Kuligina M.V.¹, Karneyeva L.V.², Komarova Yi.A.¹, Serebryannikov A.S.¹, Tsivilyova A.Ye.^3
1Ivanovo State Research Institute of Maternity and Childhood
²Vitchuga Central Municipial Hospital, Vitchuga, Ivanovo oblast
³ "Digimed", LmD inc., Moscow

Summary. To evaluate existing level of outpatient healthcare for families with disturbed reproductive function.

1998 patients with fertility problems from Ivanovo and Kostroma Regions were enrolled in this trial. Anonymous questioning was supplemented with survey of primary medical records of patients who obtained access to an obstetrician/gynecologist in antenatal consultative clinic.

Presumed unsatisfactory level of primary healthcare facilities for rehabilitation of reproductive function in affected families was confirmed. Low inclusion of female, as well as male patients in outpatient care was identified. Antenatal clinic provided amount of therapeutic and diagnostic services that was low beyond the socially required one, partly it was due to deficient material resources of such facilities. Another reason was that primary population-based obstetrician/gynecologist were referring such patients to special maternity and childhood establishments rather rarely, for example, in miscarriage cases only half of accessed patients were referred to, while 48.0% of cases applied to specialty centers on their own. As a result of this situation, the mean period between spontaneous miscarriage in desired pregnancy and access to specialty center was 13.3±3.7 months.

As a consequence of low local provision with urologists/andrologists, only 25.0% of patients with chronic vesicular prostatitis and 7.8% of patients with male infertility were involved in outpatient continuous urology observation.

Only 47.4% of male patients referred to urologist (on the motive of gynecologist prognosis of family infertility) had obtained access to this end to appropriate Regional/municipal medical establishments, while 52.6% of them were compelled to seek an access to private establishments.

High incidence of failure to fulfill standards of care for this nosology group was predetermined by insufficient provision of adult population with gynecology and urology facilities. Nevertheless, the opportune identification by outpatient obstetrician/gynecologic and urology primary services of cases with disturbed reproductive function implying their further referral to specialty centers for clinical examination and treatment could have done a good turn. The conditions to be checked at primary care for referral purposes should include female and male infertility, cases of miscarriage, and other reproductive losses.

Presumed unsatisfactory level of primary healthcare facilities for rehabilitation of reproductive function in affected families was confirmed. To overcome it, a two-step management of these conditions should be properly established. Referral access of affected family members to specialty center would be expedient only as far as municipal, Regional, and Federal medical establishments are concerned, i.e. Regional perinatal center, or municipal consultative and diagnostic center, and alike, which possess adequate clinical and laboratory facilities with implied simultaneous services for both family partners.

Key words. Reproductive disorders, ambulatory/polyclinic care

References

1. Zabolevaemost naseleniya Rossii v 2009 godu [Morbidity of Russian population in 2009]. Statistical materials. Chapter II. Moscow: Ministerstvo zdravookhraneniya i sotsialnogo razvitiya Rossiyskoy Federatsii. 2010. 169 p.
2. Osnovnye pokazateli zdorovya materi i rebenka, deyatelnost sluzhby okhrany detstva i rodovspomozheniya v Rossiyskoy Federatsii [Main indicators of maternal and child health, childhood protection and obstetric care services in the Russian Federation]. Statistical materials. Moscow. 2010. 146 p.
3. Platonova S.N., Boyko E.L., Malyshkina A.I. Analiz deyatelnosti akushersko-ginekologicheskogo priema v usloviyakh perinatalnogo tsentra [Analysis of obstetric and gynecological care provided in conditions of a perinatal center]. Byulleten natsionalnogo NII obshchestvennogo zdorovya RAMN 2002;(3):80-83.
4. Pokazateli zdorovya naseleniya i deyatelnosti uchrezhdeniy zdravookhraneniya Ivanovskoy oblasti v 2005-2009 gg. [Indicators of population health and activity of health facilities in Ivanovo region]. Statistical materials. Ivanovo. 2010. 189 p.
5. Prikaz Minzdrava RF ot 10 fevralya 2003 g. № 50 «O sovershenstvovanii akushersko-ginekologicheskoy pomoshchi v ambulatorno-poliklinicheskikh uchrezhdeniyakh» [The Order of MoH&SD of the RF of 2003, February 10, № 50 “On improving obstetric and gynecological care in out-patient polyclinic facilities] [Internet] 2003 [cited 2011 Apr 16]. Available from: http://www.med-pravo.ru/PRICMZ/PricMZ2003/50/50.htm
6. Prikaz Minzdravsotsrazvitiya RF ot 2 oktyabrya 2009 g. №808n «Ob utverzhdenii Poryadka okazaniya akushersko-ginekologicheskoy pomoshchi». [The Order of MoH&SD of the RF of 2009, October 2 №808н “ On approving the arrangement of obstetric and gynecological care delivery”]. [Internet] 2009 [cited 2011 May 21]. Available from: http://www.minzdravsoc.ru/docs/mzsr/family/8
7. Prikaz Minzdravsotsrazvitiya RF ot 8 dekabrya 2009 g № 966n. «Ob utverzhdenii poryadka okazaniya meditsinskoy pomoshchi bolnym s urologicheskimi zabolevaniyami» [The Order of MoH&SD of the RF of 2009, December 8 № 966н “On approving the arrangement of medical care delivery to urological patients] [Internet] 2009 [cited 2010 Oct 13]. Available from: http://www.minzdravsoc.ru/docs/mzsr/orders/copy_of_35

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