Analysis of the effectiveness of telemedicine consultations in obstetrics on the profile «Anesthesiology and Reanimation» in case of two-year experience of a national research center


如何引用文章

全文:

开放存取 开放存取
受限制的访问 ##reader.subscriptionAccessGranted##
受限制的访问 订阅或者付费存取

详细

The introduction of telemedicine technologies must level the geographical and time frames and considerably reduce the gap in the level of technicality and competencies of regional healthcare facilities in providing planned and emergency consultations in obstetrics. Objective. To analyze the effectiveness of telemedicine consultations and to compare the obtained data with international experience. Materials and methods. In January 1, 2017 to January 1, 2018, the V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, held 92 telemedicine consultations on the issues of anesthesiology and resuscitation. The treatment outcomes in inpatients were analyzed. Results. The distribution by groups (obstetric diseases, extragenital diseases during pregnancy, and postoperative complications) was as follows: 32.4% (11), 23.5% (8), and 44.1% (15) in 2017; 70.2% (47), 10.5% (7), and 19.4% (13) in 2018, respectively. A total of 82 (32 and 50) conferences were held to determine treatment tactics and 9 (2 and 7) were done to agree the terms and conditions of hospitalization. The territorial coverage over 2 years amounted to 7 federal districts (the largest number of presentations came from the North Caucasus and Volga Regions) of the Russian Federation and to 36 regions (in 2018, the maximum patient visit rates were recorded in the Oryol Region, the Chechen Republic, and the Republics of Bashkortostan and Udmurtia). At the end of 2018, the most pronounced dynamic increase in visit rates was observed by nosological entities: multiple organ dysfunction and sepsis (from 23.53 to 29.85%), cardiovascular diseases (including congenital malformations; from 20.59 up to 22.38%), and severe central nervous system lesions (from 2.94 to 16.42%). Conclusion. Telemedicine care is a promising area of healthcare organization designed to optimize the provision of medical care in the regions of Russia and to make a balanced decision to refer patients to an appropriate-level specialized institution to reduce maternal mortality.

全文:

受限制的访问

作者简介

Aleksey Pyregov

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia

Email: pyregov@mail.ru
MD, Head of the Department of Anesthesiology-Resuscitation, Head of the Department of Anesthesiology and Intensive Care 117997, Russia, Moscow, ul. Academician Oparin, d. 4

Alexey Kholin

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia

Email: a_kholin@oparina4.ru
Head of Department Telemedicine, Department of Regional Cooperation and Integration 117997, Russia, Moscow, ul. Academician Oparin, d. 4

Maria Yurova

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University) Ministry of Health of Russia

Email: m_yurova@oparina4.ru
Specialist; resident doctor of the Department of Obstetrics, Gynecology, Perinatology and Reproductive Health IPO

Alexander Khamo

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology Ministry of Health of Russia

Email: tutaankhamon@gmail.com
resuscitation anesthetist, department of anesthesiology and resuscitation 117997, Russia, Moscow, ul. Academician Oparin, d. 4

参考

  1. Федеральный закон от 21 ноября 2011 г. № 323-ФЗ «Об основах охраны здоровья граждан в Российской Федерации».
  2. Приказ Министерства здравоохранения РФ от 30 ноября 2017 г. № 965н «Об утверждении порядка организации и оказания медицинской помощи с применением телемедицинских технологий». http://www.consultant.ru
  3. Tafro L, Masic I. Telemedicine in Anesthesiology and Reanimatology. 2010; 18(3): 163-9. doi: 10.5455/aim.2010.18.163-169.
  4. Hollander J. E, Davis T. M., Doarn C., Goldwater J. C., Klasko S., Lowery C., Papanagnou D, Rasmussen P., Sites F.D., Stone D., Carr B.G. Recommendations from the First National Academic Consortium of Telehealth. Popul Health Manag. 2018; 21(4): 271-7. doi: 10.1089/pop.2017.0080
  5. van der Sluijs A.F., van Slobbe-Bijlsma E.R., Chick S.E., Vroom M.B., Dongelmans D.A., Vlaar A.PJ. The impact of changes in intensive care organization on patient outcome and cost-effectiveness-a narrative review. J Intensive Care. 2017; 5:13. doi: 10.1186/s40560-016-0207-7.
  6. Критерии отнесения акушерских стационаров к первой, второй и третьей группам приведены в приказе Минздрава России от 1 ноября 2012 г. № 572н «Об утверждении Порядка оказания медицинской помощи по профилю «акушерство и гинекология (за исключением использования вспомогательных репродуктивных технологий).
  7. Федорова Т.А., Шмаков Р.Г., Рогачевский О.В., Пырегов А.В., Стрельникова Е.В., Виницкий А.А., Королев А.Ю. Инфузионно-трансфузионное обеспечение при операции кесарева сечения у беременных с врастанием плаценты. Акушерство и гинекология. 2017; 12: 38-44. doi: 10.18565/aig.2017.12.38-44
  8. Пырегов А.В., Калачин К.А. Акценты интенсивной терапии тяжелой пре-эклампсии/эклампсии и осложнений. Экстренная медицина. 2018; 7(2): 280-5.
  9. Monte A.S., Teles L.M.R., Grid M.O.B., Carvalho F.H., Brown H., Damasceno A.K.C. Comparison between near miss criteria in a maternal intensive care unit. Rev Esc Enferm USP. 2018; 52: e03404. doi: 10.1590/S1980-220X2017038703404.
  10. World Health Organization 2016. Conducting a maternal near-miss case review cycle at hospital level. http://www.euro.who.int/ru/health-topics/Life-stages/maternal-and-newborn-health/publications/2016/conducting-a-maternal-near-miss-case-review-cycle-at-hospital-level-2016.
  11. Аудит критических акушерских состояний в Российской Федерации в 2016 году. Методическое письмо министерства здравоохранения Российской Федерации. М., 2017. 44 с.
  12. Айламазян Э.К., Атласов В.О., Ярославский К.В., Ярославский В.К. Аудит качества медицинской помощи при критических состояниях в акушерстве (near miss). Журнал акушерства и женских болезней. 2016; 65(4):15-23 doi: 10.17816/JOWD65415-23. (in Russian)].
  13. Magee L.A., Von Dadelszen P., Stones W., Mathai M. The FIGO Textbook of Pregnancy Hypertension: An Evidence-based Guide to Monitoring, Prevention and Management. Front Cover. Global Library of Women’s Medicine. London, 2016. 456 p.
  14. Regitz-Zagrosek V., Roos-Hesselink J.W., Bauersachs J., et al; ESC Guidelines for the management of cardiovascular diseases during pregnancy, European Heart Journal. 2018; 39(34): 3165-3241. doi: 10.1093/eurheartj/ehy340
  15. Адамян Л.В., Артымук Н.В., Башмакова Н.В., Пырегов А.В., Серов В.Н., Филиппов О.С., и др. Гипертензивные расстройства во время беременности, в родах и в послеродовом периоде. Клинические рекомендации (протоколы лечения). М., 2016. 72 с.
  16. Стрюк Р.И., Бернс С.А., Филиппова М.П., и др. Сердечно-сосудистые заболевания и ассоциированные с ними коморбидные состояния как факторы, определяющие неблагоприятные перинатальные исходы при беременности - анализ данных регистра беременных «БЕРЕГ». Терапевтический архив. 2018; 1 (90): 9-16. doi: 10.17116/terarkh20189019-1.
  17. Farr A., Lenz-Gebhart A., Einig S., Ortner C., Holzer I., Elhenicky M., Husslein P.W., Lehner R. Outcomes and trends of peripartum maternal admission to the intensive care unit. Wien Klin Wochenschr. 2017; 129(17-18): 605-11. doi: 10.1007/s00508-016-1161-z
  18. Sun W., YuL., Liu S., Chen Y., Chen J., Wen S. W., et al. Comparison of maternal and neonatal outcomes for patients with placenta accreta spectrum between online-to-offline management model with standard care model. Eur J Obstet Gynecol Reprod Biol. 2018; 222: 161-165. doi: 10.1016/j.ejogrb.2018.01.035

补充文件

附件文件
动作
1. JATS XML

版权所有 © Bionika Media, 2020
##common.cookie##