THE WORK EXPERIENCE OF THE OCCUPATIONAL PATHOLOGY CENTER OF FEDERAL SCIENTIFIC CLINICAL CENTER OF MINERS HEALTH PROTECTION IN SYSTEM OF MEDICAL AID RENDERING FOR WORKERS OF INDUSTRIAL ENTERPRISES BY THE EXAMPLE OF KUZBASS COAL INDUSTRY
Federal Scientific Clinical Center of Miners’ Health Protection,
Leninsk-Kuznetsky, Russia
The period of the political and economic changes in Russia and reformation of the healthcare system require revision of the full range of objectives for medicine and labour protection, with aim of creation of new conditions for labour capacity increase in workers and officials, and significant reduction of increasing social costs for professional and industry-conditioned morbidity, occupational traumatism and disability [1, 2].
The search of new economic, conceptual and practical solutions, pursuit of improvement in regulatory and legal basis require the development of the conception of creation of multidisciplinary services of occupational medicine and activation of participation in improvement of industrial environment and health promotion at work place. The practice of health management in conditions of working process requires inclusion of the practical models for development of multidisciplinary prophylactic service which is able to identify and control risk of injury in conditions of professional and non-professional impaction of labour factors, health and welfare promotion in workers, and improvement of industrial and social environment.
In 1998 in Federal Scientific Clinical Center of Miners’ Health Protection, owing to the reason of the sharply increased level of morbidity in the serviced mines by Leninskugol (two times absolute increase, 575 cases in 1996, 955 cases registered in 1998), the occupational pathology center was developed, which includes the rooms of ambulatory reception and the specialized department with 30 beds. The main tasks of the activity of the center were identification of relation of disease with profession, health promotion in individuals of the risk group, patients with occupational diseases, disabled persons as result of occupational diseases, development and realization of the measures for prevention and decrease of occupational morbidity.
In concordance with its objectives the occupational pathology center realizes:
- Complex diagnostics of occupational diseases, treatment, rehabilitation and periodic health examination in individuals with occupational diseases;
- Consideration and profound analysis of occupational morbidity in miners of the region and concurrent disability;
- Selective control of quality of conduction of preliminary and periodic medical examinations;
- In cooperation with the administration of the territories and employers, the development of measures for prevention and decrease of occupational morbidity;
- Organizational methodic manual concerning the issues of occupational pathology in the region, development of guidelines for prevention, diagnostics and treatment of occupational diseases on the basis of scientific achievements and advanced technologies.
In 1999 for realization of the given tasks the license from LAK AKO was received for expertise of professional suitability, expertise of relation of disease with profession, realization of occupational pathology activity in outpatient and inpatient conditions. In 2003 the license from the Ministry of Healthcare of Russian Federation was obtained. The staff of the center includes 12 doctors, 17 persons of nursing staff. All specialists of the center have the certificate of occupational pathologist and medical specialist, 8 employees have the higher and the first categories. The chief of the center is MD, PhD and the head of the occupational pathology center in Kemerovo State Medical Academy.
From the moment of creation of the occupational pathology center its functions include conduction of periodical medical examinations for mining industry workers. In cooperation with the workshop service the occupational pathology center provides realization of periodical medical examinations with profound investigation of individuals with different diseases with consideration of professional signs. The coverage of periodical examinations increased up to 98.8 % in 1998.
During the activity of the center the identification of occupational diseases increased, as well as the number of patients. As for 2012, 4401 persons are in dispensary registration, 2224 – with primary signs, 2177 – with confirmed diagnosis of occupational diseases (94 % - mining industry employees). In the composition of the diseases the respiratory diseases take the first place (pneumonoconiosis and chronic professional bronchitis), locomotorium diseases associated with functional overload (with increasing dynamics) – the second place, vibration disease – the third place.
During the center activity the values of occupational morbidity stabilized in the serviced area. For realization of the full range of the tasks for the occupational pathology center the automatic system was developed including the database of all patients: from risk groups; with occupational diseases; with disability as result of occupational diseases; the results of periodic health examinations; the information about harmful and dangerous factors of production. At the present time the occupational pathology center is included into the uniform computer net of Clinic Center of Miners’ Health Protection which combines all structural departments with more than 100 computers. The computer processing of out-patient medical records, medical histories, results of periodical medical examinations, results of functional, radiographic and endoscopic diagnostics. The creation of the information system allows to conduct health monitoring for mining industry workers from employment to retirement or to death, in case of professional disease.
The employees of the center participate actively in scientific work. As result of the scientific work 115 articles were published, 2 candidate dissertations and 1 PhD dissertation were defended. Also they participated in writing of the National Manual of Occupational Diseases, the regulatory documents of the Ministry of Health of Russian Federation. The materials of the occupational pathology study was used in development of “Conception of prevention of occupational diseases in Kemerovo region in 2003-2006” and the program “Prevention of occupational diseases in the population of Kemerovo region in 2014-2015”, confirmed by the Administration of Kemerovo region. The primary steps of realization of the program allowed to stabilize the occupational morbidity in the region. It was promoted with the measures for decrease of morbidity and disability in mining industry workers:
- using of screening methods in periodical health examination, organization of mobile teams equipped with transport, modern diagnostic technique and qualified staff;
- development of database of unfavorable industrial factors and the main nosological entities of occupational pathology;
- administration of complex modern methods of treatment of occupational diseases and industrial injuries.