Vol 62, No 1 (2018)

The purpose of the study. To analyze prevalence of diseases of musculoskeletal system in the Arkhangelsk region. The methods. The data of official statistics was used to implement analysis of general morbidity of main diseases of musculoskeletal system of adult population the Arkhangelsk region during 2010-2015 as compared with corresponding morbidity in the North-Western Federal and the Russian Federation in general. The results. In the Arkhangelsk region, among general morbidity percentage of diseases of musculoskeletal system made up to 4.2% (7th rank). The increasing of common morbidity of diseases of musculoskeletal system in adult population was marked in the Arkhangelsk region up to 14% and in the Russian Federation up to 7%. Since 2010, in the Arkhangelsk region the study established increasing of common morbidity rheumatoid joint inflammation up to 22%, spondylopathy up to 65%, osteoarthrosis up to 32.4%, osteoporosis up to 46% and systemic diseases of connective tissue up to 11.5% surpassing average Russian indices. At that, number of cases of reactive arthritis decreased up to 17.2% Conclusions. In the Arkhangelsk region, the register of diseases of musculoskeletal system on the basis of region rheumatological center is to be developed to implement an objective assessment in the existent situation.

Social efficiency of the health care system is a priority type of sector effectiveness at every management level. The actual transformations in organization of medical care require investigation of effectiveness and should not adversely effect on indices of medical organizations functioning. The satisfaction of the population with quality and accessibility of medical care are related to social efficiency evaluation. The sociological surveys pay a special attention to studying conditions of medical services provision, which are assessed by patients subjectively. The article presents the results of a study of patients concerning satisfaction with primary medical sanitary care before and after organization of the Clinical Medical Center in Chita. The estimation of efficiency was implemented on the basis of factor conditionality of satisfaction level. Identification of degree of influence of each factor was implemented using calculation of relative and absolute risks. At that, outcome of medical care provision in the form of satisfaction was considered as an effective criterion and conditions of medical care provision as "risk factors". The study results established increasing of index of patient satisfaction with medical care in the Chita Clinical Medical Center, that testifies high social efficiency. The influence of such factors conditioning a decrease of degree of satisfaction as inconvenient working schedule of physician and violation of ethical deontological standards by the medical workers in relationship with patients was established. The results of studying factor conditionality of patient satisfaction allow to consider them in development of management measures. The necessary elements of development of the system of primary medical sanitary care include implementation of modern information systems, a uniform electronic medical record, remote appointment to physician visit, telemedicine technology, systems of electronic document management.

The feature of expertise of temporary disability is that expert decisions are considered according legislation as a basis of providing patients with various types of social protection and, in particular, exemption from work during acute period of disease. Since this is an issue of spending budget funds and extra-budgetary funds for these activities, all the procedures of expertise of temporary disability are regulated by legislative and regulatory acts that not always clearly define actions of doctors in various situations, and sometimes do not correspond to constantly changing conditions in the system of medical organizations functioning. The recent alterations in the legislative base led to a significant increase of burden on medical commission of the prolongation of medical certificates, which was already high enough due to appeals related to referral of patients to medical social expertise, medical examination of citizens, etc. The article presents the analysis of medical commission functioning of a large hospital-polyclinic association related to prolongation of medical certificates. The authors pursued the goal of identifying unfavorable trends in the medical commission functioning and identify ways to optimize it. The assessment of current status of the medical commission functioning demonstrated that prevention of injuries, especially domestic ones, as well as prevention of exacerbations of chronic diseases, including within the framework of dispensary observation of corresponding contingents of patients are of great importance for reducing the temporary disability of citizens.