INFORMATION TECHNOLOGY
Telemedicine technologies (TMT) represent a digital tool within the organization of medical care aimed at increasing its accessibility as well as improving the quality of medical services provided through consultations and medical councils involving third-level organizations, including national medical research centers. A content analysis was conducted of regulatory legal acts, focusing on the application of TMT in various organizational models of medical care delivery. The authors systematized information on regulatory legal frameworks for organizing medical care using TMT, outlined organizational options for interaction among healthcare professionals, as well as within the framework of remote monitoring of patient health. The concept of an experimental legal regime in the field of digital innovations related to medical activities, including the use of TMT and technologies for collecting and processing information about patients health status and diagnoses, was analyzed. An analysis was conducted of the regulatory framework for a pilot project on remote monitoring of patient health using the information system (platform) “Personal Medical Assistants”.
INFORMATIZATION OF HEALTHCARE
Aim. To assess the possibility of expanding the use of telemedicine technologies implemented in the Sverdlovsk region in the provision of obstetric and gynecological care by SWOT analysis of strengths, weaknesses, threats and prospects.
Materials and methods. Based on the results of a survey of 305 pregnant women living in the Sverdlovsk region and 104 obstetricians and gynecologists, an analysis of data published in scientific articles and reviews, and a study of the legislative framework regulating the use of telemedicine technologies, a SWOT-analysis table was compiled. To identify the most significant parameters, the paired comparison method and the Saaty hierarchy analysis method were used. Judgments are accepted as consistent with a consistency ratio of ≤0.1.
Results. The identified factors were combined into the corresponding tables: factors ensuring a stable position and competitive advantages (Strengths (S)), factors leading to a decrease in the volume of use and loss of competitiveness (Weaknesses (W)), positive factors beyond our influence. (Opportunities (O)) and negative factors beyond our control (Treats (T)).
Conclusion. The main strength of the implemented technologies is recognized as the immediate transfer of information to the attending physician and curator to resolve issues regarding the need for emergency hospitalization, routing, and conducting a remote or inperson consultation in the event of remote detection of deviations in health parameters from standard values. The main opportunity for further use is recognized as the establishment of mandatory use of telemedicine technologies at the legislative level. The main weakness is the likelihood of data loss due to equipment failure. The main threat is the possibility of disclosure of medical confidentiality as a result of database hacking.
QUALITY AND SAFETY OF MEDICAL CARE
In patient-centered health care, patients’ perspective about treatment outcomes, namely their quality of life (QoL), is an important indicator of quality of medical care.
Aim. To develop the algorithm for QoL monitoring and satisfaction with treatment outcomes among patients receiving inpatient care to control its quality and test the algorithm across patients undergoing surgery.
Materials and methods. The algorithm was tested within a single-center prospective cohort observational study among adult patients who received surgical treatment in the Department of Cardiovascular Surgery and the Department of Gynecology of St. Petersburg State University Hospital. The analysis was performed in the group of 2117 patients (mean age 56.5 years, 71.8 % women). Statistical analysis included the Wilcoxon test, χ2 and generalized estimating equations.
Results. The developed algorithm included the following milestones: selection of questionnaires – EQ-5D for QoL assessment, Picker questionnaire for patient’s experience about hospital stay, IMPSS for satisfaction with treatment outcomes; creation of electronic forms of instruments and their integration into the medical information system; determination of the assessment time-points and the format of monitoring; elaboration of the principles of questionnaires data analysis. For the significant amount of patients steady positive changes of their wellbeing after treatment were established. The appearance of meaningful problems at discharge was registered in less than 1.5 % of patients. The vast majority of patients were satisfied with treatment outcomes. Positive experience of hospital stay was observed by most patients. Identified areas of hospital stay that can be improved are consideration of patient preferences, continuity of care, and psychological aspect.
Conclusion. Implementation of the developed algorithm into the quality management system in medical institutions could be of value to control quality of medical care with the focus on patient-reported outcomes and could contribute to the patient-centeredness of care.
PROBLEMS OF SOCIALLY SIGNIFICANT DISEASES
The study and analysis of the practice of managing patients with sexually transmitted infections (STIs) is the basis for the development of unified modern approaches to the provision of specialized medical care in the field of dermatovenerology.
Aim. To study the effectiveness of providing medical care to patients with gonococcal infection in dermatovenerological organizations in the Moscow region.
Materials and methods. A retrospective analysis of 151 medical records of outpatients with gonococcal infection identified in the Moscow region in 2020–2023 was conducted. For statistical processing of the data, the method of simple descriptive statistics was used (Pearson’s goodness-of-fit test (c2).
Results. When analyzing the results of using laboratory methods for the diagnosis of gonococcal infection, microscopic and polymerase chain reaction (NCMT – N. gonorrhoeae, С. trachomatis, M. genitalium, T. vaginalis) studies coincided in 99 (65.6 %) patients. In 27.9 %, gonococcal infection occurred as a mixed infection with other STIs. The effectiveness of the treatment of gonococcal infection and the compliance of the treatment with the algorithms presented in the approved clinical recommendations were analyzed. It was found that the prescribed methods of treatment of gonococcal infection only in 48 % of cases corresponded to the regulatory recommendations for the treatment of STIs.
Conclusion. The obtained results indicate the need to carry out organizational and methodological measures to optimize the procedure for providing medical care to patients with gonococcal infection.
PERSONNEL
Psychoemotional disorders caused by professional stress make a significant contribution to substance abuse by health workers, which requires studying specific predictors of the formation of addictive behavior and developing targeted prevention programs.
Aim. To study the socio-demographic and clinical-psychological predictors of smoking and alcohol abuse among health workers using the factor analysis method and taking into account gender differences.
Materials and methods. The sample consisted of 575 health workers (86.3% women), the average age was 42.7 ± 10.2 year. The structure of the factor analysis included socio-demographic data, parameters of clinical and psychological risk factors for addictive behavior (ASSIST test), indicators of the psychoemotional state (K10 and IES-R scales).
Results. Factor models were developed taking into account gender and the level of risk of substance use. Two risk groups for the use of nicotine-containing products (absence and low risk; moderate risk) and two risk groups for alcohol use (absence and low risk; moderate and high risk) were identified. The greatest contribution to the increase in the risk of abuse of nicotinecontaining products and alcohol for all groups was made by the factor of post-traumatic stress disorder and psychological distress, except for the group of male health workers who consumed alcohol with moderate or high risk. In the groups of health workers who consumed alcohol with moderate or high risk, regardless of gender, signs of anosognosia in relation to harmful alcohol consumption were observed.
Conclusion. The obtained results emphasize the importance of complex psychological and psychotherapeutic work with health workers who have specific socio-demographic, clinicalpsychological and psychoemotional predictors of substance abuse.
In recent years, the Russian Federation has paid great attention to the state of public health of the population, its preservation and strengthening. Specialists in this field and the level of their training play a special role in the effective solution of public health problems. The analysis of educational programs and professional standards of specialists engaged in disease prevention and health promotion is an important step to identify problems in the educational process and to develop recommendations for its improvement.
Aim. To analyze the system of personnel training in the field of public health within the framework of medical education of the Russian Federation, to propose directions for its optimization.
Materials and methods. Normative documents regulating educational and professional activities in the field of public health, public health and preventive medicine of the Russian Federation were studied: 20 federal state educational standards of higher education in the direction of training 31.00.00 Clinical Medicine and 32.00.00 Health Sciences and Preventive Medicine and 4 professional standards.
Results. The analysis has shown a discrepancy between the knowledge inherent in educational programs and the level of knowledge of medical workers on health and disease prevention, including those responsible for conducting health check-ups. There is a negative trend in the quantity and quality of graduates in the field of medical and preventive medicine. To ensure quality training of specialists in the field of public health, it is necessary to update and harmonize educational programs of all medical specialists on disease prevention with subsequent quality control of knowledge; development and approval of professional standards “doctor for medical prevention” and “specialist in the field of public health”.
Conclusion. The results of the analysis can serve as a basis for the development of strategies and initiatives aimed at developing the system of training of public health specialists, increasing the attractiveness of and interest in preventive medical specialties and the development of scientific research in this area.
LEGAL ACTS
ISSN 2713-0703 (Online)