Quality Management System: Quality of Education, Science and Clinical Practice in Primary Care, Legislative and Regulatory Framework (Distance Learning Lecture)

Abstract

The article presents modern data on the development of primary health care (PHC) and approaches to managing its quality, conceptі of quality, model of quality by A. Donabedian and WHO, the quality of structure, process and result of PHC, approaches to monitoring and improving quality. The regulatory framework and the results of reforming the PHC inUkraineare given, its impact on the quality of the PHC.

The aim: is to provide basic concepts of quality of medical care and to explain the changes of quality of medical care in the process of reforming the healthcare system inUkraine.

Materials and methods. A systematic review of the literature and legal documents, own experience and observations.

Results. According to the WHO definition, primary health care is a providing treatment and prevention services at the local community level, usually by family doctors, patronage nurses, staff at local outpatient facilities, or other medical personnel. In the Astana Declaration of 2018, all countries of the world pledged to direct efforts and public investments to improve the quality of education, science and clinical practice of primary health care in order to ensure that all patients have access to the highest possible level of health. The creation of quality management systems for medical care is one of the priority areas of health care reform and determines both current and strategic prospects for the activities of any medical organization. According to the concept of A. Donabedian and WHO, quality is a multidimensional concept that consists of many components – safety, effectiveness, timeliness/optimality, efficiency/economy, fairness/equality, patient-orientation. In addition, quality is divided into three main components – the quality of the structure, process and result. The quality of the structure is the organizational aspects of the PHC – human and material and technical resources, legal support. The quality of the process is actually medical care itself, the implementation of diagnostic procedures in accordance with protocols and standards. The quality of the result – these are indicators that indicate what happens to the patient in the process of providing PHC. Monitoring the quality of PHC is carried out using indicators that can be developed and approved at the state or local levels. Quality improvement is described by the Deming Plan-Do-Check-Act cycle. When describing these concepts, legal documents on reforming the PHC inUkraine, international directives and a description of the impact of their implementation on the quality of the PHC inUkraine are indicated.

Conclusion. Taking into account the reformation of the Ukrainian healthcare system, the recommendations of the world community and the transition to market relations, general practitioners – family doctors need to learn an additional skill in managing the quality of medical care.