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.
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.
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.
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.
2021 № 5 Organization of medical care for patients with cancer on the basis of lean production in the interests of developing organizational health-saving technologies during the pandemic
The article presents the results of the application of lean manufacturing (LM) technologies for the successful implementation of the state task of a clinical medical organization to provide high-tech medical care during the restrictions caused by the COVID19 pandemic. The highest degree of implementation of LM values and technologies was achieved in the section of respect for the person and corporate culture – 89%, compliance with specialized standards – 86%, satisfaction with quality and safety, as well as quick response to changes‑85% for each,
which allows implementing organizational health-saving technologies. The most accessible and widespread health-saving technology can be considered specialized information on the prevention of non-communicable diseases posted on the website of a medical organization in a special section and attracting the attention of patients in a voluntary informed consent. The organizational and methodological department can become the organizing structural unit of a medical organization for testing the introduction of lean production technologies and testing organizational health-saving technologies, whose specialists should be engaged in improving the level of professional training of doctors,
specialists in clinical profile and secondary medical personnel on health-saving issues, conducting communication campaigns aimed at increasing the responsibility of patients who come for examination and treatment for their health, their relatives and relatives, awareness of the value of human life and health, the formation of a culture of health in various age and social groups.
2021 № 4 ABOUT ENSURING STABILITY OF FUNCTIONING OF HEALTH CARE IN EMERGENCY SITUATIONS
The pandemic of COVID‑19 put before society new unique, economic and ethical dilemmas as it imposed increased requirements to health care systems, both on national, and at the global level. One of these problems – ensuring stability of functioning of a health care system in emergency situations.
Research objective – the analysis of the current trends defining ability of health care to satisfy sharply increasing needs of people for medical care at emergence of emergency situation.
Materials and methods. Methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, statistical materials of the Russian Ministry of Health and Federal State Budgetary Institution TSNIIOIZ of the Russian Ministry of Health , a form of the state statistical observation No. 62, summary across Russia, “Data on resource providing and on delivery of health care to the population”, methods of the content analysis, economical and statistical analysis, information and analytical materials of the Russian and foreign news agencies, expert estimates, analytical materials and statistical data of World Health Organization, statistical data and metadata over the countries of the Organization for Economic Cooperation and Development (OECD) and the certain countries which are not members and also the materials of monographic researches and periodicals including placed on the Internet are used.
Results. At the level of the state, resistance of a national health care system to emergency situations is defined by a condition of infrastructure of the industry, the mechanism and the amount of financing and also scales of attraction of the private medical sector to work for the benefit of society. For 2011–2019 the number of the hospitals of the state form of ownership participating in implementation of the Program was reduced from 4542 in 2011 to 2896 in 2019, or for 37%, and the number of the group hospitals participating in implementation of the Program increased almost by 1.5 times – from 163 organizations in 2011 to 235 in 2019. The number of the medical organizations of emergency medical service of the state form of ownership was reduced from 235 in 2011 to 169 in 2019, and the number of the private medical organizations of emergency medical service participating in implementation of the Program increased from only one organization in 2012 to 28 organizations in 2019. The number of the out-patient and polyclinic institutions of the state form of ownership participating in implementation of the Program was reduced since 2581 in 2011 to 1419 in 2019, or twice, and the number of private out-patient and polyclinic medical institutions increased from 485 organizations in 2012 to 2160 organizations in 2019, or by 4,5 times. At the level of the population stability of health care is affected by social and economic structure of society, ability and readiness of people to pay and be assessed with a tax for payment of medical care. At the same time, the solvency of the population of Russia remains low, and the insufficient amount of financing of health care leads to the accruing substitution guaranteed to medical
care by paid medical services.
Conclusions. In modern Russia there was a trend of increase in number of the private medical organizations which are carrying out activity in the sphere of compulsory health insurance in a combination to decrease in number of the public medical institutions that demonstrates gradual strengthening of a role of private business in questions of providing the population with medical care. It is necessary to guarantee that financing of the private sector at the expense of treasury will be carried out not to the detriment of the state medical organizations and will not undermine the processes which began in the country on system strengthening of health care, first of all – its primary link. For this purpose it is necessary to increase significantly a share of the public expenditures by health care in gross domestic product of Russia.