Moscow Healthcare Department Research Articles

Creation of Center for Public Health and Medical Prevention of Moscow as a structure for population-level prevention in metropolis

Introduction. Since 2011, Moscow has been implementing a three-level model for prevention of noncommunicable diseases. At the first (population) level, as part of interagency interaction, health authorities are developing measures to promote population's commitment to a healthy lifestyle. Aims. To provide rationale for management decision on creation of the Center for Public Health and Medical Prevention of Moscow in State Budgetary Institution “Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department”. The goal of the Center is to develop new urban policy in improving public health based on interdepartmental interaction by providing scientific, methodological and organizational support to promote population’s commitment to a healthy lifestyle. Materials and methods. Authors analyzed and assessed development issues of primary prevention at the population level using open data on the Internet, statistical databases of Rosstat and Mosgorstat. Content, statistical and documentary analyses were also used. Results. Currently, Moscow puts an emphasis on prevention, and for this purpose implemented a three-tier model for prevention of non-communicable diseases. At the population level, as part of interdepartmental interaction, it is required to develop measures aimed at improving healthcare, creating a health-preserving environment in the city, and forming a commitment to a healthy lifestyle among the population. Implementation gaps to a decree have been narrowed; and health authorities have created an institution that works towards the goal of strengthening public health in Moscow, covering the entire population of Moscow, and that interacts in the interests of healthcare with government bodies, departments, media and civil society. The current situation, including challenges due to COVID-19 pandemic, required wider participation of authorities and departments, leadership of administrative districts in strengthening public health, coordination and monitoring of all business processes to improve public health. Conclusion. It has been substantiated that public participation in preventive measures is not enough. To solve the issues one should develop and implement large-scale programs and projects to improve public health with more active involvement of authorities and departments of administrative districts, consultative and methodological support, taking into account the existing territorial characteristics of administrative and municipal districts of Moscow, including improving health quality of workers.

Congratulations on the anniversary of Alexey Vasilyevich Shabunin!

The staff of the journal "Annals of the Russian Academy of Medical Sciences" congratulates on the 60th anniversary of the corresponding member of the RAS, chief physician of the S.P. Botkin City Clinical Hospital , Chief Surgeon of the Moscow Healthcare Department, Honored Doctor of the Russian Federation, Professor Alexei Vasilyevich Shabunin.

Sputnik V Protection from COVID-19 of HIV-Infected Individuals Under Art

Background: HIV infection is a known factor that aggravates the clinical course of many infectious diseases including COVID-19. The international guidance suggests that benefits from preventive SARS-CoV-2 vaccination using products with proven efficacy overweigh potential risks for HIV-infected people. However, there is little data on epidemiological assessment of COVID-19 vaccines efficacy among HIV-infected people. This paper provides preliminary assessment of Sputnik V (Gam-COVID-Vac) vaccine effectiveness in HIV-infected patients under antiretroviral therapy (ART) in Moscow.Methods: We performed a retrospective cohort study to assess the effectiveness of Sputnik V standard vaccination regimen in HIV-infected patients during spring-summer 2021, comparing SARS-CoV-2 PCR-positivity, hospitalization, and severe illness rates in vaccinated and unvaccinated subjects. The study included HIV-positive subjects on ART from Moscow City Center for AIDS Prevention and Control, using data from the Moscow COVID-19 Vaccination and COVID-19 incidence Registries. Vaccine effectiveness was calculated as (1-RR)*100%, where RR – is a risk ratio to contract SARS-CoV-2 in both unvaccinated and vaccinated individuals. 2021 spring data shows Sputnik V effectiveness against initial SARS-CoV-2 variant, while summer data are indicative of vaccine effectiveness against the Delta and its descendant lines.Results: The data obtained indicate that Sputnik V epidemiological effectiveness in the entire cohort of HIV-infected people on ART in Moscow was 76·33% (95% CI 69·84% – 81·43%). In the subgroup of HIV-infected patients with CD4+ T-cell count ≥ 350 cells/μl vaccine effectiveness was 79·42% (95% CI 72·54 – 84·57), preventing hospital admissions in 90·12% (95% CI 77·70 – 95·62) and protecting from the development of moderate-to-severe and severe disease in 97·06% (95% CI 78·93 – 99·59). During predominant circulation of the delta variant Sputnik V epidemiological effectiveness in subjects with CD4+ T-cells count ≥ 350 cells/μl was 65·35% (52·61% – 74·66%), preventing hospital admissions in 75·77% (95% CI 44·25 – 89·47) and protecting from the development of moderate-to-severe and severe disease in 93·05% (95% CI 49·51 – 99·04).Conclusion: The study demonstrated high epidemiological effectiveness of full immunization with Sputnik V in HIV-infected ART-treated patients with CD4 + T-cell counts ≥ 350 cells/μl. Moreover, the epidemiological effectiveness of vaccination was documented for both – the original and the delta SARS-CoV-2 variants, with the latter predominating in the Moscow region since June 2021. Although the efficiency of the vaccine declined in immunocompromised individuals (T-cell count Funding: Ministry of Health of Russia and Moscow Healthcare Department.Declaration of Interest: DVS, DYL and ALG report patents for a Sputnik V immunobiological expression vector, pharmaceutical agent, and its method of use to prevent COVID-19. All other authors declare no competing interests.Ethics Approval Statement: All information from the databases was anonymized before it was received by the research team. The study was submitted to the Local Ethics Committee of State Budgetary Healthcare Institution Infectious Diseases Hospital № 2 Moscow Health Department. The Committee concluded (Protocol № 11 of 04/10/2021) that the study does not use identifiable biological specimens and does not provide any confidential patient data. Therefore, according to the rules of the Local Ethics Committee and National standards, this project does not require ethical approval.

ДЕФЕКТЫ ЛЕЧЕБНО-ДИАГНОСТИЧЕСКОГО ПРОЦЕССА ПРИ ОКАЗАНИИ МЕДИЦИНСКОЙ ПОМОЩИ ПАЦИЕНТАМ ПО ПРОФИЛЮ «ПСИХИАТРИЯ» В СТАЦИОНАРНЫХ УСЛОВИЯХ

Significance. Timely identification of defects in the treatment and diagnostic process during internal quality audit of care delivery stimulates evidence-based organizational and management decisions and improves quality of care delivery to mental patients. Material and methods. A retrospective analysis of 270 records of internal quality audit of care to mental patients treated at the Mental Hospital # 4 of the Moscow Healthcare Department has been conducted. A total of 156 inpatient records (57.8%) from 2015 to 2018 were compared with 114 inpatient records (42.2%) in 2019. Results and discussion. Heads of the structural units and deputy heads of the health care facility have evaluated quality of care delivery at the two levels of control. Primary medical documentation was assessed on 12 items (from 0 to 1 point). The arithmetic mean of the assessments for each of the items was calculated - the overall quality factor. At both levels of control, defects in the care delivery were described. The quality factor at the 1st level of control equalled to 0.95 (0.92; 0.96), and 0.86 (0.79; 0.91) at the 2nd level. The quality factor at the 2nd level of control in 2015 - 2018 (1.0 (0.90; 1.00)) was statistically significantly higher than in 2019 (0.86 (0.79; 0.91)) (p = 0.011). Data for the complete 2019, despite the order of the Ministry of Health of the Russian Federation as of June 7, 2019 No. 381n, were observed and obtained in accordance with the requirements of the Moscow Healthcare Department Order No. 932 as of October 30, 2019 “On procedure for implementing internal quality audit and safety performance of health organizations of the state healthcare system of the city of Moscow”. Conclusion. The ongoing monitoring of quality of inpatient health care delivery to mental patients to identify defects in the treatment and diagnostic process using internal quality audit records helps to improve quality of care delivery to patients.

Professional training of doctors: opinions of experts on problems of the educational process. (Part 1)

Among the key goals of the National Project "Healthcare" is provision of State (municipal) medical organizations with qualified medical personnel. Achievement of this goal largely depends on the quality of medical personnel training. At the same time, noticeable changes have been taking place in the medical education system in recent years: they concern regulatory and legal framework of medical and educational activities, technical equipment and conditions of economic activity of universities, etc. The changing socio-economic context has an impact on both university applicants, their motivation, and those who train future doctors. The article presents an analysis of the results of the study "Development of the human resources potential of the Moscow healthcare" carried out in 2019 under the auspices of the Moscow Healthcare Department, which addressed both the quantitative aspects of the staffing of medical organizations subordinated to the city, and the quality of medical personnel issues concerning professional training. Information on the quality of graduates from medical universities and the factors determining it was obtained through a series of in-depth structured interviews with experts, who were representatives of the capital's medical universities and chief doctors of medical institutions. In the course of the survey, experts expressed their opinion about all factors affecting the quality of medical education: the level of training and motivation of applicants; characteristics of the teaching staff; organization of the educational process, etc. Analysis of the expert opinions testifies to ambiguity of the situation in medical education. The positive aspects include the growing interest in obtaining the profession of a doctor and the demand for knowledge, as well as some improvement in the remuneration of university workers, which has a positive effect on the filling of pedagogical vacancies and the social well-being of teachers. At the same time, practically in each of the components of the quality of medical specialists training — in methodological support, technical equipment, the possibility of obtaining practical skills by future doctors — there have been found problems that require solution.

PIN26 Choice of Recommended Treatment Options for Patients with Hepatitis C Genotype 1 in Moscow, Russian Federation

The possibilities of modern therapy for chronic hepatitis C include a large number of options that have marked differences in both effectiveness and cost. The aim of this study was to select optimal treatment regimens for chronic hepatitis C virus (HCV) genotype 1 for reimbursement in Moscow in 2020 based on their comparative efficacy and costs per course. Treatment regimens were ranked based on their comparative efficacy and costs per course. Comparative efficacy was evaluated based on published network meta-analyses, as well as our own indirect comparisons. Prices for drugs were provided by the Moscow Healthcare Department. When determining the target sub-groups of patients, the virus genotype, the presence or absence of treatment experience and liver cirrhosis were taken into account. List of comparators included pangenotypic and non-pangenotypic regimens, with the exception of regimens containing peginterferons. Based on the results of the analysis, several recommended schemes were selected for each of the target groups. Multilple regimens were recommended due to the fact that the cost of the course of treatment and the efficacy of all top regimens were comparable. In genotype 1a patients independent of subgroups top-3 regimens were: daclatasvir+sofosbuvir±ribavirin (€ 5938 per course), grasoprevir+elbasvir (€ 5964) and velpatasvir+sofosbuvir (€ 6223). The 4th and 5th positions in treatment-naïve and experienced patients without cirrhosis was dasabuvir+ombitasvir+paritaprevir+ritonavir+ribavirin (€ 6237) and glecaprevir+pibrentasvir (€ 6333). The 4th regimen for treatment-naïve cirrhotic patients was glecaprevir+pibrentasvir (€ 6333). In genotype 1b patients independent of subgroups top-4 regimens were: daclatasvir+sofosbuvir±ribavirin (€ 5938), grasoprevir+elbasvir (€ 5964), dasabuvir+ombitasvir+paritaprevir+ritonavir (€ 6219) and velpatasvir+sofosbuvir (€6223). The 5th regimen for all target groups, except treatment-experienced cirrhotic patients was glecaprevir+pibrentasvir (€ 6333). As a result of a transparent and scientific-based analysis were selected treatment regimens for patients with chronic HCV genotype 1 recommended for reimbursement in Moscow in 2020.

Effect of thermal helium oxygen mixture оn сentral hemodynamics and oxygen transport in patients with acute hypercapnic respiratory failure with chronic obstructive pulmonary disease

The aim of this study is to assessment of the rapid effects of t-He/O2 in comparison with the effective level of high-flow oxygen therapy (HPO) on the main indicators of oxygen transport, central and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease (COPD) with hypercapnic acute respiratory failure.Methods. A total of 33 (29 male, 4 female) patients were included in a randomized, comparative study with exacerbation of COPD and acute respiratory failure, admitted to the department of anesthesiology and intensive care of D.D.Pletnev City Teaching Hospital, Moscow Healthcare Department, between March and May 2017. Patients were divided into two groups: the 1st group – 18 patients (15 male, 3 female) receiving t-He/O2 (He – 70%, O2 – 30% at a temperature of 70 °C; the 2nd group – 15 patients (14 male, 1 female) receiving high-flow oxygen therapy with FiO2 – 30% through a Venturi mask for the treatment of ODN against the background of basic therapy of the underlying disease, according to the recommendations of GOLD 2016. Assessment of oxygen transport, central and pulmonary hemodynamics was carried out through the definition of indicators: saturation of hemoglobin of arterial blood with oxygen (SaO2), saturation of venous blood hemoglobin with oxygen (SvO2), partial pressure of arterial blood oxygen (РaO2), partial pressure of arterial blood carbon dioxide (РaCO2), partial pressure of mixed venous blood oxygen (РvO2), partial pressure of mixed venous blood carbon dioxide (РvCO2),mean pulmonary artery pressure (MPAP), cardiac output (SV), heart index (CI), pulmonary vascular resistance (RVRI), impact volume index (SVI), pulmonary vascular resistance index (RVRI), left ventricular shock index (LVSW), right ventricular shock index (RVSW), system speed of oxygen delivery (DO2), the coeffiCIent of extraction of oxygen (ExO2), shunt fractions (venous mixing) (Qs / Qt)).Results. Short-term inhalation with a thermal helium-oxygen mixture in patients with COPD with hypercapnic acute respiratory failure is accompanied by an increase in SaO2 94,1 (92,8; 97,5) initially 86,1 (85,9; 88,1), РаО2 (78,1 (74,8; 80,1) initially 55,2 (52,5; 65,3)), decline РаСО2 (57,4 (54,2; 66.4) initially 65,4 (58,1; 67,2)). Thermal helium-oxygen mixture leads to stabilization of hemodynamics, improving the work of the right and left heart: decline MPAP 28,2 (24,3; 32,8) initially 43,3 (40,1; 49,5), RVRI (285,3 (258,4; 362,7) initially 592,1 (498,2; 623,5)), RVSW (16,2 (14,1; 21,4) initially 25,8 (21,8; 32)), HR 91,1 (86,4; 98,7) initially 115 ((105; 118) to increase LVSW (58,2 (49,8; 62,4) initially 35,5 (28,9; 42,1)), SVI 36,2 (31,8; 42,1) initially 31,5 (28,4; 36,2). Elimination of arterial hypoxemia and a positive effect on hemodynamics ensures adequate oxygen transport to tissues, which is expressed in the normalization of DO2 values DO2 (980,4 (858,45; 1208) initially 280,3 (270,34; 387,4)) и ExO2 (27,8 (25,6; 34,5) initially 32,1 (30,7; 39,8) and decline Qs/Qt. (28,7 (18,6; 35,4) initially 42,8 (39,2; 49,1).Conclusion. Short-term therapy of patients with COPD with hypercapnic acute respiratory failure using the t-He/O2 method, in comparison with high-flow oxygen therapy, improves blood oxygenation and hemodynamics. Elimination of arterial hypoxemia and a positive effect on hemodynamics made it possible to ensure adequate oxygen transport to tissues, which was expressed in the normalization of transport values, oxygen delivery, and a decrease in the shunt fraction.

Первичный центр детского инсульта на базе многопрофильного педиатрического стационара. Новая реальность в педиатрии

Background. The increase in the number of diagnosed strokes in children, significant distinctive features and complexity of diagnosis, treatment and prevention of cerebrovascular diseases in children compared with adults, the impossibility of direct extrapolation of therapeutic recommendations from adult practice to pediatrics required the creation of specialized primary centers of pediatric stroke in Russia. Purpose. The purpose of this article is to describe the experience of organizing a Center for the treatment of children and adolescents with cerebrovascular diseases (hereinafter referred to as the Center) on the basis of the multidisciplinary pediatric hospital of the Morozovskaya Children's City Clinical Hospital of Moscow Healthcare Department, the introduction of modern methods of diagnosis and treatment of strokes in pediatrics, the organization of preventive measures, maintaining the city register of children's stroke, coordinating the provision of medical care to children with cerebrovascular diseases at various levels in the city of Moscow. Materials and methods. The presented experience of organizing and operating the Center covers the period from 2014 to 2019. Researchers used descriptive, statistical, and comparative analysis to demonstrate the Center's performance and justify proposed improvements in diagnostics, management of pediatric patients with cerebrovascular disease, and relapse prevention. Results. In the course of the organization and operation of the Center, there was assessed the frequency of children's strokes in the city: in 2015 - 6.59 cases per 100 thousand of the child population of Moscow; in 2016 - 6.51 per 100 thousand; in 2017 - 6.43 per 100 thousand and in 2018 - 5.86 per 100 thousand. There were improved: the diagnostics of cerebrovascular pathology and its algorithm, modern reperfusion methods of treatment (thrombolysis, thromboextraction) were introduced into practice, outpatient observation. The equipment and trained specialists concentration on the basis of the Center allowed the creation of the Center "full cycle". Maintaining the city register of pediatric stroke made it possible to compare Russian data with those available in the literature and to establish international cooperation with the International Pediatric Stroke Organization. Conclusion. The establishment of the Center is an important example of interdisciplinary interaction in pediatrics. The City Register of Pediatric Stroke will make it possible to assess the problem of childhood stroke in Moscow. The accumulated organizational, medical and diagnostic, scientific, international and educational experience of the Center can be introduced in other regions of the Russian Federation to improve the provision of medical care to children and to solve the most important problem - preserving the health of the country's child population.

Первичный центр детского инсульта на базе многопрофильного педиатрического стационара. Новая реальность в педиатрии

Background. The increase in the number of diagnosed strokes in children, significant distinctive features and complexity of diagnosis, treatment and prevention of cerebrovascular diseases in children compared with adults, the impossibility of direct extrapolation of therapeutic recommendations from adult practice to pediatrics required the creation of specialized primary centers of pediatric stroke in Russia. Purpose. The purpose of this article is to describe the experience of organizing a Center for the treatment of children and adolescents with cerebrovascular diseases (hereinafter referred to as the Center) on the basis of the multidisciplinary pediatric hospital of the Morozovskaya Children’s City Clinical Hospital of Moscow Healthcare Department, the introduction of modern methods of diagnosis and treatment of strokes in pediatrics, the organization of preventive measures, maintaining the city register of children’s stroke, coordinating the provision of medical care to children with cerebrovascular diseases at various levels in the city of Moscow. Materials and methods. The presented experience of organizing and operating the Center covers the period from 2014 to 2019. Researchers used descriptive, statistical, and comparative analysis to demonstrate the Center’s performance and justify proposed improvements in diagnostics, management of pediatric patients with cerebrovascular disease, and relapse prevention. Results. In the course of the organization and operation of the Center, there was assessed the frequency of children’s strokes in the city: in 2015 - 6.59 cases per 100 thousand of the child population of Moscow; in 2016 - 6.51 per 100 thousand; in 2017 - 6.43 per 100 thousand and in 2018 - 5.86 per 100 thousand. There were improved: the diagnostics of cerebrovascular pathology and its algorithm, modern reperfusion methods of treatment (thrombolysis, thromboextraction) were introduced into practice, outpatient observation. The equipment and trained specialists concentration on the basis of the Center allowed the creation of the Center «full cycle». Maintaining the city register of pediatric stroke made it possible to compare Russian data with those available in the literature and to establish international cooperation with the International Pediatric Stroke Organization. Conclusion. The establishment of the Center is an important example of interdisciplinary interaction in pediatrics. The City Register of Pediatric Stroke will make it possible to assess the problem of childhood stroke in Moscow. The accumulated organizational, medical and diagnostic, scientific, international and educational experience of the Center can be introduced in other regions of the Russian Federation to improve the provision of medical care to children and to solve the most important problem - preserving the health of the country’s child population.

To the question of operation of an outpatient unit when providing specialized psychiatric care to patients

The article presents results of the operation of cluster and modular system of psychiatric care in Moscow for the studied period (2017), operating on the basis of one of the psychiatric institutions — Psychiatric clinical hospital №13 of the Moscow Healthcare Department. Advantages of this organizational form in comparison with hospital treatment are determined: reduced treatment period, proximity, relatively fast adaptation of the patients. Attention is drawn to the need to improve interaction between units of the cluster and modular system, ensuring continuity in their work.

The analysis of functioning of endoscopic service of curative preventive institutions of the Moscow Health Care Department

The article presents analysis of endoscopy departments of curative preventive institutions of the practice in the institutions Moscow Health Care Department in 2018. The endoscopy equipment support of corresponding departments and medical rooms were analyzed. The comparative study of diagnostic endoscopy procedures (esophagogastroduodenoscopy, bronchoscopy, colonoscopy, rectosigmoidoscopy, intestinoscopy, capsule endoscopy) and therapeutic procedures (endoscopic hemostasis, endoscopic removal of foreign bodies, endoscopic submucous dissection, stenting, balloon dilation) was implemented. The indices of quality of endoscopic procedures and adequate personnel support of endoscopy departments were analyzed. The analysis of study results permitted to formulate main directions of optimization of endoscopic service, quality improvement and mechanisms of regular quality.

Инфекционный мононуклеоз у детей: клинико-лабораторная характеристика в зависимости от этиологии и фазы инфекционного процесса

Objective. To assess the association between clinical and laboratory characteristics of infectious mononucleosis (IM) and disease etiology and phase of infection. Patients and methods. This prospective observational study was conducted at Z.A.Bashlyaeva Children's City Clinical Hospital, Moscow Healthcare Department and included 107 children with IM. Laboratory testing was performed at the Department of Virological Diagnostics, National Medical Research Center for Hematology, Ministry of Health of the Russian Federation. Results. IM is a polyetiologic disease. So far, researchers have failed to find a significant correlation between clinical manifestations of IM and its etiology and phase of infection. Patients with IM caused by primary monoinfection with Epstein–Barr virus (EBV) are at high risk of developing chronic EBV infection. Neutrophilia is a typical laboratory sign of IM during the acute phase of it. Conclusion. The improvement of IM diagnosis with a detailed evaluation of clinical and laboratory criteria, as well as risk assessment of unfavorable outcome are currently impossible without the identification of both disease etiology and phase of infection. Key words: human herpes virus VI, Epstein–Barr virus, children, infectious mononucleosis, cytomegalovirus

To the question of relevance of outpatient psychiatric unit (sociological aspect)

Results of a sociological survey among doctors and patients on the implementation and operation of a new organizational form — outpatient psychiatric unit — operating on the basis of the Psychiatric clinical hospital No. 13, Moscow Healthcare Department, is presented in the article. Advantages of this organizational form in comparison with hospital treatment are shown: reduced treatment period, proximity, volumes of treatment comparable with hospital treatment, maximum social adaptation of patients. Some problematic issues of the unit’s operation are identified: lack of continuity in the interaction between the individual structures of the new organizational form, as well as with other health care organizations.

The modern features of organization of hospital-substituting psychiatric care

The article presents results of study of issues of psychiatric care organization in mental hospital in 2015-2017. The structure, age distribution and social status of patients are analyzed on the basis of data from Psychiatric Hospital № 13 of the Moscow Health Care Department.

Endoscopic service specifics in the Filatov’s State Clinical Hospital 15 of the Moscow Health Care Department for new coronavirus COVID-19 epidemic and the re-profiling of the regular hospital into an infectious hospital. First results

<h3></h3> В статье описаны сложности, с которыми столкнулась эндоскопическая служба ГКБ №15 им. О.М. Филатова во время перепрофилирования под «ковидный» госпиталь: нехватка кадров, сложности работы в средствах индивидуальной защиты. Подробно указаны меры, которые были предприняты в отношении эндоскопической службы: прекращение плановых эндоскопических исследований, усиление эндоскопических бригад дополнительными сотрудниками во время проведения сложных манипуляций, исключение из пользования фиброволоконных аппаратов. Описаны результаты проведенных эндоскопических папиллотомий, литоэкстракций, эндоскопического гемостаза при кровотечениях. Сделан вывод, что в результате проведенных реформ эндоскопическая служба смогла в полном объеме выполнять поставленные задачи.

Assessment of the quality of medical care provided to patients in a psychiatric hospital

Monitoring and evaluation of the quality of medical care provided to patients is essential in any medical specialty, but especially in relation to specialized care in mental health hospitals. The aim of our work is to assess the quality of specialized medical care provided to patients in the psychiatric hospital. We have examined 270 medical records and internal quality control cards of patients hospitalized from 2015 to 2019 in the Psychiatric Clinical Hospital No. 4 of the Moscow Healthcare Department (hereinafter referred to as “PCH No. 4” of MHD). The quality control of the provided medical care was carried out twice with the assessment of each studied section in the range from 0 to 1 point. Thus, it was possible to calculate the overall medical care quality coefficient with a description of the defects found in the provision of medical services. After the first control, quality coefficient appeared to be 0.86 (0.79; 0.91), and after the second one 0.95 (0.92; 0.96). During the second control, which was conducted in 2019, the medical care quality was significantly higher (p = 0.011) compared to the results of 2015–2018. The total share of detected defects in the medical-diagnostic process in a psychiatric hospital was 40.7 % (and was captured in 110 out of 270 cases). The results of our study demonstrate the necessity of medical care internal quality monitoring in a psychiatric hospital, since it contributes not only to the improvement of overall quality of medical treatment, but also to timely detection and reduction of the number of defects in the medical-diagnostic process.

Принципы организации заместительной почечной терапии в неотложной медицине Департамента здравоохранения города Москвы

Принципы организации заместительной почечной терапии в неотложной медицине Департамента здравоохранения города Москвы

Selection of Prediction Method of Basic Statistical Work Parameters of N.V. Sklifosovsky Research Institute for Emergency Medicine of the Moscow Healthcare Department

Background The most important part of the state social and economic policy is optimization of the healthcare system, where the loss of public health leads to economic damage. Against this background, forecasting the work of medical institutions is the basis for the successful development of healthcare, despite the fact that the healthcare system, indicators and standards of medical and social welfare are still not stable, and a clear development strategy for the shortand long-term period has not been worked out. Aim of study Determining the most optimal method for predicting the work of a medical institution, based on identification of the main trends in the time series when constructing a model of the dependence of parameters or determining the behavior of data as a stochastic series (i.e. modeling random processes and random events with some random error).Material and methods To predict the main statistical indicators of N.V. Sklifosovsky Research Institute for Emergency Medicine based on a retrospective analysis, data were used that were submitted to the City Bureau of Medical Statistics and entered into official reporting forms (form № 30, approved by Goskomstat of the Russian Federation dated September 10, 2002, № 175): the number of hospitalized patients and mortality rates in inpatient and intensive care units. To select the optimal methodology for the experimental forecast model, data were used for the period from 1991 to 2016. Indicators for 2017 were taken as control values.Results As a result of the comparison of several methods (moving averages, least squares approach, Brown model, Holt–Winters method, autocorrelation model, Box–Jenkins method) as applied to the work of N.V. Sklifosovsky Research Institute for Emergency Medicine, the Holt–Winters model was chosen as the most appropriate one for the data characteristics.Findings 1. When using methods of moving averages, least squares, Box-Jenkins, as well as Brown model and autocorrelation, the forecast result is not always influenced by strictly straight-line indicators of the time series, due to the heterogeneity of the time series and the presence of outliers (often found in a medical institution providing emergency care), which lead to a significant decrease in the reliability of forecasting. 2. The application of the Holt–Winters model, which takes into account the exponential trend (the trend of time series indicators) and additive season (periodic fluctuations observed in the time series), is most suitable for processing statistical data and forecasting for long-term, medium-term and short-term periods taking the specifics of a hospital providing emergency care into account. 3. The choice of the optimal method for predicting the work of a medical institution, based on the identification of the main trends in the time series, taking most of the features in the modeling of random processes and events into account, allowed to reduce the relative forecast error.

PNS271 TESTING OF A QUESTIONNAIRE FOR ASSESSMENT OF RELATIVE WEIGHTS OF MEDICINES VALUE CRITERIA

To pilot a questionnaire on weights of medicines’ value criteria, and understand which improvements are needed? We developed a questionnaire which included 5 questions about the value of medicines themselves: 1. Influence to survival, 2. Influence to quality of life (QoL), 3. Safety, 4. Usability, 5. Prevention of costs in future; 5 questions about the importance of targeted patients’ population: 1. Prevalence/incidence, 2. Mortality, 3. Availability of treatment options, 4. Age, 5. Burden for society; And 7 questions for expertise adjustments about a level and role of respondent in decision-making. Survey was conducted as anonymous written form fulfillment. Each criterion was proposed to be evaluated in a visual scale from 1 to 10 where 1- not important, and 10 – crucially important for decision making. We calculated weighted average and standard deviation (SD). We collected fulfilled forms from 15 employee of The HTA Center of Moscow healthcare department. The most important value factor was influence to survival (9.5 SD1.00), then safety (9.25 SD0.96), cost prevention (8.5 SD1.91), influence to QoL (8.25 SD2), and usability (4.5 SD1.29). Patients’ population factors has next weights: mortality (9.0 SD0.82) and treatment options availability (9.0 SD2), then prevalence (8.3 SD1.26), burden (8 SD1.41), and age (6.5 SD3.11). The results are only approbation of the questionnaire and then should be interpreted carefully because of small sample size and one-sided respondents. To reduce deviations in responses it is needed to reformulate questions about target population importance, as well as specify scales ranges for all criteria. Current version of the questionnaire can be used in a value of medicines assessment. The mentioned improvements can make the questionnaire more accurate and precise. The questionnaire is an obligatory part of a tool for substantiated value-based decision-making in healthcare.

Modern drug therapy of prostate cancer through the example of Moscow

Background. The average annual increment (5,09 %) of the prostate cancer (PC) incidence was highest across male oncological diseases registered in Russia from 2007 to 2017. 4643 new cases of PC were diagnosed in Moscow in 2017. As of 1st January 2018, the total number of living males with PC registered within Moscow healthcare system was 31,567.The study objective was to obtain the structure of factual costs related to medicine therapy of PC covered by the budget funds of the Moscow Healthcare Department in 2016–2017, that would help to further improve the system of subsidized drug provision for Moscow residents.Materials and methods. Using data from the information database of the Center for Medicine Provision of the Moscow City Department of Healthcare the following parameters were determined: total sum of expenses on drug purchase, mean treatment cost per 1 patient, number of patients receiving therapy, number of prescriptions, number of prescribed drug packs, mean pack cost, and others. The analyzed medicines were classified based on pharmacological and clinical groups. Costs for each class of therapies were studied.Results. During studied period (2016–2017), the most funds in Moscow were spent on abiraterone and goserelin. In 2016–2017, the amounts of prescribed packs were highest for androgen deprivation therapy: luteinizing hormone-releasing hormone agonists – goserelin and buserelin. In the group comprising 10 therapeutic regimens associated with highest costs, the percentages of costs for hormonal therapy and chemotherapy were respectively as following: 80 % and 16 % in 2016 and 75 % and 23 % in 2017. In the simplified model of costs associated with androgen deprivation therapy and treatment of metastatic castration-resistant PC without consideration of androgen deprivation therapy constituted 39 % and 61 % in 2016 and 36 % and 64 % in 2017. In the population of patients with prostate cancer, zoledronic acid, abiraterone, docetaxel, cabazitaxel were the most used medications in 2017 and the rate of enzalutamide usage was lowest.Conclusion. The highest costs are associated with treatment of metastatic castration-resistant PC. There is a growing necessity for improvement of funds spending on medications for patients with castration-resistant PC. This improvement could be achieved through development of medical methodologies that facilitate the selection of the most cost-effective approaches for early diagnosis and treatment.