Medical-Social Analysis and Improvement of Emergency Medical Care in a Large City

The dissertation is devoted to the medical-social analysis and improvement of emergency medical care in the conditions of a large city. The study is based on the materials of the emergency medical care station of the city of Krasnodar and covers the period from 2000 to 2007. The work analyzes the level and structure of population utilization of emergency medical care by leading disease categories, evaluates the quality of emergency medical care provision from the standpoint of patient satisfaction, and develops organizational measures to increase the efficiency of emergency medical care operations at the municipal level. For the first time, the author conducted a comprehensive assessment of current trends in the organization of emergency medical care in specific regional conditions at the territorial level and substantiated approaches to improving this system without increasing resources.

According to WHO data, approximately 20% of individuals die due to the absence of qualified medical care at the pre-hospital stage, which determines the increasing role of emergency medical care for the population within the healthcare system (B.I. Starodubok, 1999; O.P. Shchepin, 2000; N.I. Vishnyakov, 2000; I.A. Estrin, 2004; G.Z. Elenev, L.V. Kaplan, 2005).

The existing achievements in providing this type of medical care have been attained primarily through extensive development (an increase in the number of general and specialized teams, the number of physicians and mid-level medical personnel, and the strengthening of material and technical support). Further improvement of the organization of emergency medical care for the urban population requires the identification and utilization of hidden resources based on enhancing the quality of medical care and intensifying work.

In recent years, the study of various aspects of this problem, as well as questions of improving pre-hospital care for the urban population, has been devoted to the works of V.V. Kuchenko, N.V. R.A. Khalfin, 2002; V.F. Likhina, 2003; V.F. Ozherov, 2003; A.S. Ermolova, 2004; I.S. Elyuka et al., 2005; N.G. Petrova et al., 2005. The authors of these studies note the complexity and multifaceted nature of this problem.

The demographic situation developing in recent years in the Krasnodar Territory, along with its geographic and climatic position, have altered the structure of population utilization of emergency and urgent medical care. The increase in the number of elderly individuals due to a sharp decline in the birth rate and the influx of older age groups has led to a significant increase in utilization for cardiovascular diseases, diseases of the digestive organs, respiratory organs, the nervous system, and sense organs, the outcomes of which depend to a considerable extent on the quality of medical care provided to patients at the pre-hospital stage.

An analysis of literary data and own observations based on the example of the emergency medical care station of the city of Krasnodar indicates that the most promising avenue for increasing the effectiveness and quality of emergency medical care for the city's population is the improvement of organizational forms and methods of managing emergency medical care. Despite a number of significant successes in the area of emergency medical service for the population at the pre-hospital stage, the available literature contains few studies devoted to the improvement of organizational forms of work of emergency medical care stations in specific regional conditions.

The foregoing constituted the basis for conducting the present study.

Objective of the study: to substantiate a set of organizational measures aimed at improving emergency medical care for the population.

Tasks of the study:

1. To critically generalize and systematize the available municipal-level experience in organizing emergency medical care for the population of the city of Krasnodar.

2. To determine the level and structure of utilization of emergency medical care by the population of the city of Krasnodar in 2000-2004 and to provide an analysis of quantitative and qualitative indicators of emergency medical care provision.

3. To study the degree of patient satisfaction with the quality of emergency medical care provided.

4. To develop proposals for improving the system of emergency medical care provision to the population.

The scientific novelty lies in the fact that, based on an analysis of literary data and the author's own results of a socio-hygienic study, a comprehensive assessment of current trends in the organization of emergency medical care in specific regional conditions has been conducted for the first time. An in-depth analysis of quantitative and qualitative indicators of emergency medical care activity in new socio-economic conditions (2000-2007) has been carried out. For the first time, trends in population utilization of emergency medical care by the most prevalent acute diseases have been identified and generalized from the standpoint of their priority. For the first time, a study of population satisfaction with the quality of emergency medical care has been conducted at the territorial level. Approaches to improving emergency medical care for the population under conditions of a municipal healthcare system have been developed and substantiated.

Practical significance of the work. The results of the study have made it possible to present to healthcare authorities an objective assessment of the state of emergency medical care for patients at the pre-hospital stage, to identify shortcomings in its organization, to evaluate performance indicators, and to determine optimal opportunities for increasing the efficiency of emergency medical care team utilization; an improvement in team performance indicators has been achieved without increasing resources.

The results of the socio-hygienic study and patient opinions have been utilized by practical healthcare authorities. The research results are used in the educational process at the departments of public health, healthcare and history of medicine at KGMU, clinical therapy with a course of emergency medical care, and the department of public health and healthcare at the Faculty of Advanced Training of KGMU.

The main provisions of the dissertation to be defended:

1. Features of the organization of emergency medical care.

2. Current trends in population utilization of emergency medical care. Results of the analysis of quantitative and qualitative indicators of emergency medical care provision to the population.

3. Results of the sociological survey of patients regarding the degree of satisfaction with the quality of emergency medical care provided.

4. Substantiation of a system of organizational measures for improving emergency medical care for the population.

Author's personal contribution and work performed.

The author independently conducted an analytical review of literary sources on the problem under investigation. A research program was compiled, and patient questionnaires were conducted (personal participation - 100%). The program for mathematical-statistical processing of the material was compiled, and the processing was carried out with the author's participation (personal participation share - 75%). Proposals ensuring an increase in the efficiency of emergency medical care for the city's population were developed and substantiated by the author (personal participation - 100%). Intermediate results of the study were monitored by the scientific supervisor; the presentation and interpretation of the obtained data and the preparation of recommendations were performed personally by the author (personal participation share - 95%).

Relevance of the work. The main provisions of the dissertation were reported at the collegium of the Department of Health of the Administration of the Krasnodar Territory (Krasnodar, 2004), a joint session of the departments of public health, healthcare and history of medicine and clinical therapy with a course of emergency medical care (2004), the All-Russian Scientific and Practical Conference "Problems of Demography, Medicine, and Health of the Population of Russia" (Penza, 2005), the VI International Scientific and Practical Conference "Health and Education in the XXI Century" (Moscow, 2005), the regional scientific and practical conference "Social Sphere of Kuban" (Krasnodar, 2006), the interregional scientific and practical conference "Health and Education in the XXI Century" (Maykop, 2006).