Vol. 4 No. 2 (2023): Archive

Background. The performance assessment of medical organization’s activities has taken on great
significance as the whole world tends to implement the model of value-based healthcare and the system of
compulsory health insurance is focused on increasing the financial support of medical organizations.
Purpose. To analyze methodological approaches and to design a performance indicator system for medical organizations.
Materials and Methods. The author conducted the content analysis of research articles on the study topic
published in the Russian Science Citation Index, and analyzed statistical and accounting data of Moscow
polyclinics providing primary health care to the adult population from 2016 to 2021.
Results. The author analyzed the methodological approaches of Russian researchers and practitioners to
assessing the performance of medical organizations and to choosing the relevant performance indicators.
Based on a thorough approach to selection, a set of performance assessment indicators was created by
analyzing the performance of Moscow polyclinics providing primary health care to the adult population from
2016 to 2021. The recommendation is to use the developed indicator system for rating medical organizations
in order to improve management process and to achieve desired outcomes.

For citation: Elbek Yu. V. Performance Indicator System for Medical Organizations: A Case of Moscow
Polyclinics. City Healthсare, 2023, vol. 4, iss. 2, pp. 4-14. doi: 10.47619/2713-2617.zm.2023.v.4i2;4-14 (in Russian).

Laparoscopic intracorporeal suturing (LIS) is one of the key skills in laparoscopic surgery. LIS training is
conducted in simulation centers and is aimed at transferring the knowledge into practice. The simulation
training (ST) is focused on the development of skills that allow surgeons to perform LIS operations. However,
this goal is not completely achieved: only 44,0 to 72,2 % of surgeons implement LIS skills in their practice.
There is a need to evaluate the effectiveness of such training programs and analyze factors that may
influence the results. This evaluation is required to increase the effectiveness of LIS trainings and implement
the acquired skills into practice by training surgeons.
According to commonly accepted approach to evaluation of training programs suggested by D. Kirkpatrick.,
the method of effectiveness evaluation allows to estimate the practical results achieved by all trainees.
Unfortunately, there are no commonly accepted methods aimed at evaluating the effectiveness of LIS
training programs. The existing methods estimate the results of effectiveness evaluation in simulation (Dry
lab) or practically, but in small groups. Effectiveness evaluation of LIS trainings implementation in surgical
practice among all trainees is related to significant financial costs and complexity.
A new effectiveness evaluation method of LIS simulation training programs (the Method) has been suggested.
It is aimed at evaluating the total amount of results and other ST effects, as well as analyzing individual
factors that can influence training results. The Method includes a survey among ST participants. It has been
applied to effectiveness evaluation of LIS simulation training program at Educational and Accreditation
Center of the Botkin City Clinical Hospital. The survey showed that 88.9% of surgeons attending the LIS
training program implemented their knowledge into practice.
The suggested Method allows to evaluate the effectiveness of LIS simulation training and its implementation
into practice among all trainees, analyze factors that can influence the training results and use the obtained
results for further improvement of the training program and its methods.
The Method may be recommended for implementation at medical simulation training centers.

For citation: Shabunin A. V., Klimakov A. V., Logvinov Yu. I., Maer R. Yu. Method for Evaluating the
Effectiveness of Simulation Training for Laparoscopic Intracorporeal Suturing. City Healthcare, 2023, vol. 4,
no. 2, pp. 15-29. doi: 10.47619/2713-2617.zm.2023.v.4i2;15-29 (in Russian).

Russia and other countries report an increase in the incidence of malignant neoplasms, and approximately
10 % of all oncological cases have hereditary background. Molecular genetic testing in patients with diagnosed
malignant neoplasms and a suspected hereditary factor will help to select effective modern methods of
treatment and prevention of the development of neoplasms of other localizations.
According to the study, 12,6 % of patients had hereditary cancer syndrome, which allowed to administer
molecular genetic tests to patients’ relatives. Consequently, it becomes possible to detect hereditary cancer
risk factors, improve the efficiency of clinical examination, elaborate and implement programs for prevention
and early detection of the disease.

For citation: Semenova A. B., Byakhova M. M., Galkin V. N., Parts S. A., Makarova M. V., Nemtsova M. V.,
Chernevskiy D. K., Sagaydak O. V., Baranova E. E., Belenikin M. S., Krinitsina A. A., Khatkov I. E.,
Bodunova N. A., Daishevich A. M., Kanner D. Yu., Savelov N. A., Shabunin A. V., Lebedev S. S.,
Protsenko D. N., Gadzhieva S. M. Capabilities of Molecular Genetic Methods for Effective Hereditary Cancers Detection in Individuals with High Cancer Risk Factors. City Healthсare, 2023, vol. 4, iss. 2, pp. 30-40.
doi: 10.47619/2713-2617.zm.2023.v.4i2;30-40 (in Russian).

Research shows that there is an increase in the number of young people who have never smoked before,
but now use electronic nicotine delivery systems (ENDS). Therefore, it seems relevant to study the reasons
for using electronic cigarettes.
A theoretical analysis of the problem allowed us to describe the main reasons for using electronic systems.
An empirical study involving students of the Medical Institute of the Patrice Lumumba Peoples' Friendship
University revealed the reasons among future health workers. The main reason for starting to use ENDS
among the respondents was stress. 58.3% of participants noted that it was the reason to start smoking
e-cigarettes. Other reasons included smokers in the social circle; attempts to quit smoking regular cigarettes;
a desire to copy adults and attempts to protect others from secondhand smoke exposure.

For citation: Ostrovskaya I. V., Kostsova N. G., Khozhatova A. K. Reasons for Using Electronic Nicotine
Delivery Systems by Young People. City Healthсare, 2023, vol. 4, iss. 2, pp. 41-51. doi: 10.47619/2713-2617.
zm.2023.v.4i2;41-51 (in Russian).

Background. Numerous psychological traits may contribute to the success of a doctor's career, with the
priority orientation of an individual towards qualitative and effective solving of professional tasks being
among the most important factors.
Purpose. The purpose of the study was to determine the prevalence and to study the determinants of
priority orientation of an individual towards qualitative and effective solving of professional tasks among
internal medicine physicians of the Tver region.
Materials and methods. This medical and social study was conducted as a selective single-stage study
based on a set of methodological procedures and techniques related to sociological, psychodiagnostic and
statistical methods. A representative sample (p < 0,05) included 597 internal medicine physicians working in
medical organizations in the Tver region.
Results. Authors assessed the incidence of the priority orientation towards qualitative and effective solving
of professional tasks among internal medicine physicians in general and in certain gender and age groups.
We identified 16 significant (p < 0,05) medical, social and psychological factors influencing the formation of
this priority orientation of internal medicine physicians’ personality, as well as their significance.
Conclusions
1. The prevalence of the priority orientation was observed among 32,9% of internal medicine physicians
in the Tver region. Statistical data showed that in men the indicators were significantly higher compared to
women of all age.
2. Medical and social factors of professional environment supported by psychological determinants of
professional motivational and value plan greatly influence the shaping the priority orientation of an individual
towards qualitative and effective solving of professional tasks among internal medicine physicians.

For citation: Derbenev D. P., Maiorov R. V. Assessment of Formation of the Doctor’s Priority Personality
Orientation Towards Professional Accomplishments. City Healthсare, 2023, vol. 4, iss. 2, pp. 52-59. doi:
10.47619/2713-2617.zm.2023.v.4i2;52-59 (in Russian).

Background. One of the major challenges in modern healthcare that is timely delivery of high-quality
medical care to the population must be addressed. First of all, it requires effective staff management.
The quantitative and structural imbalance of medical professionals is another common issue in modern
healthcare. The current changes in staff management are primarily related to reshaping of responsibilities
of medical personnel. In this context, we will discuss reshaping as the transfer of some responsibilities of
medical personnel to non-medical one, which is expected to reduce the excessive physician workload.
The purpose of this article is to study and analyze the existing positive practices and solutions in personnel
management aimed at delegating tasks not related to health care delivery to non-medical personnel in medical
organizations.
Materials and methods. The authors conducted an expert interview with heads of medical organizations,
doctors, heads of divisions and chiefs of departments of medical organizations in Moscow and Russian
regions. Along with interviews, authors used SWOT analysis.
Results. The conducted survey revealed potential transformation trends. According to expert opinion,
the main transformations aimed at reshaping responsibilities of non-medical personnel are related to a set
of functions such as work in call centers, implementation of telemedicine technologies, use of high-tech
equipment and technologies for timely health care delivery. This study methods and findings can contribute
to recommendations on job responsibilities of non-medical workers including the reduction of physicians
workload. The results will be of interest to scientists, researchers, HR managers and health authorities
engaged in the process of optimization and improvement of medical care provision.

For citation: Medvedeva E. I., Kroshilin S. V. Transformation of Personnel Management Process: Reshaping
Responsibilities of Non-Medical Personnel. City Healthсare, 2023, vol. 4, no. 2, pp. 60-72. doi: 10.47619/2713-
2617.zm.2023.v.4i2;60-72 (in Russian).

Aim. This study describes the development features of telemedicine technologies in Moscow. For this
purpose, authors analyzed publications, regulatory acts, and experience of the Telemedicine Center of Center
of Medical Prevention of Moscow Healthcare Department, including its work during the COVID-19 pandemic.
Results. With the onset of the COVID-19 pandemic, Telemedicine Service for Patients with Coronavirus
Infection (the Telemedicine Center of Moscow Healthcare Department) began operating in Moscow. The
service provides telemedicine doctor-patient consultations in the following areas: management of patients
with coronavirus infection, participants in a clinical trial of Gam-COVID-Vak vaccine, and visitors of Moscow
Health pavilions. Doctors and patients communicate via the Telemedicine Information System that is
accessible either through a mobile app or a browser. To access patient medical records, doctors use the
Unified Medical Information and Analytical System of Moscow. To develop the specialized skills necessary
to provide remote medical consultations to Moscow residents, a doctor of the Telemedicine Center receives further training, including workplace internships.

For citation: Andrusov V. E., Pakhuridze M. D., Skvortsova E. V. Aspects of Development of Telemedicine
Technologies in Moscow. City Healthсare, 2023, vol. 4, no. 2, pp. 73-81. doi: 10.47619/2713-2617.zm.2023.v.4i2;73-81 (in Russian).

Background. The problem of adherence to medical recommendations is always relevant. Low adherence
or nonadherence to treatment has negative clinical and economic effects, such as influence on treatment
success, prolongation of disease duration, increased risk of hospitalization, negative outcomes, and increased
mortality risk.
The aim of this study was to assess the impact of using the RX Observatory digital platform on adherence
to treatment with Etoxydol (ethylmethylhydroxypyridine malate) in patients with chronic cerebral ischemia
(CCI).
Materials and methods. Medication adherence was studied in patients with CCI who visited doctors in
three Moscow city polyclinics using the RX Observatory digital research platform and digital questionnaires.
Results. The study found that 47% of patients fully adhered to the prescribed medication. Adherence was
higher if the medication was prescribed by a medical specialist (general practitioner – 36 %, neurologist – 56
%), although adherence to medical recommendations was higher among patients visiting general practitioners
(general practitioner – 48 %, neurologist – 43 %).
Conclusions. The study showed that the RX Observatory platform may be a useful tool for developing
medication adherence in patients taking Etoxydol (ethylmethylhydroxypyridine malate).

For citation: Reshetova A. A., Bezymyanny A. S., Zuev S. S. Assessment of Adherence to Treatment with Ethylmethylhydroxypyridine Malate in Patients with Chronic Cerebral Ischemia Using a Digital Platform.
City Healthсare, 2023, vol. 4, iss. 2, pp. 82-88. doi: 10.47619/2713-2617.zm.2023.v.4i2;82-88 (in Russian).

Background. Internationalization of global healthcare and, in particular, the development of international
medical tourism, informs the creation of a strategy for the development of domestic medical tourism programs
in regions, states, or provinces using various tools for each stage of market development.
Purpose. This article aims to identify, classify, and analyze the development tools for regional medical
tourism programs applied in the countries recognized as international destinations for medical tourism.
Methods and materials. The study data are based on foreign and domestic scientific publications in the
field of international medical tourism and the export of medical services. The authors analyzed publications
on the development of regional medical tourism programs in the media and performed content analysis of
scientific publications in peer-reviewed scientific journals.
Results. The internationalization of global healthcare has a significant influence on cross-border private
medical travel (medical tourism), thus encouraging the development of both national and regional healthcare.
The existing global practice of 19 countries in regional medical tourism provides an extensive development
toolkit that includes more than 70 tools focusing on various aspects of the elaboration and implementation of
opportunities for regional medical tourism and the export of medical services. The tools can be implemented
in one of the four stages of market development: introduction, growth, maturity, and decline. The first stage
is characterized by the prevalence of tools related to analysis and the development of the market base. The
growth stage focuses on market expansion. At the third stage, the first tools aimed at offering better price
for medical services appear. The stage of market decline is focused on the expansion of the target consumers
by increasing the financial accessibility of medical tours. At the same time, the third and fourth stages are
characterized by a limited number of support tools, which can be explained by the relative immaturity of
the global medical tourism market and the focus on programs designed for the international market rather
than on increasing economic efficiency. Therefore, in the following years, the scientific and professional
communities will focus on the development and implementation of tools that can increase the reflow of
financial resources expended on market development.
The results of this study can be useful to the subjects of the Russian Federation that are interested in
the development of regional strategies in terms of the federal project on the development of the export of
medical services as part of the “Healthcare” national project.

For citation: Petrova G. D., Chernyshev E. V., Diachek E. S. Tools for the Development of Regional Medical
Tourism Programs: International Experience. City Healthсare, 2023, vol. 4, no. 2, pp. 89-100. doi: 10.47619/2713-
2617.zm.2023.v.4i2;89-100 (in Russian).

Introduction. The system of primary health care (PHC) has drastically evolved in the last few years due
to the novel challenges of the COVID-19 pandemic. The global community has developed new approaches
for using modern technologies to quickly make decisions and promote primary prevention, new software
tools and applications for patients, general practitioners, and doctors in training, and new roles for PHC
team members to support general practitioners and deliver health care to a larger part of the population.
The growing population’s needs should be met through the efficient organization of a primary care-oriented
system. In order to have timely, high-quality medical care, national authorities and healthcare organizations
providing primary care are engaged in PHC management.
Materials and methods. The review was prepared using reporting guidelines for systematic reviews
and meta-analyses (PRISMA). The search was conducted in the bibliographic databases eLibrary, PubMed,
MEDLINE, Google Scholar for the following keywords: functional-target operating model, primary health
care, management in primary health care, management of polyclinics in the countries of the world, lean
polyclinic, and medical prevention. In addition, authors analyzed and structured the information on Russian
and foreign regulations and guidelines from the official websites of WHO, the Ministry of Healthcare of the
Russian Federation, etc.
Results and discussion. The World Healthcare Organization developed the target operational framework
for PHC, including the main characteristics of models for healthcare organization and primary care provision.
The model of medical care organization is adapting to the changing goals and priorities of the global
community in healthcare.
Conclusion. The current tendencies in PHC organization are prevention, digitalization, resource optimization,
teamwork, and the transfer of functional responsibilities to non-medical specialists.
Each country chooses its own model, system, and program of PHC provision depending on the population’s
needs for medical services. Many of the developed models have already proven their efficiency.

For citation: Timofeeva A. S. Modern Models of Polyclinic Management: Literature Review. City Healthсare,
2023, vol. 4, no. 2, pp. 101-111. doi: 10.47619/2713-2617.zm.2023.v.4i2;101-111 (in Russian).

The article discusses potential applications of a risk-based approach to health facility management. The
study analyzed various management models, as well as process-oriented and project-oriented management
systems, the use of risk management, quality management standards, lean technologies (lean manufacturing),
and scorecard interfaces (score ratings). The article presents the results of applying risk analysis, which was
developed using balanced scorecard approach that describes activities of a health facility. It was found that
the balanced scorecard approach and scoring calculations enable risk level assessment in a health facility to
classify risks by work areas and take suitable measures to mitigate or prevent them.

For citation: Budarin S. S. Applying a Risk-Based Approach to Health Facility Management. City Healthсare,
2023, vol. 4, no. 2, pp. 112-119. doi: 10.47619/2713-2617.zm.2023.v.4i2;112-119 (in Russian).

Introduction. One of the tools that allows to assess the relevance of initiated or ongoing scientific studies
is the scientometric analysis of their topics. The method is actively and widely used not only for rating
models based on various bibliometric indicators and parameters, as well as for evaluating the publication
activity of authors, organizations, scientific publications, cities, and countries. Russia and other countries
have amassed extensive experience rating accomplishments in scientific and educational fields, specifically
using numerous scientometric indicators to assess scientific effectiveness and productivity. The article
compiles a scientometric rating of the subject areas covered by “Medicine” in order to identify the priority
development directions of global medical science.
Materials and methods. The study was conducted in the “Medicine” section using the SciVal analytical
platform, which uses data from the international scientific citation database Scopus. Four scientometric
indicators (scholarly output, citation count, citation per output and field-weighted citation impact) were
analyzed for a three-year period from 2019 to 2021.
Results and discussion. The paper presents a table method for determining the worldwide priority directions
of scientific research in medicine. For each of the four scientometric indicators, the TOP-5 subject areas have
been identified, the list of which is approximately the same in terms of scholarly output and citation count,
but significantly differs in citation per output and field-weighted citation impact.
Conclusion. The TOP-5 of four scientometric indicators for the period 2019–2021 includes twelve subject
areas, such as cardiology and cardiovascular medicine, oncology, surgery, infectious diseases, epidemiology,
medical microbiology, public health, etc. The data obtained during the study confirm the strong thematic
correlation between publications in certain subject areas. The algorithm described in the paper can be further
adopted on local, organizational, regional, and national levels, i. e. in organizations, cities, and countries. This
methodology seems to be promising in identifying and analyzing priority areas of scientific research and
determining the index of scientific specialization of certain groups of countries, for example, BRICS, G7, G20,
EU, ASEAN, Shanghai Cooperation Organization, Eurasian Economic Union, etc.

For citation: Tarkhov K. Yu. Priority Development Subject Areas of Global Medical Science. City Healthcare,
2023, vol. 4, no. 2, pp. 120-139. doi: 10.47619/2713-2617.zm.2023.v.4i2;120-139 (in Russian).