MEDICAL STATISTICS
Purpose of the study: to study the reasons for seeking outpatient medical care for patients in whom, after death, the code R-54 (old age) is indicated in the medical death certificate (MCD) as the initial cause of death (PPD).
Materials and methods of research. Data from the electronic database of the Main Department of the Civil Registry Office of the Moscow Region (USR registry office system of the Moscow Region) and electronic medical records (EMC) from outpatient clinics of the Moscow Region for 2020–2021. In total, 1,269 cases were registered in the MSS with the code R-54 (old age) indicated in the MCD as a PPD, of which 987 (77.7 %) sought outpatient medical care. Data included gender, age, 4-digit ICD codes for all reasons for referrals.
Results. The mean age of the deceased was 87.7 ± 4.7 years (minimum 76 years, maximum 103 years; 1.4 % under the age of 80; females 88.08 ± 4.7; males 86.59 ± 4.6 p < 0.001). In 4 of the deceased, IHD was indicated as other causes contributing to death (part II of the MCD). On average, there were 3.77 ± 3.98 (men 4.2 ± 3.6 and women 3.6 ± 3.3; p = 0.04) reasons for visiting, indicated by 4-digit ICD codes. IHD group codes were registered in 21 %; AG 38.5 %; codes of the group “cerebrovascular diseases” – 25.3 %; cancer – 6.8 %; 5.1 % diabetes mellitus; 9.8 % – COVID-19. Among those who registered one reason for contacting (25 % – 1 4-digit ICD-10 code), 70 % applied for diseases, the rest of the reasons for contacting belonged to the codes of groups R, S and Z.
Conclusion. In the overwhelming majority of cases, the R-54 code in the MCD is used unreasonably. However, taking into account the position of the WHO set out in the ICD and data from other countries, it is necessary to clarify the criteria for the use of both this code and other vaguely defined terms and codes that are used in the MCD as PPD.
REGIONAL EXPERIENCE
The article is devoted to topical issues of reducing mortality from cardiovascular diseases and the role of behavioral risk factors on the example of the Ryazan region. There is a high contribution of acute and chronic forms of coronary heart disease (IHD) to mortality from diseases of the circulatory system and, in general, to mortality from all causes. The main risk factors contributing to the development of stroke, myocardial infarction, percutaneous coronary interventions and all-cause mortality are dyslipidemias, high SCORE risk, high blood pressure, excessive alcohol consumption and coronary heart disease, stroke, a history of myocardial infarction, the need for exposure becomes obvious. on these factors and factors associated with a high risk of fatal and non-fatal events. Correction of risk factors is possible only through the implementation of integrated prevention programs. Preliminary results from the Healthy Heart 2021 project demonstrated the potential for improved control of risk factors at the population level and the need to continue the project at the regional level. In addition, it seems necessary to expand it with the formation of subprograms in the framework of reducing mortality from other chronic non-communicable diseases.
PUBLIC HEALTH
The aging of the population is a new global problem, which attracts much attention in many countries: the strategies and programs aimed at maintaining the health of people over working age are being developed and implemented.
Aim. Due to the increasing part of the elderly in the total population and the number of state programs implemented in the Russian Federation to support them, it is interesting to evaluate the satisfaction of this target group with active longevity program on the example of the Moscow Longevity Center program.
Materials and methods. The object of the study was the population of retirement age in the South-eastern administrative District (Marjino, Kapotnya) of Moscow. The site was the territorial social centers of the South-Eastern Administrative District of Marjino, Kapotnya. The subject of the study was state social programs for citizens of retirement age. The questionnaire, including 15 closed and 1 open question was created in order to study the satisfaction of citizens of retirement age with active longevity programs.
Results. Social programs for active longevity have a positive effect on citizens of retirement age, which affects their wellbeing, physical and social activities, and also encourages the population to maintain a healthy lifestyle.
Conclusion. The study showed that state social programs of supporting citizens of retirement age are an example of effective interagency cooperation, they contribute to improving the quality of the active life of older people and should be actively developed and implemented throughout the Russian Federation.
HEALTH ORGANIZATION. REGIONAL EXPERIENCE
This article provides description of the existing regulatory framework for interaction between medical organizations that provide health to people with risky, hazardous (harmful) use of alcohol or other psychoactive substances in the Russian Federation.
Aim. Exploring existing opportunities to improve interaction of primary health care institutions and narcological service to provide care to patients with risky use, harmful use or dependence on psychoactive substances.
Materials and methods. The article presents results of implementing the action plan to organize medical prevention in 71 regions of the Russian Federation, based on data provided by chief narcologists of these regions during 2017–2018. The analysis of the existing practice of the interaction of medical institutions for the prevention of the harmful use of psychoactive substances was carried out; were studied the principles of organizing screening and preventive counseling in primary health care; the features of training and education of specialists of medical organizations in the methodology of screening, preventive and motivational counseling were studied in different regions of the Russian Federation.
Discussion. During 2017–2018 more than 14.5 million patients were screened in primary health care. Problems alcohol and other psychoactive substances use were identified in more than 300,000 patients (2.4 %). The highest rates of identified substance use disorders’ risks were observed in primary specialized medical care settings (5.1 %); lower rates were observed among those who were undergoing screening in primary health care settings (1.8 %), during preventive health assessment (2.3 %) and during preventive medical check-ups (2.4 %). More than 19,000 health workers have been trained in motivational counseling techniques.
Conclusion. The problem of substance abuse and related medical and social consequences remains highly relevant, and therefore requires further implementation of preventive technologies with proven effectiveness.
The use of the method of expert assessments is an indispensable element of the search for reserves to improve the quality and safety of medical activities for the realization of strategic tasks in the field of population conservation and improvement of health indicators of the Russian population.
The purpose of the study was to assess the factors influencing the appeal for drug treatment of alcohol–associated diseases in state medical organizations on the model of a large agro-industrial region.
Materials and methods. Anonymous sociological survey was conducted in 2022. 135 doctorsspecialist in the field of “Psychiatry-narcology” working in outpatient or inpatient units of the public health system of the Krasnodar region. The following methods were applied in this study: sociological, statistical, content analysis, expert assessments.
Results. The representative group of experts was characterized by a predominance of female doctors (57,0 %), persons aged 40–49 years (25.2 %) with a qualification category (76.3 %), with more than 15 years of work experience in the specialty “Psychiatry-narcology” (58.5 %). The organization of drug treatment in outpatient settings was rated “good” and “excellent” by 54.8 % of respondents, in inpatient – 71.1 %. According to experts, the factors of legal restrictions, public censure, as well as defects in the self-assessment of the nosological status of patients and the lack of general medical literacy of the population had the greatest impact on the decrease in the incidence of drug treatment for alcohol-related pathology.
Conclusion. The potential aspects of possible directions for selective influence in order to increase the appeal of the population with addictive alcohol disorders to specialized professionals and the preservation of human resources were identified.
LEGAL ACTS
ISSN 2713-0703 (Online)