Scientific Justification of the System for Ensuring the Quality and Effectiveness of Dispensary Examination of Children and Adolescents in the Context of Urban Pediatric Clinics

The dissertation by Gasanov A.N. is devoted to the development and experimental testing of a system of measures for improving the quality and effectiveness of dispensary examination of children and adolescents in the context of urban pediatric clinics. The research is based on an analysis of the morbidity of children and adolescents based on data on healthcare utilization and complete morbidity, supplemented by preventive medical examinations, as well as on the study of the organization and volume of dispensary work of district pediatricians and medical nurses. Methodological recommendations have been developed in the work, approved by the Ministry of Health of the Republic of Dagestan, and criteria and indicators of the effectiveness of dispensary examination have been proposed, which may be used in the practical activities of healthcare authorities and educational institutions.

Relevance of the Research. The most relevant problem at the present stage of healthcare development is the problem of the quality of dispensary examination of the pediatric population. In the "Concept of Healthcare and Medical Science Development of the Russian Federation," considerable attention is devoted to issues of the quality and effectiveness of dispensary examination in healthcare institutions. A number of orders of the Ministry of Health of the Russian Federation have been issued concerning the regulation of forms and volumes of medical care provided to children: Order No. 151 of 07.05.98 "On Temporary Industry Standards of the Volume of Medical Care Provided to Children"; Order No. 154 of 05.05.99 "On the Improvement of Medical Care to Children of Adolescent Age"; Order No. 121 of 17.04.02 "On the Approval of the Medical Record of the All-Russian Dispensary Examination of Children."

Analysis of domestic literature shows that in recent years the health indicators of children and adolescents have deteriorated. Thus, according to data from the State Report of the Russian Federation (2005), the infant mortality rate in 2003 was 12.4 per 1,000 live births; the overall morbidity of newborns increased by 5.5%, children by 8.7%, and adolescents by 12%. More than half (52%) of the pediatric population have functional deviations or risk factors for disease, and 16% suffer from chronic diseases.

The results of dispensary examination in the Republic of Dagestan showed that deviations in health were detected in 65% of those examined.

At the present stage, insufficient attention is devoted to the study and improvement of preventive work, in particular to raising the quality of dispensary examination of the pediatric population. In domestic literature, there are a limited number of works devoted to separate aspects of the dispensary examination of the population (Kuznetsova V.N., 1990; Karpova S.S., 1999; Zelinskaya D.I., 2000; Baranov A.A., 2001; Gadzhiev P.S., 2001; Shchelagina L.I.A., 2001; Maximova T.M. et al., 2002; Nasybulinova G.M. et al., 2002; Chicherin L.P., 2003).

However, at present, there is insufficient research devoted to the study of the quality of dispensary examination of children and adolescents, the volume and character of preventive and dispensary work of district pediatricians.

All of the above testifies to the necessity of conducting a comprehensive research study for the development of methodological recommendations and proposals for improving the quality and effectiveness of dispensary examination of children and adolescents in the context of urban pediatric clinics.

The aim of the present research was the development and experimental testing of a system of measures for improving the quality and effectiveness of dispensary examination of children and adolescents in the context of urban clinics.

Tasks of the Research

1. To analyze the morbidity of children and adolescents based on data on healthcare utilization and complete morbidity, supplemented by preventive medical examinations.

2. To study the organization, volume, and character of the work of district pediatricians and medical nurses in the dispensary examination of children and adolescents in the context of urban clinics.

3. To develop and experimentally test a system of measures aimed at improving the quality and effectiveness of dispensary examination of children and adolescents in urban pediatric clinics.

4. To study and compare the quality and effectiveness of dispensary examination of children and adolescents in urban clinics under existing conditions and under experimental conditions.

5. To evaluate the quality and effectiveness of therapeutic, health-improving, and rehabilitation measures under experimental conditions.

Scientific Novelty of the Research

The morbidity of children and adolescents based on healthcare utilization data and complete morbidity (based on healthcare utilization data supplemented by preventive examinations) has been studied and comparatively evaluated.

The volumes of dispensary work with children and adolescents, differentiated by age groups depending on nosological forms of diseases, have been analyzed and evaluated.

A comparative analysis of the quality and effectiveness of dispensary examination of children and adolescents under existing conditions and under experimental conditions has been conducted.

A system of measures for improving the quality and effectiveness of dispensary examination of children and adolescents has been developed and experimentally tested, and the medical and economic effects of their implementation have been evaluated. The following have been developed: an organizational-methodological foundation for improving the quality of dispensary examination; a system of measures for improving the effectiveness of rehabilitation treatment, enhancing the continuity of work of district pediatricians and narrow specialists in dispensary examination, and increasing the role of the family in the dispensary examination of children and adolescents; a methodology for analyzing the quality and effectiveness of dispensary examination of children and adolescents. Recommendations have been given for the rational organization of the work of a district pediatrician at the workplace; forms and methods for advanced training of district pediatricians and medical nurses have been developed, as have criteria and indicators of the effectiveness of dispensary examination of children and adolescents.

Scientific and Practical Significance of the Research

Based on the materials of the research, methodological recommendations titled "System for Improving the Quality and Effectiveness of Dispensary Examination of Children and Adolescents in Urban Pediatric Clinics" have been developed and published. They were approved by the Ministry of Health of the Republic of Dagestan (September 20, 2005) and sent to all cities and districts of the republic.

The materials of the research are used as a teaching-methodical manual at the departments of pediatrics, public health, and healthcare, and the faculty of advanced training of physicians of the Dagestan State Medical Academy.

The methodology for analyzing the quality and effectiveness of dispensary examination of children and adolescents is used by department heads and expert physicians for intra-institutional control of the quality of dispensary examination. The recommendations and proposals may be used in the work of chief pediatricians of cities and districts, chief physicians and their deputies, and heads of clinics.

Presentation of the Research Results

The materials of the dissertation were reported and discussed at: the IV Inter-University Scientific and Practical Conference "Humanities and New Technologies in Education" (Makhachkala, May 1999); the V Inter-University Scientific and Practical Conference "Humanities and New Technologies in Education" (Makhachkala, May 2000); the VIII Inter-University Regional Scientific and Practical Conference "Humanities: New Technologies in Education" (Makhachkala, May 2003); the jubilee scientific and practical conference "Actual Problems of Postgraduate Physician Education" (Makhachkala, December 2003); the scientific and practical conference of pediatric physicians of Dagestan (Makhachkala, 2004). The work underwent experimental testing at the department of public health and healthcare of Dagestan State Medical Academy on June 27, 2005.

Publications. Fourteen scientific works have been published on the topic of the dissertation, including methodological recommendations and articles in the central press.

Main Propositions to be Defended

1. A comparative assessment of morbidity based on healthcare utilization data and complete morbidity of children and adolescents testifies to the presence of a large volume of chronic pathology among them and low medical activity of the studied contingent.

2. A system for ensuring the quality and effectiveness of dispensary examination of children and adolescents in the context of urban clinics.

3. The system for improving the quality and effectiveness of dispensary examination of children and adolescents, introduced under experimental conditions, determines the medical effectiveness and economic effect of the developed complex of measures.

Structure and Volume of the Work

The dissertation is presented across 188 pages and consists of an introduction, six chapters, a conclusion, conclusions and proposals, a list of references (163 domestic and 32 foreign sources), and appendices. The text of the dissertation is illustrated by 41 tables, 8 figures, and 1 scheme.