[The personnel maintenance of primary health care physicians in condition of challenges from menaces to population health].

In condition of challenges from menaces to health due to COVID-19 the role of primary health care physicians increases that requires development of management decisions at the regional level. The purpose of the study. On the basis of analysis of medical demographic indicators and data concerning provision of primary health care personnel in the Russian Federation, proposals were made related to reforming of primary health care system in conditions of implementation of general medical practice with purpose to counteract menaces to population health. The analytical and statistical methods were applied. The official statistics data from the Minzdrav of the Russian Federation and Rosstat, results of original researches with content analysis and interpretation were used. The COVID-19 pandemic negatively impacted population health. The indicator of newly detected morbidity in the Russian Federation in 2020 decreased as compared to 2019 from 78024.3 to 75989.7‰oo (by 2.6%). This is the result of decreasing of dispensary and preventive activities among population. In next COVID-19 year (2021), as compared to 2020, indicator of primary morbidity increased to 85531.6‰oo that 12.6% higher than in 2020. The increase occurred in all classes of diseases that caused necessity of rehabilitation of these patients. The COVID-19 morbidity increased up to 2.4 times i.e. from 3391.1 in 2020 to 8085.7‰oo in 2021. The provision of physicians in the Russian Federation was 37.7‰o in 2021. Across the Federal Okrugs differences in indicators made up to 1.3 times and in subjects of the Russian Federation - up to 2.7 times. In conditions of COVID-19 significance of menaces to population health worsened. The situation requires both enhancement of primary health care and implementation of physicians of new formation - general practitioners responsible for patient health. The general practice (GP) widely developed in Russia in the 1990s during last ten years loses its significance in most subjects of the Russian Federation. In 2021, provision of general practitioners in the Russian Federation made up to 0.67‰o. In the Federal Okrugs, difference between indicators made up to 5.6 times. In the subjects of the Russian Federation the difference is enormous - 141.5 times. The article presents and scientifically substantiates prospective functional organizational models of general practice. The established situation with COVID-19 infection requires development of management decisions and measures at the regional level concerning improvement of organization of primary health care and implementation of general practice in conditions of counteracting risks of menaces to population health and health preservation.

[Public health risk threats associated with coronavirus infection in Moscow and the need to counteract].

PURPOSE OF THE STUDY: to determine the main threats to the health of the population of Moscow based on the analysis of the medical and demographic situation in Moscow and the Russian Federation in the context of the COVID-19 pandemic, in order to develop management decisions at the regional level. MATERIAL AND METHODS: Materials of the Federal State Statistics Service (Rosstat), as well as statistical collections of the Russian Research Institute of Health of the Ministry of Health of Russia for 2013-2022 were used. RESULTS: Coronavirus infection has changed the morbidity and mortality rates of the population of the Russian Federation and its constituent entities. In the Russian Federation mortality in 2019-2021 increased from 12.3 to 13.6‰, while in Moscow the increase in the indicator is significant - from 9.5 to 16.7‰. The incidence of COVID-19 in Moscow in 2020-2021 (over the two COVID years) increased from 6191.0 to 8976.0‰oo. The noted decrease in incidence rates across almost all classes of diseases during the COVID period (2019-2020) was associated with the lower medical check-ups and preventive activities, while during 2019-2021 there was an increase in disease incidence of the following classes: mental disorders, behavior disorders; diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism, etc., indicating the need for rehabilitation of this group of patients. CONCLUSIONS: The need to counter the threats to the health of the population of Moscow caused by the coronavirus infection requires the development of management decisions aimed at strengthening preventive activities and rehabilitation of patients in the post-COVID period.

[The medical demographic indicators and health preservation of rural population of the Russian Federation].

For the last 20 years of analysis, mortality rate of rural population was higher than that one of entire population; in 2020, increasing of mortality due to COVID-19 was noted.The indicators were 15.4 per 1000 population for rural population, and 14.3‰ for urban population. In 2021, the indicators increased up to 17.5 and 16.5‰, respectively. The birth rate of rural population over last 20 years tended to increasing. In 2013, mortality and birth rates became equal (14.5‰). In subsequent years, birth rate decreased and in 2021 amounted to 9.6‰ and in 2022 to 9.5‰. In 2021, the indicator of general morbidity of rural population of the Russian Federation was 124941.0‰oo For entire population the indicator was higher - 167713.8‰oo. In 2021, the highest rates of general morbidity of rural population were in the classes of diseases of the respiratory system - 34470.2‰oo and the circulatory system - 21588.2‰oo. In 2021, the ranking of general incidence of rural population in the Federal districts of the Russian Federation demonstrated difference in indicators by 1.5 times and in the subjects of the Russian Federation it reached 5.3 times. The highest indicator was noted in the Nenets Autonomous District - 278926.7‰oo, the lowest one in the Magadan Oblast - 52441.5‰oo. In 2021, the incidence of COVID-19 in rural population amounted to 2151.9‰oo. In 2021, the indicator increased by 2.8 times up to 6056.8‰oo. There is 2.4-fold increase in incidence of COVID-19 in rural population from 3391.1‰oo (2020) to 8085.7‰oo (2021). The ranking of incidence rates of rural population of COVID-19 in the subjects of the Russian Federation demonstrated difference in 15.6 times. The highest indicators were noted in the Republic of Khakassia - 14104.1 per 100 thousand population and the lowest in the Magadan region - 902.9‰oo. Conclusions. The unfavorable medical and demographic situation in the countryside indicates the low availability of medical care, the need for financial support of rural areas at the municipal, regional and Federal levels.

[The results of analysis of morbidity and mortality of population in conditions of COVID-19 pandemic].

The COVID-19 pandemic has its own objective features associated with density of residence, organization and accessibility of medical care, migration characteristics of population, etc. Therefore, analysis of current situation with coronavirus in the Russian Federation, its Federal Okrugs and subjects is needed. The coronavirus infection resulted in significant changes in indicators of primary morbidity and mortality of population of the Russian Federation. The purpose of the study - to apply the results of analysis of primary morbidity of population of Moscow, the Central Federal Okrug and the Russian Federation in conditions of COVID-19 pandemic in developing recommendations on population health preservation. The monographic, statistical, analytical methods were applied. The official statistics data of Minzdrav of Russia and Rosstat were used. The comparative analysis of for the first time diagnosed morbidity (in 2020) in Moscow, the Central Federal Okrug and the Russian Federation established similar distribution of incidence rates for three key classes of diseases. The first rank place took respiratory diseases, the second one took traumas, poisoning and some other consequences of external causes and the third rank place took COVID-19. The decreasing of primary morbidity of population in the Russian Federation in 2019-2020 was established for almost all classes of diseases that is related to diminishing of dispensary and preventive activities concerning population. The morbidity rate of COVID-19 in the Federal Okrugs of the Russian Federation is presented. The ranking of subjects of the Russian Federation according to indicators of established pandemic was applied. The difference between the highest and the lowest morbidity rates of COVID-19 in the subjects of the Russian Federation made up to 16.8 times. The analysis established that COVID-19 determined increasing of life losses because of respiratory diseases (pneumonia in particular); circulatory system diseases (ischemic heart disease in particular); diabetes mellitus, etc. The statistical accounting of causes of death associated with COVID-19 is not accompanied by noticeable improvement of coding quality of other causes of death. The results of the analysis is be applied in developing management decisions.

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

Further reforming of the rural health care should be proceeded with special attention to availability of medical care in countryside.The purpose of the study is to develop on the basis of analysis of accounting data and research results recommendations for improving organizational forms of medical care to country dwellers. The exploration of peopleware and main performance indicators of medical organizations in rural areas was implemented.The statistical, analytical and sociological methods were applied. The reporting forms 47, 30, 12 of Federal statistical monitoring are analyzed.Results. The provision of population with medical personnel in rural municipalities in 2010-2018 increased from 12.5 to 14.5 per 10 thousand of rural population. The provision with paramedical personnel made up to 52.3%oo and during the same years indicator decreased from 55.4 to 52.3%oo. During the analysis period, 4241 feldsher obstetric posts were reduced and in 2018 their number made up to 33,350. The number of feldshers in rural areas decreased on 18.5%. In 2005-2018 number of central district hospitals and district hospitals decreased in 2.5 times. At that, provision of beds in municipalities of rural areas decreased from 49.6 to 38.8%oo. There significant winding up of district hospitals and their restructuring into branches of central district hospitals occurred. In 2018, remained only 47 out of them equipped with 1549 beds. Unfortunately, the reporting forms of the Ministry of Health of the Russian Federation do not account branches of central district hospitals. This information is to be included in accountability of the Ministry of Health.It is necessary to expand scope of authority of local government bodies in resolving medical and social problems in rural territories.

[THE AGE-RELATED FEATURES OF THE MORBIDITY OF THE POPULATION IN THE CONTEXT OF THE COVID-19 PANDEMIC].

The COVID-19 pandemic has led to changes in all medical and demographic indicators, including changes in the incidence of the population. The article provides an analysis of the age characteristics of the primary morbidity of the population in the conditions of the COVID-19 pandemic. A pattern has been determined: the highest rates of primary morbidity in the conditions of the COVID-19 pandemic (for 2020) were determined in the age group older than working age. It was in this group that the highest incidence rates of COVID-19 were established. On the contrary, a comparative analysis of the primary morbidity of children (0-14 years old) in Russia as a whole in the «pre-pandemic¼ year (2019) and in the conditions of the COVID-19 pandemic (2020) showed a decrease in the level of this indicator by 13.9% (from 172455.1 to 148537.7 per 100 thousand population, р < 0.05). Among the child population, 1208.3‱ cases of COVID-19 were registered. Thus, in the Central Federal District, the indicators of primary morbidity of children were lower than the general.

[The results and perspectives of primary health care reforming in Moscow].

The primary health care is characterized by its directivity to population health, while general practitioner is key figure in its organization and is responsible for assigned population health. The Russian Federation continues to suffer from overspecialization of medical care in outpatient health care. At that, the number of unreasonable visits to medical specialists is too high. The general practitioner, with appropriate training, can appoint patients by 11 specialties and in conditions of municipal polyclinic can undertake up to 81% of visits to medical specialists. The purpose of the study is to evaluate primary health care functioning in Moscow and to formulate proposals for reforming health care, considering development of general medical practices in a metropolis. The study was focused on analysis of morbidity of population of Moscow, on support of out-patient health care with physicians before and after implementation of three-level system of ambulatory polyclinic care, on evaluation of preventive activities of general practitioners and on development of proposals for improving organizational forms of activities with emphasis on health preservation. In the study were applied such methods as statistical, direct observation, sociological. The analysis was applied to forms of federal statistical observation i.e. form № 30 in Moscow and the Russian Federation for 2010-2019. The population sociological surveys concerning satisfaction with medical care were carried out. The research base was Moscow. The analysis demonstrated that results of Moscow health care system reformation is economically effective because of shortage of medical personnel primarily of administrative staff and its rational employment. The reformation results were positively assessed by patients, whose satisfaction with medical care made up to 95.6%. The general practitioner is to be responsible for health status of attached population and is called upon not only to carry out treatment and preventive activities, but also to coordinate organization of medical care of attached population at all stages of its provision. The implementation of general medical practice in conditions of municipality is to calculate complete transition of medical organizations providing out-patient medical care to general medical practice, that will result to certain extent, in reduction of staff positions of medical specialists. It is necessary to expand duties of medical nurse in general practice. The optimal model of joint work of general practitioner with feldsher and medical nurse of general practice. The complex general practice team can include medical registrar. The proposed perspective models permit to implement integrating role of general practitioner and to increase accessibility and efficiency of primary health care.

[The day hospitals as preventive hospitalization of patients of able-bodied age].

In accordance with the Russian Federal Law No. 350 of January 2019 the retirement age for Russians is increased for men from 60 up to 65 years, for women from 55 up to 60 years that requires implementation of organizational technologies of health-preserving, promotion of life and labor potential of population of late able-bodied age. In this regard, the role of day hospitals (DH) functioning directed at maximal possible prolongation of autonomous life and working capacity of elderly population increases. Besides, DH also presents additional reserve of optimization of medical care costs. The purpose of the study is to elaborate guidelines of improving activities of DH for population of late able-bodied age, for the purpose of preventive hospitalization. The study was organized on the basis of pilot medical organization of the Moscow Oblast, consisted of hospital of 600 beds and day hospital of 120 beds. The methods applied included sociological survey, expert judgment, statistical direct observation. The primary data was obtained from the forms of federal and sectorial statistical monitoring for 2014-2018. The analysis of medical documentation concerning pilot medical organization functioning during the year of the study was applied. The sociological surveys of patients of late able-bodied age (5 years before retirement according to the new legislation - men 60-65 years old, women 55-60 years old) who received treatment in day hospital. The results. The analysis of main indices of round-the-clock functioning in-patient and day hospitals in the Russian Federation in 2014-2018 established trend towards improvement of using hospital beds due to development of day hospital. However, bed capacity of hospitals is used ineffectively and experts assume that more than 1/3 of patients could receive medical care or aftercare in day hospitals. The experimental study of planning hospitalization of patients with chronic diseases at out-patient level demonstrated that 11.5% of population of able-bodied age need planned and preventive hospitalization in day hospital. The cost of treatment of patient with chronic pathology is 2-3 times lower in day hospital than in common hospital at the stage of exacerbation. It is reliable to apply at the out-patient level experience of planning hospitalization of patients with chronic pathology in day hospitals followed by performance control. The organization of functioning of day hospital and common hospital requires particular enhancement, including issues of succession, financing of the DS, the remuneration of medical personnel through effective contract determining interest of physician in early discharge of patient to aftercare in day hospital. The day hospital functioning is to be implemented in 2-3 turns. The day hospital is to be located in detached placement and the departments of base medical institution are to used in fullness. The day hospital is be used more actively for purpose of health preservation of population of late able-bodied age who. This contingent suffers of chronic pathology and is in need of preventive and health-promoting therapy in conditions of day hospital.

[The medical social characteristics and evaluation of life quality of patients with diseases of blood circulation system].

The increasing of longevity and quality of life and population health are considered as the most important component of human development index. The diseases of blood circulation system have leading rank in morbidity, disability and mortality of population of Russia representing one of the most actual problems of health care. The diseases of circulatory system negatively effect on physical and mental health, emotional conditions and social components of life activities. All the mentioned results related to cardiovascular diseases can be detected and measured through evaluation of indices of life quality of patients. In Russia, the directive documents and national programs concerning health care modernization were adopted to rectify the unfavorable medical demographic situation on national level through decreasing of mortality, morbidity and disability due to diseases of circulation system. The purpose of the study is to analyze social hygienic characteristic and life quality of patients with diseases of circulation system during 5 years prospective cross-sectional medical statistical study in the Nizhni Novgorod Oblast at the base of the "Specialized Cardio-surgery Clinical Hospital" of Nizhni Novgorod. The study included all patients with certain corresponding criteria of involvement being at hospital treatment in the pilot medical organization. The sampling included 420 patients. The life quality inventory SF-36 and questionnaire were applied to respondents during their first and control (5 years later) visits. The questionnaire covered social and working status, presence of risk factors of cardiovascular diseases. The study demonstrated that among respondents made no control of cholesterol level 40.3%, arterial blood pressure - 16% that determines necessity of amelioration of sanitary education activities of population. The low level of income (less than 6000 rubles per one member of family) was marked by 42% of respondents. At that, 77% had financial problems with medications purchasing that testifies necessity in co-financing with the state. The results of the study testify the positive impact of implementation of target programs of prevention of cardiovascular diseases on the life quality of patients in the pilot subject of The Russian Federation. The original technique of sociological surveys and evaluation of life quality of patients can be applied at the regional level in development of managerial decision making.

[The Medical Demographic Problems of Rural Population].

The demographic processes significantly affect society demographic burden. The geopolitical position of Russia with predominance of rural territories determines the need in developing specific model of medical and demographic policy in rural territories. The situation with population health and health care support in rural areas remains difficult due to the prevailing demographic, economic, territorial, medical, social and organizational and managerial factors of rural life. PURPOSE OF STUDY: To develop proposals improving health care in rural areas based on results of analysis of medical and demographic indices of incidence and accessibility of medical care to rural residents. METHODS: statistical, direct observation, analytical. RESULTS: The current medical and demographic situation in the country determined the output of Law No. 350-FZ on raising the retirement age in Russia, which was signed on October 3, 2018 by Vladimir Putin. Increasing the retirement age requires development of set of measures protecting population health of pre-retirement age. The article presents analysis of urban and rural population health in the Russian Federation in age-gender dependence (the younger than able-bodied, the able-bodied and the older than able-bodied groups of population). A comparative analysis of medical and demographic indices of urban and rural population in dynamics in 2005-2018 is presented. The article also presents analysis of total and primary morbidity of total urban and rural population in the Russian Federation according classes of diseases (2018) and in dynamics (2010-2018). It is established that decreasing of indices of general and primary morbidity is the result of reduced detection, deterioration of preventive and dispensary activities in rural areas and limited availability of medical care in rural settlements. The need for medical and social care of the able-bodied human potential in rural areas and the development of programs for their health conservation is substantiated. To overcome aftermaths of demographic crisis in rural areas, it is necessary to modernize demographic and economic policy in rural areas. The tasks of the municipal and Federal authorities are to provide not only declarative «program¼ support, but also tangible resources, as well as practices to implement strategic tasks in rural areas. The article presents proposals for overcoming the medical and demographic crisis in rural areas.

[Organizational reserves saving the population's health from diseases of the circulatory system].

Modern approaches to public health protection in the world are increasingly focused on health conservation, which involves focusing health care efforts on prevention. Timely identification of patients with arterial hypertension (AH) and provision of effective medical care is the main organizational reserve for preventing health losses. Based on the concept of "cardiovascular continuum", analysis of literature sources and the study itself, organizational measures have been developed to preserve health and prevent health losses and reduce mortality from diseases of the circulatory system. From the perspective of the concept of "cardiovascular continuum", the causes of death from BSC are two parallel interrelated processes: arterial hypertension and atherosclerosis, which are the consequences of endothelial dysfunction. Analysis of literature sources and survey results 123 of experts and healthcare professionals in a number of subjects of the Russian Federation show that adequate and timely medical care to the population at BSK, and a reduction in population systolic blood pressure and the reduction of lepidopteron low-density (LDL) are organizational reserves predotvratit loss health and reduce mortality from CVD. We have developed a set of measures to reduce mortality from circulatory diseases in accordance with the concept of the "cardiovascular continuum" include the following: increase population coverage with BSK medical assistance; medical surveillance and treatment of patients with prehypertension; decreased population levels of cholesterol in arterial hypertension (AH); carrying out of thrombolytic therapy; medical emergency cardiovascular conditions in accordance with the concept of "Golden hour"; improving the provision of medicines to the population, increasing the provision of cardiologists to the population. The implementation of a set of measures in the pilot rural district allowed reducing the total mortality of the population for the year of analysis by 12%.

[The hospital-substituting technologies: condition and strategic tasks of their development].

The program of state guarantees of free medical care of citizens for 2019 and up to 2020-2021 plans to reduce volume of inpatient medical care through development of hospital-replacing technologies. The economic feasibility of hospital-replacing technologies is in significantly lower cost of medical services in a day hospital as compared with twenty-four hours hospital (UPC). However, the existing legislative framework and the lack of proactive financial mechanisms do not stimulate development of hospital-replacing technologies. The purpose of study is to analyze reporting data and results of SWOT analysis of rating of factors affecting introduction of day hospitals, On the basis of analysis the strategic objectives of development of hospital-replacing technologies are formed. The study applied statistical analysis, direct observation, sociological survey, SWOT analysis. The analysis was applied to data from forms of Federal statistical observation No. 14 and industrial statistical monitoring No. 14 for 2009-2018. Based on results of SWOT analysis, experts were interviewed by the heads of health care authorities and medical organizations regarding development of strategy of medical care of children with disabilities. The expert survey was carried out with health care managers in Moscow, the Moscow oblast, Orenburg, Chelyabinsk, Samara, Ivanovo, Ryazan oblasts and the Republic of North Ossetia-Alania. The analysis established that in 2018 the number of medical care organizations increased up to 6495, including medical institutions providing outpatient medical care (41.4%) and in-patient medical care (58.6 %). The analysis demonstrated that percentage of treated patients in day hospitals out of the total number of hospitalized patients (in hospitals was 29,1% in 2018, while in 2009 this percentage was significantly lower - 15,6%, which indicates the intensification of the use of the bed fund of the UPC, which to some extent is associated with increased development of hospital-replacing technologies. The results of SWOT analysis demonstrated that the strategic objectives of development of hospital-replacing technologies should be targeted to develop financial stability of health care, active position of the heads managers of health care institutions and medical organizations and introduction of innovations if needed. It is necessary to develop modern management methods, rational application of health care resources, implementation of economic incentives in all components of health care system, ensure functioning of the system, including effective contract.

[The analysis if disability because of diseases of blood circulation system in the Nizhny Novgorod oblast].

The article presents the analysis of disability on the cardiovascular diseases, according to the Bureau of Medical and Social Expertise in the Nizhny Novgorod region in dynamics for 2003-2013. The article analyzed the number of persons recognized as disabled according the Bureau of Medical and Social Expertise, calculated accumulated contingent disabled due to cardiovascular diseases according to the pension fund. The years of life lost due to disability in dynamics were calculated for 2004-2013 years.

[The standard of position of physician-stomatologist-therapeutist in the conditions of working together with assistant-stomatological].

The article presents scope of work, algorithms of labor operations, standardization of work of stomatologist-therapeutist in the conditions of working together with assistant-stomatological in four hands. The calculations are given concerning the standard numbers of positions of stomatologist in new conditions of work.