心血管疾病的初级医疗保健专家模型

R. Goloshchapov-Aksenov, O. V. Rukodaynyy, A. G. Koledinsky, R. Shaburov, P. Volkov, A. S. Thakur
{"title":"心血管疾病的初级医疗保健专家模型","authors":"R. Goloshchapov-Aksenov, O. V. Rukodaynyy, A. G. Koledinsky, R. Shaburov, P. Volkov, A. S. Thakur","doi":"10.17802/2306-1278-2022-11-4s-125-133","DOIUrl":null,"url":null,"abstract":"Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.","PeriodicalId":227108,"journal":{"name":"Complex Issues of Cardiovascular Diseases","volume":"9 1","pages":"0"},"PeriodicalIF":0.0000,"publicationDate":"2023-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The model of a primary medical care specialist for cardiovascular diseases\",\"authors\":\"R. Goloshchapov-Aksenov, O. V. Rukodaynyy, A. G. Koledinsky, R. Shaburov, P. Volkov, A. S. Thakur\",\"doi\":\"10.17802/2306-1278-2022-11-4s-125-133\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.\",\"PeriodicalId\":227108,\"journal\":{\"name\":\"Complex Issues of Cardiovascular Diseases\",\"volume\":\"9 1\",\"pages\":\"0\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-02-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Complex Issues of Cardiovascular Diseases\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.17802/2306-1278-2022-11-4s-125-133\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Complex Issues of Cardiovascular Diseases","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17802/2306-1278-2022-11-4s-125-133","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0

摘要

高光。初级卫生保健的临床管理效率低下,主要表现为人员短缺和心血管外科医生的能力低下,这进一步加剧了心血管疾病的进展和并发症。心血管疾病初级保健专家是心血管并发症初级和二级预防过程的临床和组织管理的功能基础,促进患者遵守建议并形成健康的生活方式。提高心血管外科医生的专业技能和能力,提供全面的医疗护理-手术和保守(功能医学模式)仍然是一个紧迫的医疗保健问题。建立心血管疾病初级保健专科医生(心血管外科医生)模式,并评价其实施的临床和管理效果。该研究(2016-2022)在“俄罗斯铁路医学”中央临床医院(莫斯科)的临床诊断中心、“sm诊所”(莫斯科)和俄罗斯人民解放军人民医科大学医学院卫生组织、药物供应、医疗技术和卫生部门进行。该研究的主题是初级保健心血管外科医生的能力和技能。初级保健专科医生模式的发展是在心血管外科医生在心血管疾病临床管理技术应用方面的个人提高和专业能力和技能整合的基础上进行的(Kicha D.I, Goloshchapov-Aksenov r.s., 2019)。该研究包括65岁以上的患者(n = 422)。患者平均年龄77±8.6岁。研究对象为具有≥5年工作经验的心血管外科医生(n = 4)。根据作者提出的《初级保健医院组织和技术管理算法(2020)》实施过程中实现目标的临床指标和管理指标,对模型的有效性进行评价。随访36个月。我们比较了2016-2018年(引入该模型之前)和2019-2022年(使用该模型期间)的结果。研究方法有:内容分析、统计、数学、分析、比较、专家。采用t-White检验评估显著性。p<0.05认为比较参数的差异有统计学意义。建立的初级保健专科医生模型包括患者定位、初次门诊和重复门诊会诊时间、能力和技能、坚持手术护理和长期临床管理、初级保健过程的信息化、自动化和系统化、跨学科整合、初级保健算法的实施和评估效率等组成部分。2016-2017年和2018-2022年期间比较指标的显著差异证实了模型的性能:晚期动脉粥样硬化患者的手术血管内护理的可获得性从7%提高到100%,心血管外科医生在提高和整合掌握手术和血管内治疗技术的技能和能力的基础上对手术护理和长期持续临床管理的承诺(从25%提高到100%);患者3年内反复住院的频率从33%下降到13% (p<0.05),救护车呼叫从9%下降到0.13% (p<0.05),急性心血管疾病-原发性急性心肌梗死的发病率从12%下降到0% (p<0.05),下肢严重缺血的复发从36%下降到0.1% (p<0.05)。患者3年生存率为96%。17例患者(平均年龄85±1.03岁)以心力衰竭进展为主要死因(猝死)。初级保健中心心血管疾病专家的发展模式是一个有效的组成部分,在3年的随访期间,老年人和老年患者的存活率为96%。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The model of a primary medical care specialist for cardiovascular diseases
Highlights. Ineffective clinical management of primary health care in the form of staffing shortage and low competence within the model of cardiovascular surgeons further contribute to the progression and complication of cardiovascular diseases. Primary health care specialist for cardiovascular diseases acts as a functional basis for clinical and organizational management of the processes of primary and secondary prevention of cardiovascular complications, the development of patients' adherence to recommendations and the formation of a healthy lifestyle. Improving professional skills and competencies of cardiovascular surgeons providing comprehensive medical care – surgical and conservative (the functional medicine model) remains an urgent healthcare issue.Aim. To develop a model of a PHC specialist (cardiovascular surgeon) in CVD and evaluate the clinical and managerial effectiveness of its implementation.Methods. The study (2016–2022) was conducted at the clinical diagnostic center of the Central Clinical Hospital “Russian Railways-Medicine” (Moscow), “SM-Clinic” (Moscow) and Department of Health Organization, Medication Provision, Medical Technologies and Hygiene of the Medical institute RUDN University. The subject of the study is the competencies and skills of a cardiovascular surgeon in primary care. The development of a model of a PHC specialist was carried out on the basis of personal improvement and integration of professional competencies and skills of cardiovascular surgeons in the aspect of applying clinical management technology in CVD (Kicha D.I., Goloshchapov-Aksenov R.S., 2019). The study included patients over 65 years of age (n = 422). The mean age of the patients was 77±8.6 years. The subjects of the study were cardiovascular surgeons (n = 4) with ≥5 years of work experience. The effectiveness of the model was evaluated according to clinical and managerial indicators of achieving the goal in the implementation of the author's algorithm for the organizational and technological management of PHC (2020). The follow-up was 36 months. We compared the results of 2016–2018 – before the introduction of the model and 2019–2022 – period of use of the model. Research methods were as follows: content analysis, statistical, mathematical, analytical, comparative, expert. The t-White test was used to assess the significance. Differences in the compared parameters were considered significant at p<0.05.Results. The developed model of a PHC specialist included components of patient orientation, the time of primary and repeated outpatient consultations, competencies and skills, adherence to surgical care and long-term clinical management, informatization, automation and systematization of the PHC process, interdisciplinary integration, implementation of the PHC algorithm and assessment efficiency. The obtained performance of the model is confirmed by significant differences in the compared indicators for the periods of 2016–2017 and 2018–2022: an increase in the availability of surgical endovascular care for patients with advanced atherosclerosis from 7 to 100% and the commitment of cardiovascular surgeons to surgical care and long-term continuous clinical management for the basis of improving and integrating the skills and competencies of mastering surgical and endovascular treatment technologies (from 25 to 100%); decrease in the frequency of repeated hospitalizations of patients during 3 years from 33% to 13% (p<0.05) and ambulance calls from 9% to 0.13% (p<0.05), a decrease in the incidence of acute cardiovascular diseases – primary acute myocardial infarction from 12 to 0% (p<0.05) and recurrence of critical ischemia of the lower extremities from 36 to 0.1% (p<0.05). The 3-year survival of patients was 96%. The main cause of death (sudden) in 17 patients (mean age 85±1.03 years) was the progression of heart failure.Conclusion. The developed model of a PHC specialist in cardiovascular diseases is an effective component that contributes to 96% survival rate of elderly and senile patients during 3 years of follow-up.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
0.70
自引率
0.00%
发文量
0
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信