I.V. Khelimskaya, N.A. Kapitonenko
Far Eastern State Medical University, Khabarovsk

Summary. The article discusses major ways for further improvement and optimization (through organizational efforts) of medical care at Far-Eastern Railroad for employees with pulmonary conditions.

Comprehensive evaluation of medical and social, occupational, and ecologic risk factors was carried out with the purpose in mind of improving quality of medical care, that could lead to reduction in incidence and prevalence of pulmonary conditions in Far-Eastern Railroad employees that could imply their long-standing career. System analysis of the data from medical statistical records and primary medical accounting documentation was expertise assisted and corrected for medical standards. This expertise evaluation and standard-adjusted correction had prompted the launch of a screening program which was useful for elucidation of true incidence and prevalence of broncho-pulmonary conditions among Far-Eastern Railroad employees. Sociological survey also contributed to this end.

The reasons behind the underreported rates of chronic pulmonary diseases in the population of the Khabarovsk Territory were identified. The reconsiderations thus arisen were then linked to the emerged unbalance in the provision of specialty medical care for the Far-Eastern Railroad employees manifested in the relative and absolute lack of pulmonologists. True figures of prevalence of chronic obstructive pulmonary diseases were eventually derived: the real prevalence among the Far-Eastern Railroad employees constituted as much as 19%, specifically among the administrative employees – as much as 17%. These figures were ten times as big against the officially proclaimed ones, but the official data had totally ignored bronchial asthma in the cluster of respiratory diseases, so it was not 10 times sharp, but rather less.

Official figures when translated in official policies were partly responsible for low provision of pulmonologists for the Far-Eastern Railroad employees, as well for the population of this Land in general, also for insufficient logistics facilities and equipment of medical establishments, though this was more due to lowered standards of medical care.

Quotas of provision of pulmonologists are to be reconsidered. Medical establishments are to be made decentralized and much more economically independent - for better logistics facilities and equipment. Remote medical consultation tele-facilities are to be fully operational - for better diagnosis, as well as critically optimal strategy and tactics of disease management. Mobile diagnostic+therapeutic centers are to be more widely implemented, especially in less opened and less settled distant locations of this vast territory.

Effective ways of organization and development of pulmonology service at the Far-Eastern Railroad imply: introduction in practical medical care of certain modern techniques of early diagnosis, opportune treatment and prevention of respiratory diseases; full-scale regeneration of screening; revival of health rehabilitation social medical system; coordination of efforts of scientific and therapeutic preventive establishments in combatting respiratory diseases on this Land and in the Far-Eastern Federal District at large. Development of public health in Eastern Regions of Russia should take up the pulmonology care for the population as a priority specialty.

Keywords: Organization of medical care, management, quality, pulmonary diseases

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