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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-1
Sabgayda T.P., Zubko A.V.
Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow
Contacts: Tamara Sabgaida, e-mail:
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Information about authors:
Sabgaida T.P., http://orcid.org/0000-0002-5670-6315
Zubko A.V., http://orcid.org/0000-0001-8958-1400
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.
Summary
Relevance. The increase in mortality from vascular
surgical diseases continues in Russia after development of the network
of regional vascular centers. Less than half of these diseases are
included in the List for expensive treatment and provision of high-tech
medical care.
Purpose: Comparison of the average costs for inpatient
treatment of vascular surgical diseases which are included and not
included in the List for provision of high-tech medical care.
Methods. We analyzed the "unfinished cases of inpatient
treatment" in terminology of health insurance, i.e. the first stage of
providing emergency or planned care on the late stages of vascular
disease. Depersonalized data of Rosstat death register and database of
compulsory medical insurance fund were used for Moscow region in 2014.
We compared indicators for vascular surgical diseases which are included
(group 1) and not included (group 2) in the List for provision of
high-tech medical care for medical institutions of different levels.
Results. In Moscow Region in 2014, cardiovascular
mortality was 733.3 per 100,000 population and 6.1% of this death was
due to arterial and venous diseases, while in Russia these rates were
611.7 and 3.5%, respectively. Among the unfinished cases of inpatient
treatment of vascular surgical diseases, the diseases of group 1 consist
4.9% and 64.3% of them were treated in the third level hospitals while
18.6% were treated in the first level hospitals. In medical institutions
of the first and second levels, the cost of treatment of vascular
surgical diseases of group 2 is substantially greater than the cost of
treating diseases of group 1.
Conclusions. Later detection of vascular surgical
diseases leads to increase the expenses of medical insurance funds: the
average cost of a bed-day for deceased from diseases which included in
the List of provision of high-tech medical care is close in
organizations of different levels; for patients who are transferred to
other departments or organizations, it is three times higher than the
cost of a bed-day in hospitals of the first and second levels and only
on one-third less than the cost of a bed-day in hospitals of the third
level with provision of high-tech medical care.
Inclusion of vascular surgical diseases into the List of provision of
high-tech medical care improves the quality of medical care for
patients with these diseases.
If atherosclerosis of extremities arteries (I70.2,), embolism and
thrombosis of arteries (I74) is included into the List of provision of
high-tech medical care, then the mortality from these diseases will
significantly decrease.
Keywords: Mortality from vascular surgical diseases;
the List of provision of high-tech medical care; cost of hospital
bed-day; unfinished cases of inpatient treatment; medical institutions
of different levels; atherosclerosis of extremities arteries; embolism
and thrombosis of the arteries
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-2
Varakina Zh.L.
Northern State Medical University, Arkhangelsk
Contacts: Varakina Zhanna Leonidovna, e-mail:
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Information about author:
Varakina Z.L. http://orcid.org/0000-0002-8141-4269
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.
Abstract.
Significance. Considerable society losses from excess
mortality of men, especially from external causes, are one of the basic
problems of modern Russia. Expenses examination for health maintenance
has great value for justification of investments volume on health
promotion programs realisation. Distortion of mortality causes presented
in the official statistics blanks the violent causes.
The purpose of the study: to assess the potential years
of life lost of the Arkhangelsk region population and to calculate in
the region the economic losses of premature mortality from external
causes, to analyse the subregistration of mortality from external
causes.
Methods. Calculation and analysis of potential years
of life lost and economic losses from external causes of mortality were
conducted. Number of died due to external causes (by sex, causes,
territory) were obtained from the vital record tables of the Federal
State Statistics Service on Arkhangelsk region and the State Archives of
Arkhangelsk region (1980–2012). Data on a population (by sex,
territory) with recalculation on the basis of population censuses also
have been given by Federal State Statistics Service. The gross regional
(1994–2012) and overall social products per capita (1980–1993) were used
for the economic analysis. The analysis of mortality causes distortion
presented in official statistics was conducted.
Results. The proportion of potential years of life lost
from mortality of external causes in structure of total mortality
losses among Arkhangelsk region male population is 24,5%, among females -
6,8%. Level of losses from suicides, accidental alcohol poisoning and
homicides is the highest. The Arkhangelsk region had the maximum
economic losses from external mortality in 1980-1983, 1992-1998,
2000-2006. For the 33-year period the proportion of injuries with
indeterminate intentions in the structure of external mortality is
increased (among male population of a rural area from 1,9 to 8,0%, urban
area - from 3,0 to 15,0%, among female population of a rural area -
from 2,5 to 9,8%, urban area - from 1,9 to 13,8%). The proportion of
unknown mortality causes was increased.
Conclusion. Results of the study estimate the
contribution of external mortality in decrease in level of northern
region public health, and also define appropriateness of coding
optimisation of initial death cause.
Scope of application. Received results had been used by
elaboration of the three-level program on monitoring optimisation and
injury and external mortality decrease in the European North of Russia.
Keywords: potential years of life lost; external causes of mortality; distortion of mortality causes; economic losses.
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-3
Zhilina N. M.
Novokuznetsk State Institute of Postgraduate Medical Training, Ministry of Health of the Russian Federation, Novokuznetsk
Contacts: Natalya M. Zhilina,
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Information about author:
Zhilina N.M., http://orcid.org/0000-0001-7871-3885
Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.
Abstract. Significance of the issue is substantiated by
importance of the research subject, namely health of the city workers
with the developed metallurgical and mining industry, unfavorable
environmental situation and working conditions. Reproduction of healthy
population, efficient productivity and high quality of life are highly
dependable upon the state of health of workers. Identification of risk
zones of the workers ' health in relation to environmental factors
contributes to adoption of adequate solutions to reduce preventable loss
of population in terms of health. The purpose of the study was to
conduct a dynamic analysis of the existing situation, identify risk
zones of the workers ' health and find causal relationship between
"Health – environment".
The study considered the following indicators of the workers’ health:
incidence by care seeking at health care facilities, morbidity with
temporal disability, indicators of prophylactic medical examination for
chronic diseases, disability and mortality of employees; the integrated
indicator of the workers’ health was analyzed.
The study used methods of system analysis, expert assessments and statistical methods.
The automated system "Health workers" developed with the
participation of the author is one of the components of the
socio-hygienic monitoring of the environment and public health and is
kept up to date by the Novokuznetsk medical information and analytical
center. The output of the system for 2008-2015 was converted into series
data and analyzed using the licensed statistical package IBM SPSS
Statistics (version 19.0); data from the regional and Federal state
statistics were used. The analysis helped to identify problem
situations, to calculate significant correlation in the system
"Health-Environment".
Recommendations to eliminate risk factors of workers’ health were developed.
Results of this study can be used to identify problems and develop
priorities to reduce preventable loss in terms of workforce health at
the federal and regional levels.
Key words: workers’ health; automated monitoring; integrated indicators; risk zones; environmental factors; correlation.
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-4
Ivaninskiy O.I.
Novosibirsk State Medical University, Ministry of Health of the Russian Federation, Novosibirsk
Contacts: Oleg I. Ivaninskiy,
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Acknowledgments. The study had no sponsorship.
Conflict of interests. The authors declare no conflict of interest.
Abstract
Background. Healthcare Development Strategy within the
context of integrated medical and social care to population requires
improved performance of its primary level of care delivery focused among
other things on continuity of emergent, first and urgent care.
Purpose of the study. To substantiate priorities for
optimizing organizational and methodological approaches to development
of the territorial logistic model system for urgent care delivery to the
rural population on the basis of territorial and transport zoning.
Methods: statistical, cartographic, sociological, expert methods, situational analysis and organizational modeling.
Results. Optimization model system for providing
urgent care to the rural population includes: priorities for optimizing
urgent care delivery to rural population; structural re-organization;
implementation of regional target programs and healthcare modernization
program; monitoring performance of the system of urgent care delivery.
On the basis of the territorial matrix a medical zoning was undertaken
to identify the best locations for urgent care centers. Analysis of
transport accessibility between regional centers of the Novosibirsk
region helped to develop territorial logistic model of urgent care
delivery.
Discussion. Despite a sufficient deal of
attention to organization of urgent care delivery, there is a lack of
comprehensive studies on the performance analysis of urgent care
delivery as a comprehensive care to the rural population.
Conclusions. 1. Optimization model system for
providing urgent care to the rural population at the regional level
includes priorities for optimization; structural reorganization;
implementation of regional target programs and healthcare optimization
programs; and performance monitoring.
2. Implementation of priorities for optimizing urgent care delivery
to rural population includes the following: advanced training of care
providers; timely care delivery and patient transportation; development
of standards and protocols for urgent care delivery; development of
telecommunication system of urgent medicine; development of the system
of self and mutual assistance to patients in urgent conditions;
cooperation with other regional services.
3. Structural reorganization of the system of urgent care delivery to
the rural population at the regional level involves creation of:
emergency care facilities in rural areas; interregional and regional
specialized centers to provide urgent care at the regional hospitals and
federal centers, development and implementation of regional target
programs.
4. Organizational and methodological approaches to develop the
territorial logistic model of the system of urgent care delivery to
rural population on the basis of territorial and transport zoning
include the following: identification of the remote rural settlements
for a special procedure for emergent and first care; development of the
inter-regional center of urgent care.
5. Implementation of the optimization model showed its efficiency.
Keywords. Urgent medical care; optimization model; territorial and logistic model; rural population.
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-5
1,2Balaeva Ò.V., 1Samodova Î.V., 1Sannikov A.L.
1Northern State Medical University, Arkhangelsk, Russia
2Center of hygiene and epidemiology in Arkhangelsk region, Arkhangelsk
Contacts: Tatiana Balaeva, e-mail
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Information about authors:
Balaeva Ò.V., http://orcid.org/0000-0003-2072-3452
Samodova Î.V., http://orcid.org/0000-0002-6730-6843
Sannikov A.L., http://orcid.org/0000-0003-0405-659X
Acknowledgments. The project was funded by the Research Council of Norway and the Ministry of Foreign Affairs of Finland.
Conflct of interests. The authors declare no conflict of interest.
Abstract
Infection caused by herpes simplex virus type 2, is of interest of
researchers all around the world because of its high prevalence in the
population, high number of asymptomatic carriers and severity of
possible consequences in pregnant women and newborns. Herpes simplex
virus is a marker of sexual behavior in the population, as well as a
frequent co-factor of HIV infection. In Russia epidemiology of virus
herpes simplex type 2 is under-investigated.
The purpose of the study was to determine prevalence of
herpes simplex virus type 2 among adult population in Arkhangelsk and
to evaluate social and behavioral factors associated with this
infection.
Methods. The conducted population-based
cross-sectional study combines investigation of biological indicators
(determination of blood immunoglobulin G to herpes simplex virus type 2)
with data on behavioral risk factors. We used a quota sampling method
to create a representative sample of the adult population in Arkhangelsk
aged 18-39 years.
Results. The majority of 1243 participants were
females (56%), 44% were men. According to the laboratory tests, 18.8% of
the participants were positive on immunoglobulin G to herpes simplex
virus type 2. In multiple logistic regression analysis for men the
increasing age, marital status and history of sexually transmitted
infections were significantly associated with seropositivity on herpes
simplex type 2. In multiple logistic regression analysis for women the
increasing age, high income level, lifetime number of sexual partners
were significantly associated with herpes simplex type 2 seropositivity.
Sexual debut at the age of 18 years and over was significant as a
protective factor for women only.
Conclusion. Factors associated with herpes simplex type
2 infection in our study do not significantly differ compared with the
results in other countries. High prevalence of infection among women of
childbearing age reveals the potential risk of transmission from mother
to child, and suggests an increased risk of HIV infection in women. Our
findings will be useful to develop multilateral strategies aimed at
preventing herpes simplex type 2 and other sexually transmitted
infections in the North-West of Russia.
Keywords: herpes type 2; social factors; behavioral factors; population-based study.
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-6
1Svistunov A.A., 2Olefir Yu.V., 1Lebedev G.S., 2Koshechkin K.A.
1First Moscow State Medical University named after I. M. Sechenov,
2Scientific Centre for Expert Evaluation of Medicinal Products, Ministry of Health of the Russian Federation, Moscow
Contacts: Konstantin A. Koshechkin, e-mail:
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Information about authors:
Svistunov AA., http://orcid.org/0000-0003-1592-5703
Olefir Yu.V., http://orcid.org/0000-0001-7652-4642
Lebedev G.S., http://orcid.org/0000-0002-4289-2102
Koshechkin K.A., http://orcid.org/0000-0001-7309-2215
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.
Abstract. Significance. Modern technologies provide for a
quantum leap forward in meeting needs of the public health. In
particular, the stage of medical use of prescribed drugs can be
completely automated based on available introduced telemedicine and
healthcare information systems.
The study purpose is to analyze capabilities of
telemedicine development towards integration with distant drug sales and
subsequent development of “telepharmacy”.
The authors used system, concept-based, process-oriented and
situation modeling approaches, methods of historical, marketing,
structural, functional and logic analysis.
Results. Transition to “telepharmacy” requires
integration of telemedicine systems, systems of doctors’ prescriptions,
pharmacy information systems and monitoring of package flows and their
inclusion into a unified complex allowing to minimize both time and
financial costs.
Approval of relevant legal norms is also required to ensure legal use
of internet-technologies for developing telepharmacy as a new direction
including distant prescription of drugs and services on distant sales
of drugs.
Discussion. Implementation of the CALS/PLM-technology
for informational support for the vital cycle results in development of
the information systems accommodating different participants of the
drugs’ vital cycle.
Application of the unified regulatory and reference information as
well as comprehensive list of drugs is of great importance in achieving
those tasks.
Incorporation of all components of the Integrated national
information system into an integral technology complex will allow to
create a fully integrated system of distant prescription and sales of
drugs.
Conclusions. Integration of telemedicine services with
best practices in distant sales of drugs with due regard to the
development of the necessary support systems for the vital cycle of
drugs will help to move to a new stage of pharmacy development –
‘telepharmacy”.
Keywords: CALS/PLM-technology; vital cycle; information
system; unified information space; healthcare informatics; telemedicine;
electronic medical history.
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-7
1Shcherbakov S.M., 2,3Teplyakova E.D., 4Rumyantsev S.A., 4,5Vasilenok A.V.
1Rostov State University of Economics
2 Rostov State Medical University
3Municipal Childrens polyclinic ¹4 city of Rostov-on-Don
4Pirogov Russian National Research Medical University
5Dmitry Rogachev National Research Center of Pediatric Hematology, Oncology and Immunology
Contacts: Aleksandr Vasilenok, e-mail:
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Information about authors:
Shcherbakov S.M.,http://orcid.org/0000-0001-8001-0214
Teplyakova E.D., http://orcid.org/0000-0002-3585-7026
Rumyantsev S.A., http://orcid.org/0000-0002-7418-0222
Vasilenok A.V., http://orcid.org/0000-0003-0512-9949
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.
Abstract. Significance. The introduction
of information technology into the work of medical organizations on
different levels is one of the urgent tasks of health care system
modernization. The simulation method allows to estimate labor costs for
the execution of medical care processes and to find ways to increase
productivity of the ambulatory medical organization work while
conducting medical check ups.
Purpose of the study. Evaluation of the effectiveness
of various options for automating the processes of conducting medical
check ups and clinical examination in an ambulatory medical organization
based on the use of simulation models to reduce the cost of resources.
Methods. Visual and simulation modeling of the
processes of an ambulatory medical organization was carried out by means
of the unified UML language.
Results of the study. A set of visual and imitation
models of the process of medical check ups and clinical examination in
an ambulatory medical organization is constructed allowing to visually
reflect these processes at different levels of use of information
technology and to quantify the labor costs for their implementation
depending on the parameters of the ambulatory medical organization. As a
result of the simulation experiment a comparative assessment of the
labor costs of pediatricians, specialists, nurses and support medical
personnel was carried out for five alternative ways of organizing the
processes using medical information systems taking a pediatric
ambulatory medical organization as an example. Basing on the results of
the simulation experiment, decisions are taken on making changes in the
organization of the processes that are most optimal for the specific
tasks of the medical organization.
Conclusions. The application of the proposed
methodology of visual and simulation modeling in the ambulatory medical
organizations allows to estimate the labor costs of doctors, nurses and
support medical personnel; to highlight the most time-consuming
processes and operations; to find ways to improve efficiency, including
through the use of information technology; to compare alternative ways
of automation. The simulation modeling conducted in accordance with the
proposed methodology demonstrates the possibility of its wide use to
improve the management efficiency of an ambulatory medical organization
of any organizational form.
Keywords: medical organization; business process; information systems; simulation; SIM-UML
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Tuesday, 01 August 2017 |
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DOI: 10.21045/2071-5021-2017-56-4-8
Tsybikova E.B.1, Zubova N.A.2, Midorenko D.A.3
1 Federal Research Institute for Health Organization and Informatics of Ministry of Public Health of Russian Federation, Moscow
2 Regional TB dispensary, Saransk
3 Tver State University, Tver
Contacts: Erzheni B. Tsybikova, e-mail:
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Information about authors:
Tsybikova E.B., http://orcid.org/0000-0002-9131-3584
Zubova N.A., http://orcid.org/0000-0002-1223-4141
Midorenko D.A., http://orcid.org/0000-0002-6056-1745
Acknowledgments. The study had no sponsorship.
Conflct of interests. The authors declare no conflict of interest.
Abstract.
Background. Timely detection of TB among contacts of TB
sputum smear-positive patients requires testing not only close and
long-term contacts but people living near TB infection focal points and
people at high risk for TB due to accidental contacts with TB focal
points.
The study purpose: to analyze geographical distribution
and boundaries of TB focal points to estimate population subject to
X-ray testing (exemplified by Saransk).
Materials and methods: data on 34 patients with sputum
smear-positive chronic pulmonary tuberculosis under follow-up at the
Regional TB dispensary in Saransk and data on 198 newly diagnosed
patients with lung TB in 2014-2015.
Data were extracted from the Rosstat (Federal State Statistics
Service) reporting forms #8 and #33 and from the Order #50 of the
Ministry of Health of the Russian Federation. For each patient
information about sex, age, date of birth and residence address (street
and house number) was obtained. Data on Saransk population number and
density, and housing in each district of Saransk were also used for the
analysis.
Results. Currently, the main source of TB infection in
Mordovia is patients with chronic lung TB with unclosed cavities and
bacterial excretion after treatment.
Using cartographic methods based on geo-information systems allowed
to extend definition of TB focal point to include both actual place of
residence of patients with chronic lung TB as well as ambient
environment within boundaries of which infection spreads via accidental
contacts of the infection source with population.
Comparison of addresses of permanent residence of patients with
chronic lung TB with addresses of newly diagnosed TB patients during two
years showed that newly diagnosed TB patients lived in the vicinity of
chronic TB focal points including buffer zones.
Using cartographic methods based on geo-informational systems allowed
to identify location and boundaries of chronic TB focal points helping
to estimate population subject to chest X-ray testing due to high risk
for TB.
The analysis showed that 11952 people or 10% of the population
residing within the area covering the three epidemic clusters and one
large epidemic focus required a compulsory chest X-ray testing.
Keywords: chest X-ray testing; lung TB; TB focal points; cartographic method based on geo-information system.
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