Patient pathways as a tool of improvement in management of urgent and scheduled health care for kidney stone disease
Detsyk, O.; Solomchak, D.; Bugro, V.
Wiadomosci Lekarskie 72(11 Cz 1: 2128-2134
2019
ISSN/ISBN: 0043-5147 PMID: 31860860 Document Number: 697838
Introduction: Urolithiasis is one of the most common urological pathologies, which has a significant socio-economic burden on the health care system. The aim: To develop patient pathways based on the current guidelines on urolithiasis, and to assess the effectiveness of kidney stone management within health care system of Ukraine. Materials and methods: There were analyzed: national and international regulatory documents (12 units); 890 patient records (confirmed urolithiasis) in seven inpatient public health care facilities and private one in Ivano-Frankivsk region; 282 control cards of follow-up examination in seven public outpatient facilities in Ivano-Frankivsk region; 129 patient records in Truskavets health resort (residents of Ivano-Frankivsk region). Used methods: bibliosemantic, epidemiological, modeling, biostatistical, pharmaco-economical analysis and peer review. Results: It was established that national protocols on urgent and scheduled medical care for urolithiasis require renewal. Founded on world, national and personal experience, patient pathways were created as a sequence of outpatient and inpatient care for urolithiasis, which clarified the criteria for hospitalization, the scope and type of facility for delivery the necessary care, taking into consideration the peculiarities of the patient's medical state, the size and location of stone. It was shown that the lack of high-quality clinical protocols of medical care on urolithiasis leads to the irrational use of resources, especially in district health care facilities. Conclusion: The proposed patient pathways are an effective tool for assessment of effectiveness and identification the ways of improvement in management of medical care for patients with urolithiasis.