THE RESULTS OF THE ORGANIZATIONAL EXPERIMENT TO OPTIMIZING THE MEDICAL CARE OF PATIENTS WITH BENIGN NEOPLASMS OF THE GYNECOLOGICAL FIELD IN THE ANTENATAL CLINIC

Abstract

Relevance. Benign neoplasms of the gynecological field have a significant impact on reproductive health of the population. The efforts of the state authorities aimed at overcoming the demographic crisis; therefore, the questions of organization of medical care for women require special consideration. Goal of research – todevelop a system of measures to optimize the arrangement of medical care for women with benign neoplasms of the gynecological sphere and to evaluate its effectiveness. Materials and methods . In 2015-2016, the study of delivery of medical care of patients with benign neoplasms of the gynecological field was undertakenon the basis of the antenatal clinics of St. Petersburg. 2500 cases of treatment were analyzed with the involvement of experts. Completeness and validity of diagnostic and treatment activities, the degree of continuity in the work of health care organizations, the need of patients in treatment at different stages were estimated. Taking into account the obtained results on the basis of one of the districts organizational experiment to optimize the provision of health care to women was carried out, and further its effectiveness was evaluated: an opinion poll of 2190 patients was held, 3334 cases were analyzed according to the database of issued and paid bills and ambulatory medical records. Results. Optimization of delivery of outpatient medical care to patients with benign tumors of female genital sphere is possible by increasing the activity of their dynamic monitoring: information on the characteristics of the disease, monitoring of compliance with the schedule of doctor visits, which can increase the frequency of prophylactic visits from 1.2 to 1.8 per year (optimal frequency – no less than 1.56 visits per year). Increase of treatment efficiency is achieved by early medical rehabilitation – professional psychological support of patients. Adjusted volume of psychological problems of patients in connection with the identified benign neoplasm: consultation of psychotherapist is indicated to 67.0% of the patients, specialized treatment is prescribed to one third of them. The introduction of a two-level system of internal quality control of medical care, allows to perform the prescribed amount of medical care, to ensure continuity of outpatient and inpatient stages of its delivery and to reduce the frequency of emergency hospitalization from 11.6 to 9.0 per 100 thousand of the adult population. Conclusions . The experiment showed that the effective observation of patients is possible only under condition of close cooperation of medical organizations at all levels and building of a trusting relationship of the physician with his patient.