DEVELOPMENT AND IMPROVEMENT OF QUALITY CHARACTERISTICS OF MEDICAL CARE

The aim: to investigate changes in the interpretation of the content of the characteristics of the quality of medical care and medical service; to propose practical approaches to the formation of modern quality criteria and indicators in health care institutions. Materials and methods: sources of scientific literature from the databases PubMed, NICE, according to the selected research topic, were selected as research materials; methods: bibliosemantic; analysis and generalization of the obtained data. Results. Classic characteristics of quality – safety, quality of resources, quality of the medical care process, treatment outcome, patient satisfaction, timeliness, fairness, efficiency – are reviewed over time and acquire additional or radically changed content. The selection of relevant quality characteristics is important for health care managers to define quality criteria and indicators according to the requirements of the local context. In addition to the traditional components of infectious safety and the safety of medical interventions, the safety criterion is today complemented by the components of radiation, environmental, epidemic, physical, informational, and terrorist safety. Safety also refers to the ability of professionals to avoid, prevent and reduce harmful interventions or risks to themselves and the environment. Patient-centeredness must include respect for the relationship not only between physician and patient, but also between the patient and all providers of health care for that patient. Effective, safe health care is reflected in a culture of excellence that includes collaboration, communication, compassion, competence, advocacy, respect, accountability and reliability. The most relevant criteria and indicators of the quality of medical care must be developed in accordance with the structure of innovative organizational models of academic health care centers, where scientific, clinical and educational activities are integrated. This requires the formation of end-to-end quality criteria and indicators that cover all activities of academic centers. Conclusions: criteria and indicators of the quality of medical care and medical service are constantly supplemented with new components, in accordance with the achievements of medical science and practice. The transformation of the organizational structures of medical care into academic centers, where scientific and educational activities are added to traditional medical practice, requires the development and introduction of end-to-end criteria for the quality of medical care

STUDY OF THE RISK OF PARENTS’ DISSATISFACTION WITH THE QUALITY OF PROVIDING MEDICAL AID TO CHILDREN WITH RESPIRATORY DISEASES

Introduction. Reforming the health care system requires defining criteria for assessing patients’ dissatisfaction with the quality of medical care. It is known that the previous experience of communication with a doctor affects the quality of further interaction and compliance with medical recommendations. The aim was to predict the risk of parents’ dissatisfaction with the quality of medical care for children with respiratory diseases, depending on the number and reasons for visits to pediatricians and family general practitioners (GP), by the results of the questionnaire. Materials and methods. Overall, 171 parents were questioned (87.72 %). The analysis was by logistic regression models using the statistical analysis package MedCalc v.19.4.1 (MedCalc Software Inc, Broekstraat, Belgium, 1993-2020). Results. The results of the study show that 125 (83.3 %) parents rated satisfaction with the quality of medical care for children with respiratory diseases (RD) in health care facilities as 5 points by a five-point scale. The univariate analysis showed a significant relationship between the risk of parents’ dissatisfaction with the quality of medical care for RD children and the number of ARI visits to the GPs per year (p<0.05), namely: the increase in the number of visits is associated with significant decrease in parental dissatisfaction with quality of medical care, for every next visit (p = 0.040), OR = 0.31 (95 % CI 0.10-0.95). The area under the curve of operational characteristics AUC = 0.66 (95 % CI 0.58-0.74) indicates a weak relationship between the risk of parental dissatisfaction and the number of ARI visits to the GPs per year. When using the stepwise regression, 4 factor features were selected for multivariate analysis, namely: the number of cases of acute respiratory viral infections in a child per year, the number of pneumonias in a child during life, the number of visits to the PHC (primary health care) physician, and to the PHC pediatrician per year. According to this model, an increase in the number of visits to the GP is associated with decrease in parents’ dissatisfaction with the quality of medical care, for each repeated visit (when standardizing by the number of ARI cases in a child per year, the number of pneumonia cases in a child, and the number of visits to the PHC pediatrician) (p = 0.026), OR = 0.25 (95 % CI 0.08-0.85). Conclusions. The multifactorial factor logistic regression of the parental dissatisfaction with the quality of medical care for ARI children included 4 factors, including the number of cases of acute respiratory viral infections in a child per year, the number of pneumonias in a child during life, the number of visits to the GP, and to the PCH pediatrician per year. For every next RD-associated visit to the physician, the risk of dissatisfaction with the medical care quality significantly reduces. Positive previous experience of communication between parents and the GP leads to further satisfaction with the quality of medical care for RD children