Cannabis consumers' preferences for legal and illegal cannabis: evidence from a discrete choice experiment.

BACKGROUND: In U.S. states that legalized and commercialized recreational cannabis, cannabis sales in illegal markets are still sizable or even larger than those in legal markets. This study aimed to assess cannabis consumers' preferences for purchasing cannabis from legal and illegal markets and estimate the trade-offs under various policy scenarios. METHODS: 963 adults were recruited, who used cannabis in the past year and lived in a state with recreational cannabis legalization. In a discrete choice experiment, participants chose purchasing cannabis from a legal dispensary or an illegal dealer with varying levels in product attributes including quality, safety, accessibility, potency, and price. Mixed logit models were used to analyze preferences. RESULTS: The likelihood of choosing legal cannabis increased with a higher quality, the presence of lab test, a shorter distance to seller, a higher tetrahydrocannabinol level, and a lower price. The likelihood of choosing illegal cannabis increased with a higher quality, a shorter distance to seller, and a lower price. Among product attributes, quality and accessibility were perceived to be the most important for legal cannabis and price was perceived to be the most important for illegal cannabis. Policy simulations predicted that improving quality, ensuring safety, allowing delivery services, increasing dispensary density, and lowering prices/taxes of legal cannabis may reduce illegal cannabis market share. CONCLUSIONS: In the U.S., cannabis consumers' preferences for illegal cannabis were associated with both legal and illegal cannabis product attributes. Policies regulating legal cannabis markets should consider potential spillover effects to illegal markets.

Dispensary Staff Perceptions About the Benefits, Risks, and Safety of Cannabis for Medical Purposes.

BACKGROUND: Therapeutic use of cannabis is common in the United States (up to 18.7% of Americans aged ≥12), and dispensaries in the US are proliferating rapidly. However, the efficacy profile of medical cannabis is unclear, and customers often rely on dispensary staff for purchasing decisions. The objective was to describe cannabis dispensary staff perceptions of medical cannabis benefits and risks, as well as its safety in high-risk populations. METHODS: Online Survey study conducted using Qualtrics from February 13, 2020 to October 2, 2020 with a national sample of dispensary staff who reportedinteracting with customers in a cannabis dispensary selling tetrahydrocannabinol-containing products. Participants were queried about benefits ("helpfulness") and risks ("worry") about cannabis for a variety of medical conditions, and safety in older adults and pregnant women on a five-point Likert scale. These results were then collapsed into three categories including "neutral" (3/5). "I don't know" (uncertainty) was a response option for helpfulness and safety. RESULTS: Participants (n = 434) were from 29 states and included patient-facing dispensary staff (40%); managers (32%); pharmacists (13%); and physicians, nurse practitioners, or physician assistants (5%). Over 80% of participants perceived cannabis as helpful for post-traumatic stress disorder (88.7%), epilepsy (85.3%) and cancer (83.4%). Generally, participants were not concerned about potential cannabis risks, including increased use of illicit drugs (76.3%), decreases in intelligence (74.4%), disrupted sleep (71.7%), and new/worsening health problems from medical cannabis use (70.7%). Cannabis was considered safe in older adults by 81.3% of participants, though there was much less consensus on safety in pregnancy. CONCLUSIONS: Cannabis dispensary staff generally view medical cannabis as beneficial and low-risk. However, improvements in dispensary staff training, an increased role for certifying clinicians, and interventions to reduce dispensary staff concerns (e.g., cost, judgment) may improve evidence-based staff recommendations to patients seeking medical cannabis.

[Possibilities of dispensary observation in reducing mortality from coronary heart disease].

Dispensary observation of patients with coronary artery disease can significantly reduce the likelihood of cardiovascular complications onset. Active outpatient monitoring allows to correct the main risk factors for cardiovascular complications, to estimate the risk of unfavorable cardiovascular events onset and to identificate patients who will get benefit of coronary revascularization. The introduction of a comprehensive assessment of cardiovascular risk and the development of remote monitoring technologies will improve the long-term results of outpatient follow-up of patients with coronary artery disease at high cardiovascular risk.

[THE EVOLUTION OF PROACTIVE DISPENSARY MONITORING IN THE MOSCOW HEALTHCARE SYSTEM].

Economic and social losses due to epidemics of non-communicable diseases have put prevention and control of them on the first line in the field of sustainable development of the United Nations. The tasks of combating NCDs and risk factors within the framework of the Sustainable Development Goals require targeted actions on the part of States in the field of policy and legislation and provision of health systems with appropriate resources. In the Russian Federation, such work is being implemented within the framework of the national project "Healthcare", federal programs to combat oncological and cardiovascular diseases. Each subject takes into account the peculiarities of economic development, staffing, implementation of informatization processes, etc. The rapid pace of transformation of Moscow healthcare, its unique institutional structure allowed to form the basis for the effective development of a system of proactive dispensary monitoring of patients suffering from chronic diseases. The authors describe the process of formation of preventive work and organization of dynamic dispensary observation in Moscow. The paper presents in detail the organizational, administrative and technological resources used to create a unique system of dynamic dispensary observation. In addition, the article illustrates the personalized subsystem of dynamic dispensary observation in EMIAS and the institute of "physician assistant". The introduction of a proactive dispensary monitoring system will reduce premature mortality and disability among residents of the city. Moscow through an individual monitoring program and motivation for the responsible attitude of metropolitan patients to their health.

[The certain aspects of organization of medical care of women in period of pregnancy and delivery in the Republic of Bashkortostan].

Health protection of women of reproductive age is a priority direction of state policy. In protection of reproductive health of women no small importance is played by development of organization of primary medical sanitary care and specialized medical care of women during pregnancy and delivery. The study was carried out in the Republic of Bashkortostan and covered period of 2017-2021. It was established that the number of women of fertility age decreased up to 3,9% that became one of causes of reduction of birth rate from 12.1‰ to 9.8‰ respectively. At that, the level of maternal mortality increased up to 8.9 times (from 4.1 to 36.8 per 100,000 born alive). In 2021, out of 37,775 women who completed their pregnancy, 99.3% were examined by therapist and only 92.2% passed such an examination prior to 12 weeks of their pregnancy. On the gestation period of 11-4 weeks, 91.3 % of pregnant women were subjected to ultrasound examination of fetus with detection of maternal serum markers and 94.4% of pregnant women were examined at the 19-21 weeks of pregnancy. Among pregnant women, rate of diseases and pathological conditions that preceded or developed during pregnancy slightly increased. Increasing of morbidity of anemia, diseases of endocrine system, including diabetes mellitus, was noted. The deterioration of particular indicators of organization of medical care of women according to profile "obstetrics and gynecology" occurred during period of COVID-19 pandemic. The implementation of three-level system of organization of medical care resulted in significant reduction of number of obstetric and gynecological hospital beds.

[The means of optimization of dispensary monitoring of patients in psycho-neurological dispensary].

The actual direction of improving provision of mental care of population is increasing of efficiency of specialized primary medical sanitary care of patients with mental disorders in conditions of implementation of biopsychosocial model of its realization. The study of mental disorders morbidity demonstrated that qualitative changes occurred in structure of contingents of mental institutions towards decreasing of number of dispensary patients and corresponding increasing of number of patients receiving medical and consultative assistance. The analysis of indicators of movement of contingents with mental disorders testifies decrease in effectiveness of dispensary observation that is confirmed by decrease of rate of de-registration due to recovery, by increase of de-registration due to death, increase in number of suicidal attempts and in disability among patients with mental illness of able-bodied age. It was established that problems in ensuring quality of medical care are conditioned manly by lack of actual organizational and methodological support of dispensary observation of patients, predominance of passive dynamic observation by local psychiatrist. Based on the results of study of organization of functioning of district psychiatrist, medical and organizational measures were developed to improve organization of dispensary observation of patients with mental disorders.

Medical cannabis and automobile accidents: Evidence from auto insurance.

While many states have legalized medical cannabis, many unintended consequences remain under-studied. We focus on one potential detriment-the effect of cannabis legalization on automobile safety. We examine this relationship through auto insurance premiums. Employing a modern difference-in-differences framework and zip code-level premium data from 2014 to 2019, we find that premiums declined, on average, by $22 per year following medical cannabis legalization. The effect is more substantial in areas near a dispensary and in areas with a higher prevalence of drunk driving before legalization. We estimate that existing legalization has reduced health expenditures related to auto accidents by almost $820 million per year with the potential for a further $350 million reduction if legalized nationally.

Medical Cannabis for Headache Pain: a Primer for Clinicians.

PURPOSE OF REVIEW: Public acceptance of Cannabis sativa L. (cannabis) as a therapeutic option grows despite lags in both research and clinician familiarity. Cannabis-whether as a medical, recreational, or illicit substance-is and has been commonly used by patients. With ongoing decriminalization efforts, decreased perception of harms, and increased use of cannabis in the treatment of symptoms and disease, it is critical for clinicians to understand the rationale for specific therapies and their medical and practical implications for patients. In view of the opioid crisis, overall patient dissatisfaction, and lack of adherence to current chronic pain and headache therapies, this review provides up-to-date knowledge on cannabis as a potential treatment option for headache pain. RECENT FINDINGS: Research into the use of cannabinoids for disease treatment have led to FDA-approved drugs for seizures, nausea, and vomiting caused by cancer chemotherapy; and for decreased appetite and weight loss in people with HIV/AIDS. For a wide variety of conditions and symptoms (including chronic pain), cannabis has gained increasing acceptance in society. The effects of cannabidiol (CBD) and tetrahydrocannabinol (THC) in pain pathways have been significantly elucidated. An increasing number of retrospective studies have shown a decrease in pain scores after administration of cannabinoids, as well as long-term benefits such as reduced opiate use. Yet, there is no FDA-approved cannabis product for headache or other chronic pain disorders. More is being done to determine who is likely to benefit from cannabis as well as to understand the long-term effects and limitations of the treatment. Cannabis can refer to a number of products derived from the plant Cannabis sativa L. Relatively well-tolerated, these products come in different configurations, types, and delivery forms. Specific formulations of the plant have been shown to be an effective treatment modality for chronic pain, including headache. It is important for clinicians to know which product is being discussed as well as the harms, benefits, contraindications, interactions, and unknowns in order to provide the best counsel for patients.

Evaluation of patients admitted with musculoskeletal tuberculosis: sixteen years' experience from a single center in Turkey.

BACKGROUND: The aim of our study was to describe musculoskeletal system tuberculosis (TB) as a single-center experience. METHODS: This is a retrospective observational study conducted at a TB Dispensary in the east Mediterranean part of Turkey between 2004 and 2020. The clinical and demographic characteristics including age, gender, involvement location and duration of illness, presenting complaint, local examination findings, treatment outcome were retrieved and analyzed from the case files. Statistical analyses were performed using SPSS Statistics version 17.0 (IBM). The normality of data analysed by using Kolmogorov-Smirnov. The descriptive statistics were reported as mean ± standard deviation, medians, and ranges (min-max). RESULTS: Overall, 31 patients (3.2 % of all TB cases) with a mean age of 44.2 ± 16.7 years had musculoskeletal tuberculosis. The mean duration of treatment was 12.9 ± 5.5 months. Of the 31 patients, six (19.4 %) had concomitant pulmonary TB. One of the patients was in the pediatrics age group, and two of them were in the geriatric group. The most affected area was the vertebra. The most common complaint of the patients was back pain and seen in 22 patients (70.9 %). CONCLUSIONS: The physicians should be suspicious about the diagnosis of musculoskeletal TB disease. If the diagnosis and treatment are delayed, spinal damage and other consequences might be incurable.

Comparing older nonmedical and medical cannabis users: health-related characteristics, cannabis use patterns, and cannabis sources.

Background: US epidemiologic data show that nearly one in 10 individuals aged 50+ report past-year cannabis use, and nearly one in five users report medical use. However, research on older cannabis users, especially medical cannabis users, is scant.Objectives: We examined medical and nonmedical cannabis users aged 50+ on health-related characteristics, cannabis use patterns, and cannabis sources. Hypotheses were that compared to nonmedical users, medical users are more likely to have physical and mental health problems, use healthcare services, discuss their drug use with a healthcare professional, use cannabis more frequently, and purchase cannabis from a medical dispensary and other sources rather than obtain it as a gift, share someone else's, or use other means.Methods: We used 2018 and 2019 National Survey on Drug Use and Health data (N = 17,685 aged 50+; male = 8,030; female = 9,655). Hypotheses were tested using logistic regression analysis.Results: The past-year cannabis use rate was 8.9%. Of past-year users, 18.5% reported medical use. Compared to nonmedical use, medical use was associated with lower odds of alcohol use disorder but higher odds of discussing drug use with a healthcare professional (AOR = 4.18, 95% CI = 2.53-6.89), high-frequency use (e.g., AOR = 2.56, 95% CI = 1.35-4.86 for 200-365 days), and purchase at a medical cannabis dispensary (AOR = 4.38, 95% CI = 2.47-7.76).Conclusion: Medical and nonmedical users did not differ on physical and most behavioral health indicators. Most obtained cannabis from private/informal sources. Some medical users are likely to self-treat without healthcare professional consultation. Healthcare professionals should engage older adults in discussions of cannabis use and behavioral health needs.

[The modern problems of organization of mental stationary substitution out-patient service in Moscow].

The article considers problematic issues in hospital-replacing out-patient mental care management on the basis of the Psychiatric Hospital № 13 in 2015-2017. The analysis covered structure of mental patients, their age and social status. Also, patients under active dispensary monitoring and compulsory continuous out-patient treatment were analyzed. The new management component - «the out-patient psychiatric module¼ - is proposed to be introduced into the structure of mental dispensary.

Healthcare workers' perspectives on participatory system dynamics modelling and simulation: designing safe and efficient hospital pharmacy dispensing systems together.

With increasingly complex safety-critical systems like healthcare being developed and managed, there is a need for a tool that permits decision-makers to better understand the complexity, test various strategies and guide effective changes. System Dynamics (SD) modelling is an effective approach that can aid strategic decision-making in healthcare systems but has been underutilised partly due to the challenge of engaging healthcare stakeholders in the modelling process. This paper, therefore, investigates the applicability of a participatory SD approach based on healthcare workers' perspectives on ease of use (usability) and usefulness (utility). The study developed an interactive simulation dashboard platform which facilitated participatory simulation for exploring various hospital pharmacy staffing level arrangements and their impacts on interruptions, fatigue, workload, rework, productivity and safety. The findings reveal that participatory SD approach can enhance team learning by converging on a shared mental model, aid decision-making and identifying trade-offs. The implications of these findings are discussed as well as experience and lessons learned on modelling facilitation. Practitioner Summary: This paper reports the perspectives of healthcare workers, who were engaged with a participatory system dynamics modelling and simulation process for hospital pharmacy staffing level management. Evaluative feedback revealed that the participatory SD approach can be a valuable tool for participatory ergonomics by helping the participants gain a deeper understanding of the complex dynamic interactions between workload, rework, safety and efficiency. Abbreviations: SD: system dynamics; ETTO: efficiency-thoroughness trade-off.

Characterization of mental health in cannabis dispensary users, using structured clinical interviews and standardized assessment instruments.

BACKGROUND: Cannabis is commonly used for its medical properties. In particular, cannabis is purported to have beneficial effects on a wide range of neuropsychiatric conditions. Studies assessing mental health in cannabis dispensary users typically evaluate symptoms using self-report check lists, which provide limited information about symptom severity, and whether subjects meet criteria for a psychiatric diagnosis. There is, therefore, a need for studies which assess mental health in dispensary users with standardized and well validated scientific instruments, such as those used in clinical drug trials. METHODS: One hundred medical cannabis users were recruited from a community dispensary. All subjects completed a structured clinical interview with the Mini-International Neuropsychiatric Interview (MINI). Subjects also completed the Perceived Stress Scale-10, PROMIS Fatigue Scale, PROMIS Sleep Disturbance Scale, Beck Depression Inventory, the Patient Health Questionnaire-15 and the Brief Pain Inventory. Details about cannabis use were also recorded. RESULTS: Lifetime prevalence of mental illness in this cohort was high, and a large proportion of subjects endorsed psychological symptoms. The proportion of subjects who met criteria for classification of a current psychiatric disorder was low for mood disorders, but high for anxiety disorders and substance abuse/dependence. Cannabis use differed between the main psychiatric conditions. CONCLUSIONS: The present results indicate that rates of mental illness may be high in medical cannabis dispensary users. Use of structured clinical assessments combined with standardized symptom severity questionnaires provide a feasible way to provide a more rigorous and detailed evaluation of conditions and symptoms in this population.

Dermatology-Related Uses of Medical Cannabis Promoted by Dispensaries in Canada, Europe, and the United States.

There is a growing interest in the use of medical cannabis for a variety of dermatologic conditions. Despite the lack of evidence to validate the effectiveness and safety of marijuana, it is approved to treat a variety of dermatologic conditions in the United States. Furthermore, medical cannabis dispensaries have been making unsubstantiated claims about medical cannabis. It is important for dermatologists to know about the purported use of medical cannabis to help patients navigate this new treatment option, particularly as cannabis becomes legal in Canada in October 2018. We collected and tabulated the dermatologic indications for medical cannabis from Canada, the United States, and Europe. In the United States, dermatologic-approved indications vary by state but include psoriasis, lupus, nail-patella syndrome, and severe pain. Health Canada has listed psoriasis, dermatitis, and pruritus as potential therapeutic uses for cannabis but does not endorse its use for therapeutic purposes. We also surveyed the websites of dispensaries in Canada, the United States, and Europe and found that numerous unsubstantiated claims were being made and advertised to consumers. Dermatologic uses of medical cannabis, as claimed by dispensaries, included treating acne, aging, allergic contact dermatitis, chronic pain, herpes, dermatitis, lupus, Lyme disease, nevi, psoriasis, epidermolysis bullosa, and melanoma. Psoriasis, dermatitis, and chronic pain were the most commonly cited indications for medical cannabis listed by dispensaries. Our data indicate that the suggested and advertised uses of medical cannabis are largely unsubstantiated. Further research is necessary to validate the indications, effectiveness, and safety of medical cannabis.

Density of Medical Marijuana Dispensaries and Current Marijuana Use among Young Adult Marijuana Users in Los Angeles.

Background: While tobacco and alcohol studies have focused on density of outlets as a determinant of consumption, research has begun examining the effects of medical marijuana (MM) dispensaries on marijuana use. Objectives: Examine the relationship between density of MM dispensaries and frequency of marijuana use among young adult medical marijuana patients (MMP) and nonpatient users (NPU). Methods: Young adult marijuana users (n = 329) aged 18- to 26-year old were sampled in Los Angeles in 2014-2015 and separated into MMP (n = 198) and NPU (n = 131). In 2014, 425 operational MM dispensaries were identified within the City of Los Angeles. Sequential multilevel Poisson random effect models examined density of MM dispensaries per square mile and 90 d marijuana use among MMP and NUP at the ZIP code level while controlling for demographic, behavioral, and community characteristics. Results: Density of MM dispensaries was not related to 90 d use of marijuana (days of use or hits per day) among either MMP or NPU. MMP reported significantly greater days of marijuana use in the past 90 d compared to NPU but no differences were found for hits per day. African-Americans reported significantly greater hits per day compared to whites. Hispanics reported significantly fewer hits per day compared to non-Hispanics. Conclusion: Concentration of MM dispensaries surrounding young adult marijuana users in Los Angeles was unrelated to days of marijuana use irrespective of having a MM recommendation or not. Rather, individual factors related to consumer choices and behaviors were more important in determining recent marijuana use among MMP and NPU.

The Associations of Neighborhood Availability of Marijuana Dispensaries and DATA-2000 Waivered Providers with Hospital Stays Related to Opioids.

Background: Evidence is emerging on how state-wide marijuana legalization and increased supply of DATA-2000 waivered providers may be associated with outcomes related to opioids. It is unknown whether such associations remain at the neighborhood level. Objectives: This study examined the associations of neighborhood availability of marijuana dispensaries and DATA-2000 waivered providers with opioid-related hospital stays. Methods: Discharge-level records of inpatient (N = 264,013) and observation stays (N = 12,621) were obtained from the Washington Comprehensive Hospital Abstract Reporting System from January through June 2016. Outcomes were indicators for inpatient stays related to opioid use disorder (OUD), inpatient stays related to opioid overdose, and observation stays related to OUD. Primary predictors were the density of marijuana dispensaries and DATA-2000 waivered providers at the zip code level. Multilevel logistic regressions with random intercepts were used to examine the cross-sectional associations, controlling for other patient and neighborhood characteristics. Results: Patients living in neighborhoods with one more recreational marijuana dispensaries per square mile were more likely (OR = 1.54, p = .017) to be diagnosed with OUD in inpatient stays. Living in neighborhoods with increased density of medical marijuana dispensaries or DATA-2000 waivered providers was not associated with being diagnosed with OUD or opioid overdose in inpatient or observation stays. Conclusions: Recreational and medical marijuana dispensaries were differentially associated with opioid-related hospital stays. Further investigations are warranted to explore the causal pathways of the findings.

Analysis of the results of the questionnaire of orthodontists and children dentists of poltava-city on the optimization of orthodontic aids for children.

OBJECTIVE: Introduction: In the course of the study, we identified high prevalence rates of orthodontic pathology and identified organizational aspects regarding the provision of orthodontic care for children, and identified the need for their optimization. The aim: The purpose of the study was to analyze the results of the questionnaire of orthodontists and children's dentists, who provide dental care to the children of the Poltava region, about the importance of optimization of orthodontic care for children and improving the knowledge of doctors about the risk factors for the onset of orthodontic pathology. PATIENTS AND METHODS: Materials and methods: Methods: Sociological (questionnaire), medical-statistical, bibliosemantic. We analyze 39 questionnaires, which filled out by orthodontists and children's dentists who provide dental care to children of the Poltava region. RESULTS: Results: A questionnaire was conducted for 39 children's dentists of different specialties, and the subject for study of which was the knowledge of doctors about the risk factors for the occurrence of orthodontic pathology; the opinion of specialists on optimization of the system of prevention, dyspanserization, screening and sanitary-education work. The results of the questionnaire were processed with using of statistical methods and analyzed. CONCLUSION: Conclusions: 1. Most doctors consider the most important influencing risk factors that relate to behavioral, informational and medical-demographic, that is, those that are managed. 2. Most doctors determine the existing system of orthodontic care as ineffective, recognize the effectiveness of a joint prevention, dispensary and screening program; consider it advisable to create a single electronic medical card for the child from birth; the level of awareness of the population is low; it is expedient to involve in the preventive and sanitary-educational work of dental hygienists to reduce the burden on doctors. 3. In the training of students and interns in the specialty "Dentistry", more attention should be paid to the study of the risk factors of the occurrence of orthodontic pathology and the importance of primary prevention and dyspansery control to reduce its level.

[The compliance of patients under dispensary observation].

The treatment compliance is a phenomenon actively studied, due to the proved significant impact on medical care effectiveness. Within the study framework, the treatment compliance in dispensary patients, its relationship with individual characteristics of patients and the effectiveness of dispensary observation were studied. The questionnaire survey in the format of face-to-face standardized interview was carried out. The questionnaire consisted of passport section to record social hygienic characteristics of patients. It also included questions concerning effectiveness of dispensary observation. The special section included the Morisky-Green scale to evaluate treatment compliance. The comparative analysis was implemented concerning the results of questionnaire survey, the data of dispensary observation control cards concerning time of planned visits and also data of outpatient medical records concerning prescriptions of medications. The statistical data processing was performed using software SPSS v. 22. The correlation coefficient was considered as significant at p<0.05. No correlation between individual characteristics of respondents and effectiveness of dispensary observation was established (p>0.05). No correlation between age, marital status, education, employment and treatment compliance according the Morisky-Green scale was established (p>0.05). The correlation coefficients were significant between treatment compliance according the Morisky-Green scale and well-being (r=0.46 p=0.003), fact of hospitalization because of exacerbation of chronic diseases (r=0.71, p<0,001), awareness of planned visit date (r=0.44, p=0,004) and fact of permanent application of medicinal therapy (r=0.62, p<0,001). The partial correlation was established between treatment compliance and planned visit date (r=0.27, p<0,001), fact of permanent application of medicinal therapy (r=0.06, p=0,73). However, partial correlation is absent in case of exclusion of such sign as fact of hospitalization. The negative correlation was established between treatment compliance and time period elapsed after hospitalization (r=-0.69, p<0,001).

[The morbidity of diseases of skin and subcutaneous cellular tissue in population of the Republic of Bashkortostan].

The diseases of skin and subcutaneous tissue are an actual medical and social problem. The purpose of study was to analyze dynamics of incidence and prevalence of diseases of skin and subcutaneous tissue in population of the Republic of Bashkortostan in 2008-2017. The average rates of incidence and prevalence of these diseases in the Republic of Bashkortostan were significantly higher than relevant data in the Russian Federation and Volga federal district. In the Republic of Bashkortostan the study established increase in incidence rate of atopic dermatitis (primary morbidity increased up to 18.6%, total morbidity increased up to 20.2%) and psoriasis (total morbidity increased up to 3%). The low level of dispensary observation of patients with dermatitis in the medical organizations of the Republic of Bashkortostan was established. In 2017 full coverage with dispensary observation was established in case of children aged 0-14 years with discoid lupus erythematosus. The low level of dispensary observation of children with atopic dermatitis (42%) and adults with psoriasis (30.6%) was established. The study demonstrated necessity of further studying of total and primary morbidity of diseases of skin and subcutaneous tissue and also indices of dispensary observation of patients according nosologies and age groups, identification of corresponding risk factors, development and implementation of measures improving medical care at all stages of its rendering.

[The Activities Concerning Improvement of Dispensary Observation].

The analysis of deficiencies of organization of dispensary observation detected by the original study permitted to develop corresponding eradication measures within the framework of natural experiment. The experiment was implemented on the basis of the clinical diagnostic Center № 3 of the Moscow Health Care Department. The evaluation of measures was carried out by means of comparing criteria of efficiency of dispensary work prior and after implementation of mentioned measures. At the 18th month of measures implementation decreasing of average number of emergency hospitalization, average number of visits for acute care, percentage of patients mentioning exacerbation was established. Alternatively, increasing of percentage of patients registered for dispensarization during 10 weeks after diagnosis establishment, pending reception in waiting list lesser than 20 minutes and also patients of Dispensary groups underwent adequate medical examination, knowing expected results of treatment, treatment scheme and time of next planned visit addressing within planned terms with prevention purpose was established too.