[The development and enhancement of general medical practice as major condition of successful modernization of primary health care].

The need for changes in the primary health care system in the Russian Federation that is based on the principles of general medical practice is without any question. But, even after more than thirty years, there is no full-fledged reform still. THE OBJECTIVE: To assess the state of general medical practice in the Russian Federation to identify its strengths and weaknesses, and to determine further ways of its development. The tasks. To analyze the volume and pace of development of general medical practice; to identify its impact on key demographic, medical and social indices; to assess foreign experience in this field; to elaborate proposals on intensifying process of its development in the Russian Federation. MATERIAL AND METHODS: The analytical, sociological (n=1,573) and statistical methods were applied. THE RESULTS: Since 2007, the number of general practitioners in the Russian Federation and corresponding support of the population increased. During the same time period, population size, natality, mortality, morbidity of tuberculosis, essential hypertension and cataract had positive dynamics. The morbidity of malignant neoplasms, diabetes type II, glaucoma, coronary heart disease and cerebrovascular diseases had negative dynamics. The strong negative relationship of the population's general practitioners support was established only in case of all-cause mortality and morbidity of lungs tuberculosis. The population was more satisfied with support of general practitioner than district physician. DISCUSSION: The general practitioner support of the population of the Russian Federation continues to be insufficient and its role in public health management insignificant. The proposals are formulated to improve primary health care and its further development based on the principles of general medical practice on the basis of corresponding best international experiences and national specificity. Hence, in Russia, the national health care requires a set of measures targeted to strengthen the position of general medical practice system throughout ll territories.

[The management of professional personal potential of medical personnel].

Nowadays, the key problem in health care management is manpower issue that is manifested as acute shortage and inadequate qualification of medical personnel; working conditions providing no modern standard of living and developing type of personality uninterested in the results and unready to bear responsibility for poor quality of medical care. Purpose of the study is to develop conceptual grounds of improving manpower management in medical organizations based on the study of actual state and specifics of functioning of medical personnel in actual conditions. Material and methods: analytical, historical, statistical, sociological. The main causes of inadequate application of professional and personal capabilities of medical personnel are tough regulation and exceeding formalization of labor, inadequacy of personal funds to satisfy personal requirements in training, increased fatigue at workplace, lack of needed conditions to apply actual knowledge and skills, disinterestedness of administration in ambitious self-starters. The causes of medical personnel dissatisfaction with professional work are closely related to causes of under-exploitation of their professional and personal potential. The main factors diminishing satisfaction of medical personnel with professional labor are low wages at significant workload. The system of organizational measures to optimize application of existing manpower in medical organizations is proposed. The strategic reserve of increasing efficiency of medical organization functioning is realization of need of medical personnel in effective application and development of their professional and personal potential.

[The problems of medical care quality in primary section of private sector of health care].

The efficiency of quality control of medical care in medical organizations providing medical care in out-patient conditions is inadequate. The purpose of the study is to identify main problems of ensuring quality of medical care in private medical organizations providing medical care in out-patient conditions and to develop suggestions for their elimination. The assessment of medical care quality in private medical organizations network was carried out using expertise technique (n = 1070), intra-organizational attestation (n = 47), questionnaire survey of administrative (n = 28) and medical personnel (n = 241). The total number of medical care defects made up to 4,822, and 97.3% of them were related to diagnosis and treatment. A full justification of diagnosis was recorded in 65.8% of cases. The cases of insufficient and excessive examination have been identified. The non-compliance with duration of treatment and frequency of visits have been established. The inadequate medical efficiency (67.6%) reliably effected on low compliance of patients, recorded in 18.9% of cases (p < 0.05). The main problems of ensuring medical care quality are related to organization of internal control system, involvement and motivation of medical personnel and development and maintenance of necessary organizational culture. In the private health care sector, quality issues can be solved solely by means of material resources. It is necessary to improve of medical personnel management, internal quality control of medical care and management of organizational culture.

[The public opinion about health care: the main factors of increasing satisfaction of population with medical care].

The evaluation of satisfaction of population with medical care has become widespread in practice of medical institutions as an obligatory criterion of assessing quality of their functioning. The study objective is to determine degree of satisfaction of population Russia with health care and role of particular factors in its formation. The study applied questionnaire survey of residents of 9 subjects of the Russian Federation using representative sampling of 1457 observations. The Pearson contingency indicator and the Chuprov-Cramer indicator of association between two nominal variables were determined. The ranking of signs according their influence strength was carried out. The most significant role in evaluation of satisfaction with health system functioning is played by satisfaction with medical care. Among the factors characterizing consumers of medical services, self-assessment of one's health status, social status of respondents, residence demonstrate the most effect. The priority factors in formation of positive public opinion about health care are identified. It is proved that positive opinion about health care depends on quality and accessibility of popular types of medical care, organization of functioning of primary health care medical organizations according expectations of population. The level of satisfaction with health care system is lower than in case of rendered medical services.

[The intraorganizational training in ambulatory polyclinic organizations].

The intraorganizational training can be an efficient addition to modern system of continuous medical education. The purpose of study is to theoretically substantiate and to develop an intraorganizational system of continuous professional education of medical personnel, to implement intraorganizational system of continuous professional education of medical personnel into medical organizations providing out-patient medical care and to assess its efficiency. The study was organized at the base of three non-state medical organizations of Moscow providing out-patient medical care. Two out of them had net organizational structure, one was represented by single medical organization. The study implemented such research methods as organizational experiment, expertise, sociological survey, test control, analytical and statistical methods. The system of continuous professional education of medical personnel including "Adaptation", "Correction" and "Development" levels was developed and tested. The system of continuous professional education of medical personnel comprises intraorganizational training center, intraorganizational system of remote training, form of long-term cooperation with educational organization, application of target training programs focused on adjustment of deficiency of knowledge and skills and acquirement of new professional competences by medical personnel. The intraorganizational system of continuous professional education of medical personnel can be used as an addition to modern form of continuous medical education. It can be used in state and non-state medical organizations. The study proved positive effect of intraorganizational training on the level of professional qualification, increase of satisfaction of medical personnel and increase of quality of medical care.

[The sociomedical problems of occupational stress]. / Mediko-sotsial'nye problemy professional'nogo stressa.

The paper analyzes medicosocial problems of occupational stress, characteristics of stressor reactions associated with the health status, job parameters, and lifestyle of different social groups of population. The incidence of stress among various occupational groups in the system of the Ministry of Internal Affairs of Kazakhstan has been studied. The authors have detected the role of external and internal environmental factors (social, demographic, biological) in the appearance and development of stress. Recommendations are offered on the detection of stress, identification of groups by the severity of stressor reactions, and formation of risk groups. The scope and type of therapeutic and prophylactic care in specific groups followed up is outlined.

[The innovative process in public health institutions as mirrored by public opinion]. / Innovatsionnyi protsess v uchrezhdeniiakh zdravookhraneniia v prizme obshchestvennogo mneniia.

Problems related to innovations in the health care system and the susceptibility of medico-prophylactic institutions to advanced methodologies are discussed. Analysis of questionnaires has revealed the absence of a well-organized work for the introduction of innovations in the medical collectives, and a low interest in their introduction and exploration on the part of physicians and their authorities. The innovative activity is high enough in regional health units, but in those dealing with mass-scale medical care, rural in particular, introduction of new methodologies is much slower. At the same time, collectives of medical workers show their potential readiness to accept and explore the new advanced methodologies, which has not been realized due to the poor economic basis, low organizational level, and deficient resources. Ways to improve the process of introduction of innovative methodologies into clinical practice are offered for discussion.