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6FEATURES OF PROVIDING STATIONARY OTOLARYNGOLOGIC HELP ON THE BASIS OF THE
REGIONAL HOSPITAL OF CHERNIVTSI REGION
Yakovets K.,
«Bukovinian State Medical University», Ukraine
Yakovets R.,
«Bukovinian State Medical University», Ukraine
Chyfurko T.,
«Bukovinian State Medical University», Ukraine
Skalska S.,
«Bukovinian State Medical University», Ukraine
Chornenka Zh.,
«Bukovinian State Medical University», Ukraine
Grytsiuk M.
«Bukovinian State Medical University», Ukraine
Abstract
In Ukraine, a comprehensive health care reform has been initiated in order to provide the population with affordable and quality medical care. The reform envisages the priority implementation of primary health care assistance on the basis of family medicine, which ended by July 2019 in all regions of Ukraine and the reform of secondary medical care was started on the basis of the principle of intensifying the provision of medical inpatient care: new type of hospitals. Also, modern economic mechanisms of activity of health care institutions are being implemented. The indicated transformations at the primary and secondary levels of provision of medical care will affect the organizational plan and work of regional hospitals as centers of highly specialized assistance in the regions.
Keywords: inpatient care, otolaryngology, reform, regional hospital, highly specialized assistance.
In the organization of provision of highly specialized medical care in the context of reforming the health care system at the regional hospital, there are a number of new challenges. This is the introduction of an effective management system in the functioning of the supervisory board, the system of safe stay of patients in a health care institution, strategic planning of the development of the healthcare institution in a competitive environment with private health care institutions that are actively developing with the introduction of modern methods of financing that requires healthcare providers to develop new competences, knowledge and professional skills. The analysis shows that regional hospitals, where highly specialized, and accordingly, high-value inpatient medical care should be provided, are hospitalized to 40.0% who require only specialized secondary care. And therefore, the already insufficient resources, which are extremely needed for the development of the regional institution, are used irrationally. The analysis shows the need for volume planning, and hence the capacity of the stationary sector to provide highly specialized care as well as planned medical care. An important task is the development of demonstrations and the system of training for the provision of medical care in tertiary health care facilities. This task is complex and subject to decision at the central branch level with the involvement of scientists, practitioners and economists. Important is the issue of the existence of low-level regional specialized health care institutions (endocrinology, otolaryngology, dermatological, cardiology, etc.). There are some types of highly specialized medical care that provides health care in the city (regional center) health care institutions. Medical care in such specialties, but under certain conditions more qualitative, may be provided in regional hospitals with a significant reduction of overhead, including administrative costs. Thus, the task of reorganizing a part of health care in-
stitutions of tertiary level of medical care is by combining them with regional hospitals. An important component of the provision of medical care in the region, including highly specialized, is its continuity. The research data indicate that it is currently inadequately used. A single register of patients should be the optimum mechanism that can ensure continuity in the provision of medical care at its stages and levels. The question arises also about personnel policy at the regional hospital level. We are confident that only highly qualified medical personnel, both doctors and average health care providers, should be able to provide highly specialized medical care; by the way, their importance in providing medical care to patients should be substantially increased, which are recognized for work in the competition. At the same time, the medical staff should be motivated for high-quality and efficient work. This can be achieved by eliminating the rigid centralized rationing of staffing; the introduction of economic mechanisms for remuneration, which can ensure their professional competition. Innovation in personnel policy can be personalized automated accounting of the activities of each medical officer of a hospital according to certain criteria. Thus, regional hospitals should become centers in the regions providing advisory, diagnostic and medical highly specialized care to the population.
By the end of 2018 there were 72,50 full-time positions of otolaryngologists in the region. Provision of full-time positions of otolaryngologists for 10 thousand people is - 0.80. Provision of individuals by 10 thousand population is - 0.82. In 2017, the provision of regular posts amounted to 0.79 per 10 thousand population, individuals 0.84 per 10 tons.
Provision of ENT rates in the districts of the region in 2018 is - 0.34 per 10 thousand population. Ensuring ENT rates in the regions of the region in 2017 was -0.34 per 10 t.
Ensuring ENT rates separately for each region of the region is:
№ 3/n 2017 year 2018 year
Areas of the region Number of Provision for 10 Number of Provision for 10
regular posts thousand people regular posts thousand people
1. Vyzhnytskyi district 2,50 0,45 2,50 0,45
2. Hertzevsky district 1,25 0,38 1,25 0,37
3. Glybotsky district 1,75 0,24 1,75 0,24
4. Zastavsky district 1,0 0,20 1,00 0,20
5. Kelmenetskiy district 2,25 0,55 2,25 0,56
6. Kitsman district 2,50 0,36 2,50 0,36
7. Novoselytsya district 2,50 0,32 3,00 0,38
8. Putyla district 1,00 0,38 1,00 0,38
9. Sokyryany district 0,50 0,11 1,00 0,23
10 Storozhinets district 3,25 0,33 3,25 0,32
11 Khotyn district 3,0 0,48 2,25 0,36
12 by group 21,50 0,34 21,75 0,34
13 Novodnistrovsk 1,0 0,91 1,00 0,92
14 Chernivtsi 25,00 0,95 26,00 0,992
15 Obl. medical institutions 24,50 0,27 23,75 0,26
16 In the region as a whole 72,00 0,79 72,50 0,80
As can be seen from the table below, the level of inter-regional and higher provision in seven regions of the region: Vyzhnyts'ky (0.45), Hertzayevsky - (0.37), Kelmenetsky (0.56), Kitsmansky - (0.36), Putil'skoye (0, 38), Khotinsky (0.36), as well as in Novodnistrovsk (0.92). m Chernivtsi - (0,99)
According to the city of Chernivtsi 26,00 registered posts of otolaryngologists, respectively, the provision of rates of otolaryngologists is 0.99 per 10 thousand population, the provision of full-time positions in 2017 was also 0,95 per 10 thousand us.
In general, in Chernivtsi region in 2018, the availability of full-time positions of otolaryngologists for 10 thousand people is - 0.80.
In general, in Chernivtsi oblast in 2017, the availability of regular posts of otolaryngologists for 10 thousand people is - 0.79.
In the oblast, the availability of full-time post-doctoral otolaryngologists for adults is 0.84 per ten, and the provision of children's otolaryngologists is 0.66 per 10 tons. .
In Ukraine, the provision of ENT for adults is 0.79 per 10 tons, children's ENT positions - 1.3 per 10 tons.
Areas of the region Total physicians (individuals) Incl. in the final training of personnel, research institutes, administrative bodies Of these, there are categories Including: % of the total number of doctors certified
Higher I II
a6c % a6c % a6c %
Vyzhnytskyi district 1 2 3 4 5 6 7 8 9 10
Hertzevsky district 85 8 68 47 55,3 15 17,6 6 7,06 80,0
Glybotsky district 26 0 24 19 73,1 3 11,5 2 7,7 92,3
Zastavsky district 28,0 0 25 18 64,3 6 21,4 1 3,6 89,3
Kelmenetskiy district 3 - 2 2 100 - - - - 66,7
Kitsman district 2 - - - - - - - - 0,0
Novoselytsya district 2 - 1 - - 1 50,0 50,0
Putyla district 1 - 1 - - - - 1 100 100
Sokyryany district 2 - 1 - 1 50,0 - - 50,0
Storozhinets district 2 - 1 1 50,0 - - - - 50,0
Khotyn district 3 - - - - - - - - 0
by group 1 - 1 - - - - 1 100 100,0
Novodnistrovsk 1 - - - - - - - - 0,0
Chernivtsi 3 - 3 1 33,3 2 66,7 - - 100,0
Obl. medical institutions 4 - 1 1 25,0 - - - - 25,0
In the region as a whole 1 - 1 1 100 - - - - 100,0
Among all working otolaryngologists, 68 doctors have been certified in the qualification categories, which is 80.0%. Nine working otolaryngologists are certified after internship or correspondence with their occupation: Chyzhevskaya L.T., Serebryansky V.V., Kotsiuban V.P., Rusnak AI, Lupashko V.V., Levdnyuk S.V., Gavryshchuk E.I., Tomyuk D.M. Krivonosov S.I. Including otolaryngologists for children.
Name Total physicians (individuals) Incl. in the final training of personnel, research institutes, administrative bodies Of these, there are categories Including: % of the total number of doctors certified
Higher I II
a6c % a6c % a6c %
region 1 2 3 4 5 6 7 8 9 10
Chernivtsi 15 - 11 10 66,6 1 6,6 - - 73,3
Medical institutions are regional. subordination 3 - 3 1 33,3 2 66,7 - - 100,0
Chernivtsi 6 - 5 5 83,3 - - 83,3
Kelmenetsky 1 - - - - - - - 0,0
Novoselytsya district 1 0,0
There are 15 pediatric otolaryngologists, of which eleven have categories (73.3%), the highest category is
ten, the first one, and four work with a certificate after the end of internship. Stationary care
Otolaryngologic patients in the region were provided in 2018 with 173.49 beds, which were placed in:
The name of the institution Average summer beds in 2018 In fact, beds have been deployed
Total Incl adults Incl children's
ENT Center OKL 55,00 55,0 50 5
LOR of ODI city medication. 40,00 40,0 20 20
Vyzhnytsya CRC 5,00 5,0 5 -
Glibotska CRP 6,00 6,0 6,00 -
Kelmenetskaya CRC 2,00 2,0 2,00 -
Kitsmanskaya CRC 15,0 15,0 15,0 -
Storozhinets CRC 20 20,0 16 4
Khotyn CRC 13,0 13,0 10.00 3,00
Total in the region 156,0 156,0 124,0 32,0
Of the 156.0 annual otolaryngologic beds, at the end of 2018 12400 adult beds and 32.00 children's beds were employed.
Provision of ENT beds in the region for 10 thousand population is - 1,72.
The availability of adult beds is 2.16.
The availability of children's beds is - 1.73
Provision of ENT beds in the regions of the region - 0,96
Provision of ENT beds in the city of Chernivtsi (without ENT center) - 1,52
The provision of children's otolaryngologic beds in Ukraine is - 2.0 per 10 tons.
Ensuring the total population of Ukraine ENT beds is - 1.71 per 10 t.
Treated patients Tt was planned bed / days Actually bed / days completed % of the completed plan bed / days Number of beds The work of the bed Average length of stay of the patient on the bed Wrap the bed Died Mmortality
OKL Ad. 1930 16250 17742 109,2% 50 354,84 9,18 38,65 2 0,10
Child 813 1625 4083 251,3% 5 816,6 5,02 162,66 0 0
Gen. 2743 17875 21825 122,1% 55 396,82 7,95 49,9 2 0,07
II city -Hospital Ad. 883 6500 7351 113,1% 20 367,55 8,33 44,12 0 0
Child 822 6500 5910 90,9% 20 295,5 7,19 41,1 0 0
Gen. 1705 13000 13261 102,0% 40 331,5 7,77 42,66 0 0
Vy/.hnytsya CRC Gen. 213 1625 1640 100,9% 5 328,0 7,7 42,59 0 0
Glibotska CRP Ad. 175 1950 1857 95,23% 6 309,5 10,61 29,17 0 0
Child
Gen.
Keimen CRC Ad. 109 650 722 111,1% 2 361,0 6,62 54,53 0 0
Child
Gen.
Kitsman.CRL Gen. 613 4875 6105 125,2% 15 407,0 9,96 40,86 0 0
Storo/.hinets-KCLL Ad. 615 5200 5665 108,9% 16 354,1 9,21 38,44 0 0
Child 182 1300 1545 118,8% 4 386,25 8,49 45,49 0 0
Gen. 797 6500 7210 110,9% 20 360,5 9,05 39,8 0 0
Khotvn CRC Ad. 520 3250 4227 130,1% 10 422,7 8,13 51,9 0 0
Child 89 975 754 77,3% 3 251,33 8,47 29,6 0 0
Gen. 609 4225 4981 117,9% 13 383,15 8,17 46,89 0 0
In the region Ad. 5058 40300 45309 112,4% 124 365,39 8,96 40,78 2
Child 1906 10400 12292 118,2% 32 384,1 6,45 59,55 0 0
Gen. 6964 50700 57601 113,6% 156 369,23 8,27 44,65 2 0,03
for 2018 Gen. 6830 54095 54582 100,9% 164,6 331,6 7,99 41,5 4 0,05
In 2018, indicators of the implementation of the bed fund of ENT in the region's hospitals are at a good level.
The bed-days plan was completed on 113.6%, and in 2017 it was executed on 100.9%, the number of treated patients slightly increased by 134, the number of bed-days spent increased by 3019. The average length of stay of the patient on the bed is 8, 27, which is 0.28l / d. more than in 2017. The cooking of the bed is 44.65 versus 41.50 in 2017.
Almost all ENT hospitals in the oblast, with the exception of the Glybotsky CRP (95.23%), managed to cope with their planned tasks: the Center for Occupational Health was 122.1%, Vyzhnitskaya by 100.9%, the Kelmenetskaya CRP by 111.1%, the Kitsman Central Hospital (125 , 2%), Storozhynets' CRR by 110.9%, and Khotyn's CRR by 117.9%.
The plan for bed-days in children's beds was not performed by the II city hospital (by 90.9%) and Khotinsk CRP (by 77.3%).
Surgical activity ofENT of in-patient departments of the region in 2018.
In total there were operations in ENT in the institutions of the region - 5171, including children under 17 years old - 2031 operations.
On the ear, 600 operations were carried out, including for children under 17 years old - 276.
Twenty eight surgical operations were performed on the middle ear in patients with middle ear disease.
At chronic mean otitises in the stage of remission, for the purpose of rehabilitation and hearingrecovery, 16 operations were performed. In addition, one oto-plasty was carried out on the outer ear.
Operations on the lymphoid ring of the pharynx have been made - 2177, of which 1447 operations were carried out for children under 17 years of age.
In outpatient clinic conditions, 3982 small operations were performed on the ENT organs (paracentesis, removal of granulations and polyps from the ear, abscesses and hematomas of the ENT of organs, repositioning of the nose bones, primary surgical treatment of wounds in injuries of ENT organs, puncture of the maxillary and frontal sinuses) , of which 629 operations are in the ear.
In 2017, all operations were carried out in ENT in the institutions of the region - 5529, of which children under 17 years - 2434 operations.
On the ear, 543 operations were carried out, including for children under 17 years old - 263.
Thirty two sanitizing common-cavern operations on middle ear were performed in patients with chronic middle otitis media.
In chronic middle otitis at the stage of remission, with the aim of rehabilitation and hearingrecovery, 18 feats were performed. In addition, two otoplasty have been carried out on the outer ear.
The operations on the lymphoid ring of the pharynx are made - 2516, of which 1817 operations were performed for children under 17 years old.
In outpatient-policlinic conditions 4466 small operations on ENT organs were performed (paracentesis, removal of granulations and polyps from the ear, abscesses and hematoma of the ENT organs, nose bone repositionations, primary surgical wound healing in the trauma of the ENT of organs, puncture of the gyro-magrosis and frontal sinuses) , of which 711 operations are in the ear.
Conclusions. Thus, the level of stationary otolaryngologic help from the Chernivtsi region indicated that about 10% of patients had information about the organization of the treatment process directly, and the official information about the person of the attending physician, his qualification and the conditions for choosing a doctor, guaranteed by the current legislation, was completely closed to patients.
References
1. Lekhan VM, Slabkyi GO, Shevchenko MV. Development Strategy of the Health Care System: Ukrainian Dimension. Ukraine. The health of the nation. 2010;1 (13):5-23.
2. Matyukha LF. Scientific substantiation of the system of organization of primary medical and sanitary care on the basis of family medicine. Manuscript. Abstract. The dissertation for obtaining a scientific degree of doctoral sciences on the specialty 14.02.03 - social medicine and 14.01.38 - general practice-family medicine.
3. On amendments to the Fundamentals of Ukrainian legislation on health care in relation to improving the provision of medical care: Law of Ukraine dated July 7, 2011 No. 3611-VI [Electronic document]. -Mode of access: http://www.zakon.rada.gov.ua.
4. On the Procedure for Reforming the Health Care System in Vinnytsia, Dnipropetrovsk, Donetsk Oblast and the City of Kyiv: Law of Ukraine dated 07.07.2011 No. 3612-VI [Electronic Document]. -Access mode: http://www.zakon.rada.gov.ua.
5. Program of Economic Reforms for 2010 - 2014 "Prosperous Society, Competitive Economy, Efficient State". Committee on Economic Reforms under the President of Ukraine 2010. - 87 p .: Access mode: http://www.president.gov.ua/content/ker-pro-gram.html: Title from the screen.
6. Report of the Ministry of Health «Analysis of the work of the otorhinolaryngology service of Chernivtsi region for 2018».
7. Shevchenko MV, Zaglada OO, Karamzin LA, Boyko VYa. Directions of improvement of the system of financial and economic relations of health care (analytical review of scientific literature). Bulletin of Socrates. Hygiene and Org. health care of Ukraine. 201; 4: 58-64.
