Improvement of the Rehabilitation System for Working-Age People Suffering from Chronic Diseases in the Republic of Khakassia

The dissertation is devoted to the improvement of the rehabilitation system for working-age people suffering from chronic diseases in the Republic of Khakassia. The study is based on an analysis of the dynamics of chronic disease morbidity among the adult population of the region for 1999–2003, the social-hygienic characterization of working-age persons with chronic diseases, and the medical and social status of their families. Special attention is given to the role of the rehabilitation potential of the family in the process of patient rehabilitation.

The work develops a model for comprehensive rehabilitation of working-age people suffering from chronic diseases in the territory of the Republic of Khakassia, as well as a classifier of the rehabilitation potential of families of patients. Measures for the implementation of this model and methodological recommendations for medical specialists are proposed. The results of the study have been introduced into the practice of the State Service of Medical and Social Expertise of the Republic of Khakassia.

Relevance of the study

According to official statistics, over the past 10 years, the overall morbidity rate in healthcare institutions has shown a tendency to increase across virtually all age groups and for the majority of disease classes. (Osadchikh A.I., 2002).

Approximately 80% of the healthy life years lost by the population (due to premature mortality and disability) are attributable to somatic diseases. In the studies of several authors (Luzin S.N., Lavrova D.I., Andreeva O.S., Talalaeva N.D., Chikina N.I., 2002), it has been demonstrated that the increase in the average life expectancy of the population and the improvement in the survival prospects of patients with complex pathological conditions depend on their access to medical and social assistance.

In the materials of the meeting of the Government of the Russian Federation dated November 10, 2005, "On the implementation of the Concept for the Development of Healthcare and Medical Science in the Russian Federation and the main directions of healthcare for 2006–2010," it was noted that the overall morbidity rate of the population continues to rise, as the morbidity among the adult population increased by 16% and amounted to 1275.3 per 1000 population in 2004, compared with 1072.6 in 1997. The approach to coverage by dispensary observation remains formal, since despite the growth in the number of chronic diseases, the proportion of patients placed on dispensary registration has not increased.

The unfavorable socio-economic situation in the Republic of Khakassia that had developed by 1999 led to a significant decline in the quality of life of patients, as a result of which the level of chronicity of somatic and socially determined diseases increased, and the number of chronically ill persons, including those of working age, grew. One of the directions of the medical and social policy in the Republic of Khakassia became the formation of a rehabilitation direction in the work of various ministries and departments involved in the rehabilitation of patients of various ages with chronic pathology.

Recent studies have demonstrated the possibility of involving families in the process of comprehensive rehabilitation of children who have experienced critical conditions in the early neonatal period (Menshikova T.N., 2005), as well as of adolescent disabled persons (Likhuzova N.I., 2004).

It should be noted that the question of including families in the comprehensive rehabilitation of persons with chronic diseases remains insufficiently studied to this day.

The increase in the number of working-age persons suffering from chronic diseases and the need to improve the process of their rehabilitation with the involvement of families determined the relevance of conducting the present study in the Republic of Khakassia.

Aim of the study

Development of a model for comprehensive rehabilitation of working-age people suffering from chronic diseases in the Republic of Khakassia.

Objectives of the study:

1. To conduct an in-depth analysis of the dynamics of morbidity among the working-age population of the Republic of Khakassia.

2. To study the social-hygienic characterization of working-age people suffering from chronic diseases.

3. To assess the medical and social status of families having chronically ill members of working age.

4. To study the rehabilitation potential of families.

5. To develop a model for comprehensive rehabilitation of working-age people suffering from chronic diseases in the Republic of Khakassia.

Scientific novelty of the study

For the first time in the Republic of Khakassia, at the regional level, the medical and social status of working-age people suffering from chronic diseases and their families has been studied.

A classifier of the rehabilitation potential of families of patients has been developed.

The degree of family involvement in the comprehensive rehabilitation of working-age persons with chronic diseases has been demonstrated.

A model for comprehensive rehabilitation of working-age people suffering from chronic diseases in the territory of the Republic of Khakassia has been developed.

Practical significance of the work

The degree of influence of social-hygienic and medical and social factors on the health status of working-age persons with chronic diseases in the territory of the Republic of Khakassia has been established.

Based on the results of the study, methodological recommendations have been developed for physicians of expert medical commissions (EMC) and specialist physicians of other structures involved in the comprehensive rehabilitation of persons with chronic pathology.

The results of the study have been proposed for inclusion in the program for improving the rehabilitation system for patients in the Republic of Khakassia.

Main provisions for defense:

1. Comprehensive assessment of the health status of working-age persons suffering from chronic diseases and the medical and social characterization of their families make it possible to determine the priority of providing them with medical care.

2. Measures for the comprehensive rehabilitation of working-age persons suffering from chronic diseases should be carried out taking into account the rehabilitation potentials and capabilities of their families.

3. The model for comprehensive rehabilitation of working-age persons suffering from chronic diseases serves as the basis for improving the rehabilitation system for persons with chronic diseases residing in the territory of the Republic of Khakassia.

Implementation of results in practice

The author's adapted variant of the individual rehabilitation program for disabled persons (IRP) adapted to regional conditions has been introduced into the work of the State Service of Medical and Social Expertise of the Ministry of Labour and Social Development of the Republic of Khakassia (subsequently — FGU GB MSEx of the Republic of Khakassia).

Methodological recommendations — "Organization and methodology for developing the individual rehabilitation program for disabled persons in the Republic of Khakassia," "Features of the main directions of work of the specialist physician in rehabilitation in the bureau of medical and social expertise," "Ways to improve continuous professional education of disabled persons in the Republic of Khakassia" have been implemented in the work of FGU GB MSEx of the Republic of Khakassia.

Acquaintance with the work

The main provisions of the work were discussed at: the All-Russian Scientific Conference "Evidence-Based Medicine" — Krasnoyarsk, February 18–19, 2003; the I Russian Congress "Rehabilitation Assistance to the Population of the Russian Federation" — Moscow, October 30–31, 2003; the VIII International Congress "Man and His Health" — Saint Petersburg, November 24–28, 2003; the II Interregional Scientific and Practical Conference — Chita, August 26–27, 2004; the IX International Congress "Man and His Health" — Saint Petersburg, November 22–26, 2004; the Regional inter-university Scientific Conference "Krasnoyarsk Krai — 70 Years" — Krasnoyarsk, November 26, 2004; the problem commission on public health and healthcare of KrasGMA, October 2005.

Publications

Fourteen printed works on the dissertation topic have been published, including six in central press and three methodological recommendations.

Scope and structure of the dissertation

The work is presented on 132 pages of printed text and consists of an introduction, five chapters, a conclusion, findings, and practical recommendations. The text is illustrated with 16 tables, 21 figures, and 13 diagrams. The reference list contains 162 sources, of which 31 are by foreign authors.