Activities Of Medical Organizations Research Articles

On the Issue of Updating Technologies of Simple Medical Services

Over the past decades, Russia has carried out a huge amount of work to standardize manipulations and procedures of general and medical care in the form of technologies of simple medical services and standard operating procedures. The experience of developing, testing and implementing standards of nursing practice in the activities of medical organizations in the Tyumen region is given. The need to update the technologies of simple medical services using evidence-based nursing practice approaches to unify primary accreditation algorithms is substantiated.

Assessment of the relationship of the morbidity rate of the adult population in the Sverdlovsk region with the staffing of medical staff

Analysis of indicators of primary and general morbidity of the population plays a decisive role in the management strategy in the healthcare system. It is necessary for developing management decisions at all levels of government. Evaluation of the results of this study allows optimal planning and forecasting of the development of various health care indicators, including the staffing level of medical personnel.
 The purpose of the study is to assess the relationship between morbidity among the adult population of the Sverdlovsk region and the level of medical staffing.
 Materials and methods. statistical materials from the annual collection “Health of the population of the Sverdlovsk region and the activities of medical organizations” were used: statistical reporting data on the morbidity of the population, staffing with medical personnel.
 Results. In the Sverdlovsk region, over 2017–2021 a gain in primary morbidity among the adult population accounted for 33.1% and an increase in overall incidence — 9.4%. The medical staffing level for 2021 (61%) was by 6.1% lower than during 2017 (65%). When assessing the impact of medical staffing on the morbidity rate using correlation analysis, a strong inverse relationship between these indicators was revealed.
 Limitations. When studying the morbidity rate of the adult population of the Sverdlovsk region, an analysis of data from FFSN No. 12 and No. 30 for 2017–2021 was carried out.
 Conclusions. The identified problems can negatively affect the availability and quality of medical care provided to the population, lead to an increase in primary and general morbidity rates, as well as a decrease in their labour potential. The results we obtained require appropriate attention and subsequent management decisions in matters of training and attracting medical personnel, which should be based on systemic measures aimed at eliminating personnel shortages.

ДИНАМИКА ОБЕСПЕЧЕННОСТИ СРЕДНИМ МЕДИЦИНСКИМ ПЕРСОНАЛОМ ГОСУДАРСТВЕННЫХ МЕДИЦИНСКИХ ОРГАНИЗАЦИЙ РОССИЙСКОЙ ФЕДЕРАЦИИ В ПЕРИОД С 2018 ПО 2022 ГОД

Significance. Nursing staff play an important role in health care delivery. Specialists with secondary medical education provide "independent" medical care at rural health posts and stations (departments) of emergency medical care. Consequently, the density of such staff affects both the care availability and quality, substantiating the relevance of the study of staffing of health facilities with nurses. The purpose of the study. To analyze dynamics in the number of nurses in health facilities of the Russian Federation in 2018-2022. Material and methods. Statistical materials "Resources and activities of medical organizations" on the number of nursing staff in health facilities in the Russian Federation, federal districts and constituent entities of the Russian Federation for the period from 2018 to 2022 were used. When calculating indicators, methodological recommendations of the Ministry of Health of the Russian Federation were used. Analytical and statistical methods were used in the research process. Calculations were performed using Excel 2019 spreadsheets. Results. The results of the analysis of the number of nurses for the last five years show a 6.5% decline. In the Russian Federation, there are significant territorial differences in the number of nursing staff per population (per 10,000 population), which can be traced throughout the entire period under study. It has been revealed that the average age of nurses in the country as a whole equals to 42.62 years. Conclusion. A study on key indicators characterizing the staffing level has shown that the number of nursing staff in the country as a whole in 2022 decreased by 6.5% compared to 2018. However, 34 constituent entities of the Russian Federation report the value of 90.0 or higher per 10,000 population, which is optimal. The indicator of staffing of full-time positions with individuals decreased to 71.5%, with a secondary employment ratio of 1.3. Analysis of dynamics of the average age of nursing staff over a five-year period showed a 0.93 year increase. Scope of application. The study results can be of interest to health officials, practitioners, residents and graduate students of medical universities.

Правовая регламентация в сфере здравоохранения: особенности, перспективы с позиции регионального аспекта

The article reveals the causes and trends of increasing of the legal component in medical practice. It analyzes such aspects as the legal regulation of medical activity, the peculiarities of the interpretation of the composition of the offense, the obligations of the patient, consumer extremism. The author, as a mechanism for reducing medico-legal risks, raised the issue of introducing a medico- legal risk management system into the activities of medical organizations. The regional segment presents the unique experience of the Khabarovsk Krai in the issues of the development of medical law

Профессиональные стандарты: роль и значение в обеспечении качества и безопасности медицинской деятельности, основные задачи

The article deals into detail with the application of professional standards in the activities of medical organizations and in the training of medical personnel. The authors substantiate that the application of professional standards in the regulation of labor relations of medical workers, as well as in the development and implementation of both professional educational programs and additional professional programs is an essential tool for ensuring the quality and safety of medical activities. The main tasks facing today in the field of the application of professional standards, the implementation of which will contribute to improving the quality and safety of medical activities, are identified: the creation of legal mechanisms for the effective application of professional standards by educational organizations; ensuring continuity in the application of professional standards between the training of medical personnel and the regulation of labor relations in the process of medical activity; the need to constantly maintain professional standards up to date.

MEDICAL-ORGANIZATIONAL, DIGITAL AND SOCIO-CULTURAL TECHNOLOGIES OF WORKING WITH PATIENTS: CLASSIFICATION, QUALITY

Abstract. The introduction of the principles of the socio-cultural approach in the activities of medical organizations requires an emphasis on working with patients as full participants in the treatment and diagnostic process, taking into account their needs, values, psychological status, individual characteristics. The purpose of the study: to propose a classification of technologies for working with patients and to analyze the quality of the practice of their application in health care. The study was conducted on the basis of health care of the subjects of the Central Federal District of the Russian Federation (Ivanovo, Yaroslavl, Kostroma, Vladimir, Moscow regions). Time of the study 2020-2021 Research methods: bibliographic, expert assessments, analytical. The research program included an expert assessment of the quality of technologies for working with patients in 3 components (medical-organizational, digital and socio-cultural). The volume of the sample population formed by random selection amounted to 800 cases of medical care of oncological, pediatric and surgical profile. Under the technologies of working with patients in health care institutions, we understand - the established typical approaches, algorithms for interaction with patients, taking into account the socio-cultural characteristics of patients and with the aim of involving them in the treatment and diagnostic process as full participants, the formation of health-centric behavior and high medical activity. It is proposed to classify the technologies of working with patients into 3 groups: medical and organizational (by phasing, by purpose, by profile, by completeness, by ensuring the rights and interests of the patient, by the interaction of specialists, by timeliness, by technicality), digital (by scientific and technical level of technology, by the level of reflection on the organization's website, by the development of means of digitalization of documentation of technologies, by the development of teleconsultations and monitoring of the patient's condition) and socio-cultural (by value orientation, by the patient's motivation, by taking into account the cultural characteristics of the patient, by comfort, by the implementation of ethical and deontological patterns of interaction). The results of the study showed that the medical and organizational component of patient management technologies was violated most often - in every 10 cases of assistance, the socio-cultural component of patient management technologies was violated in every 4 cases of assistance; digital – in every second case of assistance. It was noted that the frequency of violations was significantly more frequent in the provision of assistance of an oncological and surgical profile than a pediatric one. The basis for the digitalization of patient management technologies is the original automated platform developed by the authors, which consists in the formation of an automated database based on a survey of patients, registration of data on the material and technical and personnel readiness of a medical organization to provide assistance.

Особенности состояния сети и обеспеченности коечным фондом медицинских организаций в России

The implementation of the healthcare development strategy, effective management of the healthcare system is impossible without monitoring and comprehensive comparative analysis at various levels of the state and development of the network, resources and activities of medical organizations, individual services and the healthcare system as a whole. P u r p o s e of the study is scientific assessment of the state of the network of medical organizations providing medical care in outpatient and inpatient settings, as well as analysis of the provision of beds for the population of the Russian Federation in 2012–2019. M a t e r i a l s a n d m e t h o d s . Within the framework of the conducted research, official statistics data were analyzed, modern trends and trends in the provision of beds and the state of the network of medical organizations in Russia at the regional level were determined. Statistical data processing was carried out using SPSS, Excel‑2007 packages. Such methods as analytical, statistical methods, study and generalization of experience, comparative analysis were used. R e s u l t s . The analysis has shown that the unevenness and the level of high differentiation of indicators of provision of beds by subjects of the Russian Federation remains. Thus, over the period 2012–2019, the provision of specialized beds for all the main profiles of beds is decreasing, the largest reduction affected socially significant beds – dermatovenerological – by 1,5 times, as well as therapeutic – by 32,5%, gastroenterological – by 28,2%, pediatric – by 24,4%, and infectious – by 20,3%. F i n d i n g s . The results of this study confirm the reduction in the number of beds of the main profiles, as well as the conversion of part of the bed stock, especially in the context of a pandemic of a new coronavirus infection, which showed the need for structural and functional transformations of health resources in general and the bed stock in particular.

Анализ региональных особенностей, влияющих на организацию и оказание медицинской помощи в ХМАО-Югре

Purpose of the study: assessment of the features of the geographical location, climatic conditions, economic development, demographic situation, affecting the organization of medical care in the Khanty-Mansi Autonomous Okrug-Yugra. Materials and research methods: statistical materials from the annual collection “Health of the population of the Khanty-Mansi Autonomous Okrug-Ugra and the activities of medical organizations” and data of statistical reporting on the incidence of the population from the “Medstat” program were used. The analysis used indicators such as population density, the proportion of small peoples of the North, the availability of medical care, the proportion of the able-bodied population, indicators of the economic development of the Khanty-Mansi Autonomous Okrug-Yugra. Results. The conditions for the organization and provision of medical care on the territory of the Khanty-Mansi Autonomous Okrug-Yugra are determined by the geographic location of the area, equated to the regions of the Far North, the difficult climatic conditions that negatively affect human health, a significant proportion of the visiting population, poorly adapted to the conditions of the North, a combination of developed urban agglomerations (with a developed healthcare infrastructure) and sparsely populated areas, a significant length of the territory of the Khanty-Mansi Autonomous Okrug-Yugra, problems of transport infrastructure and low transport accessibility of remote areas.The above determine the need for approaches in planning medical care that are not typical for the constituent entities of the Russian Federation (for example, the territory of the Central Federal District). These approaches require increased costs for organizing a network of medical institutions and resource and staffing of medical care to the population, which is quite feasible taking into account the economic situation of the Khanty-Mansi Autonomous Okrug-Yugra. Conclusion. Factors affecting the organization and provision of medical care, and the health of the population of the Khanty-Mansi Autonomous Okrug-Yugra, should be attributed to the harsh climatic conditions, environmental factors associated with the extraction of minerals (oil and gas). Climatogeographic and social conditions are a risk factor for alcoholization of the population, the presence of natural focal diseases. Features of the economic development of the Khanty-Mansi Autonomous Okrug-Yugra requires increased costs for organizing a network of medical organizations, resource and staffing.

Анализ уровня и структуры заболеваемости населения ХМАО-Югры

Purpose of the study: assessment of the level and structure of the incidence of the population to determine the main categories of diseases most common in the Khanty-Mansi Autonomous Okrug-Yugra, as well as making a territorial comparison of the incidence of the population. Materials and research methods: statistical materials from the annual collection “Health of the population of the Khanty-Mansi Autonomous Okrug-Yugra and the activities of medical organizations” and data of statistical reporting on the incidence of the population from the Medstat program were used, in particular, the primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in different age groups, the general incidence the population of different age groups of the Khanty-Mansi Autonomous Okrug-Yugra. The analysis used indicators such as primary morbidity, general morbidity, one-year mortality (died within the first year from the date of diagnosis) in malignant neoplasms. Results. The primary morbidity of the population in the Khanty-Mansi Autonomous Okrug-Yugra tends to grow in all age groups. The indicators of primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in 2018 are 17.1% higher than in the Russian Federation and 12.2% higher than in the Ural Federal District. In the structure of primary morbidity, the first place is taken by diseases of the respiratory system, the second place in the structure of the primary morbidity of people over working age is taken by diseases of the circulatory system, and the third place is by diseases of the genitourinary system. The overall incidence rate of the entire population is 1896 per 1000 population. In 2018, 41.2 cases of tuberculosis per 100 thousand of the population were detected for the first time in the Khanty-Mansi Autonomous Okrug-Yugra (in the Ural Federal District – 61.6, in the Russian Federation – 44.4 per 100 thousand of the population). This pathology tends to decrease and compared with 2017 decreased by 10.2% (the Russian Federation decreased by 8.1%, the Ural Federal District – 2.1%). The number of patients with newly diagnosed HIV infection in 2018 decreased by 1.5% compared to 2017 and amounted to 82.3 per 100 thousand population, which is higher than in the Russian Federation (58.5), but lower. than in the Ural Federal District (108.2) per 100 thousand population. Since 2012, there has been a tendency towards an increase in the incidence of malignant neoplasms, but the detection rate of malignant neoplasms at stages III-IV has not changed since 2015 and is 39.5%, which is higher than in the Russian Federation (38.5%). Conclusion: the primary morbidity in the Khanty-Mansi Autonomous Okrug-Yugra in 2018 is 17.1% higher than in the Russian Federation. In the first place are diseases of the respiratory system (48.4%, of which in children – 66.4, and in persons of older working age – 22.2%). In second place in children is infectious pathology, and in people of working age – diseases of the genitourinary system. The second place in morbidity in older people of working age is diseases of the circulatory system. The district has a high level of infectious and parasitic diseases. The number of patients with newly diagnosed tuberculosis is lower than in the Ural Federal District and the Russian Federation. The number of patients with HIV infection is higher than in the Russian Federation, but lower than in the Ural Federal District. There is a tendency towards an increase in the number of malignant neoplasms. The number of neoplasms is lower than in the Ural Federal District and the Russian Federation. In the Khanty-Mansi Autonomous Okrug-Yugra, there is a positive trend in the reduction of socially significant diseases, such as tuberculosis, HIV infection, STIs, alcoholism, drug addiction, injuries and an increase in overall morbidity, including malignant neoplasms, which indicates the availability of medical care, health literacy of the population and carrying out appropriate preventive work.

Анализ особенностей половозрастного состава населения ХМАО-Югры за 2018-2019 гг.

Purpose of the study: assessment of the gender and age structure of the population in terms of its impact on the upcoming dynamics of natural increase and changes in the population. Materials and methods of research. We used statistical materials from the “Health of the population of Khanty-Mansi Autonomous Okrug-Yugra and activities of medical organizations” annual collection and data of statistical reporting of the population from the program “Medstat”, in particular the number of persons residing on the territory of Khanty-Mansi Autonomous Okrug-Yugra, number of female and male population by age category (children, adults of employable age, people over employable age). Such indicators as demographic potential of gender and age structure of population, mortality, fertility, natural population growth, life expectancy, demographic load were used in the analysis. Results. It was revealed that life expectancy for 2018 in Khanty-Mansi Autonomous Okrug-Yugra is 1.4 years higher than the national average and amounts to 74.3 years (Russian Federation – 72.9 years, Ural Federal District – 72.01), which indicates high quality and availability of medical care in the Okrug. The dependency ratio (ratio between the employable part of the population and the non-employed population (children, retirees) in Khanty-Mansi Autonomous Okrug-Yugra is: 657 citizens of nonworking age per 1,000 citizens of working age, in the Ural Federal District – 803, in the Russian Federation – 804, which indicates a younger composition of the District’s population than in the whole country. The natural increase of the population in 2018 was 7.3 per 1,000 population, in 2017-7.9 (Russian Federation – natural decrease 1.6, the Ural Federal District – natural increase 0.0). The total fertility rate (number of children per woman) in KhMAO-Yugra is 1.84 (in the Russian Federation – 1.57), which indicates that the birth rate in the Okrug is higher than in the whole country. Conclusion. The age structure of the population of Khanty-Mansiysk Autonomous Okrug-Yugra is different from the age structure of the Russian Federation as a whole; the maximum number of persons is in the age group of 30-39 years old. Despite the low proportion of people over the employable age, we should note a steady trend towards an increase in the number of this age group in the Okrug. Life expectancy for 2018 in Khanty-Mansi Autonomous Okrug-Yugra is 1.4 years higher than the Russian average and amounts to 74.3 years (Russian Federation – 72.9 years, Ural Federal District – 72.01 years). The analyzed data testify to the young composition of the population, as the maximum number of persons is in the age group of 30-39 years old. There are high birth rates and low mortality rates of the Khanty-Mansi Autonomous Okrug-Yugra population.

Organization of Specialized Medical Care for Patients with the New Coronavirus Infection COVID-19 on the Basis of a Multidisciplinary Hospital

The first experience of organizing specialized care for patients with the novel coronavirus infection COVID-19 on the basis of the leading multidisciplinary hospital of the Ministry of Defense of Russia FSBI 3rd Central Military Clinical Hospital named after A. A. Vishnevsky. Aims: to scientifically substantiate and develop organizational and methodological recommendations for re-profiling a multidisciplinary hospital to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Based on the regulatory and organizational and methodological documents (Orders and Resolutions of the Government of the Russian Federation, orders of the Ministry of Health of the Russian Federation, directives and orders of the Main Military Medical Directorate of the Ministry of Defense of the Russian Federation), a set of measures was taken to create a multifunctional medical center for the treatment of the new coronavirus infection COVID-19. Algorithms for organizational, diagnostic and therapeutic resource-saving technologies, as well as standard operating procedures for assisting patients with the novel coronavirus infection COVID-19, have been developed and tested. Within the framework of the medical association of the Federal State Budgetary Institution 3 CVKG im. A. A. Vishnevsky, the Ministry of Defense of Russia created a system for the provision of specialized medical care to patients with the new coronavirus infection COVID-19 with the established routing and provision of specialized medical care with elements of high-tech medical care, including extracorporeal membrane oxygenation, biological anti-cytokine therapy. Conclusion. The accumulated experience in the work of the newly created center for the treatment of patients with the new coronavirus infection COVID-19 can be used for further medical activities of medical organizations of military and civilian health care.

On the expediency to organize monitoring of the medical and sanitary consequences of road traffic accidents

Relevance.Road traffic accidents are a source of significant medical, demographic, social and economic losses. To reduce the volume of medical and sanitary consequences of road accidents, to achieve the targets of the national project “Safe and High-Quality Roads”, it is necessary to further improve the technologies for providing medical care to victims of road accidents at all stages, including their adaptation to the regional characteristics of road traffic traumatism, and the mechanism of interaction between medical organizations performing the functions of trauma centers. This task can be solved provided that a system of information exchange between trauma centers is created, as well as the organization of monitoring of health consequences in road accidents on its basis. To accumulate and analyze information, a polynosological register, a type of distributed database, is to be used.Intention– to substantiate the expediency to organize monitoring of the health consequences of road traffic accidents.Methodology.Regulatory documents were reviewed as well as results of Russian and foreign scientific research of organizational approaches to the provision of specialized medical care to victims of road accidents at the hospital stage, and also algorithms of introducing information technologies into the activities of medical organizations. The search for sources was performed in specialized scientific search systems (eLibrary, National Library of Medicine – PubMed, Scopus etc.).Results and Discussion.The organization of monitoring of the medical and social consequences of road traffic accidents at the level of the territories of the Russian Federation has been substantiated (including its purpose, tasks, coordinators and implementers). The directions of using the monitoring results were determined.Conclusion.Monitoring of medical and social consequences of road traffic accidents will provide a reliable assessment of their scope in the regions of the country. Besides, health authorities will get reliable information to develop effective measures for reducing medical, demographic, social and economic losses associated with road traffic accidents.

Health management: fashion trend or promising investment? Overview of corporate health promotion programs

Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs $ 200 billion annually – more than $ 1,500 per employee.The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.

ЭКОНОМИКА И УПРАВЛЕНИЕ МЕДИЦИНСКОЙ ОРГАНИЗАЦИЕЙ В ПЕРИОД ПАНДЕМИИ COVID-19

The article describes the economic and socio-medical indicators of the activities of medical organizations providing primary health care to the population during the spread of Covid-19 coronavirus in-fection. The differences in the values of indicators compared to the previous period are analyzed and the financial stability of medical organizations in the prevailing economic and social conditions is assessed.

Epidemiological safety as a component of the operational management unit of the infocenter in introduction of lean manufacturing in a medical organization that provides primary health care

Currently, the primary health care system is undergoing active reformation. Lean manufacturing technologies are being introduced into the activities of medical organizations that help reduce the loss of medical and auxiliary processes. One of the main methods of lean production is visualization, which is implemented in the operational management of a medical organization in the form of creating information centers (InfoCenters) that reflect the main parameters of the activity of a medical organization in the SQDCM system: safety, quality, order execution, costs and a comfortable environment. Criteria of safety of medical activity most relevant for the national healthcare system are parameters of epidemiological safety. A parameter most difficult for indication, but necessary for reflection of epidemiological diagnostics in the InfoCenter is the accident rate at work.
 Aim. Generalization of literature data on the possibility of including epidemiological safety parameters into the operational assessment of the InfoCenter.
 Epidemiological studies conducted in our country in medical organizations of various profiles show an increasing rate of emergency situations among the medical personnel. With this, the system of indication and identification of all emergency cases still remains imperfect, and medical personnel often hide cases of emergency situations.
 Conclusion. Introduction of criteria of epidemiological safety into the practical activity of a medical organization as a component of the operational management unit of the InfoCenter will contribute to the formation of functioning and constantly improving system of analysis of the activity of medical organizations, to the control of provision of medical care, and to standardization of invasive procedures to ensure epidemiological safety. The key tasks of the InfoCenter are: focusing the attention of medical organization employees on problems, prompt response to emerging problems and risks, and also ensuring effective communication of all participants of operational meetings in a single information space.

Approaches to Increasing Access to Innovative Drugs Based on Cost-sharing Agreements

Existing approaches to the implementation of cost-sharing agreements in the Russian Federation are described. Such agreements are used in practice to limit budget expenditures while improving access to modern drug therapy for patients. Presently, innovative models of drug provision are not directly mentioned in federal legislation and are not covered by special legal regulation; therefore, they are regulated by the general rules of the applicable law. The authors propose approaches to determining the juridical nature of cost-sharing agreements, analyze the organizational schemes used in practice and assess their compliance with different legislative fields: civil law, legislation on the protection of competition, law on the contract system in the procurement of goods and services for state and municipal needs, and the law on obligatory medical insurance. The results of the analysis can be used in the implementation of cost-sharing agreements in the daily activities of medical organizations and public health authorities of the Russian Federation.

Medical and Sociological Study of the Opinion of the Population as Justification for the Implementation of the Principles of Lean Production in the Work of Medical Organizations of the Nizhniy Novgorod Region

The article is devoted to the need of implementation of lean healthcare technologies in the activities of medical organizations. The article gives a brief overview of the concept of lean technologies, stages of their implementation, prospects. The article presents the experience of the participation of the territorial fund of compulsory medical insurance of the Nizhniy Novgorod region and insurance medical organizations in assessing the effectiveness of measures to implement the principles of lean production in the work of medical organizations that provide primary health care to the population of the region. The authors analyzed the survey of the population about their interest in improving the organization of medical care and the social effectiveness of the implementation of lean healthcare technologies in the work of a large number of hospitals and clinics of the region. The pivotal conclusion from the experience of implementing lean technologies in healthcare is the need to search for and widespread use of innovative communication technologies.

Модель взаимодействия между медицинскими организациями на принципах фондодержания – способ повышения эффективности деятельности первичного звена здравоохранения

The article analyzes the experience of per capita financing of primary health care based on the principles of stock provision in the system of compulsory health insurance (MHI). The article shows the features of practical implementation of Fund-forming models of per capita financing, their impact on the final results of the activities of medical organizations of Fund-holders. A unified scheme of interaction between the MHI participants (medical organizations, insurance medical organizations, territorial MHI Fund) (medical and economic model of business processes) is proposed for the implementation per capita financing of primary health care, with provision of decoding with partial filling of the Fund for the implementation of a patient-oriented model of medical care.

The satisfaction of patients with chronic dermatoses according to the medical care they received

The article deals with the opinion of patients about different activities of medical organizations. It was established that opinion of patients about the activities of medical organizations depends on many factors, among which the most important were the place of residence, social status, level of education, material security and others. Purpose of the study . To study the satisfaction of patients with chronic dermatoses with the medical care they receive in a metropolis. Materials and methods . The satisfaction of patients with chronic dermatoses with the quality of the services provided in dermatovenerological clinics was studied on the basis of a questionnaire survey of 412 patients living in Moscow. Results . It was established that 74.0% of patients were satisfied with the quality of dermatological care, 19.6% were more likely satisfied than not, 5.8% were more unsatisfied than yes, 0.6% were not satisfied. The attentive and friendly attitude of medical personnel to patients in polyclinic and inpatient departments of specialized medical organizations noted in 91.7% of respondents, inattentive — in 0.6% and found it difficult to answer — 7.7%. The majority of respondents (97.8%) rated the schedule of doctors as convenient and waiting time for a dermatovenerologist's appointment in the clinic is not long (96.8%).The minimum proportion of patients (1.3%) indicated a refusal to conduct the necessary in their opinion examinations and treatment. Conclusion . The majority of patients were satisfied with the specialized care received and practically had no difficulties visiting specialized medical organizations in view of their sufficient number in different areas of the city.

SANATION OF PATIENTS MOUTH IN DENTAL ORGANIZATIONS OF PRIVATE HEALTH CARE SYSTEM

Oral sanitation - a set of measures aimed at curing diseases of the organs and tissues of the mouth, including the treatment of dental caries, its complications, non-carious lesions and professional hygiene or preparation of the mouth for further orthodontic and orthopedic treatment. Sanation of the mouth can be considered as an indicator of the quality of medical care, as it is a planned result of the treatment of the whole body. However, this indicator is not subject to accounting and analysis in private medical organizations, as a result of which statistical data on the true situation of dental disease and the effectiveness of treatment are unreliable. We conducted a study on the activities of four private dental organizations to achieve the effectiveness of treatment of patients. Evaluation of the scope and cost of work performed, complete rehabilitation of the mouth, carried out the certificate of completion. The collection of data on the structure of dental morbidity by turnover was studied by the medical records of the dental patient. The reason for the refusal to continue treatment before the rehabilitation of the mouth was studied by interviewing (telephone survey) of patients carried out by employees of private dental organizations (medical registrars). The activities of medical organizations, regardless of ownership, should include an in-depth analysis of statistical information, which is part of the management process in health care, ensuring the strengthening of public health and the effectiveness of the health system. Statistics reveal problems, priorities and challenges for the rational use of human, financial and logistical resources. In this regard, all offices of the organization must provide statistical data on their activities to the appropriate authorities and a range of socio-economic measures aimed at the final result of the dental Wellness of the population, strengthen the health and well-being of the person through the reorganization of the mouth.