Romaniv M. Medical and social basis of the model of oncogynecologic care in Ukraine.

The dissertation is dedicated to solving an important scientific and practical task of health care - providing the female population of Ukraine with affordable and high-quality oncogynecologic care at the current stage of health care development by substantiating and developing of functional and effective model of providing oncogynecologic care, taking into account the conditions of emergency situations, using the example of malignant neoplasms of womb and ovaries. A comprehensive medical and social investigation established that the increase in the incidence and prevalence from malignant neoplasms of the body of womb and malignant neoplasms of the ovaries, the decrease in the percentage of detection of patients with oncogynecological pathology during preventive examinations, which is one of the factors of the increase in the percentage of detection of patients in more advanced stages of the disease. The upward trend in the latter indicator has intensified during the COVID-19 pandemic. According to the results of the calculation of the coefficient of determination between the risk factors for the development of diseases and the fact of the presence of malignant neoplasms of the body of womb and malignant neoplasms of the ovaries, a synoptic table has been created, which includes the factors that were most often encountered in patients with of malignant neoplasms of the body of womb and malignant neoplasms of the ovaries, and their ranking places have been determined. It has been established that it is expedient to distinguish the following three risk groups in women according to the development of malignant neoplasms of the body of womb and malignant neoplasms of the ovaries and further tactics of their management have been developed: • Group I - women with reproductive system disorders of malignant neoplasms, precancerous and background diseases of the body of womb and ovaries, should be referred to supercluster health care facilities for providing specialized medical care to oncological patients; • Group II - practically healthy women with 4 or more risk factors for the development of oncogynecological pathology, in particular, malignant neoplasms of the body of womb and malignant neoplasms of the ovaries are subject to monitoring and in-depth preventive examination using cytology, colposcopy, ultrasound and other highly informative diagnostic methods of examination. Preventive examinations and health monitoring of women in this group are carried out by obstetrician-gynecologists; Group III - practically healthy women with 1-3 risk factors, which have a small specific share in the occurrence of oncogynecological pathology, should undergo periodic preventive examinations. To these women, the medical staff of the primary level of medical care can send reminders to the mobile application about the need to undergo a preventive examination by obstetrician-gynecologists. The obtained data became the basis for the basis and development of a functional and organizational model, the main components of which are: a woman with existing risk factors for the development of oncogynecological pathology; health care system, public health system with clearly defined structural and organizational technologies; social environment; taking into account the conditions of emergency situations (COVID-19 pandemic, military aggression). The features of the proposed organizational and structural model of providing oncogynecological care to women are preventive orientation with the aim of identifying oncogynecological pathology (malignant neoplasms of the body of womb and malignant neoplasms of the ovaries) and for stratification of risk factors, its application in emergency situations (quarantine restrictions, military invasion) with the use of modern technological solutions (telemedicine) at the primary and specialized levels of providing medical care. The model has received a positive expert assessment from scientists-organizers of health care and doctors and is recommended for implementation at the primary level of medical care. Key words: oncogynecological pathology, malignant neoplasms of the body of womb, malignant neoplasms of the ovaries, prevention, the COVID-19 pandemic, risk factors, telemedicine, emergency situations, model of oncological care, rationale.