CC BY
5Received by the Editor 19.11.2020
IRSTI 76.75.29
UDC 614.88:616.1:316.772-051-05
ASSESSMENT OF THE QUALITY OF OUTPATIENT CARE FOR DISPENSARY PATIENTS WITH DISEASES OF THE CIRCULATORY SYSTEM FOR THE PERIOD 2015-2019 IN THE REPUBLIC OF KAZAKHSTAN
Sh.Kulbayeva, A.Turgambayeva, A.Musina
NJcSC «Astana Medical University», Nur-Sultan city, Kazakhstan
Purpose: to assess the quality of outpatient dispensary patients who are registered for diseases of the circulatory system over the past 5 years. Justify the possibilities of using various remote information platforms.
Material and methods. The data were taken from the electronic resources of two medical institutions in Kokshetau and Tayynshinsky district. The statistical calculation was carried out by the direct method of standardization.
Results. The analysis of the data obtained showed that in the medical institutions of Kokshetau, the estimated number of hospitalized cases (2.44) and deaths (0.56) is less than in the Tayynshinsky district (hospitalized - 13.48 and deaths - 5.55). This means that in the city polyclinic service is better for the population than in rural areas, although the number of patients registered with dispensaries is much higher in the city.
Conclusion. It is necessary to actively use various remote information platforms to improve the quality and availability of medical services at the outpatient level.
Key words: diseases of the circulatory system, quality of medical care, clinical examination.
ОЦЕНКА КАЧЕСТВА ОКАЗАНИЯАМБУЛАТОРНОЙ ПОМОЩИ ДИСПАНСЕРНЫМ БОЛЬНЫМ БОЛЕЗНЯМИ СИСТЕМЫ
КРОВООБРАЩЕНИЯ ЗА ПЕРИОД 2015-2019ГГ. В РЕСПУБЛИКИ КАЗАХСТАН
Кульбаева Ш., Тургамбаева А.К., Мусина А.А.
НАО «Медицинский университет Астана», Нур-Султан, Казахстан
Цель:оценить качества амбулаторной диспансерным больным, находящихся учете по поводу болезней системы кровообращения за последние 5 лет. Обосновать возможности использования различных дистанционных информационных платформ.
Материал и методы. Данные были взяты из электронных ресурсов двух медицинских учреждений г. Кокшетау и Тайыншинского района. Статистический расчет был проведен прямым методом стандартизации.
Результаты. Анализ полученных данных показал, что в медицинском учреждений г. Кокшетау предполагаемое число случаев госпитализированных (2,44) и умерших (0,56) меньше, чем в Тайыншинском районе (госпитализированных
-13,48 и умершие -5,55). Это означает, что в городской поликлинике обслуживание населения идет лучше, чем в сельской местности, хотя количество больных, находящихся на диспансерном учете, намного больше в городе.
Заключение. Необходимо активное использования различных дистанционных информационных платформ для улучшения качества и доступности медицинских услуг на амбулаторном уровне.
Ключевые слова: болезни системы кровообращения, качество оказания помощи, диспансеризация.
ЦАЗАЦСТАН РЕСПУБЛИКАСЫНДА 2015-2019 ЖЫЛДАР КЕЗЕЩНДЕ ЦАН АЙНАЛЫМЫ ЖYЙЕСШЩ АУРУЛАРЫ БАР ДИСПАНСЕРЛ1К НАУЦАСТАРГА АМБУЛАТОРИЯЛЬЩ К0МЕКТЩ САПАСЫН БАГАЛАУ
Ш.Цулбаева, А.Ц.Т¥рFамбаева, А.А.Мусина
«Астана медицина университет» КеАК, Н^р-С^лтан к;., ^азакстан
Максаты: соцгы 5 жыл шщде кан айналымы жYЙесiнщ аурулары бойынша есепте т^рган амбулаториялык- диспансерлш наукастардьщ сапасын багалау. Эр тYрлi кашьщтьщтагы акпараттык платформаларды пайдалану мYмкiндiктерiн непздеу.
Материал жэне эдктер. Деректер Кекшетау каласы мен Тайыншы ауданындагы еш медициналык
мекеменщ электрондьщ ресурстарынан алынды. Статистикалык есептеу пкелей стандарттау эдiсiмен жYргiзiлдi.
Нэтижелер. Алынган мэлiметтердi талдау керсеткендей, Кекшетау каласынын емдеу мекемелерiнде ауруханага жаткызылган жагдайлардын (2,44) жэне кайтыс болудьщ (0,56) саны Тайыншы ауданына Караганда аз (ауруханага жаткызылган - 13,48 жэне кайтыс болгандар - 5,55). Демек, калалык емханада диспансерлiк есепте т^рган наукастардын саны калада элдекайда кеп болганымен, ауылды жерлерге Караганда халыкка кызмет керсету жаксырак.
^орытынды. Амбулаториялык денгейде медициналык кызметтердщ сапасы мен кол жетiмдiлiгiн арттыру Yшiн эр тYрлi кашыктыктагы акпараттык платформаларды белсендi пайдалану кажет.
ТYЙiндi сездер: канайналым жYЙесiнiн аурулары, медициналык кемек, клиникалык тексеру.
Introduction
Over decades of research, many components of quality have been described, but it is increasingly stated that the quality of health services in all countries of the world should be determined by their effectiveness, safety, accessibility and focus on the population. However, in order to realize the benefits of quality health care, it is necessary that health services are timely, equitable, integrated and rational[1-3].
With the development of chronic and non-communicable diseases, more and more people suffer from multiple and complex chronic conditions that require coordinated care at all levels and throughout the patient's life. Continuity and coordination of health care can help improve the experience of people living with these conditions and related needs [3].
Experience shows that good information on performance indicators is essential to improve the quality of care. The European Project to Improve Health, Productivity and Efficiency (Euro HOPE) finds that survival rates from heart attacks can differ by up to two times within a single national health system [4].
In this regard, we have obtained and studied data on assessing the quality of outpatient care for dispensary registration of patients with diseases of the circulatory system for 2015-2019, over the past 5 years. The main purpose of our research is to analyze the situation of providing high-quality medical care, namely, remote monitoring of patients, as well as to justify the need to use modern information technologies. The State Program for the Development of Healthcare of the Republic of Kazakhstan determined for 2020-2025 the provision of support to programs that promote the development of skills in monitoring and managing the state of health of the population.
At the same time, we selected statistical data on chronic cardiovascular diseases, since the mortality rate remains high both in the world and in our country. According to the international classification of diseases (ICD-10), the following nosology's were selected: I25-chronic ischemic heart disease and its nosological forms I25.0 - I25.9 (I 25.0 Atherosclerotic cardiovascular disease, I25.1 Atherosclerotic heart disease, I25.2 past myocardial infarction, I25.3 heart Aneurysm, i25.4 coronary artery Aneurysm, I25.5 Ischemic cardiomyopathy, I25.6 asymptomatic myocardial ischemia, I25.8 other forms of Chronic Coronary heart disease, i25.9 chronic coronary heart Disease, Unspecified).
According to the Research Institute of cardiology and internal diseases in the Republic of Kazakhstan, diseases of the circulatory system (DCS) in the structure of cardiovascular mortality occupy 26% [5]. In the healthcare system, dynamic monitoring is the main tool for countering and correcting behavioral risk factors in the population registered with chronic non-communicable diseases. Kazakhstan has defined a list of chronic diseases that are subject to dynamic monitoring in primary health care organizations, within the guaranteed volume of free medical care.
Dynamic observation or dispensary registration - systematic observation of the state of health of the population, as well as medical observation according to observation data. Patients with chronic diseases are monitored by specialists from primary health care organizations (PHCO): PHCO doctors (district therapists and pediatricians, general practitioners), a paramedical worker (PMW), and a district nurse of a medical outpatient clinic and (or) polyclinic, a nurse a medical center, (or) a paramedic of a paramedic-obstetric station [6].
To date, Kazakhstan has protocols (standards) for medical examinations of patients with chronic diseases, where there is an "instruction for the patient's route". A patient with chronic forms of diseases in primary health care organizations, who is registered at a dispensary, is observed by the PMW and the district doctors, who examine the patient and prescribe studies within the approved standard. This order contains various directions for dispensary registration, including a therapeutic direction and a brief instruction on patient management.
The study was conducted with the aim of studying the provision of outpatient care to dispensary patients who are registered with diseases of the circulatory system, substantiating the possibility of using various remote information platforms.
Materials and research methods: All state medical institutions, such as a polyclinic, providing primary health care work with electronic resources that are associated with clinical examination of patients, called "Electronic registration of dispensary patients" (ERDP) and "Population attachment register". The ERDP information system is designed to form a unified centralized information database of patients (electronic register) registered at the dispensary and to determine the need for free drug provision at the outpatient level. In terms of keeping records of dispensary patients, the ERDP Portal allows employees of medical organizations to automate dispensary registration and observation of patients, storage and formation of a register of dispensary patients, processing and provision of statistical and analytical data. Dispensary observation of patients for chronic non-infectious diseases of various nosologies is conducted throughout the republic in all state organizations that provide primary health care.
We selected a city polyclinic in the city of Kokshetau and a polyclinic in the countryside of the Taiynshinsky district to evaluate the medical services in the city and countryside.
The Kokshetau city polyclinicprovides high-quality outpatient and polyclinic care based on modern diagnostic, therapeutic, preventive and medical and social technologies. The therapeutic department includes 5 patient service areas, the number of the served population ranges from 60,000 to 65,000 people for five years.
The Taiynshinsky central regional hospital (CRH) provides primary health care and outpatient care to the attached population of the rural district. The radius of the serviced area is 110 km. The number of the attached population is about 40,000-45,000 people.
We analyzed the clinical examination of patients with DCS in the last 5 years (2015 -
2019).
Only clinical examinations for DCS in the polyclinic №1 in the last 5 years is 22302 people, including adults 21796 people (98%) and children up to 17 years 506 people (2%), and CRH in the Taiynshinsky region of 4252 people, including adults 4238 people (99%) and children up to 17 years 14 persons (1%).
Statistical calculation was carried out by direct standardization method, which included 5 stages: 1- calculation of General and special intensive for two compared populations; 2 -selection and calculation of the standard; 3-calculation of "expected values" for each group of the standard; 4 - definition of standardized indicators; 5 - comparison of groups by General intensive (or average) and standardized indicators.
Results and discussion
The quality of the provided medical care for patients registered at the dispensary is assessed by the timely rehabilitation of the patient's health status, and an emergency hospitalization indicates the need for fast qualified assistance. According to the number of patients referred to hospitalization and deaths from DCS, it is possible to calculate the dynamics of the number of expected values. It is important to note that the range of medical services provided is expanding and improving every year, respectively, the number of those directed to hospitalization should be less.
According to table 1, we calculated the mortality rate as an intensive indicator, the standard was calculated using the half-sum method, and the expected phenomenon as a standard coefficient.
Table 1 - Comparative indicators aimed at hospitalization of patients on the "D" account of the city of
Medical institution Age group Quantity on "D" account (medium) The number of hospitalize d patients (phenome non) Hospitalized (intensive indicator) Standard (half-sum method) Expect ed pheno menon Standard odds
Kokshetau city up to 20 years old 602 12 2,0 603 12,0
21-39 1805 54 3,0 1839 55,0
40-59 10633 236 2,2 11073,5 245,8
60 years and older 9262 243 2,6 10912,5 286,3
Total: 22302 545 2,4 24428 597,0 2,44
Taiynshinsky region up to 20 years old 2 1 50,0 603 1,0
21-39 68 38 55,9 1839 38,0
40-59 881 166 18,8 11073,5 166,0
60 years and older 3301 368 11,1 10912,5 368,0
Total: 4252 573 13,5 24428 573,0 13,48
The analysis of the data obtained showed that in the medical institutions of Kokshetau the estimated number of hospitalized was 2.44, and in the Taiynshinsky district - 13.48 cases. This means that the service of the population in the city polyclinic is better than in the countryside. At the same time, the frequency of hospitalizations in the Taiynshinsky district was significantly higher than in the urban (Taiynshinsky district - 13.48, the city of Kokshetau - 2.44), although the population of the rural district is 5 times less than the adjacent urban one.
The figure 1 shows that the number of hospitalized cases is growing in dynamics for all studied years.
1017 2018 2019 total Kokshetau city
Taiynshinsky region
The number of hospitalized patients (phenomenon) Hospitalized (intensive indicator) Expected phenomenon Standard odds
Figure 1 - Comparative indicators aimed at hospitalization ofpatients on the "D" account of the
city of Kokshetau and Taiynshinsky district over the past 5 years.
Since mortality is one of the key indicators of the quality of medical care provided, we studied the data on deaths from DCS over the past five years in two medical institutions. According to the data obtained, the number of deaths from DCS in the Taiynshinsky district was also much higher (5.55) than in the city of Kokshetau (0.56). Although there were more patients on "D" registration in the city of Kokshetau than in the Taiynshinsky district (table 2).
Table 2 - Comparative indicators of mortality from DCS ofpatients on the "D" registration of Kokshetau and Taiynshinsky district for 5 years.
Medical institution years Quantity on "D" account (medium) The number of patients who died (phenomeno n) Lethality (intensiv e indicator ) Standard (half-sum method) Expect ed pheno menon Standard odds
Kokshetau city 2015 2396 44 1,8 2779 51,0
2016 3579 29 0,8 3986,5 32,3
2017 4587 22 0,5 5007,5 24,0
2018 5221 10 0,2 5673,5 10,9
2019 6519 20 0,3 6981,5 21,4
total 22302 125 0,6 24428 136,9 0,56
Taiynshin sky region 2015 766 54 7,0 766 54,0
2016 815 38 4,7 815 38,0
2017 841 42 5,0 841 42,0
2018 905 59 6,5 905 59,0
2019 925 43 4,6 925 43,0
total 4252 236 5,6 4252 236,0 5,55
In the dynamics for all years, there is a tendency for an increase in mortality (figure 2).
The number of patients who died (phenomenon) Lethality (intensive indicator) Expected phenomenon Standard odds
Figure 2 - Comparative indicators of mortality from CSD ofpatients on the "D" registration of Kokshetau and Taiynshinsky district for 5 years.
Conclusion
Based on the results obtained, it can be concluded that in urban conditions the quality of medical care provided is much better than in rural areas. This may be due to the lack of highly specialized personnel, not timely provision of emergency assistance, etc. The number of patients registered on the "D" register, directed to hospitalization and who died from BSC was more registered in the rural polyclinic.Taking into account the number of patients referred for
hospitalization and who died from DCS on the "D" register, both in urban and rural areas, as well as the situation with quarantine measures, it is necessary to actively use various remote information platforms to improve the quality and availability of medical services at the outpatient level.
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Correspondence author: Kulbaeva Shynar Kambarovna, Master of MBA "Public Health", PhD candidate "Public Health" JSC "Astana Medical University"; e-mail: kayupova.sh@gmail.com
