CATEGORY OF MARKETING OF RELATIONS IN MEDICAL ORGANIZATIONS

The need for intensification of health care, raises the issue of improving the efficiency of medical organizations. The article analyzes the current management technology: “marketing relationships in medical organizations”. The aim of the research was to find the correct “definition of the concept and professional fullness” of the content of relationship marketing in medical organizations. The authors defined the marketing of relations in medical organizations as “the relationship (mutual relation) of the subjects of medical care at the level of “doctor-patient”, “administration-personnel”, “relations between medical organizations and counterparts”, in order to improve the efficiency of activities and the quality of medical care, patients and medical personnel. The results are obtained on the basis of a comparative analysis of scientific literature data and authors’ own research. In the formulation of the research, methods of content analysis of bibliographic data, the sociological method and the authors’ own experience were used. Based on the results of the research, the role of the individual characteristics of patients (gender, age, occupation, relationship to the composition of patients, transport accessibility, organization of admission) in the formation of relations between consumers and providers of medical services is shown. In conclusion, based on the results of the study, the development of marketing relationships at the level of medical organizations of different ownership forms and the need to improve marketing of communications, social networks and distant forms of work with potential and real patients are justified. Conceptual bases of the marketing relationship concept in medical organizations of different ownership forms have been developed

Remote clinical quality management of endovascular care

Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p<0.001). The frequency of performing PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI.Aim. To assess the effectiveness of remote clinical quality management of endovascular care.Methods. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008–2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019–2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019–2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p≤0.005.Results. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In AprilDecember 2020 it increased up to 71.6% (p<0.001). The frequency of performing PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005).Conclusion. Remote clinical management based on telemedicine and mentoring process technologies contributes to improving the quality of endovascular care in MI

Development of primary health care in Algeria

The human right to health means that health services should be available to everyone. According to the literature data, the availability of medical services is associated with the level and quality of primary health care. As it was announced in 1978 at WHO conference - organization of primary health care is a key aspect of the health system. For the assessment of the health situation in Algeria, we analyzed data from the literature, the WHO data, and the results of studies in different institutions. Based on the WHO guidelines, Algeria had gradually and constantly developed primary health care facilities and trained medical staff. The assessment of progress is made on the health criteria of the population and the health development in Algeria: the crude death rate and infant mortality rate, population per medical institution and per doctor Health facilities at the primary health care system are represented by the polyclinics and the care units. The number of primary health facilities had grown rapidly during the last forty years, from 1402 to 5484 care units and from 106 to 1627 polyclinics; the number of available hospital’s beds has evolved from 43404 to 63212 beds, while the population increased from 16,370,000 to 39,500,000 inhabitants. During the same period, the number of inhabitants per clinic increased from 140,000 to 20,000 people. One care unit serves about 7,000 people, the number of inhabitants per doctor decreased from 6000 to 600 inhabitants. Population health criteria shows the decline in infant mortality from 80 per 1,000 in 1984 to 46.8 per 1,000 in 1990 due to special programs for maternal and child health care and the expanded vaccination. The average life expectancy of the inhabitants of Algeria in 2014 reached the level of 77.2 years

Informative management of dispensary observation of patients with angina pectoris

In two groups of patients with angina, protected and not protected by dispensary observation, the risk of the developing of myocardial infarction and financial costs of treatment in polyclinic, ambulance and hospital were compared. It was found that the risk of Ml in patients with angina in the absence of dispensary observation increased by 2.3 times, and the financial costs due to more frequent hospitalizations and calls of the for ambulance for angina reasons in the absence of outpatient treatment are increased by 2.1 times. It was considered that the obtained data are the justification of the need for management of dispensary observation of patients with angina with the participation of the territorial fund of compulsory medical insurance (TFOMS) and insurance medical organizations. We developed a scheme for such management, based on the information capabilities of the TFOMS.V двух групп больных стенокардией, наблюдаемых в поликлинике и не охваченных диспансерным наблюдением, сравнили риски развития инфаркта миокарда и суммы финансовых затрат на лечение в поликлинике, скорой помощи и стационаре. Выявили, что риск развития ИМ у больных стенокардией при отсутствии диспансерного наблюдения повышается в 2,3 раза, а финансовые затраты из-за более частых госпитализаций и вызовов СМП по поводу стенокардии при отсутствии амбулаторного лечения увеличиваются в 2,1 раза. Посчитали, что полученные результаты являются обоснованием необходимости управления диспансерным наблюдением больных стенокардией на основе их электронных баз данных. Разработали алгоритм такого управления, основанного на информационных возможностях территориального фонда обязательного медицинского страхования, страховых медицинских организаций и медицинского информационно-аналитического центра, подведомственного Минздраву области. Адаптировали данный алгоритм к практической работе, получили существенное увеличение охвата диспансерным наблюдением больных стенокардией

Опыт реализации ценностно-ориентированного подхода в онкодерматологической практике

Objective: implementation of value-based approach and development of adherence to treatment in patients with non-melanoma cancer.Material and methods. The observational, single-arm, prospective, long-term single-center study of the quality of life and patients’ experience was performed. It included 42 patients aged from 42 to 82 years. Validated questionnaires were used: Patient-Reported Outcome Measures (PROMs) (as a decision support tool), Patient-Reported Experience Measures (PREMs) (3 months after treatment to assess the patient's experience).Results. Mean concern about appearance was 43.5 points (Rasch psychometric model). Younger patients (r=–0.398, p=0.009) and female patients (r=–0.475, p=0.001) were more concerned about appearance. In 10 cases (24%), the involvement was estimated as 4 points, in 18 cases (43%), it was 3 points, in 14 cases (33%), it was 2 points. Older patients were less involved in the choice of treatment method (r=–0633, p<0.001). The level of satisfaction with communications was more than 50 points. The use of a patient-oriented algorithm of communication has a positive effect on a patient's experience.Conclusion. The heads of oncological care are recommended to evaluate the patient's experience on a regular basis, create conditions for patients to choose treatment methods according to their individual needs, analyze the outcomes obtained by the introduction of validated questionnaires on the appropriate nosological profile and take these results into account in treatment. Further studies of the degree of influence of different factors on a patient’s choice of treatment method are needed, as well as conducting studies among other groups of patients with non-melanoma skin cancer (located in other parts of the body, larger than 2 cm).Цель: реализация ценностно-ориентированных принципов и развитие приверженности к лечению у пациентов с немеланомным раком кожи.Материал и методы. В наблюдательное несравнительное проспективное продолжительное одноцентровое исследование, посвященное изучению качества жизни и опыта пациента, включены 42 больных в возрасте от 42 до 82 лет. Использованы валидизированные опросники: Patient-Reported Outcome Measures (PROMs) как средство поддержки принятия решения, Patient-Reported Experience Measures (PREMs) спустя 3 мес после лечения для оценки опыта пациента.Результаты. Средний показатель обеспокоенности внешним видом (по психометрической модели Раша) составил 43,5 балла. Более молодые больные (r=–0,398, p=0,009) и пациентки женского пола (r=–0,475, p=0,001) более обеспокоены внешним видом. В 10 наблюдениях (24%) вовлеченность оценена в 4 балла, в 18 (43%) – в 3 балла, в 14 (33%) – в 2 балла. Более пожилые пациенты в меньшей степени вовлекались в выбор метода лечения (r=–0633, p<0,001). Уровень удовлетворенности коммуникациями составлял более 50 баллов. Использование пациентоориентированного алгоритма коммуникации положительно влияет на опыт пациента.Заключение. Руководителям онкологических служб рекомендуется на регулярной основе оценивать опыт пациентов, создавать условия для возможности выбора больными методов лечения и для учета их индивидуальных потребностей, анализировать исходы посредством внедрения валидизированных опросников по соответствующему нозологическому профилю и учитывать эти результаты в лечении. Необходимо дальнейшее изучение степени влияния различных факторов на выбор пациентом метода лечения. Также следует провести исследования в других группах больных немеланомным раком кожи (расположенным в других частях тела, размером более 2 см)

Картографический анализ показателей заболеваемости и смертности от болезней системы кровообращения населения Российской Федерации (2010-2019 гг.).

Highlights. For the first time, mapping models of morbidity and mortality from the blood circulation system diseases for assessing the performance of the health protection system in federal districts of the Russian Federation were proposed. The method makes it possible to identify low-quality health systems, and outsider regions, where it is necessary to develop measures in order to identify modifiable and non-modifiable risk factors and improve the performance of health care system both in federal districts and in the Russian Federation as a whole.Aim. To develop mapping models of morbidity and mortality from the blood circulation system diseases (BCSD) and to propose indices for assessing the performance of the health care system in different federal districts of Russia over a 10-year period (from 2010 to 2019).Methods. Reporting forms of federal statistical observation in the field of public health were used.Results. The incidence of BCSD among the population of the Russian Federation has been steadily increasing over the past two decades, increasing 2.047-fold from 2000 to 2019, while the mortality rate of the Russian population decreased 2.073-fold over the same period. Mapping models of morbidity and mortality from BCSD have been developed and indices for assessing the performance of the health protection system in different federal districts of Russia over a 10-year period (from 2010 to 2019) have been proposed.Conclusion. The mapping of low and ultra-low incidence rates of BCSD combined with high and ultra-high mortality rates from BSC among the population of the federal districts indicates low detection rates and low performance of the primary health care system in detecting BSC among the population assigned to receive primary health care according to the territorial principle. The correlation of indicators of general morbidity and mortality from HIPC in relation to health care resources allows timely assessment and finding resources in those areas that contribute to the maximum efficiency of medical organizations at minimum cost.Основные положения. Впервые предложена картографическая модель оценки показателей заболеваемости и смертности от болезней системы кровообращения по федеральным округам РФ. Метод позволяет выявить рисковые зоны, зоны неблагополучия в отношении общественного здравоохранения, регионы-аутсайдеры, где необходима разработка приоритетных мероприятий с целью выявления управляемых и условно управляемых факторов риска и повышения результативности деятельности здравоохранения как по федеральным округам, так и в России в целом.Цель. Разработать картографические модели заболеваемости и смертности от болезней системы кровообращения (БСК) и представить индексы оценки результативности деятельности по охране здоровья населения в различных федеральных округах России за 10-летний период (с 2010 по 2019 г.).Материалы и методы. Использованы отчетные формы федерального статистического наблюдения в сфере здоровья.Результаты. Показатели заболеваемости БСК населения РФ за прошедшие два десятилетия постоянно повышались, увеличившись с 2000 до 2019 г. в 2,047 раза, при этом показатель смертности за этот же период времени снизился в 2,073 раза.Заключение. Составленные картограммы низких и сверхнизких уровней заболеваемости БСК в сочетании с высокими и сверхвысокими показателями смертности от БСК в федеральных округах РФ свидетельствуют о низком выявлении БСК среди населения, прикрепленного для получения первичной медико-санитарной помощи по территориальному принципу. Анализ соотношения показателей общей заболеваемости и смертности при БСК позволяет своевременно оценивать и находить ресурсы в тех направлениях, которые способствуют достижению максимальной эффективности медицинских организаций при минимальных затратах

Информационное управление качеством диспансерного наблюдения при ишемической болезни сердца

Highlights. Using the big data databases of provided medical services belonging to the Territorial Compulsory Medical Insurance Fund and the Unified State Healthcare Information System (USHIS), clinical and statistical analysis of ambulatory follow-up of patients with coronary artery disease was carried out, an algorithm was developed and the effectiveness of the presented information management technology was determined.Aim. To assess and justify the developed information management technology for the quality management of ambulatory follow-up of patients with coronary artery disease (CAD) based on monitoring and analyzing electronic personified data on medical services.Methods. In 2018 the Territorial Compulsory Medical Insurance Fund (TCMIF), the Medical Information and Analytical Center (MIAC) and healthcare organizations of the Orenburg Region implemented information management technology to assess the quality of ambulatory follow-up in patients with CAD, which is based on big data analysis of medical services and information integration “emergency medical services (EMS), hospital-TCMIF + MIAC-polyclinic”. To assess the effectiveness of the technology, the proportion of patients with myocardial infarction (MI), death from coronary artery disease, emergency hospitalizations and emergency calls for angina pectoris were compared. The study involved   two groups of patients: 13 208 ambulatory patients with angina pectoris and 4017 patients without follow-up, according to  the  TCMIF  reports  in  2017.  Out of the 13,208 patients with angina pectoris in 2019, 10,205 patients with continued follow-up presented with the same clinical endpoints. Patients with these unfavorable outcomes in proportion to the total number of patients in each group in 2017 and 2019 were compared as well.Results. The developed and implemented information management technology led to an increase in the number of ambulatory patients with angina pectoris from 63 to 69%, with MI from 78 to 87%, and a reduction of emergency calls and emergency hospitalizations of patients with angina pectoris in the region in 2017 and 2019.Conclusion. Information quality management of ambulatory follow-up of patients with coronary artery disease using electronic personalized data on medical services increases the number of ambulatory patients with angina pectoris and myocardial infarction, and decreases the number of unfavorable outcomes of patients with angina pectoris.Основные положения. По базам больших электронных данных о медицинских услугах – территориального фонда обязательного медицинского страхования и Единой государственной информационной системы в сфере здравоохранения – проведен клинико-статистический анализ диспансерного наблюдения при ишемической болезни сердца, построен алгоритм и определена результативность разработанной технологии информационного управления качеством такого наблюдения.Цель. Оценить и обосновать разработанную технологию информационного управления качеством диспансерного наблюдения при ишемической болезни сердца (ИБС) на основе мониторинга и анализа электронных персонифицированных данных о медицинских услугах.Материалы и методы. В 2018 г. в работу территориального фонда обязательного медицинского страхования (ТФОМС), медицинского информационно-аналитического центра (МИАЦ) и медицинских организаций Оренбургской области начато внедрение информационного управления качеством диспансерного наблюдения при ИБС. Технология такого управления разработана на основе анализа больших данных о медицинских услугах и информационной интеграции «скорая медицинская помощь (СМП), стационар-ТФОМС + МИАЦ-поликлиника». Для оценки эффективности разработанной технологии в двух группах пациентов со стенокардией из 13 208 больных с диспансерным наблюдением и 4 017 больных без него за 2017 г. по реестрам счетов ТФОМС сравнили доли больных инфарктом миокарда (ИМ), с летальным исходом от ИБС, экстренными госпитализациями и вызовами СМП по поводу стенокардии. Из 13 208 больных стенокардией в 2019 г. у 10 205 пациентов, находящихся по-прежнему на диспансерном наблюдении, определили такие же конечные клинические точки. Больных с данными неблагоприятными исходами в долях от общего числа каждой группы за 2017 и 2019 гг. сравнили между собой.Результаты. Результатом внедрения разработанной технологии информационного управления стало увеличение в регионе за 2017 и 2019 гг. доли пациентов с диспансерным наблюдением при стенокардии с 63 до 69%, при ИМ – с 78 до 87%, а также достоверное снижение доли больных стенокардией с вызовами СМП и экстренными госпитализациями среди пациентов, состоящих на диспансерном наблюдении.Заключение. Информационное управления качеством диспансерного наблюдения при ИБС по электронным персонифицированным данным о медицинских услугах приводит к увеличению доли больных с диспансерным наблюдением при стенокардии и ИМ и снижению неблагоприятных исходов стенокардии

Mutation of HIV-1 Genomes in a Clinical Population Treated with the Mutagenic Nucleoside KP1461

The deoxycytidine analog KP1212, and its prodrug KP1461, are prototypes of a new class of antiretroviral drugs designed to increase viral mutation rates, with the goal of eventually causing the collapse of the viral population. Here we present an extensive analysis of viral sequences from HIV-1 infected volunteers from the first “mechanism validation” phase II clinical trial of a mutagenic base analog in which individuals previously treated with antiviral drugs received 1600 mg of KP1461 twice per day for 124 days. Plasma viral loads were not reduced, and overall levels of viral mutation were not increased during this short-term study, however, the mutation spectrum of HIV was altered. A large number (N = 105 per sample) of sequences were analyzed, each derived from individual HIV-1 RNA templates, after 0, 56 and 124 days of therapy from 10 treated and 10 untreated control individuals (>7.1 million base pairs of unique viral templates were sequenced). We found that private mutations, those not found in more than one viral sequence and likely to have occurred in the most recent rounds of replication, increased in treated individuals relative to controls after 56 (p = 0.038) and 124 (p = 0.002) days of drug treatment. The spectrum of mutations observed in the treated group showed an excess of A to G and G to A mutations (p = 0.01), and to a lesser extent T to C and C to T mutations (p = 0.09), as predicted by the mechanism of action of the drug. These results validate the proposed mechanism of action in humans and should spur development of this novel antiretroviral approach.Koronis Pharmaceutical

Features of demographic processes of Khanty-Mansiysk

In clause from analytical positions approaches to a demographical analysis of interrelation of peoples resource and forecasts of development of the population of the large social and economic centre