New programmes and the best doctors, or how Moscow healthcare is being developed

Today, life expectancy in Moscow averages 77.1 years, three years more than in 2010. Moscow doctors are working to promote preventive care and high-tech medical aid, to introduce new diagnostic and treatment methods, obstetric and neonatal care, and to improve healthcare standards at inpatient clinics. Out- and inpatient clinics work to serve patient needs.

Risk assessment

Preventive healthcare is a priority for doctors as nobody wants to get ill. Regular medical checkups help identify an illness at an early stage. Moscow residents should undergo checkups every three years from the age of 21. War veterans and some other categories can receive checkups every year. Doctors recorded nearly two million risk factors of chronic non-infectious diseases through regular checkups, last year.

This year, the checkup procedure was simplified: city clinics have a special compact room arrangement that helps patients see various specialists faster. The whole process should take 90 minutes. Within a year, separate medical checkup units will open in the city’s outpatient clinics.

The preventive medicine campaign is growing. In 2016, medical institutions opened 14 new preventive units and rooms, which now total 61 in outpatient clinics. Last year, 99 percent of children underwent medical checkups, and that number is to increase to 100 percent by 2020. Ninety-four percent of eligible Muscovites were tested for TB.

Moscow Outpatient Clinic Standards

Moscow clinics have to proceed from individual patient’s needs in accordance with the Moscow Outpatient Clinic Standards programme adopted last year. Prior to this, Muscovites were asked how to make the city’s medical institutions more convenient. The public’s responses were all compiled in a Crowd Outsourcing project, analysed, and the best ideas began to be put into practice.

One proposal was to improve the routes patients and doctors have to follow in outpatient clinics. Now they have a unified navigation system, and self-check-in screens have special staff to help patients check-in for a doctor’s appointment. Information and reception desks have been merged into reception zones. All medical records have been moved to separate rooms and only medical staff has access to them.

Waiting rooms have also become more comfortable, and now have play zones, breast feeding rooms, water coolers, food and drink vending machines. Brochures and leaflets are also available at clinics from reception desks and online.

Unified Medical Information Analysis System instead of paper records

The Unified Medical Information Analysis System (UMIAS) is gradually spreading to all Moscow clinics. The system performs automated functions for clinics and patients – online doctor’s appointments, online prescriptions, sick leaves, etc.

Nine million patients are using UMIAS today, and over 10,000 medical personnel have signed up for the analytical subsystem. A total of 36.7 million appointments and 2.3 million online referrals have been made via personalized registration. The system now includes 3.1 million medical records and 2.3 million sick leaves. Ninety-seven percent of prescriptions are now issued online.

Also, 87 outpatient and 72 inpatient clinics are now using cloud accounting, which saves the city 2.9 billion roubles a year in paper expenses and 1.7 million working hours in hospital and clinic staff hours.

Patient flow control also saves time. In 2016, only 9 percent of patients had to wait in line for over 20 minutes to be seen by a doctor, while two years ago the figure was 35 percent. Now, 85 percent of patients can expect to be seen by a doctor on the same or the next day, compared to 70 percent two years ago.

Obstetrics and neonatal care

Moscow’s birth rate is on the rise: last year, there were 11.8 childbirths per 1,000 people compared to 10.7 childbirths in 2010. The statistics also show a drop in the infant mortality rate: 5.7 deaths per 1,000 newborn infants last year against 8.4 deaths in 2010.

Neonatal screening, which includes medical tests for five potential genetic disorders, helps diagnose infant health problems during pregnancy. Each midwifery inpatient clinic in the city has a neonatal intensive care unit. The latest medical equipment and research allow doctors to save underweight or extremely underweight newborns. The current infant survival rate is 87 percent against 51 percent only four years ago.

A preventive maternity health campaign is also producing results: the abortion rate has fallen from 9 per 1,000 pregnancies in 2010 to 6.1 in 2016. Medical and social consultations operating in birth centres and gynaecological units have helped reduce the number of infants abandoned at birth to 130 last year compared to 183 in 2015 and 430 in 2010.

Women suffering from infertility can opt for IVF. The number of medical centres providing this service increased last year, and they carried out a total of 2,600 IVFs.

Modern standards at inpatient clinics

Moscow inpatient clinics are introducing up to date standards. Hospitals are being refurbished, with new smaller rooms for fewer patients, some with Wi-Fi.

Patients can expect to be treated with the latest medical technologies. Forty-five Moscow inpatient clinics use the latest medical research developments, including high-tech medical aid. Most often, this is provided to cancer patients, people with cardio-vascular diseases, traumas and orthopaedic problems.

In 2010, only 75 percent of Moscow residents received high-tech medical care compared to 95 percent last year. About 120,000 people have had access to new technology last year.

In 2016, new methods of free diagnostics were introduced in Moscow – low-dose computed tomography for lung cancer, and positron emission tomography combined with computed tomography for early cancer diagnostics. All Russian citizens with a medical referral are entitled to medical care using new, sophisticated technology for free.

Training technologies, new specialists

All these high-technologies have to be administered properly; thus, the city pays particular attention to improving the qualifications and working conditions for medical staff. Hospitals now have a network of university clinics designed to engage medical school professors and doctors at teaching universities, and in real life patient care. GPs are being trained for outpatient clinics.

Doctors have access to the most high-tech CPD centre – the Botkin Hospital simulation centre. Here doctors can receive advanced professional training, using patient simulators or training mannequins that can imitate various clinical situations. Anaesthesiologists, midwives and surgeons can improve their skills in virtual operating theatres. Since it was opened in late 2015, a total of 7,200 people have undergone training at the centre.

Key non-staff specialists at the Moscow Healthcare Department are also involved in medical staff training. These are scientists from leading research centres and practicing specialists. They hold hundreds of training sessions a year for 3,500 colleagues. Doctors can also do advanced training at medical universities. Last year, 9,100 specialists used this opportunity.

University clinics have become a new way of improving medical qualifications in Moscow. These are mergers of medical universities and hospitals where teachers and practicing doctors can share expertise, thereby making a proactive contribution to the medical treatment and educational processes altogether.

Presently, 40 medical institutions have university clinics. These include departments in the First Moscow State Medical Sechenov University, Moscow State Yevdokimov University of Medicine and Dentistry, the Pirogov Research Institute, the Central State Medical Academy of the Presidential Administration, and the Russian People’s Friendship University. Here patients can receive a consultation with professors and the most sophisticated medical aid, including the latest high-tech techniques.

General practitioners (GPs) are working more at Moscow outpatient clinics; they are trained to have knowledge in several areas of medical care, such as otolaryngology, ophthalmology and surgery. They have a wider competence than physicians. GPs are working at outpatient clinics as duty doctors so far, and can be seen without an appointment. They do diagnosis and prescribe treatment but do not do specialist referrals. In the past two years, 2,500 physicians and paediatricians were retrained as GPs at Sechenov, Pirogov and Yevdokimov universities.

Professional awards

In order to encourage young people to take up a medical profession, the city is working to raise its prestige. Competitions are organised amongst doctors and other medical staff, honoured titles and awards are conferred. The best medical employees are promoted across the city.

The medical staff is invited to take part in competitions such as the Moscow Masters, Best Employer, Best Enterprise for Working Mothers, all with various award categories. The city organise the Formula for Life festival and Russia’s Best Doctor national competition. In all, over 4,200 hospital and clinic personnel have taken part in professional competitions and 58 of them have won awards.

The best specialist achievements are considered and judged by the city and the federal government. About 3,000 medical employees have received various awards: the titles of Merited Medical Worker of Moscow, Russia’s Best Doctor, Moscow’s Merited Doctor badge, certificates of honour from the Moscow Government, the Russian Healthcare Ministry, and others.

There are also some feedback projects. One of them, Thank You, Doctor, has been launched for patients to express their gratitude to doctors, paramedics and nurses. People can share their story on a special website. The project has been widely promoted with over 1,500 billboards across the city, featuring medical worker portraits.

The city’s best medical personnel are selected by an online popular vote. The best physicians, paediatricians and nurses can be voted for on the Active Citizen website. The winners will receive Moscow Government awards and programme certificates.

Undoubtedly, the financial reward largely contributes to professional prestige. An average medical worker in Moscow has a monthly salary of 64,300 roubles, which is 8 percent more than last year. This is slightly over the average Moscow wage, which is 62,300 roubles. Moscow doctors are paid about 87,300 roubles per month, mid-level staff receives 58,000, and junior staff about 35,000 roubles.

The Moscow healthcare budget is increasing too. Last year, it increased 8.7 percent to 316.8 billion roubles. In 2017, the budget will reach 364.9 billion, with 6,400 roubles spent per patient in outpatient clinics, and 44,100 roubles per patient at inpatient clinics.

Innovations-2017

The city has ambitious healthcare plans for this year. A unified development centre will be set up for outpatient clinics, and medical training programmes will now include polite communication, conflict and stress management, plus UMIAS operation skills.

Clinical algorithms will be introduced for the treatment and diagnosing of the most frequent diseases. Elderly patients will see specially assigned doctors if they, for example, suffer from diabetes, cardiac failure and asthma simultaneously. Doctors will draw up an individual treatment plan together with lifestyle recommendations for each patient. They will also show the patient how to keep a self-control diary, monitor their symptoms and reach certain conclusions about their own health.

In order to increase the efficiency of treatment, gynaecological units and trauma centres will be attached to inpatient clinics, while emergency care clinics will be integrated into the Puchkov ambulance station.

The city’s oncological clinic network is being established now: hospitals and oncology centres will work together with area and district outpatient clinics to accelerate cancer diagnostics and treatment. The same system will be developed for psychiatric disorders.

Moscow also intends to develop online consultations, introduce a mechanism for accreditation, and improve certification of medical staff.