Patients’ assessment of medical services quality – a determinant of changes in medical entity management on the example of Poland

PurposeThe article’s primary goal is to identify areas requiring improvement in the activities of healthcare entities, suggest directions for future changes, and indicate the strengths and weaknesses of the clinic’s operation based on patients’ opinions. Subjectively expressed opinions of patients are treated as acceptance of the current state of affairs or the need to introduce changes in a given area.Design/methodology/approachThe empirical research was based on information obtained from questionnaire surveys on patients’ opinions about services provided by medical entities. The hypothesis was verified by research conducted in 23 (out of 50 possible) the most dynamically developing non-public healthcare institutions in one of the regions of Poland. The conducted research was based on a proprietary survey using questions on qualitative and quantitative scales.FindingsThe results of empirical research allowed us to identify areas requiring improvement and to propose future directions of changes in the surveyed units. The suggested changes should significantly improve efficiency in the organisation and management of a health facility, focused on medical effectiveness and patients’ health effectiveness.Originality/valueFrom a broader perspective, research results may become a starting point for further considerations on changes in the organisation and management of healthcare facilities. Using the study’s conclusions in practice may positively affect the improvement of the functioning of healthcare facilities, their better reputation and contribute to increasing competitiveness in the medical services market.

Experience in surgical treatment of idiopathic macular ruptures in Orenburg branch of The S. Fyodorov Eye Microsurgery Federal State Institution

Purpose. To study the anatomical and functional results of various methods of surgical treatment of idiopathic macular rupture. Material and methods. In the course of this study, 50 medical records of patients with a diagnosis of macular rupture were randomly selected from the total number of those, who underwent the surgery at the Orenburg branch of The S. Fyodorov Eye Microsurgery Federal State Institution for 2020 year. Patients were divided into 3 groups. In the first group (38 eyes), the macular rupture was closed using ACP and PRP, in the second group (7 eyes) – using an inverted flap of the internal border membrane, in the third group (5 eyes) – by mechanical convergence of the edges of the rupture followed by tamponade of the vitreous cavity with silicone oil. Results. To assess the medical efficiency of the studied methods of surgical treatment of idiopathic macular rupture, the rate of increase in the maximum corrected visual acuity (MCVA) was calculated for each patient. Conclusion. The calculated indicator of the dynamics of vision improvement «the rate of BCVA growth» as a whole reflects the positive dynamics of the treatment of idiopathic macular rupture by surgical methods and can be used to assess the medical effectiveness of methods of treating patients with eye diseases initially with different values of the BCVA parameter. In the course of the analysis, no significant differences were found between the influence of various methods of surgical treatment of macular rupture on the rate of BCVA growth or rupture closure. Correlation analysis did not establish a statistically significant dependence of the growth rate of BCVA on the initial size of the rupture. Key words: macular rupture, inverted flap, platelet-rich plasma (PRP), autologous conditioned plasma (ACP).

HEALTH PERFORMANCE AUDIT

The article discusses the directions and key issues of audit of efficiency in healthcare in foreign countries and in Russia. The analysis of the impact of the performance audit on the solution of socially important problems of maintaining public health is carried out. The authors determined the purpose of the audit of efficiency in the health sector, which is to promote the financial interests of the state, to ensure public health needs, to support accountability and responsibility regarding the activities of healthcare institutions. The medical effectiveness of healthcare institutions is determined as the degree of achieved results in the diagnosis, treatment, prevention, rehabilitation of patients, which is expressed as a percentage (or shares) based on the ratio of the number of cases of achieved results to the total number of observations. The absence of a specialized and legislatively fixed list of executive bodies endowed with control and supervisory powers in relation to healthcare institutions was noted. It was revealed that the requirement to exercise control related to the licensing functions of state supervision in Russia has not been established. Based on a study of foreign practice of financial control, it was found that performance audits represent a significant proportion of the control measures taken, and is the most progressive form of financial control. The article systematizes the bodies for monitoring compliance with mandatory requirements for goods, works and services at the level of medical institutions. Their non-systematic work, lack of interconnection in the implementation of supervisory activities as a factor that reduces the effectiveness of their authority is revealed.

Effectiveness of local injective therapy use for lumbosacral pain syndromes

The objective of the study was to assess the effectiveness of local injection therapy in patients with lumbosacral pain during medical blockades.Methods and materials. The results of treatment of compressive lumbosacral radiculoischemia were studied in prospective trial with placebo control. One of the most valuable criteria of medical effectiveness was decrease of pain intensity by visual analog scale and McGill’s questionnaire. 58 patients were included in the study. Comparison between the groups was carried out depending on the treatment: first group was treated with combination of anesthetic with corticosteroids (diprospan), second group – only anesthetic. Rate of pain decrease was assessed during the first day and for 14 days.Results. In patients with lumbosacral pain treated with combination of anesthetic with corticosteroids, decrease of pain intensity was obtained by visual analog scale and McGill’s questionnaire point. Local corticosteroids use was the most effective with effect in a short time – during the first 24 hours.Conclusion. Short course of local injection therapy had high effectiveness in patients with lumbosacral pain syndrome.

Cannabis Enthusiasts’ Knowledge of Medical Treatment Effectiveness and Increased Risks From Cannabis Use

Purpose: To compare cannabis enthusiasts’ knowledge about cannabis risks and effectiveness in treating medical conditions with existing empirical evidence. Design: A brief survey assessed cannabis use, information sources, and knowledge about risks and effectiveness. Setting: A cannabis advocacy event in April 2019 in a state with legal medical and recreational cannabis. Participants: Demographically diverse adults (N = 472) who frequently used cannabis; 85% used cannabis for health or medical purposes. Measures: Participants reported the sources of their cannabis information, health conditions they thought cannabis was effective in treating (n = 10), and health risks increased by cannabis (n = 6). Conditions and risks were based on ratings of evidence (ie, from substantial to insufficient) for therapeutic effects and risks identified in a review by The National Academies of Sciences, Engineering, and Medicine (NASEM, 2017). Analyses: Chi-square tests examined the correspondence between participants’ knowledge and NASEM conclusions. Results: Most participants’ (95% confidence interval [CI]: 74%-81%) knowledge of cannabis was from their own experiences; 18% (95% CI: 14%-21%) received information from primary care providers. On average, participants’ beliefs matched NASEM conclusions for half of effectiveness (95% CI: 50%-53%) and risk items (95% CI: 55%-57%). Many (95% CI: 38%-42%) thought that cannabis use did not increase any risk. Contrary to NASEM conclusions, many thought cannabis was effective in treating cancer (76%), depressive symptoms (72%), and epilepsy (68%). Those who received cannabis information from their primary care providers had better knowledge of medical effectiveness. Medicinal cannabis use frequency inversely predicted knowledge of medical effectiveness and increased risks of adverse events. Conclusion: There were considerable discrepancies between cannabis users’ knowledge and available evidence, highlighting the need for more research and education (by physicians, caregivers, and dispensaries) on effectiveness and health risks, especially for users with specific health issues such as pregnant women and people with depression.

IMPACT OF CERTAIN PUBLIC HEALTH FACTORS ON THE DURATION OF INPATIENT TREATMENT OF MI PATIENTS

The aim was to study the impact of predictors on the duration of inpatient treatment of MI patients. Materials and methods: We copied data of 462 inpatient medical records of myocardial infarction patients who underwent hospital treatment by different methods (coronary artery stenting, thrombolytic therapy, conventional drug therapy). We determined basic predictors and duration of inpatient treatment of MI patients. Impact of the parameters was studied using Cox regression. Results: We built models of hazard ratios of coronary artery stenting impact on treatment duration for myocardial infarction patients, which proved that this treatment method significantly reduced the treatment duration, even after correction of confounders like sex (HR=1.32; p=0.041), age over 60 (HR=1.31; p=0.048) and heart failure Stage 2A-2B (HR=1.36; p=0.020). Conclusions: The results we obtained indicate a statistically significant effect of CAS on MI patients’ treatment duration, both separately and combined with multiple effects of confounders, indicating its medical effectiveness and the need for widespread introduction of this treatment method in medical practice in every region of Ukraine.

REGULARITIES AND FORMING FACTORS OF THE CHILDREN’S MORBIDITY RATE AT THE BEGINNING OF THE XXI CENTURY (THE LITERATURE REVIEW)

There was shown the significance of leading risk factors for the development of adverse changes in the body, forming the high level of the morbidity rate in children: biological (the character of the course of pregnancy and parturition), social and environmental (diet, living and learning conditions, standards of living of the family, a culture of the healthcare), medical (effectiveness of preventive, health and therapeutic work in children’s groups). There was determined the necessity of a differentiated approach to the evaluation of the role and contribution of factors for groups of the various age.

Health Technology Assessments in Radiology in Germany: Lack of Demand, Lack of Supply

Background Health technology assessments (HTAs) are an interdisciplinary method to support sustainable, evidence-based healthcare decisions. They systematically assess medical products, procedures, and technologies with respect to medical, economic, legal, social, and ethical aspects. Method This review analyzes the current use of HTAs in radiology in Germany and discusses challenges associated with HTAs. In particular, incentive structures of various players in the healthcare field involved in HTA implementation are considered for both the inpatient and outpatient sectors. Taking into account that the Joint Federal Committee (G-BA) has different authority between sectors ("ban reservation” for inpatients and “authorization right” for outpatients), we focus on the repercussions on reimbursement for new diagnosis or treatment methods by statutory health insurance companies. Results The G-BA’s authority implicitly creates a paradox in terms of incentives to implement and finance HTAs: in the outpatient sector HTAs are considered necessary to evaluate new medical services while players may not have sufficient incentive to implement and finance HTAs in the inpatient sector. Conclusion Characteristics of HTAs differ widely with respect to the items to be assessed. Therefore, an HTA for drug effectiveness is not easily transferable to radiological procedures. Within radiology, each method must be assessed individually (e. g. according to tumor stage). Despite these challenges, systematic compilation and critical assessment (regarding both cost and medical effectiveness) of available evidence should be a basic component of evidence-based radiology. As companies in healthcare fail to invest in studies that advance evidence-based radiology and considering the lack of incentive for such investments, public funding institutions need to accept the challenge to support studies that assess the benefit of radiological procedures. Key Points: Citation Format

Antiaging Cosmeceuticals in Korea and Open Innovation in the Era of the 4th Industrial Revolution: From Research to Business

The importance of the healthcare industry has increased and it has thrived, although the cosmetic industry of Korea has been in depression. A recently issued group of items in Korea, ‘cosmeceuticals’, is defined as a combination of pharmaceuticals and cosmetics proven to have medical effectiveness. Antiaging cosmeceuticals in Korea have performed well in terms of expanding business by combining with beauty services, so they are viewed as high-valued items. This fact supports the evidence that there are various studies on cosmeceuticals. Therefore, this paper shows that the global status and growth potential of cosmeceuticals are documented and the concepts of the application of the demonstration complex and open innovation will be linked together based on research of antiaging cosmeceuticals in Korea for an aging society. This paper intends to provide the basic information for forming a ‘lab to market’ which connects the future cosmeceutical laboratory to the market.

Nutraceutical prospective: The synergetic mechanism of action of inositols and resveratrol on metabolic syndrome

It has been known that inositols function as insulin second messengers and mediate different insulin-dependent processes and are a valid natural, non-pharmaceutical alternative to contrast insulin-resistance as well as associated metabolic syndrome in women with Polycystic ovarian disease (PCOS). Several studies also have shown positive effects of resveratrol in reducing glucose and lipid concentrations in patients. Recently, clinical evidence has proven that an D-chiro-inositol/resveratrol combination has a potential role to play in maintaining metabolic and endocrine health, however no large clinical trials have demonstrated the medical effectiveness of the combination, and the combined mode of action remains poorly discussed. Herein, we address the hypothesis of a synergistic mechanism adopted by D-chiro-inositol and resveratrol in reducing insulin resistance and hyperlipidemia and thus showing a greater therapeutic potential compared to treatment with inositol’s alone.