Providing High-tech Health Care in the Murmansk region A.D. Rubin 2008.
-
Upload
theodore-wilkins -
Category
Documents
-
view
215 -
download
0
Transcript of Providing High-tech Health Care in the Murmansk region A.D. Rubin 2008.
Providing High-tech Health Care in the Murmansk region
A.D. Rubin
2008
Territory
The Murmansk region is one of the largest and economically developed regions in European north of Russia; it is the only subject of the Russian Federation, almost entirely located beyond the Arctic Circle, it occupies the whole of Kola Peninsula, which is washed by the Barents Sea and the White Sea.
The population density of 1 sq. km is an average of 6.6 people.
It borders on Norway and
Finland
Participant of EuroArctic Baretsregion
The nonfreezing Kola Gulf
Direct access to the Ocean
It occupies the Kola Peninsula, to the north of the Arctic Circle
The territory of 144.9 thousand sq.km.
The population density of 1 sq. km is an average of 6.6 people.
Length From West to East – 550 km, from North to South – 440 km.
Population health is influenced by extremely adverse climatic conditions of the Kola North (a complex relief, unfavorable wind and temperature conditions, long polar day and polar night, high magnetic activity and humidity, frequent changes in atmospheric pressure, which cause a syndrome of “polar stress”).
The dynamics of the resident population size in the Murmansk region (in thousands)
The number of births in the Murmansk region
(according to the registry office data)
8516
8455
8754
8300
8350
8400
8450
8500
8550
8600
8650
8700
8750
8800
2005 2006 2007
Fertility. Mortality. Natural increase.
10,2
8,6
7,6 8,
29,
89,
710
,29,
39,
2
8,1
7,9
11,7
12,713
,413
,41312
,411
,611
,1
10,1
98,
8
-1,2
-0,7
-2,5
-2,9 -3 -3
,2-3
,7 -3,2
-3,6 -2
,9
-1,5
-4
-2
0
2
4
6
8
10
12
14
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Рождаемость Смертность Ест.прирост / убыльFertility Mortality Natural increase\loss
The structure of the overall incidence of adult population
22%
12%
11%8%
5%6%
4%5%
4%10% 3%
10%
болезни системы кровообращения болезни костно-мышечной системы
болезни мочеполовой системы болезни органов пищеварения
болезни глаза болезни эндокринной системы
инфекц. болезни новообразования
бол.кожи и подкожной клетч. болезни нервной системы
травмы и отравления прочие
Diseases of the circulatory system Diseases of urogenital systemEye diseases Infectious diseases Skin and subcutaneous adipose tissue diseases Injuries and intoxication
Diseases of the musculoskeletal system Diseases of the digestive apparatus Diseases of the endocrine system Tumors Diseases of the nervous system
Others
The structure of mortality for the main classes of reasons
1%6%
3%13,6%12,2%
55,6%
9%
болезни системыкровообращения
несчастные случаи,травмы и отравления
новообразования
болезни органовдыхания
болезни органовпищеварения
инфекционные ипаразитарные болезни
прочие причины
Diseases of the circulatory system
Accidents, injuries and intoxication Tumors
Diseases of the respiratory apparatusDiseases of the digestive apparatus Infectious and parasitic diseases
Other reasons
Providing high-tech health care (HHC)
to Russian population is one of the areas
of priority national project (PNP)
“Health”. It is regulated by the orders of
Ministry of Health and Social
Development of the Russian Federation
(MHSDRF) with the allocation of quotas
for the regions. Annually about 1000
residents of the Murmansk region
receive treatment in federal health
centers.
To improve the quality and access to medical care for those people, who need high-tech care, the following documents were developed and adopted in the Murmansk region:1.Administrative Regulations on the provision of public service “Submission and providing high-tech health care to citizens of the Murmansk Region”;
2.An Order of the Murmansk Health Care Committee, which regulates procedure of selection and Committee’s activity on patients referral to treatment at clinics.
3.Software product ”Referral to treatment in Research Institute (RI)”, which is the basis for annual reports.
Referral to high-tech care in federal institutions
Application allocated quota referred patients children
2005
2007
Referral to high-tech carein federal
institutions and Municipal
Regional Clinical Hospitals (MRCH)
MoscowSt. PetersburgMRCH
MCH FSA “N.I. Pirogov NMSC”, Murmansk
Others
13%3% 7%5%
4%21%
4%
4%
25%
14%
кардиохирургия офтальмологиятравматология и ортопедия онкологиягематология эндокринологияЧЛХ урологияревматология другие
Referral to high-tech care in federal institutions in 2007 on the following profiles
CardiosurgeryTraumatology and Orthopedics Hematology Maxillofacial surgeryRheumatology
OphthalmologyOncologyEndocrinologyUrologyOthers
Certain types of medical care keep higher-priority: implantation of large joints,
certain types of heart surgery, neurosurgical treatment,
in vitro fertilization etc.
As at 01.10.2008, 244 persons are included into the
“waiting list “(within the allocated quota)
Murmansk population is provided by medical care of the highest level, which is financed from the federal budget. In 2007 GHA “P.A. Bayandin Murmansk Regional Clinical Hospital” (MRCH) was included in the List of Medical Practical Institutions (MPI), which
take part in the public task on providing high-tech care.
Clinical, logistical, intellectual and industrial facilities of the Region allow to use high-tech treatment in cardio vascular surgery, neurosurgery, traumatology and orthopedics.
As at 01.01.2008, using funds for residents of the Murmansk Region and Republic of Kareliafrom the federal budget, the following operations were performed:
180 cardio vascular operations (100%);70 trauma and orthopedic operations (100 %).
As at 01.10.2008, using funds for residents of the Murmansk Region and Republic of Kareliafrom the federal budget, the following operations were performed:
200 cardio vascular operations
(91% of the total quota);91 trauma and orthopedic operations (91% of the total quota).30 additional quotas in neurosurgical profile for residents of the Murmansk
region were allocated, in October 2008 7 operations were performed.
The cost of the regional budget for providing high-tech medical
service in the Region was in 2007 - 330.7 million
rubles, scheduled for 2008 – 375,1 million rubles.
Number of high-tech care recipients in Murmansk Regional Clinical Hospital
for the period from 2003 to 2008 (from the federal and regional budgets).
The structure of patients after high-tech care surgical treatment
in Murmansk Regional Clinical Hospital in 2007
1295
492
1220
87
34
0 200 400 600 800 1000 1200 1400
офтальмология
сердечно сосудистая хирургия
травматология и ортопедия
нейрохирургия
урологияUrology
Neurosurgery
Traumatology and Orthopedics
Cardiosurgery
Ophthalmology
The structure of patients after high-tech care surgical treatment
in Murmansk Regional Clinical Hospital for 9 months in 2008
975
560
797
333
90
0 200 400 600 800 1000 1200
офтальмология
сердечно сосудистая хирургия
урология
травматология и ортопедия
нейрохирургияNeurosurgery
Traumatology and Orthopedics
Urology
Cardiosurgery
Ophthalmology
10,3
29
12,5
64
6,3
64
3,2
62
3,1
98
2,5
118
3,2
124
6,3
96
3,9
103
2,4
82
3,1
128
4,4
137
2,4
167
4,9
223
4,1
218
4,5
269
0
50
100
150
200
250
300
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
In January 2007, the 2000-th operation
with the use of coronary artery bypass grafting was performed in
Murmansk Regional Clinical Hospital
Lethality
The number of operations
Operations with artificial blood circulation and lethality in Murmansk Regional Clinical Hospital for the period from
1992 to 2007
The number of operations on heart with an coronary artery bypass grafting
(including operations on the working heart)
2005 2006 2007The number
of operations 223 220 269
Mortality 4,8 % 3,7 % 4,42 %
The number of operations on major arteries
2005 2006 2007
399 410 425
The number of implanted pacemakers with radiofrequency
ablation2005 2006 2007
265 247 341
The number of patients with diagnostic and therapeutic endovascular interventions
2005 2006 2007
Diagnostics 4639 5058 4134
Treatment (stenting, angioplasty)
410 570 639
The number of rentgen-surgicalinterventions and operations
The number of rentgen-surgicalinterventions and operations
The data of A.N. Bakulev SCCVS, RAMN
The average frequency
of rentgen-endovascular operations
to 1 million people in 2006
RF Northwest
region
The Murmansk
region
The Northwest
region
P.A. Bayandin Murmansk Regional Clinical Hospital
takes the 15th place among all Russian clinics by the number of endovascular coronary
interventions,
but in terms of 1 mln. population andoperating room workload –
one of the ten most active clinics in Russia. (The data of A.N. Bakulev SCCVS, RAMN)
Coronary arteriography is the only method for choosing the best tactics of treatment in patients with coronary heart disease.
The need for coronary arteriography per
1 million of population is more than 3,000 procedures a year.
490
930
770
388312
299
243
16752
1228
1104
0
200
400
600
800
1000
1200
1400
1993 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Today coronary arteriography is the «gold standard»
of coronary heart disease (CHD) diagnosis
Today coronary arteriography is the «gold standard»
of coronary heart disease (CHD) diagnosis
Replacement arthroplasty
Replacement arthroplasty
Hip joint Knee joint
New high-tech methods of treatment were introduced in Murmansk Regional Clinical
Hospital in 2003 - 2007:- Knee replacement;
- Endovascular treatment of abdominal aneurysm;
- Endovascular treatment of hysteromyoma;
- Endovascular bifurcational stenting of coronary arteries in coronary heart disease;
- New endovascular methods of treatment of ischemic stroke and hemorrhagic stroke;
- Stabilizing operations on the spine using submersible systems;
- Laser discission of secondary cataract;
- Laser descemetogoniopunctura;
- Combined phacoemulsification with profundus sclerotomy;
- Intravitrial introduction of Gemaza;
- Cataract phacoemulsification with implantation of intracapsular ring in lens subluxation;
- Application of allodrains in profundus sclerotomy;
- Endoscopic operations on bile-excreting tractus using endoscopes with side-optics;
- Operations for improving hearing;
- Endoscopic operations on the nose and paranasal sinus;
- Associated operations in valvular defects and coronary heart disease.
Completion of the reconstruction of
centralized operational unit in Murmansk
Regional Clinical Hospital in 2008
will increase implement of high-tech
methods of surgical treatment in 1,7 times