2022 № 3 Assessment of time spent by patients when visiting a medical organization
The satisfaction of the population with medical care is considered today as one of the most important indicators of the health care system. At the same time, more and more attention is being paid to the time spent by patients in a medical organization when receiving outpatient care, as a factor affecting satisfaction with medical care in general.
P u r p o s e of the study is to determine the opinion of patients about their time costs when visiting a medical organization that provides outpatient care.
M a t e r i a l a n d m e t h o d s . The process of a patient’s referral to a polyclinic, a questionnaire for patients posted on the Internet on an open electronic resource Online Test Pad. The number of questionnaires is 509. Methods: analytical, sociological, descriptive statistics.
R e s u l t s . During the surveys, respondents subjectively assess the time spent on various actions: communication at the reception desk, searching for an office, waiting for an appointment, etc., as well as the total time spent in a medical organization. In addition, the appearance at the polyclinic may be preceded by an appointment, which also takes time. Respondents were asked to estimate the total time spent in the polyclinic, as well as the time they are willing to devote to visiting it. The respondents’ assessment of the time spent shows significant time reserves: in the organization of an appointment and the work of the registry (clarifications, obtaining background information, obtaining coupons), navigation and, possibly, in the location of offices, in the organization of space in waiting areas.
C o n c l u s i o n s . A tool for assessing the time spent by patients to receive care in a medical organization providing outpatient care has been developed and tested. There are significant differences in the length of time spent on making an appointment, including by phone and via the Internet. Significant reserves have been identified to reduce the total time required to visit the polyclinic. The developed tool is characterized by a short filling time, contains simple questions and allows you to quickly identify areas of necessary improvements.
2020 № 10 Self-assessment of health and satisfaction with medical care by country people of age 60+ of the Kaliningrad region
With age the state of health worsens, it is necessary to see doctors more often. Availability and quality of the
provided medical care, a set of medical services can differ depending on the place of its rendering. The work purpose – to study a self-assessment of a zdorovyapatsiyentama of age 60+ of rural out-patient clinic of the Zelenograd district of the Kaliningrad region and their relation to the organization of the primary health care (PHC) and satisfaction with it. Survey among 211 patients of rural medical out-patient clinic aged from 60 up to 88 years, within the project of Partnership “Northern measurement” in the field of health care and social wellbeing is conducted (further in the text – the Project). The factors offered in the questionnaire having the greatest impact on health, according to patients, and satisfaction with the PHC organization are studied. The patients living in rural areas often visit the medical organizations with the medical and diagnostic and advisory purposes, pay attention to medical examination passing that can testify to an active position of the general practitioner working in the Project as in answers about the factors having the greatest impact on health, questions of prevention at poll got the last place. The satisfaction with the PHC organization made in general 3.6 points on a five-point system.
2020 № 4 Training in clinical recommendations and assessment of the level of knowledge of doctors involved in providing primary health care, using remote educational technologies
The implementation of clinical recommendations is an urgent task, and it is important to maintain continuity between primary health care and specialized medical care. Distance learning courses were developed for 25 modules, and a testing system was created, which was implemented during the training of 1928 doctors from 128 medical organizations in three regions. The purpose of the work was to analyze and evaluate the effectiveness of the developed and implemented set of measures for training and testing doctors in three regions of Russia who participate in primary health care, on the implemen- tation of clinical recommendations.
Data analysis was performed using the IBM SPSS Statistics 16 software package. The samples were checked for the normality of the distribution using the Kolmogorov-Smirnov method. A nonparametric Wilcoxon test for dependent samples was used to assess the statistical significance of differences in cases where the distribution in the samples differs from the normal one. The level of statistical significance was defined as p ≤ 0.05.
The program of work consisted of five stages and included the development and implementation of distance courses in the format of multimedia lectures for doctors providing primary health care, studying a number of clinical recommendations, as well as conducting primary and repeated testing with automated evaluation of results for groups of clinical recommendations at the level of the region, medical organization and specific doctor.
The original software made it possible to evaluate the initial and received level of knowledge, to get differentiated results online, and on this basis to give reasonable targeted recommendations for further training of a particular employee, as well as for planning training events in the region as a whole.
The developed methodology of distance learning cycles allows to provide training of a significant number of doctors in a rel- atively short time with operational control of the quality of knowledge of doctors of various specialties, which is why the tested system can be easily scaled and adapted to solve any problems to improve professional competence of doctors.
2021 № 1 The role of local governments in solving the problems of providing primary health care personnel
The problem of staffing in healthcare remains relevant for a long time. The article considers the possibilities of participation of local self-government bodies in attracting and securing medical workers, primarily primary care. The
analysis of normative legal acts of the Federal level is presented. Amendments to Federal laws № 131-FZ and № 323-FZ related to specifying the powers of local self-government bodies in terms of health personnel are proposed. The necessity of a comprehensive assessment of the implemented measures of social support for medical workers to identify the most effective measures and select the best practices is justified.
2018 № 3 To create a new model of medical organization providing primary health care: characteristics of medical staff of district health services
The results of the analysis of the provision of the population of the russian federation by district physicians, general practitioners, district pediatricians are presented. Significant differences in the indicators in the subjects of the Russian Federation were established. These differences necessitate a differential approach when planning actions to improve the organization of primary health care in the subjects of the Russian Federation
2022 № 7 Data-based management in imaging: evaluation of the performance of a unified radiological information service model
The development and availability of information technologies covers all spheres of society, providing ever newer and more advanced means of automating processes and structuring data, primarily in order to improve management efficiency.
Radiation diagnostics, due to its clinical significance, is one of the key areas of modern healthcare. At the same time, it is distinguished by an extremely high degree of digitalization, which creates extensive opportunities for the development and improvement of organizational and managerial aspects. An analytical study was carried out on the principles of a systematic approach, consisting of three stages.
First stage. The main phases and indicators of the development of a single digital circuit for radiodiagnosis in Moscow are characterized: the dynamics of the integration of diagnostic equipment, the structure of medical organizations, the rate of accumulation of the results of radiological examinations by modality.
Second phase. The analysis of the influence of a single digital circuit of radiodiagnosis on the level of informatization of medical organizations and informatization of the health care system of a constituent entity of the Russian Federation was carried out, its compliance with the requirements of the Ministry of Health of Russia was assessed.
Third stage. The analysis of the influence of a single digital circuit of radiodiagnosis on the level of digital maturity of the health care system of a constituent entity of the Russian Federation was carried out.
The practical implementation of the model of a single digital circuit for radiation diagnostics of an administrative-territorial unit was carried out in the period 2015–2020 in Moscow.
The Unified Radiological Information Service (UIS) of Moscow was created – an information system in the field of healthcare that combines the workplaces of radiologists, radiologists and diagnostic equipment, accumulates information about each study or a series of studies conducted on devices connected to it, is equipped with additional tools for solving analytical, managerial and organizational tasks.
The analysis of the significance of ERIS EMIAS as an implemented single digital circuit for radiodiagnosis of a subject of the Russian Federation was carried out.
The development of URIS EMIAS ensured a steady increase in the level of informatization coverage of medical organizations that have radiation diagnostics units in their composition.
2023 № 2 Actual problems of management of the radiology diagnostics service of the primary level of health care.
The main problems of the organization of the work of the radiation diagnostics service and the possibilities for their solution provided by the tools of information systems are considered. The organizational tasks that need to be provided for in the digitalization of healthcare are formulated. The analysis of changes in the organizational and managerial approach to ensuring the work of the diagnostic department is carried out. A decisive role in the development of modern healthcare is played by a systematic approach to the digitalization of the industry and the creation of digital infrastructure in accordance with current requests for operational management.
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.
2023 № 3 The wage system as an instrument of influence on the quality of primary health care.
Qualified and motivated employees of a medical organization are a necessary component that ensures the provision of medical care of appropriate quality One of the motivating factors of medical workers for high-quality and efficient work is wages.
The purpose of the study. To analyze and evaluate the impact of the remuneration system of medical workers based on labor rationing on the quality of primary health care (PHC) on the example of the state district polyclinics of St. Petersburg. Materials and methods. Based on the reporting data of polyclinics selected by the research bases, the following were studied: the dynamics of the number and staffing of medical workers from 2018 to 2021; the percentage and structure of reasons for refusal to pay for cases of medical care in 2010–2018 and 2020–2021; the dynamics of the detection of malignant neoplasms in the early stages. The results of the patient survey were analyzed in order to assess changes in the quality of primary health care for the adult population after the introduction of a system of remuneration for medical workers based on labor rationing.
Results. After the introduction of a new wage system based on its rationing, a number of general positive trends were identified for the studied polyclinics, such as: an increase in staffing of medical personnel in general by 3.5%–8.7%, district internists by 4.6%–42.7%, specialist doctors by 2.8%–12.4%, average medical personnel by 4.5%–17.7%; increase in the proportion of oncological pathology detected at early stages by 13.5%–20.1%; decrease in the share of refusals to pay for medical care cases by 9.3%–32.9%; a decrease in the total number of citizens’ complaints in the form of complaints by 6.0–58.0%, including justified ones.
Findings. The introduction of a wage system based on labor rationing has increased the economic and medico-social efficiency of the polyclinics under study, as well as the motivation of medical workers to provide medical care of appropriate quality.
2023 № 3 Scientific substantiation of proposals for improving medical care for villagers.
P u r p o s e o f t h e s t u d y : based on the analysis of the medical and demographic situation and the staffing of the rural population, develop proposals for improving medical care for the villagers.
M a t e r i a l s a n d m e t h o d s : statistical, analytical, direct observation. The article used the forms of state statistical observation of the Ministry of Health of the Russian Federation. The results of the actual research.
Materials and methods: statistical, analytical, direct observation, the forms of state statistical observation of the Ministry of Health of the Russian Federation were used.
R e s u l t s . The rural population in the Russian Federation (2021) is 36,9 million people (25,2% of the country’s population). The proportion of the rural population of working age was 53,8%, which is lower than in Russia as a whole – 56%. A 21-year analysis showed that the birth rate of the rural population increased until 2012, while mortality rates decreased, in 2013 the mortality and birth rates became equal and amounted to 14,5‰ each, in 2020 the death rate increased to 15,4‰ due to the COVID‑19 pandemic. The average (expected) life expectancy of the rural population (70,7 years) is lower than that of the urban population (71,8 years); the indicator for rural men is extremely low (66 years). The
overall incidence of the rural population is 1,4 times lower than that of the urban population, 117993,2 and 166901,5‰oo respectively. Primary morbidity is also 1,5 times lower (55082,4 and 83002,2‰oo, respectively). The difference in primary morbidity rates of the rural population in the federal districts (2020) was 1,3 times, in the constituent entities – 8,3 times. The incidence of COVID‑19 in the rural adult population (2020) was 1986,0‰oo, which is 2 times lower than in the Russian Federation as a whole (3913.9‰oo). There was a significant difference in these indicators (by 59 times) in the subjects of the Russian Federation, which can be associated with a lower density of the rural population,
low availability of medical care in the countryside, as well as the ambiguity of COVID‑19 coding. For 6 years (2016–2021), the provision of doctors in medical organizations in rural areas in the Russian Federation decreased from 14,8 to 13,6‰o, and of nurses – from 54,6 to 49,3‰o. The number of nursing staff individuals working for feldsher-obstetric station decreased by 12,5%, paramedics – by 9,4%. Given the special importance of paramedical assistance in the countryside, the reduction in the number of paramedics should be considered a negative.
C o n c l u s i o n . The unfavorable medical and demographic situation in the countryside requires the development of organizational and managerial decisions aimed at increasing the availability of medical care to the villagers.
C o n c l u s i o n s . Proposals have been developed to improve the provision of medical care to the population of rural areas.
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
2016 № 3 Primary Health care. Medical Network organization features and staff provision
Annotation. Changes of Medical organizations network, providing ambulatory treatment, were studied, for past 10 years. In addition, trends of manning tables formation in outpatient clinic were analyzed, as well as population provision by district doctors (uchastkoviy doctor) and general doctors. The analysis of main indicators of doctors’ activities in medical organizations, providing ambulatory treatment, is provided.
2018 № 1 The Department of Medical and Social Assistance to the Adult Population and the Department of Nursing: the concept and principles of organization
The concept of the organization of medical and social assistance to the most socially vulnerable population contingents (people in the residential and senile age, the disabled and citizens with a temporary restriction of the ability to move and self-care after the transferred diseases and injuries) is proposed. This includes the creation departments of medical and social assistance in medical organizations that provide assistance to the adult population on an outpatient basis
2020 № 3 Improving the regulatory and legal framework for delivering primary health care to the population in the field of non-communicable diseases prevention and the implementation of a healthy lifestyle standardization
In order to prevent non-communicable diseases and carry out measures to model a healthy lifestyle, the article proposes changes to the regulatory and legal framework for delivering primary health care and primary specialized health care, including the introduction of a position of a physician for common hygiene in medical organizations. It is proposed to introduce additions to the nomenclature of medical services provided. There was developed a section of occupational standards program “Specialist in hygiene”, on the job functions of a physician for common hygiene. It is proposed to include in the job functions of a physician for common hygiene the diagnostic testing in health centers in order to assess the functional reserves and adaptive capabilities of a person affected by adverse environmental factors, and the prescribing appropriate curative and preventive measures. Implementation of the proposed activities in the health centers will improve the efficiency of medical and preventive work of medical organizations and reduce the level of uncertainty of preventive activities carried out, and of the expected results of preventive work carried out by a therapist and a general practitioner (family doctor). The proposed changes will help to identify causal relationships between the health status of the population and the impact of adverse environmental factors, to form risk groups among adult population in accordance with diagnostic criteria of risk factors and other pathological conditions and diseases associated with the impact of adverse environmental factors that increase the likelihood of developing of chronic non-communicable diseases in risk groups, if there are diagnostic criteria of risk factors to send the indigent to health organization for in-depth examination and carrying out the necessary medical and preventive measures, to prepare research and information materials and to participate in hygiene education, to promote healthy lifestyles and to improve health literacy of population.
2022 № 6 Staffing of primary health care in the Russian Federation
The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support.
Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care.
P u r p o s e o f t h e s t u d y . Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices.
M a t e r i a l s a n d m e t h o d s : content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular.
R e s u l t s . The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016–2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from 3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which determines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated.
F i n d i n g s . The introduction of promising general medical practice models in the urban environment implies a complete transition
of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2.
It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure.
2020 № 6 Pregnant technologies in primary health care in rural doctor’s ambulatory
The priority state project currently being implemented, “Creating a New Model of a Medical Organization Providing Primary Health Care,” is especially relevant for implementation in hard-to-reach areas. Since rural health care is character- ized by a shortage of personnel, a weak medical and diagnostic base, low material and technical equipment, a low level of development of information technologies, and a large territorial extent. Objective: to evaluate the effectiveness of the implementation of lean manufacturing technologies with the participation of nursing specialists in the work of a medical out- patient clinic. Materials and methods. To determine the directions for the implementation of lean manufacturing methods, a questionnaire was conducted among patients (n = 232). Mapping and visualization, as well as timing of the processes before and after the introduction of organizational measures in two areas of the medical ambulance clinic “Reception of healthy children” and “Reception of patients with acute disease and with exacerbation of chronic.” Results and discussions. In order to eliminate (minimize) the revealed losses, re-planning of the premises was carried out, the functions were redistributed and the working hours of the medical staff were structured, templates-forms of documentation were developed. Conclusion and conclusions. The introduction of organizational measures allowed us to significantly reduce the waiting time for admission of a healthy child on the day of the disease without additional financial costs, as well as to increase patient satisfaction.