Quality of medical care in healthcare facilities located near active hostilities: physicians’ perspective

Abstract

Purpose. To determine physicians’ opinions regarding key obstacles and current problems affecting the provision of medical care to the population living in territories adjacent to the combat zone. Materials and methods. The study was based on a sociological survey of physicians working in frontline healthcare facilities (HCFs). The target sample consisted of 42 physicians working in HCFs located near the area of active hostilities and providing medical care to the population living or temporarily residing in the Ukraine-controlled territory of the Donetsk region. During the survey, the majority of respondents (78.57%) indicated that the inpatient departments of the Municipal Non- Commercial Enterprise “Regional Territorial Medical Association of Kramatorsk” were their place of work. Another 16.67% of respondents indicated that they worked in outpatient clinics/polyclinic departments; two respondents each (4.76%) indicated that they worked in family medicine outpatient clinics and a clinical diagnostic laboratory as their place of work. The study was conducted from February to June 2025. The results are presented as percentages, along with standard errors estimated using the Wald method. Results. Indicators of the resilience and adaptability of HCFs include the preservation of access to laboratory diagnostics (69.04±7.13%), the ability to prescribe medications to patients (61.9±7.49%), continuous provision of HCFs with electricity (54.76±7.68%) and water supply (66.67±7.27%). To ensure the availability of medical consultative care for the population of frontline territories, 80.95±6.06% of respondents use telecommunication methods for patient consultations. Problems identified by the study: 85.72±5.40% of respondents reported an increase in the number of advanced cases of chronic diseases compared to 2021; 88.09±5.0% of respondents indicated an increase in advanced cases of oncological diseases in patients; 80.95±6.06% of respondents indicated worsening of working conditions during the period of the full-scale invasion; 47.62±7.71% of respondents reported a deterioration in the level and quality of medical care (QMC) in their facility compared to 2021 (40.48% of physicians noted partial and 7.14% significant deterioration of QMC); the largest number of physician respondents indicated active hostilities as the main obstacle to the high-quality performance of their professional duties (54.76±7.68% cases per 100 respondents); psycho-emotional disturbances of patients were noted in 47.62±7.71% cases per 100 respondents, and the physicians’ own psychological distress was indicated in 42.86±7.64% cases per 100 respondents; regarding the development of burnout syndrome among medical workers, 64.29±7.39% of respondents noted symptoms of burnout/ psychological exhaustion of varying degrees of severity: from mild fatigue that resolves with rest (47.62±7.71%) to pronounced physical and psychological fatigue (16.67±5.75%); 71.42±6.97% of physicians indicated the presence of psychological problems of varying degrees during communication with patients. Approximately 70% of respondents noted a shortage of consultative care provided in HCFs by physicians of various specialties (a shortage of functional diagnostics physicians was noted by every third respondent (33.33 cases per 100 respondents), every fourth respondent reported a lack of gastroenterologists (26.19 cases per 100 respondents) and endocrinologists (23.81 per 100 respondents), and every fifth physician respondent (21.43 cases per 100 respondents) reported a shortage of neurologists, infectious disease specialists, dermatologists, and psychiatrists). Every third physician we surveyed (30.95±7.13 cases per 100 respondents) also noted the lack of opportunities to conduct additional examinations to clarify/establish a diagnosis; inadequate material and technical resources of the facility were indicated in 11.9 cases per 100 respondents. Conclusions. The strengths and weaknesses, opportunities, and threats identified by the study and the conducted SWOT analysis can be used in the process of developing adaptive medical care programs for all levels of the healthcare system regarding its functioning in wartime conditions and increasing the adaptability of HCFs located in territories near the combat zone.