Некоторые результаты экспертной оценки проблем организации амбулаторно-поликлинической помощи

Introduction. An important role in health care management was taken by the service of managing the volume of medical care for this population group and the progressive development of the opportunities of the district doctor and GP for most of the population which requires only general medical assistance while maintaining all the possibilities for the consultant to get this patient’s advice.Materials and methods. An expert assessment of the organization’s problems, prospects for development and the main directions for optimizing the outpatient care were conducted among the heads of health authorities, state outpatient clinics and the oblast’s top specialists (111 experts).Results. An expert assessment of the problems and perspectives of the organization of out-patient and polyclinic care in the territorial polyclinics obtained the following results. At present, the health of the population is monitored by: citizens themselves – 23,1%; District doctors – 7,9%, medical specialists – 1,2%, no one follows – 67,8%. At the same time, according to experts, citizens themselves should monitor citizens’ health – 81,3% and district doctors – 18,7%. With a deterioration in health status or an exacerbation of the disease, patients most often turn to: the district doctor – 84,1%; The average medical worker working on the site – 2,7% and the specialist doctor – 13,2%. At the same time, according to experts, patients with worsening health or exacerbation of the disease most often need to contact the local doctor – 88,3% and the average medical worker working on the site – 11,7%.The share of unreasonable visits is: a district doctor – 28,1%, house calls – 56,4%, doctors-specialists – 37,3%. Thus, according to experts’ estimates, the share of unjustified visits of district doctors is 28,1%, of the doctor’s call at home – 56,4%, and of specialist doctors – 37,3%, which indicates a low level of organization of work of polyclinics. The proportion of visits by patients to district doctors that could be resolved: on pre-hospital admission, is 24,7%, by telephone consultation, is 24,5%. Thus, the share of visits to district doctors, which could be resolved at a pre-hospital reception and by telephone consultation, is almost half (49,2%).The proportion of visits by patients to medical specialists that could be resolved by telephone consultation: between the district doctor and medical specialists is 11,2%, the number of patients by telephone by medical specialists is 12,4%. Thus, the share of visits by specialist doctors, which could be resolved by telephone consultation between the district doctor and specialist doctors and patient consultations by telephone by specialist doctors, is almost a quarter of all visits (23,6%).Discussion. The data obtained are in some ways consistent with the results of a number of authors who are optimizing outpatient care in terms of the unreasonableness of visits, the possibility of transferring part of the functions of primary general medical reception to specially trained middle medical personnel, using telephone consultations between patients and between doctors, etc.Conclusion. The results of the expert assessment of the organization of outpatient care helped to identify some approaches to optimizing its delivery in the territorial polyclinics. This is optimization of the work of district doctors; Transfer of a certain part of the functions performed by district doctors to district nurses and paramedics; The development of a system for counseling patients and district doctors by medical specialists of polyclinics and other medical organizations. Введение. Практика здравоохранения свидетельствует, что необходимо более тщательно выделять ту незначительную часть населения, которая, как правило, использует основную часть ресурсов здравоохранения.Материал и методы. Экспертная оценка проблем организации, перспектив развития и основных направлений оптимизации амбулаторно-поликлинической помощи (АПП) проводилась среди руководителей органов управления здравоохранением, государственных амбулаторно-поликлинических учреждений (АПУ) и главных специалистов области (111 экспертов). В ходе исследования собраны и обработаны 111 экспертных карт оценки организации оказания АПП в территориальных поликлиниках (ТП) (по 45 параметрам).Результаты. В настоящее время за состоянием здоровья населения следят: сами граждане – 23,1%; участковые врачи ТП – 7,9%, врачи-специалисты ТП – 1,2%, не следит никто – 67,8%. В то же время, по мнению экспертов, следить за здоровьем граждан должны сами граждане – 81,3% и участковые врачи – 18,7%. При ухудшении состояния здоровья или обострении заболевания пациенты чаще всего обращаются к участковому врачу – 84,1%; среднему медицинскому работнику, работающему на участке, – 2,7% и врачу-специалисту ТП – 13,2%. В то же время, по мнению экспертов, при ухудшении состояния здоровья или обострении заболевания пациенты чаще всего должны обращаться к участковому врачу – 88,3% и среднему медицинскому работнику, работающему на участке, – 11,7%.Доля необоснованных посещений составляет: участкового врача в ТП – 28,1%, вызовов на дом – 56,4%, врачей-специалистов ТП – 37,3%. Таким образом, по оценкам экспертов, доля необоснованных посещений участковых врачей составляет 28,1%, вызовов участкового врача на дом – 56,4%, а врачей-специалистов – 37,3%, что свидетельствует о низком уровне организации работы ТП. Доля посещений пациентами участковых врачей, которые могли быть решены на доврачебном приеме составляет 24,7%, посредством консультации по телефону – 24,5%. Таким образом, доля посещений участковых врачей, которые могли быть решены на доврачебном приеме и посредством консультации по телефону, составляет 49,2%. Доля посещений пациентами врачей-специалистов ТП, которые могли быть решены посредством консультации по телефону между участковым врачом и врачами-специалистами, составляет 11,2% пациентов, по телефону врачами-специалистами – 12,4%. Таким образом, доля посещений врачей-специалистов ТП,которые могли быть решены посредством консультации по телефону между участковым врачом и врачами-специалистами и консультаций пациентов по телефону врачами-специалистами ТП, составляет почти четверть всех посещений (23,6%).Обсуждение. Полученные данные в определенной мере согласуются с результатами ряда авторов, занимающихся оптимизацией АПП в ТП в части необоснованности посещений в ТП, возможности передачи части функций первичного общего врачебного приема специально подготовленному среднему медицинскому персоналу, использования телефонных консультаций пациентов и между врачами и т.д.Заключение. Результаты экспертной оценки организации оказания АПП в ТП позволили определить некоторые подходы к оптимизации оказания АПП в ТП. Прежде всего, это оптимизация работы участковых врачей; перенос определенной части функций, выполняемых участковыми врачами, на участковых медицинских сестер и фельдшеров; развитие системы консультирования пациентов и участковых врачей врачами-специалистами ТП и других медицинских организаций.

Tolerance in a multicultural society: regional aspect: monograph (Kudrina E. L., Belozerova M. V., Sadovoy A. N., Ponomarev, V. D., Markov V. I.)

The brief report on the monograph published in 2013 is proposed. The book is devoted to the theoretical understanding of the tolerance problems, multiculturalism, interethnic and intercultural relations. The regional experience of interethnic and interreligious interaction on the base of tolerance principles is considered and systematizedПредлагается краткое сообщение об изданной в 2013 году монографии. Книга посвящена теоретическому пониманию проблемы толерантности, мультикультурализма, межэтнического и межкультурного взаимодействия. Рассматривается и систематизируется региональный опыт межэтнического и межрелигиозного взаимодействия на основе принципов толерантност

Results of expert evaluation of problems of organization of ambulatory-polyclinic assistance

Introduction. An important role in health care management was taken by the service of managing the volume of medical care for this population group and the progressive development of the opportunities of the district doctor and GP for most of the population which requires only general medical assistance while maintaining all the possibilities for the consultant to get this patient’s advice.Materials and methods. An expert assessment of the organization’s problems, prospects for development and the main directions for optimizing the outpatient care were conducted among the heads of health authorities, state outpatient clinics and the oblast’s top specialists (111 experts).Results. An expert assessment of the problems and perspectives of the organization of out-patient and polyclinic care in the territorial polyclinics obtained the following results. At present, the health of the population is monitored by: citizens themselves – 23,1%; District doctors – 7,9%, medical specialists – 1,2%, no one follows – 67,8%. At the same time, according to experts, citizens themselves should monitor citizens’ health – 81,3% and district doctors – 18,7%. With a deterioration in health status or an exacerbation of the disease, patients most often turn to: the district doctor – 84,1%; The average medical worker working on the site – 2,7% and the specialist doctor – 13,2%. At the same time, according to experts, patients with worsening health or exacerbation of the disease most often need to contact the local doctor – 88,3% and the average medical worker working on the site – 11,7%.The share of unreasonable visits is: a district doctor – 28,1%, house calls – 56,4%, doctors-specialists – 37,3%. Thus, according to experts’ estimates, the share of unjustified visits of district doctors is 28,1%, of the doctor’s call at home – 56,4%, and of specialist doctors – 37,3%, which indicates a low level of organization of work of polyclinics. The proportion of visits by patients to district doctors that could be resolved: on pre-hospital admission, is 24,7%, by telephone consultation, is 24,5%. Thus, the share of visits to district doctors, which could be resolved at a pre-hospital reception and by telephone consultation, is almost half (49,2%).The proportion of visits by patients to medical specialists that could be resolved by telephone consultation: between the district doctor and medical specialists is 11,2%, the number of patients by telephone by medical specialists is 12,4%. Thus, the share of visits by specialist doctors, which could be resolved by telephone consultation between the district doctor and specialist doctors and patient consultations by telephone by specialist doctors, is almost a quarter of all visits (23,6%).Discussion. The data obtained are in some ways consistent with the results of a number of authors who are optimizing outpatient care in terms of the unreasonableness of visits, the possibility of transferring part of the functions of primary general medical reception to specially trained middle medical personnel, using telephone consultations between patients and between doctors, etc.Conclusion. The results of the expert assessment of the organization of outpatient care helped to identify some approaches to optimizing its delivery in the territorial polyclinics. This is optimization of the work of district doctors; Transfer of a certain part of the functions performed by district doctors to district nurses and paramedics; The development of a system for counseling patients and district doctors by medical specialists of polyclinics and other medical organizations

Some aspects of human resources health in Siberian Federal District

Introduction. One of the main national postulates, including domestic health care, is the thesis that the cadres decide everything. At the same time, in recent years, insufficient attention has been paid to human resources for health in scientific research.Materials and methods. An analysis of the data provided by the health authorities of the regions of the Siberian Federal District (SFO) for the preparation of materials for the meeting of the Coordination Council on Health of the Interregional Association “Siberian Agreement”.Results. In general, according to the SFD, the index of the population’s supply of physical persons to physicians is 36,9 per 10 thousand of population, which is somewhat lower than the average Russian indicator (37,2). In general, according to the SFD, the indicator of the population’s availability of doctors for the occupied positions is 56,6 per 10 thousand of the population. In most regions, the part-time ratio exceeds the Russian average (1,4).In general, in the SFD, the provision of the population with doctors in outpatient care is only 17,2% higher than in inpatient care. The staffing level is quite high (90,4%), but to a large extent it was achieved due to a high level of part-time (1,5). The staffing of doctors in outpatient care is 4,7% lower than in inpatient care. At the same time, the higher staffing of physicians in inpatient care is largely due to part-time work (a factor of 1,7 and 1,4 respectively).Staffing by district doctors is quite high and amounts to 93,7% with a very low level of intercourse (1,1). The staffing of the specialists in the SFO is also quite high (89,8%), while it was largely achieved due to the high level of part-time (1,5). The staffing of doctors in outpatient care is 4,7% lower than in inpatient care. At the same time, the higher staffing of physicians in inpatient care is largely due to part-time work (a factor of 1,7 and 1,4 respectively).According to the SFD, the provision of the population with average medical personnel is 124,7 per 10 thousand of the population. The provision of the population with medium-level medical personnel in outpatient and inpatient care is almost the same (56,7 and 56,9 per 10 thousand of the population, respectively). The staffing level of the average medical personnel is quite high (93,7%), to a certain extent, it was achieved through intercourse (1,3). At the same time, the average medical staff in outpatient care is 3,6% lower than in a stationary clinic with practically the same level of part-time (1,2 and 1,3 respectively)The staffing of nurses in the SFO is quite high (94,4%), to a certain extent, it has also been achieved through part-time work (1,3). At the same time, the average medical staff in outpatient-polyclinic care is 3,6% lower than in the stationary one with practically the same level of part-time (1,2 and 1,3 respectively). In general, according to the SFO, there are 2,5 employed nurses for one doctor of clinical specialties. In inpatient care, the number of nurses per doctor is 3,6, and in the outpatient clinic – 1,9.Discussion. It seems more expedient to talk not about the absolute shortage of personnel, but about the relative, which, to a large extent, is caused by disproportions in the placement and use of personnel.Conclusion. By regions, the greatest number of deviations from the mean values for the SFO was revealed by the following parameters: qualification of doctors; Provision by medium-sized medical personnel; Availability of doctors, including medical specialists and staffing of doctors. In staffing in all regions of the SFO, priority is given to inpatient care over outpatient and outpatient care. The adequately high staffing is largely due to the high level of part-time, especially medical specialists. Practically in all regions of the SFD there is not enough high level of qualification of doctors and nurses. In all regions of the SFO, there is a significant shortage of nurses with a sufficiently high level of provision with average medical personnel in general