Abstract:The aim of the work was to investigate intersectoral cooperation in the sphere of public health care and to substantiate technologies of its optimization. Material and Methods -There were analyzed the normative legal field of public health care, the results of anonymous survey of 838 physicians -health care organizers including 34 experts, and of 6,106 persons not engaged in medical professions. Results -There were established the list and significance of 37 health determinants; the effect produced on them by 23 state and public sectors engaged in health care; characteristics of these sectors' interaction. There were substantiated 38 informative vectors for evaluating the effectiveness of intersectoral cooperation in the sphere of public health care -22 simple (each representing a single informative criterion) and 16 complex (consisting of several, from 3 to 12) informative criteria. There was developed an automatic multi-vector method for assessing success in intersectoral cooperation in the sphere of public health care in a territorial formation (formations), and there was designed an appropriate technology of optimization, including the primary multi-vector analysis, purposeful correction and dynamic evaluation. Conclusion -Public health care optimization is a process which should be carried out with regard to hierarchic interaction of the engaged sectors and peculiarities of their influence on health determinants, multi-vector evaluation of intersectoral cooperation efficacy aimed to substantiate and choose such administrative decisions which prove to be the best from the viewpoint of resulting effective achievements. The obtained materials may be realized in everyday practice of public health care.
Summary. The aim of the study is to identify problems in the organization of medical triage and medical care in trauma centers of different levels at mass simultaneous admission of victims in emergency situations and to determine possible ways to solve them. Study materials and methods. We analyzed the results of treatment of 136 emergency patients in Saratov and Saratov region trauma centers in 2010-2021. All patients were delivered by emergency medical teams (EMTs). Road traffic accidents (RTA) were the most frequent cause (76.0%) of traumatization of the patients, in the remaining cases (24.0%) carbon monoxide poisoning and burns caused by fires were the most common. The mean age of the victims was (39±7) years, of whom 71 (52.2%) were men, and 65 (47.8%) were women. The study was a total retrospective study, using patient medical histories as primary documentation. Patients older than 18 years were included in the study. Victims, who were delivered to trauma centers in addition to ambulance teams, were excluded from the study. Results of the study and their analysis. The results of the study show that of 136 accident victims delivered to trauma centers in Saratov and Saratov region, 76 cases (55.9%) proved to have errors in the organization of medical triage and medical care to the victims. Most of the errors can be conditionally divided into 2 large groups. The first group included 52 observations (38.2%) related to the organization of the admission of injured persons who arrived from the emergency area. The second group included cases of underestimation of the patient’s condition severity, wrong diagnosis, incompletely performed antishock or infusion therapy. The authors designated these errors as therapeutic — they occurred less frequently and were noted only in 9 cases (6.6%) — all these errors were made only in Level III trauma centers. Analysis of the study results showed that the main problem encountered by the management of trauma centers in Saratov region during mass simultaneous admission of victims in emergencies was the incorrect involvement of medical specialists in medical triage, which led to an increase in the timing of its implementation and in the timing of medical care — for example, the involvement of therapeutic specialists in the medical triage of surgical patients. To solve this problem, the authors propose to reverse the involvement of anesthesiology, surgery, and neurology medical specialists in the emergency departments of medical treatment organizations with their subsequent return to their departments as the workload in the emergency departments decreases.
The aim of the work has been the investigation of the viewpoint of health care supervisors on the role of Russian Federal Service for Oversight of Consumer Protection and Welfare in intersectoral cooperation on the problems of health protection of the population within the subject of the Russian Federation. Material and methods. There has been carried out an anonymous questioning of 405 health care supervisors, including 126 experts. Besides, there have been analyzed the materials of annual national reports of the Administration of the Federal Service for Oversight of Consumer Protection and Welfare in the Saratov region “On the state of sanitary-epidemiological well-being of the population in the Russian Federation”. Results. There has been determined a list of 23 sectors engaged in health care of the population at the regional level - 13 relatively more significant (basic) and 10 relatively less significant sectors. Federal Service for Oversight of Consumer Protection and Welfare Russian is one of the basic sectors. There has been established the significance of cooperation of the sector “Federal Service for Oversight of Consumer Protection and Welfare Russian” with other engaged structures. A wide spectrum of 37 health determinants has been detected. There have been obtained the data which make it possible to determine two directions of health care optimization at the regional level. The first direction is associated with purposeful influence of the engaged sectors on health determinants. To achieve this aim there has been established the possible influence of each sector, Russian “Federal Service for Oversight of Consumer Protection and Welfare” in particular, on each of the considered health determinants. This will make the formation of prophylactic programs significantly easier due to transformation of this process into a purposeful and structured process. The second direction is conditioned by the fact that optimization of any process is possible on the basis of evaluation of the initial state of the process, and evaluation is based on corresponding informative indices. These 38 indices of the effectiveness of intersectoral cooperation on the problems of health protection of the population have been established, and the significance of Russian Federal Service for Oversight of Consumer Protection and Welfare’s influence on each of these indices has been determined. At establishment of an insufficient level of corresponding indices, the sector “Russian Federal Service for Oversight of Consumer Protection and Welfare’s has been brought to optimization. Conclusion. The results of mentioned investigation may be realized in activities for health protection of the population within the subject of the Russian Federation, and in professional training of authorized employees of the engaged sectors.
Introduction. Interaction between different government sectors and society on the issues of public health and health promotion is not often sustainable. It has mostly a piecemeal and declarative approach. The aspects of this interaction are both not scientifically founded and adequately fixed in the legislation The aim of the study is to establish scientific rationale and to develop proposals for changes to the law that governs cross-sectoral collaboration on the issues of public health. Material and methods. A review and analysis of scientific literature and current federal and regional laws that govern healthcare industry tools and strategies were conducted. The study was undertaken in the Saratov region, which is a constituent entity of the Russian Federation, to study the following aspects of health care industry in the region: socioeconomic impact of the region on medical and social programs; health promotion activities of legislative and executive branches of the government, cross-sectoral Coordinating Councils, the department of Rospotrebnadzor (Federal Service for Consumer Rights Protection and Human Welfare), and the Center for Medical Preventive Measures. Health status and life style, preventive medical measures at 92 organizations, the results of anonymous questionnaire survey of more than 10,000 respondents (general public, healthcare industry officials, experts) were also analyzed. The obtained results have provided the underlying rationale for proposing changes to the legislation managing public health. Results. Technique for optimization of cross-sectoral collaboration for assessment of health promotion activities has been developed and tested. This technique is based on the impact of 23 identified sectors on both the determinants of health (37 of them were established) and the simple and complex informative vectors of computer-controlled system of assessment of health promotion activities and other results of the study. The technique was instrumental in proposing changes to the law, which governs the issues of public health. The changes proposed concern the determination of health promotion, its guidelines, organizational principles, assessment, and quality control. Conclusion. The study results provide the authors with the possibility to scientifically substantiate the necessity in making changes to the current legislation managing public health and developing improvement proposals.
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