[Improvement of quality characteristics of medical services based on patient satisfaction measurement results and QFD tools].

One of the directions to increase the effectiveness of medical organizations in the region is the development of managerial tools for improving the quality of medical services. The aim of the study is to develop an approach to improving the quality of medical services based on the results of measuring patient satisfaction with the quality of medical services, mapping satisfaction criteria to medical and technological characteristics of the quality of services, substantiation and selection of appropriate corrective measures. The method of measuring patient satisfaction with the quality of the provided medical service and the method of deploying quality functions ensuring transformation of patient needs and expectations into characteristics of service quality were used. The measurement of patients' satisfaction with the quality of medical services is carried out during medical and sociological research. The measurement results are obtained by statistical processing using a software set. To determine measures to improve the quality of cardiological services, the results of changing patient satisfaction were used in accordance with the method of deploying quality functions, which consists in implementing a number of steps that ensure the determination of a minimum set of additional requirements for medical services in order to meet the requirements of patients. This technique is supported by specialized software. Implementation of the proposed approach makes it possible to form tools aimed at creating an information model of medical services and ensure the change in the quality of such services demanded by patients.

[Childhood disability due to mental disorders in the Arkhangelsk region: structural and dynamic trends]. / Detskaya invalidnost' vsledstvie psikhicheskikh rasstroistv v Arkhangel'skoi oblasti: strukturno-dinamicheskie tendentsii.

OBJECTIVE: To examine the structural-dynamic trends in disability in children aged 0-14 and 15-17 in the Arkhangelsk region (AO) over the period 2010-2020. MATERIAL AND METHODS: The age-standardized rates of primary and total disability calculated on the basis of the official statistical data presented in the form No.19 «Statistics on Disabled Children¼ for 2010-2020 in AO excluding Nenets autonomous district.and Russian Federation (RF), section «Mental disorders and conduct disorder¼ (F00-F99 according to ICD-10) were used. Age-specific population data were taken from the Russian database on fertility and mortality. The methods of econometric and statistical analysis (the index method, the Irwin method, the Chow test) were used. RESULTS: In the Arkhangelsk Oblast, as well as in the whole country, there has been a growth in disability rates over the last decade. The level of the general children's disability in AO was lower than in the RF on the average by 25.7 (±3.45)%. The age groups 5-9 (6.03%) and 15-17 (3.70%) years contribute mostly to the ten-year trend in the overall rate of mental disabilities. The increase in childhood disability due to mental disorders was 13.96% over 2010-2019, with this increase being due to so-called 'other mental disorders' (all mental disorders other than mental retardation) by 27.29%, while the dynamic contribution of disability due to mental retardation (F70-F79) was negative (-13.32%). CONCLUSION: The dynamics of total disability in children due to mental disorders in the AO has a common with the Russian average upward trend at a lower level. The age groups 5-9 and 15-17 years old have the greatest significance for the dynamic changes in the general disability of children due to mental disorders. The leading nosological group responsible for the ten-year increase in disability due to mental disorders is «other mental disorders¼.

[The experience of SERVQUAL technique application in measuring satisfaction of patients with medical services quality].

The implementation of system of quality control conforming to requirements of interstate ISO 9001 standards in in the medical organization, the important role is assigned to indicator of satisfaction of patients with quality of medical care as a feedback channel. The study purpose was to investigate satisfaction of patients with quality of medical services in medical organization rendering hospital medical care on the basis of SERVQUAL technique. The analysis of results of survey of 339 patients treated in the twenty-four-hour department of municipal hospital demonstrated rather high rating of perception of quality of rendered medical services that made up to 4.47 points according five-point scale. The application of GAP analysis technique allowed to reveal gaps between expected and real quality of received medical services by means of SQL index quality. The highest points were received for such criteria as "Sympathy" (0.61 points), "Responsiveness" (0.20 points). The satisfactory results were in case of criteria "Materiality" (-0.38 points), "Reliability (-0.43 points). The lowest points were received for criteria "Persuasiveness, confidence" (-0.69 points) that reflects inadequate orientation of hospital personnel to settle problems of patients. The study demonstrated that applying the SERVQUAL technique in assessment of quality of medical services allows to reveal the most significant factors determining satisfaction of patients. The results of survey based on the SERVQUAL technique and processed by GAP analysis are to be considered in management decision making concerning choice of correcting and preventive actions in quality management of rendering medical services at the regional level.

[The trends in primary morbidity of adult population of the Russian population during implementation of state programs].

The article presents the results of analysis of indices of primary morbidity of adult population in the Russian Federation during implementation of state programs. The purpose of the study was to study the dynamics of indices of primary morbidity of adult population of Federal districts and subjects of the Russian Federation in 2006-2011 and 2012-2018. The analysis established the subjects of the Russian Federation where the mentioned indices factually remained unchanged or had negative dynamics. Also, the periods of health care reform with positive dynamics of indices of primary morbidity were determined. Besides, reforming process was not always systematic and not all planned tasks were completed that , resulted in significant discrepancies in values of indices of primary morbidity among particular subjects of the Russian Federation. This kind of analysis permits to identify specific directions of improving regional policy in health care.

[The public opinion about health care: the main factors of increasing satisfaction of population with medical care].

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning. The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation. The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out. The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified. It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

[The organizational forms of preventive activities in population].

The concept of health progression through treatment of patient received no justification as significant deterioration of population health in last years is an obvious evidence. The practical medicine is to be focused on both ill and healthy people. The characteristics of modern structure of morbidity and mortality in Russia force to admit priority of caring health of healthy people. In the post-Soviet period the existed then system of preventive care of schoolchildren, representatives of main professions and groups of population factually was destroyed. This kind of activities is to be restored in medical sanitary units. However, the analysis of practice of clinical examination revealed the presence of a number of organizational and methodological costs that decreases efficiency of applied resources does not allow to fully achieve established goals. The article presents analysis of dispensarization of population in the Russian Federation and evaluation of efficiency of functioning of the Health Centers. The experience of youth-friendly clinics is evaluated. The organizational structure of preventive work at the level of primary medical sanitary care and its interaction with specialized services in health care.

Working time costs of doctors-therapists of divisionals on a patient.

AIM: The aim of this article is to establish a weighted average costs of the workflow of the doctor-the therapist of the district, providing primary health care to the population in the outpatient setting to determine the costs when you visit one patient. MATERIALS AND METHODS: Held fotohronometra working process research 39 physicians in the 17th precinct pilot areas from all Federal districts. Within fotohronometra research conducted 6474 measurement. RESULTS: The average time a physician of the district while visiting a patient in a medical organization made up of 15.30±2.0 min, while visiting at home - 32.5±2.0 min the Largest proportion of the working time of the doctor-the therapist of the district while visiting a patient in the outpatient setting is necessary to work with medical records (47.31%). On core activities while visiting a patient in the practitioner, the district spends to 45.54% of the time. For other activities - 7.15%. CONCLUSION: As a result fotohronometra research workflow of doctors-therapists of district, providing primary health care in outpatient settings, set the average time a physician of the district while visiting one patient (15.30±2.0 min), while visiting at home (32.5±2.0 min).

[The main trends in primary morbidity of population in the subjects of the Russian Federation in 2008-2017].

The analysis of primary morbidity is the most important indicator of detection of population health in every single subject of the Russian Federation in whole Russia. This approach also permits to monitor impact of economic and social processes on the national level. The article presents analysis of primary morbidity in the subjects of the Russian Federation in 2008-2017. The trends are established, the rates of increase and decrease of primary morbidity in every particular subject of the Russian Federation are calculated. The subjects with significant increase of particular classes of diseases according ICD-10 were identified. During last decade, the indices of primary morbidity increased on the whole up to 0.9%. The decrease was registered only in the Central and Privolzhskiy Federal Okrugs (4.3% and -1.6% correspondingly. In the rest of Federal Okrugs increase was registered. The highest level of primary morbidity was registered in the Nenets Autonomous Okrug and the lowest level in the Kabarda-Balkar Republic. Ib 2017, the Altai Kray became a leader in registration of primary morbidity of neoplasms and diseases of endocrine system and the Pensa oblast took the lead in registration of primary morbidity of diseases of cardiovascular system. In 2017, the highest level of morbidity of diseases of respiratory system was registered in the Chukchi Autonomous Okrug and of diseases of ear and mastoid bone in the Republic of North Ossetia - Alania. The increase of morbidity in the mentioned classes of diseases in the particular subjects of the Russian Federation requires consideration of leading specialists and corresponding development of measures concerning morbidity stabilizing.

[The problems and perspectives of development of rural health care].

The changes in social and economic life that took place in Russia during last decades resulted in significant reduction in agricultural production, deterioration of life of rural population, limitation of accessibility and decreasing of quality of medical care that negatively impacted health of rural residents. The results of research studies testify low level of rural population health, which by many indices is worse as compared with urban population. The persistent tendency of its deterioration is established. These processes occur against the background of implementation of the Federal target program "The sustainable development of rural areas in 2014-2017 and until 2020" which is a logical continuation of the program "The social development of rural areas until 2013". The programs determine main directions of regulating integrated development of rural areas including such an integrated section as development of rural health care. The study was targeted present proposals concerning reformation and prospects of development of rural health care on the basis of analysis of key indices of medical organizations functioning, supporting rural population, with consideration of morbidity and accessibility of medical care to rural areas residents.

[The Actual Approaches to Reformation of Medical Organizations Providing Out-Patient Care to Population].

The article presents analysis of the system of organization of primary medical sanitary care in the Russian Federation, its strong and weak aspects are emphasized. The main indices of out-patient care of population and their dynamics are considered. The necessity of system development is substantiated with the purpose of supporting accessibility and quality of medical care in out-patient conditions. The concept of development of organizational functional model of primary medical sanitary care in actual conditions is presented. The main principles of the proposed model are founded on implementation of structural transformation of polyclinics with organization of departments of general practitioner practice, specialized consultative care, medical prevention, diagnostic, medical rehabilitation, medical social care, day-time hospital.

[The informational support of statistical observation related to children disability].

Within the framework of the Convention on rights of the disabled the revision is specified concerning criteria of identification of disability of children and reformation of system of medical social expertise according international standards of indices of health and indices related to health. In connection with it, it is important to consider the relationship between alterations in forms of the Federal statistical monitoring in the part of registration of disabled children in the Russian Federation and classification of health indices and indices related to health applied at identification of disability. The article presents analysis of relationship between alterations in forms of the Federal statistical monitoring in the part of registration of disabled children in the Russian Federation and applied classifications used at identification of disability (International classification of impairments, disabilities and handicap (ICDH), international classification of functioning, disability and health (ICF), international classification of functioning, disability and health, version for children and youth (ICF-CY). The intersectorial interaction is considered within the framework of statistics of children disability.

[The methodological prerequisites of elaboration of advanced regional patterns of medical care provision to population].

The article deals with the characteristics of medical demographic indicators, morbidity indicators, public health resources indices and medical care volumes in Federal okrugs. The analysis provided a basis to develop the designed and adjusted standards of main volumetric indicators for territorial programs of public guarantees of free-of-charge medical care to population of the Russian Federation according the Federal okrugs.

[Topical aspects of organization of tuberculosis monitoring at the level of a subject of the Russian Federation (in case of the Belgorod Region)].

The paper shows how a tuberculosis monitoring system is under development at the level of the Russian Federation subject--the Belgorod Region. The tuberculosis monitoring system allows an effective control of both tuberculosis-controlling measures determined by the existing normative documents and orders and supplementary measures to enhance the effectiveness of tuberculosis control in the region. Tuberculosis monitoring should be further improved at the regional region by the sections: outpatient visit, antiepidemic measures in the foci; children's sanatorium work, cohorts to be examined by a physio pediatrician.

[Control of tuberculosis in Russia and other countries of the former Soviet Union]. / Die Kontrolle der Tuberkulose in den Nachfolgestaaten der Sowjetunion am Beispiel Russlands.

BACKGROUND: Tuberculosis (TB) remains a serious threat to public health in Russia and other former Soviet Union Countries. The purpose of this paper is to describe the current trends of TB and MDR-TB in Russia and identify the characteristics of the traditional Russian TB control model inherited from the Soviet Union. We discuss current challenges to TB control in the country. METHODS: WHO tuberculosis notification data were analysed for Russia and 14 other former Soviet Union countries. To investigate the characteristics of TB control in Russia, we performed a systematic literature review using MEDLINE/EMBASE databases. 136 articles were initially identified of which 66 fulfilled the inclusion criteria. Full texts were reviewed. Additionally, we reviewed non-systematically Russian state reports, guidelines and legislations. RESULTS: In 2006, nearly 125 000 TB cases and 28 000 TB deaths were notified in the Russian Federation. The TB notification rate was 13 times higher than in Germany. The characteristics of the traditional Russian TB control model include: a centralised disease-specific inpatient network for diagnosis and treatment of TB, countrywide population screenings using fluorography, a strong focus on X-ray for diagnosis and disease classification, individualised and lengthy inpatient care, high rates of drug resistance, and inefficient financing systems. CONCLUSIONS: Current challenges to TB control in Russia are: the implementation of a quality-assured laboratory network for sputum-smear microscopy, culture and drug susceptibility testing, ensuring MDR-TB treatment and control, prevention and management of TB/HIV, and reform of health care financing systems. For TB control to be successful in the Russian Federation, the characteristics of the traditional TB control model need to be taken into account.

[Prevalence of tuberculosis among children and adolescents in the Russian Federation: analysis of official statistics].

The paper provides the analysis of the prevalence rates of tuberculosis among children and adolescents in the Russian Federation, which has been made on the basis of the data available in official reporting forms Nos. 8, 33 (approved by the Resolution of the Russian Statistics Agency on November 11, 2005), and 47 (approved by Resolution No. 175 of the Russian Statistics Agency on September 10, 2002). Correlations between epidemiological indices have been calculated and assessed. The age-related features of the occurrence and course of tuberculosis have been studied among various age groups of children. It is concluded that in this situation in order to improve the epidemic situation among children and adolescents, emphasis should be primarily placed on the activation of intersectoral interaction of primary health care and tuberculosis service: to actively attract general practitioners, local pediatricians and therapists to prophylaxis in children.

[Work quota setting in a phthisiatrician during outpatient reception hours (as a consulting and local physician)].

The study was undertaken to determine a phthisiatrician's man-hours during outpatient hours as a consulting and local physician in the Stavropol Territorial Tuberculosis dispensary. It used an analytical method - man-hours for individual components of work, i.e. working operations at photochronometric monitoring. The latter of the work of two consulting physicians and two local ones (two working weeks per specialist) was made. The 2006 phthisiological care schedule envisaged 185.6 visits per 1,000 dwellers. If these data are taken as the basis, then 0.64 of the position of a phthisiatrician per 10,000 is required to deliver health care to patients with tuberculosis, by taking into account the work quota setting developed in this study. An expert evaluation was to substantiate the labor hours of a phthisiatrician when he delivered outpatient health care to patients with tuberculosis. Expertise of the substantiation of the labor hours of a phthisiatrician delivering outpatient health care to patients with tuberculosis has revealed that the maximum working time spent by the phthisiatrician on medical documentation work, to the prejudice of the quality of patient examination, the raising the level of his skills, and the performance of preventive work among the patients.

[Trends of tuberculosis morbidity and mortality in Russia in 2005].

The most informative indices; such as tuberculosis morbidity and mortality, were used to assess the tuberculosis epidemiological situation in Russia in 2005. Analysis of the rates of tuberculosis morbidity and mortality showed that the epidemic situation associated with tuberculosis remained to be of strain in Russia in 2005. This is evidenced by high tuberculosis morbidity and mortality rates and their increase. In 2005, there was a considerable rise in the frequency of recurrent tuberculosis and, as before, the high incidence of extrapulmonary tuberculosis, such as tuberculosis of the meninx, central nervous system, and bones and joints, in children aged 0-14 years. In 2005, as in previous years, the peak of tuberculosis morbidity was seen in young age groups (25-45 years) irrespective of gender. In 2005 versus 2004, a 3.8% increase in tuberculosis mortality was due to higher death rates among patients with chronic tuberculosis.

[Comprehensive assessment of the tuberculosis epidemic situation in Russia].

The study including integral estimates of the tuberculosis epidemic situation in Russia as a whole in the period of 1985 to 2004 and in its regions in 2004 has been undertaken. Its basic difference from numerous studies in this area is a comprehensive assessment using integral estimates derived by the authors' method. A set of single epidemiological parameters that reflect the epidemic situation to the greatest extent and are the basis for calculating integral estimates that adequately reflect the tension of tuberculosis endemia is presented. The use of this procedure has allowed the authors to follow up trends in the tuberculosis epidemic situation in Russia in the past 20 years and to establish its association with socioeconomic upheavals occurring in the country over the study period. An association of tuberculosis endemic ill-being with its location has been established by Federal districts.

[Calculation of a risk for death due to tuberculosis in case of the Sverdlovsk Region].

Many factors influence the risk of death in patients with tuberculosis. The most significant factors are a clinical form of the disease, combinations, comorbidity, age, and the duration of death. The risk of death averaged 4.2% in patients with new-onset tuberculosis, 30.4% in those with recurrent tuberculosis, and 6.4% in the registered. In patients with new-onset tuberculosis, the highest risk of death was established in tuberculous meningitis, miliary tuberculosis, fibrocavernous tuberculosis, and complications of tuberculosis (such as hemorrhage, spontaneous pneumothorax) increased the risk of death by almost 10 times (40.2%) and progression of HIV infection to AIDS by 7 times. The risk of death was increased up to 9.2% in primary multidrug-resistant pulmonary tuberculosis and by 12.7% in acquired one.