Healthcare Management

The article analyzes the demographic problems existing in the Russian Federation and the possibilities of the obstetric and gynecological service in overcoming them. The initiatives necessary to overcome the demographic crisis are analyzed. The method of early detection of obstetric and gynecological diseases and assessment of reproductive plans in patients by passing a questionnaire is proposed. Based on the available clinical developments, a set of measures to protect women’s reproductive health and increase fertility, as well as a plan of legislative and regulatory initiatives in St. Petersburg, is proposed.

The results of the pilot survey. The statistical report included 509 patients. Menstrual disorders were most often observed in patients: 22.2% (n=113), pain syndrome 21.6% (n=110), symptoms of menopausal transition and menopause 13.9% (n=71), and infertility 9.2% (n=47).

Taking into account a significant number of patients planning to implement reproductive plans 55.2% (n=281) it is necessary to review the basic principles of therapy for menstrual disorders and endometriosis. In the treatment of menstrual disorders use of progestogens as the first line of therapy is recommended, for the pathogenetic treatment of patients taking into account reproductive plans.

The publication presents a comparative analysis of the State Guarantee Programs for the provision of free medical care for 2024–2026 in relation to similar documents for 2023–2025, in terms of the scope of work. The issues of staffing and regulatory support for changes in these documents are also considered.

The following methods were used in the study: statistical, information and analytical.

As a result of the study, the main trends in changes in state guarantees of the volume of medical care for 2024 were identified, as one of the components of the labor standardization system. A list of measures is proposed aimed at improving the current planning of the volume of medical care and the staffing standard number of medical workers.

One of the mechanisms for improving the system of planning and payment for preventive measures is the detailing of the structure of outpatient visits for preventive purposes and the introduction of financial standards for the cost of a unit of preventive measures outside the per capita funding standard. The article is devoted to an analysis of the system for planning preventive measures in relation to the volume of their implementation, financing and efficiency at the present stage of development of the compulsory health insurance sector using the example of the territorial compulsory health insurance program of the Nizhny Novgorod region. Indicators of the standard volume of preventive medical examination, clinical examination of certain categories of citizens and clinical observation of insured persons in the Nizhny Novgorod region, as well as financial standards for the cost of a unit of volume of preventive measures for the period from 2013 to 2024, approved by the relevant resolutions of the Government of the Nizhny Novgorod region, were used; indicators of actual implementation of preventive measures by medical organizations, their financial support in conjunction with indicators of their effectiveness. It has been shown that planning preventive measures by decomposing the structure of outpatient visits helps to increase the volume of preventive measures performed by medical organizations, their financing, has a positive effect on demographic indicators in the oncological field, and increases the efficiency of dispensary observation. A conclusion is drawn about the feasibility of such a system, highlighting volume and financial standards for the adult and child population.

Background. Justification of directions for improving the professional level of training of specialists in the field of healthcare organization and public health, starting with their residency training and throughout their career, is an important task of medical education.

Aim. Summarize the experience of the Department of Health Protection named after. N.A. Semashko Sechenov University to improve the educational process with residents through their preparation of calendar plans for professional self-development and career growth.

Material and methods. To achieve the purpose of the study, analytical, logical, monographic and sociological methods were used. As primary materials, studies were analyzed from 2018 to 2024. planning, reporting and educational documents at the Department of Health Protection named after. N.A. Semashko, used in the training of residents in the specialty “Healthcare Organization and Public Health”. 20 residents studying in 2024 at the Department of Health Protection named after. N.A. Semashko.

Results. It has been established that it is advisable for residents to develop a calendar plan for professional self-development and career growth in the first semester for the entire period of study and for the next five years after employment in a medical organization. In this plan, it is necessary to reflect measures for training and professional education of a specialist, conducting scientific work, preparing and passing various types of accreditation and certification for obtaining a qualification category, employment activities, estimated periods of work in various positions, etc.

Conclusion. Drawing up a calendar plan for professional self-development and career growth by residents studying in the specialty “Healthcare Organization and Public Health” provides visibility in mastering the training program and building a career path in a medical organization.

In modern conditions, the main priorities for the development of the Russian Federation and the constituent entities of the Russian Federation are to increase life expectancy and reduce mortality. Currently, there are several factors influencing the health of the working-age population. Particular attention to this issue began to be paid after the COVID-19 pandemic, determining that public health is closely related to economic indicators. Within the framework of this article, the author analyzed the factors influencing the health of the working-age population in the region. The most significant influence on the reduction in mortality among the population of working age was revealed to be exerted by economic factors and lifestyle.

Aim – to study the regional peculiarities of morbidity during pregnancy, complications of pregnancy, childbirth and the postpartum period among women in the Volga Federal District of the Russian Federation.

Material and methods. The authors analyzed the forms of the state statistical observation No. 32 "Information on medical care for pregnant women, women in labor and maternity hospitals" for 2015–2021 in the regions of the Volga Federal District. The statistical analysis was carried out using the StatTech v. 3.1.8 program (developed by Stattech LLC, Russia).

Results. In most regions for 2015–2021 a tendency has been established to decrease the proportion of normal childbirth, the incidence of pre-existing hypertension complicating pregnancy, childbirth and the postpartum period, bleeding due to blood clotting disorders, labor disorders, bleeding in the postpartum and postpartum periods, uterine ruptures, eclampsia during pregnancy, infections of the genitourinary system. Thus, in the Russian Federation and the Volga Federal District, there is a decrease in the proportion of normal births from the total by 3.1 and 8.0 percentage points, respectively, the incidence of pre-existing hypertension, complicating pregnancy, childbirth and the postpartum period, decreased in the whole country and the federal District by 20.5 and 21.1%, respectively, the incidence of eclampsia decreased in Russia by 56.6%, the incidence of placenta previa with bleeding showed a decrease in the country as a whole by 13%, premature placental abruption – by 2.2%, the incidence of obstructed labor decreased in the whole country and the district by 18.4 and 10%, respectively. The analysis of the incidence of bleeding due to blood clotting disorders allowed us to establish a decrease in the indicator in Russia and the district by 65.7 and 33.3%, respectively, labor disorders – by 23%, respectively, the incidence of perineal ruptures of III–IV degrees decreased in the district by 16.7%. An analysis of the incidence of bleeding in the postpartum and postpartum period found a decrease in the indicator for the whole country and the district by 8.3 and 8.7%, respectively. A decrease in the incidence of uterine ruptures was revealed in the district by 7.7%. The incidence of urinary tract infections has shown a decrease in Russia and the district by 4.7 and 12.8%, respectively.

In 2015–2021, an increase in the incidence of moderate preeclampsia, severe preeclampsia, placenta previa with and without bleeding, venous complications, and anemia was noted in most territories. An increase in the incidence of diabetes mellitus during pregnancy has been established in all the studied territories. Thus, the incidence of moderate preeclampsia showed an increase in Russia and the district by 30 and 18.5%, respectively, and severe preeclampsia by 30% and 1.6 times, respectively. The incidence of eclampsia and placenta previa with bleeding increased in the district by 40 and 12.5%, respectively. A 1.5-fold increase in the incidence of placenta previa without bleeding has been established in Russia and the district. An increase in the incidence of uterine ruptures has been established in the Russian Federation by 28.6%. In the whole country and the district, there is an increase in the incidence of venous complications by 32.8 and 37.1%, respectively. The incidence rate of diabetes mellitus showed an increase in Russia and the district by 331.4 and 607.8%, respectively.

The correlation analysis of the relationship between the incidence of cardiovascular pathology with moderate preeclampsia established a direct link between moderate crowding in Bashkortostan, high crowding in the Penza and Ulyanovsk regions, noticeable crowding in the Samara region; with severe preeclampsia – moderate crowding in Mari El, Saratov, Kirov and Orenburg regions, high crowding in Tatarstan, Nizhny Novgorod and Penza regions, noticeable crowding – in the Samara region; with eclampsia – noticeable crowding in the Russian Federation, Orenburg, Samara and Ulyanovsk regions, moderate crowding – in the federal District, Mordovia and the Penza region.

An analysis of the relationship between infections of the genitourinary system and diabetes mellitus established a direct link between noticeable crowding in the Perm Region and the Orenburg region, very high crowding in the Penza region, and moderate crowding in the Ulyanovsk region.

Conclusion. The conducted analysis of morbidity allowed us to identify trends that should be taken into account when planning preventive programs and organizing medical care.