PROBLEM ISSUES OF PREVENTIVE WORK OF PRIMARY CARE INSTITUTIONS

Introduction. The article is devoted to the problematicissues of preventive work of primary care institutions.The purpose of the study: is to analyze the effectivenessof preventive areas of work of primary care physicians.Material and methods. The implementation of thevolume of preventive vaccinations for 2018-2020, theresults of preventive examinations of children has beenstudied. A survey of medical workers and parents of childrenon the effectiveness of preventive work was carried out.Results. Irregular delivery of vaccines (from 35% to78% for all groups of immunological drugs) significantlyaffected the implementation of preventive vaccinations,which decreased compared to previous years. Theuncertainty of the health workers themselves about thesafety of vaccines, which is the case with family doctors(65.33 ± 2.92 %) and their nurses (51.24 ± 2.53 %), remainsproblematic. Examples of successful prevention work arethe increase in the number of children under 6 monthsof age who were exclusively breastfed (74.3 %) and thecommitment of parents to breastfeeding (83.5 - 85.5 %).Conclusions. The problematic issues of preventivework are lack of time, lack of vaccines, low prestige ofpreventive work and lack of material incentives. From30.6% of parents at pediatricians to 41.7% of parentsat family doctors are dissatisfied with the amount ofinformation received from medical workers.

Patient Choice and Willingness Toward Gatekeepers as First-Contact Medical Institutions in Chinese Tiered Healthcare Delivery System: A Cross-Sectional Study

Introduction: Gatekeeping mechanism of primary care institutions (PCIs) is essential in promoting tiered healthcare delivery system in China. However, patients seeking for higher-level institutions instead of gatekeepers as their first contact has persisted in the past decade. This study aims to explain patients' choice and willingness and to provide potential solutions.Methods: A survey was conducted among residents who had received medical care within the previous 14 days. Patients' choice and willingness of PCIs for first contact together with influencing factors were analyzed using binary logistic regression.Results: Of 728 sampled patients in Hubei, 55.22% chose PCIs for first contact. Patients who are older, less educated, with lower family income, not living near non-PCIs, with better self-perceived health status, only buying medicines, and living in rural instead of urban area had significantly higher probability of choosing PCIs. As of willingness, over 90% of the patients inclined to have the same choice for their first contact under similar health conditions. Service capability was the primary reason limiting patients' choice of PCIs.Conclusions: The gatekeeper system did not achieve its goal which was 70% of PCIs among all kinds of institutions for first contact. Future measures should aim to improve gate-keepers' capability.

Association between early treatment hospitals, serum cholesterol level and cardiovascular disease risk in dyslipidemia patients

Background Studies have shown the importance of managing chronic diseases, such as cardiovascular disease (CVD), at the primary treatment level. Here, we aimed to evaluate the association between medical treatment institutions and health outcomes in patients with dyslipidemia, a major risk of CVD, to provide evidence for increasing chronic disease management at the primary care level in Korea. Methods We used National Health Insurance Sampling cohort data, of which 37 506 patients were newly diagnosed with dyslipidemia during 2009–14. CVD risk and changes in serum cholesterol level after dyslipidemia diagnosis were outcome variable examined. A generalized estimating equation model was used to identify associations between initial medical institution, CVD risk and changes in serum cholesterol levels. The Cox proportional-hazard ratio was used to assess the association between initial medical institutions and detailed CVD risk. Subgroup analyses were conducted to assess CVD risk following treatment with prescription medication. Results Our analyses demonstrate that CVD risk was lower at primary care-level community health centers and clinics compared to tertiary hospitals, with a statistically significant difference observed in clinics. Ischemic heart disease was lower at community health centers and clinics. However, all medical institution types were associated with significantly lower serum cholesterol levels compared to the baseline. Conclusions Management of patients with dyslipidemia at primary care institutions was associated with reduced CVD risk and decreased serum cholesterol levels. Therefore, policymakers should strengthen the quality of healthcare at primary care institutions and educate patients that these institutions are appropriate for managing chronic disease.

Relationship between Morbidity and Health Behavior in Chronic Diseases

This study aimed to analyze the demographic characteristics and health behaviors related to chronic diseases and to identify factors that may affect chronic diseases. Data from the Seventh Korea National Health and Nutrition Examination Survey were used, and 3795 adults aged above 40 years were included. The following demographic variables were obtained: sex, age, education, income, type of health insurance, and private insurance. The following health behavior factors were also analyzed: medical checkup, drinking, smoking, exercise, obesity, and hypercholesterolemia. Participants with lower socioeconomic status had a higher risk of developing chronic diseases. Meanwhile, those with private health insurance had a lower risk of developing chronic diseases. In addition, participants who underwent medical checkups and performed exercises had a lower risk, while those with obesity and hypercholesterolemia had a higher risk of developing chronic diseases. It is necessary to manage chronic diseases through comprehensive programs, rather than managing these diseases individually, and through community primary care institutions to improve health behaviors.

Naming Nutrition Injustice: How Might Dietitians Articulate a Socially Just Dietetic Practice?

This paper invites readers to consider how the ideals, concepts, and language of nutrition justice may be incorporated into the everyday practice of clinical dietitians whose work is often carried out within large, conservative, primary care institutions. How might clinical dietitians address the nutritional injustices that bring people to their practice, when practitioners are constrained by the limits of current diagnostic language, as well as the exigencies of their workplaces. In the first part of this paper, I draw on Cadieux and Slocum’s work on food justice to develop a conceptual framework for nutrition justice. I assert that a justice-oriented understanding of nutrition redresses inequities built in to the biomedicalization of nutrition and health, and seeks to trouble by whom and how these are defined. In the second part of this paper, I draw on the conceptual framework of nutrition justice to develop a politicized language framework that articulates nutrition problems as the outcome of nutritional injustices rather than individuals’ deficits of knowledge, willingness to change, or available resources. This language framework serves as a counterpoint to the current and widely accepted clinical language tool, the Nutrition Care Process Terminology, that exemplifies biomedicalized understandings of nutrition and health. Together, I propose that the conceptual and language frameworks I develop in this paper work together to foster what Croom and Kortegast (2018) call “critical professional praxis” within dietetics.

Actual problems of outpatient pediatrics and their solutions (reflections and offers of the veteran)

There is presented the analysis of the state of ambulatory pediatrics and there are formulated proposals for the priority support for the development of outpatient pediatrics in the framework of improving primary health care for children for the prevention of the shortage ofpediatricians and providing the reduction in morbidity, disability and community-acquired mortality rate. To reduce the long-term shortage of physicians in ambulatory pediatrics author proposes to introduce a new specialty "general pediatrician", which is aimed to prepare a pediatrician at the postgraduate stage for the implementation ofprimary care across all the medicine of children age. The effectiveness of this solution has been proved by the World practice and domestic experiment in the city of Orenburg. It is moreover proposed to use a target distribution of graduates ofpediatric faculty, studied on a budgetary basis, to the outpatient primary care institutions. The organization of postgraduate specialization in ambulatory pediatrics according to the author opinion, should be implemented on the base of Departments of outpatient pediatrics possessing scientific and practical experience in the training of doctors specializing in ambulatory pediatrics.