The role of barriers in organizational-functional model of the rural adults preventive medical examinations

Coverage of preventive medical examinations (PMEs) and periodic health check-ups among rural populations consistently remains below the regional average, with limited quantitative analyses of the barriers. Objective. To substantiate an organizational and functional model for managing periodic health check-ups among rural populations, based on a quantitative assessment of barriers, and to evaluate the model’s effectiveness in a pilot area relative to a control. Materials and methods. A survey was administered to 511 adult residents of municipal districts in the Voronezh Region characterized by low population density. Participants were stratified into three zones based on distance from the district hospital (Zone A: up to 10 km; Zone B: 10—30 km; Zone C: over 30 km). Pearson’s χ2 test and multivariate logistic regression were applied, evaluating events per variable (EPV), receiver operating characteristic area under the curve (ROC AUC), the Hosmer–Lemeshow test, and sensitivity analysis using Firth’s method. The effectiveness of the model for 2022—2023 in the Ternovsky District was assessed using a difference-in-differences (DiD) approach compared with values from the control Vorobievsky District. The parallel pre-trend assumption was evaluated using data from 2018—2022. Results. The principal barrier identified was limited transport accessibility to the district hospital (Zone C: OR=12.127; 95% CI 4.586—32.067; p<0.001), despite higher motivation among residents in remote areas (95.3% and 84.8%, respectively). A three-tier organizational and functional model was developed, incorporating a matrix of service formats, outreach logistics based on territorial assignment, and a system of 19 key performance metrics. The number of individuals undergoing preventive medical examinations (PMEs) and comprehensive health screenings increased from 2.031 to 4.102. Coverage of the registered adult population rose from 15.5% to 40.2%, and the plan fulfillment rate improved from 34.9% to 59.7%. The additional increase in coverage compared to the control group was 5.29 percentage points (t=6.247; p<0.001; 95% CI 3.63—6.95), remaining stable on the multiplicative scale (DiD-OR 1.36; 95% CI 1.24—1.48). Conclusions. Addressing objective logistical barriers through managed territorial stratification is more effective at increasing clinical examination coverage among specific adult population groups than interventions aimed at modifying public attitudes.