Методологические и управленческие основы развития геронтологической службы в республике казахстан
Р денсаулы сатау министрлігіні паллиативті кмек туралы бйрыы, «Халы денсаулыы жне денсаулы сатау жйесі туралы» Кодексі, азастан Республикасыны денсаулы сатау жйесін реформалау жне дамыту атты Мемлекеттік бадарламасы станымдарыны атарларына атысты, ведомосто аралы ыты жне регламенттеуші ережелерден тратын зерттеу діснамалары мен нтижелеріні жиынтыы; негізгі йымдастырушылы ережелерді, дамытуды йымдастырушылы-функционалды лгісін, модулдар блогын, нормативтік-ажеттілік базасын амтитын геронтологиялы ызметті дамыту Концепциясы; оу-дістемелік нсаулар кешені оамды денсаулы жне денсаулы сатау теориясы мен тжірбиесіне осылан маызды лес болып табылады.
OSPANOVA dinara almahanovna
Methodological and managerial basis of gerontological service development in the Republic of Kazakhstan
14.00.33. – Public health and health care
Abstract of science doctor’s dissertation
The work is devoted to the solution of a major medical-social problem of public health and health care in the field of gerontology and geriatrics. In these work there were used traditional and new methods of social-hygiene research. The following valid results were obtained at that.
The proportion of persons at the age of 60 and older among the population of Almaty city (12,8%) is corresponding to international criteria, characterizing demographical ageing, which is in full accordance with the corresponding indicators by the Republic of Kazakhstan (11,6%). As for the forecasting we have determined the following structured-level regularities and peculiarities: stability of the trend towards increase of the proportion of older people from 13,3% by 2015 г., and also the prevalence of the proportion of women in all age groups older than 60 compared to the proportion of men. Age and sex specific rates of mortality among the population older than 60 years are characterized by their high level and predominance of male mortality in the all age groups (t > 2). Cause-effect relationship of these phenomena is detected with the following main>
Sociological studies have revealed that the state of health of the elderly population is corresponding to unsatisfactory one in 82,0% of cases, at that by structure and range of factors, influencing their health status, the leading factors were determined as: economical (32%); psychological (18%); ecological (14%), life>
Expert evaluation of medical, social and organizational-functional infrastructure of medical-social care to elderly people has revealed the deficiency of its volume (absence of geriatrics care, lack of physicians gerontologists, absence of teaching-methodical basis for postgraduate training of the physicians-gerontologists and therapeutics) in 72,5% of research and limitation of its accessibility, related to failure to purchase necessary medications (47,2%) and и passing clinical-diagnostically procedures (30,8% of research). Chronological studies of the technologies of a gerontologist’s activity have determined new parameters: time-costs per 1 treatment-diagnostically visit – 26 minutes (earlier it was 20 minutes) and a physician’s duty – in the average 2,3patients per hour (earlier – 3,0).
Differentiated estimated indicators of the elderly population’s need in primary health care per 1000 persons of the older age is equal to 7419,8 (1837 per 1000 of total population), out of them 4657,8 ‰ –treatment-consultative (1281 per 1000 of total population) and 2762‰ – of preventive character (556 per 1000 of total population). Structuring of visits to physicians revealed in 58,9% of cases the need of the elderly people in the services of general practitioners, ophthalmologists – in 8,9%, surgeons and neurologists – in 5,6% each. The optimal level of hospitalizing the elderly persons is detected as average rate of 294, 1 cases per 1000 patients in one year, at that the need in therapeutic care is equal to 49,7%. The indicator of need of the elderly people in various types of medical-social care among men is significantly (t > 2) lower (from 1,2 to 2,4 times), than among women. In the structure of medical-social care the need in at home services is dominating - 67,7%, living in a specialized houses – 20% and in nursing homes– 7,9%.
Key mechanisms of the process of management over the development of gerontological service are methodological approaches in the study of tendencies, peculiarities and laws of the process of ageing of the population with corresponding biological, social, psychological and medical sings of live activity, and also managerial plans of integrative character, including organizational, functional, methodical, legal, estimative and prognostic technologies of optimization of gerontological service.
Complex of projects and results of research, including interdepartmental legal and regulating statements, related to a number of positions of the Governmental program of health care development and reforming of the Republic of Kazakhstan, Codex “About health of a nation and health care system”, Order of the Ministry of Health of RK about palliative care; the developed Concept of the development of gerontological service with its main organizational positions, organizational-functional model of its development, block of modules, normative-need basis; complex of teaching-methodical plans is a significant input into the theory and practice of public health and health care.