[The problems of development of medical health-improving tourism in modern conditions].

The analysis of main approaches to determining essence of health-improving tourism in works of national scientists and researchers is presented. The conclusions are made that the most widespread classification of health-improving tourism is its division into medical and health-improving tourism. The medical tourism includes such its types as medical and sanatorium-health resort, and health-improving tourism covers balneologic, SPA-tourism, Wellness-tourism. The difference between medical and health-improving tourism is determined in order to regulate received services. The author's structure of medical and health-improving services, types of tourism and specialized organizations is developed. The analysis of supply and demand for health-improving tourism in 2014-2020 is presented. The main trends of development of health-improving segment in context of such its directions as increasing of SPA and Wellness industry, development of medical tourism, increasing of return on health tourism are formulated. The factors constraining development and reducing competitiveness of health-improving tourism in Russia are identified and structured.

[IMPROVING THE ORGANIZATION OF LABOR AND THE QUALITY OF MEDICAL CARE AT PARAMEDIC AND OBSTETRIC STATIONS].

In the provision of primary health care to the rural population, the role of paramedic and obstetric stations (FAP) is great. The purpose of the study is to develop a system of measures aimed at improving the quality of medical care provided at paramedic and obstetric stations. The study was conducted in 2019-2020 on the basis of 26 FAP of 12 central district hospitals (CRH) of the Republic of Dagestan. The organization of labor of 26 paramedics and 26 midwives during 1740 hours was studied by the method of time-lapse observation. The content of 16511 visits by the FAP population was analyzed. The expert evaluation method studied the quality of medical care to 445 patients on 7 FAP. The main work of FAP paramedics accounts for 74.5%, and for midwives - 76.3% of all labor costs. A significant share in the cost structure is occupied by preventive (22.9% for paramedics and 27.8% for midwives) and diagnostic and therapeutic activities (17% and 15.6%). There are high costs for transitions and relocations (17.3% and 14.1%) and for working with documentation (13.7% and 14.5%). In the structure of visits by the population of paramedics and midwives of FAP, for reasons of the greatest proportion are visits with therapeutic and diagnostic purposes (37%), followed by visits for medical appointments (32.8%) and preventive (23.9%). The quality of medical care provided by paramedics to patients with therapeutic diseases was inadequate in 23.8% of cases. Every third (35.7%) patient was treated with FAP unreasonably. Out of the total number of patients who were treated unreasonably on FAP, according to experts, 62.5% had to be treated in the CRH, 34.8% - in the district hospital (outpatient clinic).

[The Development of Technology of Functioning of District Physicians During Out-Patient Reception].

To develop recommendations and proposals related to amelioration of technology of of functioning of district physicians and general practitioners during out-patient reception in 2015-2016 a specialized study was carried out in three municipal polyclinics of Makhachkala of the Republic of Dagestan. The technology of functioning of 16 district physicians and general physicians during out-patient reception according information on 2685 visits in established conditions and in experiment. It is established that district physicians are insufficiently able to handle methodological issues of technology of out-patient reception. The implementation, in conditions of experiment, of enhanced medical technology at out-patient reception ameliorated quality of performance of conversation, check-up and examination of patients by district physicians. It resulted in more full-blown and targeted collection of anamnesis, in-depth physical check-up and examination, more complete giving of recommendations to every patient concerning one's treatment, diet and examination.

[The issues of medical care enhancement].

The structure of 8617 patients' home visits performed by general practitioners and district physicians is analyzed. The expert assessment technique was applied to investigate the quality of medical care rendered to 485 patients at home. The timekeeping of hours on duty of 18 district physicians and general practitioners was implemented during 965 hours. The studies were carried out during 2004-2005 and for the research base were chosen 8 polyclinics in 4 cities of the Republic of Dagestan. The general practitioners and district physicians, when visiting their patients at home, diagnose diseases of respiratory system in 29.2% and 35.2%, diseases of circulation system in 25% and 25.3% and diseases of digestive system in 16.1% and 14.4% correspondingly. It is noticed that the general practitioners encounter the patients of non-therapeutic profile almost twice more often than the district physicians. The home treatment of patients by the district physicians and general practitioners was not timely in 33.4% and 27.1% of cases; in 38.7% and 29% of cases it was not of full-fledged quality. The study revealed that general practitioners as compared with district physicians 1.5 time more contribute to prevention activities and almost twice to family medical social support. The research data was used to develop the guidelines and proposals regarding the optimization of medical care rendering at home.

[The means to enhance the quality and effectiveness of work of local physicians and general practitioners].

The content and labor of organization of 27 local physicians and 19 general practioners was studied within the time period of 355 days (2307 hours) using the photo time-sheet technique. The study was held from 2005 to 2006 in three cities and five rural districts of the Republic of Dagestan. It is revealed that the shortcomings leading to the shortage in finding time for implementation of basic professional functions are common in labor organization of local physicians and general practitioners. To the curative diagnostic and preventive activities the general practioners allocate only 40.5% of working hours and general practitioners even less - 35.5%. With that the time cost of formalization of medical documentation is too overwhelming (31.1-38.2%) and other time spending is considerable as well. In the structure of population visiting the general practioners and local physicians according the classes of diseases first place is for the diseases of respiratory system (29 and 35.6% respectively), second place is for the diseases of circulatory system (18 and 20.6%) and third place is for the diseases of musculoskeletal system (7.7 and 9.8%). On basis of research data the guidelines and proposals are developed concerning the enhancement of quality and effectiveness of professional activities of local physicians and general practitioners.

[The capacity and the pattern of the ambulatory polyclinic care provided by the general practitioners and the district doctors].

In the Republic of Dagestan, the capacity and the pattern of the ambulatory polyclinic care provided to urban population were studied during 2004-2005 in four cities--Makhachkala, Derbent, Buynaksk and Kizyljurt. The structure of 2465 visits to the general practitioners (family doctors) and 2549 visits to the district doctors was studied. In the structure of appealability to the general practitioners (family doctors) 30% fall to the neurological patients. The general practitioners (family doctors), as compared with the district doctors, twice as much pay attention to preventive activities (16.2% vs. 8.8%) and they much more often appoint their own patients to subspecialists' consultation (93.1% vs. 85.2%). It was established that 53.6% of patients with ischemic cardiac disease and 45% of patients with diseases of digestive system consult the doctor at the eighth day from the beginning of disease and later. The research data gave an opportunity to elaborate the guidelines and suggestions related to the optimization of the ambulatory polyclinic care provided by the general practitioners (family doctors) and district doctors to urban population.