Organizational and technological algorithm of primary specialized health care at cardiovascular diseases

Abramov, A.I.; Голощапов-Аксенов, Р С; Kicha, D I; Rukodayny, O V

doi:10.17816/kmj2020-394

Cited by 5 publications

(2 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The Sverdlovsk region is a subject of the Russian Federation characterized by high rates of incidence and prevalence of tuberculosis, exceeding the national average by 1.3-1.5 times. The tense epidemiological situation with respect to tuberculosis in the Sverdlovsk ОРГАНИЗАЦИЯ ЗДРАВООХРАНЕНИЯ И ОБЩЕСТВЕННОЕ ЗДОРОВЬЕ region is due to a number of factors, including high rates of HIV infection for the period of December 2012 prevalence -1347.5 cases per 100,000 population, morbidity -136.4 cases per 100,000 population, the presence in the region of a significant number of institutions of the Main Directorate of the Federal Penitentiary Service, the social, economic and geographical characteristics of the region in the national economic positioning and health care in general [13].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Development and application experience of the clinical and organizational management algorithm for tuberculosis medical care at the regional level

Kostin

Abramov

Цветков

et al. 2022

Vestn. Ross. univ. družby nar., Ser. Med.

View full text Add to dashboard Cite

Relevance. The high incidence, prevalence and mortality in tuberculosis determines the relevance of improving clinical and organizational processes in terms of algorithmization. The aim of the study was to develop and evaluate the effectiveness of the clinical and organizational management algorithm for tuberculosis medical care at the regional level. Materials and Methods. The object of the study (2007-2021) were the tuberculosis medical care system of the Sverdlovsk region, Russian Federation. The scientific and methodological bases were Department of Health Organization, Drug Supply, Medical Technologies and Hygiene of the Peoples’ Friendship University of Russia topic SRW № 214791-3-000. The development of the algorithm was carried out on the basis of a scientifically proven universal clinical management system. The epidemiological tuberculosis author data and of Rosstat in the Sverdlovsk region for 2007-2020 were used - general and structural morbidity, prevalence, mortality, as well as the number of 3, 4 and 6 groups of dispensary registration of patients. The efficiency of the algorithm was evaluated by the dynamics of the complex of epidemiological indicators of tuberculosis. Research methods were applied: content analysis, analytical, statistical, comparative, expert. Significance was assessed using the t-White test. Differences in the compared parameters were considered significant at p0.05. Results and Discussion. The effectiveness of the developed algorithm for managing regional tuberculosis medical care, including the components of needs analysis, systematization, automation and telecommunications, interdisciplinary integration, resource provision and performance evaluation, was confirmed by a significant decrease in the Sverdlovsk region for the period 2007-2020 general incidence by 2.05 times (from 119.9 to 51.7 per 100 thousand of the population), the incidence of children 0-14 years old by 1.48 times (from 18.7 to 12.6 per 100 thousand children of the corresponding age), prevalence in the population by 1.8 times (from 258.6 to 143 per 100 thousand of the population) and mortality from tuberculosis by 2.675 times (from 21.4 to 8.02 per 100 thousand of the population) (p0.001). The COVID-19 pandemic (2020-2021) did not worsen the epidemiological situation for tuberculosis in the region. In 2020, an active form of tuberculosis was detected in 2201 people, which is 16 % less than in 2019 (p0.05). The prevalence of epidemiologically dangerous bacillary forms of the disease for the period 2019-2020 decreased by 15.4 %, from 73.2 to 61.9 per 100 thousand population (p0.05). Conclusion. Clinical and organizational management of tuberculosis medical care based on the algorithmization of scientifically evidence processes increases the effectiveness of therapeutic and preventive measures and the social and epidemiological well-being of the population.

show abstract

Section: Introductionmentioning

confidence: 99%

“…Management of clinical and organizational processes based on algorithms has been scientifically proven in various diseases. The effectiveness of the developed clinical and organizational systems is widely presented in the available scientific literature [8,9,13].…”

Section: Introductionmentioning

confidence: 99%

Development and application experience of the clinical and organizational management algorithm for tuberculosis medical care at the regional level

Kostin

Abramov

Цветков

et al. 2022

Vestn. Ross. univ. družby nar., Ser. Med.

View full text Add to dashboard Cite

show abstract

The experience of the decision-making algorithm of primary healthcare for the elderly patients with cardiovascular diseases

Rukodaynyy

Голощапов-Аксенов

Shaburov³

et al. 2022

Kompleks. probl. serdečno-sosud. zabol.

View full text Add to dashboard Cite

Highlights. The basis for improving the quality of medical care is the arrangement of algorithms for clinical processes. The choice of a clinical and organizational solution for cardiovascular diseases in groups of older age patients at the stage of primary healthcare is a complex medical and economic task that requires maintaining the balance of efficiency, safety and quality of life in the "patient – risks – survival – economic efficiency" system. The development of an algorithm for making clinical and organizational decisions concerning cardiovascular diseases in elderly patients to improve the effectiveness of primary healthcare is an urgent health issue.Aim. To develop and evaluate the effectiveness of the algorithm for making clinical and organizational decisions at the primary healthcare stage for elder patients with cardiovascular diseases.Methods. The bases for the study were conducted in 2016–2020 at the Vascular Surgery Department of Peoples Friendship University of Russia and the Central Clinical Hospital “RZD-Medicine”. The object of the study was the patients with cardiovascular diseases (n = 422), mean age 76.11±7.2 years old. The subject of the study was cardiovascular surgeons (n = 4) experienced in surgical and endovascular technology. The algorithm was based on the content analysis of scientific publications (n = 27), clinical practice, the organizational and technological algorithm of PHC (primary healthcare) developed by Abramov A.Yu. and the colleagues in 2020 and the recommendations for the care of the elderly people with polymorbidity developed by the American Geriatric Society (2012). The medical, social and clinical effectiveness as well as the economic results of inpatient treatment were evaluated. The periods before and after the implementation of the algorithm in 2016–2017 and 2018–2020 were compared. Content analysis, analytical, statistical, mathematical, comparative, and expert research methods were applied.Results. The developed PHC (primary healthcare) algorithm contributed to the high level of accessibility of endovascular care (100%). Cardiovascular surgeons positively assessed the possibility of providing surgical care in 100% of cases and patient adherence to surgical treatment (99.5%). In 2016–2017 and 2018–2020 the surgical activity of the vascular surgery department significantly increased from 7 to 98.9%, the average bed-day decreased from 9.5 to 6.8 days and the postoperative bed-day from 7.2 to 4.12 days, the frequency of repeated hospitalizations in the hospital decreased during the year from 3.1±0.2 to 1.6±0.4 times, the incidence of primary acute myocardial infarction from 12 to 0% and relapses of critical ischemia of the lower extremities from 36 to 2%. The average cost of direct medical costs for the treatment of one patient during the year in the main and control groups did not differ significantly, 4 086$ (USA) и 3 887$ (USA), respectively.Conclusion. The PHC development and experience algorithm indicates the increase in the medical, social and clinical effectiveness of medical care for cardiovascular diseases in patients of older age groups and helps to reduce the direct costs of inpatient care.

show abstract

The model of a primary medical care specialist for cardiovascular diseases

Голощапов-Аксенов

Rukodaynyy

Koledinsky

et al. 2023

Kompleks. probl. serdečno-sosud. zabol.

View full text Add to dashboard Cite

Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.

show abstract

Organizational and technological algorithm of primary specialized health care at cardiovascular diseases

Cited by 5 publications

References 21 publications

Development and application experience of the clinical and organizational management algorithm for tuberculosis medical care at the regional level

Development and application experience of the clinical and organizational management algorithm for tuberculosis medical care at the regional level

The experience of the decision-making algorithm of primary healthcare for the elderly patients with cardiovascular diseases

The model of a primary medical care specialist for cardiovascular diseases

Contact Info

Product

Resources

About