Bulletin of Semashko National Research Institute of Public Health

The evaluation of the quality of health care is considered by the World Health Organization (WHO) based on its defining factors: maximum performance of professional functions, optimal use of resources, least risk to the patient and high patient satisfaction from the interaction with the medical organization. In this regard, the need for clear, constant and positive communication of the medical subsystem with the population has increased to ensure satisfaction with accessible, coordinated, comprehensive and quality health care and to measure its correspondence between patients' preferences and their expectations. The choice of research method is still an important factor in evaluating the intra-organizational processes of medical organization management and, consequently, the effectiveness of the country's health care system. Purpose of the study: to conduct a comparative analysis of existing ways of studying patients' opinions and methodological techniques to confirm the validity and reliability of these designs. Materials and Methods. On the basis of literature data and regulated survey methods, the authors conduct a comparative analysis of different methodological techniques to measure patient satisfaction index using 6 questionnaires most widely used in international and Russian healthcare practice. Results of the study. The analysis of the methodological base of public health care on conducting a survey of the population receiving medical care at different stages of treatment and medical specialization allowed to show a wide list of applied questionnaires in the world and Russian systems of public health care and to reveal the mechanisms of achieving target indicators in different systems of evaluation scale. Conclusion. The issues of improving the methods of studying and assessing patient satisfaction with medical care and the quality of patient-physician interaction in scientific practice are not presented in a wide selection and using validation of informative Russian-language versions of international questionnaires for extended comprehensive assessment of indicators of change in the parameter of the controlled process.

Purpose of the study. Develop strategic objectives for countering health risks for the rural population based on an analysis of the medical and demographic situation and morbidity of the rural population.
Methods and materials: analytical, statistical, data from Rosstat and the Federal State Budgetary Institution “TsNIIOIZ” of the Ministry of Health of Russia.

Over all 20 years (2003—2022) of the analysis, the mortality rate of the rural population was higher than that of the urban population; in the covid years (2020—2021) the figures increased, in 2022 they decreased and amounted to 13.8 and 12.6‰, respectively. . The birth rate of the rural population has been decreasing annually since 2013, in 2022 it was 8.8‰, lower than the urban population (8.9‰). The incidence rate (primary) of the rural population (in 2022) was 64755.2 per 100 thousand rural population, lower than in the Russian Federation as a whole (88748.5‰00). Lower rates are associated with poor access to medical care for rural residents. During the pandemic years (2020—2022), the incidence (primary) decreased for all classes of diseases, except for respiratory diseases, while the 2022 indicators did not reach the level of 2019 (pre-Covid year), which is the result of deterioration in preventive and dispensary work with the village population. In 2022, an increase in the pandemic was noted; the incidence rate of COVID-19 in 2020 was 2151.9‰00, in 2021 it increased to 6056.8 and in 2022 it increased to 6144.2‰00. The results of the analysis indicate that the pandemic in the Russian Federation will not weaken in 2022. The ranking of primary incidence rates of COVID-19 by constituent entities of the Russian Federation (2022) showed a difference of 12.1 times, which requires an in-depth analysis of the current situation in the regions of the country. Confronting the challenges and threats associated with coronavirus infection determines the importance of strengthening dispensary work and rehabilitation of patients. At the same time, it is necessary to reform primary health care in organizational terms and in staffing.

This study discusses ways to improve the risk management system in medical activities using digital technologies. The FMEA method is proposed as the basis, as the most effective from the point of view of assessing the onset, detecting and measuring the consequences of risky events. It is proved that the development of this method of risk assessment based on modern digital solutions makes it possible to form management decisions regarding risks affecting the effectiveness of a medical institution. The purpose of the study is to describe the experience of using digital technologies in risk management in the activities of a federal scientific medical institution.

The purpose of this study was to assess the dynamics of changes in the need for components of donor blood by medical organizations of the Republic of Tatarstan, including obstetrics and gynecology. Materials and methods. We studied the data from the AIST blood service information system on the issuance of blood components to medical organizations of the Republic of Tatarstan in 2019 — 2023. We conducted an additional survey of heads of transfusiology departments of medical organizations about the use of blood components in obstetric and gynecological hospitals (AGH). Results. During the study period, the need for blood components in medical organizations increased by 33.1%, and in AGH — significantly more, by 44.3 (p<0.001). For individual blood components, the increase in general and in the AGS in particular was: red blood cells: 29.2% and 48.5% (p<0.001), platelets: 50.4% and 520.0% (p<0.001), plasma: 31.1% and 1.1% (p<0.001), cryoprecipitate: 421.8% and 315.9% (p<0.03). Conclusion. In 2019—2023, the part of blood components received by the ACH was 3.04% — 3.37% of all blood components received by medical organizations of the Republic of Tatarstan. Compared to medical organizations in general, in the AGH the consumption of platelets and erythrocytes is predominantly increasing and less actively — plasma and cryoprecipitate.

In article the materials demonstrating to the disordered application in territorial subjects of the Russian Federation of mobile divisions of the medical organizations that demands improvement of legal regulation of their activity are stated analytically. The made analysis confirms also importance of use of the new strategy at the organization of delivery of health care based not only on growth of financing of health care and volumes of medical services, but also on estimates of the achieved results in preservation and improvement of human health at individual, group and (or) population level.

Patient compliance with medical recommendations is one of the main tasks of the medical community worldwide. Many researchers continue to study the structure of patient compliance and propose ways to improve it. In this article, based on the survey, we analyzed the medical tactics in relation to patients with age-related ophthalmological diseases, affecting the quality of medical care and, as a result, adherence to the recommended treatment. The relevance of this study also lies in the study of the organization of medical care for patients with age-associated ocular pathology, including senile cataract and concomitant diseases of the fundus. Existing studies are often devoted to the organization of medical care for patients with isolated ocular pathologies and are based solely on the results of patient surveys. This work demonstrates the data obtained during a survey of ophthalmologists. Currently, a survey is being conducted among patients with cataract and concomitant diseases of the fundus. The study is not completed.

Railway transport workers, ensuring the safety of the operation of railway transport infrastructure, loading and unloading activities, passenger transportation, cargo baggage, are exposed to various industrial risk factors in the course of their professional activities, which determines the specifics of the organization of medical care in the sectoral healthcare system. The safety of railway transportation depends, among other things, on the health status of railway transport workers. The medical examination of Russian Railways employees, being a priority area of industry medicine, makes it possible to increase the period of active work and preserve the labor potential of railway workers, prevent and timely identify diseases of various types and the main risk factors for their development, and also determines the conditions for the development of a system of measures to reduce the risks associated with the health of Russian Railways employees. The purpose of this study was to assess the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. According to the results of the study, a high indicator of the completeness of coverage of railway transport workers with medical examinations was established, which reflects the availability of primary health care and should lead to an increase in the detection of chronic non-communicable diseases and occupational pathology. However, the frequency of detection of diseases during medical examination and the indicator of timely registration of employees of JSC «Russian Railways» on dispensary registration tend to decrease. To improve the effectiveness of medical examinations and follow-up, programs have been introduced to combat cardiovascular and endocrine diseases. Based on the results of the medical examination, the health group of employees is determined, which doctors focus on when planning further tactics of medical supervision and developing a system of preventive measures. Employees of the I and III categories of work, as the most difficult, mainly have II and III health groups characterized by either the presence of risk factors or the presence of a chronic non-communicable disease, and requiring the establishment of dispensary supervision, as well as the provision of specialized medical care, including high-tech. The study of the indicators of medical examination of employees of JSC «Russian Railways» on the Trans-Baikal Railway for the period from 2018 to 2022. It allowed us to evaluate the results obtained and identify application points for the development of new structural and organizational measures, in particular, within the framework of the introduction of a three-level system of medical care, the formation of competence centers at the first level of its provision.

Ear and mastoid diseases are not only a medical and social problem, but also an economic one due to their high prevalence, development of severe complications and decreased quality of life. The aim of the study is to investigate the gender and age characteristics of the economic burden of ear and mastoid diseases in the Voronezh region for 2018—2023. Material and methods. A retrospective analytical descriptive study was conducted. The economic burden of ear and mastoid diseases among the adult population of the Voronezh region was studied for the period 2018—2023. The source of information was data from accounts from the territorial fund of compulsory medical insurance (TFOMS) of the Voronezh region. Results. The results of this study showed the gender and age characteristics of direct economic costs for the treatment of ear and mastoid diseases among the adult population of the Voronezh Region for 2018—2023, which in total over six years amounted to 555,272.5 thousand rubles. The age group of 60—69 years is the most resource-intensive for medical organizations from an economic point of view, while this age group of patients ranks first in the structure of outpatient and polyclinic medical care and in the top three in the structure of inpatient medical care. The costs of providing medical care for diseases of the ear and mastoid process among women significantly exceed those among men. The study shows that 95.6% of all costs for diseases of the ear and mastoid process fall on seven groups of diseases, of which four groups are acute and chronic inflammatory diseases. Of the other three groups, the most significant is conductive and sensorineural hearing loss, due to the fact that, according to the literature, this disease is the most common cause of hearing loss among the older generation. Conclusions. The economic burden of ear and mastoid diseases in the Voronezh region for the period 2018—2023 amounted to 555272.5 thousand rubles. Gender and age characteristics of the economic burden of ear and mastoid diseases were identified, which showed that women predominate over men in the structure of expenses, and the age group of patients aged 60—69 years. 95.6% of all expenses for diseases of the ear and mastoid process are accounted for by seven groups of diseases, which include non-suppurative otitis media, purulent and unspecified otitis media, otitis externa, other diseases of the outer ear, conductive and sensorineural hearing loss, inflammation and obstruction of the auditory tube and vestibular dysfunction. The conducted assessment of the costs of providing medical care to patients with diseases of the ear and mastoid process will contribute to more effective economic planning in the public health system.

The objective of the study was to develop an index of innovative readiness of the environment for the implementation of innovative technologies at the level of a healthcare organization. The following materials were used: legislation in the field of healthcare, including compulsory medical insurance: federal laws of the Russian Federation, decrees of the Government of the Russian Federation, orders of the Ministry of Health of Russia, and other methodological materials. Foreign and domestic scientific publications devoted to the implementation of innovative medical technologies in healthcare organizations were also used. Factors and parameters that determine the readiness of the environment of a healthcare organization for the implementation of certain medical technologies were extracted from regulatory legal acts and scientific publications in a structured form. Criteria for a comprehensive analysis of the possibility of implementing an innovative medical technology in a healthcare organization, combined into 8 main blocks, on key aspects of assessing the regional healthcare system in terms of implementing innovations: sufficient qualifications and motivation (interest) of personnel; readiness and interest of the management of the healthcare organization and the founder in implementing the innovative method; sufficient patient population for using the innovative method; availability of practical experience in using analogs of the innovative method in a healthcare organization; availability of the necessary equipment and/or drugs; availability of the necessary buildings and premises; preliminary assessment of the clinical and economic efficiency of implementing an innovative method in a medical organization; sufficiency of tariffs and volumes of medical care for the innovative method and its analogue (comparison method) in a medical organization. The environment of a medical organization is recognized as ready for implementing an innovative medical technology if the total number of points on the checklist is 8 or more points (there must be a «yes» answer to at least one item from each section of the checklist, +1 additional point for one more «yes» answer in any of the sections).

Gennady Nikolayevich Trojansky is one of the iconic figures in the national history of medicine. Having worked his way up from student to vice-rector at the Moscow Medical Stomatological Institute (now the Russian University of Medicine), with no other entries in his labor book, he would establish a museum and one of the first chairs of the history of medicine in the USSR, develop the main sections of the history of stomatology in the USSR, and do many good deeds.

The article presents brief biographical information about Doctor of MedicineN.S. Korotkov and his discovery of a simple, accessible and accurate sound method for determining blood pressure in a person, which has received worldwide recognition and its wide application in medical practice. The use of this method by doctors in their daily work made it possible to diagnose and treat cardiovascular diseases in a timely manner, including determining the tactics of surgical treatment of arterial aneurysms and measures to prevent their complications.

The aim of the study was to assess the state of social adaptation of students in the educational programs of specialist and residency of a medical university in connection with their gender, stage and specialty of professional training. Materials and methods of the study. The object of the study was a sample of 1007 students and residents of a medical university, studied using a set of applied sociological, psychological and statistical methods. Results of the study. The general state of social adaptation of students and residents of a medical university is characterized by the predominance of its average and high levels. Social adaptation of students and residents is characterized by a better state in female students, opposite dynamics in connection with the transition from the initial to the final stages of professional training, a higher general level in students majoring in Pediatrics compared to that of students in the specialties General Medicine and Dentistry.

The article presents the results of a telephone survey of Muscovites (N=1522) conducted to determine the important nuances of informing working-age residents of the capital about a healthy lifestyle. Additionally, 12 focus groups were conducted with the target audience. The majority of respondents speak about the sufficiency of information about healthy lifestyle in the foreign field (79%), the average value of interest in information about healthy lifestyle is 6.95 out of 10. In general, we should rather not talk about a lack of information, but about the need to improve ways to deliver reliable information to target groups. The main sources of information about healthy lifestyle are information sites — 76%, messengers — 68% and social networks — 65%. Format preference is given to social media posts (69%) and videos (63%). The majority of respondents (58%) noted that they had encountered potentially unreliable information about healthy lifestyle, mainly questionable information about the nuances of nutrition. The main markers of the reliability of information about healthy lifestyle for respondents are «the use of statistical data» — 63% and «the authority of the author» — 59%. Muscovites are more likely to trust their inner circle of friends and relatives in matters of maintaining a healthy lifestyle. The «rational», «accessible» and «media» models of informing about healthy lifestyle, which may conflict with each other, are highlighted. Based on the results of the study, a number of recommendations are given on the directions of information work in the field of healthy lifestyle.