The article is devoted to ethical and legal issues of organ donation. The authors analyze the main concepts of the Russian legislation concerning health care in relation to living and postmortem organ donors. The results indicate the need to specify legal norms for this type of health care and assess complex issues of organ donation on the basis of sociological approaches.
The chronic kidney diseases are recognized as one of leading problems of modern health care due to high prevalence and unfavorable prognosis. The article considers modern classification of predictors of chronic kidney diseases. It is emphasized that none of known modern classifications of chronic kidney diseases predictors don't take into account medical care accessibility to patients in disease condition as a predictor. It is proposed to consider accessibility of medical care from perspective of macrolevel social factors that represent the most widely background health predictors. The original typology of accessibility of nephrological medical care to patients with chronic kidney disease is proposed, which is implemented through prevention and/or minimization of predictors of the onset of chronic kidney diseases, management of disease progression and nephroprotection modifiable predictors, and renal replacement therapy for patients with chronic kidney disease. The one of reasons of limited accessibility of renal replacement therapy for patients with chronic kidney diseases is transportation problem that is solved in the Saratov region through organization of transportation of dialysis patients and development of domiciliary methods of renal replacement therapy. The restriction of medical care accessibility to patients is considered as an obligatory predictor of the onset, progression and unfavorable prognosis of chronic kidney diseases.
According to the authors, transformations in medicine in modern Russia are characterized by the transition to the market of medical services, which is considered as one of the causes of a relative status inflation, a decline in the prestige of the profession of a doctor. The discrepancy in the activity and status of this professional group is a determinant moment. Modern process of institutionalization of medicine is realizing in the change of the status and the marginalization of social-professional groups of the Institute of Medicine. In the opinion of the authors the process of marginalization of doctors is explained by the «concept of status inconsistency» proposed by G. Lensky.
The health care is considered as a social institution since XX century. The main purpose of health care is in amelioration, rehabilitation and promotion of health. This social institution, according to its implementing functions, comprises four sub-institutions. The analysis of trends of institutionalization of the sub-institution «Palliative medical care» is presented in methodological plane of system of social structural functions (AGIL). From the perspective of dysfunctional practices of sub-institution of palliative medical care developing in Russia, a medicalization of palliative care is discussed.
Chronic diseases, which form the somatic and social deprivation of patients, imply the provision of integrated medical and social care. National health care systems are actively pursuing processes aimed at overcoming the fragmentation of health care delivery and forming a model of integrated health care. The purpose of the study. Analysis of interaction of medical organizations and continuity in the treatment of patients in rural health care in the Saratov region.Material and methods. The authors conducted a comparative sociological study, which involved 319 physicians working in the district medical organizations of the Saratov region. The study was preceded by the construction of the medical and social portrait of the respondents.Results. The majority (73.7 %) of the respondents assessed the degree of continuity of patient care between inpatient and outpatient facilities in the district of the region as average.Conclusion. The study reveals the peculiarities of the organization of medical care for the rural population, which consist in the limited implementation of the principles of continuity in the management of patients, the presence of barriers to digitalization. The analysis of the degree of interaction between doctors when providing medical care to the rural population in inpatient and outpatient conditions reveals the fragmentation of rural and regional health systems.
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