[The social, demographic and professional characteristics of general practitioners and district therapists of state and private sectors of health care].

The article presents comparative analysis of demographic, social and professional characteristics of general practitioners and district therapists in state and private medical organizations. Sociological, statistical and analytical research methods were applied. The study was carried out on the basis of polyclinics of both Moscow Health Department and Moscow private health care sector. The sampling consisted of 399 questionnaires subjected to statistical processing. It is established that in state and private medical organizations, in this group of physicians prevail women 36-55 years old, born in the Russian Federation, in Moscow, married, having children and assessing one's income level as average. Most of them received their higher education in Moscow, graduated residency in therapy and have no medical category or academic degree. The professional experience consists 10 years or more. All physicians in state polyclinics hold more than one position and in private polyclinics 8.6% of physicians are underemployment. In the state sector, paternalistic model of communication with patient is preferable, in the private sector - a collegiate one. In the state sector, the collegiate management style of CEO is convenient and in the private sector - collegiate or dynamic one. In both sectors, adhocratic organizational culture is comfortable. Against the background of readiness to proceed working in current conditions, work in another sector is not excluded. The material factor is considered as main driver of professional motivation. The social, demographic and professional characteristics of general practitioners and district physicians in both sectors of health care in the main are similar, but have their own characteristics.

[The effect of characteristics of patient on satisfaction with medical care rendered by general practitioner and district therapist].

The patient satisfaction is one of the key criteria of quality of medical care and indicator of patient-oriented approach and factor determining competitiveness of medical organization. The purpose of the study - the comparative analysis of patient satisfaction with primary health care provided by general practitioner and district physician, taking into account their gender, age characteristics, frequency and goals of visiting polyclinic. Sociological study was carried out on the basis of out-patient medical organizations in Moscow, Kemerovo and Belgorod. The final analysis included 415 questionnaires of respondents aged 18 years and older. The patients with different rate and purposes of visiting medical institution are equally satisfied with medical care provided by general practitioner and district physician. The satisfaction with general practitioner may have gender characteristics. The satisfaction with district physician may have age characteristics. The satisfaction with both specialists may depend on health status of patient. The model of providing primary health care according to principle of general practitioner may be more universal, while according to principle of district physician more acceptable for elder patients. In order to increase satisfaction with primary health care for all categories of patients, it is necessary to consolidate best organizational approaches of both models.

[The rise of attractiveness of specialty "General Practice" for graduates of medical universities].

The choice of specialty by graduate of medical university can be promoted by particular social, demographic and personal characteristics. Purpose of the study is to investigate demographic, social and personal characteristics of students in residency on specialty "General Medical Practice" in the Russian Federation. The sociological, statistical and analytical methods are applied. The sampling for survey consisted of 81 respondents. The specialty "General Medical Practice" is chosen mainly by women residing in city, non-married and without children. They are not characterized by participation in public life and they are characterized by the presence of hobbies (hobbies). The choice is conditioned by multidisciplinary nature of medical care and scope of professional horizons. They are attracted by treatment work and are less interested in pedagogy and science. In perspective, 80% of female respondents are going to get another specialty. More than 70% of respondents plan to work in out-patient conditions and predominantly in state sector of health care. For women, main goals of further professional training are improvement in main and adjoining specialties and career promotion. And in educational program, internal diseases are of greatest interest. The preferred forms of training are internships and e-learning. The main direction of improving educational process is increasing of scope of practical training. The comparative analysis of study results with data of previous publications was implemented. The factors influencing commitment to specialty are revealed. The proposals increasing attractiveness of general medical practice for graduates of medical universities and keeping in specialty after residency are formulated.

[The influence of gender, age and length of service on educational preferences of general practitioners in Russia].

In conditions of active development of medical and pharmaceutical sciences and dynamically changing work environment the education of physician is to be both continuous and personalized. Purpose of the study. To investigate effect of gender, age and work experience on educational needs and on preferences of forms and methods of training in the system of continuing medical education of Russian general practitioners. The research bases were Chairs occupied with issues of personnel training for general medical practice in Moscow, Belgorod and Kemerovo. The sociological, statistical and analytical research methodologies were applied. The overall analysis covered 402 questionnaires for general practitioners. The sampling of respondents included 19.1% of men, 80.9% of women; 52.4% were aged 36-55 (60) years, 29.3% - 24-35 years and 18.3% - 56 (61) years and older; 45.0% had experience in general medical practice up to 2 years, 16.3% - 3-4 years, 27.0% - 5-6 years, 11.7% - 7 or more years. The results of comparative analysis of opinions of physicians of both genders and various age with different time of experience concerning level of significance for practice of various areas of competence within the framework of specialty and their preferences regarding organizational forms, training methods and its duration are presented. It is established that gender, age and length of service had no significant effect on the studied parameters. However, certain characteristics associated with these factors are identified. The further study of possible influence of other internal and external factors can contribute in the future into formulation of scientifically grounded approach to choosing personalized trajectory of education of general practitioner.

[The gender and age characteristics of general practitioners in Moscow].

The feminization and middle age decreasing in general practitioner profession is a worldwide trend.Purpose of the study is to explore gender and age structure, professional characteristics of general practitioners in Moscow.The retrospective analysis of personal records of students of the Chair of General Medical Practice of the Institute of Professional Education of the The I. M. Sechenov First Moscow State Medical University trained from 2016 to 2020 (n = 400).It is established that women made 80.5% out of them. The average age was 50.7 ± 0.7 years; average general professional experience - 28.8 ± 0.8 years, in general medical practice - 9.7 ± 0.3 years. The internship/residency in therapy was graduated by 84.2% of students. Up to 96.3% worked in state medical organizations. The majority (97.0%) had no academic degree. Indicators with positive dynamics: share of women, physicians with internship/residency in therapy, employees of state medical organizations, without an academic degree. Indicators with negative dynamics: age, professional experience. Differences between men and women were established for residency and professional experience in general medical practice.The average social and professional portrait of general practitioner in Moscow: woman 50 years old graduated internship/residency in therapy, professional experience of more than 20 years, with professional retraining about 10 years ago, working in state medical organization, no academic degree.The activities were proposed considering gender and age specifics, professional characteristics of general practitioners, directed to increasing efficiency and comfort of training.

[The state and private sector of health care system of The Russian Federation: From competition to integration and partnership].

The private health care sector in the Russian Federation is developing and its role in providing not only paid, but also free medical care is increasing. The issues of cooperation between state and private health sectors becomes more actual. The purpose of the study is to investigate current research and practical issues of private health care in the Russian Federation and to identify shared and specific problems with state sector and to develop proposals for evolution of intersectorial interaction and partnership. The study used analytical, sociological and statistical methodologies. The sociological survey covered 409 executives of state and private medical organizations. It was established that current and prospective research and practical problems of state and private health care are mostly shared. The statistically significant differences in opinions of respondents were determined. The list of most actual research and practical problems of private health care was composed. The commonality of derived valuations confirmed trend to integration. The identified sporadic differences are explained by greater social orientation of state health care and directness on competition of private health care. The generalization of national and foreign experience permitted to formulate proposals on partnership between state and private health care. The trend to integration of state and private health care can be transformed into active process of development of long-term partnership cooperation in health recovery and maintenance that will result in ensuring active longevity of population of the Russian Federation.

[The problems of medical care quality in primary section of private sector of health care].

The efficiency of quality control of medical care in medical organizations providing medical care in out-patient conditions is inadequate. The purpose of the study is to identify main problems of ensuring quality of medical care in private medical organizations providing medical care in out-patient conditions and to develop suggestions for their elimination. The assessment of medical care quality in private medical organizations network was carried out using expertise technique (n = 1070), intra-organizational attestation (n = 47), questionnaire survey of administrative (n = 28) and medical personnel (n = 241). The total number of medical care defects made up to 4,822, and 97.3% of them were related to diagnosis and treatment. A full justification of diagnosis was recorded in 65.8% of cases. The cases of insufficient and excessive examination have been identified. The non-compliance with duration of treatment and frequency of visits have been established. The inadequate medical efficiency (67.6%) reliably effected on low compliance of patients, recorded in 18.9% of cases (p < 0.05). The main problems of ensuring medical care quality are related to organization of internal control system, involvement and motivation of medical personnel and development and maintenance of necessary organizational culture. In the private health care sector, quality issues can be solved solely by means of material resources. It is necessary to improve of medical personnel management, internal quality control of medical care and management of organizational culture.

[The patients' evaluation of medical service at the out-patient level].

The article presents the results of questionnaire survey of patients' opinions about out-patient medical care. The survey was carried out using the Doctors' Interpersonal Skills Questionnaire during 12 months. The sampling consisted of 14.712 respondents. The lowest rates out of 11 parameters analyzed received parameters Q5 (Could the doctor reassure you?) and Q7 (Did the doctor help you to express your feelings and fears?). Such a situation was common for all medical specialties. Unexpectedly, combination of low estimate of mentioned parameters with their low correlation and resultant satisfaction with medical care was established. The resultant satisfaction with medical service by general practitioners (family doctors) was less dependent from physician's respectful attitude to patient than attention of physician to personal circumstances of patient choosing treatment. The patients of endocrinologists noted that the least input into resultant satisfaction with medical care was related to ability of physician to assist them to express their fears, and the greatest input was given to first impression from manner and mode of how physician received patient. The least input into resultant satisfaction of patients with medical services by cardiologists was made by respectful attitude of physician and the most input was attributed to way of how physician considers patient's personal circumstances in treatment selection. The patients of gastroenterologists mentioned physician's ability to reassure patient as least input into resultant satisfaction with medical care, and attention to way of how physician considers patient's personal circumstances in treatment selection as most input.

[The intraorganizational training in ambulatory polyclinic organizations].

The intraorganizational training can be an efficient addition to modern system of continuous medical education. The purpose of study is to theoretically substantiate and to develop an intraorganizational system of continuous professional education of medical personnel, to implement intraorganizational system of continuous professional education of medical personnel into medical organizations providing out-patient medical care and to assess its efficiency. The study was organized at the base of three non-state medical organizations of Moscow providing out-patient medical care. Two out of them had net organizational structure, one was represented by single medical organization. The study implemented such research methods as organizational experiment, expertise, sociological survey, test control, analytical and statistical methods. The system of continuous professional education of medical personnel including "Adaptation", "Correction" and "Development" levels was developed and tested. The system of continuous professional education of medical personnel comprises intraorganizational training center, intraorganizational system of remote training, form of long-term cooperation with educational organization, application of target training programs focused on adjustment of deficiency of knowledge and skills and acquirement of new professional competences by medical personnel. The intraorganizational system of continuous professional education of medical personnel can be used as an addition to modern form of continuous medical education. It can be used in state and non-state medical organizations. The study proved positive effect of intraorganizational training on the level of professional qualification, increase of satisfaction of medical personnel and increase of quality of medical care.

[The communicative skills of physicians in ambulatory practice].

The effectiveness of medical care in most cases depends on the quality of information exchange between patient and physician. The knowledge of communicative skills makes it possible for physician to settle more effectively the curative diagnostic and organizational issues in the process of providing medical care to patients. The information support and fundamental theoretical training of physicians not always correspond to modern considerations on patient-physician relationship. The long-standing traditions and profound development of theoretical issues of effective exchange of information between patient and physician provide researchers, practical physicians and teachers large possibilities in significant progressing in the field of development of communication technologies in the system of national public health system.

[The prevention of complaints concerning quality of medical services: the role of communicative skills of medical personnel].

The effective monitoring and prevention of complaints are obligatory elements of management of medical institution. The training of physicians to communicative skills has and additional positive potential in the process of prevention of occurrence of complaints. The training of physicians to communicative skills following procedure of patient-centered counseling makes it possible to significantly decrease number of complaints about quality of medical care in ambulatory medical institution. The training technology is to be convenient for simultaneous training of large amount of physicians.

[On the history of teaching to Russian physicians the communicative skills].

The views of G.A. Zkhariin and S.P. Botkin, the founders of national therapeutic scientific schools, concerning the skills of communication with patients drastically differed. The detailed systematic questioning, the priority of examining the anamnesis data prior to the results of instrumental examination are the characteristic traits of the technique developed by G.A. Zkhariin. S.P. Botkin proposed to apply the communicative technology targeted on the questioning and gathering the anamnesis data in a free manner and having minor importance in comparison with the instrumental examination.