MEDICAL-SOCIAL ESTIMATION OF CONDITIONS OF PULMONOLOGIC CARE AND ORGANIZATIONAL-METHODIC MECHANISMS OF ITS MANAGEMENT IN THE SYSTEM OF PRIMARY MEDICAL-SANITARY CARE TO THE POPULATION

The results of medical-social estimation of conditions of pulmonologic care and organizational-methodic mechanisms of its management in the system of primary medical-sanitary care are presented. A sociologic study was carried out among 460 general physicians who work in healthcare institutions of the Amur and Yaroslavl regions with a specially developed questionnaire including 45 questions. The majority of interviewed general physicians work in the city institutions (91.9%) and 8.1% in health care institutions in the village, including 66.7% in city policlinics and 20.7% in policlinics of Central Regional Hospitals, 6.9% in the village medical ambulance stations and 5.7% in departmental policlinics. As for age and sex features of the respondents, there were 89.3% of women and 10.7% of men; 13.0% were at the age of 30 years old and younger, 22.6% of 30-39 years old, 22,2% of 40-49 years old, 32.6% of 50-59 years old and 9.6% of 60 years old and older. The results of medical-social study of conditions of the professional work of GPs show that in general 33.7±2.2% of respondents are satisfied with their job and more than a half (58.3±2.2%) estimated the degree of satisfaction with 4 and 5 points (by 5-point scale). At the same time the biggest specific gravity of negative estimations of different working conditions was caused by the level of payment (57.6±2.3% of respondents) and the level of workload (55.3±2.3%). The specialists of the first sector of health care are not satisfied with the equipage of the office: the necessary equipment (48.3±2.3%), the laying out and technical condition of the office (44.1±2.3%), the stock and instruments (40.8±2.2%). The analysis of the motivation of GPs of the first healthcare sector oriented to the effective and qualitative medical care of pulmonologic patients conducted with the application of mutual coupling factor (К_а - D.Yule’s Coefficient of Association и К_к - K.Pearson’s contingency coefficient) allowed to reveal the degree of its dependence on different conditions and factors of professional work, among which the most important were the length of employment (К_а=0.821, К_к=0.371) and the level of professional qualification (К_а=0.495, К_к=0.216), social environment (city, village) and organizational forms of professional activity (К_а=0.488, К_к=0.212). On the basis of system analysis of factors which affect the organization and effectiveness of medical care of pulmonologic patients, the complex of organizational-methodic mechanisms of its optimization at the level of the first health care sector was developed and structured and 20 modules were formed. The results of the sociologic study allowed to define the degree of their priority as instruments of optimization of pulmonologic care of the population.

первичная медико-санитарная помощь населению, врач-терапевт участковый, организация пульмонологической помощи, условия профессиональной деятельности врача, организационно-методические механизмы управления медицинской помощью, социологические исследования в здравоохранении, primary medical-sanitary care, general practitioner, the organization of pulmonologic care, conditions of the professional activity of a doctor, organizational-methodic mechanisms of medical care management, sociologic studies in healthcare

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