The scientific work was carried out in accordance with the defined goal using
classical approaches to the organization of scientific research: development of a
special program structured by stages, each of which carried out specific tasks;
application of general scientific methods of research (systemic approach and
dialectical) and methods according to the passport of the specialty "Social
Medicine" (systemic approach and analysis at all stages of research,
bibliosemantic, sociological, medical-statistical, modeling, experimental, expert
evaluations, graphic); definition of the object, subject of research; collection of
information, formation of a database of primary data with their subsequent
statistical processing, analysis and generalization.
A systematic analysis of the scientific literature and statistical data showed that
the pathology of the thyroid gland occupies a leading place in the structure of
endocrine diseases of the population of Ukraine: the specific weight of the disease is
42.04%, the prevalence is 45.84%. Diffuse goiter of I-III degrees (18.6%), nodular
goiter (9.8%), hypothyroidism (6.4%), thyroiditis (5.9%), thyrotoxicosis (1.7%),
cancer (4, 3%) form the structure of thyroid pathology. The dynamics of the
indicators showed a constant increase in the incidence and prevalence of these
pathologies in the Ukrainian population over the past 10 years, which
determines their medical and social importance.
The analysis of legal acts on the provision of endocrinological care in Ukraine
identified a number of unresolved issues in the organization of surgical care for patients
with thyroid pathology, which confirmed the relevance of conducting scientific
research on the chosen topic.
The analysis of the network of health care institutions, their resource and
personnel support, and the assessment of the results of providing endocrinological care
to the population of Ukraine in 2015-2019, including the city of Kyiv, established that
the number of structural subdivisions of outpatient polyclinic institutions with the
provision of endocrinological care decreased by 5.6%, and the number of inpatient
specialized beds decreased by 108 units. The regional disproportion in the provision of
endocrinologists to the population was revealed: in the city of Kyiv – 0.73 per 10,000
inhabitants, and in 11 regions of Ukraine – 0.34 per 10,000 inhabitants. The level of
staffing of full-time positions with endocrinologists in Ukraine decreased from 90.6%
to 88.6%. The volume of surgical care for patients with thyroid pathology exceeded
90.0% in the structure of endocrine surgery with high performance indicators (fatality
rate - 0.05-0.03%).
The medical-statistical analysis proved that the mortality rate of the population
of Kyiv from diseases of the endocrine system, nutritional disorders, and metabolic
disorders during 2013–2020 increased from 3.8 to 5.4 per 100,000 population. with a
steady growth trend. The total and primary incidence of these diseases decreased by
1.4% and 24.8%, respectively. However, the incidence rate of malignant neoplasms of
the thyroid gland among the population of the capital is 16.4 per 100,000 people. in
2013, 11.4 per 100,000 population. in 2020 – remained significantly higher than the
average among the country's population (7.9 and 6.5 per 100,000 inhabitants,
respectively). This confirmed the relevance of diseases of the endocrine system among
the population of Kyiv and the need to further improve the provision of appropriate
medical care.
The municipal non-profit enterprise "Kyiv City Clinical Endocrinology Center"
(KNP "KMKEC") was chosen as the base for conducting scientific research, where the
largest number of operative interventions on the endocrine system among health care
institutions in Kyiv (89.3%) is performed.
It was established that the specific weight of operative interventions on the
endocrine system increased from 61.6% to 79.4%, in particular, on the thyroid gland,
from 95.5% to 96.3% in KNP "KMKEC" during 2015-2019. In the institution, high
indicators of the quality of surgical care (decrease in mortality from 0.04% to 0.01%,
absence of postoperative mortality), high indicators of the average number of days of
bed work (366.0-383.5) and the length of stay of the patient in bed (12.9-12.5 days)
with the corresponding indicators for the city of Kyiv 10.4-9.8 days.
This indicated the irrational use of the resource base, in particular, as a result of
inefficient interaction with health care institutions that referred patients to KNP
"KMKEC". Patients of the department of endocrine surgery (12.3 days in 2015, 14.3
days in 2019), rehabilitation of patients with thyroid pathology (13.0 and 12.6 days,
respectively) and rehabilitation of endocrine patients with heart pathology and vessels
(12.1 and 11.4 days, respectively) spent the longest time in a hospital bed.
