Abstract

The efficiency of 3 level medical care system is shown. The level of hospital is determined by the diagnostic possibilities and human resources. The task of I level is the diagnosis of biliary and duodenal obstruction of any origin. At II level perform palliative surgical bypass for malignant obstruction. Radical surgical resection for cancer, procedures for chronic pancreatitis carry out only at III level. Cases of obstructive pancreatic diseases in the Komi Republic from 2007 to 2014 were analysed. According to the accepted routing scheme for overwyelming majority of patients (92,9%) medical care was provided at III level. After analysis of minimally invasive intervention long-term results at III level indications for palliative treatment were revised in favor of surgical decompression. Thus patients judged eligible for surgical bypass may undergo this procedure at II level without being referred to III level. However, the proportion of patients at II level was insignificaqnt and accounted for only 3.9%. Hospital of II level solved its local task. However, in the region meanwhile is no real load redistribution from II level to III level. There are two hospitals in the region with high diagnostic opportunities, but currently lack of qualifiedsurgeons does not allow rank them asII level. Accepted in the republic medical care system for patients with obstructive pancreatic diseases provides effective use of health care resources and brings nearer specialized surgical aid to the population of remote territories.

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