Sociology of Medicine

Ophthalmic care in the United States is among the most technologically advanced and innovation-driven areas of modern medicine. The country's high level of clinical equipment and infrastructure, rapid adoption of surgical, pharmacological, and digital technologies, development of specialized centers, and implementation of large-scale clinical registries give US ophthalmology substantial scientific and practical potential. At the same time, this system has marked internal contradictions: high healthcare expenditures and rapid technological progress do not necessarily translate into equitable access to medical care across different population groups.

This review aimed to analyze the organizational structure, financing mechanisms, and key barriers affecting access to ophthalmic care in the United States. We analyzed data from the Organisation for Economic Co-operation and Development, the Centers for Medicare & Medicaid Services, the American Academy of Ophthalmology, the National Eye Institute, the IRIS® Registry, and scientific publications addressing workforce capacity, insurance limitations, geographic disparities, and social indicators for assessing eye health.

The review demonstrates that the main barriers to access are associated with the high cost of medical services, limitations of insurance coverage, uneven distribution of specialists, logistical difficulties, low health literacy, and communication barriers. The most vulnerable groups include low-income patients, individuals without comprehensive insurance coverage, residents of rural and remote areas, older adults, and racial and ethnic minorities. Potential directions for reform include expanding insurance coverage, developing telemedicine and mobile ophthalmic services, improving price transparency, training healthcare professionals for underserved regions, implementing culturally adapted educational programs, and using clinical registries to monitor quality of care and identify disparities.

These findings may be useful for developing strategies aimed at improving access to ophthalmic care and preventing systemic imbalances in healthcare.

BACKGROUND: The rural paramedic performs today a wide range of tasks: from conducting preventive examinations and medical check-ups to providing specialized care for patients with chronic diseases, including chronic heart failure (CHF). This multifaceted nature of their work necessitates the use of a specialized medical-sociological instrument for assessing paramedics’ self-evaluation of professional effectiveness.

AIM: To develop and test a medical-sociological instrument for assessing self-evaluation of professional effectiveness among rural paramedics, considering their specific role in the management of patients with CHF.

METHODS: The total study sample consisted of 373 paramedics from district hospitals in the Saratov region; all respondents were female. The average age of the respondents was 47 ± 4 years. To conduct a correlation analysis for the purpose of testing convergent validity, a subsample of 77 respondents was formed, with the gender and age structure of the group maintained. Statistical data processing was performed using the Jamovi 2.6.44 software package. The following analyses were conducted: reliability analysis of the instrument (McDonald’s ω), confirmatory factor analysis using the Robust Maximum Likelihood method, and Spearman rank correlation analysis.

RESULTS: The developed medical-sociological instrument “Self-Assessment of Professional Effectiveness of Paramedics” has undergone comprehensive psychometric testing on a sample of 373 individuals. Confirmatory factor analysis using robust procedures (Robust Maximum Likelihood) showed that the scaled model demonstrates optimal goodness-of-fit indices with the empirical data [standardized root mean square residual (SRMR) = 0.059; root mean square error of approximation (RMSEA) = 0.059; goodness-of-fit index (GFI) = 0.995; adjusted goodness-of-fit index (AGFI) = 0.991; comparative fit index (CFI) = 0.908], and all scale items possess statistically significant factor loadings. The reliability of the instrument is confirmed by a high level of internal consistency (McDonald’s ω = 0.838). Convergent validity was established based on identified positive correlations with traditional self-effectiveness scales. Standardization of the questionnaire was conducted, and normative values for interpreting individual results were developed.

CONCLUSION: The obtained psychometric results confirm the reliability and validity of the developed instrument, which allows it to be recommended for practical use in scientific research in sociology of healthcare. The use of this scale enables a more accurate identification of paramedics’ needs for additional support and professional development, and also contributes to the formation of targeted programs for continuing education and strengthening the human resource capacity of the primary healthcare level.