CC BY
5Received by the Editor 30.11.2020
IRSTI 76.75.75
UDC 614.88:004-047.58
Analysis of the structure of emergency medical services in the city of Nur-Sultan in 2016-2019
years
A. Chayakova1, A. Utegenova1, Ausra Berzanskyte2
1NcJSC "Astana Medical University", Nur-Sultan city, Kazakhstan
2VU MF Sveikatos moksl^ institutas, Vilnius city, Lithuania
The purpose of the study is to analyze trends in the structure of emergency medical services in Nur-Sultan for 2016-2019.
Material and methods. We took the data from electronic resources of various state medical institutions of the Republic of Kazakhstan. We conducted an analysis of trends in the structure of emergency medical services in Nur-Sultan (2016-2019). We applied a statistical method for calculating a number of dynamics.
Results. Analysis of the data obtained showed that more than 4 % of calls to Nur-Sultan emergency medical services are unsuccessful, which is higher than in the Republic (RK-3%). The maximum number of rejected calls for unjustified reasons was recorded in 2018 (73 units) compared to 2017 and the growth rate was 82 %.
Conclusions. The problem of unsuccessful emergency medical services is relevant and can cause significant financial costs.
Keywords: ambulance, visits, requests for emergency medical care.
Анализ структуры выездов скорой медицинской помощи в г. Нур- Султан за 2016-2019 гг.
А.М. Чаякова1, А.М. Утегенова1, Ausra Berzanskyte2
1НАО «Медицинский Университет Астана», Нур-Султан, Казахстан
2VU MF Sveikatos moksl^ institutas, Вильнюс, Литва
Целью исследования является анализ тенденций в отношении структуры выездов скорой медицинской помощи в г. Нур-Султан за 2016-2019гг.
Материал и методы. Данные были взяты из электронных ресурсов различных государственных медицинских учреждений РК. Нами был проведен анализ анализ тенденций в отношении структуры выездов скорой медицинской помощи г. Нур-Султан (2016 - 2019 гг.). Был применен статистический метод расчета ряда динамики.
Результаты. Анализ полученных данных показал, что более 4 % вызовов в г. Нур-Султан скорой медицинской помощи являются безрезультатными, что выше показателя по Республике (РК-3%).Максимальный уровень отклоненных звонков по необоснованным причинам был отмечен в 2018 году (73 единицы) по сравнению с 2017 годом и темп роста составил 82 %.
Заключение. Проблема безрезультатных выездов скорой медицинской помощи актуальна и могут является причиной ощутимых финансовых затрат.
Ключевые слова: скорая медицинская помощь, выезды, обращения за скорой медицинской помощи.
2016-2019 жылдар араль^ында Нур-Султан каласында жедел
медициналык комектщ шы^ курылымын талдау
А.М. Чаякова1, А.М. Утегенова1, Ausra Berzanskyte2
1«Астана медицина университет!» КеАК, Нур-Султан к;., Казакстан
2VU MF Sveikatos moksl^ institutas, Вильнюс к., Литва
Зерттеудщ максаты: 2016-2019 жылдарга арналган Нур-султан каласына жедел медициналык жэрдем шыгуларыныц курылымына катысты Yрдiстердi талдау болып табылады.
Материалдар жэне эдктер. Деректер КР эртYрлi мемлекетпк медициналык мекемелершщ электрондык ресурстарынан алынды. Бiз Нур-султан к. жедел медициналык жэрдем шыгуларыныц курылымына катысты Yрдiстердi талдауды журпздж (2016 - 2019 жж.). Бiркатар динамиканы есептеудщ статистикалык эдга колданылды.
Нэтижелер. Алынган деректердi талдау Нур-султан каласына жедел медициналык жэрдем шакыруларыныц 4%-дан астамы нэтижеаз екенш керсетп, бул Республика бойынша керсетшштен жогары (КР-3%). Непзаз себептермен кабылданбаган коцыраулардыц ец жогары децгей 2018 жылы (73 бiрлiк) 2017 жылмен салыстырганда байкалды жэне есу каркыны 82% курады.
^орытынды. Жедел медициналык кемектiц нэтижесiз шыгу проблемасы езектi жэне елеулi каржылык шыгындардыц себебi болып табылады.
Тушнд1 сездер: жедел медициналык кемек, шыгу, жедел медициналык кемекке жугшу.
Relevancy
WHO, at the seventy-second world health Assembly, emphasized that the effectiveness of the emergency care system ensures prompt care for patients with urgent conditions even before diagnosis, ensuring continuity of medical care and a safe transition for the patient's health from the primary to the secondary level of the health system [1].
Emergency medical services are a special type of activity of the national health care system. The prospect of changes in the main socio-demographic and health indicators of the population depends on the effectiveness of emergency medical services. However, the functioning of the emergency medical service is associated with a number of problems [2]. In recent years, the number of calls has increased significantly and their structure has changed, which significantly affects the quality of medical care.
Nowadays 18 independent ambulance stations provided emergency medical care to the population of the Republic of Kazakhstan (RK), 261 units - emergency departments that are part of other organizations. In the system of emergency medical care (hereinafter-EMC) of the Republic of Kazakhstan, 168 units are medical teams, 52 pediatric ones. Paramedic brigades prevail in 1817 units, which occupy 89 % of the total share of general field brigades.
Of particular interest in the structure of emergency medical care, we are concerned with unsuccessful visits and rejected for unsubstantiated calls, which affect the quality of EMC services and slow down the work of the service.
Unsuccessful trips are cases when the patient was not on the spot, the call was false (the address specified during the call was not found, the patient was practically healthy and did not need help) or when the victim died before the arrival of the ambulance team, etc. An unjustified call is considered one in which, in addition to diagnostic methods of examination, the EMC team did not provide significant assistance [3].
Currently, the activity of emergency medical services is regulated by the order of the Minister of health of the Republic of Kazakhstan dated in July 3, 2017 No. 450 "On approval of the rules for providing emergency medical care in the Republic of Kazakhstan" (as amended on 08.01.2018). Emergency medical care is one of the most expensive types of care [4].
In the structure of financial expenditures for the main types of medical care, emergency medical care accounts for 4%, outpatient care-26,7%, inpatient care-22%, inpatient replacement forms-2,4%. The presence of unsuccessful visits indicates that emergency medical teams perform unusual functions, which undoubtedly reduces economic efficiency and increases the load on staff.
In accordance with the regulations of the Ministry of health the ambulance service works round the clock, providing emergency care for adults and children, both on scene and route to the hospital for conditions that threaten the health or life caused by sudden diseases, accidents, poisonings and injuries requiring emergency or urgent medical intervention [5]. Accordingly, in this way, unsuccessful departures is a call that is made to a patient who does not actually need assistance in the emergency, urgent or urgent care defined in the decree.
Thus, it is necessary to carry out targeted work to reduce the number of unsuccessful trips and rejected for unsubstantiated calls.
Purpose
Analysis of trends in the structure of emergency medical services in Nur-Sultan for 2016-2019.
Material and methods
We conducted a retrospective analysis of emergency medical services in Nur-Sultan for 2016-2019.We used a statistical method to calculate a number of dynamics. The sources were the reports the MH of the RK on "Health of population of the Republic of Kazakhstan and activity of healthcare organizations in 2019". Also data from the National Health Account of the Republic of Kazakhstan: Review of healthcare expenditures for 2018, Republican center for health development, Nur-Sultan.
The results of the study and discussion
The collected factual material is presented in tables 1,2,3 and figure.
Calls Amount % of the total number
2016 2017 2018 2019 2016 2017 2018 2019
Total
Akmola region 246878 264006 241 535 255 734 3,3 3,5 3,2 3,3
Nur-Sultan city 433851 506160 552 173 583 561 5,7 6,8 7,3 7,4
Denied for unsubstantiated calls
Akmola region 569 484 276 565 0,2 0,2 0,1 0,2
Nur-Sultan city 99 89 162 77 0,02 0,02 0,03 0,01
Unsuccessful visits
Akmola region 5223 4406 5 346 5 262 2,1 1,7 2,2 2,1
Nur-Sultan city 23856 22317 26 840 27 486 5,5 4,4 4,9 4,7
Totally in RK for 2016 year realized 7 583 959 visits, in 2017- 7 439 092 visits in 2018 - 7 524 062 and 2019-7 838 544 visits, respectively. Of these, unsuccessful departures in 2016 amounted to 178,546 visits, in 2017- 165,475 visits were completed, in 2018- 156,614 and in 2019 -201,888 visits. In the Republic of Kazakhstan, the maximum number of unsuccessful visits executed in 2019.
In the city of Nur-Sultan, unsuccessful trips are on average twice as much as in the Akmola region. In both cases, the maximum increase in unsuccessful departures calculated in 2018. However, the number of rejected calls in Nur-Sultan is much lower, which shows the effectiveness of the dispatcher service on the spot.
Thus, more than 4 % of calls to Nur-Sultan emergency medical services are unsuccessful, which is higher than in the Republic (RK-3%).
Figure - Comparative indicators of Denied for unsubstantiated calls and Unsuccessful visits in NurSultan city at 2016-2019.
■ Total ■ Denied for unsubstantiated calls B Unsuccessful visits
Table 2-Chain indicators of a number of dynamics of rejected calls for unjustified emergency medical services in Nur-Sultan for 2017-2018.
Year Refused for unsubstantiat ed calls Absolute increase Growth rate, % Growth pace, % Absolute content of 1% increase Build-up rate, %
2016 99 0 0 100 0,99 0
2017 89 -10 -10 90 0,99 -10
2018 162 73 82 182 0,89 82
2019 77 -85 -52 48 1,62 -52
The maximum rate of rejected calls for unfounded reasons was noted in 2018. It increased by 73 units compared to 2017 and the growth rate was 82 %. In 2019, this figure was 77, which shows a minimal increase and a downward trend.
Table 3-Chain indicators of a number of dynamics of unsuccessful emergency medical services in Nur-Sultan for 20172018.
Year Unsucces sful visits Absolute increase Growt h rate, % Growth pace, % Absolute content of 1% increase Build-up rate, %
2016 23 856 0 0 100 238,56 0
2017 22 317 -1 539 -6 94 238,56 -6
2018 26 840 4 523 20 120 223,17 20
2019 27 486 646 2 102 268,4 2
Unsuccessful visits in 2016 amounted to 23,856, in 2017 this figure decreased to 22,317, respectively, the growth rate was not observed.
In 2018 compared to 2017, the number of unsuccessful departures increased by 4,523 and the growth rate was 20 %. In 2019, unsuccessful visits amounted to 27,486, which shows the maximum increase, and over the past period increased by 646. The growth rate was 2 %.
The growth rate shows that the maximum increase in unsuccessful departures was in 2018, and then there is a downward trend, which indicates a slowdown in growth.
The problem of unsuccessful emergency medical services is relevant and can cause significant financial
costs.
Conclusion
Thus, in order to optimize the work of the EMC service, we concluded that it is necessary to conduct preventive conversations with the population about moral and legal issues related to medical care, as well as about the rules for calling an ambulance, which could reduce the total number of unsuccessful visits by ambulance teams and refused calls for unreasonableness.
Listofreferences
1. Семьдесят вторая сессия Всемирной организации здравоохранения Всемирной ассамблеи здравоохранения A72/ 31, пункт 12.9 предварительной повестки дня 8 апреля 2019 г.
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4. Шляфер С. И. Организация скорой медицинской помощи в Российской Федерации //Итоги приема годовой статистической отчетности за 2008 год.
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Corresponding author: Akerke Mambetovna Chayakova, Astana Medical University, Chief Specialist, SIC, tch_akon9@mail.ru.
