ORGANIZATION OF HEMATOLOGICAL CARE IN THE REPUBLIC OF KAZAKHSTAN
Abstract
The main objectives of organizations providing hematological care in an outpatient setting are:
At the primary level: planning the volume of outpatient drug provision with the participation of a hematologist, issuing prescriptions and monitoring the outpatient drug provision of patients; organizing consultations (face-to-face and remote) with hematologists and a set of necessary therapeutic and diagnostic measures for patients with blood diseases, referral for hospitalization of patients with blood diseases in accordance with clinical protocols; development of an individual rehabilitation program for patients with blood diseases in accordance with the recommendations of a hematologist and clinical protocols; organization of palliative care; generation of the necessary documents for referral to determine the degree of disability, in the manner prescribed by the rules for conducting a medical and social examination;
At the secondary level in specialized hematologists’ offices, as well as medical organizations providing consultative and diagnostic assistance: primary diagnostics, including all types of necessary studies determined by clinical protocols; monitoring the effectiveness of treatment, including all types of necessary studies determined by clinical protocols; drawing up an individual follow-up program, as well as clinical protocols; formation of an outpatient drug supply plan, planning the volume of outpatient drug provision for patients with blood diseases; control over the provision of medicines to patients; providing consultations (face-to-face and remote) with hematologists and a set of necessary therapeutic and diagnostic measures for patients with blood diseases in accordance with clinical protocols; referral for hospitalization of patients with blood diseases in accordance with clinical protocols; selection for hematopoietic stem cell transplantation, organization of necessary preparations and referrals to medical organizations providing high-tech medical services in the field of hematology; organization of consultations with the participation of hematologists and specialized specialists in accordance with clinical protocols; development of an individual rehabilitation program for patients with blood diseases in accordance with clinical protocols; organization of palliative care, including outpatient drug provision in accordance with the list of medicines and medical devices for free and (or) preferential outpatient provision for certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions);
At the secondary and tertiary levels by medical organizations providing medical care in the specialty "Hematology (adults)" in inpatient and hospital-substituting conditions: organization of specialized medical care and, with permission from the authorized body, issued in the manner prescribed by the authorized body, high-tech medical services in planned and emergency forms in accordance with clinical protocols; coordination of continuity between medical organizations of primary and secondary levels providing medical care for patients with blood diseases is carried out in the republican coordination center; participation in the examination of the quality of medical services (care) to patients with diseases of the blood and hematopoietic organs; planning and submitting proposals to the authorized body regarding the organization of hematological care for the adult population of the Republic of Kazakhstan; organization and participation in educational and scientific activities for specialists of the hematology service of the region and the Republic of Kazakhstan. Providing hematological care at primary and secondary levels on an outpatient basis
Hematological care at the primary and secondary levels on an outpatient basis is provided in the district, city, regional clinic, consultative and diagnostic office, as well as the relevant departments of multidisciplinary city, regional, departmental, republican and specialized healthcare organizations.
Prevention, primary diagnosis, as well as referral for consultation to a hematologist, referral for treatment in inpatient and hospital-substituting conditions, organization of dynamic observation, organization of palliative care, organization of outpatient drug provision in outpatient settings for patients with blood diseases who do not need specialized hematological care is carried out in primary health care organizations, at the patient’s place of attachment.
When detecting primary manifestations of pathologies of the blood and hematopoietic organs, the primary health care doctor determines the need for: emergency medical care; conducting research if there is no need to provide emergency medical care in accordance with clinical protocols; exclusion of secondary manifestations of pathologies of the blood and hematopoietic organs, in the event of which the primary health care physician refers the patient for consultation with a hematologist; Referring the patient for a consultation with a hematologist in person or remotely.
A patient with primary manifestations of pathologies of the blood and hematopoietic organs is referred to a hematologist if he contacts specialists of any profile. Patients with blood diseases are subject to dynamic monitoring at the site of attachment.
Dynamic monitoring of patients with blood diseases is carried out by primary health care physicians with the involvement of a hematologist in accordance with the patient management program developed by him in accordance with clinical protocols, and also in case of their absence in accordance with the best medical practices in the field of hematology with the presence of evidence-based criteria
Patients with diseases of the blood and hematopoietic organs requiring hematological care in the form of specialized hematological medical care, high-tech medical services are removed from the register in the following cases: moving to another country or region, when changing their permanent place of residence; changes in diagnosis; death based on the final medical death certificate.
The appointment of studies to monitor the effectiveness of therapy is carried out by a primary health care physician in accordance with the conclusion of a hematologist within the framework of the guaranteed volume of free medical care.
Outpatient drug provision is carried out by primary health care doctors in accordance with the List of Medicines and Medical Devices for free and (or) preferential outpatient provision of certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions) based on the prescription of a hematologist.
Providing hematological care in inpatient and hospital-replacement conditions:
Hematological care in a hospital setting is provided in specialized departments of city, regional, departmental, and republican health care organizations licensed for the subtype of medical activity “Hematology”. Hematological care in inpatient conditions is provided in a district, city clinic, consultative and diagnostic center, as well as in the relevant departments of city, regional, departmental, and republican health care organizations. In primary health care organizations, medical care in inpatient conditions for patients with blood diseases in the absence of a hematologist is provided without chemotherapy and includes the supervision of a primary health care doctor, a therapist, with the implementation of the hematologist’s prescriptions for treatment and monitoring its effectiveness. Specialized care in inpatient and hospital-substituting conditions includes the provision of medical services by hematologists in the relevant departments of city, regional, departmental, and republican health care organizations for diseases of the blood and hematopoietic organs requiring hematological care in the form of specialized hematological medical care and high-tech medical services. Chemotherapy, diagnosis and treatment, and transfusion support are carried out by a hematologist. Chemotherapy for lymphoproliferative diseases may be administered by an oncologist. Specialized care is also provided by a general practitioner or oncologist, under the guidance of a hematologist, in cases where there is a shortage of specialized specialists. When providing medical care by general practitioners or oncologists, it is necessary to organize the control of a hematologist over prescriptions, interpretation of studies, development of a therapy program, and evaluation of effectiveness. Drug provision is carried out within the framework of the guaranteed volume of free medical care and (or) in the system of compulsory social health insurance in accordance with the drug formulary of the health care organization, as well as the rules for the development of drug formularies of health care organizations.
When providing hematological care in inpatient and hospital-substituting conditions, medicines purchased in accordance with the List of Medicines and Medical Products for free and (or) preferential outpatient provision for certain categories of citizens of the Republic of Kazakhstan with certain diseases (conditions) are used.
Medical indications for treatment in inpatient and inpatient conditions for patients with blood diseases are: treatment, including chemotherapy, diagnostic studies, including invasive interventions, assessment of the effectiveness of therapy, provision of transfusion support.
The provision of transfusion care in hospital-replacement conditions is carried out in accordance with the standard of transfusion care for the population of the Republic of Kazakhstan.
Surgical treatment of patients with blood diseases is carried out in specialized surgical healthcare organizations or departments, with the exception of minimally invasive interventions, when they are prescribed for health reasons.
The structural unit providing hematological care in inpatient and hospital-replacement conditions carries out: hospitalization and provision of care to patients with blood diseases according to indications in accordance with clinical protocols; providing advisory assistance to doctors and patients with manifestations of disorders of the blood system and hematopoietic organs of other structural units of the medical organization; development and implementation of measures to improve the quality of medical care and reduce hospital mortality from blood diseases; participation in advanced training of medical and nursing staff of a medical organization on the issues of prevention and provision of medical care to patients with diseases of the blood and hematopoietic organs; introduction into clinical practice of new methods of prevention, diagnosis, treatment and rehabilitation of patients with diseases of the blood and hematopoietic organs; carrying out health education work with patients and their relatives; systematic analysis of information on hospitalized patients, maintaining records and reporting documentation.
The minimum list of diagnostic services in the scope of hematological care provided by a medical organization within which a structural unit has been created that provides hematological care in inpatient and hospital-replacement conditions includes: general clinical examination; general clinical blood test, with the ability to manually count blood cells; blood chemistry; coagulogram and determination of blood coagulation factors and inhibitors to them; serological and molecular studies for the presence of infections; immunophenotyping; invasive methods of bone marrow sampling - puncture and trepanobiopsy; cytological examination of bone marrow; histological and immunohistochemical examination of bone marrow; ultrasound examination of internal organs, x-ray diagnostic methods, computed tomography; immunochemical study of blood and urine proteins; cytogenetic studies of blood and bone marrow; molecular biological methods for studying blood and bone marrow; immunological diagnostic methods during transfusion therapy; resuscitation and transfusion care services in the organization of a hospital; providing medical care for anemia and hereditary deficiencies of blood clotting factors.
