Молодежный инновационный вестник

2415-7805

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

8453

Unclassified

ASSESSMENT OF THE IMPACT OF MEDICAL AND SOCIAL ASPECTS ON ADMISSION TO TREATMENT OF PATIENTS WITH UROLITHIASIS

Proskurin

Evgeniy A.

Proskurin_e@mail.ruhttps://orcid.org/0000-0001-8949-805X

Voronezh State Medical University named after N.N. Burdenko

20042023

12S2528530

15022023

29032023

2023

Relevance: Urolithiasis remains one of the most common chronic non-communicable diseases, while there is no downward trend. Increasing morbidity, rejuvenation of the disease, and the persistence of high mortality determine the need to find new approaches to increase the effectiveness of treatment by increasing patient compliance. Purpose of the study: To assess the impact of medical and social aspects on adherence to treatment of patients with urolithiasis who are in hospital. Materials and Methods: We examined 100 patients with KSD in the acute stage (age from 20 to 60 years, mean - (42.01.2) years, men 59, women 41), who underwent inpatient treatment in the urology department. Results: The lowest adherence to treatment was observed in patients with newly diagnosed KSD the mean score was 2.01.1, and significantly differed (p0.05) from patients with a longer duration of the disease, the mean score of adherence to treatment of which was 2.90.1. When analyzing adherence to treatment depending on gender, it was found that in men, high adherence to therapy is noted in 50.1% of cases, in women - in 73%. The influence of age, level of education of patients on adherence to treatment was not revealed. Among the married / married, the proportion of people with high adherence is 56.5%, among widowers / widows - 50%, while the lowest adherence to taking drugs was observed in people who have never been married (33.3%). When assessing the influence of the nature of work on adherence to the treatment of urolithiasis, it was revealed that among mental workers the proportion of people with high adherence is higher (70%) than among manual workers (50%), unemployed (40%) and pensioners (42.9 %). Conclusion: It has been established that it was revealed that in patients with KSD there is an insufficient level of adherence to treatment. The best indicator of compliance between the doctor and the patient is observed in female patients who are married, who are knowledge workers, with a history of urolithiasis for more than 5 years. Increasing the adherence of patients with KSD to treatment is an urgent public health problem that largely determines the effectiveness of medical and social measures.

morbidityurolithiasisadherence to treatmentcompliancemedical and social aspects

заболеваемостьмочекаменная болезньприверженность к лечениюкомплаентностьмедико-социальные аспекты

Relevance. Low adherence to treatment is a common reason for the ineffectiveness of the organization of medical and preventive care for patients with chronic non-communicable diseases. This is expressed in the patient's non-compliance with the recommendations, appointments and prescriptions of a medical worker. The study of this problem was first started in 1947 by Dr. C.W. Crawford, in the course of his scientific work, it was revealed that adherence to treatment affects the correctness and effectiveness of the therapy [1]. Weak adherence is a scientifically proven factor in the low effectiveness of treatment and prevention, the occurrence of complications and relapses of the disease, directly affects the quality and life expectancy of the population, which leads to significant socio-economic losses [2]. It is worth paying special attention to the problem of adherence to the treatment of urolithiasis, which is relevant at all times due to its wide distribution throughout the world as a whole. Urolithiasis (UCD) is a chronic non-infectious, systemic, polyetiological disease that occurs as a result of metabolic disorders and the interaction of environmental factors, and is manifested by the formation of stones in the urinary system of the body. According to statistics, at present, the incidence of KSD over the past ten years in economically developed and developing countries, such as the United States of America, Germany, Japan, India, has increased by 2.2 times. Moreover, in recent years there has been a trend towards an increase in the primary incidence of KSD. As for the epidemiological situation in our country, in the Russian Federation, in the structure of the general morbidity, urological diseases account for 11-15%, in the structure of urological morbidity, ICD prevails, it accounts for from 28.5 to 33.7% of all urological morbidity in the country . [3]. Along with a high prevalence, KSD is characterized by recurrence up to 5775% within 510 years. At the same time, modern scientific studies have shown that active involvement of patients in preventive treatment, dynamic monitoring by a urologist, as well as systematic monitoring of laboratory and instrumental analyzes, leads to a decrease in urolithiasis recurrence by 48% [4]. Purpose of the study. Evaluation of the influence of medical and social aspects on adherence to treatment of patients with urolithiasis who are in hospital. Materials and methods. Within two months, 100 patients with the ICD of the urological department of the Voronezh Hospital No. 8, aged from 18 to 70 years, were surveyed, the average age was 42.0 1.2 years, of which 59 were men and 41 were women. hospital, this group of patients received in accordance with the standard of specialized medical care. The survey was conducted in compliance with all ethical and legal standards. All patients were given an individual anonymous questionnaire, including medical, social and clinical data (gender, age, level of general and professional education, nature of work, marital status, duration of the disease). Adherence to treatment (compliance) was assessed using the Morisky-Green questionnaire on the first (at admission) and last days (at discharge) of treatment in the urology department. Results. The average score of treatment adherence in men and women with KSD had statistically significant differences and amounted to 2.10.1 and 2.90.2, respectively. The lowest adherence was observed in patients with newly diagnosed KSD the mean score was 2.01.1, and significantly differed (p0.05) from patients with a longer duration of the disease (more than 5 years), the mean score of adherence to treatment of which was 2.90.1. Thus, in persons suffering from KSD for less than 5 years, high adherence was observed in 45.5% of cases. The degree of compliance plays a huge role in the outcome of treatment, the outcome and prognosis of the disease, as well as the frequency of recurrence. The specialized treatment carried out in the conditions of this hospital was effective in the opinion of 86% of patients, the rest of the respondents found it difficult to answer this question. Among all the patients surveyed, only 63% strictly followed the doctor's recommendations, 33% did not fully comply with them. The reasons for the violation of the recommended therapeutic measures were: poor memory (56.7%), inadequate assessment of the severity of the disease and one's own health (40%); distrust of medical personnel, disbelief in the effect of drugs and, consequently, the effectiveness of treatment was observed in 6.1% of all interviewed patients. Compliance has gender differences. Men are the least adherent to treatment. In 50% of cases, they had a high degree of adherence, and in women - in 73% of cases, which indicates a greater organization and responsibility of females to treatment and active individual health protection. Correlations of age and degree of adherence are statistically significant not identified during the study. An analysis of the obtained data on marital status showed that among married patients, the number of persons with high adherence was 57.5%, among unmarried patients - 33.9% and divorced - 40.1%. An assessment of labor (working) factors was made. Patients with mental work had higher adherence in 70% of cases than manual workers (52%), the unemployed of working age (41%) and pensioners (42.9%). Discussion. Patients suffering from KSD, receiving specialized medical care in an inpatient setting, had higher rates of adherence to treatment upon admission. They fully agreed and were ready to fulfill all the recommendations and prescriptions of the urologist. At discharge from the hospital, adherence to medical prescriptions and prescriptions tended to decrease. It was also found that adherence to treatment in patients with this nosology increases in direct proportion to the increase in the duration of urolithiasis in history. Thus, female patients with urolithiasis, married, whose work competencies are associated with mental work, with a history of urolithiasis for more than 5 years, had the best compliance rate, which had a positive effect on their prognosis for recovery. Conclusion. In the course of this study, it was found that patients with KSD have a rather weak level of adherence to therapeutic measures, including preventive ones. The indicators and patterns identified in this study determine the vectors for improving the organization of primary health care through the implementation of a set of measures to strengthen adherence to treatment and prevention of KSD due to its high prevalence. According to the data of domestic and foreign studies, in order to maintain adherence to the treatment of chronic non-communicable diseases at a high level, it is necessary to improve and scientifically substantiate the organizational forms of interaction between a medical worker (doctor) and a patient in the prism of modern medical and social aspects [5]. The doctor's personalized approach in carrying out medical and diagnostic measures also consists in identifying the patient's initial level of adherence to treatment and the need for its subsequent correction, expanding medical awareness, medical, social and preventive activity of the patient and the population as a whole by medical and social parameters. Measures to improve the organization and coordination of medical care should be aimed at strengthening adherence to treatment and prevention, focused on expanding and popularizing nationwide preventive measures, including changing public consciousness by raising awareness among the adult population. One of the effective strategies for strengthening patients' adherence to treatment, including informatization and promotion of health-saving behavior, is individual and group training, in particular, the organization and conduct of health schools. The use of modern organizational approaches to enhance compliance between a patient and a medical worker ensures high efficiency in fulfilling the tasks set by the Ministry of Health of the Russian Federation in the framework of providing primary health care to patients with urolithiasis, leading to a decrease in mortality and disability, improving the quality and life expectancy of patients with this disease. nosological group. Thus, increasing the adherence of patients with urolithiasis to treatment and prevention is an urgent task of the public health organization of the Russian Federation, which largely determines the effectiveness of medical and social measures.

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