[The analysis of application of telemedicine technologies in the Russian Federation in 2019-2022].

Over the past five years, development of telemedicine was accompanied by many changes. Despite the need for remote medical care, development of telemedicine technologies was not uniformly intensive, both in different countries and in regions of a single state (such as Russia). The purpose of the study is to evaluate dynamics of volume of medical care and number of types of services using telemedicine technologies in regions of the Russian Federation. The retrospective analysis was applied to data retrieved from the Form of the Federal Statistical Observation № 30 of 2019-2021, from documentation of territorial programs of state guarantees of free medical care of population and tariff agreements in regions of the Russian Federation in 2021-2022 and from the Federal Telemedicine System in 2021. The study established that total number of telemedicine consultations increased in 2021 by 23% as compared with 2020. The percentage of consultations financed by the Compulsory Health Insurance Fund also increased from 6.95% in 2020 to 11.72% in 2021. The number of patients being on remote monitoring increased in 2021 up to 44% as compared to 2020. In addition, percentage of patients receiving medical care through remote monitoring and financed by the Compulsory Medical Insurance Fund increased from 6.55% in 2021 to 19.96% as compared with 2020. In the territorial programs of state guarantees for seven regions of the Russian Federation the number of types of telemedicine services fixed in tariff agreements increased in 2022 as compared to 2021. However, it decreased in ten regions. The most common medical care profiles for which telemedicine consultations in the "physician-physician" format were provided by Federal medical organizations in 2021 were: oncology (55 regions of Russia requested consultations on this profile), pediatrics (45 regions), and intensive-care medicine (39 regions). The telemedicine solutions are in high demand, as it is demonstrated by increasing both of volume of remote medical care and of percentage of consultations financed by the Compulsory Medical Insurance Fund. The COVID-19 pandemic had rather strong impact on development of telemedicine. The alignment of market for telemedicine services in public health sector began in 2021 and it is confirmed by decreasing of total number of consultation types in tariff agreements in 2022. In terms of remote interaction in "physician-physician" format, situation continues to be stable. In the nearest future one should expect more gradual development of telemedicine in Russia with appearance of individual initiatives in terms of pilot projects and experimental law modes.

Healthcare in Russia during the COVID-19 pandemic: challenges, systemic issues, and addressing priorities

The new SARS-CoV-2 (COVID-19) coronavirus pandemic has placed unprecedented strains on healthcare systems worldwide. How-ever, the Russian Federation has demonstrated a high level of preparedness to combat the COVID-19 pandemic. First, it was re-flected in the quick reallocation of resources toward the efficient provision of medical care for patients with COVID-19. To that end, temporary hospitals were set up specifically for such patients, and the existing bed capacity was reassigned. In addition, routing schemes for patients with acute respiratory viral infections (ARVI) and community-acquired pneumonia were developed and approved. Also, provisional rules were approved for recording information and maintaining an information resource to pre-vent the spread of COVID-19 using the unified state health information system. Furthermore, from December 2020, our country began a large-scale vaccination of the adult population against COVID-19, and from January 2021, mass vaccination against CO-VID-19 was started. The mobilization of the country's human resources to combat the pandemic and the timely communication of relevant clinical guidelines to physicians enabled an effective response to the challenges of the COVID-19 pandemic. The re-turn of the healthcare system to a normal mode of operation is a high priority at the present stage. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

The calling a doctor in: what an optimal model can be? (publications review).

The primary health care represent the most common segment of medical care in many countries and provides prevention and treatment of diseases, dynamic monitoring of patients with chronic diseases and medical rehabilitation. There is substantial shortage of health personnel to meet health needs all over the world, especially in primary health care. The COVID-19 pandemic exacerbated this problem. It changed workload in primary health care and demonstrated need for new organizational solutions to increase access to primary health care. One of the new transformations in general practice can be redistribution of medical work in primary health care. In this research, five options for organizational models of primary home care were identified. We used "performer (doctor / nurse)", "payment method for the home visit", "frequency of patient visits per week" as indices. There is lack of unified approach in the way how home visits are organized so optimal organizational model of primary home medical care is needed. This will increase access of most demanded type of medical care and ensure rational use of human resources at the primary health care level, especially during COVID-19 pandemic.

Remote monitoring of chronic noncommunicable diseases: potential in the COVID-19 pandemic

Aim. To review the current progress in the use of remote health monitoring (RHM) technologies for chronic noncommunicable diseases (CNCD). To search for data, we used Web of Science, Scopus, Russian Science Citation Index, Academic Search Complete (EBSCO), Cochrain, and PubMed databases. The date range was 5-10 years. The importance of development of RHM technologies and their further study was shown to confirm the evidence of effect of certain RHM systems. New approaches to the integration of the medical community into the international telemedicine strategy are considered. It was established that RHM can potentially decrease treatment costs and reduce the burden on medical organizations. The review analyzes the experience in using RHM in patients with cardiovascular diseases, as well as respiratory and endocrine disorders. The review also summarizes and systematizes the findings of studies on assessing the effectiveness of RHM technologies in clinical practice, including their use in the COVID-19 pandemic. It is noted that despite high interest of the scientific community in the study of RHM technologies, unambiguous results demonstrating the effectiveness of such developments in clinical practice have not been presented.

Promising measures to reduce the mortality in Russia: an analytical review

The purpose of the study was to identify promising measures to reduce mortality in Russia. Methods used included analysis of systematic reviews from PubMed, Web of Science, Scopus, and Google Scholar. Results. Promising measures for reducing mortality in Russia include promoting healthy behaviour (tobacco control, alcohol control, support for healthy diet, physical activity) and preventing death due to external causes. It is necessary to increase the effectiveness of disease management, including arterial hypertension, hypercholesterolemia, diabetes mellitus, cardiovascular accidents, hepatitis C, HIV. This could require intensifying digital transformation of health care, implementing modern teamwork approaches to the patient’s treatment and follow-up with greater involvement of nurses and other personnel. In terms of screening, it is essential to expand coverage and introduce modern, effective screening methods for colorectal cancer, cervical cancer, and neonatal screening. It is necessary to expand vaccination against COVID-19, vaccination of the elderly from Pneumococcus, and teenagers from HPV. Prevention of mortality from external causes should include sets of measures targeted at the prevention of suicides, traffic accidents, fires, drownings, etc., in addition to alcohol control measures. Finally, increasing health care financing, including medication provision, can bring additional years of life. Conclusions. Russia has significant potential to implement new measures to reduce the mortality. © AUTHORS, 2021.

[The transformation of medical statistic during pandemic of new coronavirus infection (COVID-19)].

The pandemic of new coronavirus infection (COVID-19) directly effected medical statistics service. The amendments to the Federal Law "On the Official Statistical Accounting and the System of State Statistics in the Russian Federation" adopted in December 2020, regulated the provision of primary statistical data according forms of Federal and industrial statistical observation in the format of electronic document signed with electronic signature. This required the development of system of collecting and processing statistical data at the Federal level applying new technological solutions. The purpose of the study. To analyze the changes in the system of collecting and processing annual reporting on medical statistics for 2020 during the pandemic of new coronavirus infection COVID-19. The analysis was made concerning both normative legal base regulating implementation of information systems and system of receiving annual reports for current and previous years. Also content analysis was applied and materials distributed Internet were used. In conditions of new coronavirus infection (COVID-19) pandemic, instead of classical system of informational interaction at face-to-face coordination of annual report data, in extremely short terms new model of informational interaction of remote coordination and processing of annual report data was developed. The updated technological scheme was applied that included data transmission, remote coordination in VKS format, informing thriugh Telegram-channels and signing finalized forms with enhanced electronic digital signature. The complicated epidemiological situation regarding morbidity of new coronavirus infection (COVID-19) and as well as adoption of amendments in Federal legislation regarding provision of statistical observation forms in format of electronic document signed with electronic signature, required revision of format of statistical reports reception in 2020. The application of developed technology of collecting and processing annual reports data on medical statistics in online format permitted to dispense with both provision of hard copies versions of forms and reports and business trips of specialists from the subjects of the Russian Federation to Moscow that reduced expenses of the subjects of the Russian Federation when submitting annual reports. The developed mechanism of signing with unqualified electronic digital signature permitted to control data integrity. The applied mechanism for signing finalized concerted forms with enhanced electronic digital signature of public authority of the subject of the Russian Federation in the field of health protection ensured juridical significance of document provided. The establishment of base for further modernization of system of collecting statistical information from primary data, including subsequent implementation of structured electronic medical documents is proposed.

Telemedicine technologies: prospects and limitations

In the context of rapid technological progress, the outlines of the prospects for the development of telemedicine technologies are becoming more and more clear. At the same time, changes in the organizational, legal and economic spheres often do not keep up with technological changes. This was especially evident in the conditions of the spread of the COVID-19 coronavirus.The article contains an analysis of the features of telemedicine technologies application in modern conditions, prospects and obstacles that arise in this area. В условиях быстрого технологического прогресса очертания перспектив развития телемедицинских технологий становятся все более явственными. При этом изменения в организационной, правовой и экономической сфере зачастую не поспевают за технологическими изменениями. Особенно наглядно это проявилось в условиях распространения коронавирусом COVID-19.В статье содержится анализ особенностей применения телемедицинских технологий в современных условиях, перспективы и возникающие в этой сфере препятствия.

E-MAIL: CHILILOV@MAIL.RU

The aim of the research is to study the economic aspects of telemedicine technologies application, taking into account the experience of other countries;to develop methodological approaches to evaluating the effectiveness of telemedicine technologies;to analyze the features of evaluating the effectiveness of telemedicine technologies in the conditions of COVID-19 coronavirus spread. Methodological approaches to evaluating the effectiveness of telemedicine technologies are proposed.The additional costs and benefits of using telemedicine technologies are analyzed in the context of the main participants: the state, medical organizations, doctors, and patients. The additional costs of introducing telemedicine technologies are estimated in terms of their belonging to the so-called “necessary costs” or investments that have different economic content.The proposals developed by the authors allow us to more correctly assess the effectiveness of investments in the provision of telemedicine services and, thus, choose the most optimal options. Целью исследования является изучение экономических аспектов применения телемедицинских технологий с учетом опыта других стран;выработка методологических подходов к оценке эффективности применения телемедицинских технологий;анализ особенностей оценки эффективности применения телемедицинских технологий в условиях распространения коронавируса COVID-19. Предложены методологические подходы к оценке эффективности применения телемедицинских технологий. Дополнительные расходы и выгоды от применения телемедицинских технологий анализируются в разрезе основных участников: государство, медицинские организации, врачи, пациенты. Затраты на введение телемедицинских технологий оцениваются с точки зрения их принадлежности к так называемым «необходимым затратам» или инвестициям, имеющим различную экономическую природу.Выработанные авторами предложения позволяют более корректно оценивать эффективность вложений в оказание телемедицинских услуг и, тем самым, выбрать наиболее оптимальные варианты их применения.