It has been proven that the medical and organizational risk factors of the transformation GPD into GC are not consulting primary medical care (PMC) physician about the disease (6.83; 2.71-17.25), screenings (3.76; 1.75-8.09), follow-up monitoring (OR=29.18; 95%CI=11.60-73.40), low compliance to drug treatment and diet (4.73; 2.15-10, 40).5-80%).
The generalized results of the previous stages of the research made it possible to scientifically substantiate and develop a functional-organizational model of an improving the prevention of gastric cancer on the last, sixth, stage. Methods of system approach and system analysis, bibliosemantic and modeling were used. The main innovative elements of the model are: an algorithm for early diagnosis and prevention of the negative consequences of GC at the PMC level, a note for PMC physicians on monitoring risk factors and predictors of GPD malignancy, selection of a follow-up monitoring group due to the high risk of transformation GPD into GC. The effectiveness of the proposed innovations is confirmed by the positive conclusions of independent highly experienced experts, allowing recommending it for practical implementation in Ukrainian healthcare facilities.
Scientific novelty. The thesis results are the first to: problematic issues of the GC prevention organization at the current stage of socio-economic development, transformation of public health and health care systems of Ukraine are systemically presented; regional and Ukrainian features of the fifteen-year trends of GC morbidity, mortality and timeliness of detection are clarified; risk factors and predictors of GPD malignancy were identified; a functional-organizational model of an improving the prevention of gastric cancer was substantiated and developed.
There were improved: a scientific and methodological approach to the distribution of functions between primary and specialized medical care doctors in terms of early diagnosis and prevention of the negative consequences of GC; method of formation the high risk of GC group among patients with GPD.
An integrated approach to the GC prevention organization at the primary medical care level is further developed.
Practical significance of the thesis results derive from the fact that they are the basis for: development of an algorithm for early diagnosis and prevention of the negative consequences of GC at the PMC level; creation of a note for PMC physicians on monitoring risk factors and predictors of GPD malignancy; formation of a set of recommendations for primary, secondary and tertiary prevention of GC, which is based on the priority role of PMC physicians, concordance of their actions with specialized medical care doctors and coordination of efforts with other stakeholders; recommendations for improving curricula for training doctors at the graduate and post-graduate level. Key words: malignant tumors, gastric cancer, gastric precancerous diseases, morbidity, mortality, survival, malignancy risk factors, prevention, early detection, primary medical care, specialized medical care, oncological care, health care management, public health, management system. Branch-Medicine.
