Health Status and Optimization of Primary Medical-Sanitary and Emergency Medical Care for the Rural Population (on the Example of the Chesmensky Municipal District of Chelyabinsk Oblast)

The dissertation is devoted to the problems of assessing the health status of the rural population and optimizing the organization of primary medical-sanitary and emergency medical care on the example of the Chesmensky District of Chelyabinsk Oblast. Socio-economic factors, living conditions, and lifestyle of rural residents are investigated, and the organization of medical care at the district level is analyzed, including personnel provision, material and technical base, and the operation of the emergency medical service.

Recommendations have been developed for improving primary medical-sanitary care for the rural population, and a reorganization of the emergency medical service has been proposed, involving the creation of a centralized system and the deployment of mobile brigades. A forecast of the health status of the adult and child population of the rural district is presented, a characterization of the medical personnel of curative and preventive institutions is given, and measures for attracting young specialists have been developed.

Issues concerning the health of the rural population are of paramount importance to the healthcare system at both the regional and national levels. Currently, the rural population constitutes 27% of the country's total population. The extensive territorial expanse, low population density, inadequate road transport infrastructure, and underdeveloped communications and connectivity adversely affect the provision of timely medical care to rural residents.

The health status of the population of the Russian Federation has been progressively deteriorating in recent years. Particularly unfavorable trends are observed with regard to socially significant and socially conditioned diseases (Shchepin O.L., Tishuk E.A., 2001; Polzunkov E.V., Belyaev O.V., 2005). The existing system of medical care organization is unable to curb this negative trend.

Negative trends in health status are observed both in the country as a whole and in a number of individual regions (Rozenfeld L.G. et al., 1999; Kruglyakova I.P., 2000; Teslenko V.R., 2000; Khalfin R.A., 2001).

In recent years, substantial changes have been taking place in Russian healthcare, primarily in the structure of governance and in the volumes of financing. Under existing financial constraints, the maximum reduction of health losses in society can be achieved only by concentrating efforts on priority directions of healthcare (Dvoirin V.I., Pogorslono E.I., 1994). The negative consequences of socio-economic transformation have most significantly affected the functioning of curative and preventive institutions providing primary medical care (Blokhin A.B., Oshkova A.A., 2003).

As noted by V.F. Oleynichenko and T.F. Kleyn (1997), healthcare policy will be effective only when the health of the population becomes a primary, priority direction of activity for state and municipal authorities and economic entities, and when unified national and regional health protection programs are developed and annually revised.

By its official position, the Ministry of Health regards the development and implementation of a rational and effective system for providing primary medical care, with enhanced emphasis on the activity of the general practitioner and the expansion of inpatient-outpatient technologies, as an urgent priority task (Shevchenko Yu.L., 2001).

Despite repeated attempts to achieve predominantly the development of the ambulatory-polyclinic service, strengthen the role of the primary level of healthcare, and improve the efficiency of utilizing material and personnel resources accumulated over many decades, the structural efficiency of the curative-preventive care system remains low. There is no real shift in the volume of medical care toward ambulatory-polyclinic care (Main Directions of State Regulation, 2000).

The reform of primary healthcare levels involves not only the improvement of financial policy but also the introduction of new organizational forms and technologies into their activities (Starolubov V.I. et al., 2001). As I.A. Alekseev (2001) notes, "in the transitional period of healthcare reform, it is necessary to ensure the accessibility and quality of primary medical-sanitary care, determine the optimal number of specialists and ensure their employment, and develop organizational technologies for treating patients within polyclinic conditions."

The organization of primary medical-sanitary care for rural residents is characterized by a number of distinctive features. Modest diagnostic and therapeutic capabilities, a shortage of qualified medical personnel, a weak material and technical base, and a deficit of financial resources do not allow for the provision of quality medical care to the population on the basis of rural curative and preventive institutions (Vodyanenko I.M. et al., 2000).

The distinctive features of the way of life of residents of rural territories acquire particular significance in the protection and preservation of the health of the rural population. There is a limited number of studies in domestic scientific literature on the improvement of the organization of medical care, which determines the necessity and relevance of our dissertation research.

Research objective: to study the health status and the organization of medical care, and to develop measures for the optimization of primary medical-sanitary and emergency medical care for the rural population of Chelyabinsk Oblast.

In accordance with the research objective, the following tasks were set:

1. Conduct an analysis and expert assessment of socio-economic factors, socio-domestic conditions, and the lifestyle of the rural population.

2. Assess the health status of the population of the Chesmensky District of Chelyabinsk Oblast, the conditions and factors shaping it, and establish predictive criteria for morbidity.

3. Characterize the organization of primary medical-sanitary and emergency medical care for the population of the district.

4. Assess changes in the medical and mid-level medical personnel of rural curative and preventive institutions.

5. Develop a program for the optimization of primary medical-sanitary and emergency medical care for the population of the rural district.

Research object: the adult and child population of the Chesmensky District of Chelyabinsk Oblast;

2) curative and preventive institutions and medical personnel of the Chesmensky District of Chelyabinsk Oblast.

The corresponding units of observation are:

1) a resident of the rural district of Chelyabinsk Oblast; 2) a physician and a mid-level medical worker of the central district hospital, rural district hospital, medical outpatient clinic, and midwife's obstetric point.

Scientific novelty of the research:

For the first time, a comprehensive medical-social study has been conducted, covering a broad range of issues related to the health status and the organization of primary medical-sanitary care for the population of rural territories, on the example of the Chesmensky District of Chelyabinsk Oblast. The health status of the rural population was studied through a comprehensive approach based on sociological research, morbidity data, and preventive examination data. A forecast has been prepared for the main health indicators of the population.

The medical-social characterization, lifestyle, and living conditions of rural families have been studied.

An expert assessment of the activities of healthcare institutions has been provided; changes in their medical and nursing personnel have been studied; and proposals for the optimization of primary medical-sanitary care have been developed.

The emergency medical service has been reorganized, and a centralized diagnostic and treatment system has been created, with a mobile brigade deployed to the district hospital and medical outpatient clinic, to enhance the accessibility of medical care.

Scientific and practical significance.

In the theoretical aspect, the results of the research constitute new scientific data on the health status of the adult and child population of a rural district under contemporary socio-economic conditions, taking into account the causal factors determining its trends.

The system of primary medical-sanitary care organization has been comprehensively analyzed; the medical-social characterization, lifestyle, and living conditions of rural residents have been studied.

In the practical respect, the reorganization of the emergency medical service with the creation of a centralized technological system and the deployment of a mobile brigade to the district hospital and medical outpatient clinic creates objective conditions for improving the accessibility of medical care and reduces the time from the moment of the call to the arrival of the emergency medical brigade. A forecast of the health status of the adult and child population has been calculated. A characterization of the medical personnel of rural curative and preventive institutions has been provided, and measures for attracting young specialists have been developed.

Propositions for defense:

1. The medical-social study of the lifestyle and living conditions of the population of the Chesmensky District of Chelyabinsk Oblast revealed a low standard of living and the prevalence of harmful habits.

2. The analysis of the network and structure of curative and preventive institutions and the personnel potential of rural healthcare confirms insufficient material and technical provision, a low level of physician staffing, and the necessity of resolving the personnel issue.

3. A complex of measures for improving the organization of primary medical-sanitary and emergency medical care for the population of a rural municipal district is progressive and can be implemented in other rural territories.

Addenda.

Based on the results of the research, 8 printed works have been published, including in publications peer-reviewed by the Higher Attestation Commission of the Russian Federation. The main materials were presented at the international scientific conference "Medico-Biological and Ecological Problems of Human Health in the North" (Surgut, 2004), the scientific-practical conference "The Role of Healthcare in the Protection of Public Health" (Moscow, 2005). In addition, the results of the dissertation work were reported at sessions of scientific societies, meetings, and conferences at the oblast and district levels.

The results of the research are used in the teaching process at the Department of Public Health and Healthcare of the State Educational Institution of Higher Professional Education "Chelyabinsk State Medical Academy of the Federal Agency for Healthcare and Social Development," in the practical work of the clinic of the Chelyabinsk State Medical Academy, the State Medical Curative and Preventive Institution of Healthcare "Chelyabinsk Oblast Clinical Hospital," and municipal healthcare institutions "City Clinical Hospital No. 4" and "Chesmensky Central District Hospital."

Documents certifying the implementation of the research results in practice are attached (Appendices 10-14).

Literature and structure of the work.

The dissertation research is presented in 34 pages of typescript text. It consists of an introduction, five chapters, a conclusion, findings and practical recommendations, a reference list, and appendices. The structure of the research is determined by the set tasks. The work is illustrated with 27 tables, 37 figures, and 1 schema. The reference list contains 265 sources, including 34 foreign ones.