2020 № 10 The evaluation of epidemiology and the availability of medical care for patients with retina diseases in the Russian Federation
Retinal diseases are significant causes of blindness and vision loss and they take the second place in the structure
of disabilities due to blindness in Russia. Objective: analysis of the official statistical data on the disease and availability
of health care to patients with age-related macular degeneration (AMD) and diabetic retinopathy (DR) that are prescribed intravitreal injection of drugs (IVD) as the first-line therapy for wet age-related macular degeneration and diabetic macular edema, respectively. Materials and methods: Epidemiological parameters were assessed by the data obtained from the form of statistical records № 12 for 2018–2019 years. The availability of IVD was analyzed by the information registered in the form of statistical records № 14 for 2016–2019 with a recalculation per 1000 population. Results: In 2019 in the Russian Federation 330 thousand patients with AMD were registered (0.45% among the population older than 40 years old). The incidence rate was significantly lower than in other countries (8.69%). The data on the number of patients with DR was unavailable for statistical recording because of the absence of the code Н36.0 IDC‑10 in form № 12. However, according to the federal register of diabetes mellitus, the total rate of DR can reach 760 thousand people all over Russia.
The availability of IVD for all-day inpatient health care was 0.39 injections per 1000 population. In 26 subjects of the
Russian Federation, the availability was higher than the average in Russia, while in the rest 59 subjects, the availability
was lower than the average. Presently, there are no data on the number of IVD performed in day-time inpatient facilities.
Conclusions: The current rate of application of IVD in Russia can be estimated as low considering the revealed problems
with the registration and accounting of patients with AMD and DR. It is impossible to perform a complete evaluation of the availability of IVD for the Russian population within obligatory medical health insurance because of the lack of data on the provision of IVD in day-time inpatient facilities. For the rational planning of the volumes of medical care provision to patients with AMD and DR, the form of statistical records should include the data on the indication of IVD in the day-time inpatient facilities in the subjects of the Russian Federation.
2016 № 1 Chronic complications of diabetes mellitus: specialized outpatient medical service organization and efficacy according to experts’ opinion survey
Multidisciplinary outpatient care structures for patients with late complications of diabetes (diabetic foot, retinopathy, and somewhere – for diabetic nephropathy) were established in Russia since late 1990s. We conducted a survey of 22 experts from 12 regions of the Russian Federation for the analysis of the current state of specialized outpatient care for patients with these conditions, assess demand in this type of care and develop possible improvements. The necessity of outpatient diabetic foot clinics was obvious for 100% of the experts, of diabetic retinopathy consultative rooms – for 95%, of diabetic nephropathy consultative rooms – for 52%. Eighty five percent, 52% and 15% of the experts respectively reported about work of such outpatient structures in their regions. In all three fields lack of funding and lack of qualified personnel were pointed as the main barriers for establishment and development of such outpatient structures. The efficacy of patients treatment in outpatient diabetic foot clinics (where they work) was considered an effective by 47% of experts, in diabetic retinopathy consultative rooms – by 55%. In conclusion, (1) the demand in outpatient diabetic foot and diabetic retinopathy specialized structures is obvious, but is questionable with regard to diabetic nephropathy; (2) the performance of these service is not sufficiently high, which requires appealing of qualified specialists there (which is impossible without adequate funding), training of specialists and quality management; (3) we found evidence of inadequate availability of such specialized outpatient care for patients with diabetes, which requires increase of such offices number, and targeted referral of patients there from primary care physicians.
2016 № 2 Analysis of the official regulation documents on organization of outpatient care for patients with chronic complications of diabetes mellitus
Diabetes mellitus (DM) is a socially important chronic disease with the disabling and economically significant complications. Organization of specialized structures for interdisciplinary out-patient care for patients with chronic complications of diabetes (affecting kidneys, eyes, the lower extremities) is an important task. We analyzed existing National clinical expert recommendations and orders of Ministry of Health concerning standards of care for patients with DM and its complications. Conclusions are drawn on necessary development of the regulatory documentary base for out-patient multidisciplinary care for this kind of patients.