А.М. Булешова, философия докторы, Абишева М.С., магистрант

Оң тү стік Қ азақ стан медицина академиясы, Қ азақ стан Республикасы, Шымкент қ аласы.

КӨ З БҰ РШАҒ ЫНЫҢ ПАТОЛОГИЯСЫ БАР АДАМДАРҒ А ОФТАЛЬМОЛОГИЯЛЫҚ КӨ МЕК Ұ ЙЫМДАСТЫРУДЫ ЖЕТІЛДІРУДІ Ғ ЫЛЫМИ ТҰ РҒ ЫДА НЕГІЗДЕУ

Зерттеу мерзімінде кө з аурулары жә не оның қ осалқ ы ө уыстарының біріншілік аурушаң дығ ы 1000 тұ рғ ынғ а шақ қ анда хирургиялық араласулар мен стационарлық емдеуді қ ажет ететін ө те ауыр, орта есеппен 38 жағ дайды қ ұ рады, яғ ни біріншілік аурушаң дық ішінде катаракта мен глаукома 12, 3% қ ұ рады. Аурушаң дық дең гейінің таралу кө рсеткіші бойынша 1000 адамғ а шақ қ анда 115-123 жағ дайды кө рсетті, яғ ни ә р 8 немесе 9 азаматтың офтальмологиялық ауруы бар деген сө з.

2010 жылдан бастап осы кө рсеткіштің тұ рақ ты тү рде тө мендеуі байқ алады (10 000 тұ рғ ынғ а шақ қ анда 11, 2 ден 9, 9ғ а дейін).

Оң тү стік Қ азақ стан тұ рғ ындары ішіндегі ең бекке қ абілетті азаматтар жә не зейнеткерлер арасындағ ы мү гедектіктің негізгі кө рсеткіші арасындағ ы айырмашылық 6, 5 ретті кө рсетті (орташа есеппен 2010-2017ж.ж. 10 000 тұ рғ ынғ а шақ қ анда, сә йкесінше 1, 93 пен 12, 73), жә не тұ рғ ындар топтарында мү гедектік кө рсеткішінің қ ұ рамында айырмашылық дең гейінің ө суі байқ алады.

Кілтті сө здер: кө ру органы, катаракта, факоэмульсификация ультрадыбыстық тә сілі, бтнокулярлық, профессионалдық реабилитация, кө з бұ ршағ ы, профессионалдық жарамдылық.

ABSTRACT

A.M. Buleshova, Doctor of Philosophy, M.S. Abisheva, graduate student

South Kazakhstan State меdical Academy, Republic of Kazakhstan, Shymkent

SCIENTIFIC SUBSTANTIATION OF PERFECTION OF ORGANIZATION OF OPHTHALMOLOGICAL ASSISTANCE TO PERSONS WITH LUMBER PATHOLOG

The study showed that the primary incidence of diseases of the eye and its adnexa during the study period averaged 38 cases per 1000 population, with the heaviest forms requiring inpatient treatment and surgery, cataract and glaucoma, accounted for 12.3% of the primary incidence. The indicator of the prevalence of diseases has developed at the level of 115-123 cases per 1000 people, i.е. Each 8 or 9 citizen has an ophthalmic disease.

Since 2010, there has been a steady decline in this indicator (from 11.2 to 9.9 per 10, 000 populations). The difference between KPI levels among persons of retirement age and able-bodied population of the South Kazakhstan region is 6.5 times (on average for 2010-2017 - 1.93 and 12.73 per 10 thousand of the population, respectively) and there is an increase in the degree of difference in the formation indicator of disability in population groups.

Key words: organ of vision, cataract, ultrasound phacoemulsification method, binocularity, professional rehabilitation, lens, professional suitability.

UDC: 614.2: 616.12-082(574.53)

PERFECTION OF THE ORGANIZATION AND MANAGEMENT OF CARDIOLOGICAL ASSISTANCE POPULATION OF THE SOUTH KAZAKHSTAN REGION

¹ Grjibovski A.M. ²Buleshova A.M., ²Buleshova R.M., ² Abdullaeva G.B.,

² Kenzhebaev D.K. ³Y.A. Annaorazov, N.S. ³ Zh anabayev

¹ Norwegian Institute of Public Health, Osl о

² South Kazakhstan medical academy

³ International Kazakh-Turkish University

ABSTRACT

Results of studies in the field and materials of the Ministry of Health of the Republic of Kazakhstan testify to the lower effectiveness of the measures taken to reduce the mortality from cardiovascular disease than from cerebrovascular diseases. According to the research, the reasons for this are: 1) the insufficiently high quality of specialized medical care provided to patients with ACS and MI; 2) inadequate equipment and qualifications of FAP personnel, GPs (general medical practice) and ambulance teams; 3) the absence of clear criteria for choosing methods of treatment and algorithms for the action of medical personnel at each stage of care; 4) violation of continuity in the provision of medical care to patients at different stages; 5) inconsistency of equipping medical institutions with the requirements specified in the Procedures for the provision of medical care in the BSC.

Key words: cardiac care, mortality from diseases of the circulatory system, medical and social problems, effectiveness of measures.

The relevance of research. For several decades, one of the most acute medical and social problems in the world, including the Republic of Kazakhstan, is the circulatory system diseases (CSD), whose share in the mortality structure of the country in recent years has been 52-54%. In 2016, the death rate from the disease of the circulatory system was 417.8 cases per 100 thousand people, while in Western Europe - 214.5 cases, in Eastern Europe - 493.6 cases, in the USA - 315.7 cases for 100000 cases. In addition, if in the last 20 years in Western Europe and North America a stable tendency to reduce mortality from cardiovascular diseases has developed, then in the SKO until 2015 its growth continued, and only in the last 2 years its level began to decline.

Despite the severity of the epidemiological situation according to the BSK, studies that provide a complete picture of the nature of their distribution and the dynamics of changes in different regions of the country are insignificant. At the same time, the need for such research is high, since there are significant differences between the administrative regions of the SKO, reaching 3-4 times the death rate from cardiovascular diseases, and by the level of primary morbidity they are 4.5 times. There are also practically no studies on the evaluation of factors affecting the formation of the disease of the circulatory system.

Materials and methods.

The subject of the study was the mortality and morbidity rates of the main types of circulatory system diseases (CSD) and the system of cardiac care for the population, and the object is the South Kazakhstan region, one of the largest in terms of population, the level of social and economic development and the resource potential of the health system. The analysis covered the period from 2008 to 2017.

At stage 1.1, the dynamics of indicators of total mortality and mortality in working age of the population of the South Kazakhstan region from BSK, ischemic heart disease (IHD), cerebrovascular diseases (CVD) was analyzed. To estimate their possible changes in the medium-term perspective, methods of linear extrapolation of data trends have developed forecasts to 2015. In studies on district formations, the ranking and typology of the 64 largest administrative-territorial structures of the region were used.

At stage 1.2, according to a similar scheme, the dynamics of the indicators of the general and primary morbidity of BSC, IHD and CVD was assessed.

At the stage 2.0, the resources of the cardiological service of the Sverdlovsk region were studied, as well as the influence of them and a number of other factors on the formation of different levels of IHD and CVD morbidity in the district formations of the South Kazakhstan oblast and the mortality from these causes.

At stage 2.1, the influence of the resource potential of local cardiology services was determined. To assess the distribution of resources of the cardiological service in 13 district formations, their ranking and typology were carried out. The analysis was carried out by comparing the indicators of total mortality, mortality in working age, as well as the general and primary incidence of these diseases in groups of district formations with different levels of availability by cardiologists, these specialists of the highest qualification category and hospital specialized beds. The statistical significance of these differences was determined by the Student's test (p < 0.05).

At stage 2.2, a multidimensional analysis of the effect of 18 medical, organizational, socio-economic and demographic factors on the incidence of IHD and CDW and overall mortality from these diseases was performed. For mathematical processing algorithms for pattern recognition, implemented in the package of programs QUASAR (VS Kazantsev, 1990) were used.

Later (step 2.3), using the developed mathematical models, the potential effectiveness of various managerial scenarios aimed at reducing the death rate of the population of district formations from IHD and CVD was assessed.

The next stage of the study (3.1) was devoted to the evaluation of the effectiveness of practical measures to strengthen the resources of the cardiological service of the healthcare system of the South Kazakhstan region, implemented in 2008-2017 within the framework of the State Program for improving the organization of care for patients with vascular diseases. The objects of the study were the territories of the region that entered the zone of responsibility of the regional vascular center (RVC), located in Shymkent and the primary vascular departments (PVD) located in four cities of the region. For comparison, the rest of the district formations not included in this program were used. The analysis was carried out by comparing the indicators: 1) the detectability of patients with acute coronary syndrome (ACS), acute myocardial infarction (AMI), including with ST segment elevation, and acute disorders of cerebral circulation, including ischemic and hemorrhagic strokes; 2) the level of hospitalization of patients with these vascular diseases; 3) lethality of such patients.

Further, an assessment was made of the impact of the RVC and PVD activities on the change in death rates from IHD and CVD in the cities of their dislocation and municipalities within their areas of responsibility. The comparison was made between the indicators for 2015 (before the implementation of the Program for Improving Medical Care for Patients with Vascular Diseases) and 2017 (three years after the start of the Program).

With the use of the method of step-by-step allocation of district formations on the basis of typologization of mortality indicators and personnel, MOEs that needed to strengthen the cardiological service in the first place were identified.

At the final stage of the study, the analysis and examination of possible directions for improving the system of providing cardiac care to the population of the South Kazakhstan region were carried out.

Scientific results.

During 2014-2017 years. the availability of the population of the South Kazakhstan region by cardiologists remained stable at 0.6 per 10, 000 people, the proportion of these professionals of the highest category increased from 39.0 to 46.0 per cent, and the provision of specialized bed facilities decreased from 5.1 to 4.6 per 10, 000 people. Distribution of resources of the regional cardiological service across the territory of the region is uneven: in 70% of cities and rayons there are no cardiologists, and in 75% - hospital beds of this profile.

In areas of the oblast where there are no cardiologists among the medical staff of local health care systems, the doctors of this profile are of the highest qualification category, and in the structure of the hospital beds, cardiac beds, the levels of the total and primary morbidity of IHD and DVB were statistically significantly lower, and the total mortality and mortality in working age – statisticallysignificantly higher.

 

 

Potential effectiveness of different scenarios for strengthening the resources of cardiological services of district administrative entities of the region

Scenario	Reduction of a group of territories with a high mortality rate from different types of BSC (%)
	IHD	CVD
Moderate (increasing the availability of cardiologists to 0.2 per 10000, specialized beds to 2.0 per 10000, increasing the proportion of doctors with the highest category to 50%)	31	31
Optimistic (increase in the availability of cardiologists to 0.3 per 10000, specialized beds to 5.0 per 10000, an increase in the proportion of doctors with the highest category to 70%)	74	46

 

The results of multifactor analysis showed that the influence on the level of the general mortality of the population of the regional administrative entities of the region from IHD and CVD is 37% and 56% for the resources of the cardiological service; resources of the local health system - 21% and 19%; social and economic development of the territory - 30% and 15%; age structure of the population - 12% and 10% respectively. The results of the same method for the general morbidity of IHD and CVD were as follows: the contribution of the resources of the cardiological service was 44% and 53%; resources of local health care - 24% and 22%; social and economic development - 14% and 15%; age structure of the population - 18% and 10% respectively. Thus, the level of " cardiological" health of the population of the regional administrative formations of the region is formed under the influence of a complex set of factors, among which the resource potential of specialized services is of greatest importance.

It was found that the activity of cardiac centers led to an increase in radwaste related to their area of responsibility, detectable cases of acute coronary syndrome (ACS), acute myocardial infarction (AMI), including an increase in the ST segment of the electrocardiogram (AIMeST) and, in the largest degree, acute disturbance of cerebral circulation (ADCC), as well as to reduce the mortality of such patients (Table 4).

In the period 2014-2017 years. the level of total mortality of the population of the region from the Central Bank decreased by 15.9% (from 3.41 to 2.87 per 1000 people), and from CVD increased by 12.3% (from 3.18 to 3.57 per 1000 people). Thus, despite the coverage of activities of the Program to improve the organization of medical care for patients with vascular diseases of only a third of the adult population of the region, the mortality in the region as a whole has been reduced from the CVD, but the trend towards an increase in mortality from IHD has persisted. Comparable processes occurred in the Republic of Kazakhstan: for 2015-2017. the mortality from coronary artery disease decreased by only 1.2%, and from the CVD by 8.0%.

 

The effectiveness of the activity of cardiological centers in the regional administrative formations of the region, 2015-2017.

 

Territory areas	Identity (per 100, 000 people)			Mortality (per 100 patients)
	ACS	AMIeST	ADCC	ACS	AMIeST	ADCC
Area of responsibility of vascular centers	581, 8	148, 2*	597, 4*	9, 5	20, 8	21, 5
The rest of the territory of the region	571, 9	132, 4	554, 7	10, 2	22, 6	23, 8

Note: * statistically significant differences (p < 0.05)

 

With the help of the developed multifactor mathematical models, the potential effectiveness of various managerial scenarios was estimated. It is established that the greatest effect can be achieved by strengthening all resources of local cardiology services in general. In the " moderate" scenario, a reduction in the group of territories with a high mortality rate from IHD is possible by 31%, from the CVD - also by 31%, and under the " optimistic" scenario - by 74% and 46%, respectively.

Results of studies in the field and materials of the Ministry of Health of the Republic of Kazakhstan testify to the lower effectiveness of the measures taken to reduce the mortality from cardiovascular disease than from cerebrovascular diseases. According to the research, the reasons for this are: 1) the insufficiently high quality of specialized medical care provided to patients with ACS and MI; 2) inadequate equipment and qualifications of FAP personnel, GMP (general medical practice) and ambulance teams; 3) the absence of clear criteria for choosing methods of treatment and algorithms for the action of medical personnel at each stage of care; 4) violation of continuity in the provision of medical care to patients at different stages; 5) inconsistency of equipping medical institutions with the requirements specified in the Procedures for the provision of medical care in the BSC.

 

REFERENCES:

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2.      Bokeria L.A. Organization of rehabilitation of patients with vascular diseases / LA Bokerya, AE Kaili // Bull. sci. center of the heart-vessel. Surgery them.ANBakulev RAMS. Cardiovascular diseases. - 2009.- T. 10, No. 3.- P.79-83.

3.      Gaas G.N. Peculiarities of the morbidity of the working-age population by diseases of the circulatory system according to the OMS data / G. N. Gaas, AA Modestov // Social aspects of population health.-2011.- Т. 17, № 1.- С. 5.

4.      Maximova TM Social stratification in the environment of medical workers as a problem of public health protection / TMMaksimova // Healthcare of the Russian Federation. 2004. - No. 3. - P. 35-38.

5.      B.Mironovskaya, RV Buzinov, A.B. Gudkov // Healthcare of the Russian Federation.-2011.- № 5.- P.66-67.

6.      Nikiforov S.A. Information technologies in public health management / S.А.Nikiforov, V.S. Kazantsev, A.M. Allenov, E.Tambova // Physician-2011, - № 7, - P. 93-95.

ТҮ ЙІН

¹ Гржибовский А.М., ²Булешова А.М., ²Булешова Р.М.,

² Абдуллаева Г.Б. ²Кенжебаев Д.К.,

³ Аннаоразов Ы.А. ³Жанабаев Н.С.

¹ Норвегиялық қ оғ амдық денсаулық с ақ тау институты

² Оң тү стік Қ азақ стан облысының медициналық академиясы

³ Х.А. Ясауй атындағ ы Халық аралық Қ азақ -тү рік Университеті

ОҢ ТҮ СТІК Қ АЗАҚ СТАН ТҰ РҒ ЫНДАРЫНА КАРДИОЛОГИЯЛЫҚ КӨ МЕКТІ Ұ ЙЫМДАСТЫРУДЫ ЖӘ НЕ БАСҚ АРУДЫ ЖЕТІЛДІРУ.

Цереброваскулярлық ауруларғ а қ арағ анда кардиоваскулярлық патологиядан туындайтын ө лім жағ дайларын тө мендету мақ сатында жү ргізілетін іс-шаралар тиімділігінің тө мен екендігін, Денсаулық сақ тау министрлігінің мә ліметтерінен жә не аймақ бойынша жү ргізілген зерттеулердің нә тижесінен кө руге болады. Зерттеулер бойынша оның себебі болып табылады: 1) жедел миокард инфарктысы жә не жедел коронарлы синдроммен науқ астарғ а кө рсетілетін арнайы медициналық кө мектің сапасының жеткіліксіздігі; 2) ФАП, жалпы тә жірибелік дә рігер (ЖТД) жә не жедел медициналық кө мек бригадалары персоналдарының біліктілігінің жә не қ ұ рал жабдық тармен қ амтамасыз етілуінің жеткіліксіздігі; 3) кө мек кө рсетудің ә р дең гейлерінде медициналық қ ызметкерлердің алгоритмдық іс-ә рекетінің жә не емдеу тә сілдерінің критерийлеринің нақ ты болмауы; 4) ә р дең гейде кө мек кө рсету барысында сабақ тастық тың сақ талмауы; 5) қ ан айналым жү йесі аурулары кезіндегі кө рсетілетін медициналық кө мек кө рсету тә ртібіне байланысты емдеу мекемелеріндегі қ ұ рал-жабдық пен қ амтамасыз етілуінің сақ талмауы.

Кілтті сө здер: кардиологиялық кө мек, қ ан айналым жү йесі ауруларынан туындағ ан ө лім жағ дайлары, медико-ә леуметтік мә селелер, іс-шаралардың тиімділігі.

РЕЗЮМЕ

¹ Гржибовский А.М., ²Булешова А.М., ²Булешова Р.М.,

² Абдуллаева Г.Б.²Кенжебаев Д.К.,

³ Аннаоразов Ы.А., ³Жанабаев Н.С.

¹ Норвежский институт общественного здравоохранения, Осло, Норвегия

² Южно-Казахстанская медицинская академия, Шымкент

³ Международный Казахско-Турецкий университет имени Х.А. Ясави

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