Aim. To study the opinion of senior medical students about their readiness for self-guided practice in primary health care organizations.

Material and methods. In 2023, a continuous cross- sectional social study was conducted among 5th and 6th year students of the Northern State Medical University (Arkhangelsk), of which 137 were from pediatric faculty (5th year — 70, 6th year — 65), 266 — general medicine faculty (5th year — 140, 6th year — 126).

Results. An insufficient level of readiness of medical graduates for self-guided practice in primary health care facilities was revealed. Only 19,0%, after passing the primary accreditation, aim to immediately work as a local pediatrician and a local general practitioner, while 44,2% are not ready to begin independent practical activity. The main work direction of a local physician is considered to be prevention by 67,2% and 28,6% of senior pediatric and general medicine students, respectively. More than 75% of graduates are ready to work independently in a medical information system, but 15,1% of respondents are not sure that they will be able to independently make an electronic sick note, while 41% — a referral for disability examination, and about a third of graduates — fill out a statistical electronic form.

Conclusion. The study results confirm the need to strengthen the practice in the training of medical students and introduce a mentoring system in primary health care facilities.

Aim. To study the relevance of motivation measures based on the survey of medical staff.

Material and methods. Medical staff of adult primary health care facilities was surveyed using an original questionnaire regarding the organization of work, the importance of financial and non-financial incentives. The survey was strictly voluntary and anonymous, and conducted electronically and on paper. In total, 35191 questionnaires were accepted for processing. Processing was carried out using the method of descriptive statistics.

Results. The organization of work environment is of the greatest importance to respondents (>80%), while in second place is the presence of clear criteria for work efficiency assessment, and in third place — a clear incentive and penal scheme. Respondents rated the opportunity for contact with the administration more highly than "communicating work assessment criteria to employees". The undisputed top in financial incentives is payments for high performance criteria in all categories of personnel. Of the non-financial measures, the most popular were a letter of gratitude from the manager and permission to independently plan working hours (maximum among medical specialists (51%)).

Conclusion. The results obtained make it possible to highlight the main directions for motivation system of medical staff as follows: clear evaluation criteria for all personnel categories, provision of conditions for fulfilling the developed criteria, active outreach on evaluation criteria, incentive payments and other measures of material incentives, development of targeted incentive technologies, feedback with employees on issues related to their performance, working conditions, etc., developing a system of non-financial incentives and corporate culture.

Aim. To analyze digital technologies in the primary health care system, as well as studying the impact of digital health literacy on patient satisfaction with the services provided.

Material and methods. A study assessing patients' opinions on the digitalization of primary care in Russia was conducted from June to September 2023 among 1004 participants from 42 regions. A questionnaire with 33 questions was used, of which the 8 most relevant ones were selected for the article, aimed at assessing the satisfaction and personal experience of patients in using digital technologies. Data was collected through Yandex Forms. Data analysis included synthesis of results, classification and content analysis of literature.

Results. The study examined the impact of digitalization on primary care patient satisfaction. Analysis of digital technologies in the primary health care system made it possible to establish that the target audience has a positive attitude towards the introduction of innovations. The patients also aimed at using them and are ready to seek new digital medical services. At the same time, it is important for patients to increase the effectiveness of personal interaction with the physicians. In order to improve digital innovation, development of practical guidelines for the updating and further implementation of digital tools is needed.

Conclusion. The study confirmed that digital health literacy plays an important role in improving primary care patient satisfaction. Based on the data obtained, it is necessary to develop and implement educational programs for patients and medical professionals aimed at increasing the level of digital literacy and optimizing the use of digital tools in me dicine.

Aim. To identify and systematize the criteria influencing the location of healthcare facilities in small and hard-to-reach areas.

Material and methods. Within the study, regulatory legal acts of the Russian Federation and methodological guidelines on territorial planning were analyzed. Content analysis and statistical methods were used.

Results. The following criteria for a comprehensive assessment of the location of healthcare facilities should be used: 1. Age structure of the population. 2. Distance to a similar medical organization. 3. Population size within the working radius of the organization. 4. Availability of public roads (criteria and categories of roads). 5. Availability of public transport. 6. Climatic. 7. Availability of medical workers residing in the locality. 8. Availability of mobile medical teams. 9. Dilapidation and breakdown of buildings. Taking into account various criteria affecting the accessibility of primary health care to a patient, it is possible to develop and implement management decisions on the rational placement of healthcare facilities at the regional level with detail for each locality.

Conclusion. The use of criteria in territorial planning for a comprehensive assessment of the location of healthcare facilities makes it possible to take into account regional climatic, geographic, infrastructural, social and other features of the Russian constituent entities. This contributes to the implementation of development targets for primary health care in small and hard-to-reach areas.

The quality audit system for healthcare in various countries is based on the quality of medical services, the satisfaction of the patient and his relatives, as well as the quality of medical documentation. At the same time, quality indicators of healthcare facilities include criteria of the social and economic efficiency. Often these groups of indicators are considered by researchers separately from each other, and the literature available does not show balanced approaches to combining indicators from different groups within one process, which served as the basis for this work.

Aim. The article is devoted to identifying the specifics of quality balanced scorecard for outpatient clinic using the example of the results of preventive examination for children in the first year of life.

Material and methods. The study of quality indicators of the outpatient clinic was carried out from 2019 to 2023. The base of the study was the Clinical Consultative and Diagnostic Clinic № 27 in Novosibirsk. The study of the Clinic development was carried out from 2012 to 2023. The work used data from a social and expert survey of managers (20122018), as well as comparative modeling, general logical methods and techniques.

Results. The longest multi-level and complex medical service is the process of preventive examination of children in the first year of life. Therefore, using his example, a quality balanced scorecard for the outpatient clinic was developed. At the first stage, medical quality criteria were determined. Patients were interviewed and quality criteria important for the patients' parents were determined. The complexity, multi-stage nature and short time frame for providing medical services determined the criteria for the economic efficiency. At the second stage, criteria for the management effectiveness and criteria for quality monitoring were developed, which allow department heads to track key performance indicators, as well as build coordinated work between various departments. At the third stage, the quality criteria were developed, which, on the one hand, reflect the clinic work, and, on the other hand, are not redundant and can be used to assess the effectiveness of the organization as a whole.

Conclusion. The study showed that to increase the sustainability of the clinic development, effective monitoring based on key performance indicators is necessary. The classical approach to determining the effectiveness of medical facilities is based on general performance indicators to the quality criteria of individual processes, which does not allow identifying violations in individual medical and auxiliary processes, and, accordingly, does not allow identifying ways to solve them. It also does not indicate the level of violation. The use of a process and system approach in developing quality criteria allows developing a quality balanced scorecard with respect to the criteria of various groups, which ultimately reflects the effectiveness of processes as a whole, provides an understanding of cause-and-effect relationships and identifies the root cause of destabilization.

Aim. In the Russian Federation, various types of care (primary care; specialized, including high-tech, care; ambulance, including specialized emergency care; palliative care) in different conditions (outpatient, day hospital and inpatient) and forms (elective, emergency and immediate) are provided. The basis is primary health care (PHC). This also applies to military personnel, since the level of their health maintenance, recovery, and the workload of military health facilities with sick military personnel depend on the effective PHC. Thus, consideration of legal regulation and areas of concern of providing primary health care to military personnel is an urgent task and aim of the work, which requires appropriate conceptualization.

Material and methods. Characteristics of legal regulation and areas of concern of providing PHC to military personnel was studied using comparative legal, formal legal and comprehensive methodological approaches. The practical implementation of these approaches and obtaining meaningful scientific data is carried out using analytical-synthetic, deductive-inductive, system-essential and abstract-concrete methods of cognition.

Results. The main results include a generalization of regulatory legal requirements in providing PHC to military personnel.

Conclusion. The specifics of providing PHC were studied. A comparative legal study of PHC provision within compulsory health insurance and military personnel without insurance policy has been carried out. The problems associated with the legal aspects of organizing and implementing the PHC provision to military personnel are summarized and specific ways to solve them are proposed.

Aim. To analyze hospitalizations and outpatient visits to primary health care facilities of patients aged 18 years and older with chronic coronary artery disease (CAD) by federal districts and the constituent entities of the Russian Federation from the perspective of the World Health Organization concept for diseases treating mainly on an outpatient basis.

Material and methods. We used data from Federal Statistical Monitoring for 2022 on the number of diseases, hospitalizations and the number of outpatient visits of patients aged 18 years and older with an established diagnosis of CAD (ICD 10:I25).

Results. In the Central, Southern and Northwestern Federal Districts, the hospitalizations and outpatient visits of the adult population with chronic CAD were higher, and in the North Caucasus, Far Eastern and Ural Federal Districts — below the Russian average level. In the Volga Federal District, the outpatient visits with chronic CAD were higher than the Russian average, and the hospitalizations were below the Russian average. In the Siberian Federal District, the outpatient visits were lower, and the hospitalizations were higher than the Russian average level. When analyzing the ratio of hospitalization rate to the number of outpatient visits of the adult population with an established chronic CAD in the primary health care unit, characterizing the availability, quality and efficiency of outpatient care, the highest indicator was recorded in the Siberian Federal District, while its heterogeneity within the federal district was the highest in comparison with other federal districts. Its lowest was recorded in the Southern Federal District, while heterogeneity within the federal district was the lowest in comparison with other federal districts. The values of this parameter varied from 3,67 in the Kurgan Oblast to 38,33 in the Republic of Tuva.

Conclusion. Accounting for diseases treating primarily on an outpatient basis can become one of the tools for assessing the quality of adult primary health care. However, before including this indicator in the criteria for assessing the quality of medical services, a deeper understanding of the reasons influencing its change is required.

Accessibility and satisfaction with the quality of care for patients with acne are relevant, including in Russia. Therefore, Voronezh Oblast, being one of the largest in the Central Federal District, is able to present these indicators for the whole of Russia. The aim was to compare the accessibility and satisfaction of patients with acne with medical assistance in various healthcare facilities through a survey. The results obtained during the work revealed significant problems in this area and created opportunities for overcoming them.

Providing primary health care is one of the priority areas of healthcare due to importance of early detection, treatment and prevention of diseases. The development of management decisions aimed at improving the healthcare management is impossible without taking into account patient satisfaction with the availability and quality of medical services.

Aim. To assess the satisfaction of housing and utility service employees with the quality and conditions of health care in the context of the implementation of follow-up monitoring program.

Material and methods. The study was carried out before and after the implementation of the Regulations for treatment and prevention of hypertensive employees of the Water Utility of St. Petersburg. A total of 292 people were surveyed by the questionnaire recommended by the territorial compulsory medical insurance fund of St. Petersburg. There were following evaluation criteria: for the availability of healthcare — how easy it is to make an appointment with a specialist on the day of treatment; for the quality of healthcare — satisfaction with the conditions of waiting for an appointment and medical support.

Results. The majority of respondents were satisfied with both the conditions of waiting and provision of care, the respectful and professional attitude of medical staff (satisfaction rate, 83,2%). After the implementation of the Regulations, the number of people who were completely satisfied with the waiting conditions in a medical institution increased from 80,2% to 90%. Satisfaction with the medical support increased from 83,2% to 95,7%. The share of those who were completely satisfied with the clinical setting also increased — from 75,7% to 82,3%. The number of "excellent" ratings given for the physician’s explanation of the prescribed treatment and procedures has increased (from 76,8% to 85,6%). The greatest satisfaction with the quality of care was among those aged 45-49 years.

Conclusion. The results obtained indicate that there is a connection between satisfaction and both the quality of care provided and the involvement of patients in the treatment and preventive process.

The distribution of publications posted in the Elibrary for the period from January 1, 2012 to December 31, 2022, in the structure of a cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation made it possible to establish areas of scientific interest and identify gaps in specific areas and indicators characterizing its current and future development.

Aim. To distribute scientific publications according to the relevant segments of the cognitive matrix of taxonomic characteristics for the analysis and assessment of primary health care in the Russian Federation.

Material and methods. A database of 41824 publications was used, for which a triple review was carried out with the involvement of 9 experts selected according to appropriate criteria for level of education, work experience in the healthcare system, and academic credentials. At the first two stages, publications not related to primary health care, as well as duplicate publications, were excluded. At the final stage of reviewing, a selective analysis of publications was carried out, assessing the correctness of their distribution into the corresponding taxa of the cognitive matrix, followed by adjustment (if necessary).

Results. A cognitive matrix of taxonomic characteristics has been generated for the analysis and assessment of primary health care in the Russian Federation, containing 30339 publications distributed across relevant domains, subdomains and primary health care indicators. The matrix is also presented in a heat map format, allowing an assessment of the most studied taxa of primary health care, as well as highlighting those areas in primary health care in which more research should be carried out to provide a basis and methodology for making informed decisions on its development.

Conclusion. Systematized and ordered publications can serve as a basis for a wide range of users in the preparation of systematic reviews and other publications on specific domains, subdomains, primary health care indicators and universal health coverage principles. This study has shown the high efficiency of the cognitive matrix of taxonomic characteristics as a unified tool for aggregation or decomposition of features characterizing the development of primary health care in the Russian Federation.

Aim. To study the prevalence of hyperuricemia (HU) and gout depending on hypertension (HTN), as well as to evaluate their associations with mortality in the Russian population.

Material and methods. The analysis included data obtained in two cross-sectional studies — ESSE-RF and ESSE-RF2. All study participants were surveyed using a modular designed questionnaire. Serum uric acid (UA) was determined using the uricase method. HU corresponded to a UA >420 µmol/l in men and >360 µmol/l in women. HU without gout was considered asymptomatic HU in the present study. Associations with endpoints were assessed using Cox proportional hazards models with associated hazard ratios.

Results. The average prevalence of HU was 18,2%. HU, as expected, predominates among the male cohort — 22,6% vs 15,7%, respectively. The prevalence of asymptomatic HU was 4,4% higher among men compared to women. The prevalence of gout increased with age and averaged 2,6% in the entire population. A high content of UA was revealed in men in the absence of hypertension. The prevalence of HU in women with HTN was 3 times higher than in participants without hypertension. In the male cohort, in the group of hypertension without HU, all-cause and cardiovascular mortality significantly increases, and in the group with hypertension and HU, only all-cause mortality increases. In women, the cardiovascular death risk increased in HTN — hazard ratio 3,98 (95% confidence interval 1,86-8,52). At the same time, in women with HTN and HU, all-cause and cardiovascular death risk increased by 66% and 6,7 times, respectively.

Conclusion. Every fifth study participant was diagnosed with HU. The prevalence of HU in hypertensive men was approximately 1,5 times higher than without hypertension. In women with HTN, HU was detected three times more often than without HTN, which may indicate a more pronounced relationship between HTN and HU in women. HU can worsen the HTN prognosis. Thus, monitoring and timely correction of UA levels in hypertensive patients become necessary to improve the prognosis.