The article presents the results of studying the organization of work of heads of departments of central district hospitals (CRH) and the quality of therapeutic care for the rural population. The study was conducted in 2017–2019. on the basis of 26 Central District Hospital of the Republic of Dagestan. The quality of therapeutic care was studied through an expert assessment of 1,085 inpatient and 748 outpatient patient records. The timing of the working time spent by the heads of the departments of the Central District Hospital for 845 hours. It was found that under the current conditions the heads of departments devote up to 50.7% of their working time to the fulfillment of the main duties. Waste of time is 15.1%. In the therapeutic departments of the Central District Hospital, an untimely and complete examination of a significant part of the patients took place; treatment is not always complete and complete, there is no continuity in the examination and treatment of the patient between the clinic and the hospital. On the basis of the research materials, a set of recommendations was developed to improve the technology of work of heads of departments of the Central District Hospital and improve the quality of medical care. Experimental verification of the recommendations confirmed their effectiveness: the time spent on the main work increased from 51.2% to 72.4%, the share of time spent on organizing and managing the treatment and diagnostic process increased by 15.5%. Improving the organization of work of heads of departments during the experiment had a positive effect on the quality of medical care: the proportion of patients examined at the prehospital stage increased by 25.4%; the number of those fully surveyed increased from 58.4% to 90.3%; the number of patients who received full treatment increased by 14.7%.
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.
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).
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