Search

BACKGROUND: In recent years, the healthcare sector has emerged as a key area where artificial intelligence technologies are gaining strategic importance. In particular, the implementation of these technologies in primary healthcare has demonstrated particular relevance and importance [1–3]. AIM: The aim of the study is to characterize the stages of implementation of artificial intelligence technologies in the activities of urban polyclinics in Moscow. MATERIALS AND METHODS: Analytical, statistical, socio-hygienic, and experimental methods were used. RESULTS: The primary objective of integrating artificial intelligence into the operations of city polyclinics was to enhance the efficacy of medical data processing, mitigate the likelihood of professional missteps, and optimize the coordination of interactions between different medical professionals. The initial challenge of processing a vast quantity of information was met by the implementation of artificial intelligence in the analysis of electronic medical records. This approach resulted in the development of integrated and secure systems that facilitate the accessibility of patient data to physicians and medical staff for the purpose of quality of care analysis. In addressing the second task of using artificial intelligence technologies to provide consulting services to physicians in making a diagnosis, the work was carried out in several stages. In 2020, the top three medical decision support systems were implemented, which assist therapists in making preliminary diagnoses based on the International Classification of Diseases 10th revision (ICD-10). Since 2023, the Diagnostic Assistant system, which analyzes data from a patient’s electronic medical record and offers a second opinion on a confirmed diagnosis, has been actively used. Currently, this system includes 95 codes of ICD-10 and similar diagnoses, with plans to expand its functionality to 268 diagnoses. As a consequence of the training and implementation of the expansion, the system will be capable of covering approximately 85% of the most frequently established confirmed diagnoses. A considerable number of expert physicians were involved in the establishment and evaluation of the systems, with over 10,000 cases being handled. In December 2023, a pilot project was conducted at the City Polyclinic No. 64 (Moscow) with the involvement of almost 100 doctors of this medical institution to identify the possibility of improving the reliability of the model. According to its results, it was found that the diagnoses made by the doctor and the artificial intelligence system coincide by 89%. Despite the impressive achievements of technology, it is important to emphasize that the use of artificial intelligence is not intended to replace the doctor, but rather serves as a second opinion in the work of a specialist. CONCLUSIONS: The integration of artificial intelligence into the operations of Moscow’s polyclinics not only reduces the time required to search and process a substantial volume of information, but also helps to avoid professional errors. Furthermore, it enhances the efficiency of primary health care in Moscow as a whole.

Introduction. The article examines the development of Soviet Kalmykia’s healthcare that was included into the public health system of the USSR. Chronologically, the study covers the Ninth and Tenth five-year plans, fragmentary insights into the Eighth one to yield comparative statistical data. Goals. The work seeks to analyze and reveal some distinct features characterizing the development of Soviet Kalmykia’s healthcare throughout the 1970s as part the then state health agenda. The paper focuses on state policies pursued during the Ninth and Tenth five-year plans, describes the region’s general conditions, some changes in the budget process which directly influenced healthcare in the Republic, composition of capital investments, dynamics of health-related material support, and staffing issues. Materials and methods. The study widely employs the statistical (quantitative) method to trace qualitative and quantitative changes in the health system of the Kalmyk ASSR during the period under consideration. The chronological and retrospective methods make it possible to examine the Republic’s healthcare in actual historical contexts and to implement a retrospective analysis free from any ideological factors. The paper considers documents and statistical material from the State Archive of the Russian Federation, National Archive of Kalmykia, and a number of related publications. Results. The study reveals some key trends in the organization of medical and sanitary services, delineates public health policies in the region and nationwide, delves into the legislative framework that shaped the basis for public health in the whole country. The medical network development of the 1970s delivered qualified medical services to rural inhabitants and dwellers of remote areas. The undertaken measures improved and diversified health maintenance patterns both in region- and district-level treatment/prevention facilities.

Copyright of Journal of Academic Social Science Studies is the property of Journal of Academic Social Science Studies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Introduction The burden of chronic kidney disease (CKD) is rising globally including in Singapore. Primary care is the first point of contact for most patients with early stages of CKD. However, several barriers to optimal CKD management exist. Knowing healthcare professionals’ (HCPs) perspectives is important to understand how best to strengthen CKD services in the primary care setting. Integrating a theory-based framework, we explored HCPs’ perspectives on the facilitators of and barriers to CKD management in primary care clinics in Singapore. Methods In-depth interviews were conducted on a purposive sample of 20 HCPs including 13 physicians, 2 nurses and 1 pharmacist from three public primary care polyclinics, and 4 nephrologists from one referral hospital. Interviews were audio recorded, transcribed verbatim and thematically analyzed underpinned by the Theoretical Domains Framework (TDF) version 2. Results Numerous facilitators of and barriers to CKD management identified. HCPs perceived insufficient attention is given to CKD in primary care and highlighted several barriers including knowledge and practice gaps, ineffective CKD diagnosis disclosure, limitations in decision-making for nephrology referrals, consultation time, suboptimal care coordination, and lack of CKD awareness and self-management skills among patients. Nevertheless, intensive CKD training of primary care physicians, structured CKD-care pathways, multidisciplinary team-based care, and prioritizing nephrology referrals with risk-based assessment were key facilitators. Participants underscored the importance of improving awareness and self-management skills among patients. Primary care providers expressed willingness to manage early-stage CKD as a collaborative care model with nephrologists. Our findings provide valuable insights to design targeted interventions to enhance CKD management in primary care in Singapore that may be relevant to other countries. Conclusions The are several roadblocks to improving CKD management in primary care settings warranting urgent attention. Foremost, CKD deserves greater priority from HCPs and health planners. Multipronged approaches should urgently address gaps in care coordination, patient-physician communication, and knowledge. Strategies could focus on intensive CKD-oriented training for primary care physicians and building novel team-based care models integrating structured CKD management, risk-based nephrology referrals coupled with education and motivational counseling for patients. Such concerted efforts are likely to improve outcomes of patients with CKD and reduce the ESKD burden.

Introduction: The burden of chronic kidney disease (CKD) is rising globally including in Singapore. Primary care is the first point of contact for most patients with early stages of CKD. However, several barriers to optimal CKD management exist. Knowing healthcare professionals' (HCPs) perspectives is important to understand how best to strengthen CKD services in the primary care setting. Integrating a theory-based framework, we explored HCPs' perspectives on the facilitators of and barriers to CKD management in primary care clinics in Singapore.Methods: In-depth interviews were conducted on a purposive sample of 20 HCPs including 13 physicians, 2 nurses and 1 pharmacist from three public primary care polyclinics, and 4 nephrologists from one referral hospital. Interviews were audio recorded, transcribed verbatim and thematically analyzed underpinned by the Theoretical Domains Framework (TDF) version 2.Results: Numerous facilitators of and barriers to CKD management identified. HCPs perceived insufficient attention is given to CKD in primary care and highlighted several barriers including knowledge and practice gaps, ineffective CKD diagnosis disclosure, limitations in decision-making for nephrology referrals, consultation time, suboptimal care coordination, and lack of CKD awareness and self-management skills among patients. Nevertheless, intensive CKD training of primary care physicians, structured CKD-care pathways, multidisciplinary team-based care, and prioritizing nephrology referrals with risk-based assessment were key facilitators. Participants underscored the importance of improving awareness and self-management skills among patients. Primary care providers expressed willingness to manage early-stage CKD as a collaborative care model with nephrologists. Our findings provide valuable insights to design targeted interventions to enhance CKD management in primary care in Singapore that may be relevant to other countries.Conclusions: The are several roadblocks to improving CKD management in primary care settings warranting urgent attention. Foremost, CKD deserves greater priority from HCPs and health planners. Multipronged approaches should urgently address gaps in care coordination, patient-physician communication, and knowledge. Strategies could focus on intensive CKD-oriented training for primary care physicians and building novel team-based care models integrating structured CKD management, risk-based nephrology referrals coupled with education and motivational counseling for patients. Such concerted efforts are likely to improve outcomes of patients with CKD and reduce the ESKD burden. [ABSTRACT FROM AUTHOR]

Background Understanding health-seeking behaviors and determining factors help governments to adequately allocate and manage existing health resources. The aim of the study was to examine the health-seeking behaviors of people in using public and private health facilities and to assess the factors that influence healthcare utilization in Northern Cyprus. Methods A cross-sectional study was conducted in 2 polyclinics among 507 people using a structured intervieweradministered questionnaire. Health-seeking behaviors were measured using four indicators including routine medical check-ups, preferences of healthcare facilities, admission while having health problems, and refusal of health services while ill. Descriptive statistics and multivariable logistic regression analyses were done to explore factors influencing the use of health services. Results About 77.3% of the participants reported to have visited health centers while they had any health problems. More than half (51.7%) of them had a routine medical check-up during the previous year, while 12.2% of them had refused to seek healthcare when they felt ill during the last five years. Of all, 39.1% of them reported preferring private health services. Current smokers (adjusted odds ratio [AOR] = 1.92, 95% CI: 1.17-3.14), having chronic diseases (AOR = 2.05, 95% CI: 1.95-2.16), having poor perceptions on health (AOR = 2.33; 95% CI: 1.563.48), and spending less on health during the last three months (AOR = 2.08, 95% CI: 1.43- 3.01) had about twice the odds of having routine checkups. Higher education (AOR = 1.87, 95% CI: 1.38-2.55) was shown to be a positive predictor for the health-seeking behaviors, whereas having self-care problems (AOR = 0.18, 95% CI: 0.08-0.40) and having a moderate-income (AOR = 0.68, 95% CI: 0.57-0.81) were inversely associated with seeking healthcare. Conclusion The utilization of public and private health sectors revealed evident disparities in the socio-economic characteristics of participants. The health-seeking behaviors were determined by need factors including chronic disease status and having poor health perception and also by enabling factors such as education, income, insurance status and ability to pay by oneself. These findings highlight the need for further nationwide studies and provide evidence for specific strategies to reduce the socioeconomic inequalities in the use of healthcare services.

The article presents the special role of the outpatient unit (urban polyclinics) in the system of urban medical organizations, which has significant development potential in the field of clinical research. This activity became possible due to the systematic work on equipping outpatient clinics with the most modern diagnostic equipment, the availability of specialists trained in the organization and conduct of clinical trials according to the international rules of good clinical practice. A special value lies in the fact that the polyclinic network has an extensive database that includes millions of patients and provides the opportunity to perform the highest level of medical expertise and research.

Background: Understanding health-seeking behaviors and determining factors help governments to adequately allocate and manage existing health resources. The aim of the study was to examine the health-seeking behaviors of people in using public and private health facilities and to assess the factors that influence healthcare utilization in Northern Cyprus. Methods: A cross-sectional study was conducted in 2 polyclinics among 507 people using a structured intervieweradministered questionnaire. Health-seeking behaviors were measured using four indicators including routine medical check-ups, preferences of healthcare facilities, admission while having health problems, and refusal of health services while ill. Descriptive statistics and multivariable logistic regression analyses were done to explore factors influencing the use of health services. Results: About 77.3% of the participants reported to have visited health centers while they had any health problems. More than half (51.7%) of them had a routine medical check-up during the previous year, while 12.2% of them had refused to seek healthcare when they felt ill during the last five years. Of all, 39.1% of them reported preferring private health services. Current smokers (adjusted odds ratio [AOR] = 1.92, 95% CI: 1.17-3.14), having chronic diseases (AOR = 2.05, 95% CI: 1.95-2.16), having poor perceptions on health (AOR = 2.33; 95% CI: 1.563.48), and spending less on health during the last three months (AOR = 2.08, 95% CI: 1.43-3.01) had about twice the odds of having routine checkups. Higher education (AOR = 1.87, 95% CI: 1.38-2.55) was shown to be a positive predictor for the health-seeking behaviors, whereas having self-care problems (AOR = 0.18, 95% CI: 0.08-0.40) and having a moderate-income (AOR = 0.68, 95% CI: 0.57-0.81) were inversely associated with seeking healthcare. Conclusion: The utilization of public and private health sectors revealed evident disparities in the socio-economic characteristics of participants. The health-seeking behaviors were determined by need factors including chronic disease status and having poor health perception and also by enabling factors such as education, income, insurance status and ability to pay by oneself. These findings highlight the need for further nationwide studies and provide evidence for specific strategies to reduce the socioeconomic inequalities in the use of healthcare services. [ABSTRACT FROM AUTHOR]

The study was carried out using survey technique applied to sampling of workers of the first three polyclinics of Moscow. The method was based on international questionnaire Maslach Burnout Inventory (MBI) that permitted to consider characteristics of activity of medical professionals. The analysis of results of study demonstrated that overall prevalence of burnout among doctors is 17%,among nursing personnel - 21%, among non-medical personnel - 19%. The average age of workers with professional burnout is 34-49 years. Among workers with burnout more than half of them had higher education and 30% had specialized secondary education. The workers consider as main factors of professional burnout necessity to spend most of working time at the computer (up to 92%), unrealistic expectations of patients from received medical care (up to 88%), deficiency of time for reception of patients and personal life. The majority of employees had an average (35%) and low (43%) level of reduction in personal achievements that testifies well-being of work environment. The conclusion is made that in polyclinic section of Moscow health care there are no serious conflicts in collectives and existing conflicts are within limits of working relationships.

Background: An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives: To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods: Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results: Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions: On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care. Funding: The National Institute for Health Research Health Services and Delivery Research programme.

It is becoming increasingly important in the healthcare setting to treat patients as consumers and measure their satisfaction with medical services rendered. As such, patient satisfaction should be considered an important output of a country's healthcare system, basically reflecting the stage of its development. The conducted study tested students' satisfaction with the quality of service provided by student polyclinics. In particular, the study has analysed the impacts of personal relationships, promptness and tangibility on student satisfaction. The findings imply that all three factors significantly affect patient satisfaction, with personal relationships having the strongest impact. Such results suggest that healthcare providers should encourage their doctors to devote more time to their patients and show genuine concern for patients' problems if they wish to improve overall satisfaction of their patients with the delivered services. [ABSTRACT FROM AUTHOR]

Internationally, the polyclinic has been a feature of many health systems. The recent UK policy shift towards enhanced coordination of care closer to home resulted in the development of polyclinics, most notably in London. This article explores the background to the development of polyclinics and draws on the early experience of developments in London to explore what their impact has been, and is likely to be, on community nursing. Emerging findings from an evaluation of four pilot polyclinics suggests that rather than one model, polyclinics evolved in distinctively different ways more appropriately labelled as polysystems. Although policy makers clearly identified community nursing as being one of the key components of integrated, community-based care, the evaluation suggests a focus on highlevel organizational restructuring and system change can shift attention from what many would consider core activities such as community health services. [ABSTRACT FROM AUTHOR]

Recent guidance recommends that men with prostate cancer on watchful waiting and men who have a stable prostate specific antigen, with no significant complications at least 2 years following treatment, should be offered follow-up outside hospital. The study presented here represents the views of 442 men in the North East of England who fall into this group. It shows that 70·7% of the men surveyed preferred to be followed up at their local district general hospital, compared to 18·1% preferring to be followed up at their general practitioner (GP) practice. Almost 63·8% of patients in this study preferred to be followed up by the nurse specialist in comparison with 23·9% of patients preferring to be reviewed by a consultant and 9·4% choosing their GP. Patients who live in rural areas with a long journey time to the hospital were more likely to choose to be followed up by their GP. There has been no preparation of patients to change their expectations of lifelong follow-up in secondary care. Patient survivorship information needs to be developed, so that patients are prepared and supported through this change in follow-up care. This survey demonstrates that the patients within this particular National Health Service (NHS) Trust are happy with the current system of being followed up by the nurse specialist at their local district general hospital. [ABSTRACT FROM AUTHOR]

Se realizó un estudio descriptivo con la finalidad de identificar indicadores de resultado del policlínico, como primer paso para una futura medición de su eficiencia productiva. Se hizo una revisión bibliográfica y consulta a expertos a través del método Delphi. Se efectuó el análisis de las variables del estudio a partir de las bases de datos creadas mediante el empleo de porcentajes. La propuesta final está compuesta por 6 indicadores (índice de mortalidad infantil evitable, índice de cumplimiento del esquema de vacunación, índice de satisfacción de la población, índice de bajo peso al nacer, índice de casos bacilófilos positivos diagnosticados en el policlínico e índice de enfermos crónicos controlados). Los indicadores seleccionados abarcan tanto la dimensión de la salud percibida como de la salud objetiva.A descriptive study was made to identify outcome indicators of the polyclinics, as a first step for measurement of productive efficiency in the future. A literature review was made and experts were consulted through the Delphi method. The study variables were analyzed, through percentages, from developed databases. The definite proposal consisted of six indicators (preventable infant mortality index, vaccination schedule fulfillment index, population satisfaction index, low birthweight index, index of positive bacilophilic cases diagnosed by the polyclinics and controlled chronic patient index). The selected indicators cover both the perceived health dimension and the objective health dimension.

The article offers information on the plans of the government to offer community urology service to deliver primary care-based patient services in Great Britain. Researchers mention that National Health Service plans to provide care closer to home for patient specifically in the urology department. In this regard, published materials from the Department of Health are presented including the White Paper for a new direction for community service and the Shifting Care Closer to Home program.

Introduction: The impact of irrational use of drug is reduction in the quality of drug therapy leading to increased morbidity and mortality. The main objective was to obtain baseline information regarding the prescribing pattern for non-steroidal anti-inflammatory drugs (NSAIDs) by physicians in the outpatient departments (OPDs) of two selected polyclinics in Kota Kinabalu, Sabah. Methods: Four hundred (200 from each polyclinic) prescriptions containing NSAIDs were collected, photocopied and later analyzed. Two hundred selected patients (100 from each polyclinic) attending the OPDs were interviewed using a questionnaire. Results: Educated and higher income group of patients mostly attended in private polyclinic (PPC) whereas comparatively less educated and lower income group of patients generally attended government UMS polyclinic (UPC). Analgesics with no or minimal anti-inflammatory effects were the most commonly prescribed NSAIDs in the OPD of UPC. On the contrary, analgesics with potent anti-inflammatory effects were the most commonly prescribed NSAIDs in PPC. Due to the nature of potent drugs, socioeconomically advantaged patients attending PPC is more likely to develop adverse effects. Therefore, the prescribers in PPC had to prescribe additional drugs to counter the adverse effects of NSAIDs, hence increasing the cost of drugs prescribed compared to UPC. The patients taking NSAIDs before coming to hospital were influenced by pharmacists, friends and doctor's advice given previously. Conclusions: The overall prescribing pattern of NSAIDs among two polyclinics is satisfactory, although there may be scopes for improvement. Educational intervention can be designed for rational prescribing to improve the quality of health care. [ABSTRACT FROM AUTHOR]