Strategy for the development of specialized medical care for patients with urolithiasis in the armed forces of the Russian Federation

The development of a system of therapeutic, diagnostic, and organizational measures to improve specialized medical care for members of the Armed Forces of the Russian Federation with urolithiasis is scientifically substantiated. The study was conducted in 3 stages. At the first stage, the principal functions of the system of specialized urological care for patients with urolithiasis were singled out, and possible ways of their realization were determined. At the second stage, planning options for the system were formulated and described. In the third stage, the criteria for analyzing the system, estimation of their superiority, and scientific substantiation of the rational concept were elaborated. Three systems of providing specialized urological care to patients with urolithiasis with the conditional names, including “proposed,” “real,” and “adaptive,” were formulated and put forward. The proposed system was based on the principle of the maximum volume of specialized medical care according to the “urology” profile in the district hospitals of each military district and hospital of the Northern Fleet. The real system has a four-stage structure, which was based on staged treatment of patients with urolithiasis receiving the maximum treatment in organizations of central subordination. In the adaptive system, its conceptual basis is the central military medical organizations, and the volume of care in the remaining hospitals is determined by the chief urologist of the Ministry of Defense of the Russian Federation. Using hierarchy analysis, a pairwise comparison of each concept was performed, and the proposed system has the highest priority index. Generally, to improve the specialized care for members of the Armed Forces of the Russian Federation with urolithiasis, we have developed and scientifically proved the system of the organizational treatment and diagnostic measures that assume the decentralization and standardization of the urological care for patients with urolithiasis, staff reorganization, provision of modern equipment, professional training of the medical staff, improvement of research potential, and interaction with medical institutions of the civilian population.