results of study are relevant for public health specialists who plan the resources of medical organizations and assess the possibilities of using the bed fund.

    Authors: Aleksandrova O. Yu. [4] Orlov S. A. [3] Lisovskii D. A. [2] Gorenkov R. V. [2] Livshitz S. A. [2] Tikhonova E. V. [2]

    Tags: covid-1924 hospital workload2 length of stay2 resources of a medical organization1

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  • 2022 № 9 Features of national account of donor platelets collection

    Based on the analysis of the practice of collection and the volume of units of donor red blood cells, plasma and cryoprecipitate in 13 Russian blood service organizations, it was established:
    - volumes of units of 9 received types of erythrocytes differ significantly: H-test of Kruskal-Wallis – 32,071 with a critical value of 15,507 (p < 0,001);
    - the volume of red blood cells suspension exceeds the volume of red blood cells suspension mass by 28,8% (p = 0,004);
    - removal of the buffy-coat reduces the volume of red blood cells suspension suspension – by 14,8% (p = 0,002);
    - leukodepletion does not reduce the volume of red blood cells suspension and mass;
    - the volume of washed red blood cells is the most variable (median absolute deviation = 33), since it is determined by an arbitrary amount of saline added to the final product;
    - pathogen inactivation does not affect the plasma volume, which allows us to recommend the production of pathogen-reduced cryoprecipitate;
    - there is no unequivocal qualification of cryosupernatant plasma as a therapeutic product or a vastage in cryoprecipitate production (out of 12 organizations collected cryoprecipitate, 5 indicated the preparation of cryosupernatant plasma);
    - 3 out of 13 participants in the study have already implemented the production of pooled cryoprecipitate – a technology that significantly reduces labor costs and 92% – unproductive consumption of the medical product (p < 0,001);
    - the current system for accounting for the volume of red blood cells and plasma collection does not allow estimating the number of prepared therapeutic units;
    - it is proposed to account donor red blood cells, plasma for transfusion and cryoprecipitate in units, and plasma for the production of medicines – in liters.

    Authors: Zhiburt E. B. [15] Averyanov E. G. [6] Shestakov E. A. [6] Pokhabov D. S. [1]

    Tags: account2 blood8 blood collection5 plasma3 red blood cells3 unit4 volume4

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  • 2022 № 9 Identification of directions for improving the quality of medical services using SERVQUAL and IPA techniques

    Assessing patients’ expectations and perceptions of health care delivery is challenging. To understand the quality of health care delivery, a study was conducted related to how patients assess the expected and perceived quality of health care delivery in a district hospital. Modern methods of measuring patient satisfaction and its interpretation using statistical analysis methods allow solving problems of this type.
    P u r p o s e : development of approach to improvement of quality of medical services provision using results of measurement of satisfaction with quality of medical services provided to patients in inpatient conditions of regional level, using SERVQUAL technique; substantiation on built regression model of influence of certain aspects of patients’ perception of quality satisfaction.
    M a t e r i a l s a n d m e t h o d s . The materials of the study are presented in the form of the results of a medical and sociological study of 418 patients who received medical services in one of the medical organizations at the regional level. Methods of statistical analysis of patient questionnaire results, factor, regression analysis, Importance-Performance Analysis (IPA) were used.
    R e s u l t s . An analysis of the data showed that 54.3% of patients were quite satisfied with the services. A regression equation is constructed to calculate the degree of patient satisfaction depending on a number of aspects of health care delivery. According to the IPA method, a schedule of four-quadrant distributions of patient assessments has been drawn up, on the basis of which it is possible to form measures to increase patient satisfaction with medical services.
    F i n d i n g s . The use of the SERVQUAL technique allows you to measure satisfaction with the quality of medical services, and the use of the IPA technique allows you to interpret it and obtain useful information regarding the quality of medical services as an element of patient feedback in the quality management system of a medical organization

    Authors: Isaenkova E. A. [2]

    Tags: importance-performance analysis (ipa) technique1 medical organization50 patient satisfaction5 quality of services1 servqual technique1

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  • 2022 № 9 The role of naming in healthcare. From a psychiatric hospital to a mental health center.

    An urgent issue today is to increase the confidence of citizens in the healthcare system. Moreover, the issue of trust is of particular importance in the provision of psychiatric care, due to the high level of stigmatization of this area of medicine.
    The purpose of the study was to assess the significance for patients of the names of medical organizations in the profile of «psychiatry».
    Materials and methods. In 2021 Kirov Regional Clinical Psychiatric Hospital named after Academician V.M. Bekhterev changed its name and became the Center for Psychiatry and Mental Health Academician V.M. Bekhterev. A survey was conducted of 216 patients who applied or are undergoing treatment at the Center of Psychiatry and Mental Health named after Academician V.M.
    Bekhterev, using a specially designed questionnaire consisting of 24 questions. The results obtained were statistically processed.
    Results. A large proportion of the respondents had one or another mental disorder, and more than half are worried because of this, to one degree or another. One-fifth of the respondents indicate that their rights were violated due to their mental disorders.
    All this points to the problems that exist to this day associated with the stigmatization of patients with mental disorders, as well as the stigmatization of the psychiatric service itself. 43% of respondents noted that the name of a medical organization has an impact on their trust in a medical organization. The patients surveyed gave the highest rating to the name «Mental Health Center».
    Conclusions. Thus, the name of a medical organization directly affects the trust of patients in it. In addition, the name also affects the subjective assessment of the quality of medical care provided in a medical organization.

    Authors: Neznanov N. G. [1] Kochorova L. V. [1] Skripov V. S. [1] Nabatov I. F. [1] Martovetskaya G. A. [1]

    Tags: branding in healthcare1 name of a medical organization1 naming1 patient survey2 quality of medical care19

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  • 2022 № 8 Multifactorial assessment of the capacity of the laboratory service of the region in the diagnosis of COVID‑19

    The ubiquity of the new coronavirus infection contributed to the mobilization of all authorities, and a colossal burden fell on the health care system. An important stage in patient management is timely laboratory diagnostics, which allows you to adequately carry out medical and diagnostic, anti-epidemic and preventive measures. The integral indicator characterizing the readiness of the laboratory service to diagnose a new coronavirus infection is the capacity of the laboratory service. The material and technical base, personnel resources, labor organization, informatization exert their influence on the maximum design capacity of the laboratory, the current real productivity of the laboratory, the operational productivity of the laboratory. It was revealed that significant factors affecting the laboratory activity are the number of personnel, the presence of automatic nucleic acid isolation stations, and the number of amplifiers. Timely integrated material and technical support, qualified personnel are the basis for successful solution of the assigned tasks of laboratory diagnostics.

    Authors: Bilalov F. S. [3] Ismagilov R. R. [1] Gil’manov A. Zh. [1] Enikeeva D. R. [2]

    Tags: activities2 covid‑19 diagnostics1 labor organization.3 laboratory capacity1 material and technical equipment1 personnel resources1

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  • 2022 № 8 Self-assessment of health and conditions for receiving medical care by residents of the Russian Federation

    In the context of higher interest of healthcare executives in patient-centeredness, development of value-based healthcare and increasing public satisfaction with medical care, it is very important to have access to detailed information about how people evaluate the care provided, as well as to specify problems associated with receiving care. Such detailed information can provide directions for further development of organizational technologies and serve basis for developing management decisions.
    T h e p u r p o s e of the study is to analyze results of sociological surveys of the Russian population on self-assessment of health and conditions for receiving medical care.
    M a t e r i a l a n d m e t h o d s . The study used data available from the Rosstat (Federal State Statistics Service) official website – “Comprehensive monitoring over living conditions of the Russian population” (conducted in 2014, 2016, 2018 and 2020) in terms of questions related to receiving medical care by the survey respondents, based on a sample survey of representatives of various groups and population strata covering 10 thousand households. Analysis of the presented data was carried out using descriptive statistics methods by the following sections: respondents’ self-assessment of health, smoking and alcohol consumption, receiving outpatient care, receiving dental care, seeking emergency medical care, receiving inpatient care, non-care seeking if medical care is needed.
    R e s u l t s . The share of those who rated their health as “excellent” and “good” has increased. It should be noted here that males were more optimistic in assessing their health status than females. The share of the respondents reporting a chronic disease diagnosed by a doctor decreased from 30.2% in 2014 to 27.2% in 2020. There is no significant difference between urban and rural population.
    The share of non-smokers and those who have never smoked decreased from 63.5% in 2014 to 62.1% in 2020. The share of male alcohol consumers remained stable adding up to 70%, while the female share tended to increase from 49.5% in 2014 to 52.1% in 2020.
    Assessment of an average time spent on making an appointment with a doctor in outpatient settings has not changed in dynamics and equaled to about 18 minutes. The share of those receiving timely medical care out of those applied for care increased from 92.6% in 2016 to 95.1% in 2020.
    The share of those calling an ambulance tended to decrease: from 10.8% in 2014 to 10.1% in 2020. According to the surveys’ results, every year some 7–8% of the population receive specialized medical care in inpatient settings.
    The analysis of cases of non–care seeking if medical assistance is needed showed a decreased share of such respondents: 33.6% in 2014, 33.0% in 2016, 34.5% in 2018, and 29.2% in 2020. The share of those failing to get to or experiencing difficulty getting to a health care facility equaled to 3.3%, 2.5%, 2.8% and 1.9%, respectively. 7.2% of the respondents had “no time” for care seeking in 2014, 8.2% in 2016 and 2018, and 4.7% in 2020. A significant decrease in this indicator is rather logical and unsurprising in the context of the pandemic caused by a new coronavirus infection.
    C o n c l u s i o n s . From 2014–2020, self-assessment of health has improved; in general, males rate their health higher compared to females.
    Men smoke 5 times more often than women. Generally, they start smoking during the teen years. As a positive trend, we can point out an increasing share of people who quit smoking.
    Men drink alcohol 9 times more often than women. The share of the female alcohol consumers tends to increase.
    Negative trends in care delivery are as follows: increased waiting time for emergency medical care; increased average number of days waiting for hospital admission; decreased share of those admitted to the hospital on the day of the visit.
    Positive trends in care delivery include the following: decreased denials of outpatient care due to lack of necessary equipment or medicines, shorter lines in waiting premises to see a doctor; decreased offers of payed services; decreased waiting time for a doctor’s appointment; increased share of those receiving timely dental care.
    A tendency among the respondents towards self-medication and not seeking medical care due to lack of time has decreased.

    Authors: Starodubov V. I. [36] Senenko A. Sh. [7] Menshikova L. I. [5] Zubko A. V. [2]

    Tags: alcohol consumption1 conditions for receiving medical care1 lifestyle1 medical care12 not seeking medical care1 public opinion1 self-assessment by residents of the russian federation1 smoking1 sociological survey1

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  • 2022 № 7 Topical issues of organization and financial support of high-tech medical care

    The article provides a historical overview of changes in approaches to the financial provision of high-tech assistance, analyzes the causes of these changes, shows the system that has developed at the moment.
    Comments are given on the most relevant changes concerning the financial provision of high-tech medical care.

    Authors: Chililov A. M. [21]

    Tags: compulsory medical insurance14 federal budget9 financial support3 high-tech medical care10 subsidies1 subventions2

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  • 2022 № 7 Dynamics of patient loyalty before and during the COVID-19 epidemic on the example of Children’s Polyclinic

    The COVID-19 has had an enormous impact on the entire Russian health care system, including a significant impact on both the provision of medical services and the relationship between the doctor, the patient, and patient’s legal representatives. On this basis, the research is interested in issues related to the adaptation of medical organizations to the new working conditions with patients and their legal representatives. Aim of the study: to test long-term monitoring of the NPS Loyalty Index by a simplified methodology in patient’s legal representatives of pediatric polyclinic patients before and during the COVID-19 epidemic. Materials and Methods. The empirical material based on patient legal representative scores (n=22098) collected using the simplified NPS (Net Promoter Score) methodology during the two periods: 14.05.2019 -13.06.2020 and 18.06.2021 – 23.08.2021, as well as comments and predictions from lead outpatient clinic staff (n=19) collected by brainstorming to obtain additional interpretations of dynamics of patient legal representative loyalty index during the periods. The Results. According to the results of the study, the NPS patient legal representatives in pediatric polyclinics has increased significantly since the beginning of the coronavirus
    epidemic and after a year was fixed at a level almost one and a half times higher than the values from the first measurement.
    According to the initiative group, this growth was due not only to measures taken by the management of polyclinics, but also to cultural and psychological characteristics of the population; when the epidemic is over, the loyalty index of legal representatives of pediatric polyclinic patients is likely to return to its initial values. Conclusions. The use of a simplified method to measure the loyalty level (NPS) of patients and their legal representatives is a rather effective tool. An important condition in this case is to provide feedback to dissatisfied patients and their legal representatives. The professionalism and dedication of the medical staff play and will play a role in ensuring a high level of loyalty regardless of the epidemiological situation.

    Authors: Tsaranov K. N. [10] Tarbastaev A. G. [9] Markov D. I. [1] Komolova O. A. [1]

    Tags: covid-19 pandemic6 customer-oriented healthcare1 nps loyalty index1 patient loyalty3 patient- oriented2

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  • 2022 № 7 Features of national account of donor platelets collection

    Based on the analysis of the practice of donor platelet concentrates collection in 16 Russian blood service organizations, it was
    established that:
    - the term “unit” is used in relation to 4 concepts, which leads to a misreporting of the blood component “Platelet concentrate
    from a blood unit”,
    - the blood component “Leuco-reduced platelet concentrate from a blood unit” is not produced at all due to the lack of clinical need and excessively high cost,
    - ANOVA analysis of variance revealed significant differences in the volumes of both therapeutic doses (p=0,038) and units of platelet concentrates (p<0,001) prepared by eight studied methods,
    - indicators of the volume of pooled platelet concentrates are higher than similar indicators of apheresis products: a) treatment dose – by 36,1% (p=0,001), b) unit – by 35,5% (t-test – 4,771, p<0,001),
    - the current system for accounting for the volume of collection of 11 types of donor platelet concentrates does not allow assessing either the number of prepared therapeutic doses or the degree of implementation of technologies for their additional processing,
    - a form of the blood establishment report on the collection of platelets was proposed, which characterizes: a) the number of received therapeutic doses, b) the use of the processes for preparing these doses.

    Authors: Zhiburt E. B. [15] Averyanov E. G. [6] Shestakov E. A. [6] Khamitov R. G. [1]

    Tags: account2 apheresis4 blood8 blood transfusion10 platelets5 pooling4 unit4 volume4

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  • 2022 № 5 Review of lean practices in clinical laboratories

    The main role of clinical laboratory diagnostics is to obtain reliable, reproducible and timely results that help to make the right clinical decisions. As the literature review shows, there are a number of common problems for many clinical laboratories, such as: long turnaround times, high laboratory costs for consumables, insufficient level of satisfaction with quality of services received by patients and high number of complaints. The use of lean manufacturing can be one way of solving these problems.
    Purpose of the study is to summarize and analyze the literature regarding the application of lean manufacturing in clinical laboratories.
    Materials and methods. A literature review was performed using the following abstract databases: Web of Science, Scopus, PubMed, ScienceDirect, Mendeley, and NCBI. The depth of the search according to the time parameter had no limitations. The following keywords were used as search markers: “lean management”, “lean thinking”, “lean six sigma”, “lean tools”, “healthcare”, “health services”, “clinical laboratory”. More than 100 publications were analyzed, from which 28 most representative studies were selected.
    Results. The implementation of lean production methods provides a reduction in turnaround time, costs and errors in the clinical laboratory, reduces the contamination of biological material at the preanalytical stage and reduces waiting time for services and, as a consequence, reduces the number of patient complaints.
    Conclusion. The above results indicate that lean production methods can be used in laboratories to solve frequently occurring problems and demonstrate the effectiveness of their application in clinical laboratories.

    Authors: Shibalkov I. P. [8] Boykov V. A. [7] Kobyakova O. S. [13] Deev I. A. [8] Baranovskaya S. V. [4] Babeshina M. A. [2] Pavlova K. A. [1] Perfilyeva D. Yu. [1]

    Tags: clinical laboratory2 cost reduction1 lean  production6 patient satisfaction5 turnaround time (tat)1

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  • 2022 № 5 Application of the VALS and the laddering techniques at shared decision-making

    Patients values are fundamental in the process of health decision-making. The use of PROMs is often difficult in routine clinical practice, which requires the search for simpler methods of determining the patients values, where psychographic segmentation and laddering are one of those.
    The aim of the study was to improve the process of shared-decision-making in patients with non-melanoma skin cancer using the VALS segmentation and the laddering technique.
    Materials and methods. An inclusive, incomparable, prospective, long-term multicenter cohort study of the use of the laddering technique and the VALS technique was conducted in 158 patients (154 (97%) with basal cell skin cancer, 4 (3%) squamous cell skin cancer; 129 (82%) patients with stage I–II diseases, 17 (11%), with IV – 12 (7%); 56 (35%) – men, 102 (65%) – women.
    The results of psychographic segmentation showed: the clinical result of the procedure is important for 96% (n=152), the safety of treatment and adverse reactions – for 91% (n=143), the cosmetic result – for 46% (n=73), convenience and flexibility of the treatment schedule – for 36% (n=57), the painlessness of the treatment procedure – for 34% (n=54), the ability to lead a habitual lifestyle during treatment – for 23% (n=36), the comfort of the treatment procedure – for 14% (n=22), the financial costs associated with treatment – for 9% (n=14), preservation of organ function after treatment – for 3% (n=5).
    Conclusions. The method of psychographic segmentation can be adapted to the tasks of communication between the doctor and the patient. The scope of application of the VALS methodology and the laddering technique can be considered situations when a doctor is unable to use validated quality of life questionnaires due to limited resources or the absence of such questionnaires.

    Authors: Zuenkova Yu. A. [4]

    Tags: laddering1 patient behavior1 psychographic segmentation1 quality of medical care19 shared decision making1 vals1 value-based healthcare3

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  • 2022 № 5 Clinical aspects of medical-social examination of tuberculosis in adults

    The epidemiological situation with tuberculosis in the Russian Federation in the current socioeconomic conditions continues to be quite tense. In addition to all kinds of introductions from practicing physicians to combat tuberculosis, a significant contribution comes from the activities of administrative bodies aimed at creating and implementing new draft laws on disability related to tuberculosis, including methods of social expertise and safety, various support measures for disabled citizens, and methods of rehabilitation for persons with a disability group assigned.
    All persons with tuberculosis are guaranteed the right to a medical and social expert evaluation. In connection with the release of the new order, there are actual data, which require attention not only of social security workers, but also of medical personnel.
    P u r p o s e : to reveal actual aspects of medical and social examination for tuberculosis in adults.
    Methods. Regulatory documents on social security of population were analyzed and the main reasons influencing the expert evaluation and decision of commission for medical and social protection in tuberculosis in adult stratum of population were singled out.
    R e s u l t s a n d d i s c u s s i o n . As of January 1, 2020, Order No. 585n of the Ministry of Labor and Social Protection of the Russian Federation of August 27, 2019, came into force. “On the classifications and criteria used in the implementation of medical and social expert assessment of citizens by federal state medical and social expert assessment institutions. The expert evaluation for tuberculosis is based on an analysis of the totality of persistent impairments of body functions, containing significant clinical components, due to the pathological process and the severity of restrictions to vital functions, which are affected by the localization and prevalence of the specific process, the degree of activity, MBT sensitivity to antituberculosis drugs, the nature of complications and the possibilities of surgical treatment. Presence or absence of mycobacterial discharge in a patient is one of the major criteria
    of therapy efficacy and favorable prognosis.
    C o n c l u s i o n . The medical and social expert evaluation is an important component in the evaluation of a person’s state of health, in the assignment of a disability group, and in the analysis of the leading medical criteria, which characterize the degree of restriction of vital functions. The aspect of reviewing normative-legal acts concerns not only employees of social protection, but also acting clinicians for a better understanding of all the socio-economic consequences assigned when making this or that diagnosis.
    Disability of the population due to tuberculosis remains a relevant area of analysis, requiring attention from both a clinical and legal perspective.

    Authors: Morozov A. M. [4] Zhukov S. V. [4] Tyarasova K. G. [1] Altunina M. M. [1]

    Tags: clinical aspects1 medical and social expertise1 tuberculosis in adults1

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  • 2022 № 5 Child mortality in different countries during the COVID‑19 pandemic

    At the beginning of the pandemic, COVID‑19 deaths were relatively higher among older children than in younger age groups, although there was a high likelihood of life-threatening cases of COVID‑19 in children with underlying medical conditions. Low child mortality from COVID‑19 is attributed by the authors of the study to the use of protective measures by children from high-risk groups and isolation measures. However, the COVID‑19 pandemic has led to serious disruptions in the work of health services in various countries, to interruptions in the provision of maternal and child health services (medical examinations, vaccinations, prenatal and postnatal care, and others), to a shortage of medical personnel.
    Purpose: to analyze the data of scientific studies on the characteristics of child mortality in various countries with the allocation of risks in the system of maternal and child health care.
    Materials and methods: bibliographic and analytical methods were used in the work.
    Findings: Premature newborns are particularly vulnerable to the COVID‑19 pandemic, especially in low- and middle-income countries where the impact of health system failures is significant. Restrictions during the COVID‑19 pandemic exacerbate the risks of stillbirth, including delayed delivery. The drop in preterm birth rates seen in high-income countries is attributed by researchers to the indirect effects of the response to the COVID‑19 pandemic, and data on stillbirths are not taken into account, which may make it difficult to explain the decline.

    Authors: Mingazova E. N. [18] Tliashinova I. A. [3]

    Tags: child population1 covid-19 pandemic6 maternal and child health service1 mortality20 perinatal risks1 stillbirth1

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  • 2022 № 5 Telemedicine as a tool for inter-regional remote interaction with specialized medical organizations of the subjects of the Russian Federation: experience of the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution». Russian Ministry of Health

    At present, the possibility of providing qualified medical care anywhere in the world has become a reality thanks to the development of telemedicine technologies. The development and improvement of telemedicine technologies is due to the regulatory and legal regulation and implementation of the national project «Health Care», which was developed on the basis of the Presidential Decree № 204 of 07.05.2018 «On the national goals and strategic objectives of the Russian Federation for the period until 2024». (hereinafter – the Decree of the President of the Russian Federation of 07.05.2018 № 204) [9].
    The National Medical Research Centers (NMRCs) were tasked with organizing advisory and methodological expert support for specialized regional medical organizations of the 3rd level of RF subjects. Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» supervises ophthalmological service of 8 subjects of the Russian Federation: Nizhny Novgorod, Kirov, Ulyanovsk regions, Republics of Mordovia, Udmurtia, Mari-El, Tatarstan and Chuvashia. The article presents the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine technologies to improve the provision of specialized, including high-tech medical care in the profile «Ophthalmology». Over the 3-year period of operation, the number of requests for telemedicine consultations at the «doctor-physician» level has increased significantly. In addition, from January 2021, Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» provides consultative
    care at the «doctor-patient» level.
    Purpose of the study is to present the experience of Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» of Health of Russia on the use of telemedicine consultations (TMC) performed using the «Telemedicine consultations» component of the federal electronic registry subsystem of the unified state information system in healthcare (USGISZ FER TMC component) from 2019 to 2021 and the «MEDTERA Telemedicine» unified secure technological platform from 2021.
    Material and Methods. Telemedical consultations on the basis of the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» are performed by highly qualified specialists – heads of the departments, research workers, leading specialists in different fields of ophthalmology. Telemedical consultations at the «doctor-physician» level are performed as follows: at the initial stage, a request for a consultation is received from specialized medical organizations of the subjects of the Russian Federation, which is processed by the employees of the Department of Telemedical Consultations. Information about the request is registered in the database, its profile is evaluated, as well as the quality, completeness and relevance of the data of the attached medical documentation. For real-time consultation «doctor-patient» through video or audio conferencing, the patient makes an independent appointment for a convenient date and time with a particular specialist.
    Results. During 3 years of the TMC functioning at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» the number of requests for telemedicine consultations at the “doctor-physician” level in the field of ophthalmology from 8 subjects of the Russian Federation of the Volga Federal District is progressively increasing. The bulk of telemedicine consultations are scheduled requests. During the 3-year period of telemedicine consultations at the Cheboksary branch «The S. Fyodorov Eye Microsurgery Federal State Institution» there were 94 TMK from the Republic of Tatarstan, 79 TMK from the Chuvash Republic, 61 TMK from the Republic of Mariy-El, 53 TMK from the Republic of Udmurtia, 46 TMK from the Kirov region, 37 TMK from the Nizhny Novgorod region, 36 TMK from the Ulyanovsk region, 23 TMK from the Republic of Mordovia.
    Findings. Summarizing the results of the analysis of the structure of telemedicine consultations performed using the IGISZ FER TMC component, it can be summarized that the IGISZ FER TMC component is a convenient, effective tool, which allows to comply with the Russian legislation in conducting telemedicine consultations, as well as to analyze the structure of telemedicine consultations conducted with its use.

    Authors: Pozdeeva N. A. [1] Avershina L. A. [1] Sorokina O. V. [1]

    Tags: igisz1 national medical research center1 remote technologies1 telemedical consultations1

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  • 2021
  • 2021 № 1 Environment and Public Health: Actual Issues of Health Care Organization and Medical Education

    The priorities of scientific and technological development of the Russian Federation, established by Decree of
    the President of the Russian Federation № 642 of 01.12.2016, provide for the improvement of health-saving technologies, which in this article have been considered from the standpoint of their focusing on reducing health risks caused by the adverse impact of environmental factors, including by increasing the functional and adaptive reserves of the body.
    The article analyzes in order to improve regulatory legal documents in the field of improving the prevention of chronic
    non-communicable diseases, the formation of a healthy lifestyle and hygienic education of the population. Also, a critical
    analysis of the state of educational activities provided at the state level in the field of higher professional education and
    postgraduate training of medical workers in the direction (specialties): medical and preventive care, medical care, public
    health and healthcare.
    Concluded that to ensure scientific and technological development of the country's need to expand educational and
    enlightening activities on issues of ensuring sanitary and epidemiological welfare of the population, hygiene, public
    health and organization of health care in health care organizations, and also outside in all major sectors of economy
    and business, in the sphere of organized tourism and recreation, SPA, fitness centers, educational organizations, sports,
    social welfare and life of the population, especially in terms of prevention, that in accordance with Federal Law № 323 of
    21.11.2011 "On the basics of protecting the health of citizens in the Russian Federation" provides for measures to eliminate the harmful influence of environmental factors. Proposals and additions to the relevant state regulatory documents of the Russian Federation that have already been approved and are currently under development are given.

    Authors: Prilipko N. S. [4] Turbinsky V. V. [2] Bobrovnitsky I. P. [2] Yakovlev M. Yu. [1]

    Tags: chronic non-communicable diseases2 educational standards1 environmental pollution1 environmentally caused diseases1 functional reserves of the body1 healthy lifestyle5 hygiene1 hygienic upbringing1 medical and preventive care1 public health8

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  • 2021 № 1 Process-oriented management and project management as tools for the public health organization efficiency improvement

    Medical services implementation schemes, based on the optimization of the flow of patient created values, are
    proposed. Changes appearing in certain performance indicators of the medical organization during the process of new
    management model introduction are analyzed. Aim. Creation of a management model for a state medical organization
    in the basis of which are the modern methods based on a process-oriented approach to the separation of management
    functions. Relevance. The work of healthcare organizations in a highly competitive environment requires more flexibility
    and mobility, thus the primary task is to create new management models of the organization, taking into account industry characteristics and consumer needs. Materials and Methods. The work uses the published results of the analysis of structural changes in organizational activity by other authors. The study was carried out on the basis of internal documents of the FSFI FSRCC FMBA of Russia on the creation of a new management structure focused on the development of an organization in the conditions of the market of medical services. Analytical and descriptive methods and sociological survey were used. Results and Discussion. Changes in the indicators for service provision for compulsory medical insurance and the volume of medical care provided as a result of the reforms carried out by the management of the healthcare organization of the FSRCC for four years have been analyzed. There was an increase in the number of patients seeking medical services at the FSRCC, who want to receive information/assistance quickly, in accordance with the adopted concept of a client-oriented marketing strategy, which required the development of “short” routes for patients, especially in conditions of increased service. By the joint efforts of marketers and specialist doctors, using design technologies, self-supporting Centres are being formed, which are virtual subdivisions that bring together highly qualified doctors to address the specific needs of patients. The “short” path scheme is based on the adoption of the definition of “medical service” as a unit of measurement of the complexity of the process of “medical care” provision. Conclusions. An increase in the number of visits at the outpatient-polyclinic stage of medical care provision (diagnostics, consultations) over five years doubles the achievement of the goals set for the medical organization, considered as an economic entity of a market economy.

    Authors: Barankina T. A. [3] Yakimenko O. N [3] Fetisov A. O. [2] Evsukov A. A. [1]

    Tags: customer-oriented marketing1 management model1 market of medical services1

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  • 2021 № 1 Applying lean manufacturing technologies to optimize ambulance operations amid the spread of COVID‑19

    The pandemic of new coronavirus infection COVID‑19 has become a serious challenge for the national health
    systems, including Russia, setting ambitious goals aimed at preventing the spread of infection and maintaining the availability of medical care in environment of increasing pressure. The aim of the study was to develop, based on the principles of lean production, a set of measures to increase the availability of emergency medical services for patients diagnosed with or suspected of a new coronavirus infection COVID‑19 in the Tomsk Region. Standard tools of lean manufacturing are applied to the work process of the admission department of the respiratory center in RSBHI «Medical sanitary station № 2». As a result of implementation of target state map, which provides for the optimization of process of transferring a patient diagnosed or suspected of a new coronavirus infection COVID‑19 to admission department, a positive dynamics of local (5.4 times increase in the proportion of calls completed within 15 minutes after the patient was delivered to the admission department) and system (an increase of 1.3 times in the proportion of calls with the time the ambulance team reaches the patient within 20 minutes) indicators of the ambulance service was achieved. The study confirms the effectiveness of lean manufacturing tools for optimizing the work of ambulance and allows us to recommend them for use in a pandemic and other risks of emergency.

    Authors: Shibalkov I. P. [8] Boykov V. A. [7] Kobyakova O. S. [13] Deev I. A. [8] Taranov A. A. [2] Baranovskaya S. V. [4] Suvorova T. A. [3] Babeshina M. A. [2] Masunov V. N. [1] Milkevich M. N. [1] Rodionov N. V. [1]

    Tags: covid-19 pandemic6 emergency medical services2 lean  production6 patient routing1 respiratory center1

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  • 2021 № 1 Identification of patients as a safety in providing medical care (practical experience)

    Patient safety is one of the priorities in medical care. The leading place in it is occupied by “correct patient
    identification”. According to research by experts from the World Health Organization (WHO), “misidentification of a patient is the cause of many errors.” The purpose of this work is to assess the implementation of a patient identification system using bracelets in a multidisciplinary hospital. The main idea of the project is based on the use of personal identifiers, made in the form of a disposable white bracelet worn on the patient’s arm, as well as the use of color-coded bracelets (red, yellow, red-yellow), which allows identifying patients at risk of developing life-threatening conditions: high risk falling of the patient and the presence of an allergological history. The introduction of identification bracelets with patient data and a barcode on them increased the percentage of identification performance increased from 67% to 89%. After the introduction of the system of prevention of falls and color identification by bracelets, the number of falls of patients decreased by more than 4 times. Successful integration of the automatic identification system into the workflow of a multidisciplinary hospital significantly reduces the influence of the human factor on the number of medical errors and related preventable consequences for patient health.

    Authors: Potylitsyn A. V. [2] Beniova S. N. [2] Gorelova I. S. Kiku P. F. [1]

    Tags: medical information system6 patient identification1 plastic bracelets1 quality and safety of medical activities9

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  • 2021 № 1 Activity of daily stay oncological hospitals in the Russian Federation and its regions for 2010–2019

    Relevance. Oncological diseases both in our country and in other countries of the world make a significant
    negative contribution to the overall mortality and disability of the population. Moreover, in the last decade, oncopathology is significantly more often affects the younger, employable population. One of the factors improving medical care is the provision of the population with specialists and hospital beds of oncological profile, including day care, where patients with this class of diseases could undergo a full course of pre-treatment, treatment, rehabilitation and recovery.
    Aim. To identify the dynamics of the main activity indicators of daily stay oncological hospitals of the public health sector in the Russian Federation, federal districts and regions of the Russian Federation for 2010–2019.
    Materials and methods. Using the data of federal statistical observation (form № 14DS) by the method of descriptive
    statistics, the main activity indicators of daily stay oncological hospitals in the Russian Federation, federal districts and
    regions of the Russian Federation in dynamics for 2010–2019 were analyzed.
    Results and discussion. In General, in the Russian Federation, the absolute number of oncologic hospital beds in daily
    stay hospitals of medical organizations providing inpatient care for the period from 2010 to 2019 increased by 3,5 times
    (from 1,448 to 5,013 beds), in daily stay hospitals of medical organizations providing outpatient care for the period from
    2014 to 2019 by 67,1% (from 2,465 to 4,120 beds). At the same time the number of patients treated in oncological hospital beds in inpatient daily stay hospitals for the period 2010–2019 increased by 405,245 (from 78,120 to 483,365 people), and in outpatient daily stay hospitals for the period from 2014 to 2017 increased by 93939 (from 218,502 to 312,441 people). The average occupancy of an oncological hospital bed per year and the average duration of treatment in Russia in inpatient daily stay hospitals decreased from 409 days in 2010 to 380 days in 2019 and from 7,7 to 5,6 days, respectively, in outpatient daily stay hospitals from 407 days in 2014 to 386 days in 2017 and from 4,7 to 4,6 days, respectively.
    Conclusion. The expansion of the bed fund of daily stay hospitals of oncological profile is timely and justified, but its
    development in different regions of the Russian Federation is characterized by a pronounced disproportion. At present
    there are all the necessary reserves to continue the active development of the network of daily stay hospitals of this profile.

    Authors: Evdakov V. A. [6] Banteva M. N. [9] Manoshkina E. M. [7] Melnikov Y. Y. [2]

    Tags: bed fund4 daily stay hospitals1 neoplasms3 oncology6 provision of the population with oncological beds in daily stay hospitals1

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  • 2021 № 1 Experience in using the staff management structure in a redesigned infectious diseases hospital to provide medical care to patients with a new coronavirus infection

    The article presents the experience of using the staff management structure in the conditions of redesigning
    a multi-specialty hospital into an infectious hospital for providing medical care to patients with a new coronavirus infection. For example, one of the largest hospitals providing specialized medical care during coronavirus infection, proven effectiveness staff management structure as the most optimal for the purposes of redesigning and further use against the growing epidemic Covid‑19.

    Authors: Kitsul I. S. [53] Vechorko V. I. [1] Gumenyuk S. A. [1] Zhenina E. A. [1]

    Tags: hospital3 medical care12 medical organization50 new coronavirus infection2 redesigning1 staff management structure1

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  • 2020
  • 2020 № 5 Basis of a programmatic approach to ensuringthe quality and safety of antitumor treatment

    The article presents the rationale for the introduction of a single territorial approach to improving the oncological service of the Republic of North Ossetia-Alania on the basis of the “Program for the management of quality and safety of anti-tumor treatment” (Program). The program is based on the principles of quality management, on the industrial model of managing a medical organization and should help increase the efficiency of the entire oncology service of the region

    Authors: A.  M.  Кarsanov [1] A.  V.  Khasigov [1] A.  A.  Kultchiev [1]

    Tags: antitumor treatment1 oncology6 patient safety2 program2 quality management2

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  • 2020 № 5 Analysis of the activities of a multidisciplinary day hospital in a city

    In the article, based on literature sources, analysis of reporting data on the activities of medical organizations providing inpatient care (MOSU) and medical organizations providing outpatient care (MOAU), as well as studying work experience in a number of territories of the Russian Federation, the tasks are shown, organizational forms of work, medical and economic feasibility of organizing day hospitals. The experience and performance indicators of the patient care center based on the outpatient department of the city clinical hospital are presented. The medical and social efficiency of the work of the homestead and the possible economic effect of the organization of the homestead are estimated.

    Authors: A.  A.  Kalininskaya [1] M.  D.  Merekina [1]

    Tags: beds3 day hospital (ds)2 diseases3 medical organizations providing inpatient care (mosu)1 medical organizations providing outpatient care (moau)1 patient11 treatment periods1

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  • 2020 № 5 Dermatovenerologic service resources in the Republic of Bashkortostan

    The article presents the analysis of accessibility parameters related to medical care in the area of dermatovenerology in
    the Republic of Bashkortostan. We studied the dynamics of such provision parameters as the number of dermatovenerologists and
    the number of in-patient and day-patient beds for the period from 2013 to 2018. In the Republic of Bashkortostan the number of
    dermatovenerologists has decreased from 0.68 specialists/10,000 people to 0.59 specialists/10,000 people (decrease rate 13.2%);
    the amount of dermatovenerologic offices has decreased by 9.3% (from 107 to 96). We noticed the decrease in the bed capacity
    due to the decrease of in-patient beds from 1.31/10,000 people to 0.94 beds/10,000 people (decrease rate 28.2%). At the same
    time we shall point out the increase in the time of bed occupation: from 320 days/year to 344 days/year. Patient turnover per one
    bed (further referred as bed turnover) has increased from 16.1 to 24.9 patients per year (increase rate 54.7%). The average time of
    bed stay for one patient has decreased from 20.0 days to 13.8 days (decrease rate 31.0%). In the Republic of Bashkortostan (RB),
    the number of day-patient beds has increased. For outpatient medical institutions the number has increased by 12.2 times (from 10
    to 122 beds); for in-patient medical institutions it has increased by 13.8% (from 81 to 94 beds). For in-patient medical institutions,
    the accessibility of day-patient beds has increased from 0.2 beds/10,000 people to 0.23 beds/10,000 people and for outpatient
    medical institutions it has increased from 0.2 beds/10,000 people to 0.3 beds/10,000 people. By 2018, the average day-patient
    bed occupation amounted to 314 days, regardless of institution type. Further study of medical care accessibility in the sphere of
    dermatovenerology in the Republic of Bashkortostan is important; measures on its improvement shall be scientifically proven.

    Authors: Mukhamadeeva O. R. [2] N. Kh. Sharafutdinova [1] Sharafutdinov М. А. [1] M. Yu. Pavlova [1]

    Tags: accessibility of dermatovenerologic care1 dermatologic hospital bed1 estimation of medical care accessibility1 parameters of hospital bed accessibility1 s pecialized dermatovenerologic care1 venereology hospital bed1

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  • 2020 № 5 Medical rehabilitation: issues in licensing

    The article provides a legal study of a number of current problems in the field of licensing of medical rehabilitation activities and suggests some ways to resolve them

    Authors: Gameeva E. V. [1] Gabaj P. G. [1] Kostin A. A. [1] Pashigorova L. V. [1]

    Tags: licensing of medical rehabilitation1 licensing requirements2 medical rehabilitation8 oncology6 works (services) that make up medical rehabilitation1

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  • 2020 № 5 Blood collection during the period of COVID‑19 infection

    We evaluated the work of the Samara Regional Clinical Blood Transfusion Station, the collection and delivery
    of blood components in January-April 2019 and 2020 changes in activity at the beginning of the COVID‑19 pandemic
    infection. The need for blood components decreased: red blood cells – by 16,7%, platelets – by 13,0%, plasma – by 25,6%, cryoprecipitate – by 32,5%. SOKPSK provides the needs of the region’s healthcare in blood components and preparations, as well as the safety of donors and staff. For this: a) new donor recruitment methods have been introduced; b) plasma donors have been transferred to blood and platelet donors. A common pattern is the reduction in the use of medical technologies that require transfusion of blood components. According to the results of the first 4 decades of work, such a reduction in the Samara region is two time less than in other developed countries.

    Authors: Zhiburt E. B. [15] Kuznetsov S. I. [6] Kudinova E. V. [2]

    Tags: blood8 blood collection5 blood service5 blood transfusion10 covid-1924 pandemic6 safety4

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  • 2020 № 5 Analysis of the study of the opinions and satisfaction of medic al personnel with features in the organization of the work of a network of d ental clinics, united in a research and production network

    The article presents the results of a sociological survey according to a specially developed questionnaire, which made it possible to elicit the opinion of medical personnel (dentists and managers) in certain areas of improving the organization of medical care, affecting the level of service in branch clinics integrated into a research and production network. Based on this questionnaire, answers were received about the organization of activities and recommendations were developed to improve the organization of work of the integrated research and production network.

    Authors: Mingazova E. N. [18] Yu. A. Ulianov [1]

    Tags: corporate culture5 dental medical clinics united in a research and production network1 medical staff satisfaction1 motivation2 questionnaires2 sociological assessment1

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  • 2020 № 4 Perception of a threat to personal security medical professionals in the context of the COVID-19 Pandemic

    The article presents the results of an empirical study of the perception of personal safety threats by medical profes- sionals: doctors and nurses. Respondents were medical staff, conditionally divided into two groups: 1) medics in preparation for entering the high-risk zone; 2) medics working in high-risk areas. The resulting text data was processed by IBM Watson Studio (Version 1.1.0–177). Cluster analysis was carried out using the K-Means model. It is shown that the sources of health workers’ fears are determined by the area of actual workspace: preparation for entry to the high-risk zone or working in direct contact with patients infected with COVID-19.

    Authors: Tsaranov K. N. [10] Tarbastaev A. G. [9] Zhiltsov V. A. [1] Klimova E. M. [3]

    Tags: covid-19 pandemic6 fears1 medical professionals1 personal safety1

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  • 2020 № 4 The Structure of hospitalized morbidity of elderly and senile patients

    Population aging in the Russian Federation requires is a new challenge for medical and social care, including inpa- tient care, for the elderly. The purpose of this study was to study the structure of morbidity requiring hospitalization of elderly and senile people in the Krasnoyarsk territory. We analyzed data of all 36206 patients aged 60 years and older who were hospitalized to the Krasnoyarsk regional hospital for war veterans in 2014–2019. Age, gender, duration of in-hospital care, main and concomitant diseases were the main studied variables. The proportion of men among the elderly increased while the proportion of women decreased over the study period. It was found that the causes of hospitalization varied considerably between age groups. Thus, among the hospitalized elderly, diseases of the circulatory system and diseases of the genitourinary system were most often identified as the main disease in patients. Diseases of the circulatory system were diagnosed as the main disease more often also in elderly patients and in patients belonging to centenarians. Our results reflect gradual increase in life expectancy of the population. An increase in the proportion of people with advanced age in the population structure warrants structural changes in institutions that specialize in providing medical and social assistance to these categories of the population.

    Authors: E.  V.  Ryazapova [1] A.  N.  Narkevich [1] K.  A.  Vinogradov [1] A.  M.  Grjibovski [1]

    Tags: centenarians1 comorbidity1 icd-101 old age.2 senile age1

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  • 2020 № 4 Analysis of the causes of public dissatisfaction with the provision of high-tech medical care to patients with malignant neoplasms in the Moscow region

    The article presents the main approaches to analyzing the causes of public dissatisfaction with high-tech medical care for patients with malignant neoplasms on the basis of citizens’ appeals and an independent assessment of the quality of services rendered by medical organizations on websites.
    The results of the assessment sometimes show good and very good results of patient satisfaction with the work of medical organi- zations, and the number of substantiated complaints from citizens about dissatisfaction with the medical care for cancer patients in specific medical organizations remains high.
    The main causes of public dissatisfaction with medical care are analyzed and specific recommendations on the organization of work with cancer patients and the prevention of patients’ dissatisfaction are given.

    Authors: E. Yu. Ogneva [2] E.  V.  Gameeva [1]

    Tags: complaint2 dissatisfaction prevention.1 dissatisfaction with the provision of high-tech medical care to patients with neoplasms1 independent assessment  of the quality of medical services1 work with citizen’s appeals1

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  • 2019
  • 2019 № 9 Modern approaches to the analysis of emergency medical care for children

    112 936 cases of 24-hour emergency medical care in a children’s clinic for 2018 were analyzed. The meth¬ods of multivariate statistical analysis and theory of time series are used. It has been established that about 30% of the challenges occur in children of the first year of life. From January to March and from June to October, there is an increase in the number of calls. The days with the most calls are the 12th, 19th and 26th of the month. Almost a quarter of weekly calls fall on Monday. The resulting model of the call service duration structure allows you to evaluate changes in the work of the emergency service in different periods and proves the need for round-the-clock work.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3] Tricomenas N. N. [3]

    Tags: emergency medical care2 factor analysis1 markov chains with estimates1 medical care for children4 time series1

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  • 2019 № 9 Restructuring of a regional system of rendering stationary medical care on the basis of means of tool benchmarking

    In work approach to justification of management decisions on restructuring of a regional system of rendering stationary medical care with use of means of tool benchmarking is considered. Results of activity of hospitals were measured by calculation of an indicator of technical efficiency on the basis of a method of the analysis of the environment of functioning. Specialization of hospitals was measured by means of the index of the theory of information constructed on the basis of data on the clinic-statistical groups used in hospitals. The dependence between the index of specialization of hospitals and efficiency of activity of hospitals when rendering medical services on the basis of which a set of scenarios of restructuring of a regional system of rendering stationary medical care is formulated is revealed.

    Authors: Danilov A. V. [2]

    Tags: diagnosis related group1 efficiency indicators2 information theory index1 medical organizations22 scenarios of restructuring1

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  • 2019 № 9 Application of lean management in medical examination of children in Tomsk region

    The object of the study is the process of preventive medical examination of children of the first year of life, which can be improved on the basis of the principles of lean production. As part of a joint project of the Ministry of health of Russia and Rosatom state Corporation “Lean clinic”, which is designed to improve the efficiency of medical organizations and the availability of their assistance by introducing elements of lean production in public health institutions on a systematic basis, in the Tomsk region on the basis of a pilot medical organization – children’s clinic – a project was implemented to introduce lean technologies in the process of preventive examination of children of the first year of life, in order to minimize the loss of time when receiving medical services by the patient. The main directions of optimization: improving the productivity of the process using the mapping method; increasing the productivity of a single workplace using the 5C technique; increasing the productivity of the movement of medical staff using the Spaghetti diagram. During the project, the logistics scheme of patients and staff movement was significantly improved, and a route map was developed, which was issued to the parents of patients in the registry of the medical organization. In addition, in order to assess the effectiveness of the developed measures before the project and after its implementation, a sociological survey was conducted among the parents of children undergoing pre¬ventive medical examination, which allowed to assess the level of their satisfaction with the assistance provided. As a result of the implementation of the project on the introduction of lean technologies, it was possible to achieve the goals, in particular, to reduce by almost 3.5 times the time spent by patients on the passage of a full cycle of preventive examination, to reduce to 2 number of visits to the clinic, as well as to increase comfort of staying in the institution of patients and their parents.

    Authors: Shibalkov I. P. [8] Boykov V. A. [7] Kobyakova O. S. [13] Deev I. A. [8] Kanonerker L. M. [1] Kulikov E. S. [2] Novikova I. Y. [1] Osihov I. A. [1] Sivolobova T. V. [1] Taranov A. A. [2] Titova M. A. [1]

    Tags: 5s methodology.1 children’s hospital1 lean  production6 mapping method1 prophylactic medical examination1

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  • 2019 № 9 Economic efficiency of application of methods of mass-spectrometrically identification of microorganisms in a large general surgical hospital

    Bacterial complications, seen in the prism of health care-related infections, have very tangible socio-economic conse¬quences on the part of the patient, insurance companies, medical institutions, and on the part of the state as a whole. The pur¬pose of this study was to perform an economic analysis of the introduction of innovative technology for the diagnosis of bacterial infections, based on mass spectrometric technologies.

    Authors: Mironova A. V. [2]

    Tags: antibiotic resistance.1 bacterial infections1 clinical and economic analysis1 innovative technologies1

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  • 2019 № 8 Evaluation of the effectiveness of health care in the constituent entities of the Russian Federation using the Bloomberg methodology

    A point assessment of healthcare systems efficiency of the regions of the Russian Federation is conducted on the
    basis of methodological approaches of Bloomberg international rating agency using Minmax method, according to which the higher life expectancy is, the more efficient healthcare system is. The highest score according to the assessment result was given to Tyumen oblast with life expectancy of 72,1 years and minimal healthcare expenditures both per capita and in share of gross regional product. The leaders in the size of state expenditures on healthcare per capita are Magadan and Sakhalin oblasts, Kamchatka krai, the Republic of Sakha (Yakutia), accordingly reaching 80th, 77th, 78th and 72nd position on the rating. The city of Moscow reached 6th place, while surpassing the city of St. Petersburg by 19 positions, mostly because of higher life expectancy. The study showed that the variability of life expectancy in the context of the regions of the Russian Federation is about 15 times less than the indicators of health expenditure. The authors argue that since the health care system in Russia is predominantly state-owned, any estimates of economic efficiency are conditional, since only a competitive economy can be effective.

    Authors: Perkhov V. I. [20] Kudelina O. V. [1] Tret’yakov A. A. [1]

    Tags: criteria of health care effectiveness.1 efficiency of health care1 evaluation of health care effectiveness1 rating of health systems1

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  • 2019 № 8 Modern management of medical organization based on the process approach in russian scientific publications

    The intensity and direction of development of the process approach in the management of medical organizations from the time of the first publications in the Russian literature to the present has been evaluated. 282 literary sources were studied, of which 235 were for managing a medical organization and 47 were papers that analyzed the construction of business processes in non-medical enterprises. It was found that to accelerate the pace of building business processes in medical organizations, it is necessary to use computer programs for building processes.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3]

    Tags: medical organization50 process approach7 quality management system8

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  • 2019 № 8 Reference center of radiology: justification and concept

    The situation in radiology (intensive growth of infrastructure against the background of organizational, methodical
    and managerial problems) requires a new system approach to organization and management. The concept of radiology
    reference center as a structure in the health care system is supposed to provide remote assessment, interpretation, description and control of radiological studies performed in medical centers of all forms of ownership, with the use of telemedicine technologies. The reference center should simultaneously solve organizational, methodological, therapeutic, diagnostic, educational problems, information and coordination tasks and scientific issues. The concept is based on systematized results of publications and own successful experience of creation and effective functioning of the reference center on the basis of the State Funded Healthcare Institution of Moscow “Research and Practical Clinical Center of Diagnostics and Telemedicine Technologies, Department of Health Care of Moscow”. Basing on the concept, it is necessary to keep developing the scientific and practical aspects of normative, legal and methodological support of the activities of radiology reference centers.

    Authors: Morozov S. P. [1] Vladzymyrskyy A. V. [1] Vetsheva N. N. [1] Ledikhova N. V. [1] Ryzhov S. A. [1]

    Tags: information technologies3 management14 radiology3 reference center2 roentgenology1 telemedicine7

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  • 2019 № 8 Organizational and methodological work of the main external experts Coordination Council in the implementation of the regional project for cardiovascular diseases control in Moscow Region

    In this article the role of main external experts (MEE) is discussed. According to the Order of the agency of administration, MEE form a Coordination Council to implement important regional projects. Thus, as a result of the concerted organizational and methodological work, the cardiovascular mortality reduced from 676.2 in 2015 to 475.2 in 2018 per 100 000 population. It is worth to mention that in 2015 the cardiovascular mortality rate in Moscow Region was above the average for the Russian Federation (RF) and Central Federal District (CFD), while in 2018 it became below the average for the RF and CFD.

    Authors: Gurov A. N. [15] Sanina N. P. [1] Prikhodko A. N. [1]

    Tags: cardiovascular diseases2 cardiovascular diseases control1 main external experts coordination council1 organizational and methodological work1 regional project1

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  • 2019 № 8 To the question of transformation of psychiatric care in Moscow

    This article reflects the marked dynamics of inpatient care activities in the city of Moscow, however, there is still a
    need for further reform of the service. The analysis of the composition of inpatients and the effectiveness of their treatmentwas carried out and studied. The article presents the results of the organization of inpatient care for patients on the basis of GBUZ “PB No. 13 DZM” for the years studied, analyzed the main indicators of the inpatient sector of the hospital and the financing of the psychiatric inpatient service.

    Authors: Grishina N. K. [6] Belostotskiy A. V. [3] A. Yu. Ter-Israelyan [3] Ibragimov A. I. [1]

    Tags: deinstitualization1 hospitalizm1 nosological reforms1 paradigm2 personal and social restoration1 psychiatric hospital1

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  • 2019 № 8 Public Health Management in the Context of the Implementation of Preventive Health Programs

    In civil society, the features of which are manifested in the country, state bodies and society are increasingly paying attention to the problems of formation, preservation and promotion of health of healthy people of different age groups. The purpose of the study is to determine the role of the nurse of General practice (family medicine), hereinafter – OPSM, in the public administration of the formation of public health of residents of family-territorial areas receiving medical services in OPSM institutions. The objectives of this study is to study the role of nurses OPSM as partners of family doctors to provide medical care to patients on the basis of etiotropic, pathogenetic and sanogenetic therapy of various diseases; implementation of medical care of patients and healthy people of different age groups, in relation to biological, psychological, social and emotional spheres of man; prevent the impact of inadequate behavior of patients or healthy people not only on their health, but also the health of the territorial community.

    Authors: Sazhin V. L. [1]

    Tags: health care24 medical services5 population5 program2 public health8

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  • 2019 № 7 Performance optimization of the operating unit in conditions of high patient turnover using economical technologies

    Proposed methods for optimizing the work of the receiving department. The efficiency and validity of the implementation
    of these methods in the work of the receiving department has been shown. Analyzed the effectiveness of
    innovations. An assessment of the result is given.

    Authors: Stilidi I. S. [2] Doroshev I. A. [2] Kulushev V. M. [2] Ryabchikov D. A. [2] Artemyev S. A. [2] Ilyin S. N. [2] Kazakov A. M. [2] Bikova E. A. [1] Konovalov A. M. [1] Sitenkova K. V. [1] Morozova I. N. [1] Kobyakova E. A. [1]

    Tags: optimization6 receiving department1

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  • 2019 № 7 Improving the system of organizing the psychiatric aid of the megapolis

    Abstract. Currently, a restructuring of the psychiatric service is carried out in Moscow. The changes are implemented accordingto the concept of socially-oriented psychiatry based on a biopsychosocial approach. Reforms include the reductionof inpatient and the development of an outpatient unit of the psychiatric service. Psychiatric hospitals were merged with outpatient units on a territorial basis.
    The aim of the study was a comprehensive analysis of the psychiatric service functioning in Moscow during the period of
    its restructuring.
    A retrospective analysis of the demographic characteristics of the Moscow population and clinical and epidemiological
    indicators characterizing the incidence of mental disorders, as well as an analysis of the functioning of inpatient and
    outpatient units of the Moscow psychiatric service and its staff, was made. The evaluation of the conversion efficiency
    indicators was made. A sociological survey about the reforms (questionnaire) of specialists and relatives of persons with mental disorders being carried out through questionnaires was also conducted.
    During the transformation of the psychiatric service, the incidence of mental disorders, hospital mortality and the number of cases of disability decreased. The provision of the population with places in day hospitals, the number of places in day hospitals and patients who received assistance in day hospitals, the staffing level of outpatient rates, and the number of visits to district psychiatrists increased. The share of persons involuntarily examined and recognized as in need of inpatient treatment increased from 70% to 100%. According to a sociological survey, most of the heads of structural units of the psychiatric service, psychiatrists, and users of the service positively assess the reforms that have been carried out.
    For a large city, the cluster-modular system of psychiatric service, currently organized in Moscow, is a priority.
    Results of this work have found application in the organization of psychiatric care in Moscow, Vladimir, and Tula regions
    and the city of Sevastopol, and can be put into practice in other major cities of the Russian Federation.

    Authors: Zolotareva L. S. [1] Masyakin A. V. [1]

    Tags: community-based  psychiatry2 health care reform1 health care  surveys2 hospitals2 medical staff7 mental  health  services2 psychiatric1 quality of health care3

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  • 2019 № 7 Improvement of information support and organizational and managerial aspects of the chief doctors of Central district hospitals

    Annotation. The article presents the results of the study of the organization of work of chief physicians of Central district hospitals and their deputies in the Republic of Dagestan. The content of 918 administrative acts issued at the level of the Ministry of health of the Republic of Dagestan and basic CRH for the last 5 years is analyzed. Studied information provision CRH chief doctors and their deputies.
    It is established that opinion acts of management are executed partially or aren’t executed at all. Of the 436 orders of the Ministry of health of the Republic of Dagestan executed 70.6% of 482 orders of chief physicians CRH – 64.2%. About
    half (48.6%) of management decisions fall on personnel issues, 17.5% – on the organization of medical and preventive
    care, 7.1% – on the development of material and technical base. On the basis of research materials recommendations
    on improvement of information support and organizational and administrative aspects of activity of the chief physicians of the Central regional patients are developed.

    Authors: Gadzhiev R. S. [1] Omarova O. A. [1] Agalarova L. S. [1]

    Tags: consultant1 information1 labor organization.3 management14 timekeeping2

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  • 2019 № 7 Hospital replacement technologies in dermatovenereology

    The Program of State Guarantees provided for a decrease of almost 20% in the volume of inpatient care due to the development of hospital-substituting forms. The efficiency of day hospitals is higher than hospitals by 1.5–3 times, which is associated with work in 2 shifts. The economic effect of the activity of DS according to the results of research works of a number of authors reaches 70%.
    At the same time, the rate of introduction of day hospitals (DS) remains unreasonably low, and core day hospitals are not sufficiently developed, including in dermatology.
    The disadvantage of the healthcare system in Russia and dermatovenerologic care in particular is the lack of economic incentives in favor of choosing less expensive technologies, their parameters are shifted towards hospital provision. Over the past decade, the numberof research papers on the activities of CPs has significantly decreased, an economic financing mechanismhas not been developed that stimulates the development of these forms of work.

    Authors: Merekina M. D. [3]

    Tags: beds3 day hospital (ds)2 diseases3 medical organizations providing medical care in a hospital setting (mos)1 medical organizations providing medical care in an outpatient setting (moau)1 patient11 terms of treatment1

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  • 2019 № 6 Perfection of organizational forms of work in dermatovenerology in conditions of “lean production”

    An important part of the activity in dermatovenerological care in the conditions of “lean production” is the improvement of organizational forms of work of medical organizations (MO), providing medical care to patients with dermatovenerological pathology at all stages of its provision.The survey was conducted at the Samara oblast, the dermatovenerologic dispensary (SACVD). Based on the diagnosis of “zones of inefficiency” in the provision of medical care to patients with dermatovenerological pathology, the reorganization of dermatovenerological care was carried out, including: restructuring of the MO network, the creation of mo areas of responsibility for the provision of dermatovenerological care; the organization of an interdistrict center; the reorganization of three city CVD departments; the opening of CVC; the development of regulations for intradepartmental interaction of dermatovenerologists with doctors of other specialties; the organization on the basis of THE; information support of participants of interaction; increase of professional level of medical personnel. The economic effect due to the elimination of duplication of laboratory and diagnostic studies in the medical examination of patients with dermatovenerological pathology was in 2015 1190266,7 rubles. Sociological surveys of patients who applied to the CSQ, showed that the majority of respondents were satisfied with the medical care, positively assessed its availability (90,3%) and quality (96,1%).

    Authors: Kalininskaya A. A. [13] Shakurov I. G. [2] Morozova E. V. [2] Merekina M. D. [3]

    Tags: an important part of the activity in dermatovenerological care in the conditions of “lean production” is the improvement of organizational forms of work of medical organizations (mo)1 providing medical care to patients with dermatovenerological pathology at all stages of its provision.1

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  • 2019 № 6 Reduction of time of providing medical service due to approach realization of “10 seconds”

    The 10 seconds model which cornerstone creation of a multilevel cascade system of interaction with the patient in the medical organization is is offered. The main organizational documents on the basis of which realization of the specified approach is possible are listed. Introduction advantages are allocated and proved. Process realization on the example of activity of reception and diagnostic office in MSCh KFU is opened.

    Authors: Demyanova O. V. [1] Abashev A. R. [1] Nikolayeva A. A. [1] Almukhametov A. A. [1]

    Tags: appeal  of  the  medical  organization.1 emergency medical service2 process4 process  management1

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  • 2019 № 6 Experience of practical use of SWOT analysis when organizing a medical department based on a fitness center

    Abstract. SWOT analysis - relevant today strategic management can be actively used in the health care organization. Nevertheless, a full formal analysis is hampered by a number of factors, among which are high financial and time-consuming. Another difficulty in carrying out quantitative assessments will be the risk of creating an” impression” of a unique solution, without taking into account the subjective factor during the determination of weight coefficients. At the same time, this type of analysis remains a good working tool when using it to make a decision and identify key aspects of the organization’s strategy. This article provides an example of the practical use of the method of SWOT analysis with the subsequent implementation of the developed recommendations. A full Swot-analysis was conducted to determine the strengths and weaknesses of the creation of a medical unit on the basis of a modern fitness center. Specific recommendations were created after ranking the factors by importance. The analysis confirmed the feasibility of establishing a medical department, which can increase the number of consumers of services with high margins. Taking into account the obtained data, the implementation of the recommendations was carried out and the relevance of the use of this management tool in the health care organization was confirmed. The final result of the practical application of swot analysis was the expansion of the market at the expense of patients in need of rehabilitation and preventive measures.

    Authors: Valiev A. Sh. [1] Sharafutdinova N. Kh. [2] Galikeeva A. Sh [1]

    Tags: fitness1 preventive  care  in  the  fitness center1 rehabilitation5 strategic  management  in  medicine1 swot-analysis3

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  • 2019 № 6 Main trends in mortality from injuries among elderly persons

    Р. 34-38
    Abstract. Despite the fact that the main economic and demographic negative contribution to the death rate from injuries is caused by cases among the able-bodied population, a huge social role is played by mortality among the elderly and senile age. For all the major causes of death from injuries, with the exception of death in road accidents and due to injuries with sharp objects, where the maximum rates are recorded for men of working age, the leading age groups are65 years or more, and peak values occur at the age of 80 years or more.The problem of high mortality among seniors is interdepartmental in nature; to solve this problem, it is necessary to involve not only health authorities, but, above all, social services. For persons of old age, an organization of an accessible environment is necessary, not only at public and private facilities, but also at the place of residence.

    Authors: Shishkin E. V. [5] Shchepin V. O. [5]

    Tags: elderly age1 injuries3 mortality20 old age.2

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  • 2019 № 5 The main trends in the incidence of young men (15–17 years) in the context of the growth of chronic pathology

    An increase in the incidence of the population, including children and adolescents occurs in recent decades in the Russian Federation. The growth rates of the total and the first time registered incidence of young men aged 15–17 years are analyzed for the period 2000–2017, according to the data of the Federal Statistical Observation. An increase in the overall incidence of young men by 35.8% was detected, for the first time registered incidence – by 35.4%. The maximum increase in overall morbidity is observed in the following classes: neoplasms (up to 2,6 times), diseases of the blood and blood-forming organs (2 times), congenital anomalies (malformations) (1,8 times), diseases of the circulatory system (1,7 times), diseases of the musculoskeletal system and connective tissue (1,6 times), diseases of the endocrine system, metabolic disorders (1,5 times). The indicator of “chronicity” of diseases was calculated, based on the data of the total and for the first time registered incidence. With a general growth rate of this indicator – 0.3%, there is a significant increase for some of classes of diseases: mental disorders and behavioral disorders (110.6%), congenital anomalies (mal- formations) (90.6%), diseases of the endocrine system, metabolic disorders (46.9%).

    Authors: E.  M.  Manoshkina [1] E.  N.  Matveev [1] M.  N.  Banteva [1]

    Tags: chronical  diseases  of  young  men1 morbidity  of  young  men1 morbidity  of  teenagers1 the  morbidity  of  young  men  within  classes  of  diseases.1

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  • 2019 № 5 The number of the examined doctors of functional diagnostics in calculation per one resident of the Russian Federation

    Relevance. Functional research methods are one of the most demanded and important directions in the diagnosis of health care. The purpose of the study was to analyze the number of surveys among the population conducted by doctors of functional diagnostics. Material and methods. Extensive and intensive indicators of the activity of doctors of functional diagnostics in the Russian Federation were calculated according to the forms of federal statistical observation for the period from 2012 to 2017. Results: analysis of the total number of persons examined in the units that provide medical care on an outpatient basis, by a functional diagnostics doctor per resident of the Russian Federation, for the period from 2012 to 2017 showed their growth. Conclusion: the number of functional diagnostics examined by physicians per inhabitant of the Russian Federation increased by 14.2% during the period under review. The highest coverage of functional diagnostics is noted in the Volga and Ural federal districts.

    Authors: D.  A.  Tolmachev [2]

    Tags: doctors7 examinations2 functional diagnostics2 height2 per resident2

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  • 2019 № 5 Organizational, clinical and epidemiological approaches in antiretroviral therapy and tuberculosis chemoprophylaxis and tuberculosis incidance among people living with HIV

    Antiretroviral therapy continues to play a major role in reducing the spread of tuberculosis among HIV-positive population, especially with chemoprophylaxis of tuberculosis while intensifying systematic screening and fulfilling the requirements of tuberculosis infectious control in places where are staying people living with HIV. In order to assess the availability of antiretroviral therapy and prophylactic treatment of tuberculosis among people living with HIV, and to determine the tendency of the HIV/tuberculosis incidence North-West of Russia, a clinical and epidemiological analysis was conducted from 2007–2017. The analysis was based on data from Rosstat № 61 reporting form on HIV infection and on information from a form which was additionally developed by the author for the territories of the North-West of Russia. Additional information, along with data on the economic and human resources of the system to tackle HIV/tuberculosis issues in the regions, on systematic screening of tuberculosis, includes data on antiretroviral therapy and chemoprophylaxis of tuberculosis among patients with HIV-infection. Results. During the review period, the coverage of HIV-positive antiretroviral therapy increased in Russia more than 10 times, in North-West of Russia) more than 8 times, the availability of tuberculosis chemoprophylaxis increased in Russia in 7.7 times, among people in the proficient stages of HIV-infections – in 2.8 times, in the North-West of Russia – in 16.9 and 4.2 times, respectively. On this background, in the North-West of Russia in recent years there has been a decrease in the incidence of HIV/tuberculosis coinfection from 10.1 per 100 thousand population to 6.6 and 7.3, respectively in 2016 and 2017. Conclusion. In the whole Russia and in the North-West of Russia in recent years, due to the updating or development of new regulatory acts that change organizational, clinical and epidemiological approaches to the treatment of HIV infection and prevention of tuberculosis, the availability of antiretroviral therapy and chemoprophylaxis of tuberculosis has significantly increased among the HIV-positive population. With this background, in the North-West of Russia in recent years there has been a tendency towards a decrease in the HIV/tuberculosis incidence.

    Authors: Z.  M.  Zagdyn [1]

    Tags: art1 hiv/tb  coinfection1 tuberculosis  chemoprophylaxis.1

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  • 2019 № 5 Modern aspects of marking of medicinal products: organization model introduction marking «DataМatrix» drug

    The introduction of an automated system for monitoring the movement of drugs from the manufacturer to the end user is one of the priorities of the “Health”, which in the future will provide full protection of the population from counterfeit drugs and prompt removal from circulation of counterfeit and substandard drugs. Many participants in the commodity distribution chain are not fully aware of the peculiarities of registration in the system of monitoring the movement of medicines, the purchase of equipment for their labeling and subsequent inclusion in the life cycle of the goods. The aim of the study is to develop an organizational model for the introduction of “DataMatrix” labeling on the drug, which is a modern element of the system for monitoring the movement of the drug from the manufacturer to the end user and contributes to the proper step-by-step inclusion of “DataMatrix” marking at each stage of the commodity chain.
    In the course of the research the methods of analysis and synthesis, the method of observation were used, the monitoring of legal documentation in the current edition was carried out, the algorithm was compiled using logical modeling.
    As a result of the work, an organizational model for the implementation of a system for monitoring the movement of medicines was created, which provides preventive measures for the entry into circulation and simultaneous withdrawal from circulation in an automated mode of counterfeit, substandard and counterfeit medicines at any stage of their circulation; control of the targeting of the movement of drugs purchased from the budget, the cost of their acquisition; monitoring of pricing and maximum retail prices for medicines from the list of vital and essential medicines.

    Authors: Melnikova V. V. [1]

    Tags: automated  system1 datamatrix.1 drug2 health care24 labeling1

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  • 2019 № 4 On the criteria for evaluating the activities of medical organizations in the new patient-oriented healthcare system

    The patient-oriented approach will allow taking into account individual preferences and needs of patients in the process of providing medical care. The study is devoted to the system analysis of the main provisions and conditions for their implementation in the patient-oriented model. The paper presents the composition of evaluation criteria in the developed model. The introduction of a new patient-oriented model implies a broader application of modern methods and technologies for their personal information support at various stages of medical care.

    Authors: R.  A.  Khalfin [1] V.  V.  Madyanova [1] A.  P.  Stolbov [1]

    Tags: concept of the patient-centered model1 patient-oriented healthcare system1 quality of medical care19

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  • 2019 № 4 About citizens with limited mobility in the context of health care

    Abstract. The article highlights the development of regulatory support for the provision of primary health care at home to people with limited mobility. The content of this concept is analyzed in various spheres of life. The ways of improving the terminology in the acts regulating the activities of nursing services are proposed.

    Authors: A.  L.  Lindenbraten [1] N.  K.  Grishina [1] N.  B.  Ataeva [1]

    Tags: citizens with limited mobility1 patients in the nursing service1 primary health care at home1

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  • 2019 № 4 The improvement of specialized medical care for patients injured in road traffic accidents based on information technology

    The information system was developed as a part of a Uniform State Health Information System (USHIS) in Mos- cow Region. It enables to perform a statistical and economic analysis, to simulate the work of trauma centers, resulting in an improved quality of medical care, as well as to decrease unreasonable economic loss and the road traffic mortality. It also helps to support patients after limbs amputation with prostheses without any delays.

    Authors: I.  M.  Dementyev [1] A.  N.  Gurov [1]

    Tags: information system3 passportization2 prevented economic loss.1 qaly1 quality of medical care19 road traffic accidents1 trauma center1

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  • 2019 № 4 The experience and results of lean manufacturing introduction in health care

    The World Health Organization gives notice an increasing demand for medical service on the one hand and a tendency toward deterioration of financial conditions in the healthcare system on the other that is the cause of the main concern in modern medical management. The article is considerate feasibility of using principles and methods of lean production for the purposes of organizing practical healthcare. Analyzed the results of lean production implementation of over the past few decades, the main early successes achieved using the tools and methods of lean production, as well as the basic limitations of the application are evaluated. Special attention is given to potential roles of the leader of healthcare institutions in lean production adaptation as well as evaluating the success of a strategy. A deep analysis of modern economic indicators of lean production successful implemen- tation in medical clinics abroad is presented, the key points of the effective introduction of lean production are being updated. In additional to economic indicators, the impact of lean production implementation in medical organizations on reducing mortality rates, transmission of nosocomial infections, mortality from hospital infections, reducing waiting times for medical services (especially in the admission department) is estimated. The current task facing the health care system in the Russian Federation is updated. The main conclusion is made about a huge amount of positive results after introducing lean production, including the positive economic effect and the increase in the quality of medical care after the introduction of the principles and methods of lean production, and also the entity of lean production as a separate method of organizing processes.

    Authors: O.  S.  Kobyakova [1] I.  A.  Deev [1] E.  S.  Kulikov [1] V.  A.  Boykov [1] M.  A.  Titova [1] I.  A.  Osikhov [1] T.  V.  Sivolobova [1] V.  B.  Obukhovskaya [1] Vyskochkov V. S. [1] A.  G.  Varlamova [1]

    Tags: healthcare organization3 lean prodaction1 lean  management4 medical institutions2 optimization6 process4 quality4 stan- dardization1

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  • 2019 № 4 Prevention of chronic non-infectious diseases prevention in Russia: possibilities of optimization

    Chronic non-communicable diseases (CNCD) remain the cause of three-fourths of deaths in Russia, but their control is not productive enough. Achieving of planned mortality reduction to 2025 among employable persons by 25,4%, from cardiovascular diseases – by 16,5% and from cancer – by 6% is possible only due to CNCD prevention. However, the costs on the «Centers of Health» activity are not justified from the point of view of their effectiveness, and dispanser- ization is not yet fully balanced in structure and volume. The analysis of some financial, organizational, methodological, legal and reporting documents makes will be it possible to identify problems and to offer systemic measures to optimize CNCD prevention.

    Authors: T.  M.  Maksikova [1] A.  N.  Kalyagin [1]

    Tags: chronic non-infectious diseases2 dispanserization1 organizational problems1 prevention19 risk factors8 the centers of health1

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  • 2019 № 4 Activities of departments and offices of functional diagnostics in the Russian Federation, 2012–2017

    Relevance. Functional diagnostics is widely used in all branches of practical public health. The purpose of the study was the activities of the departments and offices of functional diagnostics of the Russian Federation. Material and methods. The calculation of intensive indicators of the activity of the departments and cabinets of functional diagnostics according to the number of surveys conducted among the population of the Russian Federation in the outpatient setting among the population of the Russian Federation for the period from 2012 to 2017 has been carried out. Results: analysis of the number of persons examined in total in the units providing medical care on an outpatient basis, by a functional diagnostics doctor per inhabitant of the Russian Federation for the period from 2012 to 2017. showed their growth. Conclusion: the number of surveyed in the offices and departments of functional diagnostics per inhabitant of the Russian Federation for the period analyzed increased by 14.2%. The highest coverage of functional diagnostics is noted in the Volga and Ural federal districts.

    Authors: D.  A.  Tolmachev [2]

    Tags: doctors7 examinations2 functional diagnostics2 height2 per resident2

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  • 2019 № 4 Morbidity of young doctors in connection with the characteristics of professional socialization

    Relevance. The presence of chronic diseases leads to deterioration of health, and also affects the quality of life, professional development, socialization. The occurrence of chronic diseases in young doctors is associated not only with age and sex characteristics, but also with the characteristics of professional socialization.
    Purpose. Analyze the causes and conditions of the development of chronic diseases in young doctors in connection with gender, age and professional socialization.
    Materials and methods. The presence of chronic diseases in young doctors was analyzed according to official data provided by the Tver regional organization of the trade union of medical workers and according to their own research. In order to determine professional socialization, we conducted a sociological survey and psychodiagnostic examination. Results. The prevalence of chronic diseases among men is less than among women, regardless of age group. Also, with increasing age, an increase in these indicators is observed, regardless of gender. The doctors with chronic diseases are more in the group with no characteristics of professional socialization.
    Findings. The smallest number of people suffering from chronic diseases was found among young male doctors who are in the age group up to 29 years old, and also possessing characteristics of professional socialization. In general, the presence of chronic diseases depends on gender and age, as well as on the presence or absence of characteristics of professional socialization.

    Authors: Milekhin S. M. [1] Derbenev D. P. [1]

    Tags: chronic incidence of young doctors.1 professional socialization1 young doctors1

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  • 2019 № 3 Performance optimization of the operating unit in conditions of high patient turnover using economical technologies

    Presents optimization methods of functioning of the operating unit. The efficiency and validity of the implementation of these methods in the work of the operating unit, and in the units involved in the preoperative preparation, is shown. Analyzed the effectiveness of innovations on the example of two departments of the surgical profile. An assessment of the result is given.

    Authors: Stilidi I. S. [2] Doroshev I. A. [2] Kulushev V. M. [2] Ryabchikov D. A. [2] Krokhina O. V. [1] Gruzdev V. E. [1] Artemyev S. A. [2] Ilyin S. N. [2] Kazakov A. M. [2] Dudina I. A. [1] Getazheeva L. A. [1]

    Tags: operating unit1 optimization6 surgical.1

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  • 2019 № 3 The formation of a new model of medical organization providing primary health care. Treatment of patients in the clinic: analysis and modeling

    As part of the formation of a new model of medical organization providing primary health care to children promising mathematical apparatus for management decision-making are Markov chain with estimates. The generation of models with different scenarios in the treatment of children in the clinic revealed that the activation of dispensary work leads to a decrease in both the number of visits for diagnostic and treatment purposes, as well as the total number of visits to the clinic. The experience of dispensary work will be replicated in other regions from 2019.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6] Dmitrieva I. V. [3]

    Tags: markov chains2 markov chains with assessments1 modeling of management decisions1 primary health care for children1 seeking medical care1

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  • 2019 № 3 Cost performance of the selective laser trabeculoplasty for patients with primary open-angle glaucoma

    Primary open-angle glaucoma, as the most common form of glaucoma, is an important medico-social problem. Selective laser trabeculoplasty is an effective and safe method of treatment of primary open-angle glaucoma. The purpose of this work was to estimate the cost performance of the treatment of patients with primary open-angle glaucoma using selective laser trabeculoplasty and their stagewise dynamics during the treatment. The analysis of 250 patients (338 eyes) with primary open-angle glaucoma, operated using selective laser trabeculoplasty in the Orenburg branch of S. Fyodorov Eye Microsurgery Federal State Institution of the Ministry of Health of the Russian Federation, was carried out. The patients are from 42 to 86 years old, of which 118 are women (47.2%) and 132 are men (52.8%), all of them being residents of the Orenburg region. Intraocular pressure before selective laser trabeculoplasty ranged from 20 to 30 mm Hg. All the patients attended standard ophthalmological examination before the operation. Selective laser trabeculoplasty was performed on the apparatus Quantel Medical Optimis with Solutis attachment at standard parameters. During the postoperative period, nonsteroidal anti-inflammatory drugs were prescribed to the patients for 7 days. The follow-up period after selective laser trabeculoplasty: 1 day; 1, 3, 6, 12 months. The linear method and cluster analysis were used as mathematical methods; the processing was carried out using STATISTICA 10 software package. Statistical analysis was performed on subsamples drawn on the basis of qualitative characteristics: gender code; age code; code “working/not working”; disease severity code; OD diagnosis code and OS diagnosis code. All 250 patients were divided into 5 clusters with the help of cluster analysis applied to the characteristics listed above. Clusters, in which patients have the lowest and the highest average expenditures for antihypertensive drugs for the entire period of treatment, were identified. The results of cluster analysis can be the basis for constructing a model of the average estimated expenses of patients with primary open-angle glaucoma operated with selective laser trabeculoplasty. Determining the ratio of material expenditures and the result of treatment allows to effectively plan ophthalmological care for patients with primary open-angle glaucoma.

    Authors: Chuprov A. D. [3] Borschuk E. L. [1] Kanyukov V. N. [1] Kadnikova O. V. [1]

    Tags: cost performance1 economic effect2 ocular pressure1 primary open-angle glaucoma1 selective laser trabeculoplasty1

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  • 2019 № 3 The role of air ambulance in reducing mortality in acute myocardial infarction in the Vologda region

    The incidence of acute myocardial infarction (AMI) in the Vologda region exceeds the average Russian indicators and the average in the North-West Federal District. The Vologda region has a number of geographical features, which makes it relevant to use air ambulance services to evacuate patients with acute myocardial infarction from remote locations to regional clinics. Purpose. To study the role of air ambulance in reducing the mortality of patients with acute myocardial infarction. Material and methods: statistical data on the frequency of hospitalization of patients with acute myocardial infarction in medical institutions of the Vologda region and data on the use of air ambulance to evacuate patients with the specified diagnosis for the period from 2015 to 2018. Results and its discussion. Mortality rates from acute myocardial infarction of the Vologda region exceed the average Russian level. There are significant differences in certain areas of the region, Vologda and Cherepovets, where regional vascular centers are deployed. However, mortality rates remain high in many remote and inaccessible areas of the region. Analysis of the work of air ambulance showed that with its help, at best, up to 12.5% of patients with acute myocardial infarction from among those who need to be transferred to specialized vascular centers from central regional hospitals are evacuated. Conclusion. Air ambulance is a tool of “point” medical care for people living in hard-to-reach settlements. The real improvement of statistical indicators is possible only with a complex of organizational measures.

    Authors: Vankov D. V. [3] Dyakov S. V. [1]

    Tags: acute myocardial infarction1 air ambulance1 hard-to-reach areas1 regional vascular center2

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  • 2019 № 2 Management of a medical organization based on Markov chains with grades

    Different aspects of management decision-making based on mathematical models have been actively examined in scientific papers over recent years. The mathematical apparatus of Markov chains with estimations is a perspective mathematical apparatus of management decision-making. The advantage of Markov chains with estimations is that the method adequately works with quantitative, as well as with qualitative data. The modelling based on Markov chains is a variation of imitational modelling using random number generators. Generating models with different scenarios allows to find a management decision that has the best characteristics of the required state of a medical organisation.

    Authors: Choloyan S. B. [11] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4] Ekimov A. K. [10] Baygazina E. N. [6]

    Tags: markov chains2 markov chains with estimations1 medical organisation management1 modelling management decisions1

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  • 2019 № 2 Organizational and methodological basis of the preliminary analysis of the work of outpatient clinics at the stage of the beginning the project «Lean polyclinic

    In order to start optimization and structural transformations, the external (questionnaires of patients, n = 200) and internal audit (time-related studies, n=186) of the outpatient clinic participating in the implementation of the priority project «Creating a new model of primary health care». For this purpose, 5 interrelated processes are identified in which the patient participates in the receipt of primary health care: 1 process – «Record for outpatient admission»; 2 process – «Registration»; 2 process – «Waiting for reception »; 4 process – «Medical care of the patient». 5 process – «Analysis of the nearest and remote end points». It is shown that there is a need in the outpatient clinic for information and technical improvement of the polyclinic’s Internet portal; need to improve sanitation in public places; optimizing the activity of outpatient doctors to reduce waiting times in the queue (optimizing the workplace, analyzing the workload of medical personnel, reducing the time spent on medical documentation, personalized approach to patients). Overall, 82,4% of patients were satisfied with the work of the polyclinic, assessing it as «good» (76,5%) or «excellent» (5,9%). In the future, it is planned to monitor morbidity, disability and mortality indicators as a criterion for the effectiveness of the project.

    Authors: Komanenko A. A. [1] Avdeeva M. V. [1] Filatov V. N. [1] T. Yu. Garifullin [1]

    Tags: healthcare efficiency1 primary health care14 public health8 «lean clinic»1

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  • 2018
  • 2018 № 9 Influence of activity of the medical organization, providing medical assistance to children, on the economy of the region

    The analysis of 46 7122 entries in the medical information system of the organization for 2016 characterizing the treatment of children for the purpose of medical care, 9533 cases when the sheet can not work (SNW) was issued. The costs of territorial funds of compulsory medical insurance (CMI) and social insurance fund, an internal regional product for the treatment of a child, are estimated. It is established that the budget of the region loses 8,9 times more than the amount of CMI funds that was spent for the treatment of the child, if issued by the SNW. This requires active prophylactic measures for children.

    Authors: Choloyan S. B. [11] AEkimov. K. [1] Pavlovskaya O. G. [8] Sheenkova M. V. [7] Danilova L. V. [4]

    Tags: compulsory medical insurance14 compulsory social insurance1 gross domestic product1 payment of a disability certificate1 preventive measures for children1

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  • 2018 № 9 Comparative analysis and assessment of polyclinic work at the second level of urological care to the population in the region within the framework of the developed three-level system

    The system of urological care in the region is an integral component of effective health care. The regional system of urological care, implemented in the form of the so-called “traditional approach” is not optimal. The article provides an analysis of the three-level system of restructuring of urological care in the Voronezh region in terms of the polyclinic activity of medical organizations of the second level of urological care on the example of urolithiasis, benign prostatic hyperplasia and prostate cancer. The study included two time stages: the traditional system of urological care before the introduction of the restructuring system and after the introduction of a three-level system of care for patients with urological pathology. The results demonstrate a strong statistically significant objective increase in outpatient activity and the level of medical examination for the vast majority of patients in all three diseases considered in this study reflect the ultimate performance of the regional urological service (on the example of Voronezh region), in terms of its functioning in the format developed a three-tiered system of medical care in comparison with the traditional approach.

    Authors: Esaulenko I. E. [3] Zolotukhin O. V. [3] Kochetov M. V. [2] Avdeev A. I. [1] Madykin Yu. Yu. [1] Zolotukhin V. О. [1]

    Tags: benign prostatic hyperplasia2 polyclinic4 prostate cancer4 regional system1 restructuring2 urolithiasis2 urological care1

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  • 2018 № 8 Sanitary aviation in road accidents and its economic feasibility

    Relevance: The organization of emergency medical advice, especially in road accidents is an important as¬pect in preserving the health and life of the victims. Purpose of the study: analysis of the frequency of road accidents and fatalities in the Vologda region for the period from 2006 to 2017. Material and methods: the data of medical documentation on the registration of road accidents and the provision of medical care in their presence. Results and discussion: a list of emergency medical care for road traffic incidents is defined by a number of Government Decrees and orders of the Ministry of Health at various levels. The number of dead children at the scene of the accident increased by 1 case, died at the prehospital stage and in the first seven days after admission was reduced to zero, in the period after hospitalization from 0 to 30 days decreased by 3 cases. Conclusions: during the analyzed peri¬od, the number of deaths in road accidents decreased by 34.0%, the number of deaths in the hospital for the first 7 days after hospitalization by 45.2%, from 0 to 30 days – by 46.3%. Mortality at the prehospital stage is 40.0%.

    Authors: Vankov D. V. [3]

    Tags: activities2 economic expediency1 sanitary aviation1 traffic accidents1

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  • 2018 № 7 On strengthening and preservation of health of employees at enterprises

    The issues of strengthening and maintaining the health of persons working at the enterprises of the Volga Federal district are Considered. The role of employers and trade Union organizations in this direction is studied

    Authors: Starodubov V. I. [36] Soboleva N. P. [4] Savchenko E. D. [5]

    Tags: employers2 prevention at the enterprises1 strengthening and preservation of health of workers1 trade union organizations2

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  • 2018 № 7 Development of an integrated assessment tool health and social well-being of patients aged 60 years and over and their needs for different types of care

    A tool for the comprehensive assessment of the condition of patients 60 years of age and over which allows to objectify patients’ demand for medical and social assistance, taking into account their individual characteristics has been developed and tested In the framework of this study. The suggested methodical tool is primarily focused on the use in the primary health care, makes it possible to form both a program of work with each patient at the age of 60 years and older, and an action plan to support the attached population of the given age category at the site or a specific medical organization level, and also assess the efficiency of the assistance provided

    Authors: Korotkova A. V. [3] A. Sh. Senenko [5] Vorobyev R. V. [2] Nitsenko D. I. [2]

    Tags: comprehensive assessment of the health status1 comprehensive geriatric assessment1 elderly patient1 geriatrics3 medical and social assistance3 patient-orientation5 patients aged 60 years and older1 persons of elderly and senile age2 primary health care14

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  • 2018 № 7 Formation of new management in the work of a children’s outpatient hospital based on analysis of children’s health problems and independent assessment of the quality of service

    In order to form new management in the work of the children’s outpatient hospital by analyzing children’s health problems and independent assessment of the quality of primary health care, special attention is paid to the standard of equipment and work of children’s outpatient hospitals. As a result of the formation of new management in the work of children’s outpatient hospitals, the following indicators are evaluated: increasing the time of the doctor’s work directly with patients; reduction of time required to make an appointment with a doctor; reduction of queues and waiting time for parents with children to receive a consultation; comfortable and accessible environment for parents and children in the clinic, reducing the time for children to undergo medical examination

    Authors: Gurov A. N. [15] Davronov I. V. [2] E. Yu. Ogneva [2]

    Tags: diseases of the children’s population1 new management1 population’s satisfaction with primary health care for children1 work of a children’s outpatient hospital1

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  • 2018 № 7 Process approach in the organization of medicinal support

    The purpose of this article is to define and detail the basic principles of the process-oriented approach and the regulation of the organization’s activities – as the most effective management mechanisms, and the application of the process approach in the organization of continuous targeted drug provision of the treatment and diagnostic process in a federal multidisciplinary institution on the example of the “National Pirogov Medical Surgical Center” of the Ministry of Healthcare of the Russian Federation (hereinafter Pirogov Center).

    Authors: Karpov O. E. [5] Nikitenko D. N. [2] Lyashchev S. A. [1]

    Tags: function. medicinal products. drug provision. accounting and write-off of medicines1 process4 process-oriented approach1 regulations4

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  • 2018 № 7 Оrganization of the service of radiodiagnosis in Moscow

    The analysis of uniformity of distribution of radiation diagnostics equipment in medical organizations of Moscow is Carried out. It is proposed to create a transparent and controlled system that allows to aggregate the entire volume of data on the conducted research to achieve high productivity and optimize financial costs. Redistri¬bution of loads in medical organizations by optimizing departments, revision of the regulatory framework will allow to use additional tools in the formation of x-ray conclusions. Continuous monitoring and monitoring of the radiation diagnosis equipment will significantly reduce the costs in the health care system and move to a higher and higher level of development of the radiation diagnosis service in Moscow

    Authors: Shelekhov P. V. [2]

    Tags: control3 distribution uniformity1 equipment3 monitoring3 moscow1 radiology3

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  • 2018 № 6 Contribution of the Russian Federation subjects to the total population overall incidence Levels Formation in 2010-2016 years

    The analysis results of the RF total population overall incidence by federal districts in 2010-2016, which allows to appreciate contribution of every RF federation district to the population overall incidence level formation on the nationwide scale, are presented in this work. The factors affecting to the formation of indicators of the RF total population overall incidence have been considered

    Authors: Son I. M. [38] Leonov S. A. [14] Savina A. A. [2]

    Tags: incidence rates2 overall incidence1 rate of increase1 statistical indicators analysis1 the russian federation (rf) federal district1

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  • 2018 № 6 The role of injury, poisoning and certain other consequences of external causes of mortality in the population of the Russian Federation

    The most significant dynamics of mortality reduction among the main classes is noted from external causes, according to the Russian Federation, the indicator decreased in 2017, in comparison with 2006, twice. Injuries, poisonings and some other consequences of external causes are related to «manageable» causes of mortality and are not only an important indicator of health care, but also the state of the economy and society as a whole. Despite such a significant decline, the mortality from external causes is on indicators that are 2–5 times higher than those of economically developed and developing countries. The greatest contribution to the reduction of mortality from external causes was achieved, first of all, due to road traffic injuries, as well as through injuries, the provision of medical care in which was carried out in a three-level system of trauma centers. A significant proportion in the structure of mortality from external causes is due to acute poisoning. The example of the Chelyabinsk region shows an increase in mortality from drug poisoning, including synthetic origin. The received data testify to the need to take measures aimed at further optimization of the three-level system of trauma centers, as well as the formation of a system for providing medical care for poisoning, including the organization of acute poisoning centers

    Authors: Shishkin E. V. [5] Shchepin V. O. [5]

    Tags: accidents1 alcohol1 diseases of the circulatory system1 drug poisoning1 external causes3 injuries3 oncological diseases3 poisoning2

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  • 2018 № 6 Medical care quality management system in public health institutions providing oncohaematological aid. Basic principles of functioning, implementation stages and assessment of efficiency

    The basic principles of structuring and functioning of the medical-care quality management system have been developed with regard for the specificity of haematological aid, including a complex of criteria allowing to assess in general the quality of its provision in terms of process and results, and to evaluate it from the quantitative point of view, as concerns the operation of the haematological service of the region on the whole. Stepwise intro¬duction of the quality management system elements in the operation of the public health institutions of haematological profile has been suggested; the implementation stages have been characterized; the efficiency of the quality management system in the domain of haematological aid has been shown, based on the results of follow-up expert evaluation (the indicator of efficiency of the oncohaematological aid in the outpatient setting has increased by 50%, in the inpatient setting – by 20.9%).

    Authors: Zhiguleva L. Yu. [1]

    Tags: expert assessment2 haematological aid1 management efficiency2 medical care quality management system1 quality criteria1

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  • 2018 № 5 Assessments of laboratory centralization projects in the Russian regions (pilot study)

    In the past years, a great amount of centralization projects took place in laboratory medicine in Russia. Advisors’ opinion of 65 Russian regional healthcare departments on the goals, models and results was investigated in the research. It was identified, that goals for such projects are rarely specific, measurable and achievable. The majority of laboratories are small or middle sized. The effects for regional healthcare systems are estimated rarely. In the paper a few typical models are identified, that are used in the country, and a few definitions and methods of project estimation are offered

    Authors: Sveshchinskiy M. L. [2] Goldberg A.  S. [2]

    Tags: centralization3 consolidation1 effectiveness5 efficiency10 goal setting process1 smart1

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  • 2018 № 4 Interaction tools between participants in medical insurance for improving medical care for patients with cancer

    The article describes the difficulties between all participants in health insurance in the provision of specialized medical care to patients with oncological diseases. Algorithms for interaction of the oncological dispensary, medical organizations, providing primary health care, insurance medical organizations and the Territorial Fund of Mandatory Medical Insurance proposed on the example of the Krasnoyarsk Territory. Rules for interaction of participants in medical insurance for informational support of insured persons with newly diagnosed oncological diseases and during oncoscreening process have been developed and implemented

    Authors: Modestov A. A. [1] Slepov E. V. [1] Yamschikov A. S. [1]

    Tags: insurance attorneys1 malignant neoplasms4 oncoscreening1 participants in medical insurance1 specialized medical care2

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  • 2018 № 4 Comparative characteristic of victims in road transport accidents in the arctical zone of the arkhangelsk region depending on the alcohol factor

    Road traffic trauma nowadays remains an urgent medical and socio-economic problem in Russian Federation. For the purpose of comparative analysis of characteristics in groups of victims with alcohol intoxication in road accidents that occurred in the Arctic zone of the Arkhangelsk region, a continuous, analytical, population study was conducted – documentary observation. A sample of 518 medical cards (f.003/у) of victims in road traffic accidents, who received medical care in hospitals, was analyzed in Severodvinsk from 2012 to 2016. It was found that up to 30% of injured in accidents were in a state of alcohol intoxication; young men predominated among victims, and severe concomitant trauma predominated in the structure of all injuries. The results of the research may be in demand in the development of regional programs to prevent and reduce the number of accidents and prevention of road traffic trauma

    Authors: Menshikova L. I. [5] Petchin I. V. [1] Baranov A. V. [1] Barachevskiy Y. E. [1] Klyuchevsky V. V. [1] Modyanov N. Y. [1]

    Tags: alcohol intoxication1 arctic zone1 arkhangelsk region4 injury severity1 traffic accident1

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  • 2018 № 4 Logistics of medicines as the point of optimization of costs of the medical organizations

    This article examines 3 main types of schemes for the supply of drugs in healthcare organizations. The advantages and disadvantages of each scheme are described. Based on practical experience of using various types of schemes in the Clinical center of the Federal STATE First MSMU n. a. I. M. Sechenov of the Russian Ministry of health shows the economic and organizational advantages of the centralized inventory management scheme

    Authors: Gaidukov [1] A. A. [1] Zhupanova D. B. [1] Rebrov E. L. [1] Kuznetsova S. G. [1]

    Tags: comparative analysis1 drug2 economic efficiency7 medical organizations22 support schemes1

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  • 2018 № 4 Multivariate statistical analysis by the example of transport accidents

    Modern methods of multivariate analysis allow to perform in-depth analysis on statistical data. The proposed method of multivariate analysis examines the formation of the array using the algorithm of generalized assessment of health indicators. It is possible to build and further analyze a mathematical model using an algebraic model of constructive logic. Using the proposed method, the analysis of mortality in the result of accidents in transport. This allows you to rank indicators lethality in the regions of the country and highlight the most problematic regions. The partial significance of the analyzed factors is shown. It provides analytical approach to the epidemiology of mortality in transport in different regions of the country

    Authors: Khromushin V. A [1] Lastovetsky A. G. [1] Kitanina K. Yu [1] Ayvazyan A. G. [1]

    Tags: analysis2 health indicators1 mathematical model1 mortality20

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  • 2018 № 2 The dynamics of morbidity of the population over working age with malignant skin tumors and mortality from them for the period from 2012 to 2016

    The article presents an analysis of the incidence of malignant neoplasms of the skin and mortality from them among the population over working age. Subjects with high rates of morbidity and mortality due to malignant neoplasms of the skin are identified. The need to improve the work of the observation rooms of the polyclinic health care unit and primary oncology offices in the system of oncological care for the population was noted

    Authors: Golubev N. A. [6] Ogryzko E. V. [11] Popova N. M. [1] Odinets A. V. [1]

    Tags: incidence rates2 malignant neoplasms of the skin1 population over working age1

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  • 2018 № 2 Potential years of a life lost and economic losses due to the alcohol-attributable mortality in the near-arctic regions of the european north of Russia

    Background. High level of premature alcohol-attributable mortality and associated economic losses are the con- sequences of considerable alcoholization of the population of the near-arctic regions in Russia. Aim of the study is to assess potential years of a life lost and economic losses due to the alcohol-attributable mortality in the Murmansk, Arkhangelsk regions and the Komi Republic in 2006–2015 years. Methods. Potential years of a life lost due to the premature deaths from alcohol-attributable conditions were calculated using brief tables of mortality (survival) for the five-year age intervals. This data was used to estimate the scale of the “actual” (annual) and “prospective” economic losses. Results. Distribution of the potential years of a life lost due to the premature deaths from alcohol-attributable conditions had the inverse “po- lar-equatorial gradient” (the maximum values of the indicator were in the Arkhangelsk region and the Komi Republic; and the minimum values were in the Murmansk region). Men and women aged 30–49 were at the group of a high risk. Positive dynamics in the values of the indicator in the group of elderly persons was associated with an increase in the life expec- tancy of the population. In 2006–2015 total “perspective” economic losses due to premature alcohol-attributable mortality in Murmansk region amounted to 5.5 billion rubles, Arkhangelsk region – 9 billion rubles, Republic of Komi – 11.7 billion rubles. Conclusions. In 2006–2015 alcohol-attributable mortality remained a leading cause of a significant demographic and economic damage to the population of the near-arctic regions of the European North of Russia. Application of the results. Obtained results can be used to develop programs for medical prevention and the healthy lifestyle formation, justi- fication of measures aimed at increasing the efficiency of regulation of the regional alcohol market.

    Authors: Mordovskiy E. A. [1]

    Tags: alcohol-attributable mortality1 arkhangelsk region4 economic losses2 komi republic1 murmansk region1 near-arctic territories1 potential years of life lost1

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  • 2018 № 2 Analysis of CT utilization for primary care clinics of the large city

    We studied the use of CT scans in forty-five polyclinics in a large city. The maximum load per unit was 657 exams per month. The average load was 220 exams per month (CI 95% 208–231). No direct correlation was found between the exam volume and the size of the population served by the polyclinic (r = 0.47). The average CT utiliza- tion was 14.4 exams per 1000 adults inhabitants (CI 95% 12.4–16.5). The age-specific patterns of CT usage were revealed. For population within the age group of 18 to 45 years the frequency of CT usage gradually increased from 4.24 to 5.94 per 1000 people. Most often CT was used within the age group of 70-year-olds. Within this group, the number of tests reached 30.6 per 1000 adults inhabitants. In the older age groups, the number of exams was lower. In polyclinics without an MRI scanner, the structure of CT exams differed. The share of brain exams among all CT exams was 18% (compared to 10.8% in MRI equiped polyclinics), the share of spine exams was 17.7% (compared to 9.5% in MRI equiped polyclinics). Evidence is obtained of a multiple increase in the frequency of use of contrast media for CT in response to a complex of educational, control and economic interventions

    Authors: Sveshсhinskiy M. L. [1]

    Tags: computed tomography2 ct scans1 polyclinic4 utilization2

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  • 2018 № 2 Development and implementation of a standard for the organization of work of registries medical organizations: the project «Entrance group»

    Regional project “Front-office” was set up and implemented in Tomsk oblast (Siberia, Russia). The aim of the project was launch a front-office of out-patients departments standard for improvement patients satisfaction in medical institutes. There are five directions in the project: providing affordable telephone service, front-office infrastructure, staff training, medical documents logistic, corporative style creation. Using of holistic project approach has led to significant improvement of availability and quality of health care in Tomsk oblast

    Authors: Holopov A. V. [2] Boykov V. A. [7] Kobyakova O. S. [13] Deev I. A. [8]

    Tags: flagship university1 front-office1 health care24 project management2

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  • 2017
  • 2017 № 10 Procurement management of major resources expenditure of the medical organization by creating a matrix of consumption and planning

    Effective and efficient use of budget one of the priority tasks facing the chief physicians. Nomenclature of drugs in cancer clinics has dozens of INNs and hundreds of trade names, which greatly complicates the work of purchasing departments. Maintaining an optimal balance between the income and consumption of goods is an important task of every medical institution. To achieve this goal requires a clearly established system of inventory management that will optimize and effectively predict purchases in subsequent periods. The analysis allows for closer examination of the consumption budget of the institution for each commodity group, the INNs and the ATC groups and build a matrix of inventory given the importance and deman

    Authors: Zelenova O. V. [4] Kreknina E. A. [5] Sannikov A. I. [2] Danilov V. M. [1] Abramov S. I. [1]

    Tags: abc analysis2 atc classification1 medical stores and drug inventory1 purchase of medicines1

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  • 2017 № 10 Assessment of risk factors for health in extracurricular activities of children and adolescents

    The article analyzes the influence on health of students of the primary and secondary schools of extra-curricular risk factors, which differ in the principle diversity and the moment of impact occurring on the second half of the day, with its physiologically conditioned decrease in efficiency. Methods were used to question students with statistical processing of the material, assessing its significance through the use of Student’s test, and subsequent analysis. The influence of extra-curricular risk factors on health of students was established, with features for each of the ages analyzed. Taking into account the extra-curricular risk factors in the everyday work of the participants of the educational process will allow planning the content of the work for teaching students to a healthy lifestyle

    Authors: Guriev A. V. [1] Soboleva N. P. [4] Evdokimova I. K. [1] Ishkova G. I [1]

    Tags: a healthy lifestyle1 bad habits1 children’s health center1 extracurricular risk factors1 participants of the educational process1 school medical staff1 school risk factors1

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  • 2017 № 10 Cancer incidence of Nizhny Novgorod region population from the standpoint of the concept of avoidable mortality

    The concept of avoidable mortality to evaluate healthcare provisions and identify priorities for improvement of the activity of cancer services in the region. Nizhny Novgorod region is stable is a region with a high incidence of malignant neoplasms and population mortality from cancer. Therefore, the author, using data from nationwide survey, conducted a comparative assessment of morbidity, mortality, one-year mortality, early detection External testing the main locations for the Nizhny Novgorod region. The cluster method allowed to determine the position of the region among other regions of the Russian Federation as the general indicators of cancer incidence, as well as on the most significant types of cancer. The analysis allows to plan differentiated activities in the primary, secondary and tertiary prevention of cancer pro¬grams aimed at reducing and preventing deaths from External testing of specific sites

    Authors: Denisenko A. N. [2]

    Tags: avoidable mortality1 indicators5 malignancies1 oncology service1

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  • 2017 № 10 Benchmarking of blood transfusion in regions of the Russian Federation

    Blood transfusion statistics in Russia has been evaluated. In 2016 about 1.2 million patients of Russian clinics received more than 3.2 million transfusions of blood and its components in a total volume of about 1 million liters. About 0.5% of Russian doctors certified in the specialty «Transfusiology». The practice of transfusion of blood components in the RF subjects is very variable. The degree of heterogeneity of the clinical transfusion has been determined: the decile coefficient of some indexes in the regions of Russia in 2016 amounted to: transfusionists provision – 5.31; the number of recipients of blood on 1 transfusionist – 4.91; the part of transfusionists among doctors – 3.70; the part of recipients of blood among the population – 3.04, the volume of blood transfusion for 1 recipient 1–2.43; the volume of 1 blood transfusion – 2.29; the number of blood transfusions for 1 patient – 1.74. It seems appropriate for further statistics of clinical transfusion evaluation: the term «transfusion» replaced by the term «unit»; to evaluate the practice of transfusion of different blood components separately

    Authors: Zhiburt E. B. [15] Chemodanov I. G. [1] Averyanov E. G. [6] Kozhemyako O. V. [1]

    Tags: benchmarking2 blood service5 recipient4 transfusinist1 transfusion3 unit4 volume4

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  • 2017 № 7 Pharmacoeconomic analysis of breast cancer prevention in women with BRCA1/2 mutation

    The article deals the problems of using preventive surgical interventions (preventive mastectomy, preventive adnexectomy) in patients carrying BRCA mutations. The article presents and justifies economic efficiency of methods of surgical prevention compared to the observational method estimation. The most preferable tactics of management these patients offer, according to pharmacoeconomic analysis. Five models (decision trees) were developed to assess the cost of every tactics of patient management. The following health statuses were considered: no disease, primary disease, remission, and death. Based on the results of these models, pharmacoeconomic analysis was conducted to compare preventive surgical interventions with the observational method. Life years saved was the measure of effectiveness. The cost assessment was conducted for a medical facility. The modelling horizon was the age of 25–70 years. Preventive surgical interventions enabled to save 9–88 additional years of life in the cohort of 100 women with BRCA1/2 mutation compared to the observational method. Bilateral prophylactic mastectomy and preventive adnexectomy performed in the whole cohort of 50 year-old women instead of observation resulted in additional cost of 70 323 RUB for one saved year of life. Other considered approaches connected with the preventive surgical interventions were found to be more economically effective than observation. According to pharmacoeconomic analysis, the most preferable tactics of management is bilateral prophylactic mastectomy and preventive adnexectomy in the age of 40, which allow achieving greater results with fewer costs by 70 years old.

    Authors: Solodkiy V. A. [2] Khodorovich O. S. [1] Derkach Ye. V. [1]

    Tags: brca1/2 mutations1 life years saved1 pharmacoeconomic analysis1 preventive adnexectomy1 prophylactic mastectomy1

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  • 2017 № 7 Comparative analysis and integrated assessment economic efficiency of the developed three-level system of provision of urological care to the population in the region compared to the traditional approach

    Medico-economic efficiency of functioning of the regional urological service at the modern stage of healthcare development is not optimal. In article the analysis of work-level system and the restructuring of urological care in Voronezh region for the total amount of direct costs for diagnosis and treatment of all patients and the cost of diagnosis and treatment in terms of a particular patient, for example urolithiasis, benign prostatic hyperplasia and prostate cancer. The study included two stages: a traditional system of provision of urological care to the implementation of the system restructuring, and after implementing three-tier system of care for patients with urological disorders. The results demonstrate a strong statistically significant objective reduction of economic costs of diagnosis and treatment for the vast majority of patients in all three nosological forms presented in this study reflect the ultimate performance of the regional urological service (on the example of Voronezh region), in terms of its functioning in the format developed a three-tiered system of medical care in comparison with the traditional approach.

    Authors: Esaulenko I. E. [3] Zolotukhin O. V. [3] Apolikhin O. I. [2] Avdeev [1] A. I. [1] Madykin Y. Y. [1] Kochetov M. V. [2] Anosova [1] Y. A. [1] Shaderkin I. A. [1]

    Tags: benign prostatic hyperplasia2 direct costs5 economic efficiency7 medical care12 prostate cancer4 restructuring2 urolithiasis2

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  • 2017 № 6 Peculiarities of the morbidity of teenagers 15–17 years old in Russian Federation for the period 2000–2015

    Adolescent population’s health determines the formation of the nation’s health for the future. Tendency of the general morbidity of adolescents in the dynamics for 2000–2015 in Russia is presented. For the period of study, a significant increase in the overall incidence of adolescents was revealed: from 1730 to 2193 cases per 1000 of the corresponding population (an increase of 26.8%). At the same time, the average annual growth for five-year periods (2000–2005–2010–2015) was 0.4; 5.1; and –0.2%, respectively. The growth trend is also traced for the incidence detected in adolescents for the first time in life: from 1046 to 1341 per 1000 of the respective population (by 28.2%), while the average annual growth over the five-year periods indicated above was 0.5; 5.5; –0.4, respectively. The study showed that the last 15 years were characterized by negative dynamics of the health indicators of the adolescent population. The share of diagnoses registered for the first time in life, from the total morbidity of children of 15–17 years in general for all diseases has not changed (61% in both 2000 and 2015 years), that indicates growth of both acute and chronic pathology in the population

    Authors: Banteva M. N. [9] Matveev E. N. [3] Manoshkina E. M. [7] Kuraeva V. M. [2]

    Tags: incidence of adolescents1 incidence of child population1 overall morbidity1

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  • 2014
  • 2014 № 11 Сontents of internal control quality and safety of medical activities in medical organizations: what should it be and what hinders it (Saint Petersburg; Irkutsk State Medical Academy of Continuing Education, Irkutsk, Russia)

    The issue deals with the fact that today in most medical organizations in the country is not built system of internal control quality and safety of medical activities, as provided by applicable law. In this context, the article presents and justified proposals for the filling of the internal control quality and safety of medical activities specific areas of work corresponding to the requirements of state control. The factors hindering the development of internal quality control and safety of medical activities.

    Authors: Piven D. V. [53] Kitsul I. S. [53]

    Tags: internal control7 medical organization50 quality and safety of medical activities9 quality inspection1

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  • 2014 № 11 Obstacles on the path of centralization of clinical and laboratory investigation (ADVENSUM Ltd, Moscow, Russia)

    The article presents the analysis of the state centralization of clinical laboratory research in the country. Reveals the reasons hindering the centralization at different levels of the health care system of Russia. The urgency of centralization and ways of its implementation in order to improve clinical effectiveness of laboratory tests and the quality of health care for the population.

    Authors: Kishkun A. A. [1]

    Tags: centralization of laboratory research1 economic efficiency7 reform of laboratory services1 sources of financing2 the goal of centralization1

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  • 2014 № 11 Defects of medical aid to women in deaths in the perinatal period at the regional level (State Medical Academy of the city of Izhevsk, Izhevsk, Russia)

    There has been given an expert valuation of medical services quality when dealing with perinatal mortality in Udmurtskaya Republic. There has been identified a significant spectrum of curing, diagnostics and organizationalstrategic defects. There were registered defects in diagnostics of pathological state and forecast on there productive losses. On the basis of detected defects, there were formed ways of optimizing medical aid on all stages of its provision with the aim to minimize perinatal losses.

    Authors: Bushmelеva N. N. [1]

    Tags: defects of medical care1 perinatal mortality2 reproductive losses1 somatic and reproductive health of women1

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  • 2014 № 3 Outcome of reforming the system of mandatory medical insurance in 2010–2013 years. Analysis of drawbacks of existing system of mandatory medical insurance (Ministry of health care of Novosibirsk region, Novosibirsk, Russia)

    Annotation. The article examines the system of mandatory medical insurance operating on the territory of Russian Federation, there has been conducted a complex analysis of main problems and drawbacks of the system. There are formulated the main directions of reforming Mandatory Insurance System.

    Authors: Кravchenko V. V. [2] Shatalin E. V. [2]

    Tags: competition2 insurance medical organizations4 mandatory medical insurance system3 motivational crisis1 program of state guarantees2

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  • 2014 № 3 Increase of quality and affordability of medical care — objectives and solutions in general physicians practice («Samara municipal clinic №6 of Industrial region», Samara, Russia)

    Annotation. There are studied problems and ways of optimizing management of human resources in ambulatory department of health care of Russian Federation. It is shown that deficit of human resources in the health care of Russia is provoked by the lack of physicians and middle level medical staff of several professions as well as disproportions in number of physicians and nurses. There is studied an example of experimental area of general practitioner where nurses can implement their self-sufficient reception. There are questions arisen regarding extension of functional responsibilities of medical nurses and problems occurring while its realization due to imperfections of legislative acts.

    Authors: Guseva S. L. [1] Gorochova I. V. [1]

    Tags: deficit of human resourcesin health care1 functional responsibilities of personnel1 junior medical personnel1 self-sufficient reception1

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  • 2013
  • 2013 № 4 Ensuring the rights of the patient and the need to develop a medical organization necessary internal regulatory documents (Sankt-Peterburg, Irkutsk, Russia)

    The questions related to patients' rights in health care. Detail the mechanisms to ensure patients' rights to information about their rights and responsibilities, their health status. The authors emphasize that the rights of the patient in health care is impossible without a clear regulation of this work relevant internal documents of the medical organization. Specific recommendations on the content of these documents.

    Authors: Piven D. V. [53] Kitsul I. S. [53]

    Tags: patient information2 patient rights3 quality of medical care19 regulatory documents1

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  • 2013 № 4 Self-regulation in the health care sphere (Penza State University, Penza, Russia)

    In the article prospects of transition of the sphere of health care on self-regulation principles are considered. The principle of a professional autonomy of the doctor is analyzed. Distinctions in the maintenance of some models of reform of public administration in the medicine sphere are carried out.

    Authors: Romanovskaya O. V. [6]

    Tags: administrative reform1 deregulation1 health care24 professional autonomy1 self-regulation1

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