The problem of organizing medical care for surgical patients in rural areas

Imprint

Yulia V. Nazarova, Danila A. Gluzdakov, Artem S. Karanin, Natalya V. Chvyreva. The problem of organizing medical care for surgical patients in rural areas. Cardiometry; Issue 32; August 2024; p. 60-63; DOI: 10.18137/cardiometry.2024.32.6063; Available from:

TOPICALITY

Changes in medicine are one of the essential components of development and progress in general. For many years, health care has been actively evolving, based on new scientific discoveries, technological advances and clinical research evidence. Continuous improvement in the above mentioned area has a huge impact on the health and well-being of people around the world. Along with the above, rural areas still face problems of public access to medical care services, including high-quality level health care [1-3].

Surgery is one of the areas of medicine that plays a huge role in preserving the life and health of people. However, the issue of public access to surgical care services remains relevant for patients living in rural areas. In remote areas, medical care is often limited, and procedures requiring surgical intervention may be either unavailable or significantly complicated.

Rural surgery is a special category of medical doctors who specialize in surgical operations in rural areas. These doctors must not only have the skills and knowledge of general surgery, but also be able to work with limited resources. Because, differing from hospitals in large cities, there is no access to modern technologies and equipment to facilitate conducting complex surgery [4-6].

Rural surgery is a complex, responsibility-burden, area of medicine. The need for surgery in rural areas emphasizes the importance of developing medical infrastructure in these remote regions. It is important to supply to surgeons in rural areas modern equipment and offer possibilities to them for their professional development.

The aim of the study is to analyze and propose a scientifically based model for organizing surgical care for rural residents.

MATERIALS AND METHODS

The study has used statistical and analytical methods, as well as extracting information from applicable state statistical reporting forms and reference literature sources available.

RESULTS AND DISCUSSION

According to the available statistics of the Russian Federation, in 2023 the share of the population in rural areas was 25%. Despite a fairly significant portion of the population of rural areas, they often cannot use services of the necessary medical organizations and specialists that complicate public access to high-quality surgical care services for residents of these territories. As a rule, the fundamental principles of organizing medical care in rural areas are practically the same that is the case with the urban ones, but nevertheless there are some specific features which are associated, as a rule, with rural labor and life style [7-9].

Firstly, the population density in rural areas is much lower. Secondly, rural labor is characterized by its certain seasonality. At the same time, transport accessibility therein is quite poor and requires special attention.

Currently, the problem of the lack of the proper surgical treatment profile in rural areas becomes especially urgent. In remote areas, there are not always specialized surgical organizations and / or departments of this profile found, there are no experienced specialists that make the organization of treatment a complex and expensive process. Another problem is the lack of equipment and infrastructure for surgical manipulations. As a rule, complex surgical interventions cannot be performed, which leads to a delay or incomplete provision of medical care services to patients. In addition, there is a problem associated with the collection and transmission of information, since electronic data exchange systems do not function or the Internet connection is accompanied by difficulties and is sometimes impossible that hinders obtaining a timely consultation with a specialist or sending the results of tests and examinations. However, even under the conditions of the limited resources, surgical care services can still be accessible and effective [10-12].

Medical care for patients in rural areas is usually organized in two stages: pre-hospital and hospital services. The pre-hospital stage includes rural regional medical stations, as well as rural district hospitals, independent medical outpatient clinics, medical care and obstetric offices (MCOO), district hospitals without a surgical department, polyclinics at the central district hospital (CRH), district and city polyclinics and health care centers at industrial enterprises. When employing a network of these medical institutions, the location and the number of settlements, their service radius, the actual economic situation, the locations and the quality of road network are taken into account. Their main tasks are to diagnose acute surgical diseases and injuries with rendering emergency care services; properly deliver patients directly to the surgical department; identify some visual forms of chronic surgical diseases and systematic monitoring of the health of such patients [12, 13].

The factors for assessing the quality of health care provided are the possibility of delivery to the hospital within the first hour after receiving an injury or wound; in the first hour after seeking medical service in case of penetrating ulcer, closed hernia or intestinal obstruction; in the second hour in case of acute appendicitis or gastrointestinal bleeding; within three hours in case of acute cholecystitis or pancreatitis.

An important criterion for the quality of medical care is the absence of fatal outcomes, both at home and during patient transportation. Several levels of treatment are provided within this stage. The first level is the surgical department of the central district hospital, where basic surgical care is provided to residents of the district. The main tasks at this stage are to provide emergency care in case of any acute diseases, as well as reduce the time of transportation, making diagnostics in the first hours of hospitalization and the implementation of appropriate treatment measures aimed at relieving the acute condition. It is important to note that providing emergency care in surgery requires quick decision-making and competent execution of procedures in order to save the patient’s life or prevent deterioration of his/her condition [1, 5, 12].

Currently, such basic medical procedures are appendectomy in acute appendicitis, drainage of abscesses, treatment of acute intestinal obstruction, closure of gastric ulcer in perforated ulcers, operations to remove hernias with or without resection of the intestine, cholecystectomy in acute cholecystitis, drainage in acute pancreatitis, organ-preserving operations in case if bleeding due to peptic ulcer disease and resection operations in case of tumor etiology, suturing of esophageal varices, laparotomy in case of abdominal wounds.

In other dangerous surgical diseases in difficult cases, it is necessary to redirect patients to inter-district centers, regional clinical hospitals and state med

Issue 32. August 2024 | Cardiometry | 61

ical universities’ clinics. If delivery is impossible, it is necessary to apply for medical care by air ambulance [3, 7, 9].

Implementation of scheduled surgical care is an important stage in the treatment of many diseases that require surgical intervention. This process requires high qualification and specialized equipment to achieve the best outcomes and ensure patient safety. It is performed in order to maintain and improve the health of patients.

The above stage includes a list of various diseases: for example, removal of benign soft tissue neoplasms, hernia repair and plastic surgery at various places, amputations, treatment of anal fissures and elimination of hemorrhoids.

At the second level of medical care involved are inter-district centers of surgical and specialized care. Their tasks are to provide urgent surgical care in all cases of acute diseases, injuries and conditions: reducing delivery time; diagnosis and surgery within the first 2-3 hours; planned surgical care: a full range of general surgical operations, including gastric ulcer and cancer surgery, oncoproctology, endosurgery; provision of urgent care to neighboring districts; scheduled inpatient and advisory care; organizational and methodological assistance to assigned districts [2, 6, 8].

At the 3rd level, both planned and emergency surgeries shall be performed, and also consultative assistance to patients shall be completed. The timely and high-quality treatment shall be ensured, as well the necessary support and assistance in restoring health after surgery shall be provided.

Based on the above, in order to solve the problem of organizing medical care for surgical patients in rural areas, the following is recommended. First, it is necessary to develop and implement a program to improve the availability and the quality of surgical care in rural areas. This may include training of medical personnel from district hospitals or clinics in the basics of surgery, as well as improving the skills of employed surgeons.

Second, it is necessary to establish specialized centers that provide highly qualified surgical care to the rural population. Such centers can be located in large rural settlements or on the basis of existing district hospitals, with a mandatory staff of experienced specialists and medical equipment of the appropriate level.

The third step may be the development of a telemedicine system for remote consultation and re- 62 | Cardiometry | Issue 32. August 2024

mote-assisted surgery. This will allow experts from city hospitals to perform operations at site with remote access support and consult local doctors via video system. Such a system may significantly reduce waiting times and improve the quality of medical care in this sort of patients.

CONCLUSIONS

Despite the latest achievements in theoretical medicine, the problems in rural medicine remain very acute. Solving the problem of organizing medical care for surgical patients in rural areas is a long-term task that requires not only financial investments, but also best efforts by medical personnel, governmental bodies and the society as a whole. However, due to constant changes and innovations, health care services in rural areas have been developing, and they become more effective and accessible. This is an important problem that requires immediate attention and solutions to ensure the proper high-quality and accessible medical care for all residents, regardless of their place of residence.

CONFLICT OF INTEREST

None declared.

AUTHOR CONTRIBUTIONS

Nazarova Yu.V. – concept and design development, writing the text;

Gluzdakov D.A. – data analysis and interpretation; Karanin A.S. – collection and design of statistical data;

Chvyreva N.V. – checking critical intellectual content, final approval for publication of the manuscript.

FUNDING

The authors declare no funding.