2021 № 8 Ways of optimizing the organization of providing ambulatory coloproctological assistance to the population
The article substantiates the priority directions of optimization of the organization of outpatient coloproctological care to the population of the Perm Region.
The purpose of the study is to substantiate the priority directions for optimizing the organization of outpatient coloproctological care to the population.
Materials and methods. The data on the reasons for 4822 calls to outpatient polyclinic offices for specialized medical care in the profile of «Coloproctology» in the Perm Region in 2018, as well as about 2222 calls to the Center of Coloproctology with a day-long hospital stay were analyzed.
Results. It is shown that the frequency of detection of DND in the center of coloproctology was 22.50%, with the frequency at polyclinic appointments‑11,83%, p<0,001. At polyclinic appointments, the frequency of detection of ZNO was 5,96%, in the center of coloproctology – 12,15%. The results obtained can be explained by the number and quality of diagnostic measures performed at the Coloproctology Center, which allows for almost complete coverage of all patients of the center with rigid rectoscopy – 98,38%, with 33,80% (at outpatient appointments (p<0,001). Sigmoscopy, which is not available in the coloproctologist’s offices at the Coloproctology Center, was performed in 7,02% of patients, FCS was performed in 34,29% of cases, compared to 9.49% in the polyclinic (p<0,001).
The presence of an emergency appointment in the Center of Coloproctology explains the higher frequency of detection of acute hemorrhoids – 7,06%, versus 3,2% in polyclinics; acute paraproctitis – 2,29% and 0,62%, respectively; ECC – 1,53% and 0,5%, respectively; anal itching – 1,44% and 0,64%, respectively; proctitis – 0,99% and 0,16%, respectively; rectocele – 0,99% and 0,18%, respectively; injuries of the colon and rectum – 0,72% and 0,16%, respectively; anal insufficiency – 0,72% and 0,37%, respectively; p<0,005.
Conclusions. The traditional model of providing outpatient coloproctological care (offices in polyclinics) is not effective even in diagnostics, since it does not have its own endoscopic and anesthesiological service, which significantly affects the volume and quality of the necessary studies. It is proposed to reorganize the service in order to organize a primary link on the basis of an outpatient coloproctology center with a day-long hospital, separate or at the coloproctology department of the State Clinical Hospital.