State Health Institutions Research Articles

Upravljanje zdravstvenim radnicima za vreme pandemije COVID 19

After having dealt with the growing number of infected health workers in the province of Hubei in China, it was concluded that the most important link in the fight against SARS-CoV-2 infection was the proper and responsible management of health personnel. The aim of the paper is to is to determine whether, during the pandemic, human resources were well managed in state health institutions. Discovering the critical points of health workers management is very important in order to raise the overall quality of health services in the future emergency situations. A total of 150 respondents employed in COVID hospitals in Belgrade and Loznica took part in this research. The results of the research obtained using the chi-square test, showed that the received necessary information at the beginning of the pandemic, training courses on the use, removal, putting on and disposal of protective equipment, and psychological support of the authorities significantly related with the perception of the safety of health workers in state health institutions. Management of health workers should be at a high level, with a special emphasis on improving the management of the health of employees and their safety at work.

ОРГАНІЗАЦІЯ РЕКРЕАЦІЙНИХ ЗАХОДІВ У ПРИШКІЛЬНОМУ ТАБОРІ З ДЕННИМ ПЕРЕБУВАННЯМ ДІТЕЙ

The article analyzes the modern system of recreation and recreation of schoolchildren in the country and its compliance with the Law of Ukraine «On recreation and recreation of children». The characteristics of various types of health camps are given, and statistical data are given, which indicate a reduction in the number of inpatient state health institutions and, at the same time, an increase in preschool day camps for children. Considering the economic components, it has been determined that the preschool camp with children's day stay is the most optimal form of organizing health and leisure activities for schoolchildren during the holidays. Based on the analysis of theoretical literature and practice of the work of domestic and foreign health camps of various types, contradictions between the request of modern children regarding the organization of their rest and those forms of work that prevail are highlighted. In the practical part of the article, the experience of the preschool recreation and rehabilitation camp for children is highlighted, namely: the directions of the camp's work (cognitive-intellectual, creative, physical culture-rehabilitation, entertainment), design of its activities, structuring of the recreational space (micro-local, macro-local, meso-local) are characterized; techniques for involving children in determining the content of weekly work are given; the ways of ensuring the psychological comfort of pupils are outlined; measures aimed at uniting the team and improving children's health have been determined; the possibility of children with special educational needs staying in a preschool camp as an additional condition for their further socialization has been proven. It was concluded that it is necessary to combine many years of experience in this type of camp with new forms of work that take into account modern social and cultural realities, oriented to the requests of schoolchildren, their personal characteristics, and their psychophysical state. Key words: improvement and recreation of schoolchildren, preschool day camp, recreational activities, recreational space, planning of preschool camp activities

“Affective Publics”

In Denmark, as with elsewhere in the world, Twitter has emerged as an important arena of public discussion on issues relating to the COVID-19 pandemic, including the handling of the crisis by state authorities and health institutions. On the basis of approximately 140,000 tweets from the period between February 24 and April 28, 2020, harvested from Danish Twitter, this report explores how tweeting about mis/trust on this digital platform can be understood as a kind of biopolitical nationalism. Combining computational and qualitative methods, we identify shifting performances of mis/trust and other affects on Danish Twitter and suggest that this “affective public” plays a key role in the public response to the coronavirus crisis.

New system of remuneration for health workers: pilot project

The article is devoted to the current pilot project on the introduction of a new system of remuneration for health workers of state and municipal institutions. The peculiarities of the method of determining salaries, as well as payments of incentive and compensatory nature for medical personnel according to the Draft Resolution of the Government of the Russian Federation “On approval of the estimated value, groups of health workers of State and municipal health institutions to establish salaries, regional coefficients and methods of their calculation, labour complexity coefficients, a single list of compensatory payments, a single list of incentive payments, the size and conditions of compensatory and incentive payments for the purpose of the pilot project” are analyzed. Examples of calculation of salary elements of medical workers according to the new wage system are given.

Kvalitet upravljanja zdravstvenim radnicima tokom COVID-19 pandemije na različitim nivoima zdravstvene zaštite

Emergencies occur unexpectedly, abruptly, and they set tasks for managers that are different from the usual way of work of the organization. The organization is then faced with the challenge to respond to the new situation with the available funds and following specially prescribed procedures, which can be very demanding for the management. At the moment, in the conditions of a pandemic caused by the SARS-CoV-2 virus, the problem is the fact that most health systems don't have enough health workers who can take care of a large number of infected patients. As their number is small, and at the same time they are in great danger of being easily infected with the virus, it is clear that special attention must be paid to their management and protection. The paper presents the results of research on the quality of management of employees in state health institutions that had the status of COVID hospitals in Belgrade and Loznica according to the level of health care service and highlights critical points that should be improved in the future.

Non-pharmacological labor pain management and associated factor among skilled birth attendants in Amhara Regional State health institutions, Northwest Ethiopia

BackgroundHealthcare providers have a responsibility to provide pain management support to women during labor. Labor pain management in low and middle income countries primarily relies on non-pharmacological methods, as there is little access to pharmacologic pain management. This study aimed to determine the utilization of non-pharmacological labor pain management (NPLPM) and associated factors among skilled birth attendants (SBAs) in Amhara Regional State health institutions, Ethiopia.MethodsA cross-sectional study was conducted on 592 SBAs working in the Amhara Region, Ethiopia. A multistage sampling was used to collect data using a pretested interview-administered questionnaire. Descriptive analysis was done to characterize the study population. Logistic regression was used to model predictors of NPLPM utilization among SBAs, including age, qualifications, type of medical institution, knowledge, attitudes, and the presence of a protocol.ResultNearly forty seven percent 277(46.8%) of SBAs in the study cohort utilized NPLPM. SBAs who had adequate knowledge of NPLPM had 2.8 times increased odds of using NPLPM than SBAs who had inadequate knowledge. (95%CI 1.89–4.014). SBAs who had a positive attitude had 4.12 times increased odds of using NPLPM than SBAs with a negative attitude (95%CI 2.36, 7.2). SBAs who had labor a pain management protocol in their facility had 3.98 times increased odds of using NPLPM than those who didn’t have a labor pain management protocol (95%CI 1.83, 8.62).ConclusionsThe analysis pointed to a gap in the utilization of NPLPM in the Amhara Region facilities studied. Less than half of SBAs used NPLPM when caring for laboring women. Professional factors related to use of NPLPM included the age of SBAs, their attitudes, level of education, and knowledge concerning pain management. NPLPM was also significantly associated with the availability of labor pain management protocols.

Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015.

Purpose and ObjectivesColorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation.Intervention ApproachCDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates.Evaluation MethodsWe surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation.ResultsMost grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity.Implications for Public HealthCRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.

Social order as mechanism of integrated medical and social home care funding

An introduction: In Belarus, the need for the development of integrated medical and social care is significantly increased due to the population aging, the growth of non-infectious morbidity. Beneficiaries of medical and social services are elderly lonely people over 75 and with disabilities. 14% are citizens aged 65 years and older, about 735,000 lonely and living alone, and 5.8% of the disabled. The needs of these people are covered by 2 departments: the Ministry of Health and the Ministry of Labor and Social Protection. Despite the good development of medical and social structures, there are some obstacles when there is a need for their simultaneous work at home. Medical workers in outpatient health organizations provide short-term medical care at home; social services provide social and household services. So needy citizens are often hospitalized not so much for medical reasons, but for social ones. One of the main providers of long-term integrated medico-social care at home is the Visiting Nurses Service of the Belarus Red Cross Society BRC VNS, which provides a range of medical care, social and household services. Description of policy context and objective: Since 2012 the state social order SSO has been introduced in Belarus as an innovative social mechanism. Its main goal is to solve socially significant problems of society through budgetary financing of topical social services/projects of social organizations regardless of the ownership form. The BRC acted as one of the initiators in the SSO promotion and implementation. About 135 SSO contracts were implemented for 4 years. Target population: The recipients of integrated medico-social care at home are single and lonely elderly citizens, people with disabilities, multiple chronic illnesses, mental disorders. The average age of the BRC VNS clients is 82.2 years; people with disabilities make up about 60%. Every year, about 1,500 people get help at home. Highlights innovation, impact and outcomes: The state social order is an innovative social technology. It is carried out on the basis of competitive selection of the contractor and on the principle of purchasing or subsidizing social services and social projects. The manager of financial resources - executive body of state management or local authority - becomes the customer of services in favor of consumers of services. Due to the SSO, the number of citizens who receive medical and social home help increases. In 2015, 516 people in need were served at home, in 2016 - more than 700 people, which is about 50% of all BRC recipients. Comments on transferability: The BRC has many years of experience and a big network of organizations which cover all regions in the country. Conclusions: The provision of integrated medico-social care at home is an alternative to hospitalization of elderly and disabled people. Involvement of NGOs such as the BRC VNS on the basis of financing from the state budget is an effective model that relieves the burden from state health and social protection institutions and allows increasing the availability of services to those in need.

Addressing social determinants of NCDs through community mobilisation: comparative research for effectiveness assessment

An introduction: Since 2014, Swiss Red Cross has been running a “Community Action for Health” project in Belarus. Directly implemented by the Belarus Red Cross, the project is aimed at improving knowledge, changing attitudes and behaviour of the local population on such determinants of NCDs as physical activity and healthy nutrition via establishing Initiative Groups IGs in the communities. To identify effectiveness of the community mobilisation approach, a project end-line survey was done in March-July 2017. Theory/Methods: Community mobilisation was implemented in selected geographical areas of 5 pilot districts. Base-line data on NCD related knowledge, attitudes and behaviour of people living in the pilot districts was collected in 2014. The end-line data collection was organised using quasi-experimental method. 1866 respondents were organised in three target groups TGs: 417 IGs members and volunteers with full coverage; a sample of 385 systematic random sampling from 76,500 people in pilot communities covered by the IGs’ work; a sample of 1,067 people not covered by the IGs’ work multistage samplings with district stratification at the first stage, rural/urban stratification at the second stage from 208,411 people living in the pilot districts. First two groups were considered as experimental, the third one – as a control group. The end-line results were also compared with the base-line data. Results: Not only people directly involved in the IGs – members and volunteers, - but also people “covered” by the IGs’ work are more physically active ride a bicycle every day/few times a week 31.9% of “covered” population versus 19.2% of general population; go for a walk 71.4% versus 58.5% respectively. The IGs members/volunteers and the “covered” population reported switching to healthier diet 53.3% and 41.5% respectively and weight loss 29.2% and 20.1%. Discussions: How does the research - assess “spill over” effect of targeted interventions; - eliminates role of “external environmental factors” increased state attention to the NCD prevention over the recent years; - foster programme sustainability and development. Conclusions: The research showed a high degree of effectiveness of the community mobilization approach in improve both the health status and life quality improving subjective well-being, increasing communication of the population covered by the project activities. Survey results: broadly used for advocacy, played an important role in further geographical expansion of and stronger involvement of the state health institutions in community mobilization for NCD prevention. Lessons learned: Comparative analysis experimental and control groups made a stronger policy influence; Distribution of the information on the IGs work during interviews with the “non-covered” population target group 3 was a good strategy of involving new people/communities in NCD prevention. Limitations: Questions on subjective assessment of health and wellbeing change within the project time-frame were used only for the experimental groups. Difficulties in defining “covered” population target group 2 in the urban areas. Suggestions for future research Longitude survey, based on the existing questionnaire could be used to monitor longer-term impact of community mobilisation for NCD prevention.

Cost of Public Health Response and Outbreak Control With a Third Dose of Measles-Mumps-Rubella Vaccine During a University Mumps Outbreak-Iowa, 2015-2016.

The United States is experiencing mumps outbreaks in settings with high 2-dose measles-mumps-rubella (MMR) vaccine coverage, mainly universities. The economic impact of mumps outbreaks on public health systems is largely unknown. During a 2015-2016 mumps outbreak at the University of Iowa, we estimated the cost of public health response that included a third dose of MMR vaccine. Data on activities performed, personnel hours spent, MMR vaccine doses administered, miles traveled, hourly earnings, and unitary costs were collected using a customized data tool. These data were then used to calculate associated costs. Approximately 6300 hours of personnel time were required from state and local public health institutions and the university, including for vaccination and laboratory work. Among activities demanding time were case/contact investigation (36%), response planning/coordination (20%), and specimen testing and report preparation (13% each). A total of 4736 MMR doses were administered and 1920 miles traveled. The total cost was >$649 000, roughly equally distributed between standard outbreak control activities and third-dose MMR vaccination (55% and 45%, respectively). Public health response to the mumps outbreak at the University of Iowa required important amounts of personnel time and other resources. Associated costs were sizable enough to affect other public health activities.

\u2018When helpers hurt\u2019: women\u2019s and midwives\u2019 stories of obstetric violence in state health institutions, Colombo district, Sri Lanka

BackgroundThe paper explores how age, social position or class, and linguistic and cultural background intersect and place women in varying positions of control and vulnerability to obstetric violence in state health institutions in Colombo district, Sri Lanka. Obstetric violence occurs during pregnancy, childbirth and the immediate postpartum period; hence, it is violence that directly affects women. The authors aim to break the traditional culture of silence around obstetric violence and bring attention to the resulting implications for quality of care and patient trust in obstetric care facilities or providers.MethodsFive focus group discussions were held with 28 public health midwives who had prior experience working in labor rooms. Six focus group discussions were held with 38 pregnant women with previous childbirth experience. Additionally, 10 of the 38 women, whom felt they had experienced excessive pain, fear, humiliation, and/or loss of dignity as patients in labor, participated in individual in-depth interviews. An intersectional framework was used to group the qualitative data into categories and themes for analysis.ResultsObstetric violence appears to intersect with systems of power and oppression linked to structural gender, social, linguistic and cultural inequities in Sri Lanka. In our dataset, younger women, poorer women, and women who did not speak Sinhala seemed to experience more obstetric violence than those with relevant social connections and better economic positions. The women in our study rarely reported obstetric violence to legal or institutional authorities, nor within their informal social support networks. Instead, they sought obstetric care, particularly for childbirth, in other state hospitals in subsequent pregnancies.ConclusionsThe quality of obstetric care in Sri Lanka needs improvement. Amongst other initiatives, policies and practices are required to sensitize health providers about the existence of obstetric violence, and repercussions are required for abusive or discriminatory practices. The ethics of care should be further reinforced in the professional training of obstetric health providers.

Mission and State Health Institutions: “Invisible” Public-Private Partnerships in Zimbabwe, 1980–1999

This article argues that Zimbabwe’s independence in 1980 marked not the end of the missionary era, but its high point. Government’s poor rural health infrastructure forced it to partner missionary health institutions in order to run preventive health programmes and improve access to health services for the majority of the population. Mission health institutions formed the mainstay of rural African health care needs in the colonial period and continued to do so in the post-colonial period; with 97 clinics and 70 hospitals, and 13 of the country’s 42 designated district hospitals compared to 1 032—largely small and urban based—government, council and private health facilities. Mission health institutions were regulated by the Ministry of Health and were partly funded by the government. However, the significance of the mission health endeavour was overshadowed by an overarching government development agenda and narrative. This study establishes the nature and forms of public-private health partnerships in the development of Zimbabwe’s public health system and highlights the importance of the church’s healing mandate. It also refracts on church-state relations and the broader development and policy issues during the 1980s and 1990s.

Obezbeđenost medicinskim sestrama-tehničarima u Republici Srbiji, 2000-2016. godine

In most countries, nurses are the most numerous category of employees in the healthcare system and represent the first, last and most frequent point of contact that people have with the health care system. The aim of this paper is to examine the total provision of nurses in the Republic of Serbia, by districts, in relation to the number of doctors, and in relation to other countries. Method of work: A retrospective analysis of the data on nurses in the state health institutions in Serbia indicated in the Network Plan for the period from 2000 to 2016 has been carried out. The source of the data were statistical yearbooks of the Institute of Public Health of Serbia 'Dr Milan Jovanovic Batut' and the data from the Census. Results: In the period 20002016, the total number of nurses increased from 37,613 to 38,653 (by 2.7%). The number of nurses with higher education increased significantly (by 22.1%), while the number of nurses with secondary education decreased (by 0.4%). The ratio between the number of nurses and the number of doctors was almost unchanged (1.9), and it was significantly lower than the average for OECD countries. The provision of nurses in Serbia was 628 per 100,000 inhabitants. Although it was better in comparison to 2000. (501/100,000), it was still below the average for EU Member States (740) and the average for the countries in the European region (864). There were great geographical variations in the provision of nurses in Serbia. The highest provision rates in 2016 were in Bor, Belgrade, Zajecar and Nisava District. The lowest provision rates of nurses were in Srem, West Backa, Moravica, North Backa and Rasina Districts. The districts that were best provided with nurses were at the same time best provided with doctors and vice versa. Conclusion: Although the number of nurses increased, provision of this staff in Serbia was less than the average of European countries, and there were large differences among the districts.

Efficient health care service delivery using network analysis: a case study of Kwara State, Nigeria

This paper addresses challenges with prompt health care delivery using Network Analysis of Critical Path Model (CPM) to plan the hospital capacity with a view to achieving prompt health care service delivery. Hospital activities were identified as either critical and non critical, time or cost consideration was factored in. In all, 16 state health institutions were purposively selected on the basis of most equipped from 55 state health institutions. Data on patients’ arrival and departure were observed and recorded for a period of six months. This was subjected to further analysis to identify the most important activities (critical path) and less important together with their time duration. The average total time spent in the hospital was 43 minutes but with effective capacity planning using network analysis the total time was reduced to 18 minutes and the critical path (activities) were identified to be: A - Card section, F - Medical Doctor and H – Medical Team.Keywords: Critical Path Model (CPM), Capacity Planning (CP), Hospital Services, Network Analysis

ABORTION AND CONTRACEPTIVES: AN EXPLORATORY STUDY

The article presents the factors that lead to the increasing abortion rates amongst young women in South Africa, where contraceptives are said to be readily available at all state health facilities. The study employed a qualitative approach in order to gain an understanding of the beliefs and meanings attributed to abortion and contraceptives. The research strategy used in the study was phenomenology. Non-probability sampling, particularly purposive sampling was utilised to select research participants from whom data were collected by means of semi-structured interviews. The findings of the study, amongst others, have indicated that despite the considerable expansion of contraceptive services in South Africa, the use and accessibility to these services remains a challenge. The study also conclusively indicated that there is a need to improve service delivery at state health institutions with regard to abortion and to stimulate utilisation of contraceptive services.

Partnerships between the faith-based and medical sectors: Implications for preventive medicine and public health.

Interconnections between the faith-based and medical sectors are multifaceted and have existed for centuries, including partnerships that have evolved over the past several decades in the U.S. This paper outlines ten points of intersection that have engaged medical and healthcare professionals and institutions across specialties, focusing especially on primary care, global health, and community-based outreach to underserved populations. In a time of healthcare resource scarcity, such partnerships—involving religious congregations, denominations, and communal and philanthropic agencies—are useful complements to the work of private-sector medical care providers and of federal, state, and local public health institutions in their efforts to protect and maintain the health of the population. At the same time, challenges and obstacles remain, mostly related to negotiating the complex and contentious relations between these two sectors. This paper identifies pressing legal/constitutional, political/policy, professional/jurisdictional, ethical, and research and evaluation issues that need to be better addressed before this work can realize its full potential.

Urano, Onán y Venus: La sexualidad psicopatologizada en el Uruguay del Siglo XIX

As of the second half of the nineteenth century, Uruguayan society began making strides towards a process of medicalization to have led to the growing presence of doctors in everyday life. It was in this context that psychiatry came to gain ground (as did other branches of medicine), serving as an instrument used by doctors to designate not just psychiatric illnesses of a biological origin, but also moral and social causes which unequivocally led to “madness”. Homosexuality, masturbation and prostitution were to be found among these practices, and were not only considered criminal offences, but also psychopathological manifestations. Among other social problems, psychiatrists tackled the approach to sexual practices and their normativization, charging various state police and health institutions with the containment, repression and isolation of all men and women who demonstrated any kind of “deviance” in their sexual behavior. With this as its starting point, our work analyzes the psychiatrists’ stance on sexuality during the period from 1880 to 1910. To do so, we consider four of the period’s main medical concerns: homosexuality, lesbianism, masturbation and prostitution.

Локальные правовые акты медицинских учреждений

This article focuses on problem of local lawmaking at state governmental establishments in Russia, questions of legal relations between state and public health institutions, justification of specific proposals and recommendations, that aimed to improving institutional and legal framework of public health institutions, clear regulation of the public health institutions with the relevant local regulations in order the rights of the patient. Particular attention is given to the development and publication of local legal acts, and the key violations are also highlighted here. Particular attention is paid to the development and publication of local legal acts, key violations have been outlined. Subjects of law-making, the concept and types of local legal acts in the activities of public health institutions, the grounds of origin, as well as the importance of local legal acts as instruments of decentralized self-regulation in a structure operating in the country of legal regulators are identified. Some practical recommendations for the development of local regulations aimed on improving the organizational and legal bases of maintenance of health service are given. 

Exploring Factors Influencing Recruitment and Retention of Nurses in Lagos State, Nigeria within Year 2008 and 2012

Objective: To explore the factors influencing recruitment and retention of nurses in Lagos State Hospitals. Background: Despite the perceived efforts made by Hospitals Management in Lagos State to recruit and retain nurses, there is still inadequate number of nurses to match the demand of care needed by patients in the hospitals. Methods: The descriptive study utilized mixed methods to gather data. It consisted of 330 consented and randomly selected nurses for the survey and 14 purposively selected nurse leaders and Director for the interview. The instruments were pretested questionnaire, semi-structured interview guide and existing records. Result: The study revealed that all health institutions in Lagos State were aware of the standard procedures of recruitment of nurses, but often engages in replacement rather than proper recruitment. Most of the Nursing leadership positions in Lagos State were vacant. More than half (68.2%) of the nurse respondents were not sure if they would still be working in their health institution in the next five years. It was revealed that the turnover rate of nurses in the State Health institutions was higher than the Federal health institutions in Nigeria. Conclusion: Increment in salary and allowances rated the best influence on recruitment and retention of nurses in Lagos State. Lack of nursing leadership; sense of job security and work environment were the major factors influencing recruitment and retention of nurses. There is need for adequate human resource planning; increased efforts and formulation of policies that will improve recruitment and retention of nurses in Lagos State of Nigeria.

EPA-1617 – The role of social environment in reduction of unhealthy behaviour of patients with addiction disorders

There is a number of strict alcohol and drug abusers all around the world. They need in some funds for substances buying and often they do not have regular work commit a crimes. Besides frequently addicts underestimate their own condition and anosognosia happens regularly. Sometimes they fear to attend state health institutions even on ambulant and anonymous basis, because it might lead to restriction of their work and life opportunities in consequence in Russia (taking away of drive license etc.). The last one is a way for risks reducing in society to eliminate of dangerous drivers, but it declines of addicts opportunities to get professional medical support from medical specialists. All of these factors lead to pushing out of alcohol and drug users from the society, and as a result lead to increasing of their unhealthy behavior and crime activity. There is developed system in Germany for incorporation of patients with addiction disorders into the society. It includes some social benefits for patients, encouraging their attending to outpatient departments, facilitating employers to adopt these patients for work. On the one hand, this approach increases risks for society and patient, because a person with addiction disorder get permission for potential dangerous activity (eg. driving). But ultimately it facilitates for developing of the health behavior by individuals, decreasing of social risks through incorporation of the person to the society and improving of social environment.