Viktor A. Ognev¹, Oleg A. Korop², Andriy M. Zinchuk¹
1Kharkiv National Medical University, Kharkiv, Ukraine
2Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine
Introduction: Organizational changes in the context of the transformation of the health system in Ukraine are based on deep and consistent structural and functional transformations and directed to the providing of specialized care of appropriate quality and efficiency, which are the main target function and a prominent criterion for the functioning of the national health system.
The aim: Theoretical substantiation of the ways of increasing the efficiency of specialized medical aid in patients with lung cancer.
Materials and methods: Accounting medical records were the main source for the investigation, along with that the results of sociological researches in oncological patients with lung cancer and the results of expert estimation of the ways of increasing the efficiency of specialized aid for such kind of patients. Some methods were also used, such as system approach and analysis, sociological method, methods of conceptual modeling and expert values.
Results: An increase of integral efficiency of a specialized medical aid for cancer patients in Ukraine could be reached by expected medical one (introduction of preventive, diagnostic and therapeutic technologies); social one (healthy way of life; satisfaction by the quality and availability as primary as specialized medical aid) and economic efficiency (reduction of economic losses because of disability; shortening of inpatient medical aid financing because of less number of patients with neglected stages of the disease). All of that is grounded on the development and introduction of organizational medical technologies, directed on the early detection of lung cancer and provides justification and development of an optimized model for the early detection of this disease.
Conclusions: The disadvantages and lack of efficiency of the existing system of specialized cancer care in Ukraine have identified the necessity of a systematic and integrated solution of the problem of early detection of lung cancer based on the optimization of its model, based on the principles of systemicity and complexity, the use of modern science and practice achievements in the management and organization of specialized medical care, application between sector interaction and improvement of its information and communication and organizational-economic components.
KEY WORDS: specialized medical care, efficiency of medical aid, lung cancer
Wiad Lek 2019, 72, 4, 548-552
Nowadays lung cancer in Ukraine is one of the most spread oncological diseases in able-bodied age patients. In the structure of oncological morbidity this kind of ailment has 12,8 % . In a global scale, lung cancer is diagnosed in 1,2 million patients annually, and more than 1 million deaths are caused by this kind of sickness [2,3]. There is an interesting fact that 5-year survival rate is lower in the states with the high standards of health care is only 15 %, in the countries with a middle level of medical development this number is barely reachable 5-7 %. National Cancer Institute published the data of survival rate in patients with lung cancer in Ukraine. Mortality of oncological patients in the period under one year is 63,9 %, in comparison with 60 % in the USA, and 5-year survival rate in the USA is higher than in Ukraine respectively 15 % and 9,4 % .
It is important to note the difference in the incidence of lung cancer in different geographical regions, ranging from 5.3 to 99.7 per 100,000 population , according to sex – the incidence is 6-10 times higher among men than among women  and according to the place of residence − among urban inhabitants, the incidence of lung cancer is 15 % higher than that of people living in rural areas . In addition, numerous studies identified the main risk factors for lung cancer, among which the most important are tobacco use, chronic obstructive pulmonary disease, industrial hazards, ionizing radiation and low physical activity [8,9], and high mortality from lung cancer among major nosological forms of malignant neoplasms, which is largely due to the inadequate effectiveness of the existing system of specialized medical care for cancer patients, which is largely depends on the volume of financing, organizational and technological provision of the system of specialized cancer services, the level of public confidence in the health care sector, the socio-economic development of the country and its regions, the economic differentiation of the population and its belonging to certain socio-economic groups, living and working conditions, adherence to a healthy lifestyle and a stage of disease detection .
Taking into account all above-mentioned problems it is necessary to reform health care system of Ukraine. Specialized medical aid has to be accessible, qualitative and effective. Morbidity and mortality because of different reasons (including cancer ones) have to be reduced. Public health has to re-orient onto the preventive sphere and propaganda of advantages of healthy lifestyle, improvement of personnel policy and innovation development of medical science.
Theoretical substantiation of the ways of increasing the efficiency of specialized medical care for lung cancer patients, working out and introduction of optimized model of the early cancer detection are the main goals of this publication.
MATERIALS AND METHODS
Organization of medical and sanitary care of lung cancer patients is an object of research, an information bases is accounting medical records of lung cancer patients (1,306 observations), results of sociological investigations of this kind of patients (339 observations), expert value of the ways for increasing the efficiency of specialized medical care for lung oncological patients (32 expert conclusions).
Adequate scientific methods for Social Medicine were used, such as system approach and analysis for the complex investigation of lung cancer morbidity, sociological method for the study and estimation of risk factors caused this kind of disease, quality of medical care, way and quality of life and their medical-social characteristics, conceptual modeling for optimization of organizational and functional model of the early detection of lung cancer among the population of Ukraine and an expert values’ method for the estimation of grounded and optimized model of the early detection of lung cancer among the Ukrainian population, and prediction of its effectiveness. All the methods applied in the research got the positive conclusions of the Ethics Committee of the Kharkiv National Medical University regarding their expediency and the possibility of using it.
RESULTS AND DISCUSSION
Complex medical and social research has revealed and proved the presence of restrictions in the system of medical and sanitary provision of patients with lung cancer, which is manifested, in particular, in reducing the effectiveness of specialized medical care on the late stages of detection. Accordingly, one of the main directions of increasing the efficiency and positive results of the treatment of lung cancer among the Ukrainian population should be the introduction of an effective model of its early diagnostics, which will overcome the problem of late detection of the disease, significantly improve the efficiency of treatment for patients with lung cancer, reduce of mortality and increasing the level of survival.
The modern system of cancer control in Ukraine is created in accordance with the existing regulatory framework in this area, but it should be noted that the structure of health facilities that provide cancer care to the population involves the division into a specialized oncology network and the provision of assistance in institutions of general non-oncology profile. Taking into account the high medical and social value of timely detection and effective treatment of cancer in general, and lung cancer, in particular, this process should be considered not only as a medical, but as a comprehensive medical and social process for ensuring of qualitative and timely medical care in the modern socio-economic and the social conditions of the development of Ukraine, which depends on the aspects of organizational, structural and institutional provision of the process and unconditional compliance with the necessary organization and medical technologies based on current achievements in the organization of health care, public administration and management.
Increasing the effectiveness of specialized medical care for patients with lung cancer presupposes, first of all, the necessity of applying the principles of systemicity and complexity in optimizing of the model of early detection of lung cancer among the Ukrainian population, which should mean the consideration of all components of the model in the connection and interdependence, taking into account the efficiency of components, which have both direct and indirect effects, including the influence of each of these components on the effectiveness of the entire system of specialized medical care for patients with lung cancer. The main components of the model for the early detection of lung cancer among the population are shown in Fig. 1 and 2. Determination of the essence of the model, the necessity and objectives of its optimization is determined in the first block − the input components of the optimization model, which involves analysis to identify the problem, the assessment of the situation, the definition of the subject, the object and the links between them, and as well as the definition of stakeholders interested in solving the problems of the parties, the objectives of optimizing the model and strategic directions for improving the model.
The effectiveness of specialized medical care for patients with lung cancer is achieved through the use of modern organizational and medical technologies, among which the achievement of maximum results with a spending of minimum cost for their realization in obtaining of medical, social and economic effects in the context of preservation and increase of human capital. The indicators of effectiveness reflect the interconnectedness of numerous medical, social and economic aspects of innovation, which can be increased by intensifying the improved use of all available resources − personnel, financial, material, etc.
Developed and scientifically substantiated optimized model for the early detection of lung cancer in adult patients has new elements. It is based on the contemporary approaches to the organization of health system, state management including principles of systematic and complex investigation directed on the earliest stages of cancer before the appearance of clinical manifestations. It is available, provides integrity, phasing and continuity. The use of the proposed model allows to obtain the expected medical effect (by reducing the rates of detection of oncological pathology at later stages of the disease, reducing hospitalization, increasing the coverage of adult population by targeted preventive examinations and the quality of dispensary surveillance of cancer patients, shortening the timing of treatment, lowering the level of invalidation, decreasing the mortality from this disease), social effect (increase in life expectancy and its quality, decrease in prevalence of risk factors, including a reduction in smoking, satisfaction of the population by qualitative and accessible of health care, reduce of disability, dissemination and promotion of a healthy lifestyle), and the economic effect (reduction of payments for temporary and permanent disability, reduction of losses from decreasing of labour productivity of the adult population, weakened by oncological diseases, shortening of expenses for medical care in health care facilities due to decrease in the number of patients with 3rd and 4th stages of lung cancer).
The introduction of the offered optimized model for early detection of lung cancer among the adult population at the primary level of provision of medical care (family doctors) provides an opportunity to identify people with risk factors, provide multiplicity and scope of diagnostic prophylactic examinations taking into account individual patient’s characteristics, conduct the diagnosis at early stages of the lung cancer disease, which in turn should determine the optimal and adequate treatment program with individual consideration in general, helps to prevent an increase in the rate of primary disability, increase the 5-year survival of patients, and reduce the cost for temporary disability.
In this paper, the detailed theoretical substantiation of ways to increase the efficiency of specialized medical care for patients with lung cancer on the basis of an optimized model of early detection of lung cancer among the adult population is presented and prospects for further research related to the study of qualitative changes in specialized medical aid for patients during the reform process are given. The healthcare sector of Ukraine is directed on reaching of maximum level of the integral indicator of the effectiveness of diagnostics and treatment of lung cancer in clinical practice.
1. The urgency of the problem of lung cancer is characterized by an increase in the incidence and prevalence rates, the presence of risk factors for the disease, the peculiarities of the provision of medical and sanitary care to patients, and the development of research in the field of studying the quality of life of patients with lung cancer.
2. Disadvantages and the lack of efficiency of the existing system of specialized cancer services in Ukraine determined the need for a systematic and integrated solution of the problem of early diagnostics of lung cancer based on the optimization of its model, grounded on the principles of systemicity and complexity, the use of modern scientific and practical achievements in the management and organization of specialized medical assistance, application between sector interaction and improvement of its information and communication and organizational-economic components.
3. Implementation of this model in practical health care is aimed the achievement of the maximum efficiency of specialized oncology medical care through the improvement and use of modern organizational, preventive and medical diagnostic medical technologies, observance and promotion of healthy lifestyles, population satisfaction with the quality and availability of specialized medical care, the reduction of payouts and decreasing the number of patients with abnormal stages of lung cancer.
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According to the order of the Authorship.
Conflict of interest:
The Authors declare no conflict of interest.
Viktor A. Ognev
Kharkiv National Medical University
Aveniu Nauki 4, Kharkiv, Ukraine
Figure 1. Optimized model for the early detection of lungs’ cancer for the population of Ukraine.
Figure 2. Incoming components of optimized model for the early detection of lung cancer among the population of Ukraine