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C O NTE NTS

HEАLTH АND SOCIETY

Mingazova E.N., Shchepin V.O., Shigabutdinova T.N., Sadykova R.N. Dynamics of leading reproduc-
tive and demographic indicators of motherhood and childhood protection’s system in Tatarstan Republic .......5

Kudrina V.G., Suslonova N.V., Antonova I.V., Smirnova T.L., Zhuravleva N.V., Barsukova E.V.

Special aspects of reproductive losses in the Chuvash Republic in 2014–2018..............................................14

HEАLTH CАRE SPECIАLIZED SERVICES

Shishkin E.V. Comparative analysis of road traffic injuries in different federal districts and states
of the Russian Federation.................................................................................................................................
22

Sharafutdinova N.Kh., Dautova L.P., Pavlova M.Yu., Valiev I.R. Colorectal cancer incidence in Bash- kortostan Republic: the data of comprehensive study ......................................................................................26

Kubryak O.V., Krivoshey I.V., Kriklenko E.A. Study of human posture using a force platform (stabilo-
metry): the Russian corps of experts and consensus-building .........................................................................32

Osmonaliev I.Zh., Bilgildeev M.G., Baikeev R.F. The improvement of statistics analysis of the persons
with extremities’ amputation in Tatarstan Republic (taking into consideration the data of domestic and
foreign reserches) .............................................................................................................................................37

Shaymieva N.I. Orthodontic status of the population of Tatarstan Republic and assessment of the need
for the treatment of dento-facial anomalies at children of the region................................................................49

Bayanova N.A., Begun D.N., Matchina O.I., Baryshnikova E.S., Plotnikova E.D. Comparative analy-
sis of melanoma morbidity rate and melanoma related deaths in the Orenburg region and the Russian Federation .........................................................................................................................................................54

EDUCATION AND PERSONNEL

Kharisov A.M., Bereznikov A.V., Shkitin S.O., Berseneva E.A., Skiba Ya.B., Onufriyuchuk J.O.

State normative acts and local acts of medical organization as an element of building a system

of the internal quality control of physicians training ..........................................................................................59 Titova S.V., Yashin A.S. Indicators for assessment of performance of staff relations in medical institutions ......64

ETHICS-LEGAL ASPECTS OF HEALTH CARE

Sidorenko V.A., Zubritsky V.F., Potokova M.E. Legal regulation of medical support for employees
of internal affairs bodies....................................................................................................................................68

ORGANIZATION AND IMPROVEMENT OF PROTECTION SYSTEM MANAGEMENT OF PUBLIC HEALTH

Berseneva E.A., Mendel S.A., Shkarin V.V., Kurakov D.A., Savostina E.A. Design of management and administrative processes in medical organizations using a graphical representation of the model..................73

Belostotsky A.V., Grishina N.K., Ter-Israelyan A.Ju. To the question of organization of work of day
hospital in the format of out-of-hospital inpatient care ......................................................................................80

QUALITY OF MEDICAL-SOCIAL SERVICES OF THE POPULATION

Fentisova V.N., Kiku P.F. Issues of improving the quality of services in the framework of the formation
of a new model of medical organization providing primary health care ............................................................86

ANNIVERSARY

Professor Afgat N. Galiullin celebrates the 75-th anniversary ...............................................................................93

 

 

DYNAMICS OF LEADING REPRODUCTIVE AND DEMOGRAPHIC INDICATORS OF MOTHERHOOD AND CHILDHOOD PROTECTION’S SYSTEM
IN TATARSTAN REPUBLIC

Elmira N. Mingazova, MD, Professor, chief researcher of N.A. Semashko National Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12, building 1]; Professor, Kazan State Medical University [420012 Kazan, Butlerov str., 49]; Professor of N.I. Pirogov Russian National Medical University [117997 Moscow, Ostrovityanov str., 1; e-mail: ]

Vladimir O. Shchepin, Corresponding Member of the Russian Academy of Sciences, MD, Professor, Head of Department of N.A. Semashko National Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12, building 1; e-mail: ]
Tatyana N. Shigabutdinova, Deputy head physician for obstetrics and gynecology of Municipal Clinical Hospital No 7

of Kazan [420103 Kazan, Marshal Chuikov str., 54; e-mail: ]
Romina N. Sadykova, 4th year student of Medicine Faculty of I.M. Sechenov First Moscow State Medical University of Health Ministry of Russia [119901 Moscow, Trubetskaya str., 8, building 2; e-mail: ]

Abstract. The aim of the work is to analyze the dynamics of reproductive and demographic indicators used in assessing the organization of motherhood and childhood protection on the example of Tatarstan Republic (1991–2017). Material and

6 ЗДОРОВЬЕ И ОБЩЕСТВО

methods. The study was carried out on the basis of an analysis of existing legislative and regulatory legal documents, and modern literary sources that determine the general trend in the demographic situation in the country, as well as including information from statistical collections of the Federal State Statistics Service and Health Ministry of the Russian Federation. The following methods were used in the course of the study: study and generalization of experience, analytical, statistical. The dynamics of the leading reproductive and demographic indicators of Tatarstan Republic have been analyzed in assessing of the organization of motherhood and childhood protection in TR, as a state since the formation of the new Russian state. The positive dynamics for certain indicators, such as the rate of abortion and maternal mortality, have been determined. Conclusions. 1. There is no clear trend of changes in mortality rates from complications of pregnancy, childbirth and the postpartum period; periods of decline in maternal mortality within a long time series were accompanied by a slight increase (in 1999–2001, 2008–2009). The level of this indicator in rural areas was higher than in urban areas (21,5 per 100 000 live births versus 4,3). 2. Positive dynamics are characteristic for indicators of artificial termination of pregnancy. The number of abortions per 1000 women aged 15–49 years decreased from 102 in 1991 to 23,5 in 2017; per 100 births: from 188 to 45,4. 3. Positive dynamics are observed in perinatal mortality, but with significant differentiation for urban and rural populations. The downward trend for this indicator was expressed more clearly in urban areas. 4. The maternal mortality in Tatarstan Republic is lower than in the Russian Federation: 8,9 per 100 000 live births against 10,8 in 2014; 8,3 against 8,8 in 2017. Analysis of abortion in TR exceeded the same rate in Russia in 2000–2004 in average of 6 abortions per 1000 women aged 15–49 years, then after 2005 the trend changed-the results were either the same or the indicators in TR were less than in Russia.

Key words: reproductive and demographic indicators of population health, maternal mortality, perinatal mortality, number of abortions.

 

 

SPECIAL ASPECTS OF REPRODUCTIVE LOSSES IN THE CHUVASH REPUBLIC

IN 2014–2018

Valentina G. Kudrina, MD, Professor, head of medical statistics and informatics department of Russian Medical Academy of Continuing Professional Education [125445 Moscow, Belomorskaya str., 19, tel.: 7(499)-458-95-67; e-mail: ]
Nina V. Suslonova, MD, Professor, Governor Adviser of the Moscow Region [143407 Moscow region, Krasnogorsk-7, Stroiteley Boulevard, 1.; tel.: 8(498)-602-04-20; e-mail: ]

Irina V. Antonova, Deputy Director on medical statistics of Medical Information Analytical Centre of Health Ministry
of Chuvashia [428000 Cheboksary, Kalinin str., 112, tel.: (8352)-26-00-03; e-mail: ]
Tatyana L. Smirnova, PhD, Associate Professor of obstetrics and gynecology sub-faculty of I.N. Ulyanov Chuvash State University [428000 Cheboksary, Moscow av., 15; tel.: 8-927-845-84-21; e-mail: ]

Nadezhda V. Zhuravleva, PhD, Associate Professor of internal medicine sub-faculty of I.N. Ulyanov Chuvash State University [tel.: 8-903-358-71-78; e-mail: ]
Elena V. Barsukova, PhD, Head physician of Republican Clinical Hospital of Health Ministry of Chuvashia [428000 Cheboksary, Moscow av., 9; tel.: (8352)58-16-11; e-mail: ]

Abstract. The article presents data on the level and dynamics of reproductive losses in Chuvashia in 2014–2018, which include inevitable miscarriage, abortions, maternal mortality, ectopic pregnancy, stillbirth, infant mortality. It presents data on the level and dynamics of some indicators characterizing reproductive losses in the Chuvash Republic (ChR) in comparison with the ones in the Russian Federation (RF) and in the Volga Federal District (VFD), as well as measures to improve maternity and child welfare services (MCWS) implemented in the Chuvash Republic as part of priority national projects and regional state targeted programs. We made the conclusion that a steady trend of decline in the level of reproductive losses is registered. Besides, the importance of the components in reproductive losses to increase reproductive potential is different. The increase in the level of antenatal stillbirth with simultaneous increase in the proportion of inevitable, unspecified miscarriages, other abnormal products of pregnancy in the structure of abortions demonstrate the need to further process’ improvement of reproductive losses’ prevention.

Key words: reproductive losses, infant mortality, stillbirth, perinatal mortality, maternal mortality, abortions.

 

 

COMPARATIVE ANALYSIS OF ROAD TRAFFIC INJURIES IN DIFFERENT FEDERAL DISTRICTS AND STATES
OF THE RUSSIAN FEDERATION

Evgeny V. Shishkin, PhD, Director of Troitsky Medical College, Teacher of public health and healthcare sub-faculty
of Institute of Additional Professional Education of South Ural State Medical University [454100 Troitsk, Klimov str., 17; e-mail: ]

Abstract. The article analyzes road traffic injuries in the federal districts and states of the Russian Federation in 2010–2018. There is a clear decrease trend of this type of injury. Nevertheless, significant differences in indicators were revealed in a number of territories of the Russian Federation. The highest level of injuries in road accidents was registered in the Far Eastern Federal District in 2018 – 177,1 cases per 100 thousand people (it is 21,5% higher than in the Russian Federation). The highest level of road traffic injuries among the states of the Russian Federation was registered in the Republic of Kalmykia – 258,5 cases per 100 thousand of the population (it is higher than in the Russian Federation by 76,7%). The Republic of Tuva ranks second in the frequency of road traffic injuries – 245,0 cases per 100 thousand people (it is 67,5% higher than in the Russian Federation). The third place was taken by the Novgorod region, where the rate of road traffic injuries amounted to 237,9 cases per 100 thousand people in 2018 (it is 62,6% higher than the regional value). Conclusion. The study’s data indicate significant differences in the frequency of road traffic injuries depending on certain territories of the Russian Federation and it testifies the need to develop comprehensive measures for the organization of trauma centers, taking into account the climatic and geographical and demographic conditions of a particular region.

Key words: injuries, road traffic injuries, road accidents, incidence, multiple injuries, combined injuries, injury centers.

 

 

COLORECTAL CANCER INCIDENCE IN BASHKORTOSTAN REPUBLIC:

THE DATA OF COMPREHENSIVE STUDY

Nazira Kh. Sharafutdinova, MD, Professor of public health and healthcare management sub-faculty of Bashkir State Medical University of Health Ministry of Russia [450008 Ufa, Lenin str., 3; tel.: +7(937)343-57-04; e-mail: ] Luiza P. Dautova, postgraduate student of public health and healthcare management sub-faculty of Bashkir State Medical University of Health Ministry of Russia [e-mail: ]

Marina Yu. Pavlova, PhD, Associate Professor of public health and healthcare management sub-faculty of Bashkir State Medical University of Health Ministry of Russia [tel.: +7(917)343-28-83; e-mail: ]
Ilnur R. Valiev, PhD, Associate Professor of public health and healthcare management sub-faculty of Bashkir State Medical University of Health Ministry of Russia [e-mail: ]

Abstract. Colorectal cancer ranks second in the structure of oncological morbidity in the female population and the third in the male population, excluding skin cancer. The term «colorectal cancer» includes tumors of the colon and rectum. The purpose of the study was to study the prevalence of colorectal cancer in the Republic of Bashkortostan. Material and methods. The form of Federal statistical observation No 7 «Information on the incidence of malignant neoplasms» was used in the Republic of Bashkortostan for 2008–2016 as the material. Rough and standardized indicators of primary morbidity and contingent of patients with colorectal cancer per 100 000 population have been calculated. Results. The increase in the incidence of colon cancer in 18,7%, of rectum in 14,0% has been revealed in 2008–2016. Stable growth was observed in the contingent of patients with colorectal cancer (in 31,0%) and rectum (in 27,8%). Rough and standardized incidence rates of colon cancer and a rough incidence of rectal cancer are lower in Bashkortostan Republic than in the Russian Federation and the Volga Federal District. The average annual primary incidence rate of colorectal cancer was higher among women than among men [(17,9±0,6) and (16,9±0,7) cases per 100 000 people; p>0,05], of rectal cancer was higher among men than among women [(19,8±0,7) versus (15,3±0,6) cases per 100 000 people; p<0,05]. The indicators of early detection and five-year survival of colorectal cancer were higher among urban residents than among those living in rural areas. The conclusion. The special aspects of the prevalence of colorectal cancer determine the need to develop measures to prevent oncological incidence of the colon and rectum and improve medical care for patients, taking into account gender-age characteristics and place of residence.

 

Key words: colorectal cancer, incidence, population, sex, age. 


 

STUDY OF HUMAN POSTURE USING A FORCE PLATFORM (STABILOMETRY):

THE RUSSIAN CORPS OF EXPERTS AND CONSENSUS-BUILDING

Oleg V. Kubryak, Doctor of Biology, Head of physiology of functional status of person laboratory of Anokhin Research Institute of Normal Physiology [125315 Moscow, Baltiyskaya str., 8; tel.: (495)601-22-45;
e-mail: ]
Irina V. Krivoshey, PhD Medicine, Head of medical rehabilitation unit of Combined Hospital and Polyclinic

of the Presidential Administration of the Russian Federation [119285 Moscow, Michurinsky av., 6; tel.:8(499)333-30-00; e-mail: ]
Elena A. Kriklenko, Expert, Head of scientific-organizational department of P.K. Anokhin Research Institute of Normal Physiology [tel.: (495)601-22-45; e-mail: ]

Abstract. The project in the field of practical (applied) sociology for medicine, aimed at improving the efficiency of the application of technologies to study the human posture control system in the various disciplines was initiated for the first time in Russia. Stakeholders are established using the original method-the analysis of arrays of thematic dissertations and patents. Virtual discussion platforms and a special Internet resource have been organized in order to ensure transparency. Consensus provisions were formulated in the discussed area with the participation of almost 50 specialists, which are recommended to take into account by the developers of clinical guidelines, standards and procedures as a joint opinion of the participants. This experience can be used to create similar projects in other areas related to the use of types of equipment and technologies in practical medicine.

Key words: interdisciplinary collaboration, analysis of the scientific field, the application of medical technologies, corps of experts, identification of stakeholders, posturology, consensus, management task.


THE IMPROVEMENT OF STATISTICS ANALYSIS OF THE PERSONS
WITH EXTREMITIES’ AMPUTATION IN TATARSTAN REPUBLIC
(taking into consideration the data of domestic and foreign reserches)

Ikar Zh. Osmonaliev, Ph. D, Assistant of traumatology, orthopedics and emergency surgery sub-faculty of Kazan State Medical University of Health Ministry of Russia [420012 Kazan, Butlerov str., 49; e-mail: ]
Murat G. Bilgildeev, student of medical faculty (group 1514) of Kazan State Medical University of Health Ministry
of Russia [e-mail: ]

Rustem F. Baikeev, MD, Professor of biochemistry sub-faculty of Kazan State Medical University of Health Ministry of Russia [e-mail: ]

Abstract. Registration of persons with disabilities because of the extremities’ amputation is organized in Tatarstan Republic (TR). However, data on persons with disabilities because of the extremities’ amputation, related to the state of limbs, are localized within the frames of the prosthesis-orthopedics enterprises. The form of data representation is unsuitable for the high-grade statistical and mathematical analysis aimed to the forecasting of participation and duration of participation of these persons in relations of production in society.The algorithm of form of the statistical registration is presented. It optimizes prosthetics process and allows to predict the participation and duration of participation in economic relations, and to improve the identification of their physical status at definition of physical disability status.

Key words: statistics, limb, amputation, physical status, ergonomics.


ORTHODONTIC STATUS OF THE POPULATION OF TATARSTAN REPUBLIC AND ASSESSMENT OF THE NEED FOR THE TREATMENT
OF DENTO-FACIAL ANOMALIES AT CHILDREN OF THE REGION

Nailya I. Shaymieva, PhD Medicine, Associate Professor, head of orthopedic dentistry and general dentistry sub-faculty of Kazan State Medical Academy – branch of RMACPE of Health Ministry of the Russian Federation [420012 Kazan, Butlerov str., 16; tel.: 8(843)562-00-89; е-mail: ]

Abstract. The data of the study of the needs in orthodontic care of the population of Tatarstan Republic are presented. 2411 people were examined as a result of an epidemiological study in key age groups: 6–7; 12; 15; 35–44; 60 years and older. 80% of children of 12 years old do not have signs of malocclusion (≤25 points); 15,9% need treatment (26 – up to 30 points); 3,7% have significant impairment (from 31–35 points) and 0,4% have severe form (>36 points) according to the DAI (Dental Aesthetic Index) indicators. Monitoring of orthodontic status will make possible to introduce early diagnosis programs and expand the availability of treatment for dento-facial anomalies in the region.

Key words: epidemiological study, orthodontic status, DAI, treatment needs.


COMPARATIVE ANALYSIS OF MELANOMA MORBIDITY RATE AND MELANOMA RELATED DEATHS IN THE ORENBURG REGION AND THE RUSSIAN FEDERATION

Natalia A. Bayanova, MD, Assistant Professor of public health and healthcare sub-faculty No 1 of Orenburg State Medical University of Health Ministry of Russia [460000 Orenburg, Sovetskaya str., 6; e-mail: ] Dmitry N. Begun, MD, Assistant Professor of public health and healthcare sub-faculty No 1 of Orenburg State Medical University of Health Ministry of Russia

Olga I. Matchina, MD, Assistant Professor of public health and healthcare sub-faculty No 1 of Orenburg State Medical University of Health Ministry of Russia
Ekaterina S. Baryshnikova, 5th year student of the medical faculty of Orenburg State Medical University of Health Ministry of Russia [e-mail: ]

Ekaterina D. Plotnikova, 5th year student of the medical faculty of Orenburg State Medical University of Health Ministry of Russia [e-mail: ]

Abstract. Main epidemiological parameters of melanoma morbidity rate have been considered and the data of comparative analysis of melanoma morbidity rate and melanoma related deaths in the Orenburg region and the Russian Federation have been demonstrated. The purpose of the study was the assessment of prevention, diagnostic and treatment activity of oncologic service of the Orenburg region versus the Russian Federation. Materials and methods. The system Statistica and Microsoft Excel were used for data analysis. It was found out a steady increase in the incidence of melanoma of the skin in 1,2% in 2015–2017compared with previous years in the territory of the Orenburg region. However, this is significantly lower than the average in Russia. The preventive programs «World Melanoma Day» is held in Russia; «Cancer diagnosis in remote locations» and «Saturday for health» are realized in the Orenburg region for detection of malignant neoplasms in the early stages. Despite the active preventive focus in the diagnosis of skin melanoma, the incidence and mortality from this disease are at a high level both in the Orenburg region and in Russia as a whole.

Key words: melanoma, morbidity, mortality, diagnostic indicators.


STATE NORMATIVE ACTS AND LOCAL ACTS OF MEDICAL ORGANIZATION AS AN ELEMENT OF BUILDING A SYSTEM OF THE INTERNAL QUALITY CONTROL OF PHYSICIANS TRAINING

Alsim M. Kharisov, PhD Medicine, postdoctoral student of N.A. Semashko National Research Institute of Public Health, Head of the branch No 3 of A.A. Vishnevsky Central Military Clinical Hospital of Ministry of Defence of the Russian Federation [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; tel.: 8-985-826-29-72; e-mail: ]
Alexey V. Bereznikov, MD, Associate Professor, Head of Medical Expertise Directorate of OOO «AlfaStrakhovanie-OMS» [115162 Moscow, Shabolovka str., 31, bld. 11; tel.: 8-964-799-10-22; e-mail: ]
Sergey O. Shkitin, Deputy head of Medical Expertise Directorate of OOO «AlfaStrakhovanie-OMS» [tel.: 8-903-963-39-32; e-mail: ]
Evgenia A. Berseneva, MD, Professor, Head of Higher and Additional Professional Education Center of N.A. Semashko National Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; tel.: 8-916-216-84-59; e-mail: ]
Yaroslav B. Skiba, PhD Medicine, senior physician of nervous diseases clinic of S.M. Kirov Military Medical Academy [194044 St. Petersburg, Academician Lebedev str., 6G; tel.: 8-965-753-85-53; e-mail: ]
Julia O. Onufriyuchuk, PhD Medicine, Associate Professor of medical rehabilitation and physical methods of treatment sub-faculty of Medical Institute of Continuing Education «Moscow State University of Food Production» [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; e-mail: ]

Abstract. The purpose of the study was to develop a methodology for the organization of internal training and control of knowledge of doctors of existing regulations and local acts. The developed method includes the creation of a training center, the development of training programs and control of knowledge of doctors according to the grades. After the introduction of the technique, the average score of doctors’ knowledge increased significantly (by 1.3 points). The frequency of violations significantly decreased by 11 percentage points [from 18,1 to 7,0% (p<0,05)] as a result of the implementation. The introduction of this technique significantly improves the completeness, quality and survival of doctorsknowledge; ensures the commitment of doctors to provide medical care on the basis of regulatory and local acts; allows a statistically significant reduction in the number of violations.

Key words: quality of medical care, medical organization, assessment of doctors’ knowledge, grading.


INDICATORS FOR ASSESSMENT OF PERFORMANCE OF STAFF RELATIONS

IN MEDICAL INSTITUTIONS

Svetlana V. Titova, PhD Pedagogy, Associate Professor of management sub-faculty of V.G. Timiryasov Kazan Innovative University [423815 Naberezhnye Chelny, Vakhitov boulevard, 4; e-mail: ] Alexander S. Yashin, head physician of ООО «Medical Center Alternativa» [423821 Naberezhnye Chelny, Floral boulevard, 11, bld. G, ap. 1000; e-mail: pochta1120@ mail.ru]

Abstract. The article demonstrates the assessment indicators of performance of staff relations in healthcare institutions. The following indicators are studied: personnel planning, intake candidates for a vacant post, adaptation of employees, personnel training and succession pipeline. Application of the mentioned indicators will allow getting valuable objective information about the status of work with a personnel in medical organizations of various types of ownership.

Key words: HR management, assessment indicators, staff performance, personnel assessment.


LEGAL REGULATION OF MEDICAL SUPPORT FOR EMPLOYEES

OF INTERNAL AFFAIRS BODIES

Vitaliy A. Sidorenko, PhD Medicine, Assistant Professor, head of logistics and medical support department of MIA of Russia, major general of internal service, Honored Doctor of the RF [119049 Moscow, Zhitnaya str., 12-A] Vladislav F. Zubritsky, MD, Professor, chief surgeon of MIA of Russia, colonel of internal service, Honored Doctor of the RF [123060 Moscow, Raspletin str., 26; e-mail: ]

Maria E. Potokova, deputy head of Medical Support Center of Central Primary Healthcare Unit of MIA of Russia, major of internal service [123060 Moscow, Raspletin str., 26; e-mail: ]

Abstract. The article discusses the issues of improving the legal regulation of medical support for employees of internal affairs bodies and prospects for its further development.

Key words: medical support for employees of internal affairs bodies, legislative norms, quality and safety of medical activities.


DESIGN OF MANAGEMENT AND ADMINISTRATIVE PROCESSES IN MEDICAL

ORGANIZATIONS USING A GRAPHICAL REPRESENTATION OF THE MODEL

Evgenia A. Berseneva, MD, Head of Higher and Additional Professional Education Center «N.A. Semashko National Research Institute of Public Health» [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; tel.: +7(916)216-84-59; e-mail: ; ORCID ID: orcid.org/0000-0003-3481-6190; SCOPUS Author ID 55554758300]
Sergey A. Mendel, PhD Medicine, chief of Clinical Hospital of Primary Healthcare Unit of Ministry of Internal Affairs of the Russian Federation in Moscow, doctor of the highest qualification category [127299 Moscow, Novayа Ipatovka str., 3A; tel.:+7(916)076-46-41; e-mail: ; ORCID ID:orcid.org/0000-0001-7679-7106; Researcher ID: D-2425-2018]

Vladimir V. Shkarin, PhD Medicine, head of public health and healthcare sub-faculty of the faculty of physicians ‘ improvement
of Volgograd State Medical University of Health Ministry of the Russian Federation [400131 Volgograd, Fallen Soldiers square, 1; tel.: +7(902)311-83-66; e-mail: ; ORCID ID: orcid.org/0000-0002-4009-9733; Researcher ID: D-6143-2018]
Dmitry A. Kurakov, head of the demographic policy department of Healthcare Committee of the Volgograd region [400001 Volgograd, Raboche-Krestyanskaya str., 16; tel.: +7 (927) 252-52-31; e-mail: ; ORCID ID: 0000-0002-7753-2537; Researcher ID: D-4740-2018]
Elena A. Savostina, MD, Associate Professor of medical statistics and informatics sub-faculty of Russian Medical Academy
of Postgraduate Education of Health Ministry of the Russian Federation [123242 Moscow, Barrikadnaya str., 2/1, bld. 1;
tel.: +7(916)486-50-50; e-mail: ; orcid.org/0000-0002-2039-4639; Researcher ID: D-3882-2018]

Abstract. Modeling of administrative and economic processes of medical organization is a tool to improve the efficiency of the institution. The article presents a model of the process of labor protection in graphical and textual representation as an example. The preferred approach to modeling and the way to present the results is a graphical model. It provides clear visualization of the process to all employees, which improves their interaction and leads to time savings when updating text regulations. Modeling is not a common technology of everyday activities in the practice of medical organizations despite the clear benefits.

Key words: modeling, graphic model, administrative processes, medical organization.


 

TO THE QUESTION OF ORGANIZATION OF WORK OF DAY HOSPITAL

IN THE FORMAT OF OUT-OF-HOSPITAL INPATIENT CARE

Andrey V. Belostotsky, MD, I.M. Sechenov First Moscow State Medical University [119435 Moscow, Trubetskaya str., 8, bld. 2; e-mail: ]
Natalya K. Grishina, MD, Leading Researcher of economic research department of N.A. Semashko National Research Institute of Public Health [105064 Moscow, Vorontsovo Pole str., 12, bld. 1; e-mail: ]

Alexey Ju. Ter-Israelyan, PhD Medicine, Head Physician of Mental Hospital No 13 of Moscow Healthcare Department [109559 Moscow, Stavropolskaya str., 27; e-mail: ]

Аbstract. The transformations of the psychiatric service of Moscow have been aimed at optimizing of the inpatient unit and developing out-of-hospital care since 2010. The reform of the psychiatric service is carried out in accordance with the Law dated July 2, 1992 «On Psychiatric Assistance and Guarantees of the Rights of the Citizens in Its Rendering» and the principles of community-oriented therapy. The purpose of this study is to analyze the performance indicators of the day hospital, new divisions: the intensive care unit, the medical rehabilitation unit, and analyze the performance of the out-of-hospital units in comparison with the hospital. During the reform in the psychiatric service, the redistribution of the load on inpatient forms, including day hospital, is characterized by a sufficiently high number of re-admitted patients. This category of patients has constituted: 969 people (15% of the total number of treated patients) in 2015; 982 people (14,8%) in 2016; 847 people (14,7%) in 2017. Two percent of patients treated in day hospital were admitted to hospital: in 2015 – 15 people (1,5%), in 2016 – 12 people (1,2%), in 2017 – 10 people (1,1% ). Patients participated in psychological educational programs: in 2015 – 76 patients (7,8%), in 2016 – 78 patients (7,9%), in 2017 – 77 patients (9,1%). Thus, the article notes that positive changes have been achieved in the work of the day hospital and new out-of-hospital forms. Therefore, there is still a need for further reforms in the provision of medical care to patients with mental disorders.

Key words: day mental hospital, paradigm, stigmatization, new organizational form, intensive mental care unit, medical rehabilitation department.


ISSUES OF IMPROVING THE QUALITY OF SERVICES
IN THE FRAMEWORK OF THE FORMATION OF A NEW MODEL
OF MEDICAL ORGANIZATION PROVIDING PRIMARY HEALTH CARE

Viktoria N. Fentisova, postgraduate student of public health and preventive medicine department of territory state budgetary healthcare facility «Vladivostok polyclinic No 1» [690091 Vladivostok, Utkinskaya str., 7; e-mail: ]
Pavel F. Kiku, MD, Professor, Director of the department of public health and preventive medicine of the Federal State Autonomous Educational Institution of Higher Education «Far Eastern Federal University» [690922 Primorsky territory, island Russky, Ajax 10 township, FEFU campus; e-mail: kikupf.dvfu.ru]

Abstract. The purpose of the study was to identify the main problems in the medical organization providing primary health care, and ways to solve them in order to further improvement of the quality of services. This study is the initial stage of work on the formation of a model of lean polyclinic. Research methods are: survey, questionnaire, statistical method. The main problems of improving the quality of services in the formation of a new model of medical organization – lean clinic have been defined. Ways of the solution of problems in the medical organization on improvement of quality of rendering services have been formed on the basis of data of sociological survey of the personnel. It is necessary to continue the implementation of measures to improve the availability of medical care, to conduct internal audits, to train staff in the methods of work in the medical information system, to introduce ways of motivating staff of various kinds, including organizational ones. The results of the study can be applied in a medical organization of any form of ownership.

Key words: Primary health care, quality of health care, availability of health services, lean policlinic, model of medical organization, a survey of staff.