Mechanisms of integration of otolaryngology care in the activities of family doctors

Abstract

Integration is a conceptual approach to ensuring the quality of medical care in modern conditions. One of the most important tasks of the medical services integration is the achievement of a sustainable health care system focused on the of the patient’s needs, since fragmented services, poor coordination of medical care often become the main obstacle for patients and reduce its quality. In general, about 70.0% of ENT diseases can be cured in primary care, and its importance increases with a significant shortage of ENT specialists who work mainly in clinics. Therefore, the integration of otolaryngological care into the practice of a general practitioner is considered by scientists and health care organizers as a revolutionary approach that needs to be promoted. In Ukraine, as in the whole world, the incidence of diseases of the ear, throat, and nose, especially during epidemics, according to the Center for Public Health of the Ministry of Health of Ukraine, is high. Therefore, the problem of high-quality medical care for patients with these diseases in primary care is relevant, and the mechanisms for integrating otolaryngological care into the practice of a general practitioner have not been sufficiently studied.The purpose of the study: to investigate what mechanisms for integrating medical care for patients with ear, throat, and nose diseases are implemented in the activities of a general practitioner.Materials and methods. The object of the study: mechanisms of integration of otolaryngological care in the activities of a general practitioner. The subject of the study: coordination of actions in teams of employees of a primary health care institution, cooperation of general practitioners with otolaryngologists and interested community representatives, namely social workers, suppliers of medical products, pharmacy employees, doctors of private medical institutions; the orientation of a general practitioner to a patient with ear, throat, and nose diseases.Research methods: sociological (based on the standardized questionnaire PSPIC, 2019), medical and statistical, analytical, generalization of results. Results. The results of the study showed that integration as a modern strategy for improving the quality of medical care is used by general practitioners-family doctors in Kyiv for patients with ear, throat, and nose diseases. However, integration mechanisms are used unevenly both within primary care institutions and in their external interactions. According to the respondents, coordination mechanisms for preventive measures and monitoring patients with chronic diseases need to be improved (average scores of 3.49±0.50 and 3.68±0.46 points, respectively). The survey participants gave low scores for sincerity and openness in communication between members of the teams of the primary health care institution (score of 3.58±0.55 points), which indicated the need to build more trusting relationships that will positively affect the quality and effectiveness of cooperation in the team. The most problematic position in using integration mechanisms was the coordination of activities between general practitioners and otolaryngologists (average scores of 2.62±0.48 – 2.94±0.46 points), which indicates the continued fragmentation of medical care for patients with ear, throat, and nose diseases and the threat to its quality when transferring the patient to specialized medical care institutions. More active cooperation between general practitioners and social workers, suppliers of medical devices, pharmacy employees, doctors of private medical institutions, and interested community representatives is advisable (average scores 3.58±0.49 and 3.76±0.42 points).Conclusions. The use of integration mechanisms requires management decisions by the heads of primary and specialized medical care institutions for their balanced implementation in the activities of health care institutions in the hospital district. Prospects for further research lie in further monitoring of the integration mechanisms used both within domestic primary health care institutions and in their external interactions, considering international approaches to conducting such research.