&lt;p&gt;Concentration of health care providers: does it contribute to integration of service delivery?&lt;/p&gt;

Sheiman, Igor; Shevsky, Vladimir

doi:10.2147/rmhp.s205905

Cited by 9 publications

(7 citation statements)

References 21 publications

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“…But to make this happen, speci c integrative and managerial activities are needed. There is some evidence that this strength is not fully realized in curative work [23]. Our survey provides the evidence of a poor interaction of physicians in the dispensarization process.…”

Section: Discussionmentioning

confidence: 82%

Vertical Program of Screenings and Check-ups in the Russian Federation: Design, Implementation and Lessons Learnt

Sheiman

Шишкин

Sazhina

2021

Preprint

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Background. The Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations? Methods. We analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation. Results. There is a substantial progress of the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate. Conclusion The expectations of the Program are too high due to the inconsistency in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.

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Section: Discussionmentioning

confidence: 82%

Vertical Program of Screenings and Check-ups in the Russian Federation: Design, Implementation and Lessons Learnt

Sheiman

Шишкин

Sazhina

2021

Preprint

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“…But to make this happen, specific integrative activities are needed. Our previous studies indicate that they are lacking in the curative work [ 18 ]. They are equally lacking in the area of preventive services.…”

Section: Resultsmentioning

confidence: 99%

Vertical program of screenings and check-ups in the Russian Federation: design, implementation and lessons learnt

2022

Self Cite

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Background The Russian Federation has introduced a vertical large-scale program of ‘dispensarization’ (Program) that includes health check-ups and screenings for the entire adult population. It is expected to improve the results of medical interventions and ensure health gains at a relatively low cost. The major research question: Does the design and implementation of the program meet the expectations? Methods We analyze regulatory acts and the literature on the design and the outcomes of the Program. Physicians’ surveys and interviews are conducted to understand the capacity of primary care providers to meet the requirements of the Program, as well as the link between the early identification of new illnesses and their follow-up management, administration of the program, the barriers to its successful implementation. Results There is a substantial progress in the coverage of the population and increase in the number of identified illnesses. Some specific instruments of the Program implementation work well, others require more careful design and additional integrative and managerial activities. The capacity of primary care providers does not allow to provide high quality preventive services, as well as to ensure a continuum of preventive and curative work. The pattern of the Program administration facilitates its nation-wide implementation according to the unified rules, but makes it more difficult to account for the local conditions and limits the autonomy of professionals to choose specific population risk groups and a list of services. The interaction of providers in preventive activities is inadequate. Conclusion The expectations of the Program are too high due to the inconsistencies in its design and implementation. The major lesson learnt is that the program like this should meet the capacity of primary care and be designed as a complex of interrelated activities to identify illnesses and provide their follow-up management.

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“…Furthermore, large settings can redistribute resources across geographic areas through setting up small branches in remote areas and polyclinic workers can stand in for each other in case of illness or holidays. There is evidence that these strengths are not fully realized in Russia and managerial action is needed to deal with this [8].…”

Section: Evaluation Of the Modelmentioning

confidence: 99%

What next for the polyclinic? New models of primary health care are required in many former Soviet Union countries

Edwards

Sheiman

2022

BMC Prim. Care

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Background There is unfinished reform in primary care in Russia and other former Soviet Union (FSU) countries. The traditional ‘Semashko’ multi-specialty polyclinic model has been retained, while its major characteristics are increasingly questioned. The search for a new model is on a health policy agenda. It is relevant for many other countries. Objectives In this paper, we explore the strengths and weaknesses of the multi-specialty polyclinic model currently found in Russia and other FSU countries, as well as the features of the emerging multi-disciplinary and large-scale primary care models internationally. The comparison of the two is a major research question. Health policy implications are discussed. Methods We use data from two physicians’ surveys and recent literature to identify the characteristics of multi-specialty polyclinics, indicators of their performance and the evaluation in the specific country context. The review of the literature is used to describe new primary care models internationally. Results The Semashko polyclinic model has lost some of its original strengths due to the excessive specialization of service delivery. We demonstrate the strengths of extended practices in Western countries and conclude that FSU countries should “leapfrog” the phase of developing solo practices and build a multi-disciplinary model similar to the extended practices model in Europe. The latter may act as a ‘golden mean’ between the administrative dominance of the polyclinic model and the limited capacity of solo practices. The new model requires a separation of primary care and outpatient specialty care, with the transformation of polyclinics into centers of outpatient diagnostic and specialty services that become part of hospital services while working closely with primary care. Conclusion The comprehensiveness of care in a big setting and potential economies of scale, which are major strengths of the polyclinic model, should be retained in the provision of specialty care rather than primary care. Internationally, there are lessons about the risks associated with models based on narrow specialization in caring for patients who increasingly have multiple conditions.

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<p>Concentration of health care providers: does it contribute to integration of service delivery?</p>

Cited by 9 publications

References 21 publications

Vertical Program of Screenings and Check-ups in the Russian Federation: Design, Implementation and Lessons Learnt

Vertical Program of Screenings and Check-ups in the Russian Federation: Design, Implementation and Lessons Learnt

Vertical program of screenings and check-ups in the Russian Federation: design, implementation and lessons learnt

What next for the polyclinic? New models of primary health care are required in many former Soviet Union countries

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