Sociology of Medicine

BACKGROUND: The healthcare system is the most important social institution affecting the life of each member of Russian society. To improve the organization of the provision of medical care to citizens in the context of long-term program-oriented strategic planning for health development in the region, it is necessary to take into account the interests, expectations, and requests of patients (as consumers of medical services) regarding the quality of medical care, staffing, and the material, technical, and technological equipment of medical organizations.

AIM: Construction of a social portrait of consumers of medical services of the healthcare system of the Moscow region, taking into account the socio-demographic and socioeconomic characteristics of patients and the salient characteristics of their medical behavior.

MATERIALS AND METHODS: The study (a questionnaire survey of 531 patients) was conducted in February–May 2022 based on the Moscow Regional Research Clinical Institute named after M.F. Vladimirsky. The subject of the study was consumers of medical services at the institute at the age of ≥18 years, permanently residing in the Moscow region. The survey participants were recruited based on the calculated selective population, with quotas by sex and age. The thematic sections of the questionnaire focused on the study of the level of satisfaction of respondents with the medical services received, the characteristics of their medical behavior and attitudes to their health, and the analysis of the main socio-demographic characteristics of patients (gender, age, social and family status, education, and financial situation).

RESULTS: The study, conducted among residents of the Moscow region, made it possible to determine their attitude to their health, the level of satisfaction with the medical service received, features of medical behavior, and experience of interaction with medical workers (primarily doctors), including conflict situations. It has been established that among patients, a positive assessment of the quality of the medical services they receive prevails, most of them prefer to receive information about diseases, methods of treatment, and drugs from medical professionals, and they tend to trust doctors and comply with their prescriptions. When patients experience conflict situations, this most often happens with registry workers and is mainly due to the difficulty of getting an appointment with a doctor.

CONCLUSION: The study identified the most characteristic features of medical behavior and described a social portrait of a typical consumer of medical services in the Moscow region.

Adolescent health is important because it determines the future health of adults, and because trends in this category are characterized by the most negative indicators compared to other age groups of the population.

Actualization of the importance of the problem of adolescent health in the structure of school innovations.

The study was carried out in 2022 by the staff of the Institute of Sociology of the Federal Center of Theoretical and Applied Sociology of the Russian Academy of Sciences in the form of a review based on the analysis of 92 relevant sources (scientific research and regulatory documents).

Although an intention to address the health of children and adolescents is recognized in Russia as a national task that requires an interdepartmental approach and actions from almost all ministries and departments, the reality is different. In schools, where children spend 70% of the day, the necessary conditions for their health have not been created. Two aspects of these conditions are considered — medical and educational — in the field of health. The medical aspect is associated with an insufficient number of medical rooms in educational institutions, the quality of their equipment, a lack of medical personnel, and the presence of contradictions in the regulatory framework on this issue. As a result, the actions of health workers in schools are limited mainly to medical examinations and vaccinations, instead of the nine main functions stated in the regulations. The educational aspect, on which the formation of a culture of students’ health depends also remains unrealized. Three reasons for the absence of the subject “Health” in the school curriculum and the peculiarities of the formation of the need for healthcare among schoolchildren, including with the help of the media, are considered.

A change in the state of two important aspects of the health of children and adolescents in the structure of school education — medical and educational — seems to be real in the case of solving regulatory and legal issues related to the elimination of existing contradictions in the information based on the issues of medical provision in educational institutions. Equally important is the introduction of indicators on the formation of a healthy lifestyle for various categories of the population, primarily children and adolescents, into the reporting forms of educational and medical organizations. Raising the level of public health culture and the formation of a unified preventive environment that ensures a healthy lifestyle should become a practical state task.

BACKGROUND: This article is devoted to the impact of the digitalization of modern healthcare on the nature of relationships between a doctor and a patient.

AIM: To assess the level of readiness of the patients in the city hospital for the introduction of digital technologies in the system of providing medical services.

MATERIALS AND METHODS: The study was based on the results of a questionnaire survey of 154 patients in city hospitals in July–August 2022 in Nizhny Novgorod. The survey questions included studying the use by modern day patients of various methods of digital communication with medical workers, the impact of the availability of medical information on the internet on the level of patients’ trust on a doctor, and patients’ opinions about the prospects for solving problems of modern healthcare through digitalization.

RESULTS: The results of the survey revealed that 104 (67.5%) patients do not use digital communications, and 94 (61%) have no intention of using them. Among the prospects for the use of digital technologies in healthcare, the most popular for respondents were getting referrals for medical services (n=83, 53.9%), a prescription (n=57, 37%), and documents certifying temporary disability (n=43, 27, 9%). Only 8 (5.2%) respondents systematically check the diagnoses and prescriptions received from the attending physician on the internet and 25 (16.2%) do this from time to time. Only 2 (1.3%) respondents stated that they have a priority level of trust in recommendations from internet sources, and the rest of the patients trust their real attending physicians more.

CONCLUSION: A modern patient seeks to receive medical care in real contact with a doctor, considering digital technologies mainly as a tool that addresses formal issues that arise when visiting medical organizations.

BACKGROUND: One of the leading indicators of the social effectiveness of healthcare is the assessment, monitoring, and analysis of the social satisfaction of patients with medical care, which reflect the degree of implementation of a personalized approach of medical care. Patients’ satisfaction with their interaction with the healthcare system is a result of the main characteristics of the quality of medical care, established by the professional community.

AIM: To analyze the satisfaction of consumers of medical services in terms of the accessibility and quality of medical care in regional healthcare facilities.

MATERIALS AND METHODS: The study involved 218 doctors from primary healthcare medical organizations in Saratov and 312 doctors from primary healthcare medical organizations in districts of the Saratov region.

RESULTS: From the results of the research, we determined negative phenomena in the activity of medical organizations in which the respondents received medical care. Despite the limitation of medical care accessibility for the majority of respondents in the regional healthcare (the absence of the necessary specialists, insufficient technical equipment in the medical organizations, the high cost of medicines unaffordable by patients, and queues), while assessing the satisfaction with medical care in the medical organizations of the region the majority of the respondents (63.8% of respondents in the medical organizations of Saratov and 64.9% in medical organizations of Saratov region) evaluated their satisfaction with medical care positively.

CONCLUSION: The explanation of the results obtained is possible in the context of the description by Academician of RAS A.V. Reshetnikov the phenomenon of “paradoxical” medicine, which appeared in the Russian healthcare literature at the end of the twentieth century.

On a global scale, a radical transformation of the healthcare sector is taking place right before our eyes. The last few years have become a turning point in terms of the number of new directions, the emergence of innovative diagnostic and treatment methods, and the introduction of digital platforms. Digital medicine uses information and communication technologies to address the numerous problems associated with ensuring the quality and accessibility of medical care already available today. The rapid development of neural networks and artificial intelligence (AI) provides doctors with ample opportunities to predict the course of diseases and calculate the risks to the health of patients. Manufacturers of medical devices offer consumer a wide range of software and products with AI embedded. Despite the tremendous advances in the application of AI in medicine, the medical community is highly concerned about some of the intractable problems associated with the too rapid and ubiquitous use of these digital platforms. A highly trained neural network is an extremely complex computer program consisting of a large number of internal hidden layers with customizable parameters. The more complex the neural network and the number of computational operations it performs, the more difficult it is to understand the processes in its inner layers. The functioning of AI systems in a black box format makes explaining the results of its work a very non-trivial task. Therefore, in the future, research will certainly be required assessing the reliability of these systems and interpreting their decision-making processes which, will affect the neural networks of the latest generations.

The coronavirus pandemic has caused adjustments to be made to the organization of medical care for the population worldwide. The reorganization of medical institutions to provide emergency, outpatient, and inpatient medical care to infected patients required huge financial and personnel costs and caused a kind of bias towards reducing the medical services provided to patients with chronic non-infectious diseases, which in turn determine the main levels of morbidity, premature mortality, and disability of the population. The availability of medical care to patients with chronic non-infectious diseases has decreased in all the countries that were impacted by COVID-19. This situation has not gone unnoticed by the medical community and as a result, various ways to overcome this problem have been proposed. The proposed article presents an analytical review of various types of Russian and foreign medical sources including articles, orders, statements, interviews, and surveys devoted to the problem of addressing the availability of various types of medical care. The review presents the most obvious and widespread problems in public health during the pandemic. It also analyzes the methods used in various countries, including Russia, to overcome the decline in the availability of medical care. The wide range of problems described that arose in domestic and foreign healthcare during the COVID-19 pandemic, and the variety of ways to solve them, allow us to conclude that this study is relevant. A literary review of articles (reviews, original research, interview data, and telephone surveys) published from March 2020 to March 2022 was conducted on the impact of the COVID-19 pandemic on the availability of medical care for somatic patients in the Russian Federation and several foreign countries. The methods of bibliographic, informational and semantic search for sources in Google Scholar, PubMed and Scopus databases were used. A system analysis of the sources was performed.