Organization of primary medical care for patients with osteoporosis

The author revises the latest evidence in the literature regarding of organizing medical care for patients with osteoporosis in primary medical care. In the world, there is an increase in the group of older people (60 years and older), therefore, the problem of osteoporosis and osteoporotic fractures becomes very urgent. In Russia, the number of hip fractures will increase by 70% by 2050 compared to 2015. The article provides an overview of studies demonstrating the clinical and cost-effectiveness of population-based screening programs for the identification and subsequent treatment of patients at high risk of fractures, and discusses the issues of secondary prevention of fractures. With the active identification of patients at high risk of fractures and the initiation of antiosteoporotic therapy, a decrease in the incidence of osteoporotic fractures, including hip fractures, is expected.

Integrated Learning Management Based on Face-to-Face learning and Online Instruction in Primary Medical Care Course for Nursing Students in the New Normal Era

Blended learning refers to the model of integration between face-to-face learning and online instruction. This model used in coronavirus disease 2019 (COVID-19) pandemic, essential for prevention and control the emerging infectious disease transmission, and enhanced achievement of expected learning outcomes among nursing students. This article aimed to present a blended instruction based on asynchronous and synchronous online learning with face-to-face approach in primary medical care course for nursing students in the new normal era. The instructional design based on the 5 components of the ADDIE model including 1) analysis, 2) designs, 3) development, 4) implementation, and 5) evaluation. The conceptual framework for evaluating blended learning outcomes including 1) learners’ satisfaction, 2) students’ engagement, and 3) course outcomes. It was found that the learners’ satisfaction on blended learning were at high level. Blended learning performs a pivotal role in supporting nursing students’ engagement. All nursing students gained higher scores than the pass criteria. This article determined on improving nursing education through blended learning and extended novel issues for further research and development.

Complements or substitutes? Associations between volumes of care provided in the community and hospitals

Policymakers often suggest that expansion of care in community settings may ease increasing pressures on hospital services. Substitution may lower overall health system costs, but complementarity due to previously unidentified needs might raise them. We used new national data on community and primary medical care services in England to undertake system-level analyses of whether activity in the community acts as a complement or a substitute for activity provided in hospitals. We used two-way fixed effects regression to relate monthly counts of community care and primary medical care contacts to emergency department attendances, outpatient visits and admissions for 242 hospitals between November 2017 and September 2019. We then used national unit costs to estimate the effects of increasing community activity on overall system expenditure. The findings show community care contacts to be weak substitutes with all types of hospital activity and primary care contacts are weak substitutes for emergency hospital attendances and admissions. Our estimates ranged from 28 [95% CI 21, 45] to 517 [95% CI 291, 7265] community care contacts and from 34 [95% CI 17, 1283] to 1655 [95% CI − 1995, 70,145] GP appointments to reduce one hospital service visit. Primary care and planned hospital services are complements. Increases in community services and primary care activity are both associated with increased overall system expenditure of £34 [95% CI £156, £54] per visit for community care and £41 [95% CI £78, £74] per appointment in general practice. Expansion of community-based services may not generate reductions in hospital activity and expenditure.

PRIORITY RECOMMENDATIONS FOR SOLVING THE PROBLEM OF CHILDREN OBESITY BASED ON THE RESULTS OF THE RESEARCH

The aim: Of the work was to study and evaluate the risk factors and the level of primary medical care for children with overweight and obesity. Materials and methods: A sociological survey was conducted in main (413 persons) and control group (396 persons) and the copying from the history of the child’s development (f.112/a) of 280 obese children was conducted. Results: It was defined that on the development of excess weight in children and adolescents, biological and social and hygienic factors had a significant impact (η ≥ 3%; p<0,001) and that the level of primary medical care for obese children (proved diagnosis of obesity in the history of the child (f. №.112/а) had only 61,7±2,7% of patients) was insufficient. Conclusions: Identification of comprehensive priority activities for solving problem of children overweight and obesity based on the results of conducted research were done.

CURRENT DIAGNOSING OF ASTHMA IN CHILDREN

O. O. Rechkina Abstract Underdiagnosis and late diagnosis of asthma in children remain the topical problem of current world and local pediatrics, especially in primary medical care. Considering recent literature data, the author has presented the latest recommendations on timely diagnosis of asthma in children. The causes of underdiagnosis of the disease, terminology difficulties, risk of asthma progression development have been reviewed. Based on 2021 European Respiratory Society recommendations the key criteria of asthma diagnosis in children of different age have been listed. Key words: asthma in children, risk criteria, diagnosis

Scientific substantiation of the assessment of the territorial availability of primary medical health care to the rural population

Aim. To assess the territorial accessibility of primary health care (PHC) to the rural population in the Orenburg region. Methods. Statistical, monographic, organizational experiment research methods were applied. Statistical processing was carried out by using the Statistica 10.0 software. Basic statistics were calculated (arithmetic mean, weighted arithmetic mean). All parameters were checked by using ShapiroWilk, KolmogorovSmirnov and Lilliefors tests for normal distribution. The parametric method of statistics (Student's t-test) was used. Results. The assessment of the territorial accessibility of primary medical health care to the population of the Orenburg region was carried out using the methodology developed by us for calculating the criteria for the accessibility of primary medical health care to the rural population Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population. The use the methodology allows making management decisions regarding the territorial planning of primary health care for the rural population in the selection of problem areas with low accessibility of primary medical care. In the Orenburg region, there are the following problems: different levels of accessibility of primary health care with a variety of distance up to 30 km and different population sizes in settlements create difficulties in organizing the provision of primary health care; remoteness from the regional center up to 300 km forms a personnel deficit. Conclusion. Application of the methodology Rating of medical organizations according to the criterion of territorial accessibility of primary medical care to the rural population in the Orenburg region has allowed the development of the following recommendations for making management decisions at the regional level: (1) prioritization of territories for priority measures to ensure the availability help; (2) selection of the form of primary health care organization for the timely medical care provision to the population; (3) the formation of competition among medical organizations in the ranking of the availability of primary health care.

Primary medical care continuity and patient mortality: a systematic review

BackgroundA 2018 review into continuity of care with doctors in primary and secondary care concluded that mortality rates are lower with higher continuity of care.AimThis association was studied further to elucidate its strength and how causative mechanisms may work, specifically in the field of primary medical care.Design and settingSystematic review of studies published in English or French from database and source inception to July 2019.MethodOriginal empirical quantitative studies of any design were included, from MEDLINE, Embase, PsycINFO, OpenGrey, and the library catalogue of the New York Academy of Medicine for unpublished studies. Selected studies included patients who were seen wholly or mostly in primary care settings, and quantifiable measures of continuity and mortality.ResultsThirteen quantitative studies were identified that included either cross-sectional or retrospective cohorts with variable periods of follow-up. Twelve of these measured the effect on all-cause mortality; a statistically significant protective effect of greater care continuity was found in nine, absent in two, and in one effects ranged from increased to decreased mortality depending on the continuity measure. The remaining study found a protective association for coronary heart disease mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms, although these were not investigated.ConclusionThis review adds reduced mortality to the demonstrated benefits of there being better continuity in primary care for patients. Some patients may benefit more than others. Further studies should seek to elucidate mechanisms and those patients who are likely to benefit most. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policymakers and practitioners to counter this.