STRUCTURAL AND ORGANIZATIONAL ANALYSIS OF THE PSYCHIATRIC SERVICE IN THE MOSCOW REGION

Significance. Psychiatric care in regions with a large proportion of rural population requires a differentiated approach due to differences in the needs of the urban and rural areas. Deinstitutionalization of care, stigma towards inpatient treatment, increased re-admissions and the need to optimize resources determine the significance of the study. Purpose. To conduct a structural and organizational analysis of the activities of the psychiatric service of the Moscow region during the period from 2012 to 2022, to identify major problems and propose modern ways to solve them based on trends and international experience. Material and methods. A longitudinal study (2012-2022) was conducted based on the federal statistical observation forms No. 10, 30, 36, 36-PL. The data were compared with indicators of the Central Federal District and the Russian Federation. Analytical and statistical methods (SPSS 21.0), and analysis of the Russian and foreign sources were used. The indicators for rural areas (21.7% of the Moscow Region population) were assessed separately. Results. As a result of the reorganization of the psychiatric service, the number of psychiatric hospitals was reduced from 21 to 6 clusters with branches; while inpatient departments of neuropsychiatric dispensaries were liquidated. The number of beds for rural residents increased by 25.9%. The initial decrease in the number of hospitalizations by 5.7% in recent years has regained the tendency towards growing, which may be associated with the consequences of the COVID-19 pandemic. Mortality decreased by 23.3%; suicide and accidental deaths reduced. The length of hospital stay decreased by 19.2%. The share of hospitalized rural residents remained stable (33%), and utilization of beds for elderly patients naturally increased. Conclusion. Merging individual medical organizations into several clusters has slightly reduced the overall indicators of the bed fund, while the number of beds deployed for rural residents increased. Almost all indicators of the treatment and diagnostic process of the psychiatric service in inpatient settings in the Moscow Region demonstrate positive dynamics. Psychiatric care was more commonly provided in outpatient settings for urban population, while inpatient care was more prevalent in rural areas. A similar data comparison with the indicators of the Central Federal District and the Russian Federation can become a useful tool for identifying current trends and forming organizational programs for flexible regulation of the prevalence of outpatient or inpatient provision of psychiatric care, as well as the identification of rural areas as locations requiring a personalized approach. Keywords: psychiatric care; inpatient settings; rural population; psychiatric medical organizations