[The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health].

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

[The medical demographic indicators and health preservation of rural population of the Russian Federation].

For the last 20 years of analysis, mortality rate of rural population was higher than that one of entire population; in 2020, increasing of mortality due to COVID-19 was noted.The indicators were 15.4 per 1000 population for rural population, and 14.3‰ for urban population. In 2021, the indicators increased up to 17.5 and 16.5‰, respectively. The birth rate of rural population over last 20 years tended to increasing. In 2013, mortality and birth rates became equal (14.5‰). In subsequent years, birth rate decreased and in 2021 amounted to 9.6‰ and in 2022 to 9.5‰. In 2021, the indicator of general morbidity of rural population of the Russian Federation was 124941.0‰oo For entire population the indicator was higher - 167713.8‰oo. In 2021, the highest rates of general morbidity of rural population were in the classes of diseases of the respiratory system - 34470.2‰oo and the circulatory system - 21588.2‰oo. In 2021, the ranking of general incidence of rural population in the Federal districts of the Russian Federation demonstrated difference in indicators by 1.5 times and in the subjects of the Russian Federation it reached 5.3 times. The highest indicator was noted in the Nenets Autonomous District - 278926.7‰oo, the lowest one in the Magadan Oblast - 52441.5‰oo. In 2021, the incidence of COVID-19 in rural population amounted to 2151.9‰oo. In 2021, the indicator increased by 2.8 times up to 6056.8‰oo. There is 2.4-fold increase in incidence of COVID-19 in rural population from 3391.1‰oo (2020) to 8085.7‰oo (2021). The ranking of incidence rates of rural population of COVID-19 in the subjects of the Russian Federation demonstrated difference in 15.6 times. The highest indicators were noted in the Republic of Khakassia - 14104.1 per 100 thousand population and the lowest in the Magadan region - 902.9‰oo. Conclusions. The unfavorable medical and demographic situation in the countryside indicates the low availability of medical care, the need for financial support of rural areas at the municipal, regional and Federal levels.

[The hospital substitution form of home medical care of population of Tte Russian Federation: the analysis of functioning].

The important direction of the National Project "Health Care" are improvement of primary health care system, including introduction of hospital-replacing technologies.The purpose of the study is to evaluate functioning of hospital-substituting form of home medical care (home hospitals) to population of the Russian Federation in 2006-2020.The normative legal documents regulating activities of stationary-substituting form of home medical care (home hospitals) for adults and children, reporting forms of sectoral statistical observation № 14ds for 2006-2018 were analyzed. In 2019-2020, unified data on functioning of day hospitals and home hospitals and composition of patients treated there of medical organizations providing medical care on out-patient basis was filled in form № 14ds. The in-depth analysis permitted to extract information about activities of home hospitals for adults and children and to study their functioning in dynamics for 15 years. The content analysis, statistical and analytical methods were applied.The examination of data for 2006-2020 established increasing of number of treated adult patients in home hospitals up to 27.9% and children up to 15.0%.The distribution of the number of treated adults and children in hospitals at home per 1000 of the corresponding population by subjects indicates their significant fluctuation.For 15 years, it has been established that in the structure of treated adult patients, the proportion of people with diseases of the circulatory system has decreased from 62.2 to 31.5%, the musculoskeletal system and connective tissue - from 11.7 to 7.4%; in children - with respiratory diseases from 81.9 to 63.4%, some infectious and parasitic diseases - from 7.7 to 3.0%, diseases of the digestive system - from 3.6 to 3.2%.In the country for 2019-2020 in hospitals at home, the number of treated adults significantly increased by 1.8 times, children - by 2.3 times, the composition of those treated has changed, which is associated with the treatment of patients with a new coronavirus infection COVID-19 in them under conditions re-profiling of the majority of medical organizations into infectious diseases hospitals.

[The surgical activity of medical organizations providing out-patient medical care in The Russian Federation].

One of important directions in improving effectiveness of out-patient surgical medical care is development of in-patient replacement forms. The purpose of the study. is to investigate volume of surgical work performed in medical organizations providing outpatient care in the Russian Federation in 2010-2019. To evaluate changes in dynamics of number and structure of implemented surgical operations, number of operated patients in subdivisions of medical organizations providing outpatient medical care and in conditions of day-stay hospitals, data from the Federal statistical observation form № 30 for 2010-2019 was analyzed. The statistical and analytical methods were applied. It was established that in the Russian Federation, during 10 years, in subdivisions of medical organizations providing outpatient medical care, the number of implemented operations decreased from 5,639,983 to 4,962,020 (by 12.0%), and the number of operated patients - from 5,277,077 to 4,580,195 (by 13.2%). The structure of surgical interventions performed in medical organizations providing outpatient care has practically not changed (operations on the skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). The structure of surgical interventions practically had no changes (operations on skin and subcutaneous tissue, oral cavity and maxillo-facial region, female genital organs, musculoskeletal system, organ of vision). During the studied period, the number of operations performed in day-stay hospitals of medical organizations providing outpatient medical care increased from 181,659 to 720,633 (4.0 times), the number of operated patients - from 168,188 to 650,196 (3.9 times). Mainly in day-stay hospitals, operations are performed on organ of vision, female genital organs, skin and subcutaneous tissue. In 2010-2019, the percentage of operations performed in subdivisions of medical organizations providing outpatient medical care, decreased from 96.9% to 87.3%, and in day-stay hospitals increased from 3.1% to 12.7%. The study results testify expansion of volumes of surgical work in day-stay hospitals of medical organizations providing outpatient medical care.

[The hospital medical care support of individuals older than able-bodied age in The Russian Federation].

The growth of population older than working age with specific age characteristics and problems inevitably results in increasing number of their visits to physicians both in out-patient and in-patient organizations. The purpose of the study is to evaluate indices of hospital medical care of patients older than working age based on the beds profile in the Russian Federation during 2012-2019. The comprehensive study was organized to investigate dynamics of the main indices of inpatient medical care of people older than working age residing at specialized hospital beds (hospitalization rate, hospital mortality, average length of stay in bed). The forms of the Federal statistical observation form № 47 and 30 for the Russian Federation in 2012-2019 were used. The statistical and analytical research methods were applied. During these 8 years, the hospitalization rate of patients older than working age increased up to 4.5% (from 27.36 to 28.6 per 100 of population of corresponding age), the hospital mortality rate - from 3.42% to 3.95%The average length of bed stay of patients decreased from 13.4 to 10.85 days that may be associated with intensification of treatment and diagnostic process. The rates of hospitalization of patients older than working age as compared with adults of able-bodied age were higher by 1.5-8.9 times for certain types of specialized medical care (ophthalmology, palliative care, nursing, cardiology, cardiac surgery, radiology, neurology, vascular surgery, oncology).

[The hospital-substituting technologies: condition and strategic tasks of their development].

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

[The hospitalized morbidity of the population older than working age of the Russian Federation].

The article presents the distribution of patients older than working age, retired from the hospital, analyzed the hospitalized morbidity by classes of diseases and separate nosology in the Russian Federation for the period 2010-2014 years (according to the form of Federal statistical observation № 14). During the study period, the number of persons of retirement age, people released from hospital care, increased by 13,45 % reported a slight increase in the rate of hospital morbidity by 0,14 %. The main reasons for treatment in hospital organizations are diseases of the circulatory system, neoplasms, diseases of the digestive system, respiratory system, eye and adnexa, etc. The average duration of stay on the bed of patients older than working age in hospitals were analysed accordingly classes of diseases. Over 5 years the indicator decreased by 1,3 days (from 14,2 to 12,9 days).